bluuebunny/crossref_metadata_2025 huggingface dataset:
Educating patients with limited literacy skills: the effectiveness of printed and videotaped materials about colon cancer.
Authors: Meade C D , McKinney W P , Barnas G P
Published: November 2008

We investigated whether printed or videotaped information is more effective in enhancing colon cancer knowledge. Subjects (n = 1100) were randomized into three groups: to receive a booklet, view a videotape, or receive no intervention. Subjects receiving the intervention showed increased knowledge compared with control subjects (booklet = 23% and videotape = 26% vs no intervention = 3%). Findings suggest that personalized educational materials are effective in enhancing colon cancer knowledge.
Car mass and fatality risk: has the relationship changed?
Authors: Evans L , Frick M C
Published: November 2008

OBJECTIVES. The finding that the relative safety disadvantage of small compared with large cars is less for post-1980 cars than for pre-1980 cars has stimulated speculation that increasing fuel economy standards would increase fatalities less than previously expected. Fatal crashes between two cars of similar model year were examined to see whether this would be the case. METHODS. Driver fatality risk in relation to car mass was examined with Fatal Accident Reporting System data for crashes between two cars of a specific model year. RESULTS. The relative risk for driver fatality in the lighter car compared with the other driver's risk in a car 50% heavier was as follows: for 1966 through 1979 cars, the risk was between 3.7 and 5.1; for 1984 cars, 2.6; and for 1990 cars, 4.1. CONCLUSIONS. The results suggest that the lesser mass effect observed for mid-1980s cars occurred because improved crashworthiness features appeared in small cars earlier than in large cars. As all cars are redesigned, the relationship between risk and mass can be expected to approach that observed earlier in pre-1980 cars. If so, future fatality increases from fuel economy increases will be greater than estimated on the basis of mid-1980 data.
Mammography screening: how important is cost as a barrier to use?
Authors: Urban N , Anderson G L , Peacock S
Published: November 2008

OBJECTIVES. Recent legislation will improve insurance coverage for screening mammography and effectively lower its cost to many women. Although cost has been cited as a barrier to use, evidence of the magnitude of its effect on use is limited. METHODS. Mammography use in the past 2 years among women aged 50 to 75 residing in four suburban or rural counties in Washington State was estimated from 1989 survey data. Logistic regression analysis was used to estimate the odds ratio of mammography use as a function of economic and other variables. Within a residential area, averages were used to measure the market price of mammography and the time cost to obtain a mammogram. RESULTS. Use was lower among women who faced a higher net price or who preferred to obtain a mammogram during weekend or evening hours and higher among women with higher incomes. Visiting no doctor regularly and smoking were predictors of failure to use mammography. CONCLUSION. The effects of economic variables on mammography use are important and stable across subsets of the population, but they are modest in size.
The next generation: poor compliance with risk factor guidelines in the children of parents with premature coronary heart disease.
Authors: Langner N R , Rowe P C , Davies R
Published: November 2008

OBJECTIVES. The offspring of individuals with premature coronary heart disease are themselves at increased risk for myocardial infarction before the age of 55. Consensus panels have recommended that all such offspring undergo an evaluation of cardiovascular risk, including cholesterol testing. METHODS. To examine self-reported rates of cardiovascular risk factor assessment in this population, we conducted a telephone survey of 318 Canadian adults with premature coronary heart disease and of one offspring from 298 (94%) of the 318 families. RESULTS. The median age of the offspring was 20 years (range 2 to 39 y). Among the 219 late adolescent and young adult offspring, only 97 (44%) reported having had a blood cholesterol measurement during the preceding 3 years. Thirty-seven percent reported being current smokers, 31% were overweight, and 30% exercised fewer than three times per week. Men were less likely than women to report having had their blood pressure measured in the preceding year (57% vs 80%). CONCLUSION. These low rates of cardiac risk factor assessment families of patients with premature coronary heart disease represent missed opportunities for primary prevention. More effective strategies to prevent atherosclerosis in this population are needed.
"Eat for Health": a supermarket intervention for nutrition and cancer risk reduction.
Authors: Rodgers A B , Kessler L G , Portnoy B , Potosky A L , Patterson B , Tenney J , Thompson F E , Krebs-Smith S M , Breen N , Mathews O
Published: November 2008

OBJECTIVES. The results of an evaluation of "Eat for Health," a supermarket nutrition intervention, are presented. The study tested whether such a program could be successfully carried out and whether it could effect changes in knowledge, attitudes, and food purchasing behavior in line with nutrition and cancer risk reduction guidelines. METHODS. The evaluation consisted of an in-store monitoring element, an in-store and telephone consumer survey, and an analysis of sales data on selected foods. A matched-pair design, using a total of 40 stores in the intervention and comparison groups, was used. RESULTS. The intervention was successfully implemented and had limited success in changing some food purchasing behaviors. There appeared to be no effect on knowledge and attitudes except for increased awareness of a link between diet and cancer and of the program itself. CONCLUSIONS. Despite the intervention's success, limitations of the consumer survey and sales data analyses and the continuing diffusion of nutrition messages throughout society make it difficult to specify the impact of this program on consumer nutrition knowledge and behaviors.
Racial disparities in reported prenatal care advice from health care providers.
Authors: Kogan M D , Kotelchuck M , Alexander G R , Johnson W E
Published: November 2008

OBJECTIVES. The relationship between certain maternal behaviors and adverse pregnancy outcomes has been well documented. One method to alter these behaviors is through the advice of women's health care providers. Advice from providers may be particularly important in minority populations, who have higher rates of infant mortality and prematurity. This study examines racial disparities according to women's self-report of advice received from health care providers during pregnancy in four areas: tobacco use, alcohol consumption, drug use, and breast-feeding. METHODS. Health care providers' advice to 8310 White non-Hispanic and Black women was obtained from the National Maternal and Infant Health Survey. RESULTS. After controlling for sociodemographic, utilization, and medical factors, Black women were more likely to report not receiving advice from their prenatal care providers about smoking cessation and alcohol use. The difference between Blacks and Whites also approached significance for breast-feeding. No overall difference was noted in advice regarding cessation of drug use, although there was a significant interaction between race and marital status. CONCLUSIONS. These data suggest that Black women may be at greater risk for not receiving information that could reduce their chances of having an adverse pregnancy outcome.
Job strain and health-related quality of life in a national sample.
Authors: Lerner D J , Levine S , Malspeis S , D'Agostino R B
Published: November 2008

OBJECTIVES. Studies of the health effects of job strain have focused on morbidity and mortality as outcomes. This is the first study to examine the relationship of job strain to more comprehensive health status measures that encompass health-related quality of life. METHODS. In a national cross-sectional survey, 1319 working men and women, aged 18 through 64 years, completed a modified version of the Job Content Questionnaire that classified workers' jobs into four categories: high strain, passive, low strain, and active. Subjects also completed the Medical Outcomes Study Short-Form Health Survey and a health distress scale. Logistic regression analyses were employed that controlled for age, race/ethnicity, gender, and education. Both work and nonwork variables were included. RESULTS. Job strain was significantly associated with five of nine components of health-related quality of life: physical functioning, role functioning related to physical health, vitality, social functioning, and mental health. Job strain made a modest yet statistically significant contribution beyond the effects of chronic illness and psychosocial variables. CONCLUSIONS. The results provide justification for further investigating the role of job strain as an independent risk factor for health-related quality of life.
Alcohol and drug disorders among physically abusive and neglectful parents in a community-based sample.
Authors: Kelleher K , Chaffin M , Hollenberg J , Fischer E
Published: November 2008

OBJECTIVES. The purpose of this study was to compare the frequency of substance use disorders and symptoms between adults reporting child physical abuse or neglect and individually matched control subjects in a community sample. METHODS. In a nested case-control study, 169 adults reporting physical abuse of a child and 209 adults reporting neglect of a child from 11,662 individuals successfully interviewed in a probabilistic survey in four communities were individually matched with control subjects drawn from the participants. Case subjects were compared with control subjects on the number of alcohol- or drug-related symptoms and disorder diagnoses as determined by symptoms from the Diagnostic Interview Schedule. RESULTS. Respondents reporting either physical abuse or neglect of children were much more likely than their matched control subjects to report substance abuse or dependence. These differences persisted after potential confounding variables were controlled for. CONCLUSIONS. Parental substance abuse and dependence, independent of confounding factors, are highly associated with child maltreatment. Inconsistent results in previous studies may have arisen from reliance on referred samples and unstandardized assessment methods. Agencies involved in the care of abused or neglected children and their families should consider incorporating routine substance abuse evaluations with treatment, or referral for treatment, where indicated.
Stage of cancer at diagnosis for Medicare HMO and fee-for-service enrollees.
Authors: Riley G F , Potosky A L , Lubitz J D , Brown M L
Published: November 2008

OBJECTIVES. Health maintenance organizations (HMOs) with Medicare contracts often provide cancer screening and preventive services not covered under fee-for-service. This study compared cancer patients in HMOs and fee-for-service on stage at diagnosis. METHODS. The study examined stage at diagnosis for aged Medicare enrollees in HMOs and fee-for-service, using information from the Surveillance, Epidemiology, and End Results program, linked with Medicare enrollment files. Twelve cancer sites were investigated, and demographics, area of residence, year of diagnosis (1985 to 1989), and education at the census tract level were controlled. RESULTS. HMO enrollees were diagnosed at earlier stages for cancers of the female breast, cervix, colon, and melanomas and at later stages for stomach cancer. There were no differences for cancers of the prostate, rectum, buccal cavity and pharynx, bladder, uterus, kidney, and ovary. HMO effects were strongest in areas with large, mature HMOs. CONCLUSIONS. Compared with fee-for-service enrollees, HMO enrollees were diagnosed at earlier stages for cancer sites for which effective screening services are available. The earlier detection of certain cancers among HMO enrollees may result from coverage of screening services and, perhaps, promotion by HMOs of such services.
Risk factors for delayed immunization among children in an HMO.
Authors: Lieu T A , Black S B , Ray P , Chellino M , Shinefield H R , Adler N E
Published: November 2008

OBJECTIVES. Improving the timely delivery of childhood immunizations has become a national imperative. This study aimed to identify nonfinancial predictors of delayed immunization among patients with good financial access to preventive care. METHODS. This prospective cohort study used telephone interviews and a computerized immunization tracking system to evaluate 13-month-old children (n = 530) in a regional group-model health maintenance organization. RESULTS. More than one third of parents interviewed did not know when the next immunization was due. Thirteen percent were late for the measles-mumps-rubella immunization, recommended at 15 months of age, by 90 days or more. Independent predictors of delayed immunization included having a larger number of children (odds ratio [OR] = 1.4, P < .01), not having a regular doctor (OR = 2.9, P < .05), not knowing when the shot was due (OR = 2.0, P < .01), and not worrying about the risks of shots (OR = 1.4, P < .05). CONCLUSIONS. Financial access alone does not guarantee timely childhood immunization. In managed care settings, which may cover increasing numbers of children under health care reform, interventions are needed to better inform parents of when immunizations are due.
Presumptive eligibility for pregnant Medicaid enrollees: its effects on prenatal care and perinatal outcome.
Authors: Piper J M , Mitchel E F , Ray W A
Published: November 2008

OBJECTIVES. "Presumptive eligibility" permits pregnant prospective Medicaid enrollees to obtain services during the application period. The purpose of this study was to assess the effects of presumptive eligibility on the receipt of prenatal care and the occurrence of low-birthweight births and neonatal, perinatal, and infant mortality. METHODS. Outcome rates for pregnant women who enrolled in Tennessee Medicaid in the 6-month period before presumptive eligibility was enacted were compared with those obtained for pregnant women who enrolled in the 6-month period after presumptive eligibility had been in effect for 5 months. RESULTS. Women in the "after" group were 40% more likely to enroll and 30% more likely to obtain prenatal care in the first trimester. They were 300% more likely to fill a prescription for prenatal vitamins in the first trimester and 16% more likely to have begun prenatal care before the third trimester. However, they were similar to those enrolling in the "before" time period in terms of the occurrence of adverse perinatal outcomes. CONCLUSIONS. When barriers to prenatal care, including bureaucratic ones, are removed, low-income women will seek care earlier and more frequently.
The danger of applying uniform clinical policies across populations: the case of breast cancer in American Indians.
Authors: Nutting P A , Calonge B N , Iverson D C , Green L A
Published: November 2008

OBJECTIVES. This study examined the implications of annual screening mammography for cost and mortality in American Indian populations with differing baseline breast cancer rates. METHODS. A decision tree compared annual screening mammography and screening clinical breast examination with referral for diagnostic mammography when appropriate. The decision tree was constructed to examine the effect of different base-line cancer rates, stage at diagnosis, and stage-specific survival. Outcomes included 5-year relative survival, deaths prevented at 5 years, cost per death prevented, and total costs. RESULTS. The findings suggest that the total cost of breast cancer is 3.6 times higher with the screening mammography program but results in a 27.9% reduction in breast cancer deaths over the first 5 years of the program. Both costs and deaths prevented are sensitive to the incidence of breast cancer in the population and are less favorable in the range of incidence seen in American Indians. CONCLUSIONS. The cost and impact of a given strategy for cancer screening vary among communities with different disease incidence, stage at diagnosis, and stage-specific survival, as seen in American Indian populations.
Medicare-certified home health services: national and regional supply in the 1980s.
Authors: Scalzi C C , Zinn J S , Guilfoyle M J , Perdue S T
Published: November 2008

The number of Medicare-certified home health agencies nearly doubled from 1980 to 1990. Using Health Care Financing Administration data, this study documented national and regional patterns of entry and exist by Medicare home health providers from 1980 to 1990. Nationally, agency origination rates accelerated during the early 1980s and then dropped abruptly in the second half of the decade. The proprietary sector, accounting for approximately 42% of agencies in existence during the period of the study, exhibited the greatest volatility. Regional differences are also evident. Both expansion and contraction in Medicare home health services appear to be a response to the incentives of legislation implemented during this period.
Hysterectomy use: the correspondence between self-reports and hospital records.
Authors: Brett K M , Madans J H
Published: November 2008

Studies of the relationship between hysterectomy use and sociodemographic factors tend to use self-reported data. In the current study, data were collected from a representative sample of US women who have been prospectively followed since 1971. Hysterectomy status was obtained by self-report and from hospital records. Although these two measures of hysterectomy were highly related, more women reported hysterectomy than could be confirmed by hospital records. The two measures showed similar associations between several obstetric and demographic characteristics and hysterectomy status, suggesting that the use of self-reported hysterectomy data does not bias analyses of potentially associated factors.
Patient adherence to guidelines for diabetes eye care: results from the diabetic eye disease follow-up study.
Authors: Will J C , German R R , Schuman E , Michael S , Kurth D M , Deeb L
Published: November 2008

Early detection and treatment of diabetic eye disease can prevent blindness, yet many persons with diabetes lack regular eye care. This study followed 569 people with diabetes participating in blindness prevention programs during 1985 through 1987; it was found that 35% of subjects received dilated eye examinations before entering the programs, in comparison with 60% afterward. About 85% of participants referred for proliferative retinopathy treatment began such treatment, and, of these, 85% completed treatment. A lack of knowledge about the disease and limited finances were primary reasons for nonadherence. To improve the effectiveness of prevention programs, eye care providers and program staff must strive to eliminate these educational and financial barriers.
The association between two windchill indices and daily mortality variation in The Netherlands.
Authors: Kunst A E , Groenhof F , Mackenbach J P
Published: November 2008

OBJECTIVES. The purpose of this study was to compare temperature and two windchill indices with respect to the strength of their association with daily variation in mortality in the Netherlands during 1979 to 1987. The two windchill indices were those developed by Siple and Passel and by Steadman. METHODS. Daily numbers of cause-specific deaths were related to the meteorological variables by means of Poisson regression with control for influenza incidence. Lag times were taken into account. RESULTS. Daily variation in mortality, especially mortality from heart disease, was more strongly related to the Steadman windchill index than to temperature or the Siple and Passel index (34.9%, 31.2%, and 31.5%, respectively, of mortality variation explained). The strongest relation was found with daytime values of the Steadman index. CONCLUSIONS. In areas where spells of cold are frequently accompanied by strong wind, the use of the Steadman index probably adds much to the identification of weather conditions involving an increased risk of death. The results of this study provide no justification for the wide-spread use (e.g., in the United States) of the Siple and Passel index.
First-trimester anesthesia exposure and the risk of central nervous system defects: a population-based case-control study.
Authors: Sylvester G C , Khoury M J , Lu X , Erickson J D
Published: November 2008

OBJECTIVES. Although up to 2% of women undergo surgery during pregnancy, teratogenic effects of general anesthesia have not been adequately studied. Recently, an association between first-trimester operations and central nervous system defects has been described. This issue was explored in a population-based case-control study. METHODS. Case patients included live-born and stillborn infants with central nervous system defects born to residents of metropolitan Atlanta, Ga, between 1968 and 1980. Control patients included normal babies frequency matched to case patients by race, birth hospital, and period of birth. Conditional logistic regression analysis was used to adjust for potential confounding factors. RESULTS. Of 694 mothers of infants with central nervous system defects, 12 reported first-trimester anesthesia exposure; 34 of 2984 control mothers reported such exposure (odds ratio [OR] = 1.7, 95% confidence interval [CI] = 0.8, 3.3). A striking association was observed between reported anesthesia exposure and hydrocephalus with another major defect (OR = 9.6, 95% CI = 3.8, 24.6). The strongest association was that of anesthesia exposure with hydrocephalus and eye defects (OR = 39.6, 95% CI = 7.5, 209.2). CONCLUSIONS. An increased risk of hydrocephalus with other defects was found among offspring of mothers with reported first-trimester anesthesia. Further studies are needed to explore the possible teratogenic effects of general anesthesia.
Mother-daughter correlations of obesity and cardiovascular disease risk factors in black and white households: the NHLBI Growth and Health Study.
Authors: Morrison J A , Payne G , Barton B A , Khoury P R , Crawford P
Published: November 2008

OBJECTIVES. This study sought to evaluate obesity as a potential explanatory factor for the increased relative risk for cardiovascular disease in Black compared with White women. METHODS. Familial associations for obesity and cardiovascular disease risk factors were assessed in 720 White and 580 Black mother-daughter pairs from the National Heart, Lung, and Blood Institute's Growth and Health Study by using Pearson's chi square, Spearman's correlations, and partial correlations. RESULTS. Black girls and mothers were significantly heavier and had higher body mass indices than their White counterparts. In each racial group, significant, positive mother-daughter correlations existed for weight, body mass index, and triceps skinfolds, and for all cardiovascular disease risk factors. Obesity measures correlated positively with systolic blood pressure and triglycerides and inversely with high-density lipoprotein cholesterol in girls and mothers of both races. Correlations between mothers and daughters for exercise and ideal body shape were weak and did not explain obesity associations. CONCLUSIONS. Intrafamilial associations of obesity, cardiovascular disease risk factors, and the obesity-cardiovascular disease risk factor relationship support the position that increased cardiovascular disease morbidity and mortality rates in Black women may be linked to excess obesity in Black women compared with White ones.
The prevalence of back pain, hand discomfort, and dermatitis in the US working population.
Authors: Behrens V , Seligman P , Cameron L , Mathias C G , Fine L
Published: November 2008

OBJECTIVES. The purpose of the study was to provide the health care and public health communities with national prevalence estimates of selected conditions in the US working population. METHODS. National prevalence estimates of self-reported conditions among working people were calculated from data collected for the 1988 Occupational Health Supplement to the National Health Interview Survey. RESULTS. The highest prevalence estimates were found among occupational groups. For example, the prevalence of back pain due to an injury at work among truck drivers was 6.7%; back pain due to repeated activities at work among mechanics and repairers of heavy equipment and machinery was 10.5%; hand discomfort among operators of machines that process metal, plastic, stone, and glass was 23.5%; and dermatitis due to contact with substances at work among physicians, dentists, nurses, pharmacists, and dietitians was 5.6%. CONCLUSIONS. A substantial proportion of these conditions among occupational groups with the highest prevalence estimates are occupational in origin. These prevalence estimates identify occupations in which efforts are needed to prevent these conditions.
Estimating activity limitation in the noninstitutionalized population: a method for small areas.
Authors: Lafata J E , Koch G G , Weissert W G
Published: November 2008

OBJECTIVES. Although reliable direct state and local estimates of the activity-limited population are frequently unavailable, regression-adjusted synthetic estimates can be made. Such estimates use multivariate methods to model activity limitation at the national level and then apply model-predicted probabilities to corresponding community-specific demographic data. METHODS. Using the 1989 National Health Interview Survey and the 1991 Area Resource File System, this study produced log-linear regression models that included person-level demographic and county-level contextual variables as predictors of activity limitation. Model-predicted rates were then multiplied by corresponding intercensal population data to generate state and local synthetic estimates of activity limitation. RESULTS. Rates of activity limitation generally were found to increase with age and as the socioeconomic conditions of the county in which an individual resided worsened. Race and sex also tended to be statistically significant predictors of activity limitation. CONCLUSIONS. Activity limitation can be effectively modeled by age, sex, race, and community socioeconomic status. Synthetic estimates such as these are relatively simple to generate and can be useful for small-area planning in the absence of direct local estimates.
Degree of acculturation and the risk of crack cocaine smoking among Hispanic Americans.
Authors: Wagner-Echeagaray F A , Schütz C G , Chilcoat H D , Anthony J C
Published: November 2008

Epidemiologic data from three national surveys conducted in 1988, 1990, and 1991 were used to investigate the association between acculturation and use of crack cocaine among Hispanic Americans living in the United States. Poststratification and conditional logistic regression were used to hold constant shared aspects of neighborhood environment, age, sex, and education. The analyses showed a strong inverse relationship between degree of acculturation and crack smoking among Mexican Americans (relative odds = 0.12, 95% confidence interval = 0.04, 0.34) but not among other Hispanics in the study population. This observed variation within the US Hispanic American population deserves special attention in future research.
Trends in asthma mortality among African Americans and whites in Chicago, 1968 through 1991.
Authors: Targonski P V , Persky V W , Orris P , Addington W
Published: November 2008

Death certificate data were used to examine asthma mortality among African Americans and Whites aged 5 through 34 years in Chicago from 1968 through 1991. African Americans experienced consistently higher asthma mortality throughout the period. Asthma mortality remained stable among Whites from 1968 through 1991 but increased by 337% among African Americans from 1976 through 1991 (P < .001). The increase was greatest among 20- through 34-year-olds. Between 1979 and 1991, outpatient and emergency department deaths increased significantly, while the proportion of dead-on-arrival cases remained stable at 51%. This shift to non-inpatient deaths suggests that lack of access to health care may play a role in increasing asthma mortality.
A cluster of tuberculosis among crack house contacts in San Mateo County, California.
Authors: Leonhardt K K , Gentile F , Gilbert B P , Aiken M
Published: November 2008

In March 1992, a cluster of 89 persons with tuberculosis infection was identified in San Mateo County, California. Thirteen persons (15%), including 11 children, were diagnosed with active pulmonary tuberculosis. All contacts were African Americans who resided in or visited one of two houses used for crack cocaine smoking or dealing. The patient with the index case, a male infected with human immunodeficiency virus, contributed to the transmission of tuberculosis as a transient resident of several dwellings. Public health authorities applied unique intervention methods to control the outbreak, including the use of a mobile health van. Further innovative strategies will be necessary to meet the challenge of this reemerging disease.
The incidence of tuberculosis among North Carolina migrant farmworkers, 1991.
Authors: Ciesielski S , Esposito D , Protiva J , Piehl M
Published: November 2008

All locatable subjects (n = 94) for whom tuberculosis prevalence had been determined in an earlier study were tested with purified protein derivative (PPD) and control antigens, sputum sampling, and chest x-rays. Of the 46 who had been tuberculin negative (confirmed with control antigens) 3 years earlier, 2 had developed active tuberculosis in the interim and 14 (30%) were tuberculin positive. All had been engaged continuously in migrant farmwork. Lack of access to health care, an institutional feature of migrant farmwork, was significantly associated with primary infection.
Childhood out-of-home care and current depressive symptoms among homeless adults.
Authors: Herman D B , Susser E S , Struening E L
Published: November 2008

Previous research indicates that adverse childhood experiences are associated with depression during adulthood under conditions of social stress. This relationship was examined in a large sample of homeless adults (n = 1849). Subjects with evidence of severe mental disorders such as schizophrenia were excluded. Those with out-of-home care (e.g., foster, group, or institutional care) during childhood were significantly more likely than those without such care to report current severe depressive symptoms (CES-D score greater than or equal to 30). The finding, which held up in multivariate analysis when potential confounders were statistically controlled, supports the theory that certain developmental experiences are risk factors for subsequent depressive symptoms.
Condom availability in schools: the need for improved program evaluations.
Authors: Stryker J , Samuels S E , Smith M D
Published: November 2008

OBJECTIVES. This article examines the impact of contentious local debates on the design and implementation of school-based condom availability programs. METHODS. Information about condom availability in schools was reviewed by 50 leading educators and health officials at a 1992 forum held in Menlo Park, Calif. RESULTS. Few existing condom availability programs were designed to yield definitive data on sexual risk-taking behavior or other measures of program effectiveness. CONCLUSIONS. In the debate over school-based condom availability programs, as in many aspects of human immunodeficiency virus (HIV) prevention programs, scientific, moral, and political concerns overlap. Behavioral research into the potential effectiveness of such programs can help inform debates about fundamental values concerning sexual decision making and privacy, family integrity and parental autonomy, and public health.
The effect of moderate alcohol use on the relationship between stress and depression.
Authors: Lipton R I
Published: November 2008

OBJECTIVES. The purpose of the study was to determine whether moderate alcohol use mediates or buffers the effect of stress on depression in a group of non-Hispanic White men and women. METHODS. Data are from the Los Angeles Epidemiological Catchment Area cohort. Individuals were assessed at two time periods, 1 year apart. Mean depression scores were analyzed for each level of stress and alcohol use. RESULTS. In the simultaneous presence of both chronic strain and negative life events, a U-shaped pattern was observed in which abstainers and light and heavy drinkers had higher depression scores at the second time period than did light-moderate and moderate alcohol users. The U-shaped relationship remained when the effects of sex, age, and physical health status were controlled. CONCLUSIONS. Light-moderate and moderate drinkers had less depression in the presence of stress than persons in other more extreme drinking categories. Moderate alcohol use may serve as a proxy for a spectrum of generally moderate behaviors that either attenuate the effect of stress on depression or suppress the effects of stress.
Factors mediating changes in sexual HIV risk behaviors among gay and bisexual male adolescents.
Authors: Rotheram-Borus M J , Reid H , Rosario M
Published: November 2008

OBJECTIVES. Factors mediating changes in sexual behaviors that increase the risk of human immunodeficiency virus (HIV) infection were monitored in a group of gay and bisexual male adolescents. METHODS. One hundred thirty-six males aged 14 to 19 years (Hispanic, 51%; African-American, 31%) were recruited from one gay-identified agency, were assessed at four points over a 1-year period, and participated in HIV preventive intervention sessions. RESULTS. Significant reductions occurred in the number of unprotected same-sex anal and oral acts. Those with less risk in their previous sexual history, those who did not engage in commercial sex, and those who attended more HIV intervention sessions were more likely to reduce their sexual risk. The impact of sessions varied significantly by race/ethnicity: African-American youths reduced their risk acts most dramatically. Abstinence was consistently and significantly more likely among younger youths and those who had been abstinent before enrollment. The youths significantly reduced the number of sexual partners following the intervention; this reduction in partners was maintained through the 12-month follow-up and was greatest among youths with no involvement in commercial sexual activity (prostitution). CONCLUSIONS. The efficacy of HIV prevention programs must be empirically evaluated.
Health care-seeking behavior related to the transmission of sexually transmitted diseases in Kenya.
Authors: Moses S , Ngugi E N , Bradley J E , Njeru E K , Eldridge G , Muia E , Olenja J , Plummer F A
Published: November 2008

OBJECTIVES. The purpose of this study was to identify health-care seeking and related behaviors relevant to controlling sexually transmitted diseases in Kenya. METHODS. A total of 380 patients with sexually transmitted diseases (n = 189 men and 191 women) at eight public clinics were questioned about their health-care seeking and sexual behaviors. RESULTS. Women waited longer than men to attend study clinics and were more likely to continue to have sex while symptomatic. A large proportion of patients had sought treatment previously in both the public and private sectors without relief of symptoms, resulting in delays in presenting to study clinics. For women, being married and giving a recent history of selling sex were both independently associated with continuing to have sex while symptomatic. CONCLUSIONS. Reducing the transmission of sexually transmitted diseases in Kenya will require improved access, particularly for women, to effective health services, preferably at the point of first contact with the health system. It is also critical to encourage people to reduce sexual activity while symptomatic, seek treatment promptly, and increase condom use.
The incidence of defensive firearm use by US crime victims, 1987 through 1990.
Authors: McDowall D , Wiersema B
Published: November 2008

It is well known that many crimes in the United States are committed with firearms. Less adequately documented is the frequency with which victims use guns in self-defense. We used National Crime Victimization Survey data to examine incidents where victims employed guns against offenders. Between 1987 and 1990 there were an estimated 258,460 incidents of firearm defense, an annual mean of 64,615. Victims used firearms in 0.18% of all crimes recorded by the survey and in 0.83% of violent offenses. Firearm self-defense is rare compared with gun crimes.
A rapid public health response to a cryptic outbreak of cholera in Hawaii.
Authors: Mintz E D , Effler P V , Maslankowski L , Ansdell V , Pon E , Barrett T J , Tauxe R V
Published: November 2008

In November 1991, toxigenic Vibrio cholerae O1 infection was confirmed in two unrelated persons in Hawaii. Cholera had not been acquired in Hawaii since 1895. To determine the source and extent of V cholerae O1 infections in Hawaii, both patients were interviewed, suspect food sources were investigated, and surveillance of physicians, laboratories, hospitals, and sewage treatment plants was instituted. One patient's husband had serologic titers consistent with recent V cholerae O1 infection; no other cases were confirmed and V cholerae O1 was not recovered from active surveillance of laboratories or sewage treatment plants. The investigation demonstrated that the outbreak had affected few persons and had ended.
A decline in HIV-infected needles returned to New Haven's needle exchange program: client shift or needle exchange?
Authors: Kaplan E H , Khoshnood K , Heimer R
Published: November 2008

The New Haven needle exchange program experienced a significant decline in the fraction of returned needles containing human immunodeficiency virus 1 (HIV-1) proviral DNA. Is this decline due to the operations of the needle exchange or to a shift in clients? Analysis of demographic and behavioral data revealed that only one variable, the race of participating clients, changed significantly over time. However, HIV-1 prevalences in needles given to Whites and to non-Whites were not statistically different. Thus, client shift cannot be responsible for the decline in the observed HIV prevalence in needles. Instead, needle circulation times were a significant predictor of HIV prevalence.
Predicting the effect of the Oregon Health Plan on Medicaid coverage for outpatients with HIV.
Authors: Conviser R , Retondo M J , Loveless M O
Published: November 2008

The Oregon Health Plan, which took effect in February 1994, extends Medicaid eligibility but limits coverage to conditions and treatments above a certain threshold on a prioritized list. Retrospective analysis was conducted on records of visits to two Oregon human immunodeficiency virus (HIV) outpatient clinics in 1991 and 1992 to determine Medicaid coverage if the plan had been operational. Of 1129 patients, 21.1% were Medicaid-eligible; an additional 56.5% would have been eligible under the Oregon plan. Only 5.0% to 6.8% of these patients' visits were for conditions listed below the plan's coverage threshold; almost none of these were for HIV-specific conditions.
HIV infection, risk behaviors, and depressive symptoms among Puerto Rican sex workers.
Authors: Alegría M , Vera M , Freeman D H , Robles R , Santos M C , Rivera C L
Published: November 2008

This paper examines the association of depressive symptoms with human immunodeficiency virus (HIV) infection and risk behaviors among 127 sex workers. Data were obtained by a structured interview and blood specimens tested for HIV. Findings showed a high prevalence rate of depressive symptoms for all sex workers regardless of HIV infection status. Results of a logistic regression analysis indicated that the use of injected drugs and engaging in unprotected intercourse with clients were strongly associated with a high level of depressive symptoms.
Anonymous HIV testing: the impact of availability on demand in Arizona.
Authors: Hirano D , Gellert G A , Fleming K , Boyd D , Englender S J , Hawks H
Published: November 2008

The purpose of this study was to evaluate the impact of anonymous testing availability on human immunodeficiency virus (HIV) test demand in Arizona. Testing patterns before and after the introduction of anonymous testing were compared. Client knowledge of new test policy and delay in testing until an anonymous option was available were assessed. Test numbers among men who have sex with men showed a statistically significant increase after introduction of an anonymous testing option. Arizona continues to maintain anonymous testing availability. Public health agencies should consider how test policy may influence people's HIV test decisions.
Policies of containment: immigration in the era of AIDS.
Authors: Fairchild A L , Tynan E A
Published: November 2008

The US Public Health Service began the medical examination of immigrants at US ports in 1891. By 1924, national origin had become a means to justify broad-based exclusion of immigrants after Congress passed legislation restricting immigration from southern and eastern European countries. This legislation was passed based on the alleged genetic inferiority of southern and eastern Europeans. Since 1987, the United States has prohibited the entrance of immigrants infected with the human immunodeficiency virus (HIV). On the surface, a policy of excluding individuals with an inevitably fatal "communicable disease of public health significance" rests solidly in the tradition of protecting public health. But excluding immigrants with HIV is also a policy that, in practice, resembles the 1924 tradition of selective racial restriction of immigrants from "dangerous nations." Since the early 1980s, the United States has erected barriers against immigrants from particular Caribbean and African nations, whose citizens were thought to pose a threat of infecting the US blood supply with HIV.
Circumcision and sexually transmitted diseases.
Authors: Cook L S , Koutsky L A , Holmes K K
Published: November 2008

OBJECTIVES. New evidence linking lack of circumcision with sexually transmitted human immunodeficiency virus revives concerns about circumcision and other sexually transmitted diseases. This study was undertaken to assess the relationship between circumcision and syphilis, gonorrhea, chlamydial infection, genital herpes, nongonococcal urethritis, and exophytic genital warts. METHODS. A cross-sectional study of 2776 heterosexual men attending a sexually transmitted disease clinic in 1988 was used to investigate the relationship between circumcision and sexually transmitted diseases. Subjects with specific sexually transmitted diseases and those without such diseases were compared after adjustment for age, race, zip code of residence, other sexually transmitted diseases, and number of sexual partners. RESULTS. A positive relationship was observed between uncircumcised status and both syphilis and gonorrhea. A negative relationship was found between warts and lack of circumcision. No apparent relationship was noted between uncircumcised status and genital herpes, chlamydial infection, or nongonococcal urethritis. CONCLUSIONS. Uncircumcised men were more likely than circumcised men to have syphilis and gonorrhea and were less likely to have visible warts.
Dementia-free life expectancy in France.
Authors: Ritchie K , Robine J M , Letenneur L , Dartigues J F
Published: November 2008

OBJECTIVES. Increasing concern with the quality of gains in life years has led to the development of a new synthetic indicator of population health:health expectancy. Until now, calculations have been made for physical disabilities only. A first estimate of mental health expectancy is presented: dementia-free life expectancy. METHODS. Sullivan's method was used to calculate dementia-free life expectancy for a random representative sample of 4134 persons over 65 years of age in the Bordeaux region of France. The diagnosis of senile dementia was made in two stages, based on Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) criteria. RESULTS. At 65 years of age, a person's dementia-free life expectancy is 16.9 years within a total life-expectancy of 17.7 years; it decreases with age in parallel with the decrease in total life expectancy so that life expectancy with dementia stays constant at 0.8 years. Although dementia prevalence increases with age, if the prevalence is adjusted for mortality, the largest number of persons with dementia are in their early eighties. At each age women have a higher dementia-free life expectancy. CONCLUSIONS. Trends in dementia-free life expectancy are similar to those found in disability-free life expectancy. Because the dementia prevalence rates used in this estimate resemble a general model derived from meta-analysis, it can be assumed that similar results will be found in other Western countries with similar mortality rates.
Sedatives and hypnotics in Stockholm: social factors and kinds of use.
Authors: Blennow G , Romelsjö A , Leifman H , Leifman A , Karlsson G
Published: November 2008

OBJECTIVES. The aims of the study were (1) to estimate prevalence rates of current, regular, and long-term use of sedatives and hypnotics and the incidence of regular use in an urban population and (2) to study the association between such use of drugs and sociodemographic factors, symptoms of disease, and alcohol consumption. METHODS. Data on drug use in a random sample of 6217 adults in Stockholm County were analyzed with logistic regression. RESULTS. The prevalence rate for current use of sedatives or hypnotics was 12.8% among men and 18.6% among women; the rate for regular use was 3.7% among males and 4.7% among females. The odds ratio for current use increased with age and was higher among unemployed persons and disability pensioners, high consumers of alcohol, persons with an increased level of symptoms, and widows. More than 25% of the persons who had used sedatives or hypnotics during the previous 2 weeks were regular users 6 months later. For persons aged 25 through 64 years, the annual incidence rate was 1.8% among men and 2.7% among women. CONCLUSIONS. The comparatively low incidence and high prevalence of regular use implies that long-term use of sedatives and hypnotics is common.
Societal-level predictors of groups' drinking patterns: a research synthesis from the Collaborative Alcohol-Related Longitudinal Project.
Authors: Fillmore K M , Golding J M , Leino E V , Ager C R , Ferrer H P
Published: November 2008

OBJECTIVES. Period effects of per capita consumption of alcohol and divorce rates are assessed for change in quantity and frequency among age/sex groups in multiple longitudinal studies. METHODS. Twenty-five studies of quantity and 29 studies of frequency are used. Studies are from 15 nations and cover periods of 1 to 21 years. Models predict the standardized mean difference for quantity and frequency based on period effects and group-level and methodological variables. RESULTS. When both the period effects of per capita consumption and the divorce rate are considered, the divorce rate significantly predicts change in quantity and frequency. An increase in the divorce rate is associated with a stronger decrease in frequency among younger people; men are more likely than women to decrease their frequency of drinking when divorce rates rise. CONCLUSIONS. Multiple societal-level factors should be considered critical in influencing the drinking patterns of groups. These results suggest that an increase in the divorce rate is associated with more "dry" social contexts, characterized possibly by drinking patterns of a more "volitive" nature (i.e., heavier quantity per occasion and less frequent drinking).