bluuebunny/crossref_metadata_2025 huggingface dataset:
Region of birth and mortality from circulatory diseases among black Americans.
Authors: Schneider D , Greenberg M R , Lu L L
Published: November 2008

OBJECTIVES: This study examines the relationship between birth-place and mortality from circulatory diseases among American Blacks. METHODS: All Black deaths from circulatory diseases (International Classification of Diseases, 9th Revision. codes 390 through 459) were extracted from the National Center for Health Statistics mortality detail files for 1979 through 1991. Age-specific and age-adjusted mortality rates with 95% confidence intervals were calculated for males and females for combinations of five regions of residence at birth and four regions of residence at death. RESULTS: Males had higher mortality rates from circulatory diseases than females in every regional combination of birthplace and residence at death. For both genders, the highest rates were for those who were born in the South but died in the Midwest; the lowest rates were for those who were born in the West but died in the South. Excess mortality for both Southern-born males and females begins at ages 25 through 44. CONCLUSIONS: There is a region-of-birth component that affects mortality risk from circulatory diseases regardless of gender or residence at time of death. We must examine how early life experiences affect the development of circulatory disorders.
Socioeconomic status and racial and ethnic differences in functional status associated with chronic diseases.
Authors: Kington R S , Smith J P
Published: November 2008

OBJECTIVES: This study examined the relationships between wealth and income and selected racial and ethnic differences in health. METHODS: Cross-sectional data on a national sample of 9744 men and women aged 51 through 61 from the 1992 Health and Retirement Survey were analyzed to examine the association between socioeconomic status and racial and ethnic differences in functional status among those with hypertension, diabetes, a heart condition, and arthritis. RESULTS: Compared with Whites, African Americans report higher rates of hypertension, diabetes, and arthritis, while Hispanics report higher rates of hypertension and diabetes and a lower rate of heart conditions. Accounting for differences in education, income, and wealth had little effect on these prevalence differences. In general, among those with chronic diseases, African Americans and Hispanics reported worse function than Whites. This disadvantage was eliminated in every case by controlling for socioeconomic status. CONCLUSIONS: While socioeconomic status, including wealth, accounts for much of the difference in functional status associated with these chronic diseases. It plays a relatively small role in explaining differences in the prevalence of chronic disease, possibly reflecting different causal pathways.
An experimental analysis of sociocultural variables in sales of cigarettes to minors.
Authors: Klonoff E A , Landrine H , Alcaraz R
Published: November 2008

OBJECTIVES: This study assessed the role of age, racial/ethnic group, and gender, as well as that of other sociocultural variables, in minors' access to tobacco. METHODS: Thirty-six minors attempted to purchase cigarettes once in each of 72 stores (2592 purchase attempts). The minors represented equal numbers of girls and boys; 10-year-olds, 14-year-olds, and 16-year-olds; and Whites, Blacks, and Latinos. Equal numbers of stores were in Black, White, and Latino neighborhoods. RESULTS: Older children were more likely than younger ones to be sold cigarettes, and Latino children were more likely than Whites to be sold cigarettes. Older Black children (irrespective of gender) were the single most likely group to be sold cigarettes. Cigarettes were significantly more likely to be sold to children by male than female clerks and in specific sociocultural contexts. CONCLUSIONS: Interventions with retailers must address sociocultural variables to improve effectiveness in reducing minors' access to tobacco.
A pricing strategy to promote low-fat snack choices through vending machines.
Authors: French S A , Jeffery R W , Story M , Hannan P , Snyder M P
Published: November 2008

OBJECTIVES: This study examined the role of price on purchases of low-fat snacks from vending machines. METHODS: Sales of low-fat and regular snacks were monitored in nine vending machines during a 4-week baseline, a 3-week intervention in which prices of low-fat snacks were reduced 50%, and 3 weeks postintervention. RESULTS: The proportion of low-fat snacks purchased was 25.7%, 45.8%, and 22.8% in the three periods, respectively. Total snack purchases did not vary by period. CONCLUSIONS: Reducing relative prices may be effective in promoting lower-fat food choices in the population. Vending machines may be a feasible method for implementing such nutrition interventions.
Antibody testing and condom use among heterosexual African Americans at risk for HIV infection: the National AIDS Behavioral Surveys.
Authors: Grinstead O A , Peterson J L , Faigeles B , Catania J A
Published: November 2008

OBJECTIVES: This study describes predictions of condom use and human immunodeficiency virus (HIV) antibody testing in a population-based sample of African-American heterosexuals who reported HIV risk behavior. METHODS: Data were taken from the National AIDS Behavioral Surveys. RESULTS: Of the African-American respondents, 22% reported some risk for HIV infection; of those, 24% had been tested for HIV. CONCLUSIONS: Prevention messages encouraging HIV testing and condom use have not resulted in high rates of self-protective behavior among African Americans. Future prevention interventions must focus on specific motivations and barriers with regard to engaging in preventive behavior among specific age, gender, and educational-level groups within the population of African Americans at risk for HIV infection.
Low prevalences of HIV infection and sexually transmitted disease among female commercial sex workers in Mexico City.
Authors: Uribe-Salas F , Hernández-Avila M , Conde-González C J , Juárez-Figueroa L , Allen B , Anaya-Ocampo R , Del Río-Chiriboga C , Uribe-Zúñiga P , de Zalduondo B
Published: November 2008

OBJECTIVES: This study tried to determine human immunodeficiency virus (HIV)/sexually transmitted disease (STD) prevalences among female commercial sex workers in Mexico City. METHODS: A sampling frame was constructed that included bars, massage parlors, and street corners. RESULTS: Prevalences for Treponema pallidum, herpes simplex virus type 2, HIV, Neisseria gonorrhoeae, and Chlamydia trachomatis were 6.4%, 65%, 0.6%, 3.7%, and 11.1%, respectively. A significant association was found between higher STD frequencies and working at street sites. CONCLUSIONS: Most STD frequencies were lower in comparison with rates found for female sex workers in other countries. However, preventive programs against STD/ HIV are needed in this population.
The decentralization of syphilis screening for improved care in Jamaican public clinics. Collaborative Working Group on Decentralized Syphilis Screening.
Authors: Behets F M , Brathwaite A , Bennett L , Douglas K G , Dallabetta G A , Figueroa J P
Published: November 2008

OBJECTIVES: This study examined the decentralization of syphilis screening for improved care in Jamaican public clinics. METHODS: One of every five serum samples tested at the six peripheral sites was frozen and retested at the central laboratory in Kingston. Patient files and laboratory logbooks were compared over a 3-month period. RESULTS: Between May 1993 and December 1994, 15.5% of 32913 patients with sexually transmitted diseases and 8.3% of 8914 women seeking prenatal care were found syphilis seroreactive. Of 2001 samples evaluated, 1933 (96.6%) had been correctly reported at the peripheral sites. Of 129 syphilis seroreactors detected at the peripheral sites, 88 (68%) were treated the same day and 21 (16%) more within 3 days after testing. CONCLUSIONS: Syphilis seroreactors were accurately detected and quickly treated at the peripheral sites. If these efforts can be sustained, Jamaican syphilis rates should decrease.
The effectiveness of a media-led intervention to reduce smoking among Vietnamese-American men.
Authors: Jenkins C N , McPhee S J , Le A , Pham G Q , Ha N T , Stewart S
Published: November 2008

OBJECTIVES: This study evaluated an anti-tobacco campaign targeting Vietnamese men in San Francisco, Calif. METHODS: The intervention included Vietnamese-language media, health education materials, and activities targeting physicians, youth, and businesses. Evaluation involved pretest and posttest cross-sectional telephone surveys and multiple logistic regression analyses designed to identify variables associated with smoking and quitting. RESULTS: At posttest, the odds of being a smoker were significantly lower (odds ratio [OR] = 0.82, 95% confidence interval [CI] = 0.68, 0.99), and the odds of being a quitter were significantly higher (OR = 1.65, 95% CI = 1.27, 2.15), in San Francisco than in a comparison community. CONCLUSIONS: Despite modest success, further efforts are needed to reduce smoking among Vietnamese-American men.
Some correlates of self-rated health for Australian women.
Authors: Shadbolt B
Published: November 2008

OBJECTIVES: This study aimed to identify some of the correlates of self-rated health for young to middle-aged Australian women. METHODS: Regression analyses were based on a 4-year longitudinal study using a random sample of Sydney women 20 to 59 years of age at baseline. Participants were interviewed in 1986/87 and 1990. RESULTS: Cross-sectional relationships between self-assessed health and other health measures varied significantly by age, although physical health was a common correlate. Sixty-three percent of participants reported a similar rating of health over the 4-year period between the surveys. Changes in self-assessed health were sensitive to chronic disease. Also, participants' self-ratings of health were related to their subsequent chronic disease status. CONCLUSIONS: Self-rated health reflects a complex process of internalized calculations that encompass both lived experience and knowledge of disease causes and consequences. Women seem to take into consideration a broad range of factors, including lifestyle, vitality, mental attitude, and age, and, if they have a health condition, the chronicity of their disease, duration since diagnosis, and treatment.
Frequent attendance at religious services and mortality over 28 years.
Authors: Strawbridge W J , Cohen R D , Shema S J , Kaplan G A
Published: November 2008

OBJECTIVES: This study analyzed the long-term association between religious attendance and mortality to determine whether the association is explained by improvements in health practices and social connections for frequent attenders. METHODS: The association between frequent attendance and mortality over 28 years for 5286 Alameda Country Study respondents was examined. Logistic regression models analyzed associations between attendance and subsequent improvements in health practices and social connections. RESULTS: Frequent attenders had lower mortality rates than infrequent attenders (relative hazard [RH] = 0.64;95% confidence interval [CI] = 0.53,0.77). Results were stronger for females. Health adjustments had little impact, but adjustments for social connections and health practices reduced the relationship (RH = 0.77; 95% CI = 0.64, 0.93). During follow-up, frequent attenders were more likely to stop smoking, increase exercising, increase social contacts, and stay married. CONCLUSIONS: Lower mortality rates for frequent religious attenders are partly explained by improved health practices, increased social contacts, and more stable marriages occurring in conjunction with attendance. The mechanisms by which these changes occur have broad intervention implications.
The association between the purchase of a handgun and homicide or suicide.
Authors: Cummings P , Koepsell T D , Grossman D C , Savarino J , Thompson R S
Published: November 2008

OBJECTIVES: The purpose of this study was to determine whether purchase of a handgun from a licensed dealer is associated with the risk of homicide or suicide and whether any association varies in relation to time since purchase. METHODS: A case-control study was done among the members of a large health maintenance organization. Case subjects were the 353 suicide victims and 117 homicide victims among the members from 1980 through 1992. Five control subjects were matched to each case subject on age, sex, and zip code of residence. Handgun purchase information was obtained from the Department of Licensing. RESULTS: The adjusted relative risk of suicide was 1.9 (95% confidence interval [CI] = 1.4, 2.5) for persons with a history of family handgun purchase from a registered dealer. The adjusted relative risk for homicide, given a history of family handgun purchase, was 2.2 (95% CI = 1.3, 3.7). For both suicide and homicide, the elevated relative risks persisted for more than 5 years after the purchase. CONCLUSIONS: Legal purchase of a handgun appears to be associated with a long-lasting increased risk of violent death.
Determining injury at work on the California death certificate.
Authors: Peek-Asa C , McArthur D L , Kraus J F
Published: November 2008

OBJECTIVES: This study examined decisions of California Country Coroner's offices in determining injury at work and identified factors influencing this decision. METHODS: Surveys were sent to California County Coroner's offices (response rate = 93%). The survey included 23 vignettes that required the respondent to determine whether the fatality involved an injury at work. The Rasch method was used to determine internal consistency in endorsing vignettes and to determine overall endorsability of vignettes based on underlying factors. RESULTS: Respondents showed internal consistency but much disagreement in their endorsement of vignettes. Decedents who were performing paid work or were on their work site during working hours were almost unanimously endorsed as having incurred an injury at work. Non-payment, travel/transportation, suicide, and nontraditional work sites and work hours led to disagreement and uncertainty among respondents. CONCLUSIONS: Coroners have different methods of determining injury at work on the death certificate, and available guidelines do not define many of the ambiguous situations encountered by coroners.
Evaluating OSHA's ethylene oxide standard: employer exposure-monitoring activities in Massachusetts hospitals from 1985 through 1993.
Authors: LaMontagne A D , Kelsey K T
Published: November 2008

OBJECTIVES: This study characterized exposure-monitoring activities and findings under the Occupational Safety and Health Administration's (OSHA's) 1984 ethylene oxide (EtO) standard. METHODS: In-depth mail and telephone surveys were followed by on-site interviews at all EtO-using hospitals in Massachusetts (n = 92, 96% participation rate). RESULTS: By 1993, most hospitals had performed personal exposure monitoring for OSHA's 8-hour action level (95%) and the excursion limit (87%), although most did not meet the 1985 implementation deadline. In 1993, 66% of hospitals reported the installation of EtO alarms to fulfill the standard's "alert" requirement. Alarm installation also lagged behind the 1985 deadline and peaked following a series of EtO citations by OSHA. From 1990 through 1992, 23% of hospitals reported having exceeded the action level once or more; 24% reported having exceeded the excursion limit; and 33% reported that workers were accidentally exposed to EtO in the absence of personal monitoring. CONCLUSIONS: Almost a decade after passage of the EtO standard, exposure-monitoring requirements were widely, but not completely, implemented. Work-shift exposures had markedly decreased since the mid-1980s, but overexposures continued to occur widely. OSHA enforcement appears to have stimulated implementation.
The effect of cigarette taxes on cigarette consumption, 1955 through 1994.
Authors: Meier K J , Licari M J
Published: November 2008

OBJECTIVES: This study examines the effectiveness of state and federal taxes in reducing the consumption of cigarettes, estimates the impact of government health warnings, and shows how warnings and taxes interact. METHODS: By means of a pooled time-series analysis from 1955 through 1994 with the 50 states as units of analysis, the impact of excise taxes on cigarette consumption for several different models and econometric techniques is assessed. RESULTS: From 1955 through 1994, increases in state taxes were effective in reducing cigarette use. Federal tax increases, however, appear to have been more effective. This difference is partly the result of the "bootlegging" of cigarettes across state lines and the size of the increases in the federal tax. Cigarette consumption also declined when health warning labels were added. CONCLUSIONS: Increases of taxes on cigarettes are associated with declines in the consumption of tobacco. Because of inflation, increased health concerns, and the declining percentage of smokers, however, large reductions in consumption require large tax increases.
The use of outpatient mental health services in the United States and Ontario: the impact of mental morbidity and perceived need for care.
Authors: Katz S J , Kessler R C , Frank R G , Leaf P , Lin E , Edlund M
Published: November 2008

OBJECTIVES: This study compared the associations of individual mental health disorders, self-rated mental health, disability, and perceived need for care with the use of outpatient mental health services in the United States and the Canadian province of Ontario. METHODS: A cross-sectional study design was employed. Data came from the 1990 US National Comorbidity Survey and the 1990 Mental Health Supplement to the Ontario Health Survey. RESULTS: The odds of receiving any medical or psychiatric specialty services were as follows: for persons with any affective disorder, 3.1 in the United States vs 11.0 in Ontario; for persons with fair or poor self-rated mental health, 2.7 in the United States vs 5.0 in Ontario; for persons with mental health-related disability. 3.0 in the United States vs 1.5 in Ontario. When perceived need was controlled for, most of the between country differences in use disappeared. CONCLUSIONS: The higher use of mental health services in the United States than in Ontario is mostly explained by the combination of a higher prevalence of mental morbidity and a higher prevalence of perceived need for care among persons with low mental morbidity in the United States.
An international comparison of cancer survival: Toronto, Ontario, and Detroit, Michigan, metropolitan areas.
Authors: Gorey K M , Holowary E J , Fehringer G , Laukkanen E , Moskowitz A , Webster D J , Richter N L
Published: November 2008

OBJECTIVES: This study examined whether socioeconomic status has a differential effect on the survival of adults diagnosed with cancer in Canada and the United States. METHODS: The Ontario Cancer Registry and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program provided a total of 58,202 and 76,055 population-based primary malignant cancer cases for Toronto, Ontario, and Detroit, Mich, respectively. Socioeconomic data for each person's residence at time of diagnosis were taken from population censuses. RESULTS: In the US cohort, there was a significant association between socioeconomic status and survival for 12 of the 15 most common cancer sites; in the Canadian cohort, there was no such association for 12 of the 15 sites. Among residents of low-income areas, persons in Toronto experienced a survival advantage for 13 of 15 cancer sites at 1- and 5-year follow-up. No such between-country differentials were observed in the middle- or high-income groups. CONCLUSIONS: The consistent pattern of a survival advantage in Canada observed across various cancer sites and follow-up periods suggests that Canada's more equitable access to preventive and therapeutic health care services is responsible for the difference.
The association of drinking water source and chlorination by-products with cancer incidence among postmenopausal women in Iowa: a prospective cohort study.
Authors: Doyle T J , Zheng W , Cerhan J R , Hong C P , Sellers T A , Kushi L H , Folsom A R
Published: November 2008

OBJECTIVES: This study assessed the association of drinking water source and chlorination by-product exposure with cancer incidence. METHODS: A cohort of 28,237 Iowa women reported their drinking water source. Exposure to chlorination by-products was determined from statewide water quality data. RESULTS: In comparison with women who used municipal ground-water sources, women with municipal surface water sources were at an increased risk of colon cancer and all cancers combined. A clear dose-response relation was observed between four categories of increasing chloroform levels in finished drinking water and the risk of colon cancer and all cancers combined. The relative risks were 1.00, 1.06, 1.39, and 1.68 for colon cancer and 1.00, 1.04, 1.24, and 1.25 for total cancers. No consistent association with either water source or chloroform concentration was observed for other cancer sites. CONCLUSIONS: These results suggest that exposure to chlorination by-products in drinking water is associated with increased risk of colon cancer.
An evaluation of educational outreach to general practitioners as part of a statewide cervical screening program.
Authors: Stevens S A , Cockburn J , Hirst S , Jolley D
Published: November 2008

OBJECTIVES: The purpose of this study was to determine the acceptability, effectiveness, and cost of a face-to-face educational outreach intervention in the context of a program aimed at increasing cervical screening in Victoria, Australia. METHODS: All identified general practitioners in a specified intervention area were offered a visit by a general practitioner educator. Practitioners completed a questionnaire evaluating the acceptability of the visit. Odds ratios for a woman being screened in the 3 months following the visits were determined. RESULTS: Fifty-nine general practitioners (69.4%) accepted the offer of a visit. Most found both the process and the content of the intervention to be acceptable. The intervention and nonintervention regions did not differ either before or after the intervention. In both regions, there was a statistically significant increase in number of Pap tests performed. There was no difference in the change in screening between the two regions. Costs were estimated at Au$34 per general practitioner visited. CONCLUSIONS: This strategy cannot be recommended for widespread use in a cervical screening program.
State legislators' attitudes and voting intentions toward tobacco control legislation.
Authors: Goldstein A O , Cohen J E , Flynn B S , Gottlieb N H , Solomon L J , Dana G S , Bauman K E , Munger M C
Published: November 2008

OBJECTIVES: This study describes state legislators' knowledge, attitudes, and voting intentions with regard to tobacco-related issues. METHODS: A cross-sectional survey of state legislators was conducted in North Carolina, Texas, and Vermont in 1994. RESULTS: Most legislators agreed that secondhand smoke can cause lung cancer in nonsmokers, and a majority believed that smokers are addicted to nicotine. More than 75% stated that they would support a measure to enforce laws preventing tobacco sales to youth. A majority of Texas and Vermont legislators supported an increase in the state cigarette excise tax; 43% of North Carolina legislators would support an increase if revenues were directed toward tobacco farmer diversification. CONCLUSIONS: State legislators believe tobacco to be addictive, and they support policies to protect youth from tobacco. Support for other legislative measures differs significantly across states.
A smoking cessation program at a public antenatal clinic.
Authors: Walsh R A , Redman S , Brinsmead M W , Byrne J M , Melmeth A
Published: November 2008

OBJECTIVES: A randomized trial evaluated the impact of smoking cessation interventions on point prevalence and consecutive quit rates at an Australian public prenatal clinic. METHODS: Self-reports and urine cotinine tests confirmed patients' smoking status at the midpoint and end of pregnancy and 6 weeks postpartum. RESULTS: At all points, validated abstinence rates were significantly higher in the experimental group than in the control group. The rate of failed biochemical validation was significantly higher in the control group than in the experimental group. CONCLUSIONS: Prenatal clinic staff can significantly increase quit rates by using cognitive-behavioral strategies. Brief advice appears to be ineffective.
Vaginal douching and adverse health effects: a meta-analysis.
Authors: Zhang J , Thomas A G , Leybovich E
Published: November 2008

OBJECTIVES: The meta-analysis described here reviewed the current literature on adverse health effects of vaginal douching. METHODS: Papers published in English from 1965 through 1995 were potentially eligible. RESULTS: One third of White women and two thirds of Black women of reproductive age reported douching regularly. Analyses indicated that vaginal douching increases the overall risk of pelvic inflammatory disease by 73% and the risk of ectopic pregnancy by 76%. Frequent douching was shown to be highly associated with pelvic inflammatory disease and modestly associated with cervical cancer. CONCLUSIONS: Current literature suggests that frequent douching increases the risk of pelvic inflammatory disease, ectopic pregnancy, and, possibly, cervical cancer.
State-imposed limits on Medicaid reimbursement for nursing facility care.
Authors: Swan J H , Harrington C , de Wit S K , Zhong M
Published: November 2008

OBJECTIVES: Nursing cost-center limits were examined, along with their effects on Medicaid. METHODS: A national survey of Medicaid nursing facility reimbursement provided data on cost centers for nursing, administration, and capital, whether in specific, larger, or multiple cost centers. RESULTS: Most states impose nursing and administration limits. Far fewer states impose capital limits, but only capital limits may be related to constraint of reimbursement rates. CONCLUSIONS: Shifting toward limiting capital costs, or simply eliminating cost-center limits, might accommodate cost control while removing negative constraints on direct resident care.
Sunbathing habits and sunscreen use among white adults: results of a national survey.
Authors: Koh H K , Bak S M , Geller A C , Mangione T W , Hingson R W , Levenson S M , Miller D R , Lew R A , Howland J
Published: November 2008

OBJECTIVES: This study assessed current levels of sunbathing and sunscreen use in the United States. METHODS: From a general-population telephone survey of aquatic activities among adults in 3042 US households, we examined responses by the 2459 Whites. RESULTS: Most adults (59%) reported sunbathing during the past year, and 25% reported frequent sunbathing. Of the subsample who reported sunbathing during the month before the interview, 47% routinely used sunscreen. Of these individuals, almost half did not use sunscreens with a solar protection factor of 15 or higher. CONCLUSIONS: About a quarter of US White adults report frequent sunbathing, and only about a quarter of sunbathers use sunscreens at recommended levels. These results should help focus future sun protection educational efforts.
Industrial workers' health and environmental pollution under the new international division of labor: the Taiwan experience.
Authors: Chen M S , Huang C L
Published: November 2008

Using Taiwan as an example, this paper conducts a historical analysis of the relationship between economic development in the new international division of labor and environmental pollution and industrial workers' health. Three industries-asbestos, plastic, and dye-were chosen for case studies. We trace the emergence of each industry in Taiwan and study each industry's protection of workers' health and environmental quality. Under the new international division of labor, the state's prioritization of economic development leads to lenient regulation. Under such state policies, employers have few incentives to invest in the protection of their workers' health and in the control of environmental pollution. Workers and the public are constrained in their efforts to protect their own health and prevent environmental pollution. This situation is exemplified by the deplorable working conditions and inadequate environmental pollution controls in the asbestos, plastic, and dye industries. Workers' health and the public's health are greatly compromised by economic development in the new international division of labor.
Public participation in medical policy-making and the status of consumer autonomy: the example of newborn-screening programs in the United States.
Authors: Hiller E H , Landenburger G , Natowicz M R
Published: November 2008

OBJECTIVES: State newborn-screening programs collectively administer the largest genetic-testing initiative in the United States. We sought to assess public involvement in formulating and implementing medical policy in this important area of genetic medicine. METHODS: We surveyed all state newborn-screening programs to ascertain the screening tests performed, the mechanisms and extent of public participation, parental access to information, and policies addressing parental consent or refusal of newborn screening. We also reviewed the laws and regulations of each state pertaining to newborn screening. RESULTS: Only 26 of the 51 state newborn-screening programs reported having advisory committees that include consumer representation. Fifteen states reported having used institutional review boards, another venue for public input. The rights and roles of parents vary markedly among newborn-screening programs in terms of the type and availability of screening information as well as consent-refusal and follow-up policies. CONCLUSIONS: There is clear potential for greater public participation in newborn-screening policy-making. Greater public participation would result in more representative policy-making and could enhance the quality of services provided by newborn-screening programs.
Sociometric risk networks and risk for HIV infection.
Authors: Friedman S R , Neaigus A , Jose B , Curtis R , Goldstein M , Ildefonso G , Rothenberg R B , Des Jarlais D C
Published: November 2008

OBJECTIVES: This study examined whether networks of drug-injecting and sexual relationships among drug injectors are associated with individual human immunodeficiency virus (HIV) serostatus and with behavioral likelihood of future infection. METHODS: A cross-sectional survey of 767 drug injectors in New York City was performed with chain-referral and linking procedures to measure large-scale (sociometric) risk networks. Graph-theoretic algebraic techniques were used to detect 92 connected components (drug injectors linked to each other directly or through others) and a 105-member 2-core within a large connected component of 230 members. RESULTS: Drug injectors in the 2-core of the large component were more likely than others to be infected with HIV. Seronegative 2-core members engaged in a wide range of high-risk behaviors, including engaging in risk behaviors with infected drug injectors. CONCLUSIONS: Sociometric risk networks seem to be pathways along which HIV travels in drug-injecting peer groups. The cores of large components can be centers of high-risk behaviors and can become pockets of HIV infection. Preventing HIV from reaching the cores of large components may be crucial in preventing widespread HIV epidemics.
National trends in the mortality of children with sickle cell disease, 1968 through 1992.
Authors: Davis H , Schoendorf K C , Gergen P J , Moore R M
Published: November 2008

OBJECTIVES: This paper describes national trends in mortality of children with sickle cell disease and the settings in which death occurred. METHODS: United States death certificate data from 1968 through 1992 were used to calculate mortality rates of Black children with sickle cell disease 1 to 14 years old. Deaths from trauma, congenital anomalies, and perinatal conditions were excluded. RESULTS: Between 1968 and 1992, mortality rates of Black children with sickle cell disease decreased 41% for 1- to 4-year-olds, 47% for 5- to 9-year-olds, and 53% for 10- to 14-year-olds. During 1986 through 1992, children who died before hospital admission accounted for 41% of deaths among 1- to 4-year-olds, 27% among 5- to 9-year-olds, and 12% among 10- to 14-year-olds. CONCLUSIONS: Survival of Black children with sickle cell disease has improved markedly since 1968. A substantial proportion of deaths continue to occur prior to hospital admission. Trends in sickle cell mortality can be monitored inexpensively with death-certificate data.
Quality assessment of fetal death records in Georgia: a method for improvement.
Authors: Gaudino J A , Blackmore-Prince C , Yip R , Rochat R W
Published: November 2008

OBJECTIVES: Although more fetal deaths than neonatal deaths occur, routinely collected fetal death data are seldom used for perinatal epidemiologic research because of data quality concerns. We developed a strategy for identifying and correcting errors in birthweight and gestational age in fetal death records. METHODS: Using data from Georgia for 1989 and 1990, we detected singleton fetal death records having improbable or missing birthweight or gestational age by comparing these values with referent values. To verify the questionable values, we contacted 100 reporting hospitals in 1992. RESULTS: In 817 of 2226 records, values were either improbable (60.1%) or missing (39.9%). We were able to contact the hospitals to verify data for 716 (88%) of these records. Verification resulted in corrections to 405 (57%) records, and 48% of unreported birthweights were obtained. CONCLUSIONS: Many errors in recorded gestational age and birthweight were identified by this method. Rather than deleting or inputting problem data for analyses, researchers should consider efforts to verify them. Efforts to improve this information should include improved reporting, strict quality assurance, and procedures for routine verification and correction of records.
Screening for adolescent smoking among primary care physicians in California.
Authors: Franzgrote M , Ellen J M , Millstein S G , Irwin C E
Published: November 2008

OBJECTIVES: This study determined how often primary care physicians ask adolescents about smoking. METHODS: We surveyed a stratified random sample of community-based, board-certified California physicians, using a mailed questionnaire. RESULTS: Overall, physicians (n = 343; 77% response rate) screened younger adolescents for regular smoking during 71.4% (95% confidence interval [CI] = 67.9, 74.9) of routine physical exams and older adolescents during 84.8% (95% CI = 82.3, 87.4) of such visits. For acute-care visits, the screening rates were 24.4% (95% CI = 20.6, 28.1) for younger and 40.2% (95% CI = 36.4, 44.0) for older adolescents. Physicians asked 18.2% (95% CI = 15.2, 21.3) of younger and 35.6% (95% CI = 32.0, 39.1) of older adolescents about experimental smoking. Screening varied by specialty. CONCLUSIONS: These data imply that physicians are missing opportunities to screen adolescents for smoking.
The deterioration in children's nutritional status in rural Chad: the effect of mothers' influence on feeding.
Authors: Bégin F , Habicht J P , Frongillo E A , Delisle H
Published: November 2008

OBJECTIVES: This study examined how maternal influence on child feeding modified the deterioration of child nutritional status in Chad. METHODS: The pattern of height with age was examined in 98 rural Chadian children aged 12 through 71 months from 64 households randomly chosen. RESULTS: Younger children were more stunted than older ones, probably reflecting secular deterioration in weanlings' nutritional status from 1982 to 1987. Children of mothers with influence over child feeding were taller than children of mothers with less influence, but this held only for the youngest children. CONCLUSIONS: Height-for-age can be a useful indicator of recent changes in social and environmental effects on child health. The mother's influence may have buffered the negative impact of socioeconomic conditions on child growth.
The underreporting of deaths of American Indian children in California, 1979 through 1993.
Authors: Epstein M , Moreno R , Bacchetti P
Published: November 2008

OBJECTIVES: This study linked birth and death certificates to determine misclassification of deaths of American Indian children in California. METHODS: Birth records for 1979 to 1993 were matched with mortality records through a computerized system. RESULTS: The number of deaths to American Indians was estimated to be three to four times greater than that reported on death certificates. Children in urban counties and those who died before 1987 were more likely to be misclassified. CONCLUSIONS: California death certificates identify less than one third of the deaths among American Indian children. Adjusting for racial misclassification provides a more accurate accounting of child mortality among American Indians.
The psychological consequences of cardiopulmonary resuscitation training for family members of patients at risk for sudden death.
Authors: Dracup K , Moser D K , Taylor S E , Guzy P M
Published: November 2008

OBJECTIVES: The purpose of this study was to determine psychological consequences of teaching cardiopulmonary resuscitation (CPR) to family members of patients at risk for sudden death. METHODS: Patient-family pairs (n = 337) were randomized into one of four groups: control, CPR only, CPR with cardiac risk factor education, and CPR with a social support intervention. Only family members received CPR training. Data on emotional state and psychosocial adjustment to illness were collected at baseline, 2 weeks, and 3 and 6 months following CPR training. RESULTS: There were no significant differences in the emotional states of family members across the four groups. However, significant differences in psychosocial adjustment and emotional states occurred in patients across treatment groups following CPR training. Patients whose family members learned CPR with the social support intervention reported better psychosocial adjustment and less anxiety and hostility than patients in the other groups. Control patients reported better psychosocial adjustment and less emotional distress than patients in the CPR-only and CPR-education groups. CONCLUSIONS: These findings support tailoring family CPR training so that instruction does not result in negative psychological states in patients. The findings also illustrate the efficacy of a simple intervention that combines CPR training with social support.
Factors associated with mental health, general health, and school-based service use for child psychopathology.
Authors: Zahner G E , Daskalakis C
Published: November 2008

OBJECTIVES: This study was designed to identify factors associated with service use for child psychopathology in three settings: mental health, general health, and school. METHODS: Subjects were 2519 children, 6 to 11 years of age, assessed in two cross-sectional Connecticut surveys in the late 1980s. Three groups of variables (sociodemographics, child's illness profile, and parental attitudes) were examined through multivariate logistic regression. RESULTS: Most sociodemographics showed moderate associations with all settings, although some previously reported effects (e.g. birth order, sibship size) were not observed. Of the illness profile measures, only Child Behavior Checklist total scores predicted use in the final model (odds ratio [OR] = 1.6, 95% confidence interval [CI] = 1.1, 2.3). Health problems were associated with increased use in all settings (OR = 1.5, 95% CI = 1.3, 1.9), while academic problems were associated only with increased school service use (OR = 5.2, 95% CI = 3.9, 7.0). Parental belief that the child needed help was most strongly associated with service use (common OR for all settings = 5.3, 95% CI = 4.1, 6.8). CONCLUSIONS: Sociodemographics, parental attitudes, and children's illness profiles independently influence service use for psychopathology in school-aged children.
Sudden cardiac death in Hispanic Americans and African Americans.
Authors: Gillum R F
Published: November 2008

OBJECTIVES: The goal of this study was to estimate rates of sudden cardiac death in US Hispanics and African Americans. METHODS: Data on coronary deaths occurring outside of the hospital or in emergency rooms were examined for 1992. RESULTS: In 1992, 53% (8194) of coronary heart disease deaths among Hispanic Americans 25 years of age and older occurred outside of the hospital or in emergency rooms. The percentage was lower among Hispanics than among non-Hispanic Whites and Blacks. Age-adjusted rates per 100,000 were lower in Hispanics than in non-Hispanic Whites or Blacks (Hispanic men, 75; White men, 166; Black men, 209; Hispanic women, 35; White women, 74; Black women, 108). The percentages dying outside of the hospital or in emergency rooms were higher in young persons, those living in nonurban areas, and those who were single. CONCLUSIONS: The percentage and rate of coronary deaths occurring outside of the hospital or in emergency rooms were lower in Hispanics than in non-Hispanics; African Americans had the highest rates. Further research is needed on sudden coronary death in Hispanic Americans and African Americans.
The impact of socioeconomic status on health functioning as assessed by the SF-36 questionnaire: the Whitehall II Study.
Authors: Hemingway H , Nicholson A , Stafford M , Roberts R , Marmot M
Published: November 2008

OBJECTIVES: This study measured the association between socioeconomic status and the eight scale scores of the Medical Outcomes Study short form 36 (SF-36) general health survey in the Whitehall II study of British civil servants. It also assessed, for the physical functioning scale, whether this association was independent of disease. METHODS: A questionnaire containing the SF-36 was administered at the third phase of the study to 5766 men and 2589 women aged 39 through 63 years. Socioeconomic status was measured by means of six levels of employment grades. RESULTS: There were significant improvements with age in general mental health, role-emotional, vitality, and social functioning scale scores. In men, all the scales except vitality showed significant age-adjusted gradients across the employment grades (lower grades, worse health). Among women, a similar relationship was found for the physical functioning, pain, and social functioning scales. For physical functioning, the effect of grade was found in those with and without disease. CONCLUSIONS: Low socioeconomic status was associated with poor health functioning, and the effect sizes were comparable to those for some clinical conditions. For physical functioning, this association may act both via and independently of disease.
Screening women for gonorrhea: demographic screening criteria for general clinical use.
Authors: Mertz K J , Levine W C , Mosure D J , Berman S M , Dorian K J , Hadgu A
Published: November 2008

OBJECTIVES: The purpose of this analysis was to derive potential gonorrhea screening criteria for women. METHODS: Data corresponding to 44,366 gonorrhea cultures from women 15 through 44 years of age in Columbus, Ohio, were analyzed. RESULTS: Characteristics that were associated with gonococcal infection and were suitable for screening decisions included patient's age and marital status and previous prevalence of gonorrhea at provider site. Probabilities of infection ranged from .001 for married women 25 through 44 years of age at low-prevalence provider sites to .078 for unmarried women 15 through 19 years of age at high-prevalence sites. CONCLUSIONS: Patient's age and marital status and prevalence of gonorrhea at provider site can be used as indicators to ensure testing of high-prevalence groups.
Mortality patterns among female nurses: a 27-state study, 1984 through 1990.
Authors: Peipins L A , Burnett C , Alterman T , Lalich N
Published: November 2008

OBJECTIVES: This study examined the mortality experience of 50,000 nurses using the National Occupational Mortality Surveillance database of death certificates. METHODS: Proportionate mortality ratios adjusted by race (White, Black, or other) and 5-year age groups were calculated for selected causes of death among female nurses vs all workers and white-collar workers. RESULTS: Excess deaths among nurses less than 65 years of age were seen in both comparison groups for viral hepatitis, cancer of the nasal cavities, accidental falls, suicide, and drug-related deaths. Among nurses 65 years old or older, deaths due to chronic myeloid leukemia were in excess. Proportionate mortality ratios for breast and colon cancers, diabetes, and heart disease varied by occupational comparison group. CONCLUSIONS: These findings confirm results of previous studies and identify new associations. Redoubled efforts are called for in overcoming obstacles to reducing workplace hazards.
Shigellosis on Indian reserves in Manitoba, Canada: its relationship to crowded housing, lack of running water, and inadequate sewage disposal.
Authors: Rosenberg T , Kendall O , Blanchard J , Martel S , Wakelin C , Fast M
Published: November 2008

OBJECTIVES: This study compares incidence and hospitalization rates for shigellosis between Indians and the rest of the population in Manitoba, Canada. It examines the relationship between shigellosis and environmental conditions on reserves. METHODS: Rates were calculated with surveillance data and a survey of environmental infrastructure was done. RESULTS: Indians had shigellosis incidence and hospitalization rates that were 29 and 12 times as high, respectively, as those of the rest of the population. Household crowding, lack of piped water, and inadequate sewage disposal were significantly associated with an increased incidence of shigellosis on reserves. CONCLUSIONS: Many cases of shigellosis may be prevented by improving living conditions on Indian reserves.
Aplastic anemia in rural Thailand: its association with grain farming and agricultural pesticide exposure. Aplastic Anemia Study Group.
Authors: Issaragrisil S , Chansung K , Kaufman D W , Sirijirachai J , Thamprasit T , Young N S
Published: November 2008

OBJECTIVES: A population-based case-control study was conducted to elucidate the incidence and etiology of aplastic anemia in Thailand. METHODS: Case patients and hospital control patients were enrolled in three regions from 1989 to 1994; data were collected by interview. RESULTS: Forty-six percent of 81 case patients and 19% of 295 control patients from Khonkaen were grain farmers (estimated relative risk [RR] = 2.7, 95% confidence interval [CI] = 1.4, 5.2). Sixteen percent of case patients and 6% of control patients used agricultural pesticides (estimated RR = 2.7, 95% CI = 1.1, 6.6). The association with grain farming remained among those not exposed to pesticides. In Songkla, 16% of 43 case patients and 2% of 181 control patients were grain farmers (crude RR estimate = 11, 95% CI = 3.4, 35). CONCLUSIONS: The relation of aplastic anemia to grain farming may partly explain the high incidence of aplastic anemia in Thailand.