bluuebunny/crossref_metadata_2025 huggingface dataset:
HIV risk-related behaviors among injection drug users in Rome: differences between 1990 and 1992.
Authors: Davoli M , Perucci C A , Abeni D D , Arcà M , Brancato G , Forastiere F , Montiroli P M , Zampieri F
Published: November 2008

Temporal differences in human immunodeficiency virus (HIV) risk-related behaviors among injection drug users in Rome, Italy, were analyzed in 487 drug users recruited in 1990 and 450 recruited in 1992. Sharing of syringes decreased among self-reported HIV-positive drug users between 1990 and 1992, but there was no change in their sexual behavior. Fewer HIV-seronegative drug users reported passing on used syringes in 1992 than in 1990; however, there was no change in the percentage of seronegative subjects using previously used syringes, and a reduction in condom use with primary partners. There still exists a great potential for transmission of HIV infection among injection drug users and from injection drug users to the general population.
Peer review of mammography interpretations in a breast cancer screening program.
Authors: Feldman J , Smith R A , Giusti R , DeBuono B , Fulton J P , Scott H D
Published: November 2008

Mammograms from a statewide screening program were subjected to a blind review by a panel of expert mammographers. Ninety-five percent (173/182) of original normal mammograms and 53% (164/311) of original abnormal mammograms were reread as normal. In comparison with the expert panel community radiologists were more likely to request a repeat mammogram in 6 months than to interpret a mammogram as normal or address their uncertainty with an immediate diagnostic workup.
Vaccination levels in Los Angeles public health centers: the contribution of missed opportunities to vaccinate and other factors.
Authors: Wood D , Pereyra M , Halfon N , Hamlin J , Grabowsky M
Published: November 2008

We abstracted 752 randomly selected records of 2-year-old children at 5 public health centers in Los Angeles. Only 27% of the children were up-to-date in their vaccinations by 2 years of age. Being up-to-date was strongly associated with the number of missed opportunities to vaccinate and number of well child visits. Missed opportunities to vaccinate occurred during 52% of all visits and were associated with minor illness diagnoses and inaccurate immunization status assessment by nurses. Frequent missed opportunities to vaccinate and inadequate numbers of well child visits may result in low immunization levels among children attending public health clinics.
Renal failure among male Hispanics in the United States.
Authors: Chiapella A P , Feldman H I
Published: November 2008

This study examined epidemiologic patterns and time trends among male patients with Hispanic surnames in the Medicare End-Stage Renal Disease Program and compared US Hispanics with non-Hispanic Blacks and Whites. Male Hispanics had substantially higher proportions of end-stage renal disease attributed to diabetes than did Blacks and Whites. There were notable regional differences among Hispanics. Between 1980 and 1990, the incidence of treated renal failure among Hispanics increased more than that among Blacks or Whites. The increasing number of Hispanics in the United States with end-stage renal disease emphasizes the importance of explicit health evaluations and prevention strategies for Hispanic populations.
Epidemiology, the humanities, and public health.
Authors: Weed D L
Published: November 2008

Epidemiologists may benefit from the disciplines of history, philosophy of science, ethics, literature, and art. Within these disciplines lie answers to the questions of who we are, what is right, how to think, and when to act. Studying and participating in the humanities may also help epidemiologists focus their professional concerns on the humanity their methods serve. A parallel phenomenon in the clinical sciences--medical humanities--provides support for the approach (and some lessons).
Admissions for injury at a rural hospital in Ghana: implications for prevention in the developing world.
Authors: Mock C N , Adzotor E , Denno D , Conklin E , Rivara F
Published: November 2008

OBJECTIVES. Strategies for injury prevention have been extensively studied in developed nations but not in the developing world. This study sought to determine which mechanisms of injury were common in a rural developing area and which were important contributors to mortality and disability. METHODS. All 614 patients admitted for injuries to a rural African hospital between 1987 and 1991 were analyzed retrospectively for mechanism of injury and outcome, as assessed by mortality and long-term functional status. RESULTS. The leading mechanisms of injury were transport related (29%) and burns (16%). Burns accounted for 61% of injuries in children under 5 years. Mortality was 7.3% in the series, with 24% of deaths owing to transport injuries. Disability developed in 103 (22%) of the 462 survivors available for assessment, with most disability resulting from transport injuries (26% of all disabilities), burns (13%), and agricultural injuries (14%). CONCLUSIONS. Among injured patients who presented for treatment in this rural developing area, the largest burden of mortality and disability was from burns and transport-related injuries. Population-based studies are needed to substantiate whether these should be priorities for injury prevention efforts.
Educating preschoolers about sun safety.
Authors: Loescher L J , Emerson J , Taylor A , Christensen D H , McKinney M
Published: November 2008

OBJECTIVES. This feasibility study examined whether a sun safety curriculum designed for and administered to preschoolers affects their cognition (knowledge, comprehension, application) regarding sun safety. METHODS. Twelve classes of 4- to 5-year-olds were recruited from local preschools and randomly assigned to an intervention group or a control group. The intervention group received an investigator-developed sun safety curriculum; the control group did not. Children in both groups were tested at the beginning of the study about their cognition related to sun safety. They then received posttests 2 and 7 weeks following the pretest. RESULTS. The curriculum had a significant effect on the knowledge (P = .01) and comprehension (P = .006) components of cognition. The application component of cognition was not significantly changed by the curriculum. CONCLUSIONS. A structured curriculum was found to be an efficacious means of enhancing knowledge and comprehension of sun safety in preschool children. At the preoperational developmental stage, however, children may not be able to apply such knowledge and comprehension.
Access to paid in-home assistance among disabled elderly people: do Latinos differ from non-Latino whites?
Authors: Wallace S P , Levy-Storms L , Ferguson L R
Published: November 2008

OBJECTIVES. The purpose of this study was to compare the national prevalences and predictors of paid in-home functional assistance among disabled Latino and non-Latino elderly people who receive such assistance. METHODS. Data were derived from the 1988 wave of the National Center for Health Statistics Longitudinal Study on Aging and the 1988 Commonwealth Fund Commission Survey of Elderly Hispanics. Logistic regression was used to model paid care use and to calculate estimated probabilities of such use. RESULTS. Among Latino and non-Latino Whites 74 years of age and older who received functional assistance, similar proportions used paid assistance. Predictors of paid care coincided with established models for non-Latino Whites only. Disabled Latinos had a lower estimated probability of using paid assistance when they were highly disabled and socially isolated but had a higher estimated probability when their children lived nearby. CONCLUSIONS. The effects of disability and social support differ among non-Latino White and Latino elderly people. Latino elderly people with high anticipated needs obtain less paid assistance than similar non-Latino Whites. In addition to a reduction in financial barriers, improving access to long-term care services requires addressing this diversity in service use patterns.
Patterns of alcohol use and the risk of drinking and driving among US high school students.
Authors: Escobedo L G , Chorba T L , Waxweiler R
Published: November 2008

Approximately one third of deaths among persons aged 15 to 24 years are the result of motor vehicle-related crashes. Data from a national sample of US high school students were used to assess patterns of alcohol use among adolescents in relation to the risk of drinking and driving. Prevalence and odds ratios were calculated for drinking and driving associated with patterns of alcohol use. Drinking and driving increased with increasing frequency of alcohol use and binge drinking and when alcohol was used in addition to other drugs. Efforts to reduce drinking and driving among adolescents should address underage drinking that is frequent or heavy.
Functional disability among elderly blacks and whites in two diverse areas: the New Haven and North Carolina EPESE. Established Populations for the Epidemiologic Studies of the Elderly.
Authors: Mendes de Leon C F , Fillenbaum G G , Williams C S , Brock D B , Beckett L A , Berkman L F
Published: November 2008

This study examines the prevalence of functional disability (limitation in at least one basic activity of daily living) among elderly Black and White community residents in the New Haven (n = 2812) and North Carolina (n = 4162) sites of the Established Populations for Epidemiologic Studies of the Elderly (EPESE). In New Haven, elderly Blacks, particularly women below age 75, had a higher prevalence of disability compared with Whites, which was partially attributable to a higher prevalence of chronic conditions. In North Carolina, Blacks had only a slightly higher risk of being disabled than Whites, and this was fully accounted for by differences in socioeconomic status. Black-White differences in the prevalence of functional disability reveal geographic variation.
Adolescents' perceptions of their peers' health norms.
Authors: Evans N , Gilpin E , Farkas A J , Shenassa E , Pierce J P
Published: November 2008

OBJECTIVES. The purpose of this study was to determine the relative importance adolescents place on preventive health behaviors. METHODS. Data were from a survey of California adolescents (n = 5040). Respondents were asked how important it was to their peers to avoid drugs, marijuana, cigarettes, heavy drinking, and drinking and driving and to maintain seat belt use, fitness, weight control, and healthy eating habits. Results were compared with data from a similar national survey (n = 6126). RESULTS. California teenagers perceived that their peers gave top priority to weight control: 85% of California teenagers believed that weight control was of high concern to girls in their age group. Avoiding drugs, not drinking and driving, and maintaining fitness ranked in the top five behaviors. The lowest ranked health behaviors were seat belt use, heavy drinking, and, last, eating healthily. In the national survey, healthy eating also ranked last. Although not identical in rank, teenage priorities for other health behaviors were consistent with the California results. CONCLUSION. Efforts are needed to bring adolescent health norms more into line with the objective risks of their health choices during this critical period of socialization.
Hospitalizations for near drowning in California: incidence and costs.
Authors: Ellis A A , Trent R B
Published: November 2008

California hospital discharge data for 1991 were examined to describe persons hospitalized for near drownings (i.e., a submersion incident for which the victim was admitted to a hospital). Among residents with near-drowning injuries, there were 865 discharges, regardless of outcome (rate = 2.8/100,000); 785 persons survived the hospitalization, and 80 (9%) did not. Swimming pools were the most common submersion site (62%). Highest rates per 100,000 were found among males (3.6), Blacks (3.6), and children 1 through 5 years old (18.4). Charges for the initial hospitalization (excluding physicians' fees) amounted to $11.4 million. The state government's share of these charges was $5.4 million, with Medi-Cal expected to pay $4.1 million. Blacks, males, Medi-Cal recipients, and young children are most at risk and should be targeted for prevention programs.
Syphilis in the South: rural rates surpass urban rates in North Carolina.
Authors: Thomas J C , Kulik A L , Schoenbach V J
Published: November 2008

We studied primary and secondary syphilis rates in North Carolina for 1985 through 1993 to elucidate demographic trends and the role of rurality in the state's high rates. Each of the state's 100 counties was classified by rural-urban character; and county-level rates, adjusted for gender, race, and age group, were compared. Syphilis rates rose dramatically during the 9-year period, with most of the increase occurring among women, non-Whites, and rural counties. The rural rates recently surpassed urban rates, with the greatest increase experienced by non-White rural women. The exchange of sex for drugs and characteristics of rural poverty may be fueling these trends.
A matter of opinion about hysterectomies: experts' and practicing community gynecologists' ratings of appropriateness.
Authors: Bickell N A , Earp J , Evans A T , Bernstein S J
Published: November 2008

The degree to which national expert panel survey ratings of the appropriateness of hysterectomy differed from those of a random sample of practicing community gynecologists was determined. Community gynecologists rated hysterectomy as more appropriate on six of eight cervical dysplasia scenarios. Experts agreed among themselves on 19 of 32 indications (intraclass correlation coefficient = 0.66); community gynecologists agreed on 12 of 32 indications (intraclass correlation coefficient = 0.50). Although few differences of opinion existed between experts and community gynecologists, for common clinical scenarios there was a large variation of opinion about the appropriateness of hysterectomy within each group. For areas of clinical uncertainty in which experts' opinions are used in guideline development, additional measures such as process of care, quality of life, and patient preference should be included in discussions about guidelines.
Women's receptivity to testing for a genetic susceptibility to breast cancer.
Authors: Chaliki H , Loader S , Levenkron J C , Logan-Young W , Hall W J , Rowley P T
Published: November 2008

Four hundred eighty-four patients undergoing mammography and 498 patients visiting their obstetrician-gynecologist were asked whether they would take a breast cancer 1 (BRCA1) test to detect a genetic susceptibility to breast cancer. More than 90% in both groups said they would take the test. Women were more likely to accept if they were regularly having breast examinations by a physician, believed that mammography effectively detects early breast cancer, and believed that early breast cancer is curable. If shown to have inherited a susceptibility, many reported that they would be very anxious, would want the test repeated, would examine their breasts more often than monthly, and would want mammography more often than yearly. Many also reported that they would recommend testing to relatives.
Tobacco industry smokers' rights publications: a content analysis.
Authors: Cardador M T , Hazan A R , Glantz S A
Published: November 2008

OBJECTIVES: This study was undertaken to identify the content of tobacco industry smokers' rights publications and to analyze their major themes. METHODS: Fifty-eight issues of smokers' rights publications from 1987 to 1992 were selected at random and analyzed. The number of publications per year, number of mentions (sentences) in different thematic categories per year, and number of mentions per category per publication were examined. RESULTS: The number of smokers' rights publications increased rapidly from 1987 to 1992. The number of mentions across all thematic categories increased over time, with the largest numbers appearing in 1990, 1991, and 1992. The category of Political and Social Action comprised the highest average number of mentions across years. CONCLUSIONS: These publications appear to be consistent with past and present tobacco industry strategies to counter tobacco control efforts and negative public perceptions by attempting to refute scientific evidence about the health impact of environmental tobacco smoke. Additionally, they serve the industry goals of encouraging smokers to take action to protect their rights, mobilizing public opinion, and delaying societal rejection of smoking and secondhand smoke and acceptance of smoking restrictions.
Occupational hepatitis C virus infection in Italian health care workers. Italian Study Group on Occupational Risk of Bloodborne Infections.
Authors: Puro V , Petrosillo N , Ippolito G , Aloisi M S , Boumis E , Ravà L
Published: November 2008

The risk of exposed health care workers in 16 Italian hospitals becoming infected with hepatitis C virus was assessed through two serosurveys at a 1-year interval and at follow-up. Prevalence, which was 2.2%, was significantly associated with previous acute hepatitis, blood transfusions, housekeeping, and older age (> 46 years) but not with occupational risk factors. After 1 year, 2622 (87%) of the 3006 seronegative health care workers were retested, and 3 (0.1%), who did not acknowledge occupational or community risk factors, seroconverted. Additionally, 133 (97 needlesticks) out of 370 reported occupational exposures were to hepatitis C virus; one pricked nurse seroconverted (0.75%). Although the risk is not negligible, hepatitis C virus infection does not seem to be easily occupationally transmitted.
Apolipoprotein E and Alzheimer's disease: the implications of progress in molecular medicine.
Authors: Mayeux R , Schupf N
Published: November 2008

We review the current status as well as the risks and benefits of a recently developed DNA test of risk for Alzheimer's disease: the apolipoprotein E genotype. While apolipoprotein E genotypes may indicate a degree of susceptibility, the gene is neither necessary nor sufficient to cause the disease; thus, many questions remain. Because risk prediction is not straightforward, practical issues related to the testing of complex diseases like Alzheimer's and to the ethical, legal, and social implications of genetic tests require careful consideration and unambiguous answers. The use of apolipoprotein E genotyping in patients with Alzheimer's disease should be limited to research centers, and additional studies are strongly recommended. Apolipoprotein E genotypes should not be available to third parties such as insurers or employers until genotypic risks are fully understood. National policies that encourage scientific investigation while maintaining individual privacy and limiting unnecessary access to genetic information should be immediately developed.
Social inequality and death as illustrated in late-medieval death dances.
Authors: Mackenbach J P
Published: November 2008

Late-medieval murals and books of the then-popular "dances of death" usually represented the living according to their social standing. These works of art thus provide an interesting opportunity to study the relationship between social inequality and death as it was perceived by the works' commissioners or executers. The social hierarchy in these dances of death is mostly based on the scheme of the three orders of the feudal society; variations relate to the inclusion of female characters, new occupations, and non-Christian characters. Many dances of death contain severe judgments on highplaced persons and thus seem to be expressions of a desire for greater social equality. However, a more thorough analysis reveals that the equality of all before death that these dances of death proclaimed held nothing for the poor but only threatened the rich. Because of a lack of reliable data, it is not yet completely clear whether during the late Middle Ages all were indeed equally at risk for premature mortality. Available evidence, however, suggests that the clergy and nobility actually had a higher life expectancy than people placed lower in the social hierarchy. Despite modern changes in the perception of, and knowledge about, social inequality and mortality, these dances of death still capture the imagination, and they suggest that the phenomenon of socioeconomic inequalities in mortality could be used more to emphasize contemporary moral messages on social inequality.
Judging hospitals by severity-adjusted mortality rates: the influence of the severity-adjustment method.
Authors: Iezzoni L I , Ash A S , Shwartz M , Daley J , Hughes J S , Mackiernan Y D
Published: November 2008

OBJECTIVES: This research examined whether judgments about a hospital's risk-adjusted mortality performance are affected by the severity-adjustment method. METHODS: Data came from 100 acute care hospitals nationwide and 11880 adults admitted in 1991 for acute myocardial infarction. Ten severity measures were used in separate multivariable logistic models predicting in-hospital death. Observed-to-expected death rates and z scores were calculated with each severity measure for each hospital. RESULTS: Unadjusted mortality rates for the 100 hospitals ranged from 4.8% to 26.4%. For 32 hospitals, observed mortality rates differed significantly from expected rates for 1 or more, but not for all 10, severity measures. Agreement between pairs of severity measures on whether hospitals were flagged as statistical mortality outliers ranged from fair to good. Severity measures based on medical records frequently disagreed with measures based on discharge abstracts. CONCLUSIONS: Although the 10 severity measures agreed about relative hospital performance more often than would be expected by chance, assessments of individual hospital mortality rates varied by different severity-adjustment methods.
Detecting risk drinking during pregnancy: a comparison of four screening questionnaires.
Authors: Russell M , Martier S S , Sokol R J , Mudar P , Jacobson S , Jacobson J
Published: November 2008

OBJECTIVES: This study investigated the efficacy of screening for risk drinking during pregnancy with two brief questionnaires, TWEAK and T-ACE. Both include an assessment of tolerance based on the number of drinks women report they can hold. METHODS: Subjects were disadvantaged African-American obstetric patients in Detroit, Mich. Traditional alcoholism screens (Michigan Alcohol Screening Test [MAST], CAGE) and the tolerance question were administered (n = 2717); TWEAK and T-ACE were constructed from tolerance and embedded MAST and CAGE items. In a separate sample (n = 1420), only the T-ACE was administered. Periconceptional risk drinking was the gold standard. Screen evaluations were based on receiver-operating characteristic analyses. RESULTS: At the cutpoint of 2, sensitivity/specificity for embedded screens were 91/77 for TWEAK and 88/79 for T-ACE; comparable values for T-ACE alone were 67/86. TWEAK and T-ACE screened more effectively than CAGE or MAST. CONCLUSIONS: Embedded versions of TWEAK and T-ACE were both highly sensitive to periconceptional risk drinking in this population. Administering T-ACE alone reduced its sensitivity; this suggests that MAST and CAGE administration improves its performance.
The risk of myocardial infarction among Finnish farmers seeking medical care for an infection.
Authors: Penttinen J , Valonen P
Published: November 2008

OBJECTIVES: This study determined whether people visiting a doctor because of infection had an increased risk of myocardial infarction. METHODS: For 83 case patients and 249 matched control patients nested in a cohort of 3172 Finnish male farmers, comparisons were made on the basis of visits to a doctor because of infection. RESULTS: Infections of the upper respiratory tract were statistically significantly associated with coronary artery disease. The odds ratio was 3.2 (95% confidence interval = 1.2, 8.5) for patients visiting a doctor four or more times because of infection of upper respiratory tract compared with patients with three or fewer visits. CONCLUSION: Men in this sample with recurrent or chronic infections of the upper respiratory tract exhibited a pronounced risk for myocardial infarction.
HIV test-seeking before and after the restriction of anonymous testing in North Carolina.
Authors: Hertz-Picciotto I , Lee L W , Hoyo C
Published: November 2008

OBJECTIVES: This study assessed the impact on HIV test-seeking of North Carolina's restriction of anonymous testing to 18 of its 100 counties as of September 1, 1991. METHODS: Trends from 4 months prerestriction to the 16-month restriction period in counties retaining vs counties eliminating anonymous testing were compared. RESULTS: HIV testing increased throughout the state, but more rapidly where anonymous testing was retained than elsewhere: 64% vs 44%. These differences held for all sociodemographic subgroups and were most pronounced among adolescents and African Americans and other non-Whites. CONCLUSIONS: The data are consistent with a detrimental effect of elimination of anonymous testing, although confounding from differences in AIDS awareness or in repeat tests is possible.
The history and politics of US health care policy for American Indians and Alaskan Natives.
Authors: Kunitz S J
Published: November 2008

This paper traces the development of the US federal government's program to provide personal and public health services to American Indians and Alaska Natives since the 1940s. Minimal services had been provided since the mid 19th century through the Bureau of Indian Affairs of the Department of the Interior. As a result of attempts by western congressmen to weaken and destroy the bureau during the 1940s, responsibility for health services was placed with the US Public Health Service. The transfer thus created the only US national health program for civilians, providing virtually the full range of personal and public health services to a defined population at relatively low cost. Policy changes since the 1970s have led to an emphasis on self-determination that did not exist during the 1950s and 1960s. Programs administered by tribal governments tend to be more expensive than those provided by the Indian Health Service, but appropriations have not risen to meet the rising costs, nor are the appropriated funds distributed equitably among Indian Health Service regions. The result is likely to be an unequal deterioration in accessibility and quality of care.
Pneumococcal pneumonia and influenza vaccination: access to and use by US Hispanic Medicare beneficiaries.
Authors: Mark T L , Paramore L C
Published: November 2008

OBJECTIVES: This study examined differences between elderly Hispanic Medicare beneficiaries and other Medicare beneficiaries in the probability of being immunized for pneumococcal pneumonia and influenza. METHODS: We used the 1992 national Medicare Current Beneficiary Survey to evaluate influenza and pneumococcal pneumonia immunization rates. RESULTS: Elderly Hispanic Medicare beneficiaries were less likely than non-Hispanic White Medicare beneficiaries to have received an influenza vaccine in the past year or to have ever been immunized for pneumococcal pneumonia. Speaking Spanish was statistically significantly associated with influenza vaccination but not with pneumococcal pneumonia vaccination. Supplemental insurance status, HMO enrollment, having a usual source of care, and being satisfied with access to care were positively associated with immunization. CONCLUSIONS: Strategies that may improve immunization rates among elderly. Hispanics include reducing the inconvenience of being immunized, decreasing out-of-pocket costs, linking beneficiaries with providers, and educating Hispanic beneficiaries in Spanish about the benefits of vaccinations.
Associations between physical activity and other health behaviors in a representative sample of US adolescents.
Authors: Pate R R , Heath G W , Dowda M , Trost S G
Published: November 2008

OBJECTIVES: This study examined the associations between physical activity and other health behaviors in a representative sample of US adolescents. METHODS: In the 1990 Youth Risk Behavior Survey, 11631 high school students provided information on physical activity; diet; substance use; and other negative health behaviors. Logistic regression analyses examined associations between physical activity and other health behaviors in a subset of 2652 high-active and 1641 low-active students. RESULTS: Low activity was associated with cigarette smoking, marijuana use, lower fruit and vegetable consumption, greater television watching, failure to wear a seat belt, and low perception of academic performance. For consumption of fruit, television watching, and alcohol consumption, significant interactions were found with race/ethnicity or sex, suggesting that sociocultural factors may affect the relationships between physical activity and some health behaviors. CONCLUSIONS: Low physical activity was associated with several other negative health behaviors in teenagers. Future studies should examine whether interventions for increasing physical activity in youth can be effective in reducing negative health behaviors.
The relationship between cigarette smoking and education revisited: implications for categorizing persons' educational status.
Authors: Zhu B P , Giovino G A , Mowery P D , Eriksen M P
Published: November 2008

OBJECTIVE: This study sought to reassess the relationship between cigarette smoking and education. METHODS: Data from the 1983 to 1991 National Health Interview Survey for participants aged 25 years and older were used to plot the prevalence of current smoking, ever smoking, heavy smoking, and smoking cessation, as well as the adjusted log odds ratios, by years of education. RESULTS: The "less than high school graduate" category consisted of two groups with distinct smoking patterns: persons with 0 to 8 years and persons with 9 to 11 years of education. The latter were the most likely to be current, ever, and heavy smokers and the least likely to have quit smoking, whereas the former were similar to persons having 12 years of education. After 11 years of education, the likelihood of smoking decreased and that of smoking cessation increased with each successive year of education. These results persisted after the statistical adjustment for age, sex, ethnicity, poverty status, employment status, marital status, geographic region, and year of survey. CONCLUSIONS: The relationship between smoking and education is not monotonic. Thus, when evaluating smoking in relation to education, researchers should categorize years of education as follows: 0 to 8, 9 to 11, 12, 13 to 15, and 16 or more years.
Tobacco promotion and susceptibility to tobacco use among adolescents aged 12 through 17 years in a nationally representative sample.
Authors: Altman D G , Levine D W , Coeytaux R , Slade J , Jaffe R
Published: November 2008

OBJECTIVES: The purpose of this study was to examine whether youth participation in tobacco promotion campaigns is associated with susceptibility to tobacco use. METHODS: Data were collected from telephone interviews of a national random sample of 1047 adolescents 12 to 17 years of age. RESULTS: A proportional odds model was used to estimate the effects of age, gender, presence of a tobacco user in the household, awareness of tobacco promotions, knowledge of a young adult or adolescent friend owning a promotional item, participation in tobacco promotions, and receipt of free tobacco samples or direct mail from tobacco companies on susceptibility to tobacco use. All of the covariates, except for receiving direct mailings and knowing a young adult friend who owned a promotional item, were significantly associated with susceptibility. CONCLUSIONS: There is a strong association between an awareness of and involvement with tobacco promotions and being susceptible to tobacco use or a user of tobacco products.
Patterns of health-compromising behaviors among Minnesota adolescents: sociodemographic variations.
Authors: Neumark-Sztainer D , Story M , French S , Cassuto N , Jacobs D R , Resnick M D
Published: November 2008

OBJECTIVES: This study compared prevalence rates of health-compromising behaviors among boys and girls from different ethnic backgrounds in early, middle, and late adolescence and compared co-occurrences of such behaviors across gender and ethnic groups. METHODS: The study population included 123 132 adolescents in grades 6, 9, and 12. Adolescents completed a classroom-administered statewide survey focusing on high-risk behaviors, including unhealthy weight loss, substance abuse, suicide risk, delinquency, and sexual activity. RESULTS: Prevalence rates of most health-compromising behaviors differed by gender, increased with age, and tended to be highest among American Indian youth and lowest among Asian Americans. Strong associations were found between substance abuse and delinquency across all ethnic groups. Substance abuse and delinquency were associated with suicide risk across most ethnic groups. Covariations with sexual activity and unhealthy weight loss behaviors showed more ethnic variation. CONCLUSIONS: Prevention interventions should take into account the tendency for health-compromising behaviors to co-occur and should be sensitive to demographic and socioeconomic differences in behavior patterns.
The cost-effectiveness of HIV prevention targeting: how much more bang for the buck?
Authors: Kahn J G
Published: November 2008

BACKGROUND: Although the targeting of human immunodeficiency virus (HIV) prevention to high-risk populations has been widely discussed, its benefits have not been quantified. METHODS: This analysis of cost-effectiveness combines an HIV epidemic model, target population scenarios, and data on the cost and impact of prevention. RESULTS: The number of HIV infections averted in 5 years with $1 million in annual prevention spending ranges from 164 in high-risk populations to 0.4 in very-low-risk populations. Fortyfold to two-hundredfold differences in prevention costs could equalize HIV infections averted. CONCLUSIONS: Targeting appears to provide substantial benefit and should be considered in allocation decisions about prevention.
Trends in overweight among US adults from 1987 to 1993: a multistate telephone survey.
Authors: Galuska D A , Serdula M , Pamuk E , Siegel P Z , Byers T
Published: November 2008

OBJECTIVES: Using data from the Behavioral Risk Factor Surveillance System, this study describes trends in the prevalence of overweight between 1987 and 1993. METHODS: Data were examined from 33 states participating in an ongoing telephone survey of health behaviors of adults (n = 387,704). Self-reported weights and heights were used to calculate sex-specific prevalence estimates of overweight for each year from 1987 to 1993. Time trends were evaluated with the use of linear regression. RESULTS: Between 1987 and 1993, the age-adjusted prevalence of overweight increased by 0.9% per year for both sexes (from 21.9% to 26.7% among men and from 20.6% to 25.4% among women). The increasing linear trend was observed in all subgroups of the population but was most notable for Black men (1.5% per year) and men living in the Northeast (1.4% per year). Secular changes in smoking and leisure-time physical activity did not entirely account for the increase in overweight. CONCLUSIONS: The prevalence of overweight among American adults increased by 5% between 1987 and 1993. Efforts are needed to explore the causes of this adverse trend and to find effective strategies to prevent obesity.
Faithful patients: the effect of long-term physician-patient relationships on the costs and use of health care by older Americans.
Authors: Weiss L J , Blustein J
Published: November 2008

OBJECTIVES: This study examined the impact of duration of physician-patient ties on the processes and costs of medical care. METHODS: The analyses used a nationally representative sample of Americans 65 years old or older who participated in the Medicare Current Beneficiary Survey in 1991 and had a usual source of care. RESULTS: Older Americans have long-standing ties with their physicians; among those with a usual source of care, 35.8% had ties enduring 10 years or more. Longer ties were associated with a decreased likelihood of hospitalization and lower costs. Compared with patients with a tie of 1 year or less, patients with ties of 10 years or more incurred $316.78 less in Part B Medicare costs, after adjustment for key demographic and health characteristics. However, substantial impacts on the use of selected preventive care services and the adoption of certain healthy behaviors were not observed. CONCLUSIONS: This preliminary study suggests that long-standing physician-patient ties foster less expensive, less intensive medical care. Further studies are needed to confirm these findings and to understand how duration of tie influences the processes and outcomes of care.
Don't ask, they won't tell: the quality of adolescent health screening in five practice settings.
Authors: Blum R W , Beuhring T , Wunderlich M , Resnick M D
Published: November 2008

OBJECTIVES: This study examined the extent to which comprehensive, age-appropriate adolescent health screening is undertaken in the clinical setting and whether the extent of such screening varies by setting. METHODS: Charts of adolescents 13 to 17 years old (n = 788) were randomly selected from five practice settings in Minneapolis, Minn. Each was assessed for the number of biomedical and sociobehavioral health risks screened. RESULTS: In no practice setting was there screening to the level recommended. The two teen clinics screened more extensively for behavioral, psychosocial, substance use and sexual behavior risks than the community family practice setting, which, in turn, screened more extensively than either the private family practice or private pediatric practice settings, which did not differ from each other. Age differences and gender accounted for only small amounts of variance in total number of health risks screened, whereas differences among practice settings accounted for a larger amount. CONCLUSIONS: Results suggest substantive deficiencies in private practice settings' implementation of preventive care screening protocols for adolescents.
The protective effect of AIDS-related behavioral change among injection drug users: a cross-national study. WHO Multi-Centre Study of AIDS and Injecting Drug Use.
Authors: Des Jarlais D C , Friedmann P , Hagan H , Friedman S R
Published: November 2008

OBJECTIVE: This study assessed the relationship between self-reported acquired immunodeficiency syndrome (AIDS) behavioral change and human immunodeficiency virus (HIV) serostatus among injection drug users. METHODS: The study sample involved 4419 injection drug users recruited from drug abuse treatment and nontreatment settings in 11 cities in North America, South America, Europe, Asia, and Australia. The World Health Organization multisite risk behavior questionnaire was used, and either blood or saliva samples for HIV testing were obtained. Subjects were asked, "Since you first heard about AIDS, have you done anything to avoid getting AIDS?" RESULTS: The protective odds ratio for behavioral change against being infected with HIV was 0.50 (95% confidence interval = 0.42, 0.59). While there was important variation across sites, the relationship remained consistent across both demographic and drug use history subgroups. CONCLUSIONS: Injection drug users are capable of modifying their HIV risk behaviors and reporting accurately on behavioral changes. These behavioral changes are associated with their avoidance of HIV infection.
Self-rated health among Hispanic vs non-Hispanic white adults: the San Luis Valley Health and Aging Study.
Authors: Shetterly S M , Baxter J , Mason L D , Hamman R F
Published: November 2008

OBJECTIVES: This study investigated whether objective health indicators explained lower self-rated health among Hispanics compared with non-Hispanic Whites. It also considered socioeconomic and cultural explanations. METHODS: Health ratings of 429 Hispanics and 583 non-Hispanic Whites aged 20 through 74 were analyzed with logistic regression. RESULTS: Illness indicators were found to be strongly correlated with self-rated health in both ethnic groups, but after such markers were controlled for, Hispanics remained 3.6 times more likely to report fair or poor health (95% confidence interval = 2.4, 5.3). Adjustment for socioeconomic factors accounted for a portion of Hispanics' lower health rating, but the strongest explanatory factor was acculturation. CONCLUSIONS: Because of cultural and economic influences on definitions of health, ethnic differences in self-assessed health may not accurately reflected patterns resulting from objective health measurements.
The Washington Heights-Inwood Healthy Heart Program: a 6-year report from a disadvantaged urban setting.
Authors: Shea S , Basch C E , Wechsler H , Lantigua R
Published: November 2008

OBJECTIVES. This report summarizes 6 years of experience in a large community-based cardiovascular disease prevention program in a predominately minority, urban setting. METHODS. The program seeks to reduce cardiovascular disease risk factors in an area of approximately 240,000 people in New York, NY; this population includes many Latino immigrants of low educational attainment and socioeconomic status. All program materials were in Spanish and English and at a low literacy level. RESULTS. Major elements that achieved high levels of reach and support were a marketing campaign promoting low-fat milk, exercise clubs, and a Spanish-language smoking cessation video. Program elements that did not meet expectations or were abandoned were school-based smoking prevention initiatives, cholesterol screening, and efforts to involve local physicians. At the end of 6 years, the program was transferred to a local community organization. CONCLUSIONS. Conclusions are that it is feasible to implement a complex cardiovascular disease prevention program in a socially disadvantaged urban community; that additional evaluation research is needed; that such programs can be transferred from an academic center to a community organization; and that such programs are unlikely to be sustained effectively without external resources.
Occupational exposure to chrysotile asbestos and cancer risk: a review of the amphibole hypothesis.
Authors: Stayner L T , Dankovic D A , Lemen R A
Published: November 2008

OBJECTIVES. This article examines the credibility and policy implications of the "amphibole hypothesis," which postulates that (1) the mesotheliomas observed among workers exposed to chrysotile asbestos may be explained by confounding exposures to amphiboles, and (2) chrysotile may have lower carcinogenic potency than amphiboles. METHODS. A critical review was conducted of the lung burden, epidemiologic, toxicologic, and mechanistic studies that provide the basis for the amphibole hypothesis. RESULTS. Mechanistic and lung burden studies do not provide convincing evidence for the amphibole hypothesis. Toxicologic and epidemiologic studies provide strong evidence that chrysotile is associated with an increased risk of lung cancer and mesothelioma. Chrysotile may be less potent than some amphiboles for inducing mesotheliomas, but there is little evidence to indicate lower lung cancer risk. CONCLUSIONS. Given the evidence of a significant lung cancer risk, the lack of conclusive evidence for the amphibole hypothesis, and the fact that workers are generally exposed to a mixture of fibers, we conclude that it is prudent to treat chrysotile with virtually the same level of concern as the amphibole forms of asbestos.
Chronic gynecological conditions reported by US women: findings from the National Health Interview Survey, 1984 to 1992.
Authors: Kjerulff K H , Erickson B A , Langenberg P W
Published: November 2008

OBJECTIVES. This study sought to describe prevalence rates of chronic gynecological conditions and correlates of these conditions in a representative sample of US women. METHODS. National Health Interview Survey data from 1984 through 1992 for women aged 18 to 50 were used. RESULTS. The estimated annual prevalence rate for the reported presence of one or more gynecological conditions was 97.1 per 1,000 women. Menstrual disorders were most common, with an annual prevalence rate of 53.0 per 1,000 women. Adnexal conditions and fibroids were the next most common conditions, with rates per 1,000 women of 16.6 and 9.2, respectively. Prolapse, endometriosis, and fibroids were the conditions most likely to lead to hysterectomy within the year prior to the interview. More than three quarters (77.1%) of women with gynecological conditions had talked with a doctor in the previous year concerning their condition, and 28.8% reported spending 1 or more days in bed in the previous year because of their condition. CONCLUSIONS. Nearly a tenth of American women aged 18 to 50 report having one or more chronic gynecological conditions annually, the most common being disorders of menstruation.
Is smoking associated with depression and anxiety in teenagers?
Authors: Patton G C , Hibbert M , Rosier M J , Carlin J B , Caust J , Bowes G
Published: November 2008

OBJECTIVES. An association of smoking with depression and anxiety has been documented in adult smokers. This study examines this association in a representative group of teenage smokers. METHODS. A two-stage cluster sample of secondary school students in Victoria, Australia, were surveyed by using a computerized questionnaire, which included a 7-day retrospective diary for tobacco use and a structured psychiatric interview. RESULTS. Subjects reporting high levels of depression and anxiety were twice as likely to be smokers after the potential confounders of year level, sex, alcohol use, and parental smoking were controlled for. Regular smokers were almost twice as likely as occasional smokers to report high levels of depression and anxiety. In a stratified analysis, an association between regular smoking and psychiatric morbidity was found in girls of all ages but for boys only in the youngest group. CONCLUSIONS. The cross-sectional association is consistent with the use of smoking by teenage girls as self-medication for depression and anxiety. Therefore, future health promotional campaigns might consider strategies that attend to perceived psychological benefits of smoking.
Temporal variation in drinking water turbidity and diagnosed gastroenteritis in Milwaukee.
Authors: Morris R D , Naumova E N , Levin R , Munasinghe R L
Published: November 2008

Daily counts of diagnosed gastroenteritis (gastrointestinal events) in Milwaukee County, Wisconsin, from January 1992 through April 1993 were compared with reported daily turbidity from the two drinking water treatment plants serving the county. Turbidity in both plants was associated with an increased number of gastrointestinal events even after exclusion of a major documented outbreak of cryptosporidiosis. During the 434-day period prior to the outbreak, an increase in turbidity of 0.5 nephelometric turbidity units at one of the plants was associated with relative risks for gastrointestinal events of 2.35 among children (95% confidence interval [CI] = 1.34, 4.12) and 1.17 among adults (95% CI = 0.91, 1.52).