bluuebunny/crossref_metadata_2025 huggingface dataset:
Children in special education programs: attention deficit hyperactivity disorder, use of services, and unmet needs.
Authors: Bussing R , Zima B T , Perwien A R , Belin T R , Widawski M
Published: November 2008

OBJECTIVES: Attention deficit hyperactivity disorder (ADHD), a common psychiatric condition, may impair a child's ability to learn and to form social relationships, tasks critical to healthy development. This study describes the prevalence of the disorder among children in special education programs and identifies the extent and predictors of unmet service needs. METHODS: A 2-stage screening protocol of a countywide population of second- through fourth-grade students in special education was conducted to (1) screen for ADHD, employing standardized parent and teacher questionnaires, and determine health services use (n = 499) and (2) perform diagnostic assessments of ADHD (n = 318). RESULTS: Almost half of the children qualified for a diagnosis of ADHD, yet only half of those were reportedly receiving care for the condition, mainly in the general health care sector. Girls were more than 3 times as likely as boys to have unmet service needs; minority status, low income, and health maintenance organization coverage also emerged as possible risk factors for unmet service needs. CONCLUSIONS: ADHD is a common yet often untreated condition among children in special education. Mental health services for children with this disorder should be integrated with general health care and special education programs.
Use of health services by children of smokers and nonsmokers in a health maintenance organization.
Authors: McBride C M , Lozano P , Curry S J , Rosner D , Grothaus L C
Published: November 2008

OBJECTIVES: Use of health services by children of smokers and nonsmokers was compared to assess whether exposure to environmental tobacco smoke resulted in greater use of health services among children of smokers. METHODS: Primary care and emergency room visits, asthma-related prescriptions, and inpatient stays over the 42-month study period were compared for children of smokers (n = 498) and nonsmokers (n = 1062) who were enrolled in a health maintenance organization. Parents of children aged 1 through 11 years were identified from participants in 2 randomized smoking cessation trials. RESULTS: After adjustment for parental age, education, and health status and for child's age, there were no differences between children of smokers and children of nonsmokers in use of primary care or emergency room visits, asthma-related prescriptions, or inpatient stays. However, among those with any preventive care visits, children of smokers had significantly fewer visits than children of nonsmokers. CONCLUSIONS: Further study is needed to elucidate whether parents who smoke underutilize health services for their children or use services differently from nonsmoking parents and whether these differences have cost implications.
Duration of protective immunity conferred by maternal tetanus toxoid immunization: further evidence from Matlab, Bangladesh.
Authors: Koenig M A , Roy N C , McElrath T , Shahidullah M , Wojtyniak B
Published: November 2008

OBJECTIVES: Although maternal tetanus immunization has been shown to be highly effective in the prevention of neonatal tetanus, unresolved questions remain concerning the required minimum number of doses and the resulting duration of effective immunity. This study examined the duration of effective immunity against neonatal tetanus provided by maternal tetanus immunization. METHODS: A randomized, double-blind cholera vaccine trial of 41,571 children and nonpregnant adult women carried out in 1974 in the Matlab comparison area of rural Bangladesh provided a unique opportunity to address dose and immunity issues. RESULTS: Children of women who received either 1 or 2 injections of tetanus toxoid experienced 4- to 14-day mortality levels consistently lower than those of children of unimmunized mothers. Analysis of neonatal-tetanus-related mortality showed that 2 injections of tetanus toxoid provided significant protection for subsequent durations of up to 12 or 13 years. CONCLUSIONS: The data demonstrate that a limited-dose regimen of maternal tetanus toxoid provides significant and extended protection against the risk of neonatal tetanus death.
Utility of percentage of births to teenagers as a surrogate for the teen birth rate.
Authors: Gould J , Blackwell T , Heilig C , Axley M
Published: November 2008

OBJECTIVES: The teen birth rate is commonly used in comparing regional variation in teen pregnancies, but local teen birth rates are not always available. In this study the percentage of all births that are to teens was evaluated for its utility as a surrogate for the teen birth rate. METHODS: Rank correlation and sensitivity and specificity analyses were used. RESULTS: The Spearman rank correlations between percentage of teen births (PTB) and teen birth rate (TBR) were .995, .906, and .841 for the 3 age groups suggesting that it may be reasonable to employ PTB to prioritize zip codes. Zip codes with upper quartile levels of percentages of teen births identified zip codes with upper quartile levels of TBR with a sensitivity of 83.8%, 68.8%, and 65%; a false-positive rate of 2.1%, 8.6%, and 10%; and a positive predictive value of 89.3%, 67.6%, and 67.5% for the age groups 10 through 14, 15 through 17, and 18 through 19 years. CONCLUSIONS: The percentage of births to teens is a useful surrogate for teen birth rate in California, especially among younger teenagers.
Are tobacco industry campaign contributions influencing state legislative behavior?
Authors: Monardi F , Glantz S A
Published: November 2008

OBJECTIVES: This study tested the hypothesis that tobacco industry campaign contributions influence state legislators' behavior. METHODS: Multivariate simultaneous equations regression was used to analyze data on tobacco industry campaign contributions to state legislators and legislators' tobacco control policy scores in 6 states. Campaign contributions were obtained from disclosure statements available in the specific state agency that gathers such information in each state. Tobacco policy scores were derived from a survey of key informants working on tobacco issues in each state. RESULTS: As tobacco industry contributions increase, a legislator's tobacco policy score tends to decrease (i.e., become more pro-tobacco industry). A more pro-tobacco position was associated with larger contributions from the industry. These results were significant even after controls for partisanship, majority party status, and leadership effects. In California, campaign contributions were still significantly related to tobacco policy scores after controls for constituent attitudes and legislators' personal characteristics. CONCLUSIONS: Tobacco industry campaign contributions influence state legislators in terms of tobacco control policy-making.
State variations in supplemental security income enrollment for children and adolescents.
Authors: Perrin J M , Ettner S L , McLaughlin T J , Gortmaker S L , Bloom S R , Kuhlthau K
Published: November 2008

OBJECTIVES: The purpose of this study was to determine the effects of poverty, program generosity, and health on state variations in enrollment of children and adolescents in the Supplemental Security Income (SSI) program during recent program expansions. METHODS: The relationship of state SSI rates for 1989 and 1992 to child poverty, health, and program generosity were determined by multiple regression. RESULTS: The mean percentage of children enrolled grew from 0.36% (1989) to 0.75% (1992). Poverty rates accounted for 78% of the variance among states in 1989 and 53% in 1992. Other indicators accounted for little variance. CONCLUSIONS: Differences in state poverty levels explained almost all variation in SSI enrollment.
Laying down the law: reducing illegal tobacco sales to minors in central Harlem.
Authors: Gemson D H , Moats H L , Watkins B X , Ganz M L , Robinson S , Healton E
Published: November 2008

OBJECTIVES: This study compared the impact of educational and enforcement interventions on retailers' sale of tobacco to minors in Central Harlem, New York. METHODS: In a randomized trial with repeated measures, 152 stores were randomly divided into control, education, and enforcement groups. RESULTS: Overall tobacco sales to 12- and 13-year-old minors at baseline (98%) were among the highest in the nation. At 6-month and 1-year follow-ups, decreases in rates of tobacco sales to minors were modest among education stores and substantial among enforcement stores. CONCLUSIONS: Effective reduction of tobacco sales to minors may require ongoing enforcement measures, including fines for retailers who violate state and local laws.
Teenage smoking, attempts to quit, and school performance.
Authors: Hu T W , Lin Z , Keeler T E
Published: November 2008

OBJECTIVES: This study examined the relationship between school performance, smoking, and quitting attempts among teenagers. METHODS: A logistic regression model was used to predict the probability of being a current smoker or a former smoker. Data were derived from the 1990 California Youth Tobacco Survey. RESULTS: Students' school performance was a key factor in predicting smoking and quitting attempts when other sociodemographic and family income factors were controlled. CONCLUSIONS: Developing academic or remedial classes designed to improve students' school performance may lead to a reduction in smoking rates among teenagers while simultaneously providing a human capital investment in their futures.
Effects of a community-based prevention program on decreasing drug use in high-risk adolescents.
Authors: Chou C P , Montgomery S , Pentz M A , Rohrbach L A , Johnson C A , Flay B R , MacKinnon D P
Published: November 2008

OBJECTIVES: This study investigated the secondary prevention effects of a substance abuse primary prevention program. METHODS: Logistic regression analyses were conducted on 4 waves of follow-up data from sixth- and seventh-grade baseline users of cigarettes, alcohol, and marijuana taking part in a school-based program in Indianapolis. RESULTS: The program demonstrated significant reductions in cigarette use at the initial follow-up (6 months) and alcohol use at the first 2 follow-ups (up to 1.5 years). Models considering repeated measures also showed effects on all 3 substances. CONCLUSIONS: Primary prevention programs are able to reach and influence high-risk adolescents in a nonstigmatizing manner.
Immigration Reporting Laws: Ethical Dilemmas in Pediatric Practice
Authors: Geltman Paul L. , Meyers Alan F.
Published: November 2008

Objectives.

This study assessed the potential impact of immigration reporting requirements on pediatricians' referrals to child protective services.

Methods.

A random sample of 200 Massachusetts pediatricians were surveyed. Chi-square and logistic regression analyses were performed.

Results.

Asked whether potential deportation of the family would cause them to question or alter a decision to refer, 50% of the respondents said yes.

Conclusions.

Pediatricians, as mandated reporters of child abuse, will face ethical dilemmas if laws requiring reporting of immigration status are enacted. (Am J Public Health. 1998;88:967-968)
Effects of a Dutch work-site wellness-health program: the Brabantia Project.
Authors: Maes S , Verhoeven C , Kittel F , Scholten H
Published: November 2008

OBJECTIVES: This study examined a project designed to improve the health and wellness of employees of Brabantia, a Dutch manufacturer of household goods, by means of lifestyle changes and changes in working conditions. METHODS: The workers at one Brabantia site constituted the experimental group, and the workers from two other sites formed the control group. Biomedical variables, lifestyles, general stress reactions, and quality of work were measured identically in both groups at baseline and 1, 2, and 3 years later. During this period, there was continuous registration of absenteeism. RESULTS: The interventions brought about favorable short-term changes in terms of health risks, and there were stable effects on working conditions (especially decision latitude) and absenteeism. CONCLUSIONS: A combination of interventions directed at both lifestyles and the work environment can produce extensive and stable effects on health-related variables, wellness, and absenteeism.
The effect of work status on initiation and duration of breast-feeding.
Authors: Fein S B , Roe B
Published: November 2008

OBJECTIVES: In this study, longitudinal data are used to examine the effect of work status on breast-feeding initiation and duration. METHODS: Mothers from a mail panel completed questionnaires during late pregnancy and 10 times in the infant's first year. Mother's work status was categorized for initiation by hours she expected, before delivery, to work and for duration by hours she worked at month 3. Covariates were demographics; parity; medical, delivery, and hospital experiences; social support; embarrassment; and health promotion. RESULTS: Expecting to work part-time neither decreased nor increased the probability of breast-feeding relative to expecting not to work (odds ratios [ORs] = .83 and .89, P > .50), but expecting to work full-time decreased the probability of breast-feeding (OR = .47, P < .01). Working full-time at 3 months postpartum decreased breast-feeding duration by an average of 8.6 weeks (P < .001) relative to not working, but part-time work of 4 or fewer hours per day did not affect duration, and part-time work of more than 4 hours per day decreased duration less than full-time work. CONCLUSION: Part-time work is an effective strategy to help mothers combine breast-feeding and employment.
Occupational skin diseases in Washington State, 1989 through 1993: using workers' compensation data to identify cutaneous hazards.
Authors: Kaufman J D , Cohen M A , Sama S R , Shields J W , Kalat J
Published: November 2008

OBJECTIVES: This study sought to characterize occupational dermatoses and cutaneous hazards. METHODS: Workers' compensation claims filed for skin disease in the Washington State Fund were analyzed for 1989 through 1993; incidence rates for industries and employers were calculated, and cutaneous hazards associated with the highest rates were identified. RESULTS: A total of 7445 claims were filed for skin disorders, principally contact dermatitis; 675 (9.1%) involved more than 3 missed work-days. The rate of accepted skin disorder claims was 1.0 per 1000 full-time employee-years. The highest incidence rates (4.6 to 30.7 accepted claims per 1000 full-time employee-years) were in certain manufacturing industries (plastics related, concrete products, aircraft parts, sporting goods, and boat building), wholesale farm product raw materials, automotive glass replacement, and beauty shops. Seven of the 10 employers with the highest incidence rates (19.6 to 85.5 accepted claims per 1000 full-time employee-years) used fiber-reinforced plastics (composites) and exposed workers to epoxy and other resin systems associated with contact dermatitis. CONCLUSIONS: Workers' compensation data identify known and emerging workplace cutaneous hazards and show promise for targeting prevention efforts.
Directly observed therapy and treatment completion for tuberculosis in the United States: is universal supervised therapy necessary?
Authors: Bayer R , Stayton C , Desvarieux M , Healton C , Landesman S , Tsai W Y
Published: November 2008

OBJECTIVES: This study examined the relationship between directly observed therapy and treatment completion rates in the years before and after infusion of federal funding for tuberculosis (TB) control in 1993. METHODS: An ecological study of estimated directly observed therapy rates and 12-month treatment completion rates from 1990 through 1994 was undertaken for TB control programs in all 25 cities and counties across the nation with 100 or more incident TB cases in any year from 1990 to 1993. Three cohorts were formed: high treatment completion, intermediate completion, and low completion. RESULTS: In 1990, the median 12-month treatment completion rate was 80% for the entire study population, with a median estimated directly observed therapy rate of 16.8%. By 1994, those rates had increased to 87% and 49.4%, respectively, and increases were shown in all 3 cohorts. CONCLUSIONS: Directly observed therapy has had a marked impact on treatment completion rates in jurisdictions with historically low rates. But TB treatment completion rates of more than 90% can be attained with directly observed therapy rates far lower than those proposed by advocates of universal supervised therapy.
Distinct trends in tuberculosis morbidity among foreign-born and US-born persons in New Jersey, 1986 through 1995.
Authors: Liu Z , Shilkret K L , Tranotti J , Freund C G , Finelli L
Published: November 2008

OBJECTIVES: This study evaluated tuberculosis (TB) morbidity trends among foreign-born and US-born persons. METHODS: TB surveillance data in New Jersey from 1986 to 1995 were analyzed. RESULTS: The overall TB incidence rate in New Jersey declined 15% from 1992 to 1995 after 7 years of increase. However, the incidence rate of TB in foreign-born persons increased 75% from 1986 through 1995. The proportion of foreign-born persons with TB increased from 20% in 1986 to 37% in 1995. CONCLUSIONS: TB morbidity among foreign-born persons has continued to increase, despite the decline in overall TB morbidity since 1992. Targeted TB prevention and control strategies should be developed to effectively reduce TB morbidity in foreign-born persons.
Income inequality and mortality in metropolitan areas of the United States.
Authors: Lynch J W , Kaplan G A , Pamuk E R , Cohen R D , Heck K E , Balfour J L , Yen I H
Published: November 2008

OBJECTIVES: This study examined associations between income inequality and mortality in 282 US metropolitan areas. METHODS: Income inequality measures were calculated from the 1990 US Census. Mortality was calculated from National Center for Health Statistics data and modeled with weighted linear regressions of the log age-adjusted rate. RESULTS: Excess mortality between metropolitan areas with high and low income inequality ranged from 64.7 to 95.8 deaths per 100,000 depending on the inequality measure. In age-specific analyses, income inequality was most evident for infant mortality and for mortality between ages 15 and 64. CONCLUSIONS: Higher income inequality is associated with increased mortality at all per capita income levels. Areas with high income inequality and low average income had excess mortality of 139.8 deaths per 100,000 compared with areas with low inequality and high income. The magnitude of this mortality difference is comparable to the combined loss of life from lung cancer, diabetes, motor vehicle crashes, human immunodeficiency virus (HIV) infection, suicide, and homicide in 1995. Given the mortality burden associated with income inequality, public and private sector initiatives to reduce economic inequalities should be a high priority.
Prevalence of cigar use in 22 North American communities: 1989 and 1993.
Authors: Hyland A , Cummings K M , Shopland D R , Lynn W R
Published: November 2008

OBJECTIVES: This study examined the prevalence rate of and characteristics associated with cigar use. METHODS: Data were derived from population-based telephone surveys of adults conducted in 22 North American communities in 1989 and 1993 as part of the National Cancer Institute's Community Intervention Trial for Smoking Cessation. RESULTS: Averaged across the 22 communities, the prevalence rate of regular cigar use increased 133% from 1989 to 1993. Regular cigar use increased in every gender, age, race, income, education, and smoking status category. CONCLUSION: These results confirm other data indicating that cigar use is increasing.
Health care reform in Croatia: for better or for worse?
Authors: Chen M S , Mastilica M
Published: November 2008

Along with the rest of Central and Eastern Europe, Croatia has begun to dismantle its long-standing socialist health care system and to replace it with a market-based approach. Marketization's advocates maintain that the market will bring efficiency and quality to the Croatian health care system. Nevertheless, data from consumer surveys and official statistics reflect the reform's hidden costs: limited access to care, heightened costs, growing inequality, and the deemphasis of preventive and proactive care in favor of costly therapeutic medicine.
Final results of the Maryland WIC 5-A-Day Promotion Program.
Authors: Havas S , Anliker J , Damron D , Langenberg P , Ballesteros M , Feldman R
Published: November 2008

OBJECTIVES: This National Cancer Institute-funded study sought to increase fruit and vegetable consumption among women served by the WIC program in Maryland. METHODS: Over a 2-year period, a multifaceted intervention program using a randomized crossover design sought to increase fruit and vegetable consumption at 16 WIC program sites in Baltimore City and 6 Maryland counties. Participants were surveyed at baseline, 2 months postintervention, and 1 year later. RESULTS: Two months postintervention, mean daily consumption had increased by 0.56 +/- 0.11 servings in intervention participants and 0.13 +/- 0.07 servings in control participants (P = .002). Intervention participants also showed greater changes in stages of change, knowledge, attitudes, and self-efficacy. Changes in consumption were closely related to number of nutrition sessions attended, baseline stage of change, race, and education. One year later, mean consumption had increased by an additional 0.27 servings in both intervention and control participants. CONCLUSIONS: Dietary changes to prevent cancer can be achieved and sustained in this hard-to-reach, low-income population. However, many obstacles must be overcome to achieve such changes.
Region of birth and black diets: the Harlem Household Survey.
Authors: Greenberg M R , Schneider D , Northridge M E , Ganz M L
Published: November 2008

OBJECTIVES: This study compared dietary risk factors among Southern-born and other Blacks in Central Harlem. METHODS: A survey of residents of Central Harlem was used to compute a "healthy diet" score for 621 subjects. RESULTS: Southern-born respondents had the highest-risk diets. Although their numbers were small, Caribbean-born respondents, particularly those younger than 45 years, had the lowest-risk diets. CONCLUSIONS: The variation in diets in Central Harlem was considerable, with Southern-born Blacks at highest dietary risk for chronic diseases. These results remain to be tested elsewhere, as does the contribution of other chronic disease risk factors.
Is anorexia nervosa associated with elevated rates of suicide?
Authors: Coren S , Hewitt P L
Published: November 2008

OBJECTIVES: The purpose of this study was to ascertain whether individuals with anorexia nervosa are more likely to commit suicide, as suggested by previously noted associations between anorexia nervosa and mood disorders. METHODS: Data from death records representing over 5 million women were examined, yielding 571 cases in which anorexia nervosa was mentioned as an existing condition. The women with anorexia were compared with 1713 control subjects matched for age, sex, and race. RESULTS: The percentage of suicides among those listed as having anorexia nervosa was only 1.4%, compared with 4.1% for the controls. CONCLUSIONS: These findings suggest that the suicide rate is not elevated among individuals currently suffering from anorexia nervosa.
Comparison of 4 questionnaires for assessment of fruit and vegetable intake.
Authors: Field A E , Colditz G A , Fox M K , Byers T , Serdula M , Bosch R J , Peterson K E
Published: November 2008

OBJECTIVE: This study compared fruit and vegetable assessments derived from 4 self-administered questionnaires. METHODS: Among 102 adolescents, servings of fruits and vegetables assessed by 4 questionnaires were compared with estimates from 24-hour recalls. RESULTS: The prevalence of consuming 5 or more servings of fruits and vegetables a day was underestimated by the questionnaires. Questionnaires asking subjects to recall their diet over the previous year were more effective in ranking subjects (r's > or = .42) than those assessing previous-day diet (r's > or = .30). CONCLUSIONS: Brief assessments of fruit and vegetable intake are more useful for ranking subjects than for estimating prevalence of consumption of 5 or more servings per day.
The epidemiology of raw milk-associated foodborne disease outbreaks reported in the United States, 1973 through 1992.
Authors: Headrick M L , Korangy S , Bean N H , Angulo F J , Altekruse S F , Potter M E , Klontz K C
Published: November 2008

OBJECTIVES: This study describes the epidemiology of raw milk-associated outbreaks reported to the Centers for Disease Control and Prevention from 1973 through 1992. METHODS: Surveillance data for each reported raw milk-associated outbreak were reviewed. A national survey was conducted to determine the legal status of intrastate raw milk sales for the period 1973 through 1995. RESULTS: Forty-six raw milk-associated outbreaks were reported during the study period; 40 outbreaks (87%) occurred in states where the intrastate sale of raw milk was legal. CONCLUSIONS: Consumption of raw milk remains a preventable cause of foodborne disease outbreaks.
Perinatal mortality and its relationship to the reporting of low-birthweight infants.
Authors: Phelan S T , Goldenberg R , Alexander G , Cliver S P
Published: November 2008

OBJECTIVES: This study examined changes in the reporting of very low-birthweight infants in Alabama from 1974 to 1994 and the impact on perinatal mortality rates. METHODS: Linked live birth, neonatal death, and stillbirth records of infants born weighing less than 1500 g were compared. RESULTS: The changes in mortality over time ranged from a drop from 100% to 92% in the under-500-g group to a drop from 39% to 4% in the 1000-to 1499-g group. The percentage of total births weighing less than 500 g increased by 155%; the percentage of 1000- to 1499-g births increased by only 7%. As a result, the percentage of neonatal mortality attributable to live births below 500 g increased from 3% to 32%. CONCLUSIONS: Increased reporting of births below 500 g has masked improvements in neonatal mortality.
Pregnant women as a reservoir of undetected sexually transmitted diseases in rural South Africa: implications for disease control.
Authors: Sturm A W , Wilkinson D , Ndovela N , Bowen S , Connolly C
Published: November 2008

OBJECTIVES: This study was undertaken to determine the prevalence of sexually transmitted diseases (STDs) in pregnant women in rural South Africa and to determine the value of using abnormal urogenital symptoms to identify infected women. METHODS: This was a cross-sectional study of 327 patients attending prenatal clinics. RESULTS: Of the 271 women with complete data, 141 (52%) had at least 1 STD and 49 (18%) had more than 1. Abnormal symptoms were common (n = 225; 83%), but associations were weak, and the positive predictive value of different symptoms for infection ranged from 2% to 54%. CONCLUSIONS: Most STDs in rural South African women remain undetected and untreated. As the scope for laboratory diagnosis in resource-poor settings is limited, presumptive treatment of pregnant women and their partners may be a cost-effective option to reduce transmission of STDs and HIV infection.
The socially constructed breast: breast implants and the medical construction of need.
Authors: Jacobson N
Published: November 2008

When silicone gel breast implants became the subject of a public health controversy in the early 1990s, the most pressing concern was safety. This paper looks at another, less publicized issue: the need for implants. Using a symbolic interactionist approach, the author explores the social construction of the need for implants by tracing the history of the 3 surgical procedures for which implants were used. Stakeholders in this history constructed need as legitimized individual desire, the form of which shifted with changes in the technological and social context.
The prevalence of homelessness among adolescents in the United States.
Authors: Ringwalt C L , Greene J M , Robertson M , McPheeters M
Published: November 2008

OBJECTIVES: Homeless adolescents represent one of the nation's most vulnerable populations. This study reports the 12-month prevalence of homeless episodes among US adolescents. METHODS: Personal, audiotaped interviews were conducted in 1992 and 1993 with a representative household sample of 6496 adolescents aged 12 to 17 as part of the Youth Risk behavior Survey sponsored by the Centers for Disease Control and Prevention. Respondents reported whether they had spent the night in any of a variety of locations other than home during the previous 12 months. RESULTS: Altogether, 7.6% of the youths questioned reported that they had spent at least 1 night in youth or adult shelter (3.3%), public place (2.2%), an abandoned building (1.0%), outside 2.2%), underground (0.4%), or with a stranger (1.1%). Boys were much more likely than girls to report having experienced a homeless episode. CONCLUSIONS: This study suggests that homelessness among adolescents is not simply an urban problem and that prevention programs targeting homeless youths should be implemented nationwide. Additional research is needed to assess the frequency and duration of homeless experiences. Future studies of homelessness in the general population should include questions pertinent to adolescents.
Projections of Alzheimer's disease in the United States and the public health impact of delaying disease onset.
Authors: Brookmeyer R , Gray S , Kawas C
Published: November 2008

OBJECTIVES: The goal of this study was to project the future prevalence and incidence of Alzheimer's disease in the United States and the potential impact of interventions to delay disease onset. METHODS: The numbers of individuals in the United States with Alzheimer's disease and the numbers of newly diagnosed cases that can be expected over the next 50 years were estimated from a model that used age-specific incidence rates summarized from several epidemiological studies, US mortality rates, and US Bureau of the Census projections. RESULTS: in 1997, the prevalence of Alzheimer's disease in the United States was 2.32 million (range: 1.09 to 4.58 million); of these individuals, 68% were female. It is projected that the prevalence will nearly quadruple in the next 50 years, by which time approximately 1 in 45 Americans will be afflicted with the disease. Currently, the annual number of new incident cases in 360,000. If interventions could delay onset of the disease by 2 years, after 50 years there would be nearly 2 million fewer cases than projected; if onset could be delayed by 1 year, there would be nearly 800,000 fewer prevalent cases. CONCLUSIONS: As the US population ages, Alzheimer's disease will become an enormous public health problem. interventions that could delay disease onset even modestly would have a major public health impact.
An assessment of US and Canadian smoking reduction objectives for the year 2000.
Authors: Pechmann C , Dixon P , Layne N
Published: November 2008

OBJECTIVES: This study assessed whether US and Canadian smoking reduction objectives for the year 2000 are attainable. The United States seeks to cut smoking in its population to 15%; the Canadian goal is 24%. METHODS: Smoking data were obtained for the United States (1974-1994) and Canada (1970-1995) for the overall populations and several age-sex subpopulations. Analyses estimated trends, future prevalences, and the likelihood of goal attainment. Structural time-series models were used because of their ability to fit a variety of trends. RESULTS: The findings indicate that smoking has been declining steadily since the 1970s, by approximately 0.7 percentage points a year, in both countries. Extrapolating these trends to the year 2000, the US prevalence will be 21% and the Canadian prevalence 24%. CONCLUSIONS: If the current trends continue, the Canadian goal seems attainable, but the US goal does not. The US goal is reachable only for 65-to 80-year-olds, who already have low smoking prevalences. It appears that both countries must increase their commitment to population-based tobacco control.
The developmental status and adaptive behavior of homeless and low-income housed infants and toddlers.
Authors: Garcia Coll C , Buckner J C , Brooks M G , Weinreb L F , Bassuk E L
Published: November 2008

OBJECTIVES: This study describes the development status of 127 homeless and 91 low-income housed infants and toddlers. METHODS: The Bayley Scales of Infant Development and the Vineland Screener were used to gather data. RESULTS: There were no differences between homeless and low-income housed children. However, younger children in both groups performed better than the older children on most summary scores. CONCLUSIONS: Homeless and low-income housed children did not differ in their cognitive and motor skills. However, older children scored lower than younger children on most measures of development status, suggesting that the cumulative effects of poverty may increase with time.
Dispensation of emergency contraceptive pills in Michigan Title X clinics.
Authors: Brown J W , Boulton M L
Published: November 2008

OBJECTIVES: Emergency contraceptive pill dispensation was estimated in Michigan Title X family planning programs. METHODS: Logistic regression and tobit estimation models were used to predict whether and to what extent emergency contraceptive pills are dispensed. RESULTS: Of the 53 programs studies, 32 dispensed emergency contraceptive pills, averaging fewer than one client per month. Total dispensation was skewed toward a few programs, and the contribution of health departments to this total was small. Emergency contraceptive pill services appeared to be randomly distributed across programs, although most dispenser reported having provided the pills for less than 12 months. CONCLUSIONS: Recent policy advances should lead to more consistent emergency contraceptive pill dispensation in Title X programs.
Changes in indications for cesarean delivery: United States, 1985 and 1994.
Authors: Gregory K D , Curtin S C , Taffel S M , Notzon F C
Published: November 2008

OBJECTIVES: The percentages of cesarean deliveries attributable to specific indications (breech, dystocia, fetal distress, and elective repeat cesarean) were computed for 1985 and 1994. METHODS: Data were derived from the 1985 and 1994 National Hospital Discharge Surveys. RESULTS: Dystocia was the leading indication for cesarean delivery in both years. In comparison with 1985, cesareans performed in 1994 that were attributable to dystocia and breech presentation increased, those attributable to fetal distress did not change significantly, and elective repeat cesareans declined. CONCLUSIONS: Studying indications for cesareans can be useful for hospitals, clinicians, and researchers in determining strategies to lower primary and repeat cesarean rates.
Telephone coverage and measurement of health risk indicators: data from the National Health Interview Survey.
Authors: Anderson J E , Nelson D E , Wilson R W
Published: November 2008

OBJECTIVES: This study compared health behavior variables for all US households and households with telephones to measure the potential impact of telephone coverage on estimates from telephone surveys. METHODS: Data were derived from the 1991 through 1994 version of the National Health Interview Survey. RESULTS: Ninety-five percent of respondents lived in households with telephones. Differences in health indicators were small (< 1%) in comparisons between all households and those with telephones. Results were similar when only respondents below the poverty level were included. CONCLUSIONS: Telephone noncoverage effects appear to be small, supporting the use of telephone surveys for health risk behavior surveillance with most population groups.
Pathologies of power: rethinking health and human rights.
Authors: Farmer P
Published: November 2008

The field of health and human rights has grown quickly, but its boundaries have yet to be traced. Fifty-one years after the Universal Declaration of Human Rights, consensus regarding the most promising directions for the future is lacking; however, outcome-oriented assessments lead us to question approaches that rely solely on recourse to formal legal and civil rights. Similarly unpromising are approaches that rely overmuch on appeals to governments: careful study reveals that state power has been responsible for most human rights violations and that most violations are embedded in "structural violence"--social and economic inequities that determine who will be at risk for assaults and who will be shielded. This article advances an agenda for research and action grounded in the struggle for social and economic rights, an agenda suited to public health and medicine, whose central contributions to future progress in human rights will be linked to the equitable distribution of the fruits of scientific advancement. Such an approach is in keeping with the Universal Declaration but runs counter to several of the reigning ideologies of public health, including those favoring efficacy over equity.
The role of socioeconomic status gradients in explaining differences in US adolescents' health.
Authors: Goodman E
Published: November 2008

OBJECTIVE: This study sought to determine whether socioeconomic status (SES) gradients exist among US adolescents for self-rated health and for 5 diseases that cause serious adolescent and continuing adult morbidity. METHODS: Baseline data from 15,483 adolescent and parental surveys from the National Longitudinal Study of Adolescent Health were used. SES indicators included parental education and occupation, and household income. Dependent variables included self-rated health and the presence of depression, obesity, asthma, suicide attempt in the past year, and prior sexually transmitted disease. RESULTS: SES gradients were found for self-rated health, depression, and obesity (P < .01). Suicide attempt was linearly associated with income (P < .01). After adjustment for other SES and sociodemographic factors, education and income remained independent correlates of both depression and obesity; income remained an independent correlate of attempted suicide. CONCLUSIONS: Differences in susceptibility to socially mediated etiologic mechanisms of disease may exist during adolescence. Understanding the sociostructural context and patterning of adolescents' lives is crucial to clearly understanding health and disease etiology throughout the course of life.
Lifetime health and economic benefits of weight loss among obese persons.
Authors: Oster G , Thompson D , Edelsberg J , Bird A P , Colditz G A
Published: November 2008

OBJECTIVES: This study estimated the lifetime health and economic benefits of sustained modest weight loss among obese persons. METHODS: We developed a dynamic model of the relationship between body mass index (BMI) and the risks and costs of 5 obesity-related diseases: hypertension, hypercholesterolemia, type 2 diabetes, coronary heart disease (CHD), and stroke. We then calculated the lifetime health and economic benefits of a sustained 10% reduction in body weight for men and women aged 35 to 64 years with mild, moderate, and severe obesity. RESULTS: Depending on age, gender, and initial BMI, a sustained 10% weight loss would (1) reduce the expected number of years of life with hypertension, hypercholesterolemia, and type 2 diabetes by 1.2 to 2.9, 0.3 to 0.8, and 0.5 to 1.7, respectively; (2) reduce the expected lifetime incidence of CHD and stroke by 12 to 38 cases per 1000 and 1 to 13 cases per 1000, respectively; (3) increase life expectancy by 2 to 7 months; and (4) reduce expected lifetime medical care costs of these 5 diseases by $2200 to $5300. CONCLUSIONS: Sustained modest weight loss among obese persons would yield substantial health and economic benefits.
The Latino mortality paradox: a test of the "salmon bias" and healthy migrant hypotheses.
Authors: Abraído-Lanza A F , Dohrenwend B P , Ng-Mak D S , Turner J B
Published: November 2008

OBJECTIVES: Relative to non-Latino Whites, Latinos have a worse socioeconomic profile but a lower mortality rate, a finding that presents an epidemiologic paradox. This study tested the salmon bias hypothesis that Latinos engage in return migration to their country of origin and are thereby rendered "statistically immortal" and the alternative hypothesis that selection of healthier migrants to the United States accounts for the paradox. METHODS: National Longitudinal Mortality Study data were used to examine mortality rates of the following groups for whom the salmon hypothesis is not feasible: Cubans, who face barriers against return migration; Puerto Ricans, whose deaths in Puerto Rico are recorded in US national statistics; and US-born individuals, who are not subject to either salmon or healthy migrant effects. RESULTS: The sample included 301,718 non-Latino Whites and 17,375 Latino Whites 25 years or older. Cubans and Puerto Ricans had lower mortality than non-Latino Whites. Moreover, US-born Latinos had lower mortality than US-born non-Latino Whites. CONCLUSIONS: Neither the salmon nor the healthy migrant hypothesis explains the pattern of findings. Other factors must be operating to produce the lower mortality.
Coverage of beverage alcohol issues in the print media in the United States, 1985-1991.
Authors: Lemmens P H , Vaeth P A , Greenfield T K
Published: November 2008

OBJECTIVES: This study assessed the portrayal of alcohol-related issues in the print media in the United States during the 7-year period bracketing implementation of the US alcohol warning label act in November 1988. METHODS: All articles that appeared from 1985 to 1991 in 5 national newspapers and that were indexed as dealing with beverage alcohol were identified. Content analysis of a 15% sample of these articles allowed an in-depth assessment of the conceptualization of alcohol in the US print media. RESULTS: A slight decrease in articles related to alcoholism was offset by an increase in articles about the more general health-related effects of alcohol. The warning label act received little attention. Most articles portrayed alcohol neutrally or negatively, using information from government sources. CONCLUSIONS: Portrayal of alcohol in the US print media has changed in recent decades. A general shift noted as early as the 1960s has increasingly emphasized public health issues and deemphasized clinical aspects of alcoholism. This has been accompanied by a continuing shift away from a biopsychological definition of alcohol-related behavior to a definition stressing external environmental factors.
Patient satisfaction with care at directly observed therapy programs for tuberculosis in New York City.
Authors: Davidson H , Smirnoff M , Klein S J , Burdick E
Published: November 2008

OBJECTIVES: This study examined patients' satisfaction with New York State's tuberculosis (TB) directly observed therapy (DOT) programs in New York City. METHODS: A survey was conducted of 435 patients at 19 public, private, and community-based TB DOT clinics about their satisfaction with various aspects of the programs. RESULTS: Patients identified the opportunity to receive good medical care as the most important aspect of TB DOT. Also significant was the supportiveness of DOT staff. Receiving incentives to encourage participation was statistically less important. Half of the patients reported being better off with DOT than with self-supervised care. CONCLUSIONS: This study confirms the value of patient-focused care among inner-city TB patients.
Correlates of leisure-time physical activity in an elderly population in Singapore.
Authors: Lian W M , Gan G L , Pin C H , Wee S , Ye H C
Published: November 2008

OBJECTIVES: This study assessed correlates of leisure-time physical activity among the elderly in Singapore. METHODS: A cross-sectional household survey was conducted in 1998 with 2494 subjects 60 years and older. RESULTS: Regular leisure-time physical activity was practiced by 47.0% of men and 38.5% of women. It was significantly correlated with family support, proportion of family members exercising, awareness of benefits of exercise, and healthy dietary habits. Other significant but negative correlates were smoking and barriers to exercise, such as lack of time and poor health. CONCLUSIONS: Exercise programs for the elderly should aim at helping them overcome barriers to exercise, informing them of the benefits of exercise, and involving their families.
Powerful connections for public health: the National Library of Medicine and the National Network of Libraries of Medicine.
Authors: Humphreys B L , Ruffin A B , Cahn M A , Rambo N
Published: November 2008

As incorporated in Healthy People 2010 objectives, data and information systems and a skilled workforce are 2 of the critical components of the public health infrastructure. The National Library of Medicine (NLM) and the National Network of Libraries of Medicine (NN/LM) are important resources for improving Internet access and providing related training to the public health workforce and to those in training for public health careers. The NLM and the NN/LM have joined forces with the Centers for Disease Control and Prevention, the Health Resources and Services Administration, the Association of State and Territorial Health Officials, the National Association of County and City Health Officials, and the Public Health Foundation. The goal of this collaboration is to improve electronic resources useful in public health practice and increase awareness of them, to train public health professionals to use electronic information services, and to help public health agencies obtain the equipment and Internet connections needed to use these services effectively. The databases, outreach programs, and connection grants available to public health professionals from the NLM, and the training and ongoing support available from the NN/LM for accessing these programs and services, are described.
Prenatal diagnosis and selective abortion: a challenge to practice and policy.
Authors: Asch A
Published: November 2008

Professionals should reexamine negative assumptions about the quality of life with prenatally detectable impairments and should reform clinical practice and public policy to improve informed decision making and genuine reproductive choice. Current data on children and families affected by disabilities indicate that disability does not preclude a satisfying life. Many problems attributed to the existence of a disability actually stem from inadequate social arrangements that public health professionals should work to change. This article assumes a pro-choice perspective but suggests that unreflective uses of prenatal testing could diminish, rather than expand, women's choices. This critique challenges the view of disability that lies behind the social endorsement of such testing and the conviction that women will or should end their pregnancies if they discover that the fetus has a disabling trait.