bluuebunny/crossref_metadata_2025 huggingface dataset:
The contribution of diabetes to early deaths from ischemic heart disease: US gender and racial comparisons.
Authors: Will J C , Casper M
Published: November 2008

We evaluated the contribution of diabetes mellitus to premature ischemic heart disease mortality among US race- and gender-specific groups in 1986. Among persons aged 45 to 64 years, we examined ischemic heart disease death rates (corrected for underreporting of diabetes on death certificates) by diabetes status and calculated the population attributable risk due to diabetes for each group. Diabetes increased the ischemic heart disease death rate by 9 to 10 times for women but by only 2 to 3 times for men. Racial differences in ischemic heart disease mortality attributable to diabetes were greater for women (Blacks = 39%; Whites = 27%) than for men (Blacks = 19%; Whites = 14%). These discrepancies in the contribution of diabetes to ischemic heart disease mortality warrant further study.
Sexual assault history and eating disorder symptoms among White, Hispanic, and African-American women and men.
Authors: Laws A , Golding J M
Published: November 2008

Data from two Epidemiologic Catchment Area Program sites (Los Angeles and North carolina) were analyzed to examine relations of sexual assault history to eating disorder symptoms. In regression analyses controlling for age, gender, ethnicity, income, socioeconomic status, and study site, persons with sexualy assault history (n = 514) were more likely than those not assaulted (n = 5511) to report thinking they were too fat (odds ratio [OR] = 1.6); losing > or = 15 lb (OR = 1.86); weight loss to 85% of normal (OR = 2.08); one or more anorexia symptoms (OR = 1.81); and sudden weight change (OR = 2.32). Ethnicity and income modified the relations. The data support an association of sexual assault history with eating disorder symptoms.
Surveillance in environmental public health: issues, systems, and sources.
Authors: Thacker S B , Stroup D F , Parrish R G , Anderson H A
Published: November 2008

This article describes environmental public health surveillance and proposes a framework to enhance its practice in the United States. Special issues for surveillance in environmental public health are examined, and examples of existing systems useful for environmental public health practice are provided. Current and projected surveillance needs, as well as potential sources of data, are examined. The proposed framework for conducting environmental public health surveillance involves data from three points in the process by which an agent in the environment produces an adverse outcome in a host: hazards, exposures, and outcomes. Environmental health practitioners should build on efforts in other fields (e.g., infectious diseases and occupational health) to establish priorities in the surveillance of health conditions associated with exposure to environmental toxicants. For specific surveillance programs, existing data systems, as well as data gaps, should be identified. Coordinated surveillance systems can facilitate public health efforts to prevent and control disease, injury, and disability related to the interaction between people and their environment.
Comment: Toward a coordinated system for the surveillance of environmental health hazards.
Authors: Hertz-Picciotto I
Published: November 2008

The rapid increases in the numbers and quantities of chemicals released into the environment have been accompanied by a lack of adequate prerelease testing for adverse health outcomes. Environmental health surveillance is used both to track changes in exposures that are known to have adverse health effects and to identify previously unrecognized hazards. Surveillance data can directly aid in the design of interventions to reduce the level of hazardous agents in the environment or the opportunities for human contact with them. Components of an ideal environmental health surveillance system are discussed. For well-recognized hazards, databases related to exposure alone are adequate. However, for uncovering previously unrecognized associations, linkage between exposure and outcome databases that are collected or aggregated at the same geographic scale and for regions of relatively homogeneous exposures are needed.
The risk of suicide among wounded Vietnam veterans.
Authors: Bullman T A , Kang H K
Published: November 2008

OBJECTIVES: This study was undertaken to determine whether an association exists between combat trauma and risk of postservice suicide among Vietnam veterans. METHODS: Risk of suicide for 34,534 veterans who were wounded in Vietnam was evaluated for severity of wound and number of times wounded. RESULTS: There was a trend of increasing risk of suicide with increased occurrence of combat trauma, the highest relative risk (1.82, 95% confidence interval [CI] = 1.12, 2.96) being observed for those veterans who were wounded more than once and hospitalized for a wound. In comparison with the US male general population, veterans hospitalized because of a combat wound or wounded more than once had a significantly increased risk of suicide (standardized mortality ratios [SMRs] of 1.22 [95% CI = 1.00, 1.46] and 1.58 [95% CI = 1.06, 2.26], respectively). Those wounded more than once and hospitalized had the highest increased risk of suicide (SMR = 1.73, 95% CI = 1.10, 2.60). CONCLUSIONS: This study suggests that, among wounded Vietnam veterans, there is an increased risk for suicide associated with increased occurrence of combat trauma.
Choosing a future for epidemiology: I. Eras and paradigms.
Authors: Susser M , Susser E
Published: November 2008

To inform choices about the future of epidemiology, the present condition of epidemiology is examined, in terms of its evolution through three eras, each demarcated by its own paradigm: (1) the era of sanitary statistics with its paradigm, miasma; (2) the era of infectious disease epidemiology with its paradigm, the germ theory; and (3) the era of chronic disease epidemiology with its paradigm, the black box. The historical context in which these eras arose is briefly described. In each era, the public health was at the center of the concerns of the founders and early protagonists of the prevailing paradigm. Around this intellectual development we weave a further theme. We argue that in the present era, the public health has become less central a concern. At the same time, in epidemiology today the dominant black box paradigm is of declining utility and is likely soon to be superseded.
Traditional epidemiology, modern epidemiology, and public health.
Authors: Pearce N
Published: November 2008

There have been significant developments in epidemiologic methodology during the past century, including changes in basic concepts, methods of data analysis, and methods of exposure measurement. However, the rise of modern epidemiology has been a mixed blessing, and the new paradigm has major shortcomings, both in public health and in scientific terms. The changes in the paradigm have not been neutral but have rather helped change--and have reflected changes in--the way in which epidemiologists think about health and disease. The key issue has been the shift in the level of analysis from the population to the individual. Epidemiology has largely ceased to function as part of a multidisciplinary approach to understanding the causation of disease in populations and has become a set of generic methods for measuring associations of exposure and disease in individuals. This reductionist approach focuses on the individual, blames the victim, and produces interventions that can be harmful. We seem to be using more and more advanced technology to study more and more trivial issues, while the major causes of disease are ignored. Epidemiology must reintegrate itself into public health and must rediscover the population perspective.
Genetic screening for reproductive planning: methodological and conceptual issues in policy analysis.
Authors: Asch D A , Hershey J C , Pauly M V , Patton J P , Jedrziewski M K , Mennuti M T
Published: November 2008

OBJECTIVES: This paper explores several critical assumptions and methodological issues arising in cost-effectiveness analyses of genetic screening strategies in the reproductive setting. METHODS: Seven issues that arose in the development of a decision analysis of alternative strategies for cystic fibrosis carrier screening are discussed. Each of these issues required a choice in technique. RESULTS: The presentations of these analyses frequently mask underlying assumptions and methodological choices. Often there is no best choice. In the case of genetic screening in the reproductive setting, these underlying issues often touch on deeply felt human values. CONCLUSIONS: Space limitations for published papers often preclude explaining such choices in detail; yet these decisions determine the way the results should be interpreted. Those who develop these analyses need to make sure that the implications of important assumptions are understood by the clinicians who will use them. At the same time, clinicians need to enhance their understanding of what these models truly mean and how they address underlying clinical, ethical, and economic issues.
Clinical and prophylactic trials with assured new treatment for those at greater risk: II. Examples.
Authors: Finkelstein M O , Levin B , Robbins H
Published: November 2008

OBJECTIVES: The preceding article proposed an assured treatment design that would address certain difficulties in recruiting persons who are at greater risk into randomized clinical trials. The purpose of this article is to illustrate the statistical validity of the design in a practical setting. METHODS: Three actual randomized clinical trials were considered as case studies; in each, the data that would have been obtained under assured allocation were identified. Then, with only these data, together with a reasonable choice of model describing the response of subjects under standard treatment as a function of initial severity, the treatment effect was estimated for the subjects at greater risk. The estimates were compared with conventional estimates for the sicker patients randomized in the original trials. RESULTS: In each case, the estimates produced in the assured treatment trial were close to those observed in the randomized trial. CONCLUSIONS: Risk-based allocation trials deserve serious consideration when randomized clinical trials are difficult or impossible to execute. The proposed designs and analyses would allow physicians to offer persons at greater risk assurance that they would receive the new treatment, while researchers would retain the ability to draw valid statistical conclusions about treatment efficacy.
The expanded racial and ethnic codes in the Medicare data files: their completeness of coverage and accuracy.
Authors: Lauderdale D S , Goldberg J
Published: November 2008

OBJECTIVES: This paper evaluates the new race/ethnicity codes for Asian Americans, Hispanics, and Native Americans that have recently been added to the Medicare enrollment database. METHODS: The race/ethnicity code revisions made by the Health Care Financing Administration are described and evaluated by (1) comparing the numbers of persons identified as Asian Americans, Hispanics, and Native Americans with corresponding population census projections and (2) determining whether Medicare enrollees born in Asian and Hispanic countries are assigned Asian and Hispanic codes. RESULTS: Among persons 65 years of age and older, approximately 24% of Hispanics, 17% of Native Americans, and 56% of Asian Americans are identifiable by the new codes. From 18% to 29% of enrollees 65 years old or older born in Mexico, Puerto Rico, and Cuba are coded as Hispanic, and from 14% to 73% of enrollees born in nine Asian countries are classified as Asian American. Classification is not random but is related to timing of migration and to country of origin. CONCLUSIONS: Researchers should resist the temptation to base analyses on the revised Health Care Financing Administration race/ethnicity codes, since coverage is incomplete and biased.
Trends in US urban black infant mortality, by degree of residential segregation.
Authors: Polednak A P
Published: November 2008

Trends in Black infant mortality rates from 1982 through 1991 in large US metropolitan statistical areas were examined. In some least-segregated areas, the total Black infant mortality rate reached a low of 13 per 1000 live births in 1985; it increased sharply after 1985 in the West but not in the South. The explanation for these trends is unknown, but variation in regional trends in Black postneonatal infant mortality rates suggested that social and medical-care differences among Blacks should be examined. A high Black infant mortality rate for a group of most-segregated metropolitan statistical areas persisted and contributed to the rising Black-White ratio of rates.
Tuberculosis surveillance in the United States: case definitions used by state health departments.
Authors: McCombs S B , Onorato I M , McCray E , Castro K G
Published: November 2008

Health departments in all 53 reporting areas in the United States were asked to submit the case definition they used for tuberculosis surveillance. Sixteen areas used the 1990 case definition; two areas sent 1977 guidelines; and 34 areas sent other definitions. Case reports sent to the Centers for Disease Control and Prevention (CDC) in 1992 were analyzed; 4% of cases did not meet the 1990 definition. Tuberculosis case reporting criteria are not uniformly applied in the United States. CDC, in collaboration with state and local health officials, is evaluating the current definition and will implement uniform national criteria for tuberculosis surveillance.
The surveillance of birth defects: the usefulness of the revised US standard birth certificate.
Authors: Watkins M L , Edmonds L , McClearn A , Mullins L , Mulinare J , Khoury M
Published: November 2008

To assess the sensitivity and positive predictive value of birth defects reported on the 1989 revision of the US Standard Birth Certificate, a population of 76,862 Atlanta-area births during 1989 and 1990 was used as the basis for comparing 771 birth certificates that reported birth defects with 2428 live-born infant records in a birth defects registry that uses multiple sources of case ascertainment. Only 14% of birth defects in the registry records were reported on birth certificates. After the analysis was restricted to defects recognizable at birth, the sensitivity and positive predictive value of the birth certificates were 28% and 77%, respectively. Birth certificates underestimate birth defect rates and should be used cautiously for birth defect surveillance and epidemiological studies.
Reporting vaccine-associated paralytic poliomyelitis: concordance between the CDC and the National Vaccine Injury Compensation Program.
Authors: Weibel R E , Benor D E
Published: November 2008

This paper compares cases of paralytic poliomyelitis reported to the systems operated by the National Vaccine Injury Compensation Program and the Centers for Disease Control and Prevention (CDC) for reporting of adverse events associated with vaccination. Of the 118 cases of vaccine-associated paralytic poliomyelitis determined by either system, 18 were reported initially only to the compensation program, 50 only to the CDC, and 50 to both. The annual incidence of vaccine-associated paralytic poliomyelitis determined from data from both systems varied from 6 to 13 cases (mean = 9.1) a year, with an increase of 1.4 cases a year when initial reports only to the compensation program are included. Thus, the compensation program provides important supplemental incidence data.
Reducing alcohol-impaired driving in Massachusetts: the Saving Lives Program.
Authors: Hingson R , McGovern T , Howland J , Heeren T , Winter M , Zakocs R
Published: November 2008

OBJECTIVES: The purpose of this study ws to assess whether a community program begun in March 1988 that organized multiple city departments and private citizens could reduce alcohol-impaired driving, related driving risks, and traffic deaths and injuries. METHODS: Trends in fatal crashes and injuries per 100 crashes were compared in Saving Lives Program cities and the rest of Massachusetts from March 1984 through February 1993. In annual roadside surveys conducted at randomly selected locations, safety belt use among occupants of 54577 vehicles and travel speeds of 118442 vehicles were observed. Four statewide telephone surveys (n = 15188) monitored self-reported driving after drinking. RESULTS: In program cities relative to the rest of Massachusetts during the 5 program years in comparison with the previous 5 years, fatal crashes declined 25%, from 178 to 120, and fatal crashes involving alcohol decreased 42%, from 69 to 36. Visible injuries per 100 crashes declined 5%, from 21.1 to 16.6. The proportions of vehicles observed speeding and teenagers who drove after drinking were cut in half. CONCLUSIONS: Interventions organized by multiple city departments and private citizens can reduce driving after drinking, related driving risks, and traffic deaths and injuries.
Aiding troubled employees: the prevalence, cost, and characteristics of employee assistance programs in the United States.
Authors: Hartwell T D , Steele P , French M T , Potter F J , Rodman N F , Zarkin G A
Published: November 2008

OBJECTIVES: Employee assistance programs (EAPs) are job-based programs designed to identify and assist troubled employees. This study determines the prevalence, cost, and characteristics of these programs in the United States by worksite size, industry, and census region. METHODS: A stratified national probability sample of more than 6400 private, nonagricultural US worksites with 50 or more full-time employees was contacted with a computer-assisted telephone interviewing protocol. More than 3200 worksites responded and were eligible, with a response rate of 90%. RESULTS: Approximately 33% of all private, nonagricultural worksites with 50 or more full-time employees currently offer EAP services to their employees, an 8.9% increase over 1985. These programs are more likely to be found in larger worksites and in the communications/utilities/transportation industries. The most popular model is an external provider, and the median annual cost per eligible employee for internal and external programs was $21.83 and $18.09, respectively. CONCLUSIONS: EAPs are becoming a more prevalent point of access to health care for workers with personal problems such as substance abuse, family problems, or emotional distress.
The cost of prematurity: a case-control study of twins vs singletons.
Authors: Luke B , Bigger H R , Leurgans S , Sietsema D
Published: November 2008

OBJECTIVES: This study evaluated the extent to which morbidity and costs at birth were associated with plurality, gestational age, and birth-weight with a sample of twins from a large urban hospital. METHODS: Each twin infant was matched to two singleton infants (control [ctrl]-singletons) for payor status and race, and to one singleton infant (gestation [ga]-singleton) for payor status, race, and gestational age; after exclusion of infants who were transferred, the study population included 111 twins, 242 ctrl-singletons, and 106 ga-singletons. Data were stratified by five gestational categories and compared across study groups. Outcomes included birthweight, neonatal diagnoses, infant length of stay, infant costs per day, and total infant and total birth costs. RESULTS: Total birth costs ranged from $280,146 at 25 to 27 weeks to $9,803 at 39 to 42 weeks, decreasing with advancing gestation to means of $88,891 (twins), $43,041 (ga-singletons), and $9,326 (ctrl-singletons). Twins did not differ from either group of singletons in prematurity-related diagnoses, length of stay, or costs until after 34 weeks' gestation. CONCLUSIONS: In this sample, prematurity, not plurality, was the predominant cost factor at birth. Compared with singletons, twins experienced increased morbidity and associated costs after 38 weeks' gestation.
Pregnancy outcomes of US-born and foreign-born Japanese Americans.
Authors: Alexander G R , Mor J M , Kogan M D , Leland N L , Kieffer E
Published: November 2008

OBJECTIVES: This study investigated the birth outcomes of Japanese Americans, focusing on the role of the mother's place of birth. METHODS: Single live births to US-resident Japanese American mothers (n = 37,941) were selected from the 1983 through 1987 US linked live birth-infant death files. RESULTS: US-born mothers were more likely than foreign-born mothers to be less than 18 years old and not married, to start prenatal care early, and to more adequately use prenatal care. Infants of foreign-born Japanese Americans had a slightly lower risk of low birthweight.No significant differences were found between nativity groups for very low birthweight or neonatal, postneonatal, and infant mortality. The mortality rates of infants of US-born (6.2) and foreign-born (5.4) Japanese American women were below the US Year 2000 objective but still exceeded Japan's 1990 rate (4.6). However, low-birthweight percentages of the US-born group (5.7%) and the foreign-born group (5.0%) were similar to that of Japan (5.5%). CONCLUSIONS: The infants of foreign-born Japanese-American women exhibited modestly better low-birthweight percentages than those of US-born Japanese Americans. This finding supports theories of the healthy immigrant.
The risk of prematurity and small-for-gestational-age birth in Mexico City: the effects of working conditions and antenatal leave.
Authors: Cerón-Mireles P , Harlow S D , Sánchez-Carrillo C I
Published: November 2008

OBJECTIVES: This study examined the effect of working conditions, occupational stress, and antenatal leave on risk of small-for-gestational age and premature births in Mexico City. METHODS: Over a 3-month period, 2663 (96.2%) of 2767 women who gave birth at three major hospitals and worked at least 3 months during pregnancy were interviewed shortly after delivery. After the exclusion of multiple gestations and birth defects, 261 (10.0%) small-for-gestational-age and 288 (11.0%) preterm births were identified. RESULTS: For small-for-gestational-age births, working more than 50 hours a week (odds ratio [OR] = 1.59), standing more than 7 hours a day (OR = 1.40), and no antenatal leave (OR = 1.55) were associated with an increased risk. Women with no antenatal leave were also much more likely to give birth prematurely (OR = 3.04). CONCLUSIONS: In this study, arduous working conditions and lack of antenatal leave benefits were found to increase the risk of poor birth outcome in Mexican women. Enforcement of existing antenatal leave laws and provision of comparable benefits for the uninsured may reduce the incidence of small-for-gestational-age births and prematurity.
Vaginal douching and reduced fertility.
Authors: Baird D D , Weinberg C R , Voigt L F , Daling J R
Published: November 2008

OBJECTIVES: This study investigated douching and reduced fertility. METHODS: The monthly probability of conception for douchers and nondouchers was compared in a sample of 840 married, parous women in King County, Washington. Data on the number of months required to conceive were analyzed. RESULTS: In comparison with nondouchers, women who douched were 30% less likely to become pregnant each month they attempted pregnancy. This relationship remained after adjustment for covariates, and it could not be explained by women douching for medical reasons. The reduction was not related to the type of douching preparation used. Young women who douched had significantly greater reductions in monthly fertility than older women (50% reduction for women 18 to 24 years old, 29% reduction for women 25 to 29 years old, and 6% reduction for women 30 to 39 years old). CONCLUSIONS: Douching was associated with reduced fertility. Further research is needed to determine whether the relationship is casual and, if so, to what extent it is mediated by pelvic infection. In the meantime, women should be informed that douching may have adverse effects.
Socioeconomic status and weight control practices among 20- to 45-year-old women.
Authors: Jeffery R W , French S A
Published: November 2008

OBJECTIVES. This study examined the relationship between socioeconomic status (SES) and weight control practices in women. METHODS. SES, defined by family income, was examined in an economically diverse sample of 998 women in relation to dieting practices by means of multivariate regression analyses controlling for age, ethnicity, smoking, and body mass index. RESULTS. SES was positively associated with healthy, but not unhealthy, weight control practices; inversely related to energy and fat intake; and positively associated with weight concern and perceived social support for healthy eating and exercise. SES gradients were particularly striking at the low end of the income distribution (i.e., family income < or = $10,000 per year). The SES gradient in body mass index persisted in analyses controlling for attitudes and behaviors. CONCLUSIONS. Economic deprivation may contribute to high rates of obesity among lower SES women. The reasons for this require further research.
Mammography use among sociodemographically diverse women: the accuracy of self-report.
Authors: Zapka J G , Bigelow C , Hurley T , Ford L D , Egelhofer J , Cloud W M , Sachsse E
Published: November 2008

OBJECTIVE. This study sought to determine the accuracy of self-report of mammography experience among 392 ethnically diverse women aged 50 to 74. METHODS. Subjects were randomized to the telephone or mail condition and surveyed. RESULTS. Thirty-one percent of women reported accurately the exact month and year of their most recent mammogram; 54% reported accurately within +/- 3 months, and 83% reported accurately within the year. Greater accuracy was associated with exam recency, White race, and non-Hispanic ethnicity, but not with age, education, or income. Most women could correctly report the reason for, the findings of, and the payor of their mammograms but knew little about how much they or their insurance paid. CONCLUSIONS. For population surveillance of mammography in the past year, self-report data are generally valid. However, clinical studies requiring more precise dates must use such data with caution. The telephone method, as compared with mail, appears to be a better option for some variables.
High-density-lipoprotein cholesterol and types of alcoholic beverages consumed among men and women.
Authors: Parker D R , McPhillips J B , Derby C A , Gans K M , Lasater T M , Carleton R A
Published: November 2008

OBJECTIVES. Differences by sex in the relationship between high-density-lipoprotein (HDL) cholesterol and consumption of alcoholic beverages were examined in 1516 individuals. METHODS. Questionnaires and blood-sample data from cross-sectional surveys were analyzed. RESULTS. Both beer and liquor were independently associated with increased HDL cholesterol in the total group, in men, and in women after covariates were controlled for. Wine was associated with a significant increase in HDL cholesterol in women only. CONCLUSIONS. Among women and men, amount may be more important than type of alcoholic beverage consumed. The independent effect of wine on HDL cholesterol among men remains unclear since few men in this population consumed wine exclusively or in large quantities.
Preventing diabetic foot disease: lessons from the Medicare therapeutic shoe demonstration.
Authors: Wooldridge J , Bergeron J , Thornton C
Published: November 2008

OBJECTIVES. Every year about 38,000 elderly people with diabetes have a lower extremity amputation. Therapeutic shoes are prescribed by clinicians specializing in foot care to prevent foot ulcerations and amputations among at-risk patients with diabetes. Medicare ran a 3-year demonstration of a therapeutic-shoe benefit for beneficiaries with diabetes. Medicare added the benefit nationwide in May 1993. METHODS. This paper describes the benefit and its implementation in the demonstration based on demonstration records, a patient survey, and discussions with clinicians and shoe suppliers before and during the demonstration. RESULTS. During the demonstration, far fewer beneficiaries applied for the therapeutic shoes than were eligible for them. The paper discusses reasons for the low beneficiary application rate and the associated low participation rate among physicians treating patients with diabetes. CONCLUSIONS. The benefit is unlikely to be used any more in the national program than in the demonstration unless physicians are educated in the role therapeutic shoes can play in diabetic foot disease, they prescribe the shoes for their patients, and they increase their patients' awareness of the shoes' value.
Work site-based cancer prevention: primary results from the Working Well Trial.
Authors: Sorensen G , Thompson B , Glanz K , Feng Z , Kinne S , DiClemente C , Emmons K , Heimendinger J , Probart C , Lichtenstein E
Published: November 2008

OBJECTIVES. This paper presents the behavioral results of the Working Well Trial, the largest US work site cancer prevention and control trial to date. METHODS. The Working Well Trial used a randomized, matched-pair evaluation design, with the work site as the unit of assignment and analysis. The study was conducted in 111 work sites (n = 28,000 workers). The effects of the intervention were evaluated by comparing changes in intervention and control work sites, as measured in cross-sectional surveys at baseline and follow-up. The 2-year intervention targeted both individuals and the work-site environment. RESULTS. There occurred a net reduction in the percentage of energy obtained from fat consumption of 0.37 percentage points (P = .033), a net increase in fiber densities of 0.13 g/1000 kcal (P = .056), and an average increase in fruit and vegetable intake of 0.18 servings per day (P = .0001). Changes in tobacco use were in the desired direction but were not significant. CONCLUSIONS. Significant but small differences were observed for nutrition. Positive trends, but no significant results, were observed in trial-wide smoking outcomes. The observed net differences were small owing to the substantial secular changes in target behaviors.
Project Northland: outcomes of a communitywide alcohol use prevention program during early adolescence.
Authors: Perry C L , Williams C L , Veblen-Mortenson S , Toomey T L , Komro K A , Anstine P S , McGovern P G , Finnegan J R , Forster J L , Wagenaar A C , Wolfson M
Published: November 2008

OBJECTIVES. Project Northland is an efficacy trial with the goal of preventing or reducing alcohol use among young adolescents by using a multilevel, communitywide approach. METHODS. Conducted in 24 school districts and adjacent communities in northeastern Minnesota since 1991, the intervention targets the class of 1998 (sixth-grade students in 1991) and has been implemented for 3 school years (1991 to 1994). The intervention consists of social-behavioral curricula in schools, peer leadership, parental involvement/education, and communitywide task force activities. Annual surveys of the class of 1998 measure alcohol use, tobacco use, and psychosocial factors. RESULTS. At the end of 3 years, students in the intervention school districts report less onset and prevalence of alcohol use than students in the reference districts. The differences were particularly notable among those who were nonusers at baseline. CONCLUSIONS. The results of Project Northland suggest that multilevel, targeted prevention programs for young adolescents are effective in reducing alcohol use.
Recovery from alcohol problems with and without treatment: prevalence in two population surveys.
Authors: Sobell L C , Cunningham J A , Sobell M B
Published: November 2008

OBJECTIVES. The purpose of this study was to determine the prevalence of recovery from alcohol problems with and without treatment, including whether such recoveries involved abstinence or moderate drinking. METHODS. Data from two surveys of randomly selected adults in the general population were analyzed. Random-digit dialing was used to conduct telephone interviews with 11,634 and 1034 respondents. Respondents 20 years of age or older were categorized on the basis of drinking status and history. RESULTS. Both surveys found that most individuals (77.5% and 77.7%) who had recovered from an alcohol problem for 1 year or more did so without help or treatment. A sizable percentage (38% and 63%) also reported drinking moderately after resolving their problem. CONCLUSIONS. These two surveys are among the first to report prevalence rates for recovery from alcohol problems for treated and untreated individuals and for moderation and abstinence outcomes.
Violence and substance use among North Carolina pregnant women.
Authors: Martin S L , English K T , Clark K A , Cilenti D , Kupper L L
Published: November 2008

OBJECTIVES. Prenatal patients were studied to examine the proportion of women who had been violence victims, women's patterns of substance use (cigarettes, alcohol, and illegal drugs) before and during pregnancy, and relationships between violence and substance use. METHODS. More than 2000 prenatal patients in North Carolina were screened for violence and substance use. Relationships between violence and patterns of substance use before and during pregnancy were examined, as well as women's continuation of substance use during pregnancy as a function of violence and sociodemographic factors. RESULTS. Twenty-six percent of the women had been violence victims during their lives. Before pregnancy, 62% of the women had used one or more substances; during pregnancy, 31% had used one or more substances. Both before and during pregnancy, violence victims were significantly more likely to use multiple substances than nonvictims. Continuation of substance use during pregnancy was significantly more likely among violence victims than nonvictims. CONCLUSIONS. Care providers should screen women for violence as well as for substance use and should ensure that women are provided with appropriate interventions.
Childhood sexual abuse and bulimic behavior in a nationally representative sample.
Authors: Wonderlich S A , Wilsnack R W , Wilsnack S C , Harris T R
Published: November 2008

OBJECTIVES. This study examines whether childhood sexual abuse is a significant risk factor for the development of bulimic behavior in women. METHODS. Interviews were conducted among a representative national sample of 1099 US women regarding their sexual experiences during childhood as well as their lifetime prevalence of bulimic behavior. Logistic regression was used to calculate adjusted odds ratios to measure the contribution of childhood sexual abuse to the odds of several measures of bulimic behavior in the population, controlling for the respondent's age, ethnic group, and parents' educational level. Attributable risk analyses were conducted to estimate how much risk for bulimic behavior was due to childhood sexual abuse. RESULTS. Victims of childhood sexual abuse were significantly more likely to display bulimic behavior, and a substantial fraction of cases of bulimic behavior could be attributed to such abuse. CONCLUSIONS. Childhood sexual abuse is a risk factor for bulimic behavior. Between one sixth and one third of the cases of significant bulimic disturbance could be attributed to childhood sexual abuse.
Gender differences in sexual practices and sexually transmitted infections among adults in Lima, Peru.
Authors: Sánchez J , Gotuzzo E , Escamilla J , Carrillo C , Phillips I A , Barrios C , Stamm W E , Ashley R L , Kreiss J K , Holmes K K
Published: November 2008

OBJECTIVES. This study examined the prevalences of antibodies to Treponema pallidum, Chlamydia trachomatis, and herpes simplex virus type 2 in a sample of Peruvian adults. METHODS. Among adults seeking health certification in Lima, Peru, 600 were randomly selected to undergo interviews and serologic testing. RESULTS. Men's reported mean lifetime number of partners (10.6) far exceeded women's (1.1), yet antibody to sexually transmitted infection pathogens among sexually experienced participants was 2.8 times more prevalent among women than among men. Among men, female sex workers accounted for 37% of recent partners, and only sex with female sex workers while using condoms less than half of the time was independently associated with antibody (odds ratio = 3.6, 95% confidence interval = 1.5, 8.8). among women, number of partners was associated with any sexually transmitted infection antibody, while intercourse before 18 years of age was associated with C trachomatis antibody. At every level of perceived risk, sexually transmitted infection antibody was more frequent among women. CONCLUSIONS. Men having unprotected sex with female sex workers had the greatest risk of acquiring infections and (by inference) of transmitting them to women.
A prospective study of syphilis and HIV infection among injection drug users receiving methadone in the Bronx, NY.
Authors: Gourevitch M N , Hartel D , Schoenbaum E E , Selwyn P A , Davenny K , Friedland G H , Klein R S
Published: November 2008

OBJECTIVES. The purpose of this study was to assess the relationship between syphilis and human immunodeficiency virus (HIV) infection in injection drug users. METHODS. A 6-year prospective study of 790 injection drug users receiving methadone maintenance treatment in the Bronx, NY, was conducted. RESULTS. Sixteen percent (4/25) of HIV-seroconverting patients, 4.8% (16/335) of prevalent HIV-seropositive patients, and 3.5% (15/430) of persistently HIV-seronegative patients was diagnosed with syphilis. Incidence rates for early syphilis (cases per 1000 person-years) were 15.9 for HIV-seroconverting patients, 8.9 for prevalent HIV-seropositive patients, and 2.9 for persistently HIV-seronegative patients. Early syphilis incidence was higher among women than men (8.4 vs 3.2 cases per 1000 person-years). Independent risks for early syphilis included multiple sex partners, HIV seroconversion, paid sex, and young age. All HIV seroconverters with syphilis were female. CONCLUSIONS. Diagnosis of syphilis in drug-using women reflects high-risk sexual activity and is associated with acquiring HIV infection. Interventions to reduce the risk of sexually acquired infections are urgently needed among female drug users.
HIV risk behaviors among women living in low-income, inner-city housing developments.
Authors: Sikkema K J , Heckman T G , Kelly J A , Anderson E S , Winett R A , Solomon L J , Wagstaff D A , Roffman R A , Perry M J , Cargill V , Crumble D A , Fuqua R W , Norman A D , Mercer M B
Published: November 2008

OBJECTIVES. This study describes the prevalence and predictors of human immunodeficiency virus (HIV) risk behaviors among women living in low-income, inner-city housing developments. METHODS. Anonymous questionnaires were administered to 671 women living in 10 inner-city, low-income housing developments in five US cities to determine their levels of HIV risk behavior and predictors of HIV risk practices. RESULTS. Approximately one third of women were at high risk for HIV because of the risk behavior of their sexual partners. HIV risk was highest among women who accurately perceived themselves to be at increased HIV risk, held strong beliefs about barriers to condom use, and reported weak behavioral intentions to reduce risk. Women at higher risk were also younger and reported higher rates of alcohol and substance use. CONCLUSIONS. HIV prevention efforts are needed for inner-city women. Interventions should focus on overcoming women's barriers to condom use, strengthening their intentions to change behaviors, and managing the risk related to their use of substances.
HIV infection and risk behaviors among male port workers in Santos, Brazil.
Authors: Larcerda R , Stall R , Gravato N , Tellini R , Hudes E S , Hearst N
Published: November 2008

OBJECTIVES. This paper measured the extent to which human immunodeficiency virus (HIV) infection has spread among the male working-class population of Santos, Brazil. METHODS. Questionnaires on risk behaviors and blood tests were administered to a random sample (n = 395) of male port workers employed by the Santos Port Authority. RESULTS. Although the rate of HIV infection among these men- the working-class male population of Santos-remains low (1.1%), self-reported behavioral risks for HIV infection are common. CONCLUSIONS. There is still time to prevent a widespread outbreak of HIV infection among the hetero-sexual population of Santos and of the transportation corridors emanating from that city.
The legal strategies used in operating syringe exchange programs in the United States.
Authors: Burris S , Finucane D , Gallagher H , Grace J
Published: November 2008

OBJECTIVES. This study sought to identify the strategies used by syringe exchange programs to establish their legality. METHODS. Statutes, court decisions, published studies of exchange programs, and news stories were reviewed, and telephone interviews were conducted with syringe exchange personnel. RESULTS. Twenty-seven exchanges have been authorized by amendments to or judicial interpretations of state drug laws or by administrative action under such laws, or operate in a state that has no laws regulating needles. At least 13 programs operate under claims of legality based on local interpretations of state law, principally public health law. The remaining syringe exchanges operate without a claim of legality. CONCLUSIONS. The deployment of syringe exchanges has been hindered by concerns about their legal status. This study shows that the applicability of drug laws to syringe exchange is open to dispute, and that local public health authorities may under some circumstances rely on their own legal authority to fund or operate syringe exchange programs.
Disasters, the environment, and public health: improving our response.
Authors: Logue J N
Published: November 2008

Natural and human-made disasters continue to adversely affect all areas of the world in both predictable and unpredictable ways. To highlight the importance of natural disasters, the United Nations declared the 1990s the International Decade for Natural Disaster Reduction. This paper considers the public health response to disasters. It highlights environmental health issues and approaches since disasters are extreme environmental events, and it reviews developments relating to capacity building, training, and collaboration. Although progress is noted, a comprehensive federal or academic approach is not evident in the United States and the proper linkage to environmental health is lacking. With the International Decade now half over, public health professionals and others involved with disaster management should reflect on progress made to date and goals for the future.
The use of breast milk substitutes in developing countries: the impact of women's employment.
Authors: Hight-Laukaran V , Rutstein S O , Peterson A E , Labbok M H
Published: November 2008

OBJECTIVES: This study quantified the influence of employment, specifically a mother's employment away from her infant, on the use of breast milk substitutes in developing countries. METHODS: Data from the Demographic and Health Surveys were used to calculate the population attributable risk percentage for use of breast milk substitutes among women employed away from their babies in 15 countries for which suitable data were available. RESULTS: The estimated proportion of breast milk substitute use attributable to employment away from the baby ranged from 0.74% to 20.9% in the various countries. CONCLUSIONS: Employment is not the main determinant of breast milk substitute use. Efforts to improve breast-feeding can be safely targeted at the majority of women who are not employed away from their babies while nevertheless giving appropriate attention to the minority of new mothers who are employed away from their babies.
Polychlorinated biphenyl (PCB) and dichlorodiphenyl dichloroethylene (DDE) concentrations in the breast milk of women in Quebec.
Authors: Dewailly E , Ayotte P , Laliberté C , Weber J P , Gingras S , Nantel A J
Published: November 2008

OBJECTIVES: This study documented the concentration of polychlorinated biphenyls (PCBs) and dichlorodiphenyl dichloroethylene (DDE) in the breast milk of women from Quebec, Canada, and assessed the impact of various sociodemographic and lifestyle factors on these levels. METHODS: From 1988 to 1990, milk samples were obtained from 536 Quebec women and analyzed for seven PCB congeners and p,p'-DDE. Information was obtained on subjects' physical, sociodemographic, and lifestyle characteristics. RESULTS: Mean concentrations were 0.52 mg/kg lipids (95% confidence interval [CI] = 0.50, 0.54) and 0.34 mg/kg lipids (95% CI = 0.32, 0.35) for PCBs (Aroclor 1260) and DDE, respectively. Age and history of breast-feeding showed statistically significant correlations with PCB and DDE concentrations. CONCLUSIONS: Concentrations of PCBs and DDE measured in this study are at the lower end of the concentration range recently reported for women living in industrialized countries. The modulating factors identified here should be considered when conducting studies on organochlorine exposure and disease.
Semivolatile organic compounds in adipose tissue: estimated averages for the US population and selected subpopulations.
Authors: Lordo R A , Dinh K T , Schwemberger J G
Published: November 2008

OBJECTIVES: The fiscal year (FY) 1986 Environmental Protection Agency National Human Adipose Tissue Survey (NHATS) was conducted to estimate average concentrations of 111 semivolatiles in human adipose tissue within the US general population and selected subpopulations. METHODS: Population and subpopulation estimates of average semivolatile concentrations were established from 671 adipose tissue specimens pooled across 50 analytical samples. RESULTS: Among polychlorinated biphenyls (PCBs), average concentrations for the group aged 45 and older were from 188% to 706% higher than for the 0- through 14-year-old age group. Similar increases with age were observed for pesticides. Geographic effects on average concentration were mixed, and no significant race or sex effects were observed. Statistically significant increases from FY 1982 NHATS results were observed for PCBs and hexachlorobenzene, whereas a decrease from FY 1982 was significant for beta-BHC (benzene hexachloride). Increases from FY 1984 NHATS results were significant for p,p-DDT (dichlordiphenylethylene), p,p-DDE (dichlordiphenyldichlor), hexachlorobenzene, and PCBs. CONCLUSIONS: The survey establishes baseline average levels of semivolatile compounds in the adipose tissue of US residents.
Occasional smoking in a Minnesota working population.
Authors: Hennrikus D J , Jeffery R W , Lando H A
Published: November 2008

OBJECTIVES: This study examined the prevalence of occasional smoking in a population of working adults, compared the characteristics of occasional and daily smokers, and prospectively examined the long-term smoking patterns of occasional smokers. METHODS: At 32 Minnesota work sites, 5681 randomly selected workers were surveyed at baseline; 5248 of these were surveyed again 2 years later. A cross-sectional sample of 5817 workers was also surveyed at follow-up. RESULTS: Occasional smokers constituted 18.3% of all smokers in the baseline sample and 21.5% of all smokers in the cross-sectional sample surveyed 2 years later. Baseline occasional smokers were significantly more likely than daily smokers to have quit at follow-up. Job monotony or repetitiveness was related to an increase to daily smoking at follow-up among baseline occasional smokers, and a change to a more restrictive workplace smoking policy was associated with quitting. CONCLUSIONS: The results confirm that a substantial proportion of smokers are low-rate users and suggest that the proportion may be rising. Further research on this group is warranted.