bluuebunny/crossref_metadata_2025 huggingface dataset:
Frequent dieting among adolescents: psychosocial and health behavior correlates.
Authors: French S A , Story M , Downes B , Resnick M D , Blum R W
Published: November 2008

OBJECTIVES. The present study examined correlates of frequent dieting in 33,393 adolescents. It was hypothesized that frequent dieting would be correlated with negative psychosocial and health behavior outcomes. METHODS. A comprehensive, school-based health behavior survey was administered in 1987 to public school students in grades 7 through 12 in Minnesota. Students self-reported dieting behavior; substance use; suicidal, sexual, and delinquent behavior; family and peer concerns; sick days; and abuse history. Differences on psychosocial and health behavior risk factors by dieting frequency and by purging status were assessed with multivariate logistic regression, with body mass index and demographic variables controlled. RESULTS. Dieting frequency was associated with history of binge eating (females: odds ratio [OR] = 1.46, males: OR = 1.53); poor body image (females: OR = 0.56, males: OR = 0.63); lower connectedness to others (females: OR = 0.79); greater alcohol use (females: OR = 1.17); and greater tobacco use (females: OR = 1.08). Purging status was independently associated with negative risk factors in both males and females. CONCLUSIONS. These findings suggest that frequent dieting efforts in adolescents should not be viewed in isolation, but rather in the broader context of health and risk-taking behaviors.
Chronic obstructive pulmonary disease in lifelong nonsmokers: results from NHANES.
Authors: Whittemore A S , Perlin S A , DiCiccio Y
Published: November 2008

The prevalence of chronic obstructive pulmonary disease was evaluated in 12,980 lifelong nonsmoking adults who participated in one of three National US Health and Nutrition Examination Surveys. Also evaluated were the relationships between chronic obstructive pulmonary disease and age, sex, ethnicity, education, income, and certain environmental and occupational factors. Overall, 4% of men and 5% of women reported physician-diagnosed chronic obstructive pulmonary disease. Prevalence increased with age and with decreasing household income, was higher in Whites than in non-Whites, and was particularly high in Hispanic women. Further research is needed to explain the excess risk for chronic obstructive pulmonary disease in economically disadvantaged nonsmokers, and to assess the role of environmental tobacco smoke in nonsmokers' risk for the disease.
The epidemiology of walking for exercise: implications for promoting activity among sedentary groups.
Authors: Siegel P Z , Brackbill R M , Heath G W
Published: November 2008

The relative contribution of walking to overall leisure-time physical activity participation rates was studied among respondents from the 45 states that participated in the 1990 Behavioral Risk Factor Surveillance System (n = 81,557). The percentages of low income, unemployed, and obese persons who engaged in leisure-time physical activity (range = 51.1% to 57.7%) were substantially lower than the percentage among the total adult population (70.3%). In contrast, the prevalence of walking for exercise among these sedentary groups (range = 32.5% to 35.9%) was similar to that among the total population (35.6%). Walking appears to be an acceptable, accessible exercise activity, especially among population subgroups with a low prevalence of leisure-time physical activity.
Vitamin A capsule supplementation in Malawi villages: missed opportunities and possible interventions.
Authors: Berger R A , Courtright P , Barrows J
Published: November 2008

A population-based survey was used to assess childhood and maternal vitamin A capsule coverage in Malawi and to investigate missed opportunities for capsule distribution. Overall, 9.3% of children had received vitamin A supplementation in the previous 6 months. Missed opportunities for receiving vitamin A were high in younger children. Fifty-five percent of mothers were covered in 8 villages served by volunteers and 23% in the 58 villages without volunteers. Existing strategies need to be redesigned and new strategies defined. For instance, mothers could receive supplementation during infant BCG vaccination, and children could receive initial supplementation during measles vaccination. Village health volunteers could be used to target children over 2 years of age.
Physician recommendations for dietary change: their prevalence and impact in a population-based sample.
Authors: Hunt J R , Kristal A R , White E , Lynch J C , Fries E
Published: November 2008

A random-digit-dialing survey to examine the prevalence, content, and impact of physician dietary recommendations in a representative population-based sample of Washington State residents was administered to 1972 persons aged 18 years and older. Twenty percent of those surveyed received a physician's recommendation for dietary change in the previous year. The most common recommendations were to decrease intake of cholesterol, calories, and red meat and to increase intake of vegetables and fiber. Respondents receiving recommendations were more likely to report decreased use of high-fat foods and increased use of high-fiber foods and to be in the maintenance stage of dietary change. Results suggest that physicians can play a limited role in promoting dietary change.
The Pawtucket Heart Health Program: community changes in cardiovascular risk factors and projected disease risk.
Authors: Carleton R A , Lasater T M , Assaf A R , Feldman H A , McKinlay S
Published: November 2008

OBJECTIVES. Whether community-wide education changed cardiovascular risk factors and disease risk in Pawtucket, RI, relative to a comparison community was assessed. METHODS. Random-sample, cross-sectional surveys were done of people aged 18 through 64 years at baseline, during, and after education. Baseline cohorts were reexamined. Pawtucket citizens of all ages participated in multilevel education, screening, and counseling programs. RESULTS. The downward trend in smoking was slightly greater in the comparison city. Small, insignificant differences favored Pawtucket in blood cholesterol and blood pressure. In the cross-sectional surveys, body mass index increased significantly in the comparison community; a similar change was not seen in cohort surveys. Projected cardiovascular disease rates were significantly (16%) less in Pawtucket during the education program. This difference lessened to 8% posteducation. CONCLUSIONS. The hypothesis that projected cardiovascular disease risk can be altered by community-based education gains limited support from these data. Achieving cardiovascular risk reduction at the community level was feasible, but maintaining statistically significant differences between cities was not. Accelerating risk factor changes will likely require a sustained community effort with reinforcement from state, regional, and national policies and programs.
The screening histories of women with invasive cervical cancer, Connecticut.
Authors: Janerich D T , Hadjimichael O , Schwartz P E , Lowell D M , Meigs J W , Merino M J , Flannery J T , Polednak A P
Published: November 2008

OBJECTIVES. Each case of a continuous series of invasive cervical cancer cases was studied with a structured review procedure conducted by an expert panel to assess the reason that it was not detected before it became invasive. METHODS. All cases of invasive cervical cancer diagnosed in a 5-year period among Connecticut residents were identified; a screening history and screening outcome were obtained for 72% (481 of 664). RESULTS. Two hundred fifty women (51.9%) had suboptimal screening. One hundred thirty-seven women (28.5%) had never had a screening test, and their mean age was greater than that of the rest of the study population (64.5 years vs 46.5 years). Of the 344 women who had ever had a Pap test, 113 (32.8%) had their last Pap test 5 or more years before their diagnosis of invasive cancer; 52 (15.1%) were not followed up properly; 33 (9.6%) had their last smear misread as normal; and 118 (34.3%) developed cervical cancer within 3 years of their last Pap test. CONCLUSIONS. Physicians, nurses, and other care providers need to ensure that woman have timely and accurate screening with proper follow-up, make increased efforts to reach older women, and improve quality control of Pap smear readings.
Cancer screening by primary care physicians: a comparison of rates obtained from physician self-report, patient survey, and chart audit.
Authors: Montaño D E , Phillips W R
Published: November 2008

OBJECTIVES. This study measured the cancer screening rates of family physicians and compared the measures obtained through physician self-reports, chart audits, and patient surveys. METHODS. A cancer screening survey was sent to 50% of the members of the Washington Academy of Family Physicians, with 326 family physicians (74% response rate) completing the survey. Sixty physicians were recruited for the patient survey and chart audit phase, with a 90% participation rate. Patient surveys were conducted with about 350 patients per physician, and chart audits were conducted on a subset of about 50 patients per physician. Each physician's rate of providing each service was computed from the self-report, the patient survey, and the chart audit. RESULTS. Physicians provided many of these services at rates different from those commonly recommended. Large discrepancies were found between the rates measured by different methods. Correlations between rates derived from chart audits and patient surveys were high; however, correlations between rates from physician self-report and either patient survey or chart audit were much lower for all services. CONCLUSIONS. Studies of physicians' provision of cancer prevention services should not rely on physician self-report, but should obtain the rates through patient surveys or chart audits.
The limitations of breast cancer screening for first-degree relatives of breast cancer patients.
Authors: Neugut A I , Jacobson J S
Published: November 2008

Bitter controversy surrounds the recommendation of mammographic breast-cancer screening for women aged 40 and 49 years of average risk. This paper considers the case for screening women in their 40s with higher risk, specifically women who have one or more first-degree relatives with breast cancer. A review of the literature and of current knowledge suggests that screening such women is more cost-effective, in the sense of having a higher yield per mammogram and better predictive value, than screening women of average risk in this age group. However, there is no evidence that screening is more efficacious in reducing mortality in this subgroup than in other women in their 40s.
Should college students be vaccinated against meningococcal disease? A cost-benefit analysis.
Authors: Jackson L A , Schuchat A , Gorsky R D , Wenger J D
Published: November 2008

Outbreaks and sporadic cases of meningococcal disease among college students have prompted consideration of a policy of routine vaccination for this group. Purchase and administration of the vaccine for routine vaccination would cost $56 million per year. Savings in medical care and indirect costs would not equal this amount unless the annual rate of disease among students is at least 6.5/100,000. The actual rate among students is unknown; however, surveillance data suggest it could not be more than 1.3/100,000. At rates near this estimate, the net cost of the program would be approximately $45 million annually. More cost-effective prevention strategies might be yielded by further studies to identify students at substantial risk of meningococcal disease, or by the development of a conjugate serogroup C vaccine that could be administered during infancy.
A preventive child health program: the effect of telephone and home visits by public health nurses.
Authors: Oda D S , Heilbron D C , Taylor H J
Published: November 2008

A randomized trial was conducted to determine if a public health nursing intervention consisting of telephone contacts or home visits affected the receipt of preventive health services by children eligible for the Early Periodic Screening, Diagnosis, and Treatment program. Each nursing intervention was applied using a protocol, and outcome data for 1654 case subjects were obtained from state-paid provider claims. However, the trial revealed no statistically significant differences between the study groups, nor was ethnicity a significant factor. Methodological and study context issues were identified that may have affected the results, the generalization of which is limited by the strict selection of cases.
Characteristics of repeat trauma patients, San Diego County.
Authors: Hedges B E , Dimsdale J E , Hoyt D B , Berry C , Leitz K
Published: November 2008

Data on 22,312 admissions to the San Diego County Trauma System were used to identify 185 trauma patients admitted repeatedly to trauma units. These patients were compared with the entire group of nonrepeating trauma patients admitted during the 80-month period of the study. In comparison with nonrepeaters, the repeaters were younger, were more often men, were more often Black, and were much more frequently victims of assault. Forty-eight percent of the repeaters were injured by the same general mechanism on both admissions.
Neonatal technology, perinatal survival, social consequences, and the perinatal paradox.
Authors: Kliegman R M
Published: November 2008

Exogenous surfactant therapy for premature infants with respiratory distress syndrome has had a significant impact on infant mortality and on some complications of prematurity. Yet the total number of low-birthweight infants has not declined, resulting in a high-risk population who would require surfactant therapy and long-term child care. Surviving low-birthweight infants (despite surfactant therapy) remain at risk for the consequences of premature birth, such as neurosensory impairment, cerebral palsy, and chronic lung disease. In addition, because of the close association between poverty and low birthweight, surviving premature infants are at increased risk for the new morbidities such as violence, homelessness, child abuse and neglect, and addictive drug use. A goal should be to reduce the risk of being born with a low birthweight, rather than having to treat the consequences of premature gestation. Despite the marvelous advances that permit us to treat respiratory distress syndrome, the continuing high low-birthweight rate places a significant strain on our health care system. The goal should be redirected to identifying large population-based efforts to reduce the number of low-birthweight infants.
Correlates of college student binge drinking.
Authors: Wechsler H , Dowdall G W , Davenport A , Castillo S
Published: November 2008

OBJECTIVES. This study examines the individual correlates of college student binge drinking. METHODS. Questionnaires were completed by a representative national sample (n = 17,592) of students on 140 campuses in 1993. Binge drinking was defined as five or more drinks per episode for men and as four or more drinks per episode for women. RESULTS. Overall, 44% of the students (50% of the men and 39% of the women) binged. While demographic factors such as sex and race were significantly related to binge drinking, prior binging in high school was crucial, suggesting that for many students, binge drinking begins before college. The strongest predictors of college binge drinking were residence in a fraternity or sorority, adoption of a party-centered life-style, and engagement in other risky behaviors. CONCLUSIONS. Interventions must be targeted at high school binge drinking as well as at several characteristics of college life--most notably fraternity residence. Legal drinking age fails to predict binge drinking, raising questions about the effectiveness of the legal minimum drinking age of 21 in college alcohol policies.
The epidemiology of nonfatal injuries among US children and youth.
Authors: Scheidt P C , Harel Y , Trumble A C , Jones D H , Overpeck M D , Bijur P E
Published: November 2008

OBJECTIVES. National data are not routinely available regarding the incidence of and associated risk factors for nonfatal injuries in children and youth. The Child Health Supplement to the 1988 National Health Interview Survey provided an opportunity to determine accurate national estimates of childhood injury morbidity by demographic factors, location, external cause, nature of injury, and other factors. METHODS. The closest adult for 17,110 sampled children was asked whether the child had had an injury, accident, or poisoning during the preceding 12 months and about the cause, location, and consequences of the event. An analysis for potential underreporting from 12 months of recall provided adjustments of annual rates to those for a 1-month recall period. RESULTS. On the basis of 2772 reported injuries, the national estimated annual rate for children 0 to 17 years of age was 27 per 100 children after adjustment to 1-month recall. Boys experienced significantly higher rates than girls (risk ratio [RR] = 1.52, 95% confidence interval [CI] = 1.37, 1.68), and adolescents experienced the highest overall rate (38 per 100 children) and proportion of serious injuries. CONCLUSIONS. Approximately one fourth of US children experience a medically attended injury each year, but the risks vary considerably depending on the characteristics of subgroups and the injury cause.
Infant mortality in the United States: trends, differentials, and projections, 1950 through 2010.
Authors: Singh G K , Yu S M
Published: November 2008

OBJECTIVES. This study examined long-term trends and differences in infant mortality in the United States from 1950 through 1991 according to race and ethnicity, education, family income, and cause of death. Forecasts are made through the year 2010. METHODS. Log-linear regression models were applied to data from the National Vital Statistics System, National Linked Birth and Infant Death files, the National Maternal and Infant Health Survey, the National Natality Survey, and the National Infant Mortality Survey to model and forecast infant mortality. RESULTS. Dramatic declines in the US infant mortality rate have occurred in the past 4 decades, largely as a result of declines in mortality from pneumonia and influenza, respiratory distress syndrome, prematurity and low birthweight, congenital anomalies, and accidents. Despite the overall reductions, however, substantial racial/ethnic, educational, and income differences in infant mortality still exist. CONCLUSIONS. The long-term downward trend in US infant mortality has not benefited Blacks and Whites equally. The Black/White disparity in infant mortality has not only persisted but increased over time and is not expected to diminish in the near future. Educational inequalities have also widened, and racial disparities have generally increased across all educational levels.
Gender differences in nutritional status and feeding patterns among infants in the Gaza Strip.
Authors: Schoenbaum M , Tulchinsky T H , Abed Y
Published: November 2008

OBJECTIVES. This study examined gender variation in nutritional treatment and anthropometric status of infants in the Gaza Strip. Numerous studies have documented gender differences in health status in developing areas, generally finding boys to be at an advantage over girls. Social and economic characteristics in Gaza suggest that one might expect preferential treatment of boys there. METHODS. The study used data on two samples of infants 0 to 18 months of age collected from five health centers in Gaza. A variety of different analytic methods were used to look for gender differences in feeding patterns, prevalence of malnutrition, and anthropometric status. RESULTS. Although some differences in nutritional treatment and anthropometric outcome for infants of different socioeconomic status and between the earlier and later samples were found, no consistent gender differences were revealed. CONCLUSIONS. The findings are consistent with several different explanations. First, expectations of finding gender differences may have been unfounded. Alternatively, such differences may have existed previously but have been eliminated through successful public health intervention, rising levels of education, and economic development.
Tuberculosis knowledge among New York City injection drug users.
Authors: Wolfe H , Marmor M , Maslansky R , Nichols S , Simberkoff M , Des Jarlais D , Moss A
Published: November 2008

Structured interviews measuring tuberculosis knowledge were administered to 494 New York City injection drug users, 31% of whom reported a history of having a reactive tuberculin skin test. Medical records review of a subsample confirmed the validity of self-reported data. Most respondents understood the mechanisms of tuberculosis transmission. Three fourths of the subjects did not fully understand the distinction between a reactive skin test and active tuberculosis, but those who reported a history of skin test reactivity were twice as likely to understand this distinction. Forty percent of subjects did not understand the importance of medication adherence. Misunderstandings, based on a recent lack of tuberculosis education, may contribute to the fear and confusion that interfere with efforts to control tuberculosis.
Promoting tobacco control policies in northwest Indian tribes.
Authors: Lichtenstein E , Glasgow R E , Lopez K , Hall R , McRae S G , Meyers G B
Published: November 2008

A culturally sensitive consultative process to facilitate adoption by tribal councils of more effective tobacco control policies was developed and evaluated. Thirty-nine Northwest Indian tribes were randomized to early intervention or late intervention conditions. Early intervention tribes received a policy workbook and consultation by means of meetings and telephone calls. Late intervention tribes were assessed but received no assistance or encouragement regarding tobacco use policies. The stringency of the policies was assessed via telephone at baseline and after intervention. At postintervention, there were consistent, and generally statistically significant, differences in adoption of more stringent and comprehensive smoking policies for early intervention tribes compared with late intervention tribes. The intervention could be used in other Indian settings.
Redefining the goals of national drug policy: recommendations from a working group.
Authors: Reuter P , Caulkins J P
Published: November 2008

This paper discusses what the goals of national drug policy have been and suggests an alternative set of goals. The past emphasis on use reduction is found wanting. Total harm related to drugs can be viewed as the product of use and harm per use. Thus, reducing use usually serves to reduce harm. However, in some cases, use reduction programs may increase harm per use so much that they increase overall harm even as they succeed in reducing use. Hence, use reduction goals can be usefully augmented with the explicit objective of reducing the total harm created by the production, distribution, consumption, and control of drugs. Numerous programmatic recommendations flow from this approach.
Company characteristics and workplace medical testing.
Authors: Boden L I , Cabral H
Published: November 2008

OBJECTIVES. This study measures the relative impact of company economic characteristics and workplace hazards on the prevalence of several types of medical testing. It uses the results to assess likely public health impacts of testing. METHODS. We used data on potential exposure to workplace hazards, medical testing, unionization, firm size, and turnover from the National Occupational Hazards Survey and the National Occupational Exposure Survey. Other sources provided industry-specific data on wages and turnover. Logistic regression analysis estimated the relationship of economic variables and workplace health risks to the prevalence of medical testing. RESULTS. Economic variables were related to the prevalence of testing. However, consistent positive relationships were not found between health hazards and testing. CONCLUSIONS. Employers' testing decisions may not be beneficial to the health of workers and may shift the costs of illness to workers or other employers. Safer firms may provide too much medical testing, and firms that are less safe may provide too little.
Syphilis and gonorrhea in Miami: similar clustering, different trends.
Authors: Hamers F F , Peterman T A , Zaidi A A , Ransom R L , Wroten J E , Witte J J
Published: November 2008

During the second half of the 1980s, Miami had a syphilis epidemic while gonorrhea rates decreased. To determine whether the direction of these trends truly differed within all population subgroups or whether they resulted from aggregating groups within which trends were similar, records from four sexually transmitted disease clinics from 1986 to 1990 and census data from 1990 were used to compare race-, sex-, age-, and zip code-specific groups. Syphilis and gonorrhea clustering was similar; 50% of cases occurred in the same zip codes, representing 10% of the population. In all groups, gonorrhea decreased (aggregate 48%) while syphilis first increased (aggregate 47%) and then decreased. Determining reasons for these different trends may facilitate controlling these diseases.
Hormonal replacement therapy and morbidity and mortality in a prospective study of postmenopausal women.
Authors: Folsom A R , Mink P J , Sellers T A , Hong C P , Zheng W , Potter J D
Published: November 2008

We assessed the association of hormonal replacement therapy with mortality and incidence of multiple diseases in over 40,000 postmenopausal women followed for 6 years as part of the Iowa Women's Health Study. Compared with women who never used hormone replacement therapy, current users had multivariate adjusted relative risks (RR) as follows: total mortality (RR = 0.78; 95% confidence interval [CI] = 0.65, 0.94), coronary heart disease mortality (RR = 0.74; 95% CI = 0.48, 1.12), endometrial cancer incidence (RR = 4.3; 95% CI = 2.7, 6.9), breast cancer incidence (RR = 1.23; 95% CI = 0.99, 1.55), colon cancer incidence (RR = 0.72; 95% CI = 0.46, 1.12), and hip fracture incidence (RR = 0.53; 95% CI = 0.31, 0.91).
The epidemiology of vulvovaginal candidiasis among university students.
Authors: Geiger A M , Foxman B , Gillespie B W
Published: November 2008

Vulvovaginal candidiasis affects approximately 20% of women annually, but it is not well characterized epidemiologically. Of 1027 respondents to two mailed cross-sectional surveys at a large university, 37.5% reported a prior clinical diagnosis of vulvovaginal candidiasis. The frequency of first diagnosis increased rapidly after age 17, with an estimated 54.7% of women experiencing the condition by age 25. In a proportional hazards model of age at first diagnosis, vulvovaginal candidiasis was associated with initiation of sexual activity (rate ratio [RR] = 2.9; 95% confidence interval [CI] = 2.2, 3.8), oral contraceptive use (RR = 1.7; CI = 1.4, 2.2), and White (RR = 3.1; CI = 1.7, 5.7) and Black (RR = 5.9; CI = 3.0, 11.5) race vs Asian.
Retaining cocaine-abusing women in a therapeutic community: the effect of a child live-in program.
Authors: Hughes P H , Coletti S D , Neri R L , Urmann C F , Stahl S , Sicilian D M , Anthony J C
Published: November 2008

A clinical trial examined whether retention of cocaine-abusing women in a therapeutic community can be improved by permitting their children to live with them during treatment. Fifty-three women were randomly assigned to either the standard community condition (n = 22), in which children were placed with the best available caretaker, or the demonstration condition (n = 31), in which one or two of the children lived with their mother in the community. Survival analysis distributions indicated that demonstration women remained in treatment significantly longer than standard treatment women. (Mean length of stay was 300.4 days vs 101.9 days, respectively.)
Risk factors for homelessness among women with schizophrenia.
Authors: Caton C L , Shrout P E , Dominguez B , Eagle P F , Opler L A , Cournos F
Published: November 2008

A study of risk factors for homelessness among the severely mentally ill was extended to include women, and a case-control study of 100 indigent women with schizophrenia meeting criteria for literal homelessness and 100 such women with no history of homelessness was conducted. Subjects were recruited from shelters, clinics, and inpatient psychiatric programs in New York City. Clinical interviewers used standardized research instruments to probe three domains of risk factors: severity of mental illness, family background, and prior mental health service use. Findings adjusted for ethnicity revealed that homeless women had higher rates of a concurrent diagnosis of alcohol abuse, drug abuse, and antisocial personality disorder. Homeless women also had less adequate family support.
The rise of the modern addict.
Authors: Jonnes J
Published: November 2008

In the mid-19th century, most American addicts were genteel women hooked on opiates through medical treatment. Within a few decades, a new group of addicts emerged--pleasure users who patronized opium dens. As local laws closed dens, the pleasure users--most often poor young men in northern cities--began experimenting with cocaine and heroin, causing an alarmed government to launch an escalating campaign to root out the new deviant subculture. Various treatment efforts were instituted, from short-lived clinics to federal narcotics farms. This drug use epidemic peaked in the 1920s and was essentially quelled by World War II. This paper briefly discusses differences between early British and US policies and the contemporary implications of this early drug use epidemic.
Excess mortality among cigarette smokers: changes in a 20-year interval.
Authors: Thun M J , Day-Lally C A , Calle E E , Flanders W D , Heath C W
Published: November 2008

OBJECTIVES: This study was undertaken to examine changes in smoking-specific death rates from the 1960s to the 1980s. METHODS: In two prospective studies, one from 1959 to 1965 and the other from 1982 to 1988, death rates from lung cancer, coronary heart disease, and other major smoking-related diseases were measured among more than 200,000 current smokers and 480,000 lifelong non-smokers in each study. RESULTS: From the first to the second study, lung cancer death rates (per 100,000) among current cigarette smokers increased from 26 to 155 in women and from 187 to 341 in men; the increase persisted after current daily cigarette consumption and years of smoking were controlled for. Rates among nonsmokers were stable. In contrast, coronary heart disease and stroke death rates decreased by more than 50% in both smokers and nonsmokers. The all-cause rate difference between smokers and nonsmokers doubled for women but was stable for men. CONCLUSIONS: Premature mortality (the difference in all-cause death rates between smokers and nonsmokers) doubled in women and continued unabated in men from the 1960s to the 1980s. Lung cancer surpassed coronary heart disease as the largest single contributor to smoking-attributable death among White middle-class smokers.
Socioeconomic indicators and mortality from coronary heart disease and cancer: a 22-year follow-up of middle-aged men.
Authors: Bucher H C , Ragland D R
Published: November 2008

OBJECTIVES: Data from the Western Collaborative Group Study were used to determine the extent to which the inverse association between socioeconomic status (SES) and mortality can be explained by risk factors for major causes of mortality. METHODS: The relation of education and income to subsequent mortality was studied in 3154 employed, middle-aged men over 22 years of follow-up. RESULTS: Over the follow-up period, 584 (18.5%) men died, 214 (6.8%) from coronary heart disease and 70 (2.2%) from lung cancer. A significant inverse association with systolic blood pressure, serum cholesterol, and smoking was found only for education. For education, adjustment for risk factors reduced the relative risk for coronary heart disease mortality from 1.80 (95% confidence interval = 1.33, 2.44) to 1.54 (1.13, 2.09), for lung cancer mortality from 1.60 (0.95, 2.70) to 1.38 (0.81, 2.34), and for all-cause mortality from 1.49 (1.09, 1.13) to 1.33 (1.12, 1.60). For income, adjustment for risk factors did not change relative risk for mortality from coronary heart disease (1.27 [0.97, 1.66]) and all causes (1.21 [1.03, 1.43]), but it did increase the relative risk for lung cancer mortality from 1.68 (1.05, 2.68) to 1.83 (1.13, 2.96). CONCLUSIONS: In middle-aged, employed men, the association between SES and mortality is partially but not completely accounted for by major risk factors for mortality.
Child morbidity and mortality following vitamin A supplementation in Ghana: time since dosing, number of doses, and time of year.
Authors: Ross D A , Kirkwood B R , Binka F N , Arthur P , Dollimore N , Morris S S , Shier R P , Gyapong J O , Smith P G
Published: November 2008

OBJECTIVES: The impact of large-dose vitamin A supplementation given at intervals of 4 months on child mortality and morbidity was examined according to the time interval since dosing, number of doses received previously, and time of year. METHODS: Two double-blind, randomized, placebo-controlled trials of large doses of vitamin A administered at intervals of 4 months were conducted in adjacent populations in northern Ghana. RESULTS: While vitamin A supplementation significantly reduced the overall incidence of severe illnesses (especially diarrhea with dehydration), clinic attendances, hospital admissions, and mortality, there was no evidence that the impact of each dose of vitamin A was related to the number of doses the child had received previously. There was no evidence that the effectiveness of the supplement waned over the 3 to 5 months between doses. The impact on mortality did not differ significantly by the month in which the supplement had been given. CONCLUSIONS: In the study population, there was no evidence that an interval between doses of less than 4 months would have had a greater impact on severe morbidity or mortality, and the effectiveness of supplementation did not vary by time of year.
Associations of peptic ulcer and gastric cancer with other diseases in US veterans.
Authors: Sonnenberg A , Wasserman I H
Published: November 2008

OBJECTIVES: The purpose of this study was to examine, through the database of the Department of Veterans Affairs, the joint occurrence of different diseases in individual patients. METHODS: Patients with a diagnosis of gastric cancer, gastric ulcer, or duodenal ulcer were extracted from the 1987 through 1990 computer files. A random sample of patients from each annual file served as a control population. All previous discharges of each case or control patient between 1970 and 1990 were searched for the occurrence of hypertensive diseases or chronic diseases of the joints, lungs, pancreas, and liver. The relative frequencies of such diagnoses in case and control patients were compared by multivariate logistic regression. RESULTS: Gastric ulcer and duodenal ulcer, but not gastric cancer, were significantly associated with chronic diseases of the joints, lungs, pancreas, and liver. None of the three diagnoses showed any significant association with hypertensive diseases. CONCLUSIONS: These relationships may reflect the influence of nonsteroidal anti-inflammatory drugs, smoking, and alcohol. They stress the importance of environmental risk factors other than Helicobacter pylori in terms of damage to the upper gastrointestinal mucosa.
Chronic liver disease mortality in the United States, 1979 through 1989.
Authors: Hurwitz E S , Holman R C , Strine T W , Chorba T L
Published: November 2008

OBJECTIVES: Rates and trends for chronic liver disease mortality in the United States were examined. METHODS: National Center for Health Statistics data on underlying cause of death for chronic liver disease for the United States from 1979 through 1989 were analyzed. Four groups of diseases and conditions included under the International Classification of Diseases, 9th Revision, code for chronic liver disease were assessed separately. RESULTS: From 1979 through 1989, there were 303,875 deaths from chronic liver disease; 48% were in the cirrhosis without alcohol group, 42% in the alcohol-related liver disease group, 8% in the liver disease without alcohol group, and 1.5% in the biliary cirrhosis group. Chronic liver disease death rates for Blacks were more than 1.5 times greater than those for Whites and for other races. Chronic liver disease mortality declined 22% overall among both sexes. The largest decreases were for liver disease without alcohol (42%) and cirrhosis without alcohol (25%), followed by alcohol-related liver disease (14%) and biliary cirrhosis (12%). CONCLUSION: Although declines in US chronic liver disease deaths have been attributed to declining alcohol consumption, these analyses suggest that greater declines have occurred in deaths not coded as alcohol related.
Trends in state agency oral health and public health expenditures, 1984 through 1989.
Authors: Lockwood S A , Malvitz D M
Published: November 2008

This paper documents oral health and public health expenditures for fiscal years 1984, 1986, 1988, and 1989, as reported by state health agencies. During this period, reported national expenditures for public and oral health increased 68% and 46%, respectively; between successive fiscal years, fewer states (73%, 67%, 57%) reported increased oral health expenditures, while increasingly more states reported no categorical oral health expenditures. Block grant expenditures for oral health increased overall but decreased as a percentage of total oral health expenditures; 16 states reported no block grant expenditures for oral health in fiscal year 1989, perhaps reflecting either substantial state support, or marginal to nonexistent oral health programs in these states.
Decreasing disability in the 21st century: the future effects of controlling six fatal and nonfatal conditions.
Authors: Boult C , Altmann M , Gilbertson D , Yu C , Kane R L
Published: November 2008

OBJECTIVES: This study assessed the effects of reducing fatal and nonfatal health conditions on the number of functionally limited older Americans in the coming decades. METHODS: Data from the 1990 census and the Longitudinal Study of Aging were used to project the number of functionally limited older Americans from 2001 to 2049, assuming 1% biennial reductions in five conditions that shorten life expectancy (coronary artery disease, stroke, cancer, diabetes, and confusion) and one condition that decreases functional ability (arthritis). RESULTS: Decreasing the prevalence of arthritis by 1% every 2 years would lead to a much greater reduction in functional limitation between 2001 and 2049 (4 million person-years) than would decreasing any of the other conditions by the same amount. Decreases in two fatal conditions (cancer and coronary artery disease) would lead to increases in functional limitation (0.9 and 0.1 million person-years, respectively). CONCLUSIONS: Advances against common nonfatal disabling conditions would be more effective than advances against fatal conditions in blunting the large increase in the functionally limited older population anticipated in the 21st century.
Alcohol and drug use, abuse, and dependence among welfare recipients.
Authors: Grant B F , Dawson D A
Published: November 2008

OBJECTIVES: This paper presents national estimates of heavy drinking, drug use, and alcohol and drug abuse and/or dependence among recipients of selected welfare programs. METHODS: Data from the 1992 National Longitudinal Alcohol Epidemiologic Survey were analyzed. RESULTS: The percentages of welfare recipients using, abusing, or dependent on alcohol or drugs were relatively small and consistent with the general US population and those not receiving welfare benefits. CONCLUSIONS: Although a minority of welfare recipients have alcohol or drug problems, substance abuse prevention and treatment services are needed among high-risk subgroups.
Racial differences in Urban children's environmental exposures to lead.
Authors: Lanphear B P , Weitzman M , Eberly S
Published: November 2008

OBJECTIVES: This study explored whether differences in environmental lead exposures explain the racial disparity in children's blood lead levels. METHODS: Environmental sources of lead were identified for a random sample of 172 urban children. RESULTS: Blood lead levels were significantly higher among Black children. Lead-contamination of dust was higher in Black children's homes, and the condition of floors and interior paint was generally poorer. White children were more likely to put soil in their mouths and to suck their fingers, whereas Black children were more likely to put their mouths on window sills and to use a bottle. Major contributors to blood lead were interior lead exposures for Black children and exterior lead exposures for White children. CONCLUSIONS: Differences in housing conditions and exposures to lead-contaminated house dust contribute strongly to the racial disparity in urban children's blood lead levels.
US emergency department costs: no emergency.
Authors: Tyrance P H , Himmelstein D U , Woolhandler S
Published: November 2008

BACKGROUND: Many perceive emergency department (ED) overuse as an important cause of high medical care costs in the United States. Managed care plans and politicians have seen constraints on ED use as an important element of cost control. METHODS: We measured ED-associated and other medical care costs, using the recently released 1987 National Medical Expenditure Survey of approximately 35,000 persons in 14,000 households representative of the US civilian, noninstitutionalized population. RESULTS: In 1987, total ED expenditures were $8.9 billion, or 1.9% of national health expenditures. People with health insurance represented 86% of the population and accounted for 88% of ED spending. The uninsured paid 47% of ED costs themselves; free care covered only 10%. For the uninsured, the cost of hospitalization initiated by ED visits totaled $3.3 billion, including $1.1 billion in free care. Whites accounted for 75% of total ED costs. The ED costs of poor and near-poor individuals accounted for only 0.47% of national health costs. CONCLUSIONS: ED use accounts for a small share of US medical care costs, and cost shifting to the insured to cover free ED care for the uninsured is modest. Constraining ED use cannot generate substantial cost savings but may penalize minorities and the poor, who receive much of their outpatient care in EDs.
Socioeconomic differences in cervical cancer: two case-control studies in Colombia and Spain.
Authors: de Sanjosé S , Bosch F X , Muñoz N , Tafur L , Gili M , Izarzugaza I , Izquierdo A , Navarro C , Vergara A , Muñoz M T , Ascunce N , Shah K V
Published: November 2008

OBJECTIVES: This study examined the causes of socioeconomic differences in invasive cervical cancer in two countries that differ substantially in cervical cancer incidence and economic development. METHODS: Data were derived from two case-control studies carried out in Spain and Colombia; there were 373 case subjects, 387 control subjects, and 425 husbands interviewed with a structured questionnaire. Exfoliated cells were obtained from cervical or penile scrapes and tested for human papillomavirus (HPV) DNA. RESULTS: Relative to better educated women, women with low educational levels in both countries reported fewer Pap smears and had a higher prevalence of HPV DNA. The prevalence ratio of HPV DNA across educational strata was twofold in Spain and fourfold in Colombia. In both countries, husbands of poorly educated women reported higher use of prostitutes than husbands of better educated women. In Colombia, 30% of husbands of poorly educated women harbored HPV DNA, compared with 10% of husbands of better educated women. CONCLUSIONS: Socioeconomic differences in invasive cervical cancer could be partly explained by differences in the prevalence of HPV DNA and by a lower use of preventive care.
Trends in drug use among American Indian students and dropouts, 1975 to 1994.
Authors: Beauvais P
Published: November 2008

OBJECTIVES: This 20-year surveillance project tracks the trends in substance abuse among American Indian students and examines the observed patterns to discover implications for prevention and treatment. The current phase of this work includes data on drug use among Indian school dropouts. METHODS: Anonymous drug use surveys are administered annually to a nationally representative sample of 7th- to 12th-grade Indian youths residing on or near reservations. An adjustment for dropouts is made to provide estimates for the entire age cohort. RESULTS: Indian youth continue to show very high rates of drug use compared with their non-Indian peers. The trends in rates during the last 20 years parallel those of non-Indian youth. While overall drug use may be decreasing, about 20% of Indian adolescents continue to be heavily involved with drugs, a proportion that has not changed since 1980. Adjustment for school dropouts increases the estimate for the entire age cohort. CONCLUSIONS: Indian youth, particularly school dropouts, remain at high risk for drug use. The similarity to trends for non-Indians indicates that prevention strategies effective with other youth can be effective with this population.
Characteristics of women 50 years of age or older with heterosexually acquired AIDS.
Authors: Schable B , Chu S Y , Diaz T
Published: November 2008

OBJECTIVES: This study compared characteristics of older (> or = 50 years) and younger (< 50 years) women with acquired immunodeficiency syndrome (AIDS) attributed to heterosexual contact. METHODS: We interviewed women with heterosexually acquired AIDS reported to 12 state and local health departments. Of 556 women interviewed, 59 (11%) were 50 or older. RESULTS: Older women were more likely than younger women to live alone (24% vs 11%), to have not completed high school (63% vs 37%), to be tested for human immunodeficiency virus (HIV) while hospitalized (51% vs 32%), and to have never used a condom before HIV diagnosis (86% vs 67%). CONCLUSIONS: Health care providers need to recognize HIV risk behavior in older women, encourage testing, and promote condom use.
Assessing immigration status and eligibility for publicly funded medical care: a questionnaire for public health professionals.
Authors: Loue S , Foerstel J
Published: November 2008

OBJECTIVES: After reviewing the requirements for establishing a legal presence in the United States and securing health care services under Medicaid and Medicare, this article reports on a questionnaire developed to determine patients' documentation status and eligibility for publicly funded medical care. METHODS: The questionnaire was developed based on an integration of the relevant provisions of the Immigration and Nationality Act and the Social Security Act. RESULTS: The questionnaire is both valid and reliable when compared with an instrument currently used by immigration attorneys. CONCLUSIONS: This assessment is useful provided there is no requirement that undocumented individuals be reported to the Immigration and Naturalization Service.
Preventing recurring injuries from violence: the risk of assault among Cleveland youth after hospitalization.
Authors: Litacker D
Published: November 2008

OBJECTIVES: Although interpersonal violence has increased among urban youth, its epidemiology remains unclear. To prevent such violence, identifying the susceptible population is important. METHODS: Medical records for 998 patients aged 5 to 25 years at an urban hospital were reviewed to compare data for patients admitted for assault-related injuries, those admitted for unintentional injuries, and those for problems other than injuries. RESULTS: Those initially admitted for treatment of assault were found to be at greater risk of subsequent treatment for assault than those admitted for noninjuries. CONCLUSIONS: Admission for injuries caused by violence may increase risk for future assaults; hospitalization may offer an opportunity to interrupt these patterns.