bluuebunny/crossref_metadata_2025 huggingface dataset:
The pattern of maternal weight gain in women with good pregnancy outcomes.
Authors: Carmichael S , Abrams B , Selvin S
Published: November 2008

OBJECTIVES: This study describes the pattern of maternal weight gain in women with good pregnancy outcomes and provides data to fill in the provisional weight-gain charts published by the Institute of Medicine (IOM) in 1990. METHODS: We selected 7002 women with good outcomes (defined by factors related to maternal and infant health) from the University of California, San Francisco, Perinatal Database. For each body mass index category, we compared percentiles of weight gain by trimester in women who achieved the IOM recommendations for total gain and those who did not. RESULTS: Trimester rates of gain varied by body mass index category and exceeded IOM guidelines in all groups. Forty percent of these women with good outcomes had total gains within the guidelines and provided data to complete the IOM weight-gain charts. CONCLUSIONS: Most women in this good-outcome sample would have been suspected of being at increased risk for poor outcome on the basis of their weight gain. This confirms the IOM recommendation that evaluation of the underlying causes of excessively high or low weight gain during pregnancy is necessary before appropriate interventions can be applied.
The relationship between students' sense of their school as a community and their involvement in problem behaviors.
Authors: Battistich V , Hom A
Published: November 2008

OBJECTIVES: There has been relatively little research on the contributions of school context to developmental outcomes. This study examined relationships between students' sense of the school as a community and their involvement in problem behaviors. METHODS: Participants were an ethnically and socioeconomically diverse sample of 1434 fifth and sixth grade students from 24 elementary schools around the United States. Data were analyzed by hierarchical linear regression. RESULTS: The major finding was that, with several relevant student- and school-level characteristics controlled, schools with higher average sense-of-community scores had significantly lower average student drug use and delinquency. Caution is warranted in inferring causality, however, owing to the cross-sectional design. CONCLUSIONS: The findings suggest that school context may moderate relationships between individual risk and protective factors and developmental outcomes, and that schools that are experienced as communities may enhance students' resiliency.
The risk of Guillain-Barré syndrome after tetanus-toxoid-containing vaccines in adults and children in the United States.
Authors: Tuttle J , Chen R T , Rantala H , Cherry J D , Rhodes P H , Hadler S
Published: November 2008

OBJECTIVES: This study examined whether there is a risk that tetanus-toxoid-containing vaccines could cause Guillain-Barré syndrome and, if so, how large the risk is. METHODS: This study was based on previous active surveillance epidemiological studies of Guillain-Barré syndrome and vaccination history. RESULTS: A background rate of 0.3 cases of Guillain-Barré syndrome per million person-weeks has been estimated. By chance, 2.2 people with the syndrome would have received tetanus-toxoid-containing vaccine within the 6 weeks before onset, yet only 1 person had done so. Data on children show similar results. CONCLUSIONS: If an association exists, it must be extremely rare and not of public health significance.
Public policy and environmental noise: modeling exposure or understanding effects.
Authors: Staples S L
Published: November 2008

This paper argues that if the federal government is to successfully protect the public from the adverse effects of environmental noise, its policies will need to be informed by a scientific understanding of the psychological and social factors that determine when noise results in annoyance and when noise may affect health as an environmental stressor. The overreliance of federal agencies on mathematical modeling of average group responses to physical noise levels is discussed as oversimplifying and limiting the understanding of noise effects in crucial ways. The development of a more sophisticated information base is related to policy needs, such as the need to make accurate predictions about the annoyance of particular communities, the need to understand relationships between public participation in noise abatement efforts and annoyance, and the need to identify populations that may be susceptible to stress-related health effects.
The prevalence of hypertension in seven populations of west African origin.
Authors: Cooper R , Rotimi C , Ataman S , McGee D , Osotimehin B , Kadiri S , Muna W , Kingue S , Fraser H , Forrester T , Bennett F , Wilks R
Published: November 2008

OBJECTIVES: This study was undertaken to describe the distribution of blood pressures, hypertension prevalence, and associated risk factors among seven populations of West African origin. METHODS: The rates of hypertension in West Africa (Nigeria and Cameroon), the Caribbean (Jamaica, St. Lucia, Barbados), and the United States (metropolitan Chicago, Illinois) were compared on the basis of a highly standardized collaborative protocol. After researchers were given central training in survey methods, population-based samples of 800 to 2500 adults over the age of 25 were examined in seven sites, yielding a total sample of 10014. RESULTS: A consistent gradient of hypertension prevalence was observed, rising from 16% in West Africa to 26% in the Caribbean and 33% in the United States. Mean blood pressures were similar among persons aged 25 to 34, while the increase in hypertension prevalence with age was twice as steep in the United States as in Africa. Environmental factors, most notably obesity and the intake of sodium and potassium, varied consistently with disease prevalence across regions. CONCLUSION: The findings demonstrate the determining role of social conditions in the evolution of hypertension risk in these populations.
The Northwest Lipid Research Clinic Fat Intake Scale: validation and utility.
Authors: Retzlaff B M , Dowdy A A , Walden C E , Bovbjerg V E , Knopp R H
Published: November 2008

OBJECTIVES: This paper describes the Northwest Lipid Research Clinic Fat Intake Scale, a brief dietary questionnaire to screen and monitor dietary intake related to plasma cholesterol levels. METHODS: The 12-item instrument assesses intake of foods high in fat, saturated fat, and cholesterol. Test-retest reliability was assessed on 194 men and 116 women with high cholesterol prior to a dietary intervention study. To measure validity and responsiveness to dietary change, scores were compared with 4-day food records before and after diet education classes. RESULTS: Test-retest correlation coefficients were .88 for men and .90 for women (2 weeks between scores). Scores for men and women were correlated with nutrients shown by food records at baseline (.47 and .54, total fat; .50 and .51, saturated fat) and 18 months postintervention (.52 and .58, total fat; .56 and .64, saturated fat; all Ps < .001). Mean scores decreased from about 30 to 23 (P < .001, paired t test). CONCLUSIONS: The Fat Intake Scale, a qualitative instrument, has acceptable reliability and validity for estimating the level of cholesterol-related diet components and reflects dietary modification. The format of the instrument also lends itself to patient education and goal setting.
Identifying areas with vitamin A deficiency: the validity of a semiquantitative food frequency method.
Authors: Sloan N L , Rosen D , de la Paz T , Arita M , Temalilwa C , Solomons N W
Published: November 2008

OBJECTIVES: The prevalence of vitamin A deficiency has traditionally been assessed through xerophthalmia or biochemical surveys. The cost and complexity of implementing these methods limits the ability of nonresearch organizations to identify vitamin A deficiency. This study examined the validity of a simple, inexpensive food frequency method to identify areas with a high prevalence of vitamin A deficiency. METHODS: The validity of the method was tested in 15 communities, 5 each from the Philippines, Guatemala, and Tanzania. Serum retinol concentrations of less than 20 micrograms/dL defined vitamin A deficiency. RESULTS: Weighted measures of vitamin A intake six or fewer times per week and unweighted measures of consumption of animal sources of vitamin A four or fewer times per week correctly classified seven of eight communities as having a high prevalence of vitamin A deficiency (i.e., 15% or more preschool-aged children in the community had the deficiency) (sensitivity = 87.5%) and four of seven communities as having a low prevalence (specificity = 57.1%). CONCLUSIONS: This method correctly classified the vitamin A deficiency status of 73.3% of the communities but demonstrated a high false-positive rate (42.9%).
Employment, job strain, and preterm delivery among women in North Carolina.
Authors: Brett K M , Strogatz D S , Savitz D A
Published: November 2008

OBJECTIVES: A population-based case-control study was conducted in central North Carolina to assess the relationship between occupational stress and preterm delivery. METHODS: Four hundred twenty-one women delivering infants before 37 weeks' gestation and 612 women delivering infants at term were interviewed a median of 6 months after delivery. Exposure information was collected for all jobs held for at least 1 month during pregnancy. RESULTS: Work in a "high strain" job (i.e., high demand and low control) was not associated with increased risk of preterm delivery compared with work in "low strain" jobs (all other combinations of job demand and control). Narrowing the exposure window to the third trimester did not modify the results. However, women who worked at a high-strain job full-time (odds ratio [OR] = 1.4, 95% confidence interval [CI] = 0.9, 2.0) or for 30 or more weeks (OR = 1.4, CI = 1.0, 2.2) had a modestly increased risk. Several analyses suggested that Black women were at greater risk from job strain than White women. CONCLUSIONS: This study suggests that chronic exposure during pregnancy to work characterized by high demand and low control may be modestly associated with preterm delivery.
Competing priorities as a barrier to medical care among homeless adults in Los Angeles.
Authors: Gelberg L , Gallagher T C , Andersen R M , Koegel P
Published: November 2008

OBJECTIVES: The role of competing priorities as a barrier to the utilization of physical health services was assessed in a subset (n = 363) of a probability sample of homeless adults in Los Angeles. METHODS: Unadjusted odds of four measures of health services utilization were calculated for those with frequent difficulty in meeting their subsistence needs. These odds were then adjusted for a range of characteristics assumed to affect the utilization of health services among the homeless. RESULTS: Before and after adjustment, those with frequent subsistence difficulty were less likely to have a regular source of care (odds ratio [OR] = 0.30, 95% confidence interval [CI] = 0.16, 0.53) and more likely to have gone without needed medical care (OR = 1.77, 95% CI = 1.04, 3.00). Subsistence difficulty had no impact on the likelihood of having an outpatient visit or having been hospitalized. Conclusions remained the same after adjustment. CONCLUSIONS: Frequent subsistence difficulty appears to be an important nonfinancial barrier to the utilization of health services perceived as discretionary among homeless adults.
Sheltered homeless children: their eligibility and unmet need for special education evaluations.
Authors: Zima B T , Bussing R , Forness S R , Benjamin B
Published: November 2008

OBJECTIVES: This study described the proportion of sheltered homeless children in Los Angeles, Calif, who were eligible for special education evaluations because of a probable behavioral disorder, learning disability, or mental retardation, and to explore their level of unmet need for special education services. METHODS: This was a cross-sectional study of 118 parents and 169 children aged 6 through 12 years living in 18 emergency homeless family shelters in Los Angeles County, California. Parents and children were interviewed with standardized mental health and academic skill measures in English and Spanish. RESULTS: Almost half (45%) of the children met criteria for a special education evaluation, yet less than one quarter (22%) had ever received special education testing or placement. The main point of contact for children with behavioral disorders and learning problems was the general health care sector. CONCLUSIONS: School-aged sheltered homeless children have a high level of unmet need for special education evaluations, the first step toward accessing special education programs. Interventions for homeless children should include integration of services across special education, general health care, and housing service sectors.
Homelessness in female-headed families: childhood and adult risk and protective factors.
Authors: Bassuk E L , Buckner J C , Weinreb L F , Browne A , Bassuk S S , Dawson R , Perloff J N
Published: November 2008

OBJECTIVES: To identify risk and protective factors for family homelessness, a case-control study of homeless and low-income, never-homeless families, all female-headed, was conducted. METHODS: Homeless mothers (n = 220) were enrolled from family shelters in Worcester, Mass. Low-income housed mothers receiving welfare (n = 216) formed the comparison group. The women completed an interview covering socioeconomic, social support, victimization, mental health, substance use, and health domains. RESULTS: Childhood predictors of family homelessness included foster care placement and respondent's mother's use of drugs. Independent risk factors in adulthood included minority status, recent move to Worcester, recent eviction, interpersonal conflict, frequent alcohol or heroin use, and recent hospitalization for a mental health problem. Protective factors included being a primary tenant, receiving cash assistance or a housing subsidy, graduating from high school, and having a larger social network. CONCLUSIONS: Factors that compromise an individual's economic and social resources are associated with greater risk of losing one's home.
Preventing recurrent homelessness among mentally ill men: a "critical time" intervention after discharge from a shelter.
Authors: Susser E , Valencia E , Conover S , Felix A , Tsai W Y , Wyatt R J
Published: November 2008

OBJECTIVES: This study examined a strategy to prevent homelessness among individuals with severe mental illness by providing a bridge between institutional and community care. METHODS: Ninety-six men with severe mental illness who were entering community housing from a shelter institution were randomized to receive 9 months of a "critical time" intervention plus usual services or usual services only. The primary analysis compared the mean number of homeless nights for the two groups during the 18-month follow-up period. To elucidate time trends, survival curves were used. RESULTS: Over the 18-month follow-up period, the average number of homeless nights was 30 for the critical time intervention group and 91 for the usual services group. Survival curves showed that after the 9-month period of active intervention, the difference between the two groups did not diminish. CONCLUSIONS: Strategies that focus on a critical time of transition may contribute to the prevention of recurrent homelessness among individuals with mental illness, even after the period of active intervention.
The impact of lifestyle characteristics on carotenoid intake in the United States: the 1987 National Health Interview Survey.
Authors: Nebeling L C , Forman M R , Graubard B I , Snyder R A
Published: November 2008

OBJECTIVES: This study compared mean carotenoid intake in the United States by demographic and lifestyle variables to identify potential high-risk subgroups for disease. METHODS: Adults 18 to 99 years of age (n = 22 080) completed a food frequency questionnaire in the 1987 National Health Interview Survey, and mean carotenoid intakes were estimated. RESULTS: Carotenoid intakes were lower among Whites (vs Blacks), current smokers (vs nonsmokers), nondrinkers (vs drinkers), adults 18 to 39 years of age (vs those 40 to 69 years of age), frequent restaurant consumers (vs those who ate at home), and less educated (vs college-educated) persons. CONCLUSIONS: The benefits of a carotenoid-rich diet should be communicated to high-risk subgroups.
Interspecialty differences in the obstetric care of low-risk women.
Authors: Rosenblatt R A , Dobie S A , Hart L G , Schneeweiss R , Gould D , Raine T R , Benedetti T J , Pirani M J , Perrin E B
Published: November 2008

OBJECTIVES: This study examined differences among obstetricians, family physicians, and certified nurse-midwives in the patterns of obstetric care provided to low-risk patients. METHODS: For a random sample of Washington State obstetrician-gynecologists, family physicians, and certified nurse-midwives, records of a random sample of their low-risk patients beginning care between September 1, 1988, and August 31, 1989, were abstracted. RESULTS: Certified nurse-midwives were less likely to use continuous electronic fetal monitoring and had lower rates of labor induction or augmentation than physicians. Certified nurse-midwives also were less likely than physicians to use epidural anesthesia. The cesarean section rate for patients of certified nurse-midwives was 8.8% vs 13.6% for obstetricians and 15.1% for family physicians. Certified nurse-midwives used 12.2% fewer resources. There was little difference between the practice patterns of obstetricians and family physicians. CONCLUSIONS: The low-risk patients of certified nurse-midwives in Washington State received fewer obstetrical interventions than similar patients cared for by obstetrician-gynecologists or family physicians. These differences are associated with lower cesarean section rates and less resource use.
Cocaine use during pregnancy: sensitive detection by hair assay.
Authors: Kline J , Ng S K , Schittini M , Levin B , Susser M
Published: November 2008

OBJECTIVES: This paper compares the sensitivity of two tests of cocaine use, interview and urine test, with that of a radioimmunoassay of hair. METHODS: Interviews and hair samples were provided by 397 obstetric patients in one New York City hospital; urine samples were obtained in 377. Of these patients, 241 were receiving prenatal care (were registered) and 156 delivered without prenatal care (were unregistered). The 241 registered patients were derived from 400, comprising all reporting use of cocaine ever ("ever-users"), all reporting use by the father but not themselves ("lifestylers"), and a sample of women who were neither ever-users nor lifestylers. The 156 unregistered patients were derived from 352 women interviewed at delivery, unselected for reported use. RESULTS: Thirty-two percent reported ever using cocaine, 45% of these within 6 months before interview. Urine tests were positive in 20%, hair tests in 59%. The estimated sensitivity of the hair test (92%) was 3.1 times higher than that of the urine test (95% confidence interval [CI] = 2.5, 3.8) and 4 times higher than that of reported use in the past 6 months (95% CI = 3.2, 5.0). CONCLUSIONS: Self-report and urine tests alone miss most of cocaine users during pregnancy. Hair tests greatly improve detection and thus can enhance evaluations of the effects of prenatal cocaine use on fetal and child development.
The great efficacy of personal and equipment assistance in reducing disability.
Authors: Verbrugge L M , Rennert C , Madans J H
Published: November 2008

OBJECTIVES: Personal and equipment assistance are common strategies to reduce disability. This study sought to determine how often assistance reduces or even completely resolves health-related difficulties in everyday tasks. METHODS: Data are from the NHANES I Epidemiologic Followup Study. Adults aged 35 to 90 reported difficulty doing 12 everyday tasks on their own without assistance. Those stating that they had much difficulty or were unable were asked if they had personal assistance and/or equipment assistance, and their degree of difficulty with assistance. Use and efficacy of assistance are studied by gender, age, intrinsic (unassisted) degree of difficulty, and type of assistance. RESULTS: Most people use assistance for the 12 tasks; "personal assistance only" is the principal type used for upper-extremity and body transfer tasks; "equipment only" ranks first for lower-extremity tasks. Assistance reduces difficulty for the great majority of persons (75% to 85%) and completely resolves difficulty for about 25%. Equipment only proves to be the most efficacious strategy for reducing and resolving limitations. CONCLUSIONS: Equipment's success may be due to greater perceived gains when people accomplish the assistance by themselves.
Health care seeking behaviors related to sexually transmitted diseases among adolescents.
Authors: Fortenberry J D
Published: November 2008

OBJECTIVES: This study identified social, cognitive, and behavioral factors associated with how adolescents seek health care for sexually transmitted diseases. METHODS: Data for male and female adolescents (n = 208) attending a clinic specializing in sexually transmitted diseases were examined. RESULTS: Symptomatic female adolescents required greater time to obtain care than asymptomatic female adolescents or symptomatic male adolescents. Factors affecting duration of care seeking interval included perception of barriers to care, lower self-efficacy for response to a sexually transmitted disease, greater perceived seriousness of sexually transmitted diseases, previous history of sexually transmitted diseases, and stigma. CONCLUSIONS: Improved secondary sexually transmitted disease prevention efforts among adolescents require reductions in barriers to care and improved symptom recognition by adolescents.
Condom breakage and slippage during heterosexual intercourse: a French national survey. French National Survey on Sexual Behavior Group (ACSF).
Authors: Messiah A , Dart T , Spencer B E , Warszawski J
Published: November 2008

OBJECTIVES: This study examined condom failure rates in a representative sample of French men and women. METHODS: Condom users who experienced breakage or slippage were compared with those who reported no difficulties. RESULTS: The rate of breakage at last heterosexual intercourse was 3.4%, and the slippage rate was 1.1%. Significantly associated with breakage and slippage were being age 25 through 34, being sexually active for more than 5 years, condom use for less than 5 years, condom not used for contraception, and sexual intercourse 12 or more times per month. CONCLUSIONS: People who became sexually active before the era of acquired immunodeficiency syndrome, who began condom use in recent years, and who have frequent sex are at increased risk. The low risk observed among experienced condom users below age 25 supports condom promotion to youth.
Weak associations between hospital mortality rates for individual diagnoses: implications for profiling hospital quality.
Authors: Rosenthal G E
Published: November 2008

OBJECTIVES: This study examined the consistency of hospital mortality rates across different diagnoses. METHODS: Standardized mortality ratios for patients discharged in 1991 from US hospitals were determined via the Medicare Hospital Information Report. RESULTS: Correlations between standardized mortality ratios for different diagnoses were relatively weak, ranging from .03 to .34. Agreement between hospital rankings (based on standardized mortality ratios), as measured by the weighted kappa statistic, was also weak. CONCLUSIONS: The present results indicate that hospital mortality rates for individual diagnoses are weakly associated. Thus, it may not be valid to generalize conclusions about hospital performance from a single diagnosis.
The health status of elderly persons in the last year of life: a comparison of deaths by suicide, injury, and natural causes.
Authors: Grabbe L , Demi A , Camann M A , Potter L
Published: November 2008

OBJECTIVES: This study identified health status variables related to suicide by elderly persons and compared the health status of suicide decedents with natural death and injury decedents. METHODS: Data were obtained from the 1986 National Mortality Followback Survey. RESULTS: When other variables were controlled for, suicide decedents were significantly more likely than injury decedents to have a history of cancer (odds ratio [OR] = 51.94), moderate (OR = 29.37) or heavy (OR = 22.87) alcohol use, and mental or emotional disorder (OR = 10.91) and to be White (OR = 18.54) and male (OR = 9.12). CONCLUSIONS: The findings indicate that a history of cancer should be considered as a risk for suicide in the elderly.
US trends in disability and institutionalization among older Blacks and Whites.
Authors: Clark D O
Published: November 2008

OBJECTIVES: This study estimated and compared the prevalence of disability and institutionalization in 1982, 1984, and 1989 among the older Black and White populations of the United States. METHODS: Data on over 1100 Blacks and 14,000 Whites in each of a series of three National Long Term Care Surveys were used. RESULTS: Diverging trends for Blacks and Whites led to statistically significant increases in the age- and sex-adjusted odds of disability (19%) and institutionalization (31%) for Blacks relative to Whites. CONCLUSIONS: Black and White disparities in disability appear to have widened, while disparities in institutionalization appear to have narrowed during the decade of the 1980s.
An increasing prevalence of hearing impairment and associated risk factors over three decades of the Alameda County Study.
Authors: Wallhagen M I , Strawbridge W J , Cohen R D , Kaplan G A
Published: November 2008

OBJECTIVES: This study assessed changes in the prevalence of hearing impairment in persons aged 50 years and older over the past 30 years and identified risk factors. METHODS: Age-adjusted hearing impairment prevalence rates at four time intervals were calculated from the Alameda County Study (n = 5108). Logistic regression models analyzed risk factors from 1974 for 1994 incident hearing impairment. RESULTS: The prevalence of hearing impairment nearly doubled between 1965 and 1994. The increase was significantly greater for men. The higher incidence was associated with potentially high-noise-exposure occupations for men and with symptoms and conditions associated with ototoxic drug use for both men and women. Exercise was protective. CONCLUSIONS: Given the serious health and social consequences of hearing impairment, its increasing prevalence is cause for concern.
The Boston AIDS Survival Score (BASS): a multidimensional AIDS severity instrument.
Authors: Seage G R , Gatsonis C , Weissman J S , Haas J S , Cleary P D , Fowler F J , Massagli M P , Stone V E , Craven D E , Makadon H , Goldberg J , Coltin K , Levin K S , Epstein A M
Published: November 2008

OBJECTIVES: This study developed a new acquired immunodeficiency syndrome (AIDS) severity system by including diagnostic, physiological, functional, and sociodemographic factors predictive of survival. METHODS: Three-hundred five persons with AIDS in Boston were interviewed; their medical records were reviewed and vital status ascertained. RESULTS: Overall median (+/- SD) survival for the cohort from the first interview until death was 560 +/- 14.4 days. The best model for predicting survival, the Boston AIDS Survival Score, included the Justice score (stage 2 relative hazard [RH] = 1.25, 95% confidence interval [CI] = 0.80, 1.96; stage 3 RH = 1.76, 95% CI = 1.15, 2.70), a newly developed opportunistic disease score (Boston Opportunistic Disease Survival Score; stage 2 RH = 1.35, 95% CI = 0.90, 2.02; stage 3 RH = 2.10, 95% CI = 1.38, 3.18), and measures of activities of daily living (any intermediate limitations, RH = 1.84, 95% CI = 1.05, 3.21; any basic limitations, RH = 2.60, 95% CI = 1.44, 4.69). This model had substantially greater predictive power (R2 = .17, C statistic = .68) than the Justice score alone (R2 = .09, C statistic = .61). CONCLUSIONS: Incorporating data on clinically important events and functional status into a physiologically based system can improve the prediction of survival with AIDS.
A community waterborne outbreak of salmonellosis and the effectiveness of a boil water order.
Authors: Angulo F J , Tippen S , Sharp D J , Payne B J , Collier C , Hill J E , Barrett T J , Clark R M , Geldreich E E , Donnell H D , Swerdlow D L
Published: November 2008

OBJECTIVES: A 1993 large water-borne outbreak of Salmonella typhimurium infections in Gideon, Mo, a city of 1100 with an unchlorinated community water supply, was investigated to determine the source of contamination and the effectiveness of an order to boil water. METHODS: A survey of household members in Gideon and the surrounding township produced information on diarrheal illness, water consumption, and compliance with the boil water order. RESULTS: More than 650 persons were ill; 15 were hospitalized, and 7 died. Persons consuming city water were more likely to be ill (relative risk [RR] = 9.1, 95% confidence interval [CI] = 2.9, 28.4), and the attack rate increased with increased water consumption. S. typhimurium was recovered from samples taken from a city fire hydrant and a water storage tower. Persons in 31% (30/ 98) of city households had drunk unboiled water after being informed about the boil water order, including 14 individuals who subsequently became ill. Reasons for noncompliance included "not remembering" (44%) and "disbelieving" (25%) the order. CONCLUSIONS: Communities with deteriorating water systems risk widespread illness unless water supplies are properly operated and maintained. Effective education to improve compliance during boil water orders is needed.
Marijuana use and mortality.
Authors: Sidney S , Beck J E , Tekawa I S , Quesenberry C P , Friedman G D
Published: November 2008

OBJECTIVES: The purpose of this study was to examine the relationship of marijuana use to mortality. METHODS: The study population comprised 65171 Kaiser Permanente Medical Care Program enrollees, aged 15 through 49 years, who completed questionnaires about smoking habits, including marijuana use, between 1979 and 1985. Mortality follow-up was conducted through 1991. RESULTS: Compared with nonuse or experimentation (lifetime use six or fewer times), current marijuana use was not associated with a significantly increased risk of non-acquired immunodeficiency syndrome (AIDS) mortality in men (relative risk [RR] = 1.12, 95% confidence interval [CI] = 0.89, 1.39) or of total mortality in women (RR = 1.09, 95% CI = 0.80, 1.48). Current marijuana use was associated with increased risk of AIDS mortality in men (RR = 1.90, 95% CI = 1.33, 2.73), an association that probably was not causal but most likely represented uncontrolled confounding by male homosexual behavior. This interpretation was supported by the lack of association of marijuana use with AIDS mortality in men from a Kaiser Permanente AIDS database. Relative risks for ever use of marijuana were similar. CONCLUSIONS: Marijuana use in a prepaid health care-based study cohort had little effect on non-AIDS mortality in men and on total mortality in women.
The effects of cigarette smoking and gestational weight change on birth outcomes in obese and normal-weight women.
Authors: Hellerstedt W L , Himes J H , Story M , Alton I R , Edwards L E
Published: November 2008

OBJECTIVES: The associations of infant birth outcomes with maternal pregravid obesity, gestational weight gain, and prenatal cigarette smoking were examined. METHODS: A retrospective analysis of 1343 obese and normal-weight gravidas evaluated the associations of cigarette smoking, gestational weight change, and pregravid body mass index with birthweight, low birthweight, and small- and large-for-gestational-age births. RESULTS: Smoking was associated with the delivery of lower-birthweight infants for both obese and normal-weight women, and gestational weight gain did not eliminate the birthweight-lowering effects of smoking. Women at highest risk of delivering lower-birthweight infants were obese smokers whose gestational gains were less than 7 kg and normal-weight smokers whose gestational gains were less than 11.5 kg. CONCLUSIONS: To balance the risks of small and large-size infants, gains of 7 to 11.5 kg for obese women and 11.5 to 16 kg for normal-weight women appear appropriate.
Workplace conditions, socioeconomic status, and the risk of mortality and acute myocardial infarction: the Kuopio Ischemic Heart Disease Risk Factor Study.
Authors: Lynch J , Krause N , Kaplan G A , Tuomilehto J , Salonen J T
Published: November 2008

OBJECTIVES: This study investigated whether the association between workplace conditions and the risk of all-cause and cardiovascular mortality and acute myocardial infarction differed by socioeconomic status. METHODS: Prospective data were used to examine these associations in 2297 Finnish men, with adjustment for prevalent diseases and biological, behavioral, and psychosocial covariates, and stratified by employment status and workplace social support. RESULTS: Elevated age-adjusted relative hazards for all-cause mortality were found for men who reported high demands, low resources, and low income; high demands, high resources, and low income; and low demands, high resources, and low income. Similar patterns were found for cardiovascular mortality. In contrast, elevated age-adjusted relative hazards for acute myocardial infarction were observed only in men who reported high demands, low resources, and low income. These results did not differ by level of workplace social support or employment status. CONCLUSIONS: The negative effects of workplace conditions on mortality and of myocardial infarction risk depended on income level and were largely mediated by known risk factors.
Low blood pressure and five-year mortality in a Stockholm cohort of the very old: possible confounding by cognitive impairment and other factors.
Authors: Guo Z , Viitanen M , Winblad B
Published: November 2008

OBJECTIVES: Low blood pressure has often been reported to be related to excess mortality in people over the age of 75 years. This study examined whether other predictors may account for the association. METHODS: A community-based cohort of 1810 people who were aged 75 years and older was followed for 5 years. RESULTS: The relative risk of death was 1.39 (95% confidence interval [CI] = 1.11, 1.73) for people with systolic pressure lower than 130 mm Hg and 1.21 (95% CI = 1.02, 1.43) for those with diastolic pressure lower than 75 mm Hg, compared with corresponding reference groups, when all other variables were simultaneously considered in Cox proportional hazards models. The observed association was present mainly in subjects with at least two of the three conditions (cardiovascular disease, limitation in activities of daily living, or cognitive impairment). The effect of low diastolic pressure on mortality was also significant in those with only cognitive impairment. CONCLUSIONS: Preexisting cardiovascular disease, limitation in activities of daily living, and, more important, cognitive impairment may be responsible for the association of low blood pressure with increased mortality in the very old in that they cause both reductions in blood pressure and excess deaths.
Lifetime cocaine use and cardiovascular characteristics among young adults: the CARDIA study.
Authors: Braun B L , Murray D M , Sidney S
Published: November 2008

OBJECTIVES: Cocaine is a central nervous system stimulant associated with cardiovascular disease risk factors, morbidity, and mortality. Despite these demonstrated relationships, it has been difficult to assess the long-term cardiovascular consequences of cocaine use. METHODS: The Coronary Artery Risk Development in Young Adults study provides an opportunity to evaluate the association of lifetime cocaine use with cardiovascular disease risk factors in a randomly sampled biethnic cohort of men and women of varied socioeconomic status, aged 20 to 32 in 1987. RESULTS: More extensive cocaine use experience was associated with being White, older, and less educated, regardless of sex. Higher levels of licit and illicit substance use behavior were reported by those reporting more extensive cocaine experience; however, most cardiovascular disease risk factors such as systolic and diastolic blood pressure, heart rate, hypertension, physical activity, and anthropometric measurements were not related to lifetime cocaine experience. CONCLUSIONS: In this age group, the detrimental cardiovascular effects of cocaine may be limited to acute effects. Further studies are needed to determine whether continued exposure is related to cardiovascular disease risk factors later in life.
The feasibility of a street-intercept survey method in an African-American community.
Authors: Miller K W , Wilder L B , Stillman F A , Becker D M
Published: November 2008

OBJECTIVES: This study evaluates the feasibility of a nonquota, street-intercept survey method that utilized random selection of interview sites. METHODS: The street-intercept survey was compared with a random digit-dial telephone survey conducted in the same catchment area among African-American adults aged 18 or older. RESULTS: The street-intercept survey's response rate was 80.2%; residence rate, 85.3%; interview completion rate, 97.9%; interference rate, 4.0%; and yield rate, 2.5 interviews per interviewer per hour. The street-intercept method produced more representative distributions of age and sex than the random-digit-dial survey. CONCLUSIONS: The street-intercept method is a feasible alternative to traditional population survey methods and may provide better access to harder-to-reach segments of the urban population in a safe manner.
The effectiveness of family planning programs evaluated with true experimental designs.
Authors: Bauman K E
Published: November 2008

OBJECTIVES: This paper describes the magnitude of effects for family planning programs evaluated with true experimental designs. METHODS: Studies that used true experimental designs to evaluate family planning programs were identified and their results subjected to meta-analysis. RESULTS: For the 14 studies with the information needed to calculate effect size, the Pearson r between program and effect variables ranged from -.08 to .09 and averaged .08. CONCLUSIONS: The programs evaluated in the studies considered have had, on average, smaller effects than many would assume and desire.
Hysterectomy, oophorectomy, and heart disease risk factors in older women.
Authors: Kritz-Silverstein D , Barrett-Connor E , Wingard D L
Published: November 2008

OBJECTIVES: This study examined the relation of hysterectomy and oophorectomy to heart disease risk factors. METHODS: Data were collected and analyzed for 1150 women aged 50 through 89. RESULTS: Of these women, 21.8% reported hysterectomy with bilateral oophorectomy; 22.1%, hysterectomy with ovarian conservation. Compared with women without hysterectomy, oophorectomized women, especially those 20 or more years postmenopause, had increased lipids, lipoproteins, glucose, and insulin; blood pressures were increased among current estrogen users. Women with hysterectomies with ovarian conservation had similar or more favorable risk factors than nonhysterectomized women. CONCLUSIONS: Bilateral oophorectomy, but not hysterectomy, may have long-term negative consequences for heart disease risk factors not totally ameliorated by estrogen use.
Policy research for disease prevention: challenges and practical recommendations.
Authors: Brownson R C , Newschaffer C J , Ali-Abarghoui F
Published: November 2008

Policy approaches to health promotion and disease prevention hold great potential, as several community-based projects have illustrated. Policy interventions, despite their wide-spread use, frequently lack a systematic framework for implementation and evaluation. The authors propose a four-stage framework for the formation and evaluation of public health policy. The stages are identification of health risks and preventive options; intervention development; policy development; and policy enactment and assurance. A strong focus on evaluation is included within the framework. In addition, a series of practical implications and recommendations are given under the broad headings of evaluation issues and linkages. It is hoped that the issues described will lead to more systematic implementation and evaluation of public health policy measures.
US trends in nutrient intake: the 1987 and 1992 National Health Interview Surveys.
Authors: Norris J , Harnack L , Carmichael S , Pouane T , Wakimoto P , Block G
Published: November 2008

OBJECTIVES: This study examined US trends in nutrient intake, using almost identical methods and nutrient databases in two time periods. METHODS: An extensive dietary intake questionnaire was included in supplements to the 1987 and 1992 National Health Interview Surveys. Dietary data from approximately 11,000 persons in each of those years were analyzed. RESULTS: The total and saturated fat intake and the percentage of energy from fat declined among Whites and Hispanics, but only minimal changes were seen in Black Americans. The changes in fat intake were attributable principally to behavioral changes in frequency and type of fat-containing foods consumed rather than to the increased availability of leaner cuts of meat. Dietary cholesterol showed one of the largest declines of the nutrients examined. Less desirable changes were also seen. Cereal fortification played an important role in the observed changes in several micronutrients. CONCLUSIONS: Educational campaigns on dietary fat and cholesterol have been moderately effective, but not in all racial/ethnic groups. Future campaigns should emphasize maintaining or increasing micronutrient intake.
Childhood abuse and the use of inhalants: differences by degree of use.
Authors: Fendrich M , Mackesy-Amiti M E , Wislar J S , Goldstein P J
Published: November 2008

OBJECTIVES: Using two existing ethnographic studies of drug-involved adults, this study evaluates the association between child-abuse victimization and levels of involvement in inhalant use. METHODS: Historical accounts of childhood exposure to physical or sexual abuse were compared among nonusers of inhalants (n = 197), light inhalant users (n = 64), and heavy inhalant users (n = 24). Crude and adjusted odds ratios were used to compare informants with no history of inhalant use with those having a history of light inhalant use and those having a history of heavy inhalant use. RESULTS: Heavy inhalant use was associated with history of any child abuse (adjusted odds ratio [OR] = 4.6) and physical abuse (adjusted OR = 3.8). Light inhalant use showed no association with child-abuse history. CONCLUSIONS: Child abuse may be an important correlate of extensive involvement in inhalant use. The findings invite speculation with respect to a hypothetical causal role for child abuse in the etiology of inhalant use. The lack of support for causality in this study underscores the need for replication and more carefully designed longitudinal research.
The AIDS epidemic among Spanish drug users: a birth cohort-associated phenomenon.
Authors: Castilla J , Pollán M , López-Abente G
Published: November 2008

OBJECTIVES: In Spain the number of new acquired immunodeficiency syndrome (AIDS) cases among injection drug users continues to rise. The time trend up to 1994 has been analyzed, with special attention paid to the different generations. METHODS: The source for injection drug use-related cases was the Spanish AIDS Register. Independent analyses of annual specific rates were run for each sex with the use of an age-period-cohort log-linear model. RESULTS: After adjustment for age and year of diagnosis, AIDS incidence related to injection drug use is associated with specific birth cohorts. Rising values are observed in the successive generations born during the 1950s, peaking in men born in 1962 and women born in 1964. In subsequent cohorts, there is a marked falloff in incidence for both sexes, but this decline is seen to halt in men from the 1972 birth cohort onwards. The overall period effect is upward, yet the trend flattens in the last years. There is a pronounced age effect with maximum values in men and women at ages 29 and 27, respectively. CONCLUSIONS: It is essential to urge avoidance of risk behaviors in new generations.
Recent trends in breast cancer mortality among white and black US women.
Authors: Chevarley F , White E
Published: November 2008

OBJECTIVES: Time trends in breast cancer mortality were analyzed from 1970 to 1992 among White and Black US women aged 25 and over. METHODS: Mortality data from the National Center for Health Statistics were summarized within three periods 1970 to 1979, 1980 to 1988, and 1989 to 1992. The annual change was calculated as the average yearly percentage of change based on the logistic model. RESULTS: For White women of all ages, breast cancer mortality decreased by 1.6% (95% confidence interval = -2.0%, -1.1%) per year on average during 1989 to 1992, in contrast to the flat mortality rates observed during the 1970s and a 0.5% average annual increase during 1980 to 1988. The decline was observed for White women under age 60, among whom breast cancer mortality had been decreasing, and for White women aged 60 to 79, among whom breast cancer mortality had been increasing, but it was not observed among Black women. CONCLUSIONS: The long-awaited decline in US breast cancer mortality has finally appeared, although only among White women. The possible contributions are changes in inherent risk of disease, changes in treatment effectiveness, and increased use of screening mammography.
Ethnic differences in birthweight: the role of lifestyle and other factors.
Authors: Shiono P H , Rauh V A , Park M , Lederman S A , Zuskar D
Published: November 2008

OBJECTIVES: The purpose of this study was to expand the search for risk factors for low birthweight and to find new explanations for the ethnic-group disparities in birth outcomes. METHODS: The subjects were 1150 pregnant women from six ethnic groups (African American, Chinese, Dominican, Puerto Rican, Mexican, and White) who received prenatal care at clinics in New York and Chicago between December 1987 and December 1989. Two interviews were conducted during the second and third trimesters of pregnancy. RESULTS: The study, after controlling for poverty and other birthweight correlates, showed that living in public housing and believing that chance plays a major role in determining one's health status were negatively associated with birthweight. Having a stable residence was positively related to birthweight. Material hardship, social adversity, perceived racial discrimination, physical abuse, anxiety, and depression were not associated with birthweight. CONCLUSIONS: The negative role of an impoverished living environment and feelings of helplessness, as well as the positive role of having a stable form of social support, suggest new directions for research on the causes of low birthweight and the ethnic disparities in US birth outcomes.