bluuebunny/crossref_metadata_2025 huggingface dataset:
Restaurant smoking restrictions and environmental tobacco smoke exposure.
Authors: Brauer M , Mannetje A
Published: November 2008

OBJECTIVES: This study evaluated the effectiveness of smoking restrictions. METHODS: We measured particulate concentrations in restaurants with different levels of allowable smoking. RESULTS: Mean particulate concentrations were 70% higher in establishments without smoking restrictions compared with those with partial smoking restrictions. Concentrations in nonsmoking restaurants were reduced by an additional 20% to 30%. Measurements of cadmium, an environmental tobacco smoke (ETS) marker, implicated ETS as the major source of particulate in restaurants that allowed smoking. CONCLUSIONS: Partial smoking restrictions substantially reduce, but do not eliminate, ETS exposure in restaurants. Occupants of nonsmoking restaurants avoid ETS exposure but may experience substantial particulate exposures from cooking emissions.
Potential barriers to the removal of Norplant among family planning clinic patients.
Authors: Kalmuss D , Davidson A , Cushman L , Heartwell S , Rulin M
Published: November 2008

OBJECTIVES: This study examined the prevalence and effects of potential barriers to removal of levonorgestrel implants (Norplant) among low-income women. METHODS: A sample of 687 women who received Norplant at hospital-based family planning clinics were interviewed before Norplant insertion and 6 months after Norplant insertion (or at Norplant removal if removal occurred earlier). Those who continued to use Norplant were reinterviewed at 2 years or at removal. RESULTS: In a multivariate analysis, only 1 of the 4 potential barriers--cost--significantly impeded Norplant discontinuation. CONCLUSIONS: Family planning clinics need to make clear that they follow a policy of Norplant removal on demand, regardless of the patient's ability to pay.
Scales of geography, time, and population: the study of violence as a public health problem.
Authors: Wallace D , Wallace R
Published: November 2008

OBJECTIVES: In this study, data on violent deaths in the Bronx, New York City, from the 1970, 1980, and 1990 censuses were analyzed. METHODS: The incidence and areal density of intentional deaths were mapped by health area. Simple and stepwise regressions between violent death measures and other factors were performed. RESULTS: The incidence of deaths at levels of those in the highest 1970 quintile spread so that by 1990 only 2 areas saw incidences at levels of the lowest 1970 quintile. Overcrowding, socioeconomic status, population, population change, and drug deaths in simple regressions and overcrowding, socioeconomic status, and low-weight births in stepwise regressions correlated significantly with violent death incidence or density. CONCLUSIONS: Understanding the spatiotemporal development of violence can contribute to public policy on violence.
Childhood lead poisoning: the promise and abandonment of primary prevention.
Authors: Needleman H L
Published: November 2008

In 1991, the Public Health Service published the Strategic Plan for the Elimination of Childhood Lead Poisoning. This document marked a fundamental shift in federal policy from finding and treating lead-poisoned children to authentic primary prevention. It spelled out a 15-year strategy to achieve this goal and provided a cost-benefit analysis showing that the monetized benefits far exceeded the costs of abatement. A strong national effort to eliminate the disease developed. Now, 7 years after publication of the plan, primary prevention of lead exposure has been abandoned. This article examines the role of some prevailing attitudes and institutions in derailing the effort. Some institutions--the lead industry, real estate interests, and insurance interests--behaved as anticipated. Others, including private pediatricians, the American Academy of Pediatrics, some federal agencies, and a public interest group ostensibly dedicated to eliminating lead poisoning, also played an unexpected part in derailing the plan.
Commentary: Medicaid reform issues affecting the Indian health care system.
Authors: Wellever A , Hill G , Casey M
Published: November 2008

Substantial numbers of Indian people rely on Medicaid for their primary health insurance coverage. When state Medicaid programs enroll Indians in managed care programs, several unintended consequences may ensue. This paper identifies some of the perverse consequences of Medicaid reform for Indians and the Indian health care system and suggests strategies for overcoming them. It discusses the desire of Indian people to receive culturally appropriate services, the need to maintain or improve Indian health care system funding, and the duty of state governments to respect tribal sovereignty. Because of their relatively small numbers, Indians may be treated differently under Medicaid managed care systems without significantly endangering anticipated program savings. Failure of Medicaid programs to recognize the uniqueness of Indian people, however, may severely weaken the Indian health care system.
The decline in Rh hemolytic disease: should Rh prophylaxis get all the credit?
Authors: Joseph K S , Kramer M S
Published: November 2008

OBJECTIVES: This study sought to quantify the magnitude of Rh disease reduction occurring secondary to Rh prophylaxis and other determinants. METHODS: Outcomes considered included maternal Rh sensitization, neonatal Rh disease, and perinatal deaths from Rh disease. Analysis was based on Poisson regression modeling of ecological data from Manitoba, Canada, and conditional probability modeling. RESULTS: The ecological analysis showed that changes in birth order and Rh prophylaxis resulted in 24% (95% confidence interval [CI] = 1% 42%) and 69% (95% CI = 61%, 76%) decreases, respectively, in Rh sensitizations (D and non-D) in Manitoba between 1963 and 1988. Rh prophylaxis and nonprogram factors were responsible for 83% (95% CI = 44%, 95%) and 78% (95% CI = 42%, 91%), respectively, of the reduction in perinatal deaths from Rh disease. Similar results were obtained with conditional probability modeling, which also provided estimates for the effects of changes in abortion rates and racial composition. CONCLUSIONS: In addition to Rh prophylaxis, changes in other determinants were responsible for an important fraction of the decline in Rh disease. These results provide a historical perspective on the conquest of Rh disease and also have important implications for public health policy, particularly in developing countries.
The preterm prediction study: the value of new vs standard risk factors in predicting early and all spontaneous preterm births. NICHD MFMU Network.
Authors: Goldenberg R L , Iams J D , Mercer B M , Meis P J , Moawad A H , Copper R L , Das A , Thom E , Johnson F , McNellis D , Miodovnik M , Van Dorsten J P , Caritis S N , Thurnau G R , Bottoms S F
Published: November 2008

OBJECTIVES: This study was undertaken to determine the relationship between fetal fibronectin, short cervix, bacterial vaginosis, other traditional risk factors, and spontaneous preterm birth. METHODS: From 1992 through 1994, 2929 women were screened at the gestational age 22 to 24 weeks. RESULTS: The odds ratios for spontaneous preterm birth were highest for fetal fibronectin, followed by a short cervix and history of preterm birth. These factors, as well as bacterial vaginosis, were more strongly associated with early than with late spontaneous preterm birth. Bacterial vaginosis was more common--and a stronger predictor of spontaneous preterm birth--in Black women, while body mass index less than 19.8 was a stronger predictor in non-Black women. This analysis suggests a pathway leading from Black race through bacterial vaginosis and fetal fibronectin to spontaneous preterm birth. Prior preterm birth is associated with spontaneous preterm birth through a short cervix. CONCLUSIONS: Fetal fibronectin and a short cervix are stronger predictors of spontaneous preterm birth than traditional risk factors. Bacterial vaginosis was found more often in Black than in non-Black women and accounted for 40% of the attributable risk for spontaneous preterm birth at less than 32 weeks.
Identifying condom users at risk for breakage and slippage: findings from three international sites.
Authors: Spruyt A , Steiner M J , Joanis C , Glover L H , Piedrahita C , Alvarado G , Ramos R , Maglaya C , Cordero M
Published: November 2008

OBJECTIVES: This study examined whether past condom failure (breakage, slippage, or both) can predict future failure and evaluated other predictors of condom failure. METHODS: At each of 3 international sites, approximately 130 male condom users were enrolled and given 5 condoms to use for vaginal intercourse over a 3-week period. RESULTS: Men at increased risk (history of 1 or more condoms that broke or slipped off) reported approximately twice as many condom failures as those not in this group. Condom failure increased with the number of adverse condom use behaviors reported per participant. Opening condom packages with sharp objects and unrolling condoms before donning were associated with breakage. Unrolling condoms before donning and lengthy or intense intercourse were associated with slippage. Of background characteristics evaluated, having less education was associated with condom failure. CONCLUSIONS: These data suggest that a history of condom failure predicts future failure, a finding that may be useful for targeted intervention. Moreover, these data provide further evidence that certain behaviors and lower educational attainment are associated with condom failure.
Correlates of same-sex sexual behavior in a random sample of Massachusetts high school students.
Authors: Faulkner A H , Cranston K
Published: November 2008

OBJECTIVES: This study documented risk behaviors among homosexually and bisexually experienced adolescents. METHODS: Data were obtained from a random sample of high school students in Massachusetts. Violence, substance use, and suicide behaviors were compared between students with same-sex experience and those reporting only heterosexual contact. Differences in prevalence and standard errors of the differences were calculated. RESULTS: Students reporting same-sex contact were more likely to report fighting and victimization, frequent use of alcohol, other drug use, and recent suicidal behaviors. CONCLUSIONS: Students with same-sex experience may be at elevated risk of injury, disease, and death resulting from violence, substance abuse, and suicidal behaviors.
Differences in fertility associated with caffeinated beverage consumption.
Authors: Caan B , Quesenberry C P , Coates A O
Published: November 2008

OBJECTIVES: The effect of caffeine consumption on fertility was examined prospectively in 210 women. METHODS: Women reported on caffeinated beverage consumption and pregnancy status monthly. Odds ratios for becoming pregnant were calculated for both high and moderate vs low consumption. RESULTS: No significant association was found for any of the caffeinated beverages except tea. Drinking one-half cup or more of tea daily approximately doubled the odds of conception per cycle. CONCLUSIONS: These data suggest that caffeine may not be the responsible agent for variation in fertility associated with consumption of the beverages examined.
Violence during pregnancy: measurement issues.
Authors: Ballard T J , Saltzman L E , Gazmararian J A , Spitz A M , Lazorick S , Marks J S
Published: November 2008

OBJECTIVES: Standardized quantitative methods are needed to study occurrence and timing of violence in relation to pregnancy and to study the context in which pregnancy-related violence occurs. METHODS: Data from three published studies of prevalence of violence during pregnancy are used to illustrate ways to measure the association of violence in relation to pregnancy. RESULTS: Four patterns of violence in relation to pregnancy are identified, and related research issues are discussed. Also, 2 population-based surveys that address the suggestions presented here are discussed. CONCLUSIONS: Better measurement of the association between violence and pregnancy will facilitate development of data-based prevention and intervention programs.
Hospital- and patient-related characteristics determining maternity length of stay: a hierarchical linear model approach.
Authors: Leung K M , Elashoff R M , Rees K S , Hasan M M , Legorreta A P
Published: November 2008

OBJECTIVES: The purpose of this study was to identify factors related to pregnancy and childbirth that might be predictive of a patient's length of stay after delivery and to model variations in length of stay. METHODS: California hospital discharge data on maternity patients (n = 499,912) were analyzed. Hierarchical linear modeling was used to adjust for patient case mix and hospital characteristics and to account for the dependence of outcome variables within hospitals. RESULTS: Substantial variation in length of stay among patients was observed. The variation was mainly attributed to delivery type (vaginal or cesarean section), the patient's clinical risk factors, and severity of complications (if any). Furthermore, hospitals differed significantly in maternity lengths of stay even after adjustment for patient case mix. CONCLUSIONS: Developing risk-adjusted models for length of stay is a complex process but is essential for understanding variation. The hierarchical linear model approach described here represents a more efficient and appropriate way of studying interhospital variations than the traditional regression approach.
Decision latitude, job strain, and myocardial infarction: a study of working men in Stockholm. The SHEEP Study Group. Stockholm Heart epidemiology Program.
Authors: Theorell T , Tsutsumi A , Hallquist J , Reuterwall C , Hogstedt C , Fredlund P , Emlund N , Johnson J V
Published: November 2008

OBJECTIVES: This study examined the role of decision latitude and job strain in the etiology of a first myocardial infarction. METHODS: Eligible case patients were all full-time working men 45 to 64 years of age who suffered a first myocardial infarction during the period January 1992 to January 1993 in the greater Stockholm region. Referents were selected from the general population. Participation rates were 82% (case patients) and 75% (referents). RESULTS: Both inferred and self-reported low decision latitude were associated with increased risk of a first myocardial infarction, although this association was weakened after adjustment for social class. A decrease in inferred decision latitude during the 10 years preceding the myocardial infarction was associated with increased risk after all adjustments, including chest pain and social class. The combination of high self-reported demands and low self-reported decision latitude was an independent predictor of risk after all adjustments. CONCLUSIONS: Both negative change in inferred decision latitude and self-reported job strain are important risk indicators in men less than 55 years of age and in blue-collar workers.
Does low socioeconomic status potentiate the effects of heightened cardiovascular responses to stress on the progression of carotid atherosclerosis?
Authors: Lynch J W , Everson S A , Kaplan G A , Salonen R , Salonen J T
Published: November 2008

OBJECTIVES: This study examined whether heightened cardiovascular reactivity and low socioeconomic status had synergistic effects on the progression of carotid atherosclerosis in a population of eastern Finnish men. METHODS: Data from the Kuopio Ischemic Heart Disease Risk Factor Study were used to measure 4-year progression of intima-media thickness in 882 men according to cardiovascular reactivity and socioeconomic status. Associations were examined in relation to risk factors and were stratified by baseline levels of atherosclerosis and prevalent ischemic heart disease. RESULTS: The effect of reactivity on atherosclerotic progression depended on socioeconomic status. Men who had heightened cardiovascular responsiveness to stress and were born into poor families, received little education, or had low incomes had the greatest atherosclerotic progression. CONCLUSIONS: An understanding of associations between individual risk factors and disease should be based on etiologic hypotheses that are conceived at the population level and involve fundamental social and economic causes of disease. This study demonstrates how examining the interaction of an individual biological predisposition will low socioeconomic status over the life course is etiologically informative for understanding the progression of atherosclerotic vascular disease.
Correcting for bias in relative risk estimates due to exposure measurement error: a case study of occupational exposure to antineoplastics in pharmacists.
Authors: Spiegelman D , Valanis B
Published: November 2008

OBJECTIVES: This paper describes 2 statistical methods designed to correct for bias from exposure measurement error in point and interval estimates of relative risk. METHODS: The first method takes the usual point and interval estimates of the log relative risk obtained from logistic regression and corrects them for nondifferential measurement error using an exposure measurement error model estimated from validation data. The second, likelihood-based method fits an arbitrary measurement error model suitable for the data at hand and then derives the model for the outcome of interest. RESULTS: Data from Valanis and colleagues' study of the health effects of antineoplastics exposure among hospital pharmacists were used to estimate the prevalence ratio of fever in the previous 3 months from this exposure. For an interdecile increase in weekly number of drugs mixed, the prevalence ratio, adjusted for confounding, changed from 1.06 to 1.17 (95% confidence interval [CI] = 1.04, 1.26) after correction for exposure measurement error. CONCLUSIONS: Exposure measurement error is often an important source of bias in public health research. Methods are available to correct such biases.
The influence of program acceptability on the effectiveness of public health policy: a study of directly observed therapy for tuberculosis.
Authors: Heymann S J , Sell R , Brewer T F
Published: November 2008

OBJECTIVES: This study examined how patient acceptability influences the effectiveness of directly observed therapy for tuberculosis. METHODS: Decision and sensitivity analyses were used in assessing influences. RESULTS: If mandatory directly observed therapy discourages 6% of initial tuberculosis patients (range: 4% to 10%) from seeking care, then such therapy will be less effective than self-administered therapy. Directly observed therapy is more effective than repeated self-administered therapy for patients failing to complete initial treatment unless 32% (range: 27% to 38%) of patients avoid seeking care. CONCLUSIONS: Patient acceptability must be taken into consideration before selecting public health strategies.
Health insurance coverage among Chinese Americans in Los Angeles County.
Authors: Takeuchi D T , Chung R C , Shen H
Published: November 2008

OBJECTIVES: This paper examines the factors associated with health insurance coverage among Chinese Americans in Los Angeles County. METHODS: Data were obtained through interviews conducted in 1993 and 1994 with Chinese Americans (aged 18 through 65 years) residing in Los Angeles County. A multistage probability sample was used to select respondents. RESULTS: The final sample consisted of 1747 respondents, which represented an 82% response rate. Thirty-nine percent of the respondents in the survey were without health insurance at the time of the survey. CONCLUSIONS: Logistic regression analysis showed that marital status, length of residence in the United States, education, employment, and household income were associated with health insurance coverage among Chinese Americans.
Problem gamblers, problem substance users, and dual-problem individuals: an epidemiological study.
Authors: Feigelman W , Wallisch L S , Lesieur H R
Published: November 2008

OBJECTIVES: This study compared problem gamblers, problem substance users, dual-problem individuals, and persons without these problems in the general population. METHODS: On the basis of computer-assisted telephone interviews of a random sample of Texas adults (n = 6308) standard instruments were used to gauge substance use and gambling problems in the general population. RESULTS: Compared with those having a substance use or gambling problem only, dual-problem individuals were more likely to be young, never-married men, without conventional religious affiliations. There was more dysfunctionality (as evidenced by treatment-seeking and problems with the law) among dual-problem respondents than among those troubled exclusively by gambling or substance use problems. CONCLUSIONS: Screening and treatment for gambling problems should be offered in drug treatment and criminal justice arenas.
Inequalities in mortality by social class measured at 3 stages of the lifecourse.
Authors: Hart C L , Smith G D , Blane D
Published: November 2008

OBJECTIVES: This study examined how social class, measured at 3 staged of life, contributes to mortality risk. METHODS: A cohort of employed Scottish men (n = 5567) provided their fathers' occupation and their own first and current occupations, from which social class in childhood, at labor-market entry, and at screening (1970 to 1973) was determined. Relative rates of mortality and relative indices of inequality were calculated from 21 years of follow-up. RESULTS: Mortality risk was similar at each stage of life, with men in the higher social classes having the lowest risk. Social class at screening produced the greatest relative indices of inequality. CONCLUSIONS: The widening of inequalities in mortality in adulthood suggests the importance of the accumulation of poor socioeconomic circumstances throughout life.
Quality of reviews in epidemiology.
Authors: Breslow R A , Ross S A , Weed D L
Published: November 2008

OBJECTIVES: This study examined the quality of recent reviews in epidemiology. METHODS: All 1995 issues of 7 widely read epidemiology journals were searched to identify reviews. RESULTS: Twenty-nine reviews were identified. Methodology was not specified or incomplete for literature searches in 79% of reviews; the same was true for inclusion criteria in 83% and for combining studies in 62%. More than 60% of the reviews were not methodologically systematic. CONCLUSIONS: There is a need to improve the quality of review papers in epidemiology. If systematic methodology were followed more frequently, epidemiologic science and its application could be improved.
Trends in pulmonary embolism mortality in the US elderly population: 1984 through 1991.
Authors: Siddique R M , Siddique M I , Rimm A A
Published: November 2008

OBJECTIVES: This study determined race-, age- and sex-specific trends in 30-day pulmonary embolism mortality rates. METHODS: Medicare beneficiaries with a primary or secondary discharge diagnosis of pulmonary embolism from 1984 to 1991 (n = 391,991) were examined. RESULTS: For a primary diagnosis of pulmonary embolism, mortality rates declined by 15.2% and 16.0%, respectively, for White male patients 65 to 74 years old and 75 years or older. There was a corresponding decline in mortality rates for White women. For a secondary diagnosis of pulmonary embolism, mortality rates declined by 14.7% and 9.8%, respectively, for White male patients 65 to 74 years old and 75 years or older. CONCLUSIONS: The White mortality rate declines revealed in this study did not translate, in all cases, to Black patient groups.
The effect of lead exposure on behavior problems in preschool children.
Authors: Wasserman G A , Staghezza-Jaramillo B , Shrout P , Popovac D , Graziano J
Published: November 2008

OBJECTIVES: Interpreting associations between lead exposure and child behavior problems is difficult because studies have not controlled for sociodemographic confounders or have used shed teeth to mark exposure. This study explored associations between blood lead and preschool behavior. METHODS: Children from a smelter town and a non-lead-exposed town in Yugoslavia were followed up prospectively from pregnancy through age 3. The Child Behavior Checklist was used to assess behavior problems in 379 3-year-olds, controlling for sociodemographic factors and difficult infant temperament. RESULTS: Multiple regression revealed the expected significant associations between checklist subscales and sociodemographic factors, which explained 7% to 18% of the variance on the subscales. Concurrent blood lead explained a significant 1% to 4% of the variance on the Destructive and Withdrawn subscales. Earlier difficult temperament explained an additional 2% to 5% of the checklist variance. Scores on the Destructive subscale were consistently associated with blood lead. As blood lead increased from 10 to 20 micrograms/dL, subscale scores increased by approximately 0.5 points. CONCLUSIONS: Lead/behavior associations are significant but small compared with the effects of social factors.
A regression analysis estimating the number of drug-using arrestees in 185 US cities.
Authors: Hser Y I , Prendergast M , Anglin M D , Chen J K , Hsieh S C
Published: November 2008

OBJECTIVES: This study sought to provide population-based estimates of drug-using arrestees in the 185 largest US cities. METHODS: A prevalence model for drug-using arrestees was developed by relating selected social indicators (from 1990 census data) and drug use rates (from Drug Use Forecasting program data) via logistic regression analysis. RESULTS: It was estimated that in 1990, across the 185 cities, about 925,000 arrestees used cocaine, 317,000 used opiates, 213,000 used amphetamines, 389,000 were drug injectors, and 1,296,000 used an illicit drug. CONCLUSIONS: This approach represents a cost-efficient method for prevalence estimation based on empirically demonstrable relationships between social indicators and drug use rates.
Deficient dietary iron intakes among women and children in Russia: evidence from the Russian Longitudinal Monitoring Survey.
Authors: Kohlmeier L , Mendez M , Shalnova S , Martinchik A , Chakraborty H , Kohlmeier M
Published: November 2008

OBJECTIVES: This study evaluated the iron sufficiency of the Russian diet. METHODS: Data were obtained from 24-hour dietary recalls conducted in 4 rounds (1992 through 1994) of a nationally representative longitudinal survey of 10,548 women and children. Iron bioavailability was estimated via algorithms adjusting for enhancers (heme, vitamin C) and inhibitors (tannins in tea, phytates in grains) consumed at the same meal. RESULTS: Dietary iron intakes were deficient in the most vulnerable groups: young children and women of reproductive age. Poverty status was strongly associated with deficiency. After adjustment for enhancers and inhibitors, estimated bioavailable iron intakes at 3% to 4% of total iron were inadequate in all women and children. CONCLUSIONS: These dietary data suggest that Russian women and children are at high risk of iron deficiency. Grain products rich in phytates, which inhibit absorption, were the major food source of iron in Russia. High intakes of tea and low consumption of vitamin C also inhibited iron bioavailability. Since changes in eating behavior could potentially double iron bioavailability, educational programs should be explored as a strategy for improving iron nutriture.
Substance use among nurses: differences between specialties.
Authors: Trinkoff A M , Storr C L
Published: November 2008

OBJECTIVES: Valid data on factors that increase a health care worker's likelihood of substance use are integral in ensuring professional standards and quality health care for consumers. This study explored the association between nursing specialty and past-year substance use. METHODS: In an anonymous mailed survey, a balanced stratified sample of registered nurses (n = 4438) reported their use of marijuana, cocaine, and prescription-type drugs, as well as cigarette smoking and binge drinking. RESULTS: Prevalence of use of all substances was 32%. Rates varied by specialty, even when sociodemographics were controlled. Compared with nurses in women's health, pediatrics, and general practice, emergency nurses were 3.5 times as likely to use marijuana or cocaine (odds ratio [OR] = 3.5; 95% confidence interval [CI] = 1.5, 8.2); oncology and administration nurses were twice as likely to engage in binge drinking; and psychiatric nurses were most likely to smoke (OR = 2.4; 95% CI = 1.6, 3.8). No specialty differences appeared for prescription-type drug use. CONCLUSIONS: Certain nursing specialties were more likely than others to be associated with substance use. The differences were not explained by demographic characteristics. Inasmuch as a comparison of these results for nurses with prior work on physicians found considerable agreement by specialty, preventive initiatives should consider inter-disciplinary approaches to substance use education.
The protective effect of condoms and nonoxynol-9 against HIV infection.
Authors: Wittkowski K M , Susser E , Dietz K
Published: November 2008

OBJECTIVES: Whether or not spermicides can reduce the risk of human immunodeficiency virus (HIV) transmission remains an important question for the control of heterosexual HIV transmission. The authors provide estimates from a reanalysis of one of the few observational studies on the efficacy of condoms and spermicides, used separately and together, per vaginal contact. METHODS: In this reanalysis, three different models were used to assess the efficacy of spermicides and condoms: linear (Pearl index), exponential (maximum likelihood), and monotonic (marginal likelihood). RESULTS: Reported use of barrier methods among 27,432 contacts was as follows: condoms plus nonoxynol-9, 39%; condoms alone, 25%; nonoxynol-9 alone, 24%; and unprotected, 11%. Under all three models, the results indicate a strong protective effect for spermicidal suppositories. The Pearl index indicated that spermicide alone is apparently efficacious, but the efficacy per contact cannot be quantified with this approach. Maximum likelihood estimates for the efficacy of nonoxynol-9 alone and condoms (with or without nonoxynol-9) were 100% (95% confidence interval [CI95] = 43%, 100%) and 92% (95% CI95 = 79%, 100%), respectively. CONCLUSIONS: The data from this observational study suggest that spermicides may be efficacious in reducing the risk of HIV transmission.
Prevalence and impact of disabling chronic conditions in childhood.
Authors: Newacheck P W , Halfon N
Published: November 2008

OBJECTIVES: This study provides a current national profile of the prevalence and impact of chronic conditions causing childhood disability. Disability is defined as a long-term reduction in ability to conduct social role activities, such as school or play, because of a chronic physical or mental condition. METHODS: A cross-sectional descriptive analysis was performed on data from 99513 children younger than 18 years who were included in the 1992-1994 National Health Interview Survey. The response rate exceeded 93% during each year. RESULTS: A significant proportion of children, estimated at 6.5% of all US children, experienced some degree of disability. The most common causes of childhood disability were respiratory diseases and mental impairments. Prevalence of disability was higher for older children, boys, and children from low-income and single-parent families. Childhood disability is estimated to result in 66 million restricted activity days annually, including 24 million days lost from school. Furthermore, disability in childhood results in an added 26 million physician contacts and 5 million hospital days annually. CONCLUSIONS: Childhood disability has profound impacts on children, the education system, and the health care system.
Variation between studies in reported relative risks associated with hypertension: time trends and other explanatory variables.
Authors: Marang-van de Mheen P J , Gunning-Schepers L J
Published: November 2008

OBJECTIVES: This study examined the variation in reported relative risks of coronary heart disease and stroke associated with hypertension and determined reasons for the interstudy variation. METHODS: Studies published since 1970 were examined that reported the absolute number of events and person-years for men by age and hypertensive status. The data were pooled in Poisson regression models with the coronary heart disease or stroke rate as the dependent variable. Independent variables were hypertensive status, age at entry, age of study, duration of follow-up, diastolic blood pressure cut-off point, and interactions of all these variables with hypertensive status. RESULTS: The reported relative risks associated with hypertension ranged from 1.45 to 2.77 for coronary heart disease and from 1.86 to 5.78 for stroke. Smaller relative risks were found in more recent studies, in studies with long follow-up, and in studies using a lower cut-off point to define hypertension. CONCLUSIONS: Part of the interstudy variation in relative risks associated with hypertension can be attributed to differences in duration of follow-up, blood pressure cutoff point, and time at which blood pressure was measured, suggesting declining relative risks over time.
Facilitating condom use with clients during commercial sex in Nevada's legal brothels.
Authors: Albert A E , Warner D L , Hatcher R A
Published: November 2008

OBJECTIVES: This study examined condom use in legal Nevada brothels. METHODS: Forty female prostitutes in two brothels were interviewed about client resistance to condoms and techniques for facilitating condom use. RESULTS: Of 3290 clients in the previous month, 2.7% (95% confidence interval [CI] = 2.2%,3.4%) were reluctant to use condoms. Of these individuals, 72% ultimately used condoms, while 12% chose nonpenetrative sex without condoms. The remaining 16% left the brothels without services. Condom use rates were markedly lower with nonpaying sex partners (lowers) than with clients. CONCLUSIONS: Brothel prostitutes may be at greater risk for acquiring HIV and other sexually transmitted diseases from lovers than from clients.
Infant mortality differences between whites and African Americans: the effect of maternal education.
Authors: Din-Dzietham R , Hertz-Picciotto I
Published: November 2008

OBJECTIVES: Despite decreasing infant mortality in North Carolina, the gap between African Americans and Whites persists. This study examined how racial differences in infant mortality vary by maternal education. METHODS: Data came from Linked Birth and Infant Death files for 1988 through 1993. Multiple logistic regression models adjusted for confounders. RESULTS: Infant mortality risk ratios comparing African Americans and Whites increased with higher levels of maternal education. Education beyond high school reduced risk of infant mortality by 20% among Whites but had little effect among African Americans. CONCLUSIONS: Higher education magnifies racial differences in infant mortality on a multiplicative scale. Possible reasons include greater stress, fewer economic resources, and poorer quality of prenatal care among African Americans.
Rates and independent correlates of Pap smear testing among Korean-American women.
Authors: Wismer B A , Moskowitz J M , Chen A M , Kang S H , Novotny T E , Min K , Lew R , Tager I B
Published: November 2008

OBJECTIVES: This study reports population estimates of Pap smear testing among Korean-American women and evaluates correlates of testing. METHODS: Korean Americans in 2 California counties were surveyed by telephone. Frequencies were age-adjusted to the 1990 census to produce population estimates of testing. Logistic regression models were used to evaluate independent correlates of testing RESULTS: Only 50% of the Korean-American women surveyed had a Pap test in the previous 2 years. The strongest independent correlate was having had a regular check-up in the previous 2 years (odds ratio 7.2, 95% confidence interval 4.2, 12.1). CONCLUSIONS: Rates of Pap testing among Korean-American women are well below national objectives. Collaboration and community-sensitive research are essential to collect data and design programs to improve the health of ethnic minority communities.
Contraception and abortion in two Vietnamese communes.
Authors: Gorbach P M , Hoa D T , Nhan V Q , Tsui A
Published: November 2008

OBJECTIVES: The authors examined factors predicting abortion use in two communes in northern Vietnam. METHODS: A survey of 504 rural and 523 urban women of childbearing age was conducted. RESULTS: For the 13.6% of urban and 19% of rural commune women having had an abortion in the previous year, logistic regression analyses demonstrated that use of an intrauterine device reduced the likelihood of subsequent abortion in both communes. Traditional method use in the rural commune, however, increased women's likelihood of a subsequent abortion. CONCLUSIONS: Contraceptive use in these 2 communes affected abortion more than sociodemographic factors. Traditional method use by rural women is a risk for abortion.
Evaluation of a public-private certified nurse-midwife maternity program for indigent women.
Authors: Lenaway D , Koepsell T D , Vaughan T , van Belle G , Shy K , Cruz-Uribe F
Published: November 2008

OBJECTIVES: This study assessed the impact of a public-private certified nurse-midwife program on prenatal and delivery outcomes among medically indigent women. METHODS: A population-based quasi-experimental design was used to compare 1 intervention county with 2 nonintervention counties. RESULTS: The program significantly reduced the number of women who received no prenatal care and the risk of acquiring less than adequate prenatal care. Reductions in the proportion of infants born premature or with low birth-weights were of borderline significance. The use of induction and/or stimulation of labor was statistically elevated. CONCLUSIONS: These results suggest that the intervention program was instrumental in reducing some, but not all, negative prenatal and delivery outcomes.
Private sexual behavior, public opinion, and public health policy related to sexually transmitted diseases: a US-British comparison.
Authors: Michael R T , Wadsworth J , Feinleib J , Johnson A M , Laumann E O , Wellings K
Published: November 2008

OBJECTIVES: The purpose of this study was to characterize sexual behavior and opinions about sex in the United States and Britain; implications are discussed for effective public health policy regarding sexually transmitted diseases (STDs) in the United States. METHODS: Large-scale national probability surveys conducted in the 2 countries detailed sexual behavior, opinions, and the prevalence of STDs. RESULTS: In comparison with that of Britain, the US population has greater variability in sexual behavior, less tolerant opinions about sexual behavior, and a higher STD prevalence and lower condom usage among men. CONCLUSIONS: The survey data show compelling evidence from both countries of a strong association between number of sex partners and STD risk. In the United States relative to Britain, there is both greater dispersion in sexual behavior and a greater incidence of unconditional opposition to certain sexual practices. The former implies a need for strong public health policy to address the risks of STDs, but the latter implies strong opposition to that policy. This disjuncture between public health need and feasibility may contribute to the high US rate of STDs.
From assurance to insurance in Russian health care: the problematic transition.
Authors: Burger E J , Field M G , Twigg J L
Published: November 2008

OBJECTIVES: Given the declining health status of the Russian population and the negative social impact of ongoing economic reforms, it is important to understand the nature and scope of Russia's innovations in health care financing. METHODS: Data on Russian health care and its financing were gathered from Russian newspapers and journals. US government agency reports, recent press accounts, and the authors' observations and interviews in Russia. RESULTS: The 1991 statutory basis for the Russian mandatory medical insurance system replaced the traditional, state-funded medical care system with a regional system principally reliant on an enterprise-based with-holding tax plus supplementation by local government and, to a minor extent, federal funds. The regional agent for distribution and management of these funds is a series of Territorial Health Insurance Funds. Implementation thus far has been highly uneven among territories. CONCLUSIONS: An insurance model patterned after the Western example may not be the optimal solution to Russia's current health financing problems. Given the chaotic nature of political and economic reform, Russia may simply not be ready for market-based medical insurance.
Mortality in a large population-based cohort of patients with drug-treated diabetes mellitus.
Authors: Koskinen S V , Reunanen A R , Martelin T P , Valkonen T
Published: November 2008

OBJECTIVES: This paper presents detailed cause-specific data about excess mortality among diabetic persons in Finland, by age and sex. METHODS: Five-year follow-up data on the Finnish population aged 30 through 74 years were analyzed. During these 5 years, 11,215 persons with diabetes and 102,843 persons without diabetes died. The diabetic population was defined as people who were entitled to free medication for diabetes at the beginning of the follow-up period, that is, at the end of 1980. RESULTS: The relative mortality of persons with drug-treated diabetes compared with nondiabetic persons was higher among women (3.4) than among men (2.4). Almost three quarters of the mortality excess was due to circulatory diseases. For most other causes of death, too, diabetic persons had higher than average mortality. The exceptions were lung cancer, chronic obstructive pulmonary disease, and alcohol poisoning. CONCLUSIONS: Diabetes is a general risk factor for untimely death and makes a significant contribution to overall national death rates, particularly for circulatory diseases. Lower than average mortality from smoking-related diseases and alcohol poisoning, however, warrant optimism about the effects of health education among diabetic persons.
Increased cesarean section rates and emerging patterns of health insurance in Shanghai, China.
Authors: Cai W W , Marks J S , Chen C H , Zhuang Y X , Morris L , Harris J R
Published: November 2008

OBJECTIVES: This study examined the trend in cesarean section deliveries and the factors associated with it in the Minhang District of Shanghai, China. METHODS: A representative sample of the members of 2716 households in the district were interviewed in the fall of 1993. This study analyzed the data from 1959 married women of reproductive age with at least one live birth. RESULTS: During the past 3 decades, the proportion of infants born by cesarean section increased from 4.7% to 22.5%. Logistic regression analysis revealed that the highest cesarean section rate, which occurred in the most recent period of 1988 through 1993, was associated with form of medical payment, self-reported complications during pregnancy, higher birthweight, and maternal age. Government insurance pays all costs of cesarean sections and accounted for the highest proportion of the cesarean section rate. CONCLUSIONS: The high rates of cesarean sections in China are surprising given the lack of the factors that usually lead to cesarean sections. The increasing cesarean section rates may be an early indication that emerging forms of health insurance and fee-for-service payments to physicians will lead to an excessive emphasis on costly, high-technology medical care in China.
Respiratory diphtheria in the United States, 1980 through 1995.
Authors: Bisgard K M , Hardy I R , Popovic T , Strebel P M , Wharton M , Chen R T , Hadler S C
Published: November 2008

OBJECTIVES: The purpose of this study was to describe the epidemiologic, laboratory, and clinical features of respiratory diphtheria cases reported in the United States during 1980 through 1995. METHODS: Respiratory diphtheria cases reported to the Centers for Disease Control and Prevention were reviewed. Cases were defined as physician-diagnosed cases with signs and symptoms compatible with respiratory diphtheria, including the presence of a pseudomembrane without other apparent cause. RESULTS: From 1980 through 1994, 41 respiratory diphtheria cases were reported; none were reported in 1995, and no secondary cases were identified. Nine (22%) case patients were 4 years of age or younger, and 28 (68%) were 15 years of age or older. None of the case patients were up to date with diphtheria vaccination; 4 unvaccinated children died. Seventeen (43%) of 40 case patients had positive culture results. CONCLUSIONS: Available surveillance data suggest that respiratory diphtheria has become a rare disease in the United States. However, importation and circulation of toxigenic strains continue to present a threat and require achieving and maintaining high coverage with diphtheria toxoid-containing vaccines in both children and adults.
Tuberculosis screening and compliance with return for skin test reading among active drug users.
Authors: Malotte C K , Rhodes F , Mais K E
Published: November 2008

OBJECTIVES: This study assessed the independent and combined effects of different levels of monetary incentives and a theory-based educational intervention on return for tuberculosis (TB) skin test reading in a sample of active injection drug and crack cocaine users. Prevalence of TB infection in this sample was also determined. METHODS: Active or recent drug users (n = 1004), recruited via street outreach techniques, were skin tested for TB. They were randomly assigned to 1 of 2 levels of monetary incentive ($5 and $10) provided at return for skin test reading, alone or in combination with a brief motivational education session. RESULTS: More than 90% of those who received $10 returned for skin test reading, in comparison with 85% of those who received $5 and 33% of those who received no monetary incentive. The education session had no impact on return for skin test reading. The prevalence of a positive tuberculin test was 18.3%. CONCLUSIONS: Monetary incentives dramatically increase the return rate for TB skin test reading among drug users who are at high risk of TB infection.
Health benefits and risks of reporting HIV-infected individuals by name.
Authors: Colfax G N , Bindman A B
Published: November 2008

With more treatment options emerging for human immunodeficiency virus (HIV) infection, the policy of reporting HIV-infected individuals by name merits reevaluation. This paper reviews the benefits and risks of name reporting of persons infected with HIV. Public health departments have linked name reporting with medical referrals, risk reduction counseling, and partner notification programs. Yet some studies indicate that people are less likely to be tested for HIV infection when name reporting is implemented. Whether name reporting actually improves individual or public health, therefore justifying the increased risk of loss of confidentiality and possibly reduced testing rates, remains unknown. The lack of health outcome data on name reporting allows beliefs rather than facts to dominate debate about this policy. Before this practice is more widely adopted, a determination should be made as to whether the potential benefits of name reporting outweigh the risks.