bluuebunny/crossref_metadata_2025 huggingface dataset:
Emotional and behavioral problems and severe academic delays among sheltered homeless children in Los Angeles County.
Authors: Zima B T , Wells K B , Freeman H E
Published: November 2008

OBJECTIVES. Few studies have estimated the extent of specific emotional, behavioral, and academic problems among sheltered homeless children. The objectives of this study were to describe such problems, identify those children with the problems, and evaluate the relationship between child problems and use of physical and mental health services. METHODS. From February through May 1991, 169 school-age children and their parents living in 18 emergency homeless family shelters in Los Angeles County were interviewed. To evaluate the answers, interviewers used standardized measures of depression, behavioral problems, receptive vocabulary, and reading. RESULTS. The vast majority (78%) of homeless children suffered from either depression, a behavioral problem, or severe academic delay. Among children having a problem, only one third of the parents were aware of any problem, and few of those children (15%) had ever received mental health care or special education. CONCLUSIONS. Almost all school-age sheltered homeless children in Los Angeles County have symptoms of depression, a behavioral problem, or academic delay severe enough to merit a clinical evaluation, yet few receive specific care. Programs targeted at sheltered homeless school-age children are needed to close this gap.
AIDS, HIV infection, and illicit drug use within inner-city families and social networks.
Authors: Pivnick A , Jacobson A , Eric K , Doll L , Drucker E
Published: November 2008

OBJECTIVES. Drug use is commonly depicted and treated as an individual problem. This study describes the extent of drug use, human immunodeficiency virus (HIV) infection, and acquired immunodeficiency syndrome (AIDS) among drug users' sexual partners and family and household members in order to broaden considerations of risk. METHODS. Social network charts and structured interviews were administered to 126 women (predominantly African American and Latino) enrolled in methadone treatment. The charts elicited the prevalence of drug use and HIV infection among subjects' family and household members. RESULTS. Drug use and HIV/AIDS permeated subjects' sexual, familial, and household relationships. More than half of the women who resided with a sexual partner reported that their partners currently used drugs. Almost one third of the subjects' siblings were drug users. Of the 715 total siblings (all subjects plus their siblings), 69 (9.7%) were known to be HIV positive or to have an AIDS diagnosis. CONCLUSIONS. The sexual, familial, and household expressions of drug use underscore the notion that drug use and attendant risks, including but not limited to HIV infection, might be usefully viewed and treated as an inter- and intracommunity problem rather than as an exclusively individual one.
Chronic fatigue syndrome: have flawed assumptions been derived from treatment-based studies?
Authors: Richman J A , Flaherty J A , Rospenda K M
Published: November 2008

Chronic fatigue syndrome is a disabling disorder that has been studied primarily in clinical settings. In the absence of an adequate epidemiological database, cultural stereotypes have influenced the characterization of chronic fatigue syndrome as "the yuppie flu," similar to the 19th century characterization of neurasthenia as a disease of the affluent. The limited epidemiological data available and the overall medical-sociological literature call this assumption into question. Only a community "true" prevalence study that is unbiased by help seeking and access to health care can provide an accurate assessment of the risk factors for and the public health ramifications of this disease.
The provision and use of mental health services in nursing homes: results from the National Medical Expenditure Survey.
Authors: Smyer M A , Shea D G , Streit A
Published: November 2008

Data from the Institutional Population Component of the National Medical Expenditure Survey were used to provide national estimates of annual mental health service provision and use in nursing homes. In addition, the relationship between service provision and setting characteristics such as ownership, size, Medicaid certification, and chain status was examined. Although more than three quarters of residents with a mental disorder resided at a nursing home that provided counseling services, fewer than one fifth actually received any mental health services within the year.
Psychotic inpatients' social class and their first admission to state or private psychiatric Baltimore hospitals.
Authors: Muntaner C , Wolyniec P , McGrath J , Pulver A E
Published: November 2008

Social class differences were investigated among patients admitted to public and private psychiatric hospitals. Participants included first admission White psychotic men admitted to Baltimore metropolitan area hospitals between 1983 and 1989. After adjusting for age and diagnosis, patients with low levels of skills/credentials were found to be more likely than patients with higher levels to be admitted to state psychiatric hospitals. These findings underscore the persistence of social class as a determinant of differences in the use of psychiatric care.
A pilot syringe exchange program in Washington, DC.
Authors: Vlahov D , Ryan C , Solomon L , Cohn S , Holt M R , Akhter M N
Published: November 2008

The Washington, DC City Council authorized a pilot syringe exchange program to operate for only 60 days at a single drug abuse treatment facility in the District. Only adults on the waiting list for treatment were eligible (n = 467). Of the 33 who enrolled, median duration of drug injection was 18 years. Twenty-seven participants denied needle sharing. Of 209 needles distributed, 69% were returned. Low enrollment might have been due to restrictive entry criteria, inconvenient location, incorrect syringe size, and attitudes of treatment staff. For future efforts to have a public health impact, wider accessibility will be needed.
US dietary patterns associated with fat intake: the 1987 National Health Interview Survey.
Authors: Subar A F , Ziegler R G , Patterson B H , Ursin G , Graubard B
Published: November 2008

OBJECTIVES. This research used food frequency data to investigate dietary patterns associated with fat intake. METHODS. Data from the 1987 National Health Interview Survey of 20,143 adults were used to determine correlations between fat (adjusted for kilocalories) and both nutrient and food group intakes. Median food and nutrient intakes were determined within quartiles of percentage of kilocalories from fat. RESULTS. Intakes of vegetables, fruits, cereals, fish/chicken, low-fat milk, alcoholic beverages, vitamin C, percentage of kilocalories from carbohydrates, carotenoids, folate, dietary fiber, carbohydrates, and vitamin A decreased as percentage of kilocalories from fat increased. Intakes of salty snacks, peanuts, processed and red meats, whole milk and cheese, desserts, eggs, fried potatoes, table fats, cholesterol, vitamin E, sodium, protein, and energy increased with percentage of kilocalories from fat. Results by demographic subgroups showed few differences from those found in the total population. CONCLUSIONS. Fat intake is consistently associated with specific dietary patterns. Such patterns need to be evaluated concurrently in studies of diet and chronic disease.
The trading of sex for drugs or money and HIV seropositivity among female intravenous drug users.
Authors: Astemborski J , Vlahov D , Warren D , Solomon L , Nelson K E
Published: November 2008

OBJECTIVES. Data from 538 women in a cohort study recruited in 1988-1989 were analyzed to determined whether trading sex for drugs or money was independently associated with human immunodeficiency virus (HIV) seroprevalence in a population of female intravenous drug users. METHODS. The women were grouped according to the number of partners with whom they reported trading sex for drugs or money during the previous 10 years: none, 1 through 49 (low), or 50 or more (high); the prevalence of HIV seropositivity in the three groups was 23.2%, 23.7%, and 47.6%, respectively. Logistic regression was used to compare the low- and high-trade groups separately with the group that reported no trading. RESULTS. Low trading was not associated with seroprevalent HIV infection. In a multivariate model, high trading (compared with no trading) was significantly associated with HIV seropositivity after adjustment for cocaine use, history of sexually transmitted diseases, and duration of intravenous drug use. CONCLUSIONS. These data indicate that, among intravenous drug-using women, high levels of trading sex for drugs or money were independently associated with HIV infection. This group needs to be targeted for further intensive intervention.
Changes in HIV-related information sources, instruction, knowledge, and behaviors among US high school students, 1989 and 1990.
Authors: Holtzman D , Lowry R , Kann L , Collins J L , Kolbe L J
Published: November 2008

OBJECTIVES. Few data have been available among adolescents to determine behavioral changes that may prevent human immunodeficiency virus (HIV) infection. This analysis examines changes in the prevalence of self-reported HIV-related information sources, instruction, knowledge, and behaviors among high school students in the United States. METHODS. Two independent, multistage national probability samples of students in grades 9 through 12 were surveyed in 1989 (n = 8098) and 1990 (n = 11,631) with self-administered, anonymous questionnaires that included similar items. RESULTS. Compared with students surveyed in 1989, a significantly greater proportion of students surveyed in 1990 had received HIV instruction in school. Significant decreases were found in the proportion of White and female students who reported having had sexual intercourse, in the proportion of White students reporting two or more lifetime sex partners, and in the proportion of 15- and 16-year-olds, White students, and female students who reported having had four or more lifetime sex partners. For both years, students who had a greater level of HIV knowledge were less likely to have had multiple lifetime sex partners or to have injected illicit drugs. CONCLUSIONS. The findings suggest that school-based HIV education and knowledge may be contributing factors in reducing certain risk behaviors that can lead to HIV transmission among secondary school youth.
Maternal attitude toward pregnancy and the risk of neonatal death.
Authors: Bustan M N , Coker A L
Published: November 2008

OBJECTIVES. Reduced options for fertility control over the past decade have increased the rates of unwanted pregnancy. We evaluated whether a woman's negative attitude toward her pregnancy increased the risk of perinatal mortality, in a large, prospective cohort study. METHODS. The association between attitude toward the pregnancy and perinatal mortality was evaluated in a longitudinal cohort study of 8823 married, pregnant patients enrolled from 1959 to 1966 in the Child Health and Development Studies. RESULTS. Women who reported during the first trimester of prenatal care that the pregnancy was unwanted were more than two times more likely to deliver infants who died within the first 28 days of life than were women reporting accepted pregnancies. A positive attitude toward pregnancy was not associated with fetal death or post-neonatal death. CONCLUSIONS. These data, collected when induced abortions were illegal, may have important implications for the 1990s. If maternal attitude toward the pregnancy is associated with neonatal mortality and abortion laws change such that access is restricted, infant mortality may increase because a greater proportion of births will be unwanted.
The weights and heights of Mexican-American adolescents: the accuracy of self-reports.
Authors: Davis H , Gergen P J
Published: November 2008

The accuracy of Mexican-American adolescents' self-reported weights, heights, and body mass indexes was evaluated with data from the Hispanic Health and Nutrition Examination Survey. On average, adolescents with low measured body mass indexes and high measured body mass indexes overestimated and underestimated their weights, respectively. Categories of low and high body mass indexes created by applying cutoffs to reported body mass indexes had low sensitivities. For weight, height, and body mass indexes, measured and reported values were highly correlated. This high correlation suggests that adolescents' reported values can be used as continuous variables in multivariate analyses with only small errors resulting in the coefficients for weight, height, and body mass index.
The proportion of veterans among homeless men.
Authors: Rosenheck R , Frisman L , Chung A M
Published: November 2008

This study used data from four surveys conducted in 1986/87 to identify age-race cohorts of homeless men in which veterans are overrepresented. The overall proportion of veterans among homeless men (41%) was somewhat higher than that in the general population (34%). This overrepresentation is largely attributable to the disproportionate representation of veterans in the youngest age cohort (20 to 34 years) of homeless White men. Veterans in this group are 4.76 times more likely to be homeless than nonveterans. Other national data on this cohort reveal higher rates of unemployment, substance abuse, and antisocial personality among veterans than among nonveterans.
The report of the Surgeon General: preventing tobacco use among young people.
Authors: Elders M J , Perry C L , Eriksen M P , Giovino G A
Published: November 2008

This year's surgeon general's report on smoking and health is the first such report to focus on young people. From extensive data that indicate that tobacco use is a pediatric epidemic, the report reached six major conclusions: (1) Nearly all first use of tobacco occurs by age 18. (2) Most adolescent smokers are addicted to nicotine. (3) Tobacco is often the first drug used by young people who subsequently use illegal drugs. (4) There are identified psychosocial risk factors for the onset of tobacco use. (5) Cigarette advertising also appears to increase young people's risk of smoking. (6) Communitywide efforts have successfully reduced adolescent use of tobacco. This commentary restates each of the six conclusions, summarizes the data that support each, and then considers the implications of the conclusions for public health action.
Commentary: Lessons from Medicaid--improving access to office-based physician care for the low-income population.
Authors: Rowland D , Salganicoff A
Published: November 2008

Medicaid offers important lessons about providing access to office-based physician services for the poor. First, differentials in physician fees between Medicaid and other payers compromise access to care and are difficult to reverse. Second, managed care alone is not enough to attain equity in access, especially if differentials in payment rates between Medicaid and private patients in managed care settings are allowed to grow. Finally, financing strategies alone are not sufficient to resolve the shortage of health care providers in medically underserved areas. In these areas, payment policy must be combined with resource development to ensure that vulnerable populations have access to care.
The characteristics of northern black churches with community health outreach programs.
Authors: Thomas S B , Quinn S C , Billingsley A , Caldwell C
Published: November 2008

OBJECTIVES. The Black church has a long history of addressing unmet health and human service needs, yet few studies have examined characteristics of churches involved in health promotion. METHODS. Data obtained from a survey of 635 Black churches in the northern United States were examined. Univariate and multivariate statistical procedures identified eight characteristics associated with community health outreach programs: congregation size, denomination, church age, economic class of membership, ownership of church, number of paid clergy, presence of other paid staff, and education level of the minister. RESULTS. A logistic regression model identified church size and educational level of the minister as the strongest predictors of church-sponsored community health outreach. The model correctly classified 88% of churches that conduct outreach programs. Overall, the model correctly classified 76% of churches in the sample. CONCLUSIONS. Results may be used by public health professionals and policy makers to enlist Black churches as an integral component for delivery of health promotion and disease prevention services needed to achieve the Year 2000 health objectives for all Americans.
The impact of the Safe Kids/Healthy Neighborhoods Injury Prevention Program in Harlem, 1988 through 1991.
Authors: Davidson L L , Durkin M S , Kuhn L , O'Connor P , Barlow B , Heagarty M C
Published: November 2008

OBJECTIVES. This study evaluated the effectiveness of a community coalition to prevent severe injuries to children in Central Harlem, New York, NY. It was hypothesized that injury incidence rates would decline during the intervention (1989 through 1991) relative to preintervention years (1983 through 1988); that the decline would be greatest for the targeted age group (5 through 16 years) and targeted injury causes (traffic accidents, assaults, firearms, outdoor falls); and that the decline would occur in the intervention community rather than a control community. METHODS. Surveillance of injuries that result in hospitalization and/or death among children in the two communities has been under way since 1983. Data from this surveillance were used to test whether the incidence of severe injury declined during the intervention; other temporal variations were controlled by Poisson regression. RESULTS. The incidence of injury among school-aged children in central Harlem declined during the intervention. The decline was specific to the targeted age group and targeted causes. A nonspecific decline also occurred in the control community. CONCLUSIONS. The declining incidence rate in Central Harlem is consistent with a favorable program effect, but additional investigation of possible secular trend or spillover effects is needed.
Suicidal ideation and attempts among chemically dependent adolescents.
Authors: Deykin E Y , Buka S L
Published: November 2008

OBJECTIVES. Suicidal ideation and attempts were examined in a population of chemically dependent adolescents, a group at high risk of self-destructive behavior. METHODS. The prevalence and correlates of suicidality and of major depressive disorder were assessed by the Diagnostic Interview Schedule and a structured family and social history interview with 300 addicts aged 15 through 19 years. RESULTS. Suicidal ideation was reported by 31% to 75% of the subjects and suicide attempts were reported by 28% to 61%, with females predominating. Thoughts of suicide combined with prolonged thoughts of death in general and a desire to be dead were highly associated with suicide attempts. Exposure to physical or sexual abuse was associated with a significantly increased risk of suicide attempts for males but not for females. CONCLUSIONS. The probability of a suicide attempt increases when thoughts of suicide coincide with morbid ideation of extended duration, suggesting that risk assessment should be based on duration as well as presence of morbid thoughts. Substance abuse treatment requires an assessment of suicidal potential and counseling for those whose potential is high, with special attention to males exposed to abuse.
Risk factors for violent behavior in elementary school boys: have you hugged your child today?
Authors: Sheline J L , Skipper B J , Broadhead W E
Published: November 2008

Seventeen Hispanic elementary schoolboys with violent behavior problems were compared with 27 matched control students who were not overtly violent at school. Violent boys were significantly more likely to not live with their fathers, to have unmarried parents, to have more siblings, and to have fathers who never show them affection. Parents of violent boys were more likely than those of matched control students to use spanking for discipline and to admit that they rarely express affection for their sons.
Reflections on a half century of injury control.
Authors: Waller J A
Published: November 2008

Using both historical analysis and personal reminiscence, this article describes the development of injury control activities since about 1940, focusing particular attention on the rise and fall of the Public Health Service's Division of Accident Prevention. By the 1940s and 1950s, modest but useful efforts in injury control research and programming had been made. The 1960s and early 1970s then saw an explosion of new concepts, programs, and enthusiasm, but much of this soon dissipated. Since 1985 there has been a renaissance of interest and effort, and the development of a new cadre of injury control professionals. This progress is threatened, however, by both old and new problems.
Chronic neurological sequelae to organophosphate pesticide poisoning.
Authors: Steenland K , Jenkins B , Ames R G , O'Malley M , Chrislip D , Russo J
Published: November 2008

OBJECTIVES. This work was undertaken to determine whether there are any chronic neurological sequelae to acute organophosphate pesticide poisoning. METHODS. California surveillance data were used in a study of neurological function among 128 men poisoned by organophosphate pesticides in California from 1982 to 1990 and 90 referents. Tests included a neurological physical examination, 5 nerve conduction tests, 2 vibrotactile sensitivity tests, 10 neurobehavioral tests, and 1 postural sway test. RESULTS. After correcting for confounding, the poisoned group performed significantly worse than the referent group on two neurobehavioral tests (sustained visual attention and mood scales). When the data were restricted to men with documented cholinesterase inhibition (n = 83) or to men who had been hospitalized (n = 36), the poisoned subjects also showed significantly worse vibrotactile sensitivity of finger and toe. Significant trends of increased impairment were found with increased days of disability on a wide spectrum of tests of both central and peripheral nerve function. CONCLUSIONS. While these findings are limited by low response rates and by small sample sizes for specific pesticides, this study was based on a large surveillance database and is the largest study to date of the chronic effects of organophosphate pesticide poisoning. The evidence of some long-term effects of poisoning is consistent with two prior studies.
Health status differentials in the People's Republic of China.
Authors: Lawson J S , Lin V
Published: November 2008

OBJECTIVES. This study sought to demonstrate that health status varies markedly in different parts of China. METHODS. The main source of data was statistics compiled by the Chinese Ministry for Public Health for 1978 to 1990 regarding causes of death. However, because mortality statistics in China are based on localities that have the capacity to provide data, they are not entirely representative. The international classification of disease categories was also used, together with anatomically based disease descriptions. Rates were calculated using the 1982 and 1990 population censuses. RESULTS. Death rates differ markedly between urban and rural areas. Deaths due to infectious diseases, respiratory diseases, pregnancy and childbirth, and injuries and poisoning are much higher in rural areas; those due to pertussis, dysentery, typhoid, hepatitis, rabies, and anthrax are much more common in the apparently poorer provinces. Schistosomiasis remains a major problem in some provinces. Goiter and cretinism are still major diseases in many parts of China, especially those areas with iodine deficiency. CONCLUSIONS. Cause-of-death patterns in Chinese cities are similar to those of industrially developed countries such as Australia, Japan, and the United States. Such patterns in the poorer rural areas are much more typical of those of developing countries.
Improving dietary behavior: the effectiveness of tailored messages in primary care settings.
Authors: Campbell M K , DeVellis B M , Strecher V J , Ammerman A S , DeVellis R F , Sandler R S
Published: November 2008

OBJECTIVES. To achieve the Healthy People 2000 objectives, public health professionals must develop effective dietary interventions that address psychosocial and behavioral components of change. This study tested the effect of individually computer-tailored messages designed to decrease fat intake and increase fruit and vegetable intake. METHODS. Adult patients from four North Carolina family practices were surveyed at baseline and then randomly assigned to one of two interventions or to a control group. The first intervention consisted of individually computer-tailored nutrition messages; the second consisted of nontailored nutrition information based on the 1990 Dietary Guidelines for Americans. Patients were resurveyed 4 months postintervention. RESULTS. The tailored intervention produced significant decreases in total fat and saturated fat scores compared with those of the control group (P < .05). Total fat was decreased in the tailored group by 23%, in the nontailored group by 9%, and in the control group by 3%. Fruit and vegetable consumption did not increase in any study group. Seventy-three percent of the tailored intervention group recalled receiving a message, compared with 33% of the nontailored intervention group. CONCLUSIONS. Tailored nutrition messages are effective in promoting dietary fat reduction for disease prevention.
High temporal, geographic, and income variation in body mass index among adults in Brazil.
Authors: Sichieri R , Coitinho D C , Leão M M , Recine E , Everhart J E
Published: November 2008

OBJECTIVES. Population-based data on body mass index for developing countries are scarce. Body mass index data from two Brazilian surveys were examined to determine regional and temporal variations in the prevalences of underweight, overweight, and obesity. METHODS. Nationwide surveys in 1974/75 and 1989 collected anthropometric data in Brazil from 55,000 and 14,455 households, respectively. Trained interviewers used the same methods to measure weight and stature in both surveys, and survey designs were identical. Prevalences of underweight, overweight, and obesity were determined for persons 18 years of age and older. RESULTS. In the 1989 survey, body mass index varied greatly according to region of the country, urbanization, and income. In the wealthier South, the prevalence of overweight/obesity was the highest and the prevalence of underweight was the lowest; in the poorer rural Northeast, these patterns were reversed. For both surveys, overweight/obesity was more common among women than among men and peaked at age 45 to 64 years in both sexes. Over the 15 years between surveys, the prevalence of both overweight and obesity increased strikingly. CONCLUSIONS. In contrast to findings in developed countries, obesity in Brazil was positively associated with income and was much more prevalent among women than among men. For Brazilian women, the overall prevalence of overweight was nearly as high as that among women in the United States.
Dietary sources of fats and cholesterol in US children aged 2 through 5 years.
Authors: Thompson F E , Dennison B A
Published: November 2008

OBJECTIVES. This study of lipid intakes among preschool children (1) analyzed the contributions of 38 food groups to fat, saturated fat, and cholesterol intakes; (2) estimated the effects of food substitutions on intakes; and (3) examined demographic differences in food group intake and food group sources of these lipids. METHODS. The sample consisted of 547 children, aged 2 to 5 years, from the US Department of Agriculture's 1985 and 1986 Continuing Surveys of Food Intakes by Individuals. Dietary information for 4 nonconsecutive days throughout a year was used. All foods were classified into groups and the lipids contributed from each group were computed. RESULTS. Over 80% of the children consumed more total fat, saturated fats, and cholesterol than is recommended. The major source of total fat and saturated fats was whole milk; the major sources of dietary cholesterol were eggs and whole milk. Children's food consumption patterns differed by region of the country and race/ethnicity, providing opportunities to refine nutrition education interventions and evaluations. CONCLUSIONS. By substituting lower-fat foods for the major sources of saturated fats, significant reductions in preschool children's intakes of saturated fats, fat, and dietary cholesterol could be achieved.
The fallacy of the ecological fallacy: the potential misuse of a concept and the consequences.
Authors: Schwartz S
Published: November 2008

Ecological studies have been evaluated in epidemiological contexts in terms of the "ecological fallacy." Although the empirical evidence for a lack of comparability between correlations derived from ecological- and individual-level analyses is compelling, the conceptual meaning of the ecological fallacy remains problematic. This paper argues that issues in cross-level inference can be usefully conceptualized as validity problems, problems not peculiar to ecological-level analyses. Such an approach increases the recognition of both potential inference problems in individual-level studies and the unique contributions of ecological variables. This, in turn, expands the terrain for the location of causes for disease and interventions to improve the public's health.
The logic in ecological: II. The logic of design.
Authors: Susser M
Published: November 2008

The utility of ecological studies is considered in terms of the salience of their designs and is exemplified in four levels: obligate and apt; optional and apt; optional, not apt but convenient; and maladroit (neither obligate, apt, nor justifiable by convenience). Ecological studies are obligate when they are the only choice available, either because of the question asked (as in testing differences between groups and discovering group effects), or where there are "dependent happenings" (as in transactions involving more than one individual), or because individual data are lacking. Apt studies are logically appropriate; analysis and results are not extrapolated beyond necessity or without precautions. Obligate studies enforced by lack of individual data may be apt or less than apt. Optional ecological studies may be apt or, if less than apt, they may yet be convenient. Maladroit studies are neither obligate, apt, nor convenient. Each class of study is illustrated by examples ordered according to a standard design hierarchy.
Family networks: predictors of nursing home entry.
Authors: Freedman V A , Berkman L F , Rapp S R , Ostfeld A M
Published: November 2008

Despite the importance of kin in caring for older relatives, few studies have examined the relationship between the family network and the risk of nursing home placement. Data from a cohort of noninstitutionalized elderly persons living in New Haven in 1982 were used to predict nursing home admission through 1985. Logistic regression analyses show that older persons who have regular contact with kin have a lower risk of institutionalization. For men, the spouse is most important in reducing the risk of entry; for women, having regular contact with at least one family member--of any relation--reduces the risk of entry.
The teaching of occupational health in US medical schools: little improvement in 9 years.
Authors: Burstein J M , Levy B S
Published: November 2008

A questionnaire survey of the 127 US medical schools was undertaken to assess the present status of occupational health teaching as a follow-up to two prior similar studies. The present study revealed that 78 (68%) of the 115 responding schools specifically taught occupational health during the 1991/92 academic year, in comparison with 50% in the 1977/78 and 66% in the 1982/83 academic years. The median required curriculum time was 6 hours in 1991/92, as compared with 4 hours in both previous surveys. Despite the increasing recognition of occupational health and growth of information in this field of medicine, occupational health teaching to medical students has not progressed proportionately.
International infant mortality rates: bias from reporting differences.
Authors: Howell E M , Blondel B
Published: November 2008

International infant mortality statistics have caused concern in the United States, since the US ranking relative to other developed countries has declined since World War II. This paper suggests that there may be international differences in reporting of very-low-birthweight infants and perinatal deaths and that such reporting differences bias comparisons of national perinatal and infant mortality rates. Efforts must be made to adopt standard conventions for the inclusion of small, early infants and fetal deaths in rate calculations.
Racial differences in cervical cancer mortality in Chicago.
Authors: Samelson E J , Speers M A , Ferguson R , Bennett C
Published: November 2008

Racial differences in cervical cancer mortality in Chicago were examined. Age-adjusted mortality in Blacks (10.0/100,000) was over twice the rate found in Whites (4.6/100,000). Age-specific rates also showed significant excess mortality among Blacks. After stratification by a group-level defined poverty indicator, the race differential in age-adjusted rates remained significant. The race differential in age-specific rates diminished in the group with more than 30% living below the national poverty level, in contrast to the group with 30% or fewer living below the national poverty level, in whom race differences were more marked. Methodological issues concerning hysterectomy prevalence, Hispanic ethnicity, and social class must be considered with respect to interpretation of these findings.
Sex bias in the management of coronary artery disease in Quebec.
Authors: D'Hoore W , Sicotte C , Tilquin C
Published: November 2008

This study tests the hypothesis that, given the absence of financial barriers to major coronary procedures in Quebec, women are as likely as men to undergo such procedures. The use of coronary procedures in 33,940 patients with ischemic heart disease, admitted during 1 year to 78 Quebec hospitals, was analyzed. The male-to-female age- and severity-adjusted odds ratios for the use of these procedures were 1.47 for diagnostic procedures, 1.38 for therapeutic procedures, and 1.26 for diagnostic and therapeutic procedures. These results suggest that differences in the use of coronary procedures by sex are influenced by factors other than financial accessibility.
Health insurance coverage among persons with AIDS: results from a multistate surveillance project.
Authors: Diaz T , Chu S Y , Conti L , Nahlen B L , Whyte B , Mokotoff E , Shields A , Checko P J , Herr M , Mukhtar Q
Published: November 2008

To determine factors associated with health insurance coverage among persons with acquired immunodeficiency syndrome (AIDS), we interviewed 1958 persons 18 years of age or older who were reported to have AIDS in 11 states and cities. Overall, 25% had no insurance, 55% had public insurance, and 20% had private insurance. Factors associated with lack of insurance varied by current employment status. Employed persons with an annual household income of less than $10,000 were 3.6 times more likely to lack insurance than employed persons with a higher income. Unemployed persons diagnosed with AIDS for less than 1 year were two times more likely to lack health insurance than unemployed persons diagnosed for a longer time. Making insurance available to persons identified as most likely to lack insurance should improve access to care for persons with AIDS.
The reliability of racial classifications in hospital discharge abstract data.
Authors: Blustein J
Published: November 2008

Many studies demonstrating an association between race and the use of medical services have used hospital discharge abstract data. The quality of the measures of race in such data sources has heretofore been unexplored. Hospital discharge abstract data from New York State were used to identify 767 cardiac patients who had been admitted to a hospital twice. Racial classifications during the two admissions were concordant 93.7% of the time. Kappa was .89 for Blacks, .72 for Whites, and .43 for all other racial groups. Evidence suggests that the misclassification of race in hospital discharge abstract data is nondifferential; racial discrepancies in access to medical services are thus probably even greater than those previously reported.
Rationing or rationalizing children's medical care: comparison of a Medicaid HMO with fee-for-service care.
Authors: Mauldon J , Leibowitz A , Buchanan J L , Damberg C , McGuigan K A
Published: November 2008

OBJECTIVES. This paper examines how medical care obtained by children enrolled in a Medicaid health maintenance organization (HMO) differs from that obtained by similar children who receive care from fee-for-service Medicaid providers. METHODS. In a randomized trial, some Medicaid households were assigned to remain in a traditional fee-for-service arrangement and others were randomly selected to join a Medicaid prepaid plan (an HMO). Participating households recorded data on children's health status and use of medical care. RESULTS. The prepaid plan members and the fee-for-service recipients received equivalent numbers of checkup visits, but the children in the prepaid plan made significantly fewer acute care visits. This plan appeared to target its services to children with the greatest health care needs. However, the content of health visits in the two systems did not differ, nor did prepaid and fee-for-service enrollees use the emergency room differently. CONCLUSIONS. It is possible to design a Medicaid HMO that achieves financial savings without reducing services to the most vulnerable patients. However, these findings alone do not provide a basis for widespread policy change in the direction of Medicaid HMOs. Further research is needed to establish whether the children treated in the HMO differed in health outcomes from those treated by fee-for-service care.
Are bisexually identified men in San Francisco a common vector for spreading HIV infection to women?
Authors: Ekstrand M L , Coates T J , Guydish J R , Hauck W W , Collette L , Hulley S B
Published: November 2008

OBJECTIVES. This article examines sexual risk taking among self-identified bisexual men in San Francisco and whether risk reduction has occurred, with respect to both homosexual and heterosexual behaviors, among human immunodeficiency virus (HIV) antibody-positive and HIV antibody-negative men. It also examines psychosocial correlates of unprotected anal and vaginal intercourse. METHODS. The participants were members of a population-based longitudinal cohort of 1034 single men aged 25 through 54 years recruited from the 19 census tracts in San Francisco that had the greatest prevalence of the acquired immunodeficiency syndrome in 1984. Of the total sample, 140 subjects initially identified themselves as bisexual; 85% of these men remained in the study. RESULTS. The participants reported dramatic reductions in sexual risk taking. Prevalences of unprotected anal sex with men were similar among HIV-positive bisexual men (89% in 1984-1985 and 18% in 1988-1989) and those who were HIV negative (65% and 20%). The prevalence of unprotected vaginal sex was much lower for HIV-positive men (16% in 1984-1985 and 2% in 1988-1989) than for HIV-negative men (35% and 20%). Unprotected intercourse was associated primarily with situational and interpersonal factors. CONCLUSIONS. Striking reductions in risk behaviors were reported. This subgroup of single, bisexually identified men appears unlikely to be a common vector for spreading HIV infection to women.
The effects of occupational class transitions on hypertension: racial disparities among working-age men.
Authors: Waitzman N J , Smith K R
Published: November 2008

OBJECTIVES. This study was undertaken to examine how the interaction between occupational class transitions and race affects the incidence of hypertension. METHODS. A cohort of 1982 men (183 Black), ages 25 to 55, received a baseline medical exam between 1971 and 1975 and a follow-up between 1982 and 1984. Logistic regressions were estimated for hypertension at follow-up controlling for hypertension at baseline, other risk factors associated with blood pressure, and interaction terms identifying specific occupational class transitions among Blacks and Whites. The occupational class matrix was based largely on scores of US Census Bureau occupations from the Dictionary of Occupational Titles. RESULTS. Relative to Whites who remained in professional and technical jobs between baseline and follow-up, Blacks and Whites who remained in lower occupational classes or made specific transitions--notably into the lowest class--had significantly higher incidence rates of hypertension. These differences were greater among Blacks, who are also more concentrated in and less likely to move upward from the lower end of the occupational class matrix. CONCLUSIONS. Widening racial disparities in high blood pressure over the period of study may be partly attributable to characteristics associated with occupational class position and dynamics.
Diagnoses, symptoms, and attribution of symptoms among black and white inpatients admitted for coronary heart disease.
Authors: Raczynski J M , Taylor H , Cutter G , Hardin M , Rappaport N , Oberman A
Published: November 2008

OBJECTIVES. This study examined health care-seeking behaviors to elucidate factors that contribute to differences in patterns of coronary heart disease between African Americans and Whites. The prevalence of diagnosed coronary heart disease, patients' perceptions of symptoms and attribution of symptoms, and predictors of painful symptoms and attribution of cardiac symptoms were examined. METHODS. The study involved 2416 patients admitted with diagnoses of coronary artery disease, ischemic heart disease, or myocardial infarction or to rule out myocardial infarction. Structured interview questions were used to obtain demographic information, symptoms precipitating admission, and patients' attribution of their symptoms. Discharge diagnoses were obtained from hospital records. RESULTS. Acute myocardial infarction, unstable angina, nonacute ischemic heart disease, and atherosclerosis were more frequent in White patients. For Blacks, the odds of reporting painful symptoms were only 64% of the odds found for Whites when other factors were controlled, and the odds of attributing symptoms to cardiac origins were almost 50% lower for Blacks than for Whites. CONCLUSIONS. The tendency of Blacks to report fewer painful symptoms and to attribute their symptoms to noncardiac origins may contribute to differences in care-seeking and in medical management of heart disease in Blacks.
Social influences on the sexual behavior of youth at risk for HIV exposure.
Authors: Romer D , Black M , Ricardo I , Feigelman S , Kaljee L , Galbraith J , Nesbit R , Hornik R C , Stanton B
Published: November 2008

OBJECTIVES. Adolescents are increasingly at risk for infection with human immunodeficiency virus (HIV) and other sexually transmitted diseases, especially in poor urban minority communities. To aid the design of interventions in these communities, this study investigated the role of knowledge, attitudes, perceived parental monitoring, and peer behavior in the onset and progression of sexual behavior in children at risk for exposure to HIV. METHODS. A computerized personal interview was administered to 300 African-American 9- to 15-year-old children living in six public housing developments in a large US city. RESULTS. Although children's knowledge about the hazards of sex increased with age, their sexual activity also increased (from 12% sexually experienced at 9 years of age to more than 80% experienced at 15 years of age). Parental monitoring appeared able to influence sexual activity. However, the perceived behavior of friends was associated with the rate at which sexual activity progressed with age and the degree to which condom use was maintained with age. CONCLUSIONS. The early onset and prevalence of sexual behavior and the importance of peer group influence call for early interventions that simultaneously influence the parents and peers in children's social networks.
The utility of HMO data for the surveillance of chronic diseases.
Authors: Nordstrom D L , Remington P L , Layde P M
Published: November 2008

In an area served by a single medical center that operates as both health maintenance organization (HMO) and fee-for-service clinic, we reviewed existing computerized medical records to determine the prevalence of 11 diseases. Standardized medical care utilization prevalence ratios, comparing the annual prevalences in the two groups, varied from 1.38 for rheumatoid arthritis to 0.60 for liver cirrhosis. Unless supplemented by data from hospitals, physicians, and other sources, HMO data may result in invalid estimates of the prevalence of chronic disease.
The academic health center and the healthy community.
Authors: Naughton J , Vana J E
Published: November 2008

US medical care reflects the priorities and influence of academic health centers. This paper describes the leadership role assumed by one academic health center, the State University at Buffalo's School of Medicine and Biomedical Sciences and its eight affiliated hospitals, to serve its region by promoting shared governance in educating graduate physicians and in influencing the cost and quality of patient care. Cooperation among hospitals, health insurance payers, the business community, state government, and physicians helped establish priorities to meet community needs and reduce duplication of resources and services; to train more primary care physicians; to introduce shared governance into rural health care delivery; to develop a regional management information system; and to implement health policy. This approach, spearheaded by an academic health center without walls, may serve as a model for other academic health centers as they adapt to health care reform.
The effect of ordinances requiring smoke-free restaurants on restaurant sales.
Authors: Glantz S A , Smith L R
Published: November 2008

OBJECTIVES: The effect on restaurant revenues of local ordinances requiring smoke-free restaurants is an important consideration for restauranteurs themselves and the cities that depend on sales tax revenues to provide services. METHODS: Data were obtained from the California State Board of Equalization and Colorado State Department of Revenue on taxable restaurant sales from 1986 (1982 for Aspen) through 1993 for all 15 cities where ordinances were in force, as well as for 15 similar control communities without smoke-free ordinances during this period. These data were analyzed using multiple regression, including time and a dummy variable for whether an ordinance was in force. Total restaurant sales were analyzed as a fraction of total retail sales and restaurant sales in smoke-free cities vs the comparison cities similar in population, median income, and other factors. RESULTS. Ordinances had no significant effect on the fraction of total retail sales that went to restaurants or on the ratio of restaurant sales in communities with ordinances compared with those in the matched control communities. CONCLUSIONS. Smoke-free restaurant ordinances do not adversely affect restaurant sales.