bluuebunny/crossref_metadata_2025 huggingface dataset:
Atrial fibrillation as a risk factor for stroke: a retrospective cohort study of hospitalized Medicare beneficiaries.
Authors: Yuan Z , Bowlin S , Einstadter D , Cebul R D , Conners A R , Rimm A A
Published: November 2008

OBJECTIVES: This study examined the relationship between atrial fibrillation and (1) stroke and (2) all-cause mortality. METHODS: All eligible Medicare patients older than 65 years of age hospitalized in 1985 were followed up for 4 years. Kaplan-Meier and Cox proportional hazards models were used for assessment of risk of stroke and mortality. RESULTS: A total of 4,282,607 eligible Medicare patients were hospitalized in 1985. The mean age was 76.1 (+/- 7.7) years; 58.7% were female; 7.2% were Black; and 8.4% had a diagnosis of atrial fibrillation. During the follow-up period, 66,063 patients (32.6/1000 person-years) developed nonembolic stroke and 7285 (3.6/1000 person-years) developed embolic stroke. After adjustment for age, race, sex, and comorbid conditions, atrial fibrillation remained a significant risk factor for both nonembolic stroke (relative risk [RR] = 1.56) and embolic stroke (RR = 5.80) and for mortality (RR = 1.31). Approximately 4.5% of nonembolic and 28.7% of embolic strokes among hospitalized Medicare patients aged 65 years and older were attributable to atrial fibrillation. CONCLUSIONS: This study demonstrates that atrial fibrillation is associated with an appreciable increase in the risk of stroke (both embolic and nonembolic) and in the risk of mortality from all causes.
Risk of ectopic pregnancy and previous induced abortion.
Authors: Tharaux-Deneux C , Bouyer J , Job-Spira N , Coste J , Spira A
Published: November 2008

OBJECTIVES: This study investigated the role of prior history of induced abortion in subsequent ectopic pregnancies. METHODS: Data from two French case-control studies were used to examine the effect of induced abortion on ectopic pregnancy risk. Case patients (n = 570) were women admitted for ectopic pregnancy during the study period; controls (n = 1385) were women who delivered in the same center. RESULTS: The analysis among women with no previous ectopic pregnancy showed that, after control for the main ectopic pregnancy risk factors, prior induced abortion was associated with an increased risk of ectopic pregnancy (odds ratio [OR] = 1.5, 95% confidence interval [CI] = 1.0, 2.0); there was a significant trend between number of previous induced abortions and ectopic pregnancy risk (ORs = 1.4 for 1 previous induced abortion and 1.9 for 2 or more). CONCLUSIONS: This study suggests that induced abortion may be a risk factor for ectopic pregnancy for women with no previous ectopic pregnancy, particularly in the case of women who have had several induced abortions.
How safe are our schools?
Authors: Miller T R , Spicer R S
Published: November 2008

OBJECTIVES: The goal of this study was to provide national estimates of the frequency and cost of school injuries. METHODS: Six years of National Health Interview Survey data were used to estimate nonfatal injury incidence rates, multiple sources were used to estimate fatalities, and national highway crash data were used to estimate school bus injury incidence. RESULTS: Each year, 3.7 million children suffer a substantial injury at school, resulting in an estimated $3.2 billion in medical spending and $115 billion in good health lost. Nonschool fatalities greatly exceed school fatalities; from an incidence per hour perspective, however, school hours are no safer than nonschool hours despite greater formal supervision. School bus injuries account for half of school injury deaths but less than 1% of total school injury costs. CONCLUSIONS: Nonfatal injury is a problem in schools. The concentration of injury at secondary schools suggests that interventions there may be most cost-effective. Data on school injury causes are greatly needed.
Human rights and maternal-fetal HIV transmission prevention trials in Africa.
Authors: Annas G J , Grodin M A
Published: November 2008

The human rights issues raised by the conduct of maternal-fetal human immunodeficiency virus transmission trials in Africa are not unique to either acquired immunodeficiency syndrome or Africa, but public discussion of these trials presents an opportunity for the United States and other wealthy nations to take the rights and welfare of impoverished populations seriously. The central issue at stake when developed countries perform research on subjects in developing countries is exploitation. The only way to prevent exploitation of a research population is to insist not only that informed consent be obtained but also that, should an intervention be proven beneficial, the intervention will be delivered to the impoverished population. Human rights are universal and cannot be compromised solely on the basis of beliefs or practices of any one country or group. The challenge to the developed countries is to implement programs to improve the health of the people in developing countries both by improving public health infrastructure and by delivering effective drugs and vaccines to the people.
Ethical challenges in efficacy trials of vaginal microbicides for HIV prevention.
Authors: de Zoysa I , Elias C J , Bentley M E
Published: November 2008

This paper discusses some of the ethical challenges raised by advanced clinical trials designed to assess the safety and efficacy of vaginal microbicides in protecting women from HIV infection. The ethical principles that guide clinical research involving human subjects require that all participants in such trials be provided available measures known to reduce the risk of HIV infection. However, this will reduce the ability of the study to assess the protective effect of the test microbicide. In addition, providing extensive services to trial participants may be construed as an undue inducement if the study is being conducted among vulnerable groups such as sex workers or women from disadvantaged communities. Suggestions are provided to resolve this dilemma in the planning and implementation of HIV prevention services for trial participants.
Unemployment and the likelihood of detecting early-stage breast cancer.
Authors: Catalano R A , Satariano W A
Published: November 2008

OBJECTIVES: The objective of this study was to test the hypothesis that unexpectedly high unemployment in a community is associated with reduced odds that registered breast tumors are local. METHODS: The hypothesis was tested with data from San Francisco for the 132 months beginning with January 1983. RESULTS: Registered breast tumors were less likely to be local during periods of unexpectedly high unemployment (8% less likely among non-Hispanic White women and 24% less likely among African-American women). CONCLUSIONS: Job loss may restrict access to health services. Fear of job loss may also distract women from breast self-examination and the identification of suspicious breast signs.
Changing fruit and vegetable consumption among children: the 5-a-Day Power Plus program in St. Paul, Minnesota.
Authors: Perry C L , Bishop D B , Taylor G , Murray D M , Mays R W , Dudovitz B S , Smyth M , Story M
Published: November 2008

OBJECTIVES: A randomized school based trial sought to increase fruit and vegetable consumption among children using a multicomponent approach. METHODS: The intervention, conducted in 20 elementary schools in St. Paul, targeted a multiethnic group of children who were in the fourth grade in spring 1995 and the fifth grade in fall 1995. The intervention consisted of behavioral curricula in classrooms, parental involvement, school food service changes, and industry support and involvement. Lunchroom observations and 24-hour food recalls measured food consumption. Parent telephone surveys and a health behavior questionnaire measured psychosocial factors. RESULTS: The intervention increased lunchtime fruit consumption and combined fruit and vegetable consumption, lunchtime vegetable consumption among girls, and daily fruit consumption as well as the proportion of total daily calories attributable to fruits and vegetables. CONCLUSIONS: Multicomponent school-based programs can increase fruit and vegetable consumption among children. Greater involvement of parents and more attention to increasing vegetable consumption, especially among boys, remain challenges in future intervention research.
Body mass index and mortality in nonsmoking older adults: the Cardiovascular Health Study.
Authors: Diehr P , Bild D E , Harris T B , Duxbury A , Siscovick D , Rossi M
Published: November 2008

OBJECTIVES: This study assesses the relationship of body mass index to 5-year mortality in a cohort of 4317 nonsmoking men and women aged 65 to 100 years. METHODS: Logistic regression analyses were conducted to predict mortality as a function of baseline body mass index, adjusting for demographic, clinical, and laboratory covariates. RESULTS: There was an inverse relationship between body mass index and mortality; death rates were higher for those who weighed the least. Inclusion of covariates had trivial effects on these results. People who had lost 10% or more of their body weight since age 50 had a relatively high death rate. When that group was excluded, there was no remaining relationship between body mass index and mortality. CONCLUSIONS: The association between higher body mass index and mortality often found in middle-aged populations was not observed in this large cohort of older adults. Over-weight does not seem to be a risk factor for 5-year mortality in this age group. Rather, the risks associated with significant weight loss should be the primary concern.
Informed consent for HIV testing in a South African hospital: is it truly informed and truly voluntary?
Authors: Abdool Karim Q , Abdool Karim S S , Coovadia H M , Susser M
Published: November 2008

OBJECTIVE: The purpose of this study was to assess informed consent to human immunodeficiency virus (HIV) testing in a perinatal HIV transmission study in a major referral hospital serving a largely Black population in South Africa. METHODS: First-time antenatal clinic attenders who were randomly selected from those enrolled in the perinatal HIV study (n = 56) answered questionnaires before and after counseling. RESULTS: Knowledge of HIV transmission and prevention, high at the outset, was little improved after counseling. The acceptance rate for HIV testing was high. Despite assurances that participation was voluntary, 88% of the women said they felt compelled to participate in the study. CONCLUSIONS: Informed consent in this setting was truly informed but not truly voluntary.
Differences in the risk of homicide and other fatal injuries between postpartum women and other women of childbearing age: implications for prevention.
Authors: Dietz P M , Rochat R W , Thompson B L , Berg C J , Griffin G W
Published: November 2008

OBJECTIVES: This study compared injury deaths between postpartum women and other women aged 15 to 44. METHODS: Risk ratios and 95% confidence intervals (CIs) were computed for injury fatality rates. RESULTS: Fifty percent (29/58) of postpartum injury deaths were homicides, compared with 26% (427/1648) of injury deaths among nonpregnant, nonpostpartum women. For females aged 15 to 19, the homicide rate was 2.6 times higher (95% CI = 1.17, 5.95) for postpartum females than for other females. The motor-vehicle fatality rate was lower for postpartum females than for nonpregnant, nonpostpartum females (risk ratio = 0.30, CI = 0.18, 0.48). CONCLUSIONS: Postpartum females aged 15 to 19 years were at higher risk of homicide. Postpartum women were at reduced risk of motor-vehicle fatalities.
Family planning in China: out of control?
Authors: Bogg L
Published: November 2008

OBJECTIVES: This study examined sex ratios in 6 counties in China. METHODS: Data from a household survey (n = 5756) were retrospectively analyzed. RESULTS: A normal sex ratio was found for children less than 18 years of age. Significant differences in sex ratios and family size were observed between the household survey data and population registers. CONCLUSIONS: The findings indicate a high number of unregistered female births and are consistent with calls for a rethinking of Chinese population policies in the direction of a more collaborative policy based on female education and participation.
Differences in preconceptional and prenatal behaviors in women with intended and unintended pregnancies.
Authors: Hellerstedt W L , Pirie P L , Lando H A , Curry S J , McBride C M , Grothaus L C , Nelson J C
Published: November 2008

OBJECTIVES: This study examined whether pregnancy intention was associated with cigarette smoking, alcohol drinking, use of vitamins, and consumption of caffeinated drinks prior to pregnancy and in early pregnancy. METHODS: Data from a telephone survey of 7174 pregnant women were analyzed. RESULTS: In comparison with women whose pregnancies were intended, women with unintended pregnancies were more likely to report cigarette smoking and less likely to report daily vitamin use. Women with unintended pregnancies were also less likely to decrease consumption of caffeinated beverages or increase daily vitamin use. CONCLUSIONS: Pregnancy intention was associated with health behaviors, prior to pregnancy and in early pregnancy, that may influence pregnancy course and birth outcomes.
The impact of mammography quality improvement legislation in Michigan: implications for the National Mammography Quality Standards Act.
Authors: Fintor L , Brown M , Fischer R , Suleiman O , Garlinghouse C , Camburn J , Frazier E , Houn F
Published: November 2008

OBJECTIVES: This study examined the impact of state legislation on mammography quality and access in Michigan. METHODS: The impact of state legislation was analyzed with respect to utilization, numbers of machines and facilities, and image quality. RESULTS: The legislation had a positive effect on image quality improvement, had no impact on utilization by women aged 50 years and above, and resulted in few facility closures. CONCLUSIONS: Michigan's legislative intervention appears to have had a positive effect on efforts to improve mammography quality assurance with implications for other federal and state efforts to achieve quality assurance in health care delivery.
The globalization of public health, II: The convergence of self-interest and altruism.
Authors: Yach D , Bettcher D
Published: November 2008

The transnationalization of disease and health risks will require global awareness, analysis, and action and indicates a need for global cooperation. Transnational actions must be built on firm local and national foundations, but they also require new forms of transnational collaboration in order to minimize risks and build on opportunities. In a world characterized by the globalization of public health, countries and communities will need to look beyond their narrow self-interests in defining and confronting the shared problems that are emerging. In fact, a strong case can be made that enlightened self-interest and altruism will converge in the increasingly interdependent world being shaped by the process of globalization.
Smoking in the home: changing attitudes and current practices.
Authors: Ashley M J , Cohen J , Ferrence R , Bull S , Bondy S , Poland B , Pederson L
Published: November 2008

OBJECTIVES: Trends in attitudes and current practices concerning smoking in the home were examined. METHODS: Data from population-based surveys of adults in Ontario, Canada, were analyzed. RESULTS: Between 1992 and 1996, the percentage of respondents who agreed that parents spending time at home with small children should not smoke increased from 51% to 70%. In 1996, 34% of the homes surveyed were smoke-free. Smoke-free homes were associated with nonsmoking respondents and with the presence of children and no daily smokers in the home. Only 20% of homes with children and any daily smokers were smoke-free. CONCLUSIONS: Efforts are needed to assist parents in reducing children's exposure to environmental tobacco smoke in the home.
Anemia in young children of the Muynak District of Karakalpakistan, Uzbekistan: prevalence, type, and correlates.
Authors: Giebel H N , Suleymanova D , Evans G W
Published: November 2008

OBJECTIVES: This study examined prevalence and correlates of anemia in the Muynak District of Uzbekistan, an area of rapidly changing social and economic conditions following the collapse of the Soviet Union. METHODS: Questionnaire data and blood samples were collected on a random sample of 433 children aged 1 through 4 years. RESULTS: The prevalence of anemia ranged from 89% in 1-year-olds to 48% in 4-year-olds. Correlates for anemia included younger age, a communal water source, and a history of pica. CONCLUSIONS: Anemia is a widespread problem in young children in this district. An aggressive attempt to reverse this problem is needed.
High birthweights among infants of north African immigrants in Belgium.
Authors: Buekens P , Masuy-Stroobant G , Delvaux T
Published: November 2008

OBJECTIVES: This study examined birthweights of North African immigrants in Belgium. METHODS: Analyses focused on Belgian single live birth certificates from 1981 to 1988. RESULTS: Low-birthweight (< 2500 g) rates were 3.1% among 34,686 newborns of North African origin and 4.8% among 804,286 newborns of Belgian origin. The entire North African birthweight distribution was shifted toward higher birthweights than the Belgian distribution. Low frequencies of low birthweights among North Africans were still observed after marital status, occupation of the father, and parity had been taken into account. CONCLUSIONS: Despite their low socioeconomic status, North African immigrants have high birthweights.
Effects of radon mitigation vs smoking cessation in reducing radon-related risk of lung cancer.
Authors: Mendez D , Warner K E , Courant P N
Published: November 2008

OBJECTIVES: The purpose of this paper is to provide smokers with information on the relative benefits of mitigating radon and quitting smoking in reducing radon-related lung cancer risk. METHODS: The standard radon risk model, linked with models characterizing residential radon exposure and patterns of moving to new homes, was used to estimate the risk reduction produced by remediating high-radon homes, quitting smoking, or both. RESULTS: Quitting smoking reduces lung cancer risk from radon more than does reduction of radon exposure itself. CONCLUSIONS: Smokers should understand that, in addition to producing other health benefits, quitting smoking dominates strategies to deal with the problem posed by radon.
Validity of insurance information on California birth certificates.
Authors: Braveman P , Pearl M , Egerter S , Marchi K , Williams R
Published: November 2008

OBJECTIVES: This study assessed the validity of health insurance information on California birth certificates. METHODS: Insurance information from birth certificates and linked face-to-face interviews was compared for 7428 postpartum women in California. RESULTS: There was excellent agreement between insurance information in birth certificate and interview data, especially when capitated plans were grouped with all other private coverage. Analyses using both data sources produced similar estimates of the likelihood of untimely prenatal care according to type of insurance coverage. CONCLUSIONS: Birth certificate data including insurance information appear to be an appropriate resource for examining both the extent of coverage for maternity care and associations between prenatal care use and insurance status.
Decrease in infant mortality in New York City after 1989.
Authors: Kalter H D , Na Y , O'Campo P
Published: November 2008

OBJECTIVES: This study identified factors contributing to the rapid decline in infant mortality in New York City from 1989 to 1992. METHODS: Changes in birthweight distributions and in birthweight/age-, cause-, and birthweight/age/cause-specific mortality rates from 1988/89 (before the mortality reduction) to 1990/91 were identified from New York City vital statistics data. RESULTS: Infant, neonatal, and postneonatal mortality of very-low-birthweight (< 1500 g) and normal-birthweight infants decreased significantly. The declines were almost entirely due to decreases in birthweight-specific mortality rates, rather than increased birthweights. All races experienced most of these reductions. Mortality decreased significantly for 6 causes of death. These decreases were consistent with the birthweight/age groups experiencing mortality declines. CONCLUSIONS: Widespread, multiple perinatal and postnatal factors contributed to the decline in infant mortality.
Exposure of young infants to environmental tobacco smoke: breast-feeding among smoking mothers.
Authors: Mascola M A , Van Vunakis H , Tager I B , Speizer F E , Hanrahan J P
Published: November 2008

OBJECTIVES: This study examined the degree to which breast-feeding and cigarette smoking by mothers and smoking by other household members contribute to the exposure of infants to the products of tobacco smoke. METHODS: The subjects were 330 mother-infant pairs derived from a cohort of 1000 pairs enrolled in a longitudinal study of the pulmonary effects of prenatal and postnatal smoking. The main outcome measure was corrected urinary cotinine levels. RESULTS: Urinary cotinine levels were 10-fold higher in breast-fed infants of smoking mothers than among bottle-fed infants of smoking mothers. Among infants of nonsmoking mothers, urine cotinine levels were significantly increased in infants living in homes with other smokers; in this group there was no significant difference between bottle-fed and breast-fed infants. Infants whose mothers smoked in the same room as the infant had only nonsignificant increases in cotinine levels compared with infants whose mothers restricted their smoking to other rooms. CONCLUSIONS: Breast-fed infants of smoking mothers have urine cotinine levels 10-fold higher than bottle-fed infants whose mothers smoke, suggesting that breast-feeding, rather than direct inhalation of environmental tobacco smoke, is the primary determinant of cotinine levels in infants whose mothers smoke.
Injury and anomie: effects of violence on an inner-city community.
Authors: Fullilove M T , Héon V , Jimenez W , Parsons C , Green L L , Fullilove R E
Published: November 2008

OBJECTIVES: Widespread violence affects individuals but also alters group life. This study was designed to examine the effects of violence on an inner-city community. METHODS: A qualitative study was undertaken that included field observations and semistructured interviews. The study took place in Washington Heights, a New York City neighborhood with a high rate of violence, largely secondary to the drug trade. RESULTS: The 100 people interviewed differed widely in their definitions of violence and in their likelihood of having experienced violent acts in the course of daily life. High, medium, and low violence microenvironments were identified; risk of exposure to violence, but not individual definitions of violence, differed by location. Violence in all parts of the neighborhood inhibited social interactions, but the intensity of this effect differed by microenvironment. CONCLUSIONS: In Washington Heights, violence has injured individuals and fractured social relationships, leading to the state of social disarray referred to as "anomie." The public health response to the violence epidemic should address anomie through community organizing efforts.
Effects of school-based aerobic exercise on blood pressure in adolescent girls at risk for hypertension.
Authors: Ewart C K , Young D R , Hagberg J M
Published: November 2008

OBJECTIVES: This study evaluated the effects of aerobic exercise physical education on blood pressure in high-risk, predominantly African-American, adolescent girls. METHODS: Ninth-grade girls (n = 99) with blood pressure above the 67th percentile were randomized to 1 semester of aerobic exercise classes or standard physical education classes. RESULT: The study was completed by 88 girls. At posttest, only members of the aerobic exercise group increased their estimated cardiorespiratory fitness. The aerobic exercise group had a greater decrease in systolic blood pressure than the standard physical education group (P < .03). CONCLUSIONS: Aerobic exercise physical education is a feasible and effective health promotion strategy for high-risk adolescent girls.
Adolescents engaging in unhealthy weight control behaviors: are they at risk for other health-compromising behaviors?
Authors: Neumark-Sztainer D , Story M , Dixon L B , Murray D M
Published: November 2008

OBJECTIVES: This study sought to determine whether adolescents engaging in weight control behaviors are at increased risk for tobacco, alcohol, and marijuana use; suicide ideation and attempts; and unprotected sexual activity. METHODS: Data were collected on a nationally representative sample of 16,296 adolescents taking part in the 1993 Youth Risk Behavior Survey. RESULTS: Adolescents using extreme weight control behaviors were at increased risk for health-compromising behaviors, while associations with other weight control behaviors were weak and inconsistent. CONCLUSIONS: The findings have relevance to clinical work with youth, provide a better understanding of disordered eating, and open up a number of opportunities for future research.
Prospective psychosocial, interpersonal, and behavioral predictors of handgun carrying among adolescents.
Authors: Simon T R , Richardson J L , Dent C W , Chou C P , Flay B R
Published: November 2008

OBJECTIVES: This study identified behavioral and psychosocial/interpersonal factors in young adolescence that are associated with handgun carrying in later adolescence. METHODS: A sample of 2200 high school students was surveyed at 9th grade and again at 12th grade. RESULTS: Multivariate logistic regression analyses indicated that measures of risk-taking preference, depression, stress, temper, and drug use assessed while the students were in 9th grade were predictive of handgun carrying in 12th grade for both male and female students. CONCLUSIONS: These findings suggest the need for a comprehensive approach to prevention that focuses on both individual and interpersonal factors associated with adolescents' decision to carry a handgun.
Association between duration of residence and access to ambulatory care among Caribbean immigrant adolescents.
Authors: Sonis J
Published: November 2008

OBJECTIVES: The purpose of this study was to determine the association between duration of residence and access to ambulatory care among Caribbean immigrant adolescents. METHODS: A cross-sectional survey of adolescents at a New York City high school was conducted. Multivariate modeling methods were used to adjust for demographic and socioeconomic covariates. RESULTS: Duration of residence was strongly and directly associated with access to ambulatory care after adjustment for ethnicity. CONCLUSIONS: Caribbean immigrant adolescents, particularly recent immigrants, have reduced access to ambulatory care.
Phantom of the area: poverty-area residence and mortality in the United States.
Authors: Waitzman N J , Smith K R
Published: November 2008

OBJECTIVES: The purpose of the study was to conduct a national multivariate analysis on poverty-area residence and mortality in the United States. METHODS: Proportional hazards analyses were performed of the effect of poverty-area residence on the risk of mortality among adult examinees in the 1971 through 1974 National Health and Nutrition Examination Survey who were followed through 1987. RESULTS: Poverty-area residence was associated with significantly elevated risk of all-cause mortality (rate ratio = 1.78, 95% confidence interval = 1.33, 2.38) and some cause-specific mortality among those aged 25 through 54 years, but not among those aged 55 through 74 years, at baseline after adjustment for several individual and household characteristics. CONCLUSIONS: Residence in poverty areas contributes to socioeconomic gradients in mortality among nonelderly adults in the United States.
Lung cancer from passive smoking at work.
Authors: Wells A J
Published: November 2008

OBJECTIVES: This study was undertaken to determine whether exposure at work to environmental tobacco smoke is associated with an increased risk of lung cancer. METHODS: Data from 14 studies providing information on lung cancer and exposure to environmental tobacco smoke at work were examined. Six quality criteria were developed for determining usable data. A meta-analysis was performed to obtain a combined risk for those data that met the quality restrictions. RESULTS: Five studies met the quality standards. Their combined relative risk was 1.39 (95% confidence interval [CI] = 1.15, 1.68) based on 835 lung cancer cases. In various meta-analyses prepared by tobacco industry employees or consultants, no increase in risk was found. The main reason for this difference is that the earlier analysts failed to find errors in 2 underlying studies that resulted in overweighting of the odds ratios from those studies, both of which were less than unity. CONCLUSIONS: When appropriate cognizance is taken of the quality of data inputs, the increase in lung cancer risk from workplace exposure to environmental tobacco smoke is about the same as that from household exposure.
The fall after the rise: Tuberculosis in the United States, 1991 through 1994.
Authors: McKenna M T , McCray E , Jones J L , Onorato I M , Castro K G
Published: November 2008

OBJECTIVES: Factors associated with decreases in tuberculosis cases observed in the United States in 1993 and 1994 were analyzed. METHODS: Changes in case counts reported to the national surveillance system were evaluated by dividing the number of incident cases of TB reported in 1993 and 1994 by the number of cases reported in 1991 and 1992 and stratifying these ratios by demographic factors, AIDS incidence, and changes in program performance. RESULTS: Case counts decreased from 52,956 in 1991 and 1992 to 49,605 in 1993 and 1994 (case count ratio = 0.94, 95% confidence interval [CI] = 0.93, 0.95). The decrease, confined to US-born patients, was generally associated with AIDS incidence and improvements in completion of therapy, conversion of sputum, and increases in the number of contacts identified per case. CONCLUSIONS: Recent TB epidemiology patterns suggest that improvements in treatment and control activities have contributed to the reversal in the resurgence of this disease in US-born persons. Continued success in preventing the occurrence of active TB will require sustained efforts to ensure appropriate treatment of cases.
Differences in the effect of patients' socioeconomic status on the use of invasive cardiovascular procedures across health insurance categories.
Authors: Carlisle D M , Leake B D
Published: November 2008

OBJECTIVES: This study evaluated the effect of patients' socioeconomic status on use of coronary angiography, bypass grafting, and angioplasty across health insurance categories. METHODS: Multiple logistic regression was used to compute the odds of receiving each procedure among 206 233 ischemic heart disease patients residing in urban California zip codes from 1991 through 1993. RESULTS: Residents of high socioeconomic status areas were more likely (odds ratios [ORs] = 1.20-1.41) and residents of low socioeconomic status areas were less likely (ORs = 0.79-0.84) than residents of middle socioeconomic status areas to undergo each procedure. These effects were common among Medicare and health maintenance organization patients and uncommon for privately insured and uninsured patients. CONCLUSIONS: The effect of socioeconomic status varies across health insurance categories.
Promoting skin cancer prevention counseling by pharmacists.
Authors: Mayer J A , Eckhardt L , Stepanski B M , Sallis J F , Elder J P , Slymen D J , Creech L , Graf G , Palmer R C , Rosenberg C , Souvignier S T
Published: November 2008

OBJECTIVES: This study evaluated the effects of an intervention on rates of skin cancer prevention counseling by pharmacists. METHODS: Fifty-four pharmacies were randomly assigned to intervention or control conditions. Intervention consisted of training, feedback, and prompts. Counseling rates before and after the intervention were obtained from study confederates. RESULTS: At pretest, the proportions of control and intervention sites providing counseling at least once were 7.4% and 0%, respectively (NS). At posttest, these proportions were 3.7% and 66.7%, respectively (P < .001). CONCLUSIONS: The results indicated that the intervention was successful and that pharmacists can play an important role in educating the public about skin cancer prevention strategies.
Public health nihilism vs pragmatism: history, politics, and the control of tuberculosis.
Authors: Fairchild A L , Oppenheimer G M
Published: November 2008

Tuberculosis (TB) began to decline in the Western world in the mid- to late 1800s. In the United States, the disease receded until the mid-1980s, when that trend was reversed. Although the TB epidemic in the United States subsided in response to public health interventions, it sparked a controversy regarding the relative value of targeted public health measures vs broad social reform. That controversy, which echoed earlier debates calling for structural reform over public health programs, was further strengthened by the historical and demographic studies of Thomas McKeown. His influential thesis maintains that clinical and primary prevention efforts had little effect on TB mortality. In this paper, the historical literature is used to examine whether public health had a significant impact on the decline of TB mortality rates in several countries. Specifically, the paper describes the arguments for and data affirming the efficacy of 2 major public health interventions over time: segregation of those infected with pulmonary TB and eradication of bovine TB. This review finds support for the hypothesis that public health measures, along with other factors, led to falling rates of TB mortality beginning in the late 19th century.
The effect of cigarette taxes on cigarette consumption.
Authors: Showalter M H
Published: November 2008

OBJECTIVES: This paper reexamines the work of Meier and Licari in a previous issue of the Journal. METHODS: The impact of excise taxes on cigarette consumption and sales was measured via standard regression analysis. RESULTS: The 1983 federal tax increase is shown to have an anomalous effect on the regression results. When those data are excluded, there is no significant difference between state and federal tax increases. Further investigation suggests that firms raised cigarette prices substantially in the years surrounding the 1983 federal tax increase, which accounts for the relatively large decrease in consumption during this period. CONCLUSIONS: Federal excise taxes per se do not appear to be more effective than state excise taxes in terms of reducing cigarette consumption. The reaction of cigarette firms to government policies appears to be an important determinant of the success of antismoking initiatives.
Implications of the Institute of Medicine weight gain recommendations for preventing adverse pregnancy outcomes in black and white women.
Authors: Caulfield L E , Stoltzfus R J , Witter F R
Published: November 2008

OBJECTIVES: This study examined the relation between gestational weight gain and risk of delivering a small-for-gestational-age or large-for-gestational-age infant by race, along with the implications of gaining weight according to the Institute of Medicine guidelines. METHODS: Logistic regression methods were used to identify risk factors for small- and large-for-gestational-age births among 2617 Black and 1253 White women delivering at the Johns Hopkins Hospital between 1987 and 1989. RESULTS: Rate of total weight gain was related to risk of small- and large-for-gestational-age births; the relationship differed according to maternal body mass index but not race. No differences in outcome by race were evident for women with low body mass indexes; among those with average or high indexes, however, Black women were at higher risk of small-for-gestational-age births and at lower risk of large-for-gestational-age births. CONCLUSIONS: Having Black women gain at the upper end of the recommended range is unlikely to produce measurable reductions in small-for-gestational-age births. Some beneficial reductions in the risk of large-for-gestational-age births may occur if weight gain recommendations are lowered for average-weight and overweight White women.
Norplant selection and satisfaction among low-income women.
Authors: Clarke L L , Schmitt K , Bono C A , Steele J , Miller M K
Published: November 2008

OBJECTIVES: This study examined correlates of Norplant selection and satisfaction among low-income women. METHODS: Interviews were completed in family planning clinics in 4 Florida counties with 1152 Norplant users and 1268 nonusers, with follow-up interviews with a subsample up to 1 year later. Logistic regression models estimated the associations of socio-demographic and medical characteristics with Norplant selection and method satisfaction. RESULTS: Odds ratios for Norplant selection were significantly greater among women who planned to have children in 5 or more years, those who were "offered" Norplant, those who lived in Palm Beach County, those who were using drugs, and those who were Medicaid clients. Women younger than 17 and those who learned about Norplant from a friend were twice as likely as others to select Norplant. Ninety-two percent of Norplant users were satisfied with the method; women with side effects and those who felt pressure to select a method were significantly less likely than others to be satisfied. CONCLUSIONS: Norplant provides an acceptable and satisfying method of birth control for many low-income women. Proper counseling about all methods of birth control and about Norplant's side effects remains critical to the appropriate delivery of this method.
Breast cancer detection: maps of 2 San Francisco Bay area counties.
Authors: Selvin S , Merrill D W , Erdmann C , White M , Ragland K
Published: November 2008

OBJECTIVES: This study describes the incidence of late-stage and in situ breast cancer among White women, using specialized mapping techniques that reflect incidence adjusted for the population at risk, and applies these maps to characterize areas with high and low risk of breast cancer. METHODS: Data from the Surveillance, Epidemiology, and End Results (SEER) database and the US Census Bureau were used to study the geographic distribution of breast cancer at the census-tract level in 2 San Francisco Bay Area counties for the years 1978 through 1982. Sociodemographic characteristics of areas with high and low incidence of the stage-specific disease were compared by means of a linear discriminant function. RESULTS: For late-stage breast cancer, the most important variables in discriminating high-risk from low-risk areas were college education, percentage of residents over age 65, and median income. The strongest ecologic indicators of high risk for in situ breast cancer were median income and percentage unemployed. CONCLUSIONS: This study demonstrates the usefulness of census tracts and sociodemographic measures of income and education in describing in situ and late-stage breast cancer.
Dietary cardiovascular risk factors and serum cholesterol in an Old Order Mennonite community.
Authors: Glick M , Michel A C , Dorn J , Horwitz M , Rosenthal T , Trevisan M
Published: November 2008

OBJECTIVES: Dietary and coronary heart disease risk factors in Old Order Mennonite men and women were examined. METHODS: A food frequency questionnaire was mailed to 250 Mennonites who had participated in a previous study of coronary heart disease risk factors. RESULTS: Mennonites consumed a diet high in total fat, saturated fats, and cholesterol. Men had lower average serum cholesterol levels (174 mg/dL) than women (191 mg/dL). CONCLUSIONS: The Mennonites' diet was similar to that of the overall US population in saturated fat percentage and higher in cholesterol. Serum cholesterol levels, adiposity, and blood pressure were lower than expected among Mennonite men, perhaps because of their higher levels of physical activity.
Milk consumption in older Americans.
Authors: Elbon S M , Johnson M A , Fischer J G
Published: November 2008

OBJECTIVES: The purpose of this study was to identify individual characteristics associated with types and frequency of milk consumption in older American adults. METHODS: A national probability-based sample (response rate = 91%) completed a telephone survey. Generalized logit and cumulative logit analyses were used to identify predictors of and barriers to fluid milk consumption in 494 elderly people. RESULTS: The likelihood of drinking skim or 1% milk rather than whole milk increased with nutrition knowledge, income, trying to reduce cholesterol intake, and being female (P < .05). Frequency of milk consumption was higher with nutrition knowledge, frequency of milk consumption during adolescence, and following a diabetic diet but was lower with milk intolerance. CONCLUSIONS: The present results could be used to develop intervention strategies for improving milk consumption rates among older adults. These strategies might focus on increasing elderly people's awareness of milk intolerance and lactose-reduced milk products and their concern about cholesterol. The relationship between current and adolescent milk consumption suggests that intervention strategies should begin early in life.
The association of non-insulin-dependent diabetes mellitus with perceived quality of life in a biethnic population: the San Luis Valley Diabetes Study.
Authors: Caldwell E M , Baxter J , Mitchell C M , Shetterly S M , Hamman R F
Published: November 2008

OBJECTIVES: This study evaluated the association between quality of life and non-insulin-dependent diabetes mellitus (NIDDM) status, and whether this association differs between Hispanics and non-Hispanic Whites. METHODS: Between 1986 and 1989, cross-sectional data on perceived quality of life (PQOL) were collected from 223 persons with NIDDM and 753 non-diabetic subjects. RESULTS: After adjustment, persons with NIDDM rated their PQOL significantly lower than did control subjects. The relationship of diabetes and PQOL did not differ by ethnicity. The number of complications of diabetes was not associated with lower PQOL scores. CONCLUSIONS: Control and treatment strategies should reflect an understanding of the impact that diabetes has on social functioning, leisure activities, and physical and mental health.
Trends in cigarette smoking: the Minnesota Heart Survey, 1980 through 1992.
Authors: Arnett D K , Sprafka J M , McGovern P G , Jacobs D R , Shahar E , McCarty M , Luepker R V
Published: November 2008

OBJECTIVES: The purpose of this study was to describe trends in the prevalence of cigarette smoking between 1980 through 1982 and 1990 through 1992 in Minneapolis and St. Paul, Minn. METHODS: Three population-based surveys were conducted among adults 25 to 74 years of age in 1980 through 1982, 1985 through 1987, and 1990 through 1992. RESULTS: Overall age-adjusted prevalences of cigarette smoking declined significantly between 1980-1982 and 1985-1987 and between 1985-1987 and 1990-1992. Serum thiocyanate, a biochemical marker for tobacco use, also declined significantly over the 3 periods. CONCLUSIONS: Favorable trends in smoking prevalence and cigarette consumption among smokers were observed, but disturbing trends in some smoking behaviors were also noted.
1996 congressional campaign priorities of the AMA: tackling tobacco or limiting malpractice awards?
Authors: Sharfstein J
Published: November 2008

OBJECTIVES: This study sought to determine whether the political action committee of the American Medical Association (AMA) contributed more to pro- or anti-tobacco members of Congress in the 1995/96 campaign and whether representatives' voting records on malpractice reform could explain the AMA's contribution patterns. METHODS: Campaign contributions to House members were analyzed. RESULTS: The AMA's political action committee contributed averages of $5382 to pro-tobacco representatives and $2103 to anti-tobacco representatives (P < .0005). This contribution pattern can be fully explained by representatives' votes to limit malpractice awards. CONCLUSIONS: In seeking malpractice reform, the AMA contributed significantly more to pro-tobacco representatives, potentially undermining tobacco control legislation.
Cost-effectiveness of a community-level HIV risk reduction intervention.
Authors: Pinkerton S D , Holtgrave D R , DiFranceisco W J , Stevenson L Y , Kelly J A
Published: November 2008

OBJECTIVES: The authors evaluated the cost-effectiveness of a community-level HIV prevention intervention that used peer leaders to endorse risk reduction among gay men. METHODS: A mathematical model of HIV transmission was used to translate reported changes in sexual behavior into an estimate of the number of HIV infections averted. RESULTS: The intervention cost $17,150, or about $65,000 per infection averted, and was therefore cost-saving, even under very conservative modeling assumptions. CONCLUSIONS: For this intervention, the cost of HIV prevention was more than offset by savings in averted future medical care costs. Community-level interventions to prevent HIV transmission that use existing social networks can be highly cost-effective.
Racial discrimination and skin color in the CARDIA study: implications for public health research. Coronary Artery Risk Development in Young Adults.
Authors: Krieger N , Sidney S , Coakley E
Published: November 2008

OBJECTIVES: This study assessed whether skin color and ways of handling anger can serve as markers for experiences of racial discrimination and responses to unfair treatment in public health research. METHODS: Survey data on 1844 Black women and Black men (24 to 42 years old), collected in the year 5 (1990-1991) and year 7 (1992-1993) examinations of the Coronary Artery Risk Development in Young Adults (CARDIA) study, were examined. RESULTS: Skin color was not associated with self-reported experiences of racial discrimination in 5 of 7 specified situations (getting a job, at work, getting housing, getting medical care, in a public setting). Only moderate associations existed between darker skin color and being working class, having low income or low education, and being male (risk ratios under 2). Comparably moderate associations existed between internalizing anger and typically responding to unfair treatment as a fact of life or keeping such treatment to oneself. CONCLUSIONS: Self-reported experiences of racial discrimination and responses to unfair treatment should be measured directly in public health research; data on skin color and ways of handling anger are not sufficient.
Atopy in children and parental social class.
Authors: Heinrich J , Popescu M A , Wjst M , Goldstein I F , Wichmann H E
Published: November 2008

OBJECTIVES: This analysis was conducted to determine whether atopic disorders were related to social class in a pediatric population of a former socialist country. METHODS: A cross-sectional study of 2471 schoolchildren was carried out in 1992 and 1993 in 3 towns in the former East Germany. Parents completed a standardized questionnaire regarding health events and lifestyle factors. In addition, skin-prick tests were performed and total serum immunoglobulin (IgE) was determined. RESULTS: Lifetime prevalence rates for atopic disease and rates of allergic sensitization were highest in children from social class III (in which parents had more than 10 years of formal education) and lowest in social class I (less than 10 years of parental education), while rates in social class II (10 years of parental education) were constant at an intermediate level. CONCLUSIONS: The data confirmed the assumption that in formerly socialist countries social inequalities existed under the socialist system, which were reflected by a social gradient in health outcomes. The findings support the hypothesis that increased access to modern lifestyle could be one reason for the increasing rates of atopic disorders during the last 3 decades.