bluuebunny/crossref_metadata_2025 huggingface dataset:
A note on the measurement of hypertension in HHANES.
Authors: Geronimus A T , Neidert L J , Bound J
Published: November 2008

Using data from the HHANES, we found the rates of elevated blood pressure readings on clinical examination to be extremely low for a sample of Mexican American and Puerto Rican women. The prevalence rates were one-fourth to one-fifth the rates found for a comparable sample of White women from NHANESII. These findings are discrepant with the little that is known about hypertension prevalence among Hispanics and with estimates of hypertension prevalence for Mexican Americans and Puerto Ricans drawn from NHANESII. While our HHANES samples women had much lower rates of clinical high blood pressure than Whites, they reported hypertension histories in excess of Whites. Rates of medicine usage among Hispanics were insufficiently large for effective treatment to explain the disparity. The prevalence estimates increased, but the relative discrepancies remained when we altered our sample specifications and clinical high blood pressure measure. A possible explanation for these discrepancies is that few physicians performed the majority of blood pressure readings in our HHANES sample. This may have been statistically inefficient. The discrepancies noted suggest that HHANES may not be a reliable source of information on hypertension among Hispanic women.
Nongenetic influences of obesity on other cardiovascular disease risk factors: an analysis of identical twins.
Authors: Newman B , Selby J V , Quesenberry C P , King M C , Friedman G D , Fabsitz R R
Published: November 2008

The importance of genetic influences on obesity has been emphasized recently. We conducted matched co-twin analyses of 250 pairs of White, male, monozygotic twins from the National Heart, Lung, and Blood Institute (NHLBI) Twin Study. Entirely in the absence of genetic influences, obesity was significantly associated with systolic and diastolic blood pressures; one-hour, post-load glucose; total, LDL-, and HDL-cholesterol; and triglycerides among these 42-55 year old men. Similar results were obtained in longitudinal analyses of weight change during adulthood (from mean age of 20 to mean age of 48 years) and risk factor status at middle-age. These results indicate that behaviors and environmental exposures that occur later in life are responsible, at least in part, for the associations between adult obesity and cardiovascular disease risk, supporting the appropriateness of weight reduction efforts during adulthood.
Evaluating community-based nutrition programs: assessing the reliability of a survey of grocery store product displays.
Authors: Cheadle A , Psaty B , Wagner E , Diehr P , Koepsell T , Curry S , Von Korff M
Published: November 2008

A pilot test of a survey of grocery store product displays was conducted to measure the amount of health-education information provided and the proportion of the display devoted to "healthier" products. Inter-rater reliability ranged between 0.73 and 0.78 for the healthiness indices and between 0.30 and 0.67 for the health education measures. Test-retest reliability ranged from 0.44 to 1.0.
Seat belt use on interstate highways.
Authors: Wells J K , Williams A F , Lund A K
Published: November 2008

More than 5,000 miles of limited-access highways in the eastern United States and Canada were traveled to observe seat belt use. Overall belt use was 58 percent in the United States and 79 percent in Canada. The data indicate that belt use in the United States follows a different pattern on interstate highways than on other streets and roads, with relatively high belt use rates (over 50 percent) appearing to be somewhat independent of belt use law provisions.
Effect of changing patterns of care and duration of survival on the cost of treating the acquired immunodeficiency syndrome (AIDS).
Authors: Seage G R , Landers S , Lamb G A , Epstein A M
Published: November 2008

We performed a two-year cost of illness study of 240 AIDS patients (55 percent of all Massachusetts cases) diagnosed and treated at five hospitals from March 1984 through February 1986. Sociodemographic and clinical data as well as information on medical utilization were obtained from review of inpatient and outpatient hospital records. The yearly inpatient cost per patient decreased by 28 percent from $38,369 in year one to $27,714 in year two. These changes were related to shorter lengths of stay (from 20.6 days to 16.8 days per hospitalization, mean difference of 3.8 days, 95% CI of the difference -.2, 7.8), and less costly hospitalizations (from $12,463 to $9,957, mean difference of $2,506, 95% CI of the difference $135, $4,877). The probability of hospitalization, however, was similar in both years. These patterns of care were still evident after controlling for transmission category, race, site, mortality, insurance, age, gender, number and type of opportunistic diseases and time since diagnosis. Although the cost per patient per year decreased between years one and two, median survival increased by 70 percent (from 10 to 17 months). Hence overall estimated lifetime costs increased by 24 percent.
The federal environmental health workforce in the United States.
Authors: Sexton K , Perlin S A
Published: November 2008

This paper summarizes existing data on the size and composition of the federal environmental health workforce, delineates the major categories of activities carried out by its members, identifies current and emerging issues that are likely to affect workforce activities, and makes qualitative inferences about future trends and directions. Findings suggest that there is a current and future need for more and better qualified professionals in the federal environmental health workforce.
HIV seroprevalence and the acceptance of voluntary HIV testing among newly incarcerated male prison inmates in Wisconsin.
Authors: Hoxie N J , Vergeront J M , Frisby H R , Pfister J R , Golubjatnikov R , Davis J P
Published: November 2008

In 1986-88, voluntary and blinded HIV testing was conducted among Wisconsin male prison entrants. The HIV seroprevalence was 0.30 percent in 1986, 0.53 percent in 1987, and 0.56 percent in 1988. The seroprevalence rates among entrants tested voluntarily did not differ from those tested blindly. Voluntary HIV testing was accepted by 71 percent of male prison entrants in 1988; among entrants reporting intravenous drug use 83 percent consented to voluntary HIV testing. Voluntary HIV testing of entrants appears to be an effective screening strategy in Wisconsin prisons.
Socioeconomic status and electrolyte intake in black adults: the Pitt County Study.
Authors: Gerber A M , James S A , Ammerman A S , Keenan N L , Garrett J M , Strogatz D S , Haines P S
Published: November 2008

BACKGROUND. Although the inverse association between socioeconomic status (SES) and blood pressure has often been observed, little is known about the relationship between SES and dietary risk factors for elevated blood pressure. Therefore, this study described the distribution of dietary intakes of sodium, potassium, and calcium and examined the association between electrolyte intake and SES among 1784 Black men and women aged 25 to 50 residing in eastern North Carolina. METHODS. Household interviews were conducted in 1988 to obtain information on psychosocial and dietary correlates of blood pressure. Electrolyte intake (mg/day) was assessed using a food frequency questionnaire adapted to reflect regional and ethnic food preferences. SES was categorized into three levels defined by the participant's educational level and occupation. RESULTS. After adjustment for age and energy intake, potassium and calcium intake increased with increasing SES for both sexes. Sodium intake was high for all groups and did not vary markedly with SES, but sodium to potassium and sodium to calcium ratios decreased with increasing SES. In addition, high SES individuals were more likely to believe that diet affects risk for disease and to report less salt use at the table and less current sodium consumption than in the past. CONCLUSION. These data indicate that nutritional beliefs as well as the consumption of electrolytes are associated with SES in Black adults.
Knowledge about HIV and behavioral risks of foreign-born Boston public school students.
Authors: Hingson R W , Strunin L , Grady M , Strunk N , Carr R , Berlin B , Craven D E
Published: November 2008

In 1990, 3049 Boston public middle and high school students were surveyed anonymously in English, Spanish, Vietnamese, Chinese, French, or Haitian Creole. Significantly fewer immigrant students, 35% of those surveyed, knew the principal modes of human immunodeficiency virus transmission. Fewer immigrants reported having sexual intercourse (31% vs 53% of nonimmigrants), but among the sexually active only 38% always used condoms, and more immigrants reported intercourse with intravenous drug users (4% vs 1% of non-immigrants). AIDS education should be taught to immigrant students in their native languages.
The effects of removing a statutory barrier to workers' compensation for farm workers.
Authors: Demers P , Rosenstock L
Published: November 2008

In 1983 the Washington State Supreme Court ruled unconstitutional a unique exemption that excluded farm workers from workers' compensation if they had not earned $150 in continuous work with the same employer. In order to examine the effect of removing this restriction, workers' compensation data were analyzed to examine the number of farm workers covered, the number of claims submitted, and claim acceptance rates before and after the ruling. Although the 1983 ruling appears to have had a significant impact on the treatment of claims, no increase in utilization of the workers' compensation system was observed. Further intervention is required if the objective of treating farm workers equitably is to be realized.
Oral public health programs for the elderly: 1989.
Authors: Strayer M S
Published: November 2008

Forty-eight of the 50 state dental directors, program managers, or state health officials were interviewed by telephone about the nature of current oral health programs for the elderly and factors that aided or hindered the development of such programs. Oral health programs for the elderly were reported in 30 states (63 percent of respondents). A majority of respondents indicated that a perceived or documented need for oral health programs for the elderly and lobbying by local advocacy groups were instrumental in implementing or planning such programs.
Regular source of ambulatory care and access to health services.
Authors: Hayward R A , Bernard A M , Freeman H E , Corey C R
Published: November 2008

BACKGROUND: To examine why people lack a regular source of ambulatory care (RSAC) and explore whether this commonly used access measure accurately identifies population subgroups at risk for barriers to continuity care. METHODS: Using data from a 1986 national telephone survey, we performed a content analysis of subjects' verbatim reports as to why they lacked an RSAC (n = 5,748). RESULTS: The 16.4 percent of respondents who lacked an RSAC gave the following reasons: 1) financial problems, 8 percent; 2) local resource inaccessibility, 5 percent; 3) not wanting a regular source of ambulatory care, 61 percent; and 4) transitory loss of their regular source of ambulatory care, 18 percent. However, some sociodemographic subgroups reported substantially more problems with access barriers, and these disparities were often not detected by the global measure, RSAC. The poor were not more likely than the non-poor to lack an RSAC (odds ratio [OR] = 0.8; 95% confidence interval, [0.6, 1.1]), but were much more likely to lack an RSAC for financial reasons (OR = 5.2 [2.6, 10.6]). Similarly, rural respondents were not more likely than urban dwellers to lack an RSAC, but were more likely to lack an RSAC because of local resource inaccessibility (OR = 5.8 [2.8, 11.9]). CONCLUSIONS: We conclude that the global measure, RSAC, is not an accurate indicator of whether population subgroups have access barriers to obtaining a source of continuity care.
Screening recommendations for the elderly.
Authors: Beers M H , Fink A , Beck J C
Published: November 2008

BACKGROUND. Studies have documented the potential contributions of preventive health care programs. Yet little is known about which screening tests should be included in public health programs for older persons. This study offers recommendations regarding these tests. METHODS. The recommendations come from synthesizing the findings of the US Preventive Services Task Force, the literature, and the consensus of experts in geriatrics, gerontology, and health policy research. The literature was evaluated to identify methodologically sound studies of the prevalence of selected disorders and benefits and availability of screening procedures for those disorders. Experts from various fields specializing in the care of the elderly formed panels to assist in evaluating the literature and providing further information from gerontological and public health perspectives. RESULTS. We recommend vision testing for refractive error; inspection of the skin surface for fungal infection and skin cancer, drug eruptions, and xerosis; a history for symptoms of xerosis; audiometric testing for presbycusis; surveys for hearing loss; otoscopic inspection for cerumen impaction; dental examination for caries; measurement of blood pressure for hypertension; and breast examination and mammography for cancer. CONCLUSIONS. Our study suggests that these screening procedures are useful for public health screening programs. More information is needed on the effects of screening services on the health and functioning of older persons.
Prevalence of human T-lymphotropic virus in civilian applicants for the United States Armed Forces.
Authors: Roberts C R , Fipps D R , Brundage J F , Wright S E , Goldenbaum M , Alexander S S , Burke D S
Published: November 2008

BACKGROUND. The wide range in human T-lymphotropic virus (HTLV) seroprevalences reported worldwide has made estimates of seroprevalence difficult in unique populations. In this study, the seropositivity of young adult civilian applicants for the US Armed Forces was determined. METHODS. Serum samples from nine geographic regions were screened by an Enzyme-Linked Immunosorbent Assay (ELISA), and repeatedly reactive samples were further tested by Western blot and radioimmunoprecipitation. Specimens were scored as positive when antibody to gag (p24) and env (gp46 or gp68) were detected. RESULTS. Of the 43,750 samples analyzed, 18 were positive for HTLV antibodies. Ten (55%) were from males and eight (45%) were from females. Nine (90%) of the males and seven (87.5%) of the females were Black. Twelve of the positive samples (66.6%) were from the New York City region, which represented only 18.8% of the sample population. CONCLUSIONS. The overall HTLV seroprevalence of civilian applicants for the US Armed forces was 0.41 per 1000. This was higher than the seroprevalence reported for volunteer blood donors.
Ownership and performance of outpatient substance abuse treatment centers.
Authors: Wheeler J R , Fadel H , D'Aunno T A
Published: November 2008

BACKGROUND. Little is known about the organization and performance of outpatient substance abuse treatment (OSAT) centers. We examine several performance measures of OSAT units, including clients treated, services provided, revenue sources, financial performance, and access to care, in relation to ownership of the center. METHODS. Data were drawn from a national random sample of 575 OSAT centers (85.8% response rate) participating in a telephone survey conducted in 1988. Analysis of variance by ownership was conducted on each performance measure, with differences subjected to tests of statistical significance. RESULTS. Descriptive results show that major funding sources differ by ownership. Private for-profit centers generate higher profits, charge higher prices, and achieve higher levels of financial performance than public and not-for-profit centers. Public centers provide better access to care for persons who are unable to pay. CONCLUSIONS. There appear to be substantial and interrelated differences by ownership type in the financing and operation of OSAT units.
Making human junk: child labor as a health issue in the Progressive Era.
Authors: Derickson A
Published: November 2008

The adverse health effects of work on approximately 2 million employed children troubled many in the United States during the early 20th century. Advocates of reform initially built a rationale for protective legislation primarily from informal, lay observations of the broad developmental outcomes of premature employment. In this endeavor, they projected a dismal scenario of impending national deterioration. This argument received strong criticism for the inadequacy of its corroborating evidence. In response, Progressive reformers emphasized the specific, measurable consequences of particular occupations. Increasingly, liberal advocates of the exclusion of boys and girls from the work force drew upon statistical compilations of occupational injuries and illnesses diagnosed by physicians. Despite their turn toward scientism, Progressives remained somewhat ambivalent about the sufficiency of quantitative data alone to achieve their aims.
HIV transmission: Women's risk from bisexual men.
Authors: Wood R W , Krueger L E , Pearlman T C , Goldbaum G
Published: November 2008

The purpose of this study was to characterize the risk of human immunodeficiency virus (HIV) infection for men who have sex with men and to identify the risk such men pose to their female sex partners. The subjects were 5480 men who were tested for HIV between January 1987 and December 1991 and who reported having had sex with a man since 1977. Men who identified themselves as bisexual or straight were more likely to use injection drugs, had a substantial HIV seroprevalence, and reported many more female partners than men who identified themselves as gay. Men who identify themselves as bisexual pose the greatest risk to their female partners.
Reducing the use of physical restraints in nursing homes: will it increase costs?
Authors: Phillips C D , Hawes C , Fries B E
Published: November 2008

OBJECTIVES. Reducing the widespread use of physical restraints in nursing homes is a primary goal of the federal nursing home reforms enacted as part of the Omnibus Budget Reconciliation Act of 1987. However, some nursing home operators assert that reducing restraint use could be prohibitively expensive, costing payors perhaps as much as $1 billion annually. We investigated whether nursing home residents free from physical restraint require more care and resources than similar residents who are restrained. METHODS. We examined the major component of nursing home costs--staff time--and its allocation among residents who were physically restrained and those who were not restrained. The multivariate analysis used staff-time-study data on the care of 11,932 nursing home residents in 276 facilities in seven states. RESULTS. The analyses indicate that, when differences in impairment and care needs are controlled for, residents who are physically restrained require more nursing care than other residents. Higher levels of nursing-assistant time were consistently provided to restrained residents. CONCLUSIONS. Residents free of restraints are less costly to care for than restrained residents. The 1987 federal requirements concerning restraint use, which are aimed at improving quality of care and quality of life, can be implemented without engendering a major increase in care costs.
Depressive symptoms in blood donors notified of HIV infection.
Authors: Cleary P D , Van Devanter N , Rogers T F , Singer E , Shipton-Levy R , Steilen M , Stuart A , Avorn J , Pindyck J
Published: November 2008

OBJECTIVES. Understanding more about the psychological state of persons notified of human immunodeficiency virus (HIV) infection is critical for designing notification and counseling programs that will have the most positive effect. METHODS. The subjects were blood donors who had been notified of HIV infection by the New York Blood Center. A nurse elicited a medical history, performed a limited medical examination, and asked the subjects to complete a questionnaire that included questions about drug use, sexual behavior, and psychological characteristics. The subjects completed another questionnaire approximately 2 weeks later. RESULTS. The average depressive symptom scores for both men and women were substantially higher than scores typically found in representative population samples. More than a quarter of the men and more than a third of the women reported seeking psychological or psychiatric services in the first few weeks following notification. CONCLUSIONS. Anticipating and meeting individuals' psychological needs may be necessary if HIV screening programs are to address effectively the needs of persons infected with HIV.
Increasing frequency of heterosexually transmitted AIDS in southern Florida: artifact or reality?
Authors: Nwanyanwu O C , Conti L A , Ciesielski C A , Stehr-Green J K , Berkelman R L , Lieb S , Witte J J
Published: November 2008

Acquired immunodeficiency syndrome (AIDS) cases reported as the result of heterosexual contact have been increasing in the United States, with Florida reporting a disproportionate number. We investigated 168 such AIDS cases from southern Florida. After follow-up, 50 (30%) patients were reclassified into other transmission categories. The data suggest that the increased rate of heterosexually acquired AIDS cases reported from southern Florida was partially related to misclassification of risk.
Antidepressants and falls among elderly people in long-term care.
Authors: Ruthazer R , Lipsitz L A
Published: November 2008

All eligible residents of a long-term care facility (488 women and 147 men with a 6-month minimum stay) were prospectively followed for 1 month for the development of falls. Use of psychotropic medications (excluding as needed prescriptions), functional status, and a history of falls were assessed at the start of the study month. Results of analyses using logistic modeling procedures suggest that institutionalized women on antidepressants may have an increased risk of falling, regardless of fall history, functional status, or age. A relationship between antidepressants and falls was not found for men. These results may help target high-risk individuals for future preventive efforts.
Commentary: tuberculosis in New York City--the consequences and lessons of failure.
Authors: Landesman S H
Published: November 2008

The resurgent tuberculosis epidemic represents--especially in New York City--a failure to maintain a public health infrastructure that was focused on preventing active disease in high-risk populations (i.e., individuals with the human immunodeficiency virus [HIV]) and on treating active tuberculosis patients until cured. Although the tuberculosis problem in New York City and other localities is worsened by homelessness, poverty, and substance abuse, it is possible to bring tuberculosis under control by directing public health resources into targeted programs that enhance compliance with tuberculosis treatment regimen and expand chemoprophylaxis efforts among HIV-infected individuals. These two avenues will decrease, respectively, the number of cases of multidrug-resistant tuberculosis and the total number of new cases.
Acculturation and alcohol consumption in Puerto Rican, Cuban-American, and Mexican-American women in the United States.
Authors: Black S A , Markides K S
Published: November 2008

Data from the Hispanic Health and Nutrition Examination Survey were used to examine the influence of acculturation on alcohol consumption among Puerto Rican, Cuban-American, and Mexican-American women in the United States. Acculturation was found to be positively related to frequency of consumption and probability of being a drinker among all three groups. A positive relationship was also evident for total drinks consumed among Cuban-American women, and volume (drinks per occasion) and total drinks consumed among Mexican-American women.
Work-site smoking policies: their population impact in Washington State.
Authors: Kinne S , Kristal A R , White E , Hunt J
Published: November 2008

This article presents data from a population-based, random-digit dialing telephone survey of 1228 employed adults in Washington State, conducted 1989 through 1990. Eighty-one percent of men and 91% of women reported work-site smoking restrictions. Employees in work sites with no-smoking policies were less likely to be current smokers; men in work sites with policies restricting smoking smoked fewer cigarettes on both workdays and nonworkdays. Forty-eight percent of male and 53% of female smokers reported reduced smoking as a result of work-site policy. Work-site smoking policies, intended to protect against smoke exposure, may also reduce employee smoking.
Integrating smoking control policies into employee benefits: a survey of large California corporations.
Authors: Schauffler H H
Published: November 2008

OBJECTIVES. Public health policy promotes the use of risk-rating health insurance and payment for smoking cessation as economic incentives to encourage smoking cessation. This study was undertaken to learn more about the adoption of these policies in large corporations. METHODS. A random sample survey of 280 private California corporations with more than 500 employees was undertaken to document the prevalence of policies integrating smoking control into employee benefit designs. RESULTS. Only 8.6% of large corporations had ever considered risk-rating health insurance premiums using smoking status and only 2.15% had implemented a risk-rating policy. Nearly 20% of the companies offered health insurance plans that covered smoking cessation services. Subsidization or payment for smoking cessation outside health insurance was provided by over 37% of the companies surveyed, and 87% had adopted formal work-site smoking policies. CONCLUSION. Benefit policies that provide financial support to smokers to participate in smoking cessation services are much more prevalent and are viewed more positively by the benefits managers in large corporations than are policies to risk-rate health insurance premiums on the basis of smoking.
Is cardiopulmonary resuscitation training deleterious for family members of cardiac patients?
Authors: Dracup K , Moser D K , Guzy P M , Taylor S E , Marsden C
Published: November 2008

The purpose of the study was to determine the attitudes toward cardiopulmonary resuscitation (CPR) training and subsequent CPR use of 172 CPR-trained family members of cardiac patients. The majority (88.9%) reported positive attitudes. Only 14 (8.1%) reported feeling too responsible for their family member. One hundred and forty-one (81.9%) said that they would perform CPR if required to do so. Family members do not feel unduly burdened by learning CPR, and CPR training should be recommended to families of patients at risk for sudden cardiac death.
Tuberculosis: is the past once again prologue?
Authors: Comstock G W
Published: November 2008

Tuberculosis has been considered the result of hereditary susceptibility, miasmas in the environment, and contact with contagious patients. During most of the latter half of this century, tuberculosis control efforts have concentrated almost exclusively on contagion by treating patients to make them noninfectious, treating latent tuberculosis to prevent reactivation, and in some countries, vaccinating uninfected persons to protect them from the consequences of infection. With the resurgence of tuberculosis in 1985, interest in all methods of tuberculosis control has been rekindled. Much remains to be discovered and much needs to be done. If renewed efforts succeed in again forcing tuberculosis rates downward, will we have the wisdom to eliminate tuberculosis in the United States, or will we relax and bring about another resurgence?
Lifetime and five-year prevalence of homelessness in the United States.
Authors: Link B G , Susser E , Stueve A , Phelan J , Moore R E , Struening E
Published: November 2008

OBJECTIVE. Intense debate exists concerning the number of homeless people in the United States. Previous studies, counting currently homeless people, have provided point-prevalence estimates of homelessness but have been criticized on methodological grounds. This study reports lifetime and 5-year prevalence estimates of homelessness using a different methodological approach. METHODS. Random-digit dialing was used to interview 1507 adults living in households with telephones in the 48 contiguous states in the fall of 1990. Respondents were asked whether they had ever been homeless and if so, where they had slept while homeless. RESULTS. Lifetime and 5-year prevalence of all types of homelessness combined were 14.0% (26 million people) and 4.6% (8.5 million people), respectively. Lifetime "literal homelessness" (sleeping in shelters, abandoned buildings, bus and train stations, etc.) was 7.4% (13.5 million people). Five-year (1985 through 1990) prevalence of self-reported homelessness among those who had ever been literally homeless was 3.1% (5.7 million people). CONCLUSIONS. The magnitude of the problem of homelessness is much greater than most previous attempts to enumerate homeless people have led us to believe. This finding requires reconsideration of inferences about the causes of homelessness that were derived from point-prevalence studies of currently homeless people.
Work-site cholesterol screening and dietary intervention: the Staff Healthy Heart Project. Steering Committee.
Authors: Barratt A , Reznik R , Irwig L , Cuff A , Simpson J M , Oldenburg B , Horvath J , Sullivan D
Published: November 2008

OBJECTIVES. The Staff Healthy Heart Project was established to run a work-site cholesterol screening project and a randomized controlled trial of dietary interventions. METHODS. Screening was offered to all staff at six Australian hospitals. Participants with blood cholesterol of 5.2 mmol/L (200 mg/dL) or above were randomly allocated to receive screening only (control group), a self-help package, or a nutrition course. Participants were seen 3 and 6 months after intervention to measure blood cholesterol and dietary changes. RESULTS. Eighty percent of available staff (n = 2638) were screened. Of those eligible, 67% (n = 683) entered the trial. Follow-up measures of blood cholesterol and dietary intake were obtained for 63% and 38% of trial participants, respectively. A reduction in reported dietary fat was found for all groups, but there were no significant differences between groups. Reported dietary fiber rose by 0.6 g/MJ/day for those in the nutrition course. There were no changes in total blood or high-density lipoprotein cholesterol. CONCLUSIONS. Cholesterol reduction was not demonstrated, but this result is difficult to interpret given the poor ongoing participation rates. Strategies to improve ongoing participation in work-site projects are needed to achieve adequate assessment of dietary interventions used in cholesterol screening.
The use of nonoxynol-9 for protection against cervical gonorrhea.
Authors: Weir S S , Feldblum P J , Zekeng L , Roddy R E
Published: November 2008

OBJECTIVES. Although condoms are the best defense against sexually transmitted disease, little is known about the effectiveness of female-controlled methods containing nonoxynol-9 as backup protection when condoms are not being used. METHODS. To assess the extent to which nonoxynol-9 protects women against gonorrhea, a cohort of 303 female sex workers (prostitutes) in Yaounde, Cameroon, were asked to use condoms and suppositories containing nonoxynol-9 at every sexual encounter and to record daily sexual activity and use of condoms and suppositories on coital logs that were reviewed monthly. Evidence of gonorrheal infection was based on a positive gonorrhea culture. Stratified analysis and proportional hazards regression were used to estimate rate ratios. RESULTS. Forty-one women enrolled in the study were excluded from the current analysis. The estimated incidence of gonorrhea was 6.2 infections per 100 person-months of observation. Incidence rate ratios estimated from proportional hazards regression models controlling for condom use showed that using nonoxynol-9 during acts not protected by condoms reduced the risk of infection. CONCLUSIONS. Although the protective effect of condoms against sexually transmitted disease is greater than that afforded by nonoxynol-9, using nonoxynol-9 when condoms are not used is a far better strategy in gonorrhea prevention than using no method at all.
Emotional disability days: prevalence and predictors.
Authors: Kouzis A C , Eaton W W
Published: November 2008

This study considered days missed from work or usual activities for emotional reasons associated with a range of specific psychopathologic disorders, psychosocial distress, and persons found to be asymptomatic. Analyses were performed with the presence or absence of emotional disability days as the dependent variable using logistic regression. The effects of specific mental disorders were compared with the effects of chronic physical conditions for labor force participants and for the total population. The odds ratio (and 95% confidence interval) for subjects with major depressive disorder was 27.8 (6.93, 108.96); for panic disorder, 21.1 (2.25, 198.44); and for schizophrenia, 17.8 (1.73, 182.99). Work-place adjustments for persons with psychopathology are encouraged.
AIDS phobia, public health warnings, and lawsuits: deterring harm or rewarding ignorance?
Authors: Mariner W K
Published: November 2008

Courts in more than a dozen states have decided cases in which a person has claimed money damages for his or her fear of getting acquired immunodeficiency syndrome (AIDS). Although most courts have rejected such claims in the absence of actual exposure to the human immunodeficiency virus (HIV), their reasoning has varied slightly from state to state. This article argues that negligence law should not permit people who are HIV negative to recover damages for an unfounded fear of AIDS. Public health statements intended to educate the public about preventing HIV transmission may have encouraged some fear-of-AIDS lawsuits against health care practitioners. Although well intentioned, such statements have been used to justify inappropriate restrictions on medical practice and disclosure of a practitioner's HIV status. To avoid such misuse, such statements should be revised to make clear that the way in which procedures are performed, not who performs them, determines HIV transmission.
Agent Orange and the Vietnamese: the persistence of elevated dioxin levels in human tissues.
Authors: Schecter A , Dai L C , Thuy L T , Quynh H T , Minh D Q , Cau H D , Phiet P H , Nguyen N T , Constable J D , Baughman R
Published: November 2008

OBJECTIVES. The largest known dioxin contamination occurred between 1962 and 1970, when 12 million gallons of Agent Orange, a defoliant mixture contaminated with a form of the most toxic dioxin, were sprayed over southern and central Vietnam. Studies were performed to determine if elevated dioxin levels persist in Vietnamese living in the south of Vietnam. METHODS. With gas chromatography and mass spectroscopy, human milk, adipose tissue, and blood from Vietnamese living in sprayed and unsprayed areas were analyzed, some individually and some pooled, for dioxins and the closely related dibenzofurans. RESULTS. One hundred sixty dioxin analyses of tissue from 3243 persons were performed. Elevated 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) levels as high as 1832 ppt were found in milk lipid collected from southern Vietnam in 1970, and levels up to 103 ppt were found in adipose tissue in the 1980s. Pooled blood collected from southern Vietnam in 1991/92 also showed elevated TCDD up to 33 ppt, whereas tissue from northern Vietnam (where Agent Orange was not used) revealed TCDD levels at or below 2.9 ppt. CONCLUSIONS. Although most Agent Orange studies have focused on American veterans, many Vietnamese had greater exposure. Because health consequences of dioxin contamination are more likely to be found in Vietnamese living in Vietnam than in any other populations, Vietnam provides a unique setting for dioxin studies.
Women dieters of normal weight: their motives, goals, and risks.
Authors: Biener L , Heaton A
Published: November 2008

Using data from a national survey of weight loss practices, this study examined those dieters who were of normal weight. Forty-seven percent of White women, 25% of Black women, and 16% of men currently trying to lose weight had a body mass index under 25. Women's primary motive was health improvement. Among normal-weight female dieters, 12% of Whites and 27% of Blacks were using risky strategies. Dieters were less likely than nondieters to smoke and reported better nutritional practices; however, they were not more likely to exercise, and their maximum weight fluctuation was 50% greater. Additional research on the consequences of dieting among normal-weight individuals is of high priority.
Cutaneous melanoma mortality among the socioeconomically disadvantaged in Massachusetts.
Authors: Geller A C , Miller D R , Lew R A , Clapp R W , Wenneker M B , Koh H K
Published: November 2008

OBJECTIVES: To identify groups for melanoma prevention and early detection programs, this study explored the hypothesis that survival with cutaneous melanoma is disproportionately lower for persons of lower socioeconomic status. METHODS: Massachusetts Cancer Registry and Registry of Vital Records and Statistics data (1982 through 1987) on 3288 incident cases and 1023 deaths from cutaneous melanoma were analyzed. Mortality/incidence ratios were calculated and compared, predictors of late stage disease were examined with logistic regression analysis, and a proportional hazards regression analysis that used death registration as the outcome measure for incident cases was performed. RESULTS: Lower socioeconomic status was associated with a higher mortality/incidence ratio after adjustment for age and sex. For education, the mortality/incidence ratio was 0.37 in the lower group vs 0.25 in the higher group (rate ratio = 1.48, 95% confidence interval [CI] = 1.08, 2.03). Late stage disease was independently associated with lower income (rate ratio for lowest vs highest tertile = 1.64, 95% CI = 1.20, 2.25), and melanoma mortality among case patients was associated with lower education (rate ratio = 1.52, 95% CI = 1.09, 213). CONCLUSIONS: Melanoma patients of lower socioeconomic status may be more likely to die from their melanoma than patients of higher socioeconomic status. Low- SES communities may be appropriate intervention targets.
A two-step intervention of increase mammography among women aged 65 and older.
Authors: Janz N K , Schottenfeld D , Doerr K M , Selig S M , Dunn R L , Strawderman M , Levine P A
Published: November 2008

OBJECTIVES: This study evaluated a two-step intervention for mammography screening among older women. METHODS: Four hundred and sixty women, identified from physician practices, were randomized to a control or a two-step intervention (physician letter and peer counseling call) group. Women in the intervention group who obtained a mammogram received a grocery coupon. RESULTS: Over the 12 months of the study, more women in the intervention group than in the control group obtained mammograms (38% vs 16%). The most dramatic difference was in the higher odds that women in the intervention group would obtain a mammogram within 2 months (odds ratio = 10.5). CONCLUSIONS: The intervention significantly increased screening mammography. Future efforts must be multifaceted and incorporate the unique concerns of older women.
The Junior Red Cross goes to Healthland.
Authors: Hutchinson J F
Published: November 2008

An amusing reminder of earnest attempts to teach the principles of public health, Junior Red Cross Time brought plays and games about "Healthland" to schoolchildren in the 1920s. Explaining why health education became part of the mission of the Junior Red Cross raises larger issues, such as the ideology and practice of the American Red Cross in war and peace, the place of health in the moral education of children, and the transition from the activism of the Progressive Era to the markedly different social climate of the 1920s. The Junior Red Cross promoted Healthland largely because it was an innocuous concept that had been stripped of potentially controversial features to adapt it to the conservative mood of postwar America. This process of dilution mirrored the fate of the adult Red Cross, which briefly and unsuccessfully sought to reinvent itself as a national (and international) agency for the promotion of public health. The unreality of Healthland is no mere coincidence; its separation from the real world was a crucial part of its appeal to the Red Cross in the 1920s.
Rural hospitals' experience with the National Practitioner Data Bank.
Authors: Neighbor W E , Baldwin L M , West P A , Hart L G
Published: November 2008

OBJECTIVES: This study examined hospital administrators' experiences with the National Practitioner Data Bank. METHODS: One hundred forty-nine rural hospital administrators completed questionnaires assessing their perceptions of the data bank. RESULTS: Nearly 90% of respondents rated the data bank as an important source of information for credentialing. Three percent indicated it had directly affected privileging decisions; 43% and 34%, respectively, believed the costs exceeded or equaled the benefits. Twenty percent reported changes that could decrease disciplinary action reports to the data bank. CONCLUSIONS: While the National Practitioner Data Bank is an important source of information to rural hospitals, it may, affect few credentialing decisions and motivate behavioral changes that could have a paradoxical effect on quality assurance.
Ethnic differences in the prevalence of nonmalignant respiratory disease among uranium miners.
Authors: Mapel D W , Coultas D B , James D S , Hunt W C , Stidley C A , Gilliland F D
Published: November 2008

OBJECTIVES: This study (1) investigates the relationship of nonmalignant respiratory disease to underground uranium mining and to cigarette smoking in Native American, Hispanic, and non-Hispanic White miners in the Southwest and (2) evaluates the criteria for compensation of ethnic minorities. METHODS: Risk for mining-related lung disease was analyzed by stratified analysis, multiple linear regression, and logistic regression with data on 1359 miners. RESULTS: Uranium mining is more strongly associated with obstructive lung disease and radiographic pnuemoconiosis in Native Americans than in Hispanics and non-Hispanic Whites. Obstructive lung disease in Hispanic and non-Hispanic White miners is mostly related to cigarette smoking. Current compensation criteria excluded 24% of Native Americans who, by ethnic-specific standards, had restrictive lung disease and 4.8% who had obstructive lung disease. Native Americans have the highest prevalence of radiographic pneumoconiosis, but are less likely to meet spirometry criteria for compensation. CONCLUSIONS: Native American miners have more nonmalignant respiratory disease from underground uranium mining, and less disease from smoking, than the other groups, but are less likely to receive compensation for mining-related disease.
Depression, anxiety, and smoking initiation: a prospective study over 3 years.
Authors: Patton G C , Carlin J B , Coffey C , Wolfe R , Hibbert M , Bowes G
Published: November 2008

OBJECTIVES: This report considers the extent to which depression and anxiety predict smoking onset in adolescence. METHODS: A 6-wave cohort design was used to study a sample of 14- and 15-year-old students (n = 2032) drawn from 44 secondary schools in the state of Victoria, Australia. The students were surveyed between 1992 and 1995 with a computerized questionnaire that included a 7-day retrospective diary for tobacco use and a structured psychiatric interview. RESULTS: Experimental smokers were 29 times more likely than non-smokers to make a transition into daily use in the subsequent 6 months. Depression and anxiety, along with peer smoking, predicted initiation of experimental smoking. Specifically, depression and anxiety accentuated risks associated with peer smoking and predicted experimentation only in the presence of peer smoking. CONCLUSIONS: The finding that experimental smoking is an overwhelmingly strong predictor of later daily smoking focuses attention on smoking initiation. Depressive and anxiety symptoms are associated with higher risks for initiation through an increased susceptibility to peer smoking influences. Promoting the psychological well-being of adolescents and addressing perceived interpersonal benefits of smoking may play a role in the prevention of adolescent tobacco use.
The demographic characteristics of Medicaid-eligible uninsured children.
Authors: Avruch S , Machlin S , Bonin P , Ullman F
Published: November 2008

OBJECTIVES: This study estimated the number of uninsured children in 1993 who were eligible for Medicaid. METHODS: Data from the March 1990 and 1994 Current Population Surveys were analyzed. RESULTS: At least 2.3 million Medicaid-eligible children were uninsured in 1993. These children were more likely to have a working parent than children on Medicaid. Higher proportions of uninsured children less than 6 years of age, children who lived in female-headed single-parent families, and African-American and Hispanic children were eligible for Medicaid. CONCLUSIONS: Many eligible children do not enroll in Medicaid, and they differ in specific ways from enrolled children.
Air pollution and daily mortality in Sydney, Australia, 1989 through 1993.
Authors: Morgan G , Corbett S , Wlodarczyk J , Lewis P
Published: November 2008

OBJECTIVES: This study examined the effects of outdoor air pollutants in Sydney, Australia, on daily mortality. METHODS: Time-series analysis was performed on counts of daily mortality and major outdoor air pollutants (particulates, ozone, and nitrogen dioxide) in Sydney (1989 to 1993) with adjustment for seasonal and cyclical factors. Poisson regression was calculated with allowance for overdispersion and autocorrelation. The effects of lagging exposure by 0 to 2 days were assessed with single- and multiple-pollutant models. RESULTS: An increase in daily mean particulate concentration from the 10th to the 90th centile was associated with an increase of 2.63% (95% confidence interval 0.87 to 4.41) in all-cause mortality and 2.68% (0.25 to 5.16) in cardiovascular mortality. An increase in daily maximum 1-hour ozone concentration from the 10th to the 90th centile was associated with an increase of 2.04% (0.37 to 3.73) in all-cause mortality and 2.52% (-0.25 to 5.38) in cardiovascular mortality. An increase in the daily mean nitrogen dioxide concentration from the 10th to the 90th centile was associated with an increase of 7.71% (-0.34 to 16.40) in respiratory mortality. Multiple-pollutant models suggest that the effects of particulates and ozone on all-cause and cardiovascular mortality, and of nitrogen dioxide on respiratory mortality, are independent of the effects of the other pollutants. CONCLUSIONS: Current levels of air pollution in Sydney are associated with daily mortality.