Template-Type: ReDIF-Article 1.0 Title: Outbreak of hepatitis A among homosexual men in Sydney Journal: American Journal of Public Health Author-Name: Stokes, M.-L. Author-Name: Ferson, M.J. Author-Name: Young, L.C. Author-Name: Person, M.J. Year: 1997 Volume: 87 Issue: 12 Pages: 2039-2041 Abstract: Objectives. This study examined an outbreak of hepatitis A in eastern Sydney during 1991-1992. Methods. Data were based on cases of hepatitis A in eastern Sydney residents reported from January 1991 to October 1992. Results. Five hundred seventy cases of hepatitis A were reported. Of these, 515 (90%) occurred in male patients, of whom 330 were reported to be homoxesual or bisexual. The highest attack rate (71/10 000) occurred in men aged 20 to 29 years of age. Conclusions. This outbreak affected large numbers of young homosexual men living in the inner eastern suburbs of Sydney. Hepatitis A vaccination should be considered for all susceptible homosexual men. Further research into the use of hepatitis A vaccine as an outbreak control measure is also recommended. Handle: RePEc:aph:ajpbhl:1997:87:12:2039-2041_0 Template-Type: ReDIF-Article 1.0 Title: Erratum: State variations in Medicare expenditures (American Journal of Public Health (1997) 87 (1611-1619)) Journal: American Journal of Public Health Author-Name: Kane, R.L. Author-Name: Friedman, B. Year: 1997 Volume: 87 Issue: 12 Pages: 2052 Handle: RePEc:aph:ajpbhl:1997:87:12:2052_3 Template-Type: ReDIF-Article 1.0 Title: The cost-effectiveness of alternative methods of nutrition education for hypercholesterolemic children Journal: American Journal of Public Health Author-Name: Brannon, S.D. Author-Name: Tershakovec, A.M. Author-Name: Shannon, B.M. Year: 1997 Volume: 87 Issue: 12 Pages: 1967-1970 Abstract: Objectives. This study compared the cost-effectiveness, from the family's perspective, of a parent-child auto-tutorial nutrition education program with that of counseling by a dietitian after identification of hypercholesterolemic children in pediatric offices. Methods. Personnel, parent time, equipment, and laboratory costs associated with the interventions were analyzed. Reductions in dietary fat as a percentage of total calories were analyzed by means of 24-hour dietary recalls and in plasma low-density lipoprotein cholesterol at 3 and 12 months postintervention. Results. Average costs totaled $208.08 for the parent- child auto-tutorial program and $213.28 for counseling. While the parent- child program was somewhat less cost-effective in terms of dietary change, it was more cost-effective in terms of lipid reduction at 3 months, although this advantage disappeared by 12 months. Conclusions. Modest reductions in fat in the diet and in plasma lipid levels were achieved at costs that also appear modest in comparison with treatment of elevated cholesterol in adulthood. Follow-up interventions may be needed to sustain effects, while longitudinal studies are needed to assess the long-term cost benefit. Handle: RePEc:aph:ajpbhl:1997:87:12:1967-1970_1 Template-Type: ReDIF-Article 1.0 Title: Use of capitated reimbursement to provide comprehensive management of childhood lead poisoning Journal: American Journal of Public Health Author-Name: Davoli, C. Year: 1997 Volume: 87 Issue: 12 Pages: 2056-2057 Handle: RePEc:aph:ajpbhl:1997:87:12:2056-2057_0 Template-Type: ReDIF-Article 1.0 Title: Cryptosporidiosis-associated mortality following a massive waterborne outbreak in Milwaukee, Wisconsin Journal: American Journal of Public Health Author-Name: Hoxie, N.J. Author-Name: Davis, J.P. Author-Name: Vergeront, J.M. Author-Name: Nashold, R.D. Author-Name: Blair, K.A. Year: 1997 Volume: 87 Issue: 12 Pages: 2032-2035 Abstract: Objectives. This study estimated the magnitude of cryptosporidiosis- associated mortality in the Milwaukee vicinity for 2 years following a massive waterborne outbreak. Methods. Death certificates were reviewed. Results. During approximately 2 years before the outbreak, cryptosporidiosis was listed as an underlying or contributing cause of death on the death certificates of four Milwaukee-vicinity residents. In the approximately 2 years after the outbreak, this number was 54, of whom 85% had acquired immunodeficiency syndrome (AIDS) listed as the underlying cause of death. In the first 6 months after the outbreak, the number of death certificates indicating AIDS, but not cryptosporidiosis, as a cause of death was 19 (95% confidence interval = 12.26) higher than preoutbreak trends would have predicted. Conclusions. Waterborne outbreak of cryptosporidium infection can result in significant mortality, particularly among immunocompromised populations. Any discussion of policies to ensure safe drinking water must consider the potential fatal consequences of waterborne cryptosporidiosis among immunocompromised populations. Handle: RePEc:aph:ajpbhl:1997:87:12:2032-2035_5 Template-Type: ReDIF-Article 1.0 Title: The impact of influenza epidemics on mortality: Introducing a severity index Journal: American Journal of Public Health Author-Name: Simonsen, L. Author-Name: Clarke, M.J. Author-Name: Williamson, G.D. Author-Name: Stroup, D.F. Author-Name: Arden, N.H. Author-Name: Schonberger, L.B. Year: 1997 Volume: 87 Issue: 12 Pages: 1944-1950 Abstract: Objectives. The purpose of this study was to assess the impact of recent influenza epidemics on mortality in the United States and to develop an index for comparing the severity of individual epidemics. Methods. A cyclical regression model was applied to weekly national vital statistics from 1972 through 1992 to estimate excesses in pneumonia and influenza mortality and all-cause mortality for each influenza season. Each season was categorized on the basis of increments of 2000 pneumonia and influenza excess deaths, and each of these severity categories was correlated with a range of all-cause excess mortality. Results. Each of the 20 influenza seasons studied was associated with an average of 56000 pneumonia and influenza excess deaths (range, 0-11 800) and 21 300 all-cause excess deaths (range, 0-47 200). Most influenza A (H3N2) seasons fell into severity categories 4 to 6 (23 000-45 000 all-cause excess deaths), whereas most A (H1N1) and B seasons were ranked in categories 1 to 3 (0-23 000 such deaths). Conclusions. From 1972 through 1992, influenza epidemics accounted for a total of 426 000 deaths in the United States, many times more than those associated with recent pandemics. The influenza epidemic severity index was useful for categorizing severity and provided improved seasonal estimates of the total number of influenza- related deaths. Handle: RePEc:aph:ajpbhl:1997:87:12:1944-1950_7 Template-Type: ReDIF-Article 1.0 Title: Behavior intentions of the public after bans on smoking in restaurants and bars Journal: American Journal of Public Health Author-Name: Biener, L. Author-Name: Siegel, M. Year: 1997 Volume: 87 Issue: 12 Pages: 2042-2044 Abstract: Objectives. This study assessed the potential effect of smoke-free policies on bar and restaurant patronage. Methods. Random-digit dialing techniques were used in surveying a representative sample of Massachusetts adults (n = 2356) by telephone. Results. Approximately 61% of the respondents predicted no change in their use of restaurants in response to smoke-free policies, 30% predicted increased use, and 8% predicted decreased use. In turn, 69% of the respondents predicted no change in their patronage of bars, while 20% predicted increased use and 11% predicted decreased use. Conclusions. These results suggest that smoke-free policies are likely to increase overall patronage of bars and restaurants. Handle: RePEc:aph:ajpbhl:1997:87:12:2042-2044_9 Template-Type: ReDIF-Article 1.0 Title: Can physicians treat tuberculosis? Report on a national survey of physician practices Journal: American Journal of Public Health Author-Name: Sumartojo, E.M. Author-Name: Geiter, L.J. Author-Name: Miller, B. Author-Name: Hale, B.E. Year: 1997 Volume: 87 Issue: 12 Pages: 2008-2011 Abstract: Objectives. Researchers examined physicians' treatment strategies for tuberculosis to determine whether they would follow recommendations of the Centers for Disease Control and Prevention and the American Thoracic Society. Methods. A national survey sampled 1772 physicians. Analyses tested correlates of recommended treatment regimens. Results. Among respondents, 59.4% described a recommended regimen. Specialists; physicians aware of professional publications, treatment recommendations, and reporting requirements; and those having more than 50% of patients in nursing homes were more likely to describe recommended regimens. Physicians who had been in practice longer, relied on personal experience, or had more than 50% of patients receiving Medicaid were less likely to describe recommended regimens. Conclusions. Physicians who treat tuberculosis require training and support. Policymakers should consider who should treat tuberculosis and how recommended practice should be ensured. Handle: RePEc:aph:ajpbhl:1997:87:12:2008-2011_6 Template-Type: ReDIF-Article 1.0 Title: The risk of Guillain-Barre syndrome after tetanus-toxoid-containing vaccines in adults and children in the United States Journal: American Journal of Public Health Author-Name: Tuttle, J. Author-Name: Chen, R.T. Author-Name: Rantala, H. Author-Name: Cherry, J.D. Author-Name: Rhodes, P.H. Author-Name: Hadler, S. Year: 1997 Volume: 87 Issue: 12 Pages: 2045-2048 Abstract: Objectives. This study examined whether there is a risk that tetanus- toxoid containing vaccines could cause Guillain-Barre syndrome and, if so, how large the risk is. Methods. This study was based on previous active surveillance epidemiological studies of Guillain-Barre syndrome and vaccination history. Results. A background rate of 0.3 cases of Guillain- Barre syndrome per million person-weeks has been estimated. By chance, 2.2 people with the syndrome would have received tetanus-toxoid-containing vaccine within the 6 weeks before onset, yet only 1 person had done so. Data on children show similar results. Conclusions. If an association exists, it must be extremely rare and not of public health significance. Handle: RePEc:aph:ajpbhl:1997:87:12:2045-2048_0 Template-Type: ReDIF-Article 1.0 Title: On paradigms, community participation, and the future of public health Journal: American Journal of Public Health Author-Name: Schwab, M. Author-Name: Syme, S.L. Year: 1997 Volume: 87 Issue: 12 Pages: 2049-2051 Handle: RePEc:aph:ajpbhl:1997:87:12:2049-2051_7 Template-Type: ReDIF-Article 1.0 Title: Erratum: Injury and death associated with hospital bed side-rails: Reports to the US Food and Drug Administration from 1985 to 1995 (American Journal of Public Health (1997) 87 (1675-1677)) Journal: American Journal of Public Health Author-Name: Todd, J. Author-Name: Ruhl, C.E. Author-Name: Gross, T.P. Year: 1997 Volume: 87 Issue: 12 Pages: 2052 Handle: RePEc:aph:ajpbhl:1997:87:12:2052_9 Template-Type: ReDIF-Article 1.0 Title: Active and passive surveillance for communicable diseases in child care facilities, Seattle-King County, Washington Journal: American Journal of Public Health Author-Name: MacDonald, J.K. Author-Name: Boase, J. Author-Name: Stewart, L.K. Author-Name: Alexander, E.R. Author-Name: Solomon, S.L. Author-Name: Cordell, R.L. Year: 1997 Volume: 87 Issue: 12 Pages: 1951-1955 Abstract: Objectives. The purpose of this study was to develop and evaluate models for public health surveillance of illnesses among children in out-of-home child care facilities. Methods. Between July 1992 and March 1994, 200 Seattle-King County child care facilities participated in active or enhanced passive surveillance, or both. Reporting was based on easily recognized signs, symptoms, and sentinel events. Published criteria were used in evaluating surveillance effectiveness, and notifiable disease reporting of participating and nonparticipating facilities was compared. Results. Neither surveillance model was well accepted by child care providers. Enhanced passive and active surveillance had comparable sensitivity. Reporting delays and the large amount of time needed for data entry led to problems with timeliness, especially in terms of written reporting during active surveillance. Conclusions. Widespread active public health surveillance in child care facilities is not feasible for most local health departments. Improvements in public health surveillance in child care settings will depend on acceptability to providers. Handle: RePEc:aph:ajpbhl:1997:87:12:1951-1955_4 Template-Type: ReDIF-Article 1.0 Title: The relationship between students' sense of their school as a community and their involvement in problem behaviors Journal: American Journal of Public Health Author-Name: Battistich, V. Author-Name: Hom, A. Year: 1997 Volume: 87 Issue: 12 Pages: 1997-2001 Abstract: Objectives. There has been relatively little research on the contributions of school context to developmental outcomes. This study examined relationships between students' sense of the school as a community and their involvement in problem behaviors. Methods. Participants were an ethnically and socioeconomically diverse sample of 1434 fifth and sixth grade students from 24 elementary schools around the United States. Data were analyzed by hierarchical linear regression. Results. The major finding was that, with several relevant student-and school-level characteristics controlled, schools with higher average sense-of-community scores had significantly lower average student drug use and delinquency. Caution is warranted in inferring causality, however, owing to the cross-sectional design. Conclusions. The findings suggest that school context may moderate relationships between individual risk and protective factors and developmental outcomes, and that schools that are experiences as communities may enhance students' resiliency. Handle: RePEc:aph:ajpbhl:1997:87:12:1997-2001_5 Template-Type: ReDIF-Article 1.0 Title: Primary HIV infection - A public health opportunity Journal: American Journal of Public Health Author-Name: Cates Jr., W. Author-Name: Chesney, M.A. Author-Name: Cohen, M.S. Year: 1997 Volume: 87 Issue: 12 Pages: 1928-1930 Abstract: Primary human immunodeficiency virus (HIV) infection should be considered a key target for HIV prevention activities. Mathematical models suggest that the primary HIV infection interval makes a disproportionate contribution to the HIV epidemic, perhaps accounting for as many as half of the existing infections at any point in time. If this is true, primary infection presents a special window of opportunity within which exert a maximum impact on the spread of HIV. A combination of biological, behavioral, and social factors may account for the influence of primary infection on the HIV epidemic. HIV prevention measures can be focused on each of these factors. Biologically, detecting individuals early in the course of infection and offering treatment can reduce viral load and possibly and individual's infectiousness. Behaviorally, counseling newly infected persons about the importance of adopting safer practices may instill prevention behaviors at a critical time. Socially, using a network approach to notify persons exposed to those with primary infections can dampen the amplification effect of rapid HIV spread through high-risk environments. By focusing prevention efforts on the primary HIV infection interval, public health officials could increase their leverage in slowing the HIV epidemic. Handle: RePEc:aph:ajpbhl:1997:87:12:1928-1930_4 Template-Type: ReDIF-Article 1.0 Title: Pearce responds. Journal: American Journal of Public Health Author-Name: Pearce, N. Year: 1997 Volume: 87 Issue: 12 Pages: 2051-2052 Handle: RePEc:aph:ajpbhl:1997:87:12:2051-2052_7 Template-Type: ReDIF-Article 1.0 Title: Nutrient intakes of individuals from food-insufficient households in the United States Journal: American Journal of Public Health Author-Name: Rose, D. Author-Name: Oliveira, V. Year: 1997 Volume: 87 Issue: 12 Pages: 1956-1961 Abstract: Objectives. Understanding the nutritional consequences of food insufficiency is important for informed policy-making that addresses the problem of domestic hunger. This study estimated the extent to which individuals from food-insufficient households were likely to have low intake of energy and 14 other nutrients. Methods. The diets of preschoolers adult women and the elderly were analyzed with 24 hour recall data from the 1989 through 1991. Continuing Survey of Food Intake by Individuals Logistic regression analysis was used to study the association of self-reported household food-insufficiency with nutrient intakes below 60% of the recommended daily allowance. Results. For adult women, food- insufficiency was significantly associated with low intakes of eight nutrients including energy, magnesium, and vitamins A, E, C, and B6. Elderly individuals in the food-insufficient group were also more likely to have low intakes of eight nutrients, including protein, calcium, and vitamins A and B6. Household food-insufficiency was not significantly associated with low intakes among preschoolers. Conclusions. The results validate the use of self-reported hunger measures in nutritional surveillance and highlight nutrients surveillance and high nutrients of concern for food assistance and nutrition education efforts targeted at individuals from food-insufficient households. Handle: RePEc:aph:ajpbhl:1997:87:12:1956-1961_4 Template-Type: ReDIF-Article 1.0 Title: The Stanford Nutrition Action Program: A dietary fat intervention for low-literacy adults Journal: American Journal of Public Health Author-Name: Howard-Pitney, B. Author-Name: Winkleby, M.A. Author-Name: Albright, C.L. Author-Name: Bruce, B. Author-Name: Fortmann, S.P. Year: 1997 Volume: 87 Issue: 12 Pages: 1971-1976 Abstract: Objective. This study was undertaken to test the effectiveness of the Stanford Nutrition Action Program, an experimental trial to reduce dietary fat intake among low-literacy, low-income adults. Methods. Twenty-four paired adult education classes (351 participants, 85% women, mean age = 31 years) were randomly assigned to receive a newly developed dietary fat curriculum (the Stanford Nutrition Action Program) or an existing general nutrition curriculum. Food frequency and nutrition-related data, body mass index, and capillary blood cholesterol were collected at baseline and at baseline and at two postintervention follow-ups. Results. The Stanford Nutrition Action Program classes showed significantly greater net improvements in nutrition knowledge (+7.7), attitudes (+0.2), and self-efficacy (+0.2) than the general nutrition classes, they also showed significantly greater reductions in the percentage of calories from total (-2.3%) and saturated (-0.9%) fat. There were no significant differences in body mass index or blood cholesterol. All positive intervention effects were maintained for 3 months postintervention. Conclusions. The Stanford Nutrition Action Program curriculum, tailored to the cultural, economic, and learning needs of low-literacy, low-income adults, was significantly more effective in achieving, fat-related nutritional changes than the general nutrition curriculum. Handle: RePEc:aph:ajpbhl:1997:87:12:1971-1976_1 Template-Type: ReDIF-Article 1.0 Title: The defeat of Philip Morris' 'California uniform tobacco control Act' Journal: American Journal of Public Health Author-Name: Macdonald, H. Author-Name: Aguinaga, S. Author-Name: Glantz, S.A. Year: 1997 Volume: 87 Issue: 12 Pages: 1989-1996 Abstract: Objectives. This paper describes the strategies used by Philip Morris and other tobacco companies to promote a California initiative (Proposition 188) preempting local control of tobacco and those used by public health groups to defeat the initiative. Methods. Interviews with the key informants were conducted, and the written record was reviewed. Results. Tobacco companies nearly succeeded in passing Proposition 188 by presenting it as a pro-health measure that would prevent children from obtaining cigarettes and provide protection against secondhand smoke. Public health groups defeated it by highlighting tobacco industry backing. A private charitable foundation also played an innovative role by financing a non-partisan public education campaign. Conclusions. Public health forces must be alert to sophisticated efforts by the tobacco industry to enact preemptive state legislation by making it look like tobacco control legislation. The coalition structure that emerged in the 'No on 188' campaign represents an effective model for future tobacco control activities. The new role of charitable foundations defined in the Proposition 188 campaign can be used in other public health issues. Handle: RePEc:aph:ajpbhl:1997:87:12:1989-1996_9 Template-Type: ReDIF-Article 1.0 Title: Maternal acculturation and childhood immunization levels among children in Latino families in Los Angeles Journal: American Journal of Public Health Author-Name: Anderson, L.M. Author-Name: Wood, D.L. Author-Name: Sherbourne, C.D. Year: 1997 Volume: 87 Issue: 12 Pages: 2018-2021 Abstract: Objectives. This study examined the relationship between acculturation levels of poor Latina women in Los Angeles and their children's immunization status. Receipt of three doses of diphtheria-tetanus-pertussis vaccine and two doses of oral polio vaccine by the age of 12 months was considered adequate immunization. Methods. Household interviews were conducted in East Los Angeles and South Central Los Angeles with mothers (n = 688) about one randomly selected child aged 12 to 36 months. Results. One fourth of the children were inadequately immunized. Less-acculturated mothers were more likely to have adequately immunized children. Inadequate prenatal care, absence of close family members, the child's birth position as other than firstborn, and more than one family relocation during the child's lifetime were associated with inadequate immunization. Conclusions. The findings challenge the notion that children of recent immigrants bear a higher risk of underimmunization. Handle: RePEc:aph:ajpbhl:1997:87:12:2018-2021_8 Template-Type: ReDIF-Article 1.0 Title: The epidemiology of necrotizing enterocolitis infant mortality in the United States Journal: American Journal of Public Health Author-Name: Holman, R.C. Author-Name: Stoll, B.J. Author-Name: Clarke, M.J. Author-Name: Glass, R.I. Year: 1997 Volume: 87 Issue: 12 Pages: 2026-2031 Abstract: Objectives. This study examined trends and risk factors for infant mortality associated with necrotizing enterocolitis in the United States. Methods. Necrotizing enterocolitis-associated deaths and infant mortality rates from 1979 through 1992 were determined by means of US multiple cause- of-death and linked birth/infant death data. Results. Annual necrotizing enterocolitis infant mortality rates decreased from 1979 through 1986 but increased thereafter and were lower during the 3-year period before (1983 through 1985; 11.5 per 100 000 liver births) the introduction of surfactants than after (1990 through 1992; 12.3 per 100 000). Low-birthweight singleton infants who were Black, male, or born to mothers younger than 17 had increased risk for necrotizing enterocolitis-associated death. Conclusions. As mortality among low-birthweight infants continues to decline and smaller newborns survive early causes of death, necrotizing enterocolitis-associated infant mortality may increase. Handle: RePEc:aph:ajpbhl:1997:87:12:2026-2031_4 Template-Type: ReDIF-Article 1.0 Title: Incidence of tuberculosis infection among New York State prison employees Journal: American Journal of Public Health Author-Name: Steenland, K. Author-Name: Levine, A.J. Author-Name: Sieber, K. Author-Name: Schulte, P. Author-Name: Aziz, D. Year: 1997 Volume: 87 Issue: 12 Pages: 2012-2014 Abstract: Objectives. This study examined tuberculosis skin test conversions among 24 487 New York State prison employees in 1992. Methods. Conversions were analyzed by prison and by job category. Results. The conversion rate was 1.9%. Employees in prisons with low and high numbers of prisoner cases had odds ratios for conversion of 1.67 (95% confidence interval [Cl] = 1.27, 2.19) and 2.20 (95% Cl = 1.69, 2.87), respectively, relative to employees in prisons with no prisoner case. In prisons with case, guards and medical personnel had odds ratios of 1.64 (95% Cl = 1.11, 2.43) and 2.39 (95% Cl = 1.40, 4.08), respectively, relative to employees with little prisoner contact. Conclusions. In 1992, approximately one third of new infections among New York State prison employees wee due to occupational exposure. Handle: RePEc:aph:ajpbhl:1997:87:12:2012-2014_8 Template-Type: ReDIF-Article 1.0 Title: The mental health of informal caregivers in Ontario: An epidemiological survey Journal: American Journal of Public Health Author-Name: Cochrane, J.J. Author-Name: Goering, P.N. Author-Name: Rogers, J.M. Year: 1997 Volume: 87 Issue: 12 Pages: 2002-2007 Abstract: Objectives. This study describes the mental health status, disabilities, physical health and mental health service utilization of informal caregivers under the age of 65 in the province of Ontario. Methods. The study analyzed data collected in the 1991 province-wide, population based mental health supplement to the Ontario Health Survey Diagnoses from the Diagnostic and Statistical Manual of Mentals Disorders, 3rd edition revised, were generated on the basis of a structured diagnostic interview. Caregivers and noncaregivers are compared here or past-year prevalence of psychiatric disorder, physical illness, disability, and utilization of mental health services. The possible confounding effects of age, sex, employment status, and economic disadvantages are explored. Results. Informal caregivers (n = 121.9) constituted 15.0% of the sample. Caregivers had higher rates of effective (6.3% vs. 4.2%) and anxiety (17.5% vs 10.9%) disorders than noncaregivers and used health services for mental health problems at nearly twice the rate. Conclusions. Documentation of the prevalence of caregiving and the increased prevalence of psychiatric disorders, disability, and service utilization among caregivers is of critical importance as governments continue to move toward community based care. To accomplish this goal, the needs of caregivers must be acknowledged and met by the establishment of appropriate and readily accessible support services. Handle: RePEc:aph:ajpbhl:1997:87:12:2002-2007_5 Template-Type: ReDIF-Article 1.0 Title: AIDS education in Tanzania: Promoting risk reduction among primary school children Journal: American Journal of Public Health Author-Name: Klepp, K.-I. Author-Name: Ndeki, S.S. Author-Name: Leshabari, M.T. Author-Name: Hannan, P.J. Author-Name: Lyimo, B.A. Year: 1997 Volume: 87 Issue: 12 Pages: 1931-1936 Abstract: Objective. The purpose of this study was to test the effects of an education program in Tanzania designed to reduce children's risk of human immunodeficiency virus (HIV) infection and to improve their tolerance of and care for people with acquired immunodeficiency syndrome (AIDS.) Methods. A randomized controlled community-trial including baseline and 12-month follow- up surveys was employed. Public primary schools in the Arusha and Kilimanjaro regions of Tanzania were stratified according to location and randomly assigned to intervention (n = 6) or comparison (n = 12) conditions. Of the 1063 sixth-grade students (average age 13.6 years) who participated at baseline, 814 participated in the follow-up survey. Results. At follow-up, statistically significant effects favoring the intervention group were observed for exposure to AIDS information and communication. AIDS knowledge, attitudes toward people with AIDS, and the subjective norms and behavioral intentions toward having sexual intercourse. A consistent positive but nonsignificant trend was seen for attitudes toward having sexual intercourse and for initiation of sexual intercourse during the previous year (7% vs. 17%). Conclusions. It is feasible and effective to train local teachers and health workers to provide HIV/AIDS education to Tanzanian primary school children. Handle: RePEc:aph:ajpbhl:1997:87:12:1931-1936_7 Template-Type: ReDIF-Article 1.0 Title: Predisposing factors for individuals' Lyme disease prevention practices: Connecticut, Maine, and Montana Journal: American Journal of Public Health Author-Name: Herrington Jr., J.E. Author-Name: Campbell, G.L. Author-Name: Bailey, R.E. Author-Name: Cortter, M.L. Author-Name: Adams, M. Author-Name: Frazier, E.L. Author-Name: Damrow, T.A. Author-Name: Gensheimer, K.F. Year: 1997 Volume: 87 Issue: 12 Pages: 2035-2038 Abstract: Objectives. This study examined factors that predispose individuals to protect against Lyme disease. Methods. Knowledge attitude and practice questions concerning Lyme disease prevention were included in the Behavioral Risk Factor Surveillance survey in Connecticut, Maine, and Montana. A total of 4246 persons were interviewed. Results. Perceived risk of acquiring Lyme disease, knowing anyone with Lyme Disease, knowledge about Lyme disease, and believing Lyme disease to be a common problem were significantly associated with prevention practices. Conclusions. Predisposing factors differ substantially between states and appear related to disease incidence. Personal risk, knowing someone with LYme disease and cognizance about Lyme disease and acting on this information are consistent with social learning theories. Handle: RePEc:aph:ajpbhl:1997:87:12:2035-2038_2 Template-Type: ReDIF-Article 1.0 Title: In utero exposure to famine and subsequent fertility: The Dutch famine birth cohort study Journal: American Journal of Public Health Author-Name: Lumey, L.H. Author-Name: Stein, A.D. Year: 1997 Volume: 87 Issue: 12 Pages: 1962-1966 Abstract: Objectives. We hypothesized that if prenatal caloric restriction due to nutritional deprivation had affected development of the organs responsible for producing and regulating female reproductive hormones, a woman's fertility would be impaired. Methods. Women born in Amsterdam from August 1, 1944, through April 15, 1946, a period encompassing a severe 5-month famine, were identified (n = 700; 85% response rate). Date of birth and vital status of all offspring were ascertained by home interview between 1987 and 1991. Famine exposure was inferred from the mother's date of birth. Results. Of the study participants, 74 (10.6%) had no children. The remainder reported 1334 off-spring (1294 singletons, 20 pairs of twins) of whom 14 were stillborn and 22 died in the first 7 days of life. There was no detectable effect of famine exposure on age at menarche, the proportion having no children, age at first delivery, or family size. An excess of perinatal deaths occurred among offspring of famine-exposed women, particularly those exposed in their third trimester. Conclusions: Acute famine exposure in utero appears to have no adverse consequences for a woman's fertility. The excess perinatal mortality in the second generation is unexplained and should be confirmed by other studies. Handle: RePEc:aph:ajpbhl:1997:87:12:1962-1966_7 Template-Type: ReDIF-Article 1.0 Title: Leprosy and tuberculosis: The epidemiological consequences of cross- immunity Journal: American Journal of Public Health Author-Name: Lietman, T. Author-Name: Porco, T. Author-Name: Blower, S. Year: 1997 Volume: 87 Issue: 12 Pages: 1923-1927 Abstract: Objectives. This study tested the hypothesis, first proposed by Chaussinand, that individual-level immunity acquired from exposure to tuberculosis may have contributed to the disappearance of leprosy from western Europe. Methods. The epidemiological consequences of cross-immunity were assessed by the formulation of a mathematical model of the transmission dynamics of tuberculosis and leprosy. Results. The conditions under which Mycobacterium tuberculosis could have eradicated Mycobacterium leprae were derived in terms of the basic reproductive rates of the two infections and the degree of cross-immunity. Conclusions. If the degree of cross-immunity between two diseases within an individual is known, then the epidemiological consequences of this cross-immunity can be assessed with transmission modeling. The results of this analysis, in combination with previous estimates of the basic reproductive rate of tuberculosis and degree of cross- immunity, imply that tuberculosis could have contributed to the decline of leprosy if the basic reproductive rate of leprosy was low. Handle: RePEc:aph:ajpbhl:1997:87:12:1923-1927_0 Template-Type: ReDIF-Article 1.0 Title: Public policy and environmental noise: Modeling exposure or understanding effects Journal: American Journal of Public Health Author-Name: Staples, S.L. Year: 1997 Volume: 87 Issue: 12 Pages: 2063-2067 Abstract: This paper argues that if the federal government is to successfully protect the public from the adverse effects of environmental noise, its policies will need to be informed by a scientific understanding of the psychological and social factors that determine when noise results in annoyance and when noise may affect health as an environmental stressor. The overreliance of federal agencies on mathematical modeling of average group responses to physical noise levels is discussed as oversimplifying and limiting the understanding of noise effects in crucial ways. The development of a more sophisticated information base is related to policy needs, such as the need to make accurate predictions about the annoyance of particular communities, the need to understand relationships between public participation in noise abatement efforts and annoyance, and the need to identify population that may be susceptible to stress-related health effects. Handle: RePEc:aph:ajpbhl:1997:87:12:2063-2067_7 Template-Type: ReDIF-Article 1.0 Title: Racial and ethnic differences in determinants of intrauterine growth retardation and other compromised birth outcomes Journal: American Journal of Public Health Author-Name: Parker Frisbie, W. Author-Name: Biegler, M. Author-Name: De Turk, P. Author-Name: Forbes, D. Author-Name: Pullum, S.G. Year: 1997 Volume: 87 Issue: 12 Pages: 1977-1983 Abstract: Objectives. This study examined the extent of variation by race/ethnicity in the prevalence of adverse birth outcomes, whether differentials persisted after other risk factors were controlled for, and whether the direction and magnitude of relationships differed by type of outcome. Methods. A revised system of measurement was used to estimate multinomial logistic models in a large, nationally representative US data set. Results. Considerable racial/ethnic variation was found across birth outcome categories; differences persisted in the adjusted parameter estimates; and the effects of other risk factors on birth outcomes were similar as to direction, but varied somewhat in magnitude. The odds of compromised birth outcomes were much higher among African Americans than among Mexican Americans and non-Hispanic Whites. Conclusions. In addition to persistent racial inequality, we found strong adverse effects of both inadequate and 'adequate-plus' prenatal care and smoking. Risk of intrauterine growth retardation was higher in the absence of medical insurance, and risk of all adverse birth outcomes was lower among mothers participating in the Special Supplemental Food Program for Women, Infants, and Children. Handle: RePEc:aph:ajpbhl:1997:87:12:1977-1983_6 Template-Type: ReDIF-Article 1.0 Title: Compliance with tuberculosis drug regimens: Incentives and enablers offered by public health departments Journal: American Journal of Public Health Author-Name: Buchanan, R.J. Year: 1997 Volume: 87 Issue: 12 Pages: 2014-2017 Abstract: Objectives. This research examined incentives implemented by public health departments to encourage tuberculosis patients to comply with tuberculosis drug regimens. Methods. A questionnaire addressing incentives was mailed to the directors of each state's health department during May 1995. All 50 states and the District of Columbia returned questionnaires. Results. The survey results indicate that public health departments in almost all states are implementing the incentives advocated by tuberculosis experts. Conclusions. The implementation of these incentives may help to explain why the incidence of tuberculosis resumed its long-term decline in the United States during 1993 after a decade of resurgence. Handle: RePEc:aph:ajpbhl:1997:87:12:2014-2017_1 Template-Type: ReDIF-Article 1.0 Title: The pattern of maternal weight gain in women with good pregnancy outcomes Journal: American Journal of Public Health Author-Name: Carmichael, S. Author-Name: Abrams, B. Author-Name: Selvin, S. Year: 1997 Volume: 87 Issue: 12 Pages: 1984-1988 Abstract: Objectives. This study describes the pattern of maternal weight gain in women with good pregnancy outcomes and provides data to fill in the provisional weight-gain charts published by the Institute of Medicine (IOM) in 1990. Methods. We selected 7002 women with good outcomes (defined by factors related to maternal and infant health) from the University of California, San Francisco, Perinatal Database. For each body mass index category, we compared percentiles of weight gain by trimester in women who achieved that IOM recommendations for total gain and those who did not. Results. Trimester rates of gain varied by body mass index category and exceeded IOM guidelines in all groups. Forty percent of these women with good outcomes had total gains within the guidelines and provided data to complete the IOM weight-gain charts. Conclusions. Most women in this good-outcome sample would have been sample suspected of being at increased risk for poor outcome on the basis of their weight gain. This confirms the IOM recommendation that evaluation of the underlying causes of excessively high or low weight gain during pregnancy is necessary before appropriate interventions can be applied. Handle: RePEc:aph:ajpbhl:1997:87:12:1984-1988_8 Template-Type: ReDIF-Article 1.0 Title: Geographic analysis of pertussis infection in an urban area: A tool for health services planning Journal: American Journal of Public Health Author-Name: Siegel, C. Author-Name: Davidson, A. Author-Name: Kafadar, K. Author-Name: Norris, J.M. Author-Name: Todd, J. Author-Name: Steiner, J. Year: 1997 Volume: 87 Issue: 12 Pages: 2022-2026 Abstract: Objective. This study examined whether incident cases of pertussis cluster in urban census tracts and identified community characteristics that predict high-incidence areas. Methods. An ecological study design was used. The study population included all persons diagnosed with pertussis from January 1, 1986, through December 31, 1994. Maps of rats were constructed via a geographic information system and clustering was statistically confirmed. Associations between pertussis rates and community characteristics were tested. Results. Mapping and statistical analysis revealed spatial clustering of pertussis. Higher age-adjusted rates of pertussis infection were associated with higher proportions of residents below poverty level. Conclusions. In urban areas, pertussis infection clusters in areas of poverty. Handle: RePEc:aph:ajpbhl:1997:87:12:2022-2026_6 Template-Type: ReDIF-Article 1.0 Title: Physician assisted suicide and the Supreme Court: Putting the constitutional claim to rest Journal: American Journal of Public Health Author-Name: Mariner, W.K. Year: 1997 Volume: 87 Issue: 12 Pages: 2058-2062 Abstract: Like the debate about many controversial questions of ethics and medical care in America, public debate about physician assisted suicide became focused on questions of constitutional law. On June 26, 1997, the United States Supreme Court unanimously rejected any constitutional right of terminally ill patients to physician assisted suicide. An analysis of the Court's reasoning reveals that its decisions resolved only a narrow constitutional question that affects relatively few people-mentally competent, terminally ill patients who wish to hasten their imminent deaths by having a physician prescribe mediation that they intend to use to commit suicide. Although suicide is not a crime, states remain free to prohibit assisted suicide. One consequence of the Court's decisions may be renewed debate on state laws. A more productive result would be to address the broader public health concerns that gave rise to support for physician assisted suicide-inadequate care for the terminally ill and prevention of suicide. Handle: RePEc:aph:ajpbhl:1997:87:12:2058-2062_6 Template-Type: ReDIF-Article 1.0 Title: Sociodemographic factors and the variation in syphilis rates among US countries, 1984 through 1993: An ecological analysis Journal: American Journal of Public Health Author-Name: Kilmarx, P.H. Author-Name: Zaidi, A.A. Author-Name: Thomas, J.C. Author-Name: Nakashima, A.K. Author-Name: St. Louis, M.E. Author-Name: Flock, M.L. Author-Name: Peterman, T.A. Year: 1997 Volume: 87 Issue: 12 Pages: 1937-1943 Abstract: Objectives. Syphilis in the United States is focally distributed, with high incidence rates in the South and in metropolitan areas nationwide. In this study an ecological analysis, using the county as the unit of analysis, was performed to generate hypotheses about community-level determinants of syphilis rates. Methods. Bivariate rank correlations and multivariate, backward stepwise elimination linear regressions were performed. Mean annual incidence of primary- and secondary-stage syphilis in a county was the dependent variable, and county sociodemographic characteristics (from census data) where the independent variables. Results. In the multivariate regression model, sociodemographic characteristics accounted for 71% of the variation in syphilis rates among counties. With other factors accounted for, the most highly correlated characteristics were percentage non-Hispanic Black population, county location in the South, percentage of the population that was urban, percentage Hispanic population, and percentage of births to women younger than 20 years. Conclusions. Most of the variation is syphilis rates among counties is accounted for by sociodemographic characteristics. Identification and remediation of modifiable health determinants for which these factors are markers are needed to improve the health status of these populations. Handle: RePEc:aph:ajpbhl:1997:87:12:1937-1943_3 Template-Type: ReDIF-Article 1.0 Title: Anniversary--a time for reflection. Journal: American Journal of Public Health Author-Name: Susser, M. Year: 1997 Volume: 87 Issue: 11 Pages: 1765 Handle: RePEc:aph:ajpbhl:1997:87:11:1765_8 Template-Type: ReDIF-Article 1.0 Title: The quality of data reported on birth certificates. Journal: American Journal of Public Health Author-Name: Freedman, M.A. Year: 1997 Volume: 87 Issue: 11 Pages: 1867 Handle: RePEc:aph:ajpbhl:1997:87:11:1867_4 Template-Type: ReDIF-Article 1.0 Title: A community research model: A challenge to public health Journal: American Journal of Public Health Author-Name: Brown-Peterside, P. Author-Name: Laraque, D. Year: 1997 Volume: 87 Issue: 9 Pages: 1563-1564 Handle: RePEc:aph:ajpbhl:1997:87:9:1563-1564_8 Template-Type: ReDIF-Article 1.0 Title: A two-step intervention to increase mammography among women aged 65 and older Journal: American Journal of Public Health Author-Name: Janz, N.K. Author-Name: Schottenfeld, D. Author-Name: Doerr, K.M. Author-Name: Selig, S.M. Author-Name: Dunn, R.L. Author-Name: Strawderman, M. Author-Name: Levine, P.A. Year: 1997 Volume: 87 Issue: 10 Pages: 1683-1686 Abstract: Objectives. This study evaluated a two-step intervention for mammography screening among older women. Methods. Four hundred and sixty women, identified from physician practices, were randomized to a control or a two- step intervention (physician letter and peer counseling call) group. Women in the intervention group who obtained a mammogram received a grocery coupon. Results. Over the 12 months of the study, more women in the intervention group than in the control group obtained mammograms (38% vs 16%). The most dramatic difference was in the higher odds that women in the intervention group would obtain a mammogram within 2 months (odds ratio = 10.5). Conclusions. The intervention significantly increased screening mammography. Future efforts must be multifaceted and incorporate the unique concerns of older women. Handle: RePEc:aph:ajpbhl:1997:87:10:1683-1686_9 Template-Type: ReDIF-Article 1.0 Title: Plasma polychlorinated biphenyl levels in Dutch preschool children either breast-fed or formula-fed during infancy Journal: American Journal of Public Health Author-Name: Patandin, S. Author-Name: Weisglas-Kuperus, N. Author-Name: De Ridder, M.A.J. Author-Name: Koopman-Esseboom, C. Author-Name: Van Staveren, W.A. Author-Name: Van Der Paauw, C.G. Author-Name: Sauer, P.J.J. Year: 1997 Volume: 87 Issue: 10 Pages: 1711-1714 Abstract: Objectives. This study examined the influence of lactational and in utero exposure to polychlorinated biphenyls (PCBs) on plasma PCB levels in children. Methods. Plasma PCB levels were measured in 173 children at 3.5 years, of whom 91 were breast-fed and 82 were formula-fed in infancy. Results. Median plasma PCB levels were 3.6 times higher in breast-fed children (0.75 μg/L) than in their formula-fed peers (0.21 μg/L). Breast- feeding period and breast-milk PCB levels were important predictors for PCB levels in the breast-fed group. For children in the formula-fed group, PCB levels were significantly related to their maternal plasma PCB levels. Conclusions. PCB levels in Dutch preschool children are related to transfer of maternal PCBs; therefore, strategies should be aimed at reducing maternal PCB body burden. Handle: RePEc:aph:ajpbhl:1997:87:10:1711-1714_1 Template-Type: ReDIF-Article 1.0 Title: The effect of ordinances requiring smoke-free restaurants and bars on revenues: A follow-up Journal: American Journal of Public Health Author-Name: Glantz, S.A. Author-Name: Smith, L.R.A. Year: 1997 Volume: 87 Issue: 10 Pages: 1687-1693 Abstract: Objectives. The praise of this study was to extend an earlier evaluation of the economic effects of ordinances requiring smoke-free restaurants and bars. Methods. Sales tax data for 15 cities with smoke-free restaurant ordinances, 5 cities and 2 counties with smoke-free bar ordinances, and matched comparison locations were analyzed by multiple regression, including time and a dummy variable for the ordinance. Results. Ordinances had no significant effect on the fraction of total retail sales that went to eating and drinking places or on the ratio between sales in communities with ordinances and sales in comparison communities. Ordinances requiring smoke- free bars had no significant effect on the fraction of revenues going to eating and drinking places that serve all types of liquor. Conclusions. Smoke-free ordinances do not adversely affect either restaurant or bar sales. Handle: RePEc:aph:ajpbhl:1997:87:10:1687-1693_5 Template-Type: ReDIF-Article 1.0 Title: State smoking prevalence estimates: A comparison of the behavioral risk factor surveillance system and current population surveys Journal: American Journal of Public Health Author-Name: Arday, D.R. Author-Name: Tomar, S.L. Author-Name: Nelson, D.E. Author-Name: Merritt, R.K. Author-Name: Schooley, M.W. Author-Name: Mowery, P. Year: 1997 Volume: 87 Issue: 10 Pages: 1665-1669 Abstract: Objectives. This study examined whether there are systematic differences between the Behavioral Risk Factor Surveillance System (BRFSS) and the Current Population Survey (CPS) for state cigarette smoking prevalence estimates. Methods. BRFSS telephone survey estimates were compared with estimates from the US Census CPS tobacco-use supplements (the CPS sample frame includes persons in households without telephones). Weighted overall and sex- and race-specific BRFSS and CPS state estimates of adult smoking were analyzed for 1985, 1989, and 1992/1993. Results. Overall estimates of smoking prevalence from the BRFSS were slightly lower than estimates from CPS (median difference: -2.0 percentage points in 1985, -0.7 in 1989, and -1.9 in 1992/1993; P < .05 for all comparisons), but there was variation among states. Differences between BRFSS and CPS estimates were larger among men than among women and larger among Blacks than among Hispanics or Whites; for most states, these differences were not significant. Conclusions. The BRFSS generally provides state estimates of smoking prevalence similar to those obtained from CPS, and these are appropriate for ongoing state surveillance of smoking prevalence. Handle: RePEc:aph:ajpbhl:1997:87:10:1665-1669_3 Template-Type: ReDIF-Article 1.0 Title: Dog bite incidence in the city of pittsburgh: A capture-recapture approach Journal: American Journal of Public Health Author-Name: Chang, Y.-F. Author-Name: McMahon, J.E. Author-Name: Hennon, D.L. Author-Name: LaPorte, R.E. Author-Name: Coben, J.H. Year: 1997 Volume: 87 Issue: 10 Pages: 1703-1705 Abstract: Objectives. The purpose of this study was to estimate the number of dog bite injuries occurring in the city of Pittsburgh in 1993. Methods. The capture-recapture method was used, along with log-linear modeling. Three sources were used to identify victims: hospital reports, animal control reports, and police/victim reports. Results. In 1993, 790 dog bites were reported. The capture-recapture method estimated that them were 1388 unreported dog bites, with an estimated incidence rate of 58.9 per 10 000. Conclusions. Dog bite is a common but preventable injury. To improve surveillance, the focus should be on educating the general public about the serious consequences of dog bite injuries. Handle: RePEc:aph:ajpbhl:1997:87:10:1703-1705_8 Template-Type: ReDIF-Article 1.0 Title: Do we ask too much from community-level interventions or from intervention researchers? Journal: American Journal of Public Health Author-Name: Kraemer, H.C. Author-Name: Winkleby, M.A. Year: 1997 Volume: 87 Issue: 10 Pages: 1727 Handle: RePEc:aph:ajpbhl:1997:87:10:1727_0 Template-Type: ReDIF-Article 1.0 Title: Thyroxine values from newborn screening of 919 infants born before 29 weeks' gestation Journal: American Journal of Public Health Author-Name: Reuss, M.L. Author-Name: Leviton, A. Author-Name: Paneth, N. Author-Name: Susser, M. Year: 1997 Volume: 87 Issue: 10 Pages: 1693-1697 Abstract: Objectives. Severe transient hypothyroxinemia in premature infants is associated with cerebral palsy and mental retardation; this study assessed its prevalence in very premature infants. Methods. Congenital hypothyroidism screening programs in three states provided thyroxine values for 919 newborn infants younger than 29 weeks who were enrolled in a multicenter study. Results. Thyroxine values were lower than 4.0 μg/dL in 21% of survivors and increased each week by 0.6 μ/dL (95% confidence interval [CI] = 0.4, 0.7). At tests done 1 to 2 days after birth, levels were 2.5 μg/dL higher (95% CI= 1.8, 3.3) than at tests done at 8 to 14 days. In New York, levels were 1.0 μg/dL higher (95% CI = 0.3, 1.6) than elsewhere. The levels of infants who died were 1.3 μg/dL lower (95% CI = 0.6, 2.0) than those of survivors. Conclusions. Severe transient hypothyroxinemia is common in very premature infants and deserves further study. Handle: RePEc:aph:ajpbhl:1997:87:10:1693-1697_3 Template-Type: ReDIF-Article 1.0 Title: Consequences of foot binding among older women in Beijing, China Journal: American Journal of Public Health Author-Name: Cummings, S.R. Author-Name: Ling, X. Author-Name: Stone, K. Year: 1997 Volume: 87 Issue: 10 Pages: 1677-1679 Abstract: Objectives. This study examined the prevalence and consequences of foot binding in older Chinese women. Methods. Women older than 70 years in Beijing, China, were assessed for bound feet, falls, functional status, and bone density. Results. Thirty-eight percent of women aged 80 years and older and 18% of women aged 70 through 79 years had bound-foot deformities. Women with bound feet were more likely to fall, less able to squat, and less able to stand up from a chair without assistance than women with normal feet. They also had 14.3% less functional reach (a test of balance) and 5.1% lower hip bone density. Conclusions. Foot binding has caused substantial disability that is still evident in many elderly Chinese women. Handle: RePEc:aph:ajpbhl:1997:87:10:1677-1679_5 Template-Type: ReDIF-Article 1.0 Title: The invisibility of public health: Population-level measures in a politics of market individualism Journal: American Journal of Public Health Author-Name: Burris, S. Year: 1997 Volume: 87 Issue: 10 Pages: 1607-1610 Abstract: This paper models the prevailing political attack on government as a heuristic, a judgmental strategy that simplifies complex phenomena by applying simple tests to a limited set of relevant data. The heuristic of market individualism offers three tools for analyzing the problems of governing: the supremacy of the free market as a regulatory device, a belief in individual freedom of choice and personal responsibility, and die elevation of individual satisfaction as the chief goal of society. Because public health is inherently concerned with the health of the population rather than individual health, because the market itself is a major source of ill health, and because individual choice is socially mediated, use of the heuristic precludes the recognition of the value of public health work. Although some degree of accommodation to current political realities is a practical necessity, public health advocates must not neglect the task of fashioning radically different alternative visions over the long term. Handle: RePEc:aph:ajpbhl:1997:87:10:1607-1610_7 Template-Type: ReDIF-Article 1.0 Title: Are the best coronary artery bypass surgeons identified by physician surveys? Journal: American Journal of Public Health Author-Name: Hartz, A.J. Author-Name: Pulido, J.S. Author-Name: Kuhn, E.M. Year: 1997 Volume: 87 Issue: 10 Pages: 1645-1648 Abstract: Objectives. This study assessed the validity of surveys for identifying the best coronary artery bypass surgeons. Methods. Data on physicians who performed coronary artery bypass surgery were available from New York, Pennsylvania, and Wisconsin. Data on physicians' reputation were obtained from one national and five city surveys. The measure of surgical performance was the mortality ratio (MR), that is, the ratio of the observed to the predicted patient mortality rate. Results. Mortality ratios were very similar for the 10722 patients treated by the 31 surgeons defined as 'best' doctors in the surveys (MR = .98) and for the 74 854 patients treated by 243 other surgeons who had more than a minimal number of cases (MR = .96). The mortality ratio was 1.34 for the patients treated by surgeons with the lowest volumes and .87 for the surgeons who performed more than 400 coronary artery bypass surgeries in 3 years. Conclusions. These results suggest that the quality of a coronary artery bypass surgeon may be more closely associated with patient volume than with the surgeon's reputation among peers. Handle: RePEc:aph:ajpbhl:1997:87:10:1645-1648_3 Template-Type: ReDIF-Article 1.0 Title: Age, time, and cohort effects on functional status and self-rated health in elderly men Journal: American Journal of Public Health Author-Name: Hoeymans, N. Author-Name: Feskens, E.J.M. Author-Name: Van Den Bos, G.A.M. Author-Name: Kromhout, D. Year: 1997 Volume: 87 Issue: 10 Pages: 1620-1625 Abstract: Objectives. This study investigated age-related changes in functional status and serf-rated health in elderly men, taking into account changes over time and differences between birth cohorts. Methods. The Zutphen Elderly Study is a longitudinal study of men born in the Netherlands between 1900 and 1920. Functional status and self-rated health were measured in 513 men in 1990, in 381 men in 1993, and in 340 men in 1995. Age, time, and cohort effects were analyzed in a mixed longitudinal model. Results. Longitudinal analyses showed that during 5 years of follow-up, the proportion of men without disabilities decreased from 53% to 39%, whereas the percentage who rated themselves as healthy decreased from 50% to 35%. Cross-sectional analyses confirmed changes in functional status, suggesting an age effect. Time-series analyses confirmed changes in self-rated health, suggesting a time effect. No birth-cohort effects were found. Conclusions. Functional status deteriorates with age, whereas self-rated health is not related to age in men aged 70 years and older. The observed 5-year decline in self-rated health seemed to be due to a secular trend. Handle: RePEc:aph:ajpbhl:1997:87:10:1620-1625_6 Template-Type: ReDIF-Article 1.0 Title: Unintended pregnancy and breast-feeding behavior Journal: American Journal of Public Health Author-Name: Dye, T.D. Author-Name: Wojtowycz, M.A. Author-Name: Aubry, R.H. Author-Name: Quade, J. Author-Name: Kilburn, H. Year: 1997 Volume: 87 Issue: 10 Pages: 1709-1711 Abstract: Objectives. This study assessed the effect of unintended pregnancy on breast-feeding behavior. Methods. All women delivering a live birth between January 1, 1995, and July 31, 1996 (n = 33 735), in the 15-county central New York region were asked whether they had intended to become pregnant and their breast-feeding plans. Results. Women with mistimed pregnancies, and pregnancies that were not wanted were significantly less likely to breast- feed than were women whose pregnancies were planned. After adjustment for confounding variables and contraindications for breast-feeding, the odds ratios of not breast-feeding remained significant. Conclusions. Promoting breast-feeding among women with unintended pregnancies is important to improve health status. Handle: RePEc:aph:ajpbhl:1997:87:10:1709-1711_0 Template-Type: ReDIF-Article 1.0 Title: Improving publicly funded substance abuse treatment: The value of case management Journal: American Journal of Public Health Author-Name: Shwartz, M. Author-Name: Baker, G. Author-Name: Mulvey, K.P. Author-Name: Plough, A. Year: 1997 Volume: 87 Issue: 10 Pages: 1659-1664 Abstract: Objectives. This study evaluated the impact of case management on client retention in treatment and short-term relapse for clients in the publicly funded substance abuse treatment system. Methods. A retrospective cohort design was used to study clients discharged from the following four modalities in 1993 and 1994: short-term residential (3112 clients), long- term residential (2888 clients), outpatient (7431 clients), and residential detox (7776 clients). Logistic regression models were used to analyze the impact of case management after controlling for baseline characteristics. Results. The odds that case-managed clients reached a length of stay previously identified as associated with more successful treatment were 1.6 (outpatient programs) to 3.6 (short-term residential programs) times higher than the odds for non-case-managed clients. With the exception of outpatient clients, the odds of case-managed clients' being admitted to detox within 90 days after discharge (suggesting relapse) were about two thirds those of non- case-managed clients. The odds of case-managed detox clients' transitioning to post-detox treatment (a good outcome) were 1.7 times higher than the odds for non-case-managed clients. Conclusions. Case management is a low-cost enhancement that improves short-term outcomes of substance abuse treatment programs. Handle: RePEc:aph:ajpbhl:1997:87:10:1659-1664_1 Template-Type: ReDIF-Article 1.0 Title: 'Call fast, call 911': A direct mail campaign to reduce patient delay in acute myocardial infarction Journal: American Journal of Public Health Author-Name: Meischke, H. Author-Name: Dulberg, E.M. Author-Name: Schaeffer, S.S. Author-Name: Henwood, D.K. Author-Name: Larsen, M.P. Author-Name: Eisenberg, M.S. Year: 1997 Volume: 87 Issue: 10 Pages: 1705-1709 Abstract: Objectives. A 10-month direct mail campaign was implemented to increase use of emergency medical services via 911 calls and to reduce prehospital delay for individuals experiencing acute myocardial infarction symptoms. Methods. This prospective, randomized, controlled trial involved three intervention groups (receiving brochures with informational, emotional, or social messages) and a control group. Results. Intervention effects were not observed except for individuals who had a history of acute myocardial infarction and who were discharged with a diagnosis of acute myocardial infarction; their 911 use was meaningfully higher in each intervention group than in the control group. Conclusions. The mailings affected only the individuals at greatest risk. Handle: RePEc:aph:ajpbhl:1997:87:10:1705-1709_2 Template-Type: ReDIF-Article 1.0 Title: Prescription drug spending: The impact of age and chronic disease status Journal: American Journal of Public Health Author-Name: Mueller, C. Author-Name: Schur, C. Author-Name: O'Connell, J. Year: 1997 Volume: 87 Issue: 10 Pages: 1626-1629 Abstract: Objectives. The purpose of this study was to examine how pharmaceutical expenditures vary by age and the presence of chronic health problems. Methods. Data from the 1987 National Medical Expenditure Survey were used to obtain nationally representative estimates of outpatient prescription drug expenditures for the noninstitutionalized population and the fraction of total health expenditures used to purchase medications for age-chronic disease population subgroups. Results. Although the elderly make up 12% of the population, they account for 34% of total pharmaceutical expenditures. Pharmaceutical expenditures are 9% of total expenditures for children, 13% for nonelderly adults, and 23% for the elderly. Among nonelderly adults, approximately one third have at least one chronic condition and account for over two thirds of drug expenditures. Among the elderly, 36% have three or more chronic conditions and account for 57% of drug expenditures for this group; 41% of total drag expenditures are for cardiovascular or renal drugs. Conclusions. Significant pharmaceutical spending is for treatment of chronic conditions, which subjects insurance coverage to adverse selection and could affect the design of prescription drug benefit packages. Current enrollees in Medicare risk management plans who have drag benefits may face significantly higher out-of-pocket expenses for pharmaceuticals if capitation rates are cut as a means of controlling Medicare program expenditures. Handle: RePEc:aph:ajpbhl:1997:87:10:1626-1629_4 Template-Type: ReDIF-Article 1.0 Title: Telephone support as an adjunct to transdermal nicotine in smoking cessation Journal: American Journal of Public Health Author-Name: Lando, H.A. Author-Name: Rolnick, S. Author-Name: Klevan, D. Author-Name: Roski, J. Author-Name: Cherney, L. Author-Name: Lauger, G. Year: 1997 Volume: 87 Issue: 10 Pages: 1670-1674 Abstract: Objectives. Transdermal nicotine patches have shown considerable promise in improving smoking cessation outcomes. The present study assessed telephone support as an adjunct to a managed creed, single-session group orientation smoking cessation program with nicotine patch therapy. Methods. The unit of randomization was the orientation session (n = 35). Subjects (n = 509) were randomly assigned to a group session without telephone support, the session plus access to a toll-free help line, or the session with telephone help line plus active telephone outreach. Results. Contrary to hypothesis, there were no differences between treatment conditions. Overall abstinence rates were 22% at 6 months and 21% at 1 year. Fewer than 1% of eligible subjects called the toll-free help line. An average of 3.8 of a possible 4 calls were completed in the telephone outreach condition. Conclusions. Abstinence results obtained in this program were comparable to those obtained with more extensive counseling. However, there was no evidence of benefit from telephone support beyond the initial physician-led group orientation session. Handle: RePEc:aph:ajpbhl:1997:87:10:1670-1674_8 Template-Type: ReDIF-Article 1.0 Title: Daytime sleepiness: An epidemiological study of young adults Journal: American Journal of Public Health Author-Name: Breslau, N. Author-Name: Roth, T. Author-Name: Rosenthal, L. Author-Name: Andreski, P. Year: 1997 Volume: 87 Issue: 10 Pages: 1649-1653 Abstract: Objectives. Although excessive daytime sleepiness is associated with increased risks for accidents, decreased productivity, and interpersonal difficulties, information on its epidemiology is scarce. This paper examines correlates of and suspected risk factors for daytime sleepiness from a longitudinal epidemiological study of young adults. Methods. The sample consisted of 1007 randomly selected young adults from a large health maintenance organization in southeast Michigan. Data were gathered in personal interviews conducted with 97% of the sample 5.5 years after baseline. Information on sleep characteristics in the last 2 weeks, including daytime sleepiness, nocturnal sleep onset, snoring, and hours of sleep, was collected on a self-administered instrument. Psychiatric disorders were measured by the National Institute of Mental Health's Diagnostic Interview Schedule. Results. The average length of nocturnal sleep on weekdays was 6.7 hours. Daytime sleepiness was inversely related to hours of sleep and positively related to the ease of falling asleep at night; it varied significantly by employment and marital status. Snoring was associated with increased daytime sleepiness, as was recent major depression. Conclusions. Factors that might increase daytime sleepiness among young adults include social factors (being single and being employed full time) and pathological conditions (frequent snoring and major depression). Handle: RePEc:aph:ajpbhl:1997:87:10:1649-1653_9 Template-Type: ReDIF-Article 1.0 Title: Diabetes in Hawaii: Estimating prevalence from insurance claims data Journal: American Journal of Public Health Author-Name: Maskarinec, G. Year: 1997 Volume: 87 Issue: 10 Pages: 1717-1720 Abstract: Objectives. The purpose of this study was to determine the prevalence of diabetes mellitus in Hawaii from insurance claims data. Methods. Information from two major health plans coveting approximately 66% of the state's population was used to estimate prevalence rates by sex, age group, and geographic area. Weighted multiple linear regression was applied to identify predictors of diabetes prevalence. Results. The statewide diabetes prevalence was estimated at 43.8 per 1000 persons. The ethnic composition of the population and rural residence partially explained the geographic variation in diabetes prevalence. Conclusions. Insurance claims data may be a useful tool for population-based diabetes surveillance. Handle: RePEc:aph:ajpbhl:1997:87:10:1717-1720_7 Template-Type: ReDIF-Article 1.0 Title: An investigation of increased tuberculosis case reports in Santa Clara County, California, 1993-1994. Journal: American Journal of Public Health Author-Name: Cummings, K. Author-Name: Mohle-Boetani, J. Author-Name: Catlos, E. Author-Name: Fenstersheib, M. Author-Name: Royce, S. Year: 1997 Volume: 87 Issue: 10 Pages: 1721 Handle: RePEc:aph:ajpbhl:1997:87:10:1721_3 Template-Type: ReDIF-Article 1.0 Title: Hepatitis A among schoolchildren in a US-Mexico border community Journal: American Journal of Public Health Author-Name: Redlinger, T. Author-Name: O'Rourke, K. Author-Name: VanDerslice, J. Year: 1997 Volume: 87 Issue: 10 Pages: 1715-1717 Abstract: Objectives. A cross-sectional study investigated the association of hepatitis A seropositivity with environmental and personal risk factors among children in a United States-Mexico border community. Methods. Hepatitis A serological markers and a questionnaire identifying risk factors were evaluated for 523 primary school children. Results. Of the children studied, 16.9% tested positive for total antihepatitis A virus. Risk factors included being in the first grade, low maternal educational attainment, living in Mexico for more than 6 months, household crowding, and inadequate excreta disposal systems. Conclusions. To decrease enteric disease, improvements in excreta disposal infrastructures and educational programs are needed. Hepatitis A vaccine should be administered before school age. Handle: RePEc:aph:ajpbhl:1997:87:10:1715-1717_2 Template-Type: ReDIF-Article 1.0 Title: The contribution of six chronic conditions to the total burden of mobility disability in the Dutch population Journal: American Journal of Public Health Author-Name: Picavet, H.S.J. Author-Name: Van Den Bos, G.A.M. Year: 1997 Volume: 87 Issue: 10 Pages: 1680-1682 Abstract: Objectives. This study assessed the proportions of the burden of mobility disability in the Dutch population that are attributable to musculoskeletal disease, lung diseases, neurological disorders, heart diseases, diabetes, and cancer. Methods. National survey data were analyzed with an elimination technique that combines the results of logistic regression analysis and the disease prevalence. Results. Of the total prevalence of disability (20.5%), 33:7% can be attributed to these six chronic conditions. Musculoskeletal disorders account for the major part, whereas the contribution of cancer is very small. Conclusions. The potential benefits of effective curative or preventive treatments for chronic conditions, in terms of reduction of disability burden in the population, are limited. Handle: RePEc:aph:ajpbhl:1997:87:10:1680-1682_0 Template-Type: ReDIF-Article 1.0 Title: The changing distribution of HIV infection: HIV surveillance in Lazio, Italy, 1985 through 1994 Journal: American Journal of Public Health Author-Name: Brancato, G. Author-Name: Perucci, C.A. Author-Name: Abeni, D.D.C. Author-Name: Sangalli, M. Author-Name: Ippolito, G. Author-Name: Arcà, M. Year: 1997 Volume: 87 Issue: 10 Pages: 1654-1658 Abstract: Objectives. This study sought to describe the human immunodeficiency virus (HIV) surveillance system in Lazio, Italy, and to analyze exposure patterns and time trends of HIV serodiagnoses from January 1985 to December 1994. Methods. A linkage procedure made it possible to identify newly diagnosed HIV cases. Anonymous information was collected on demographic and exposure factors for each individual. Results. Of 35 425 reports, 13 660 were newly diagnosed HIV cases, 70.9% of them in men. The proportion of women increased at the beginning of the study period (the male:female ratio declined from 3.5 in 1985 to 2.6 in 1986) and then remained stable. The proportion of subjects reporting heterosexual exposure, in men and women, respectively, increased from 1.5% and 2.0% in 1985 to 21.2% and 60.8% in 1994. Starting in 1992, heterosexual contact has become the main transmission mote for women. Conclusions. A changing pattern in the HIV epidemic is emerging, with a shift in the incidence of HIV diagnosis from 'core' high- risk groups (drag injectors) to the large low-risk population (the general population) exposed through heterosexual transmission. This is probably occurring in other areas (e.g., large urban centers in the United States) with a similar epidemiological situation. Handle: RePEc:aph:ajpbhl:1997:87:10:1654-1658_6 Template-Type: ReDIF-Article 1.0 Title: Residential lead-based-paint hazard remediation and soil lead abatement: Their impact among children with mildly elevated blood lead levels Journal: American Journal of Public Health Author-Name: Aschengrau, A. Author-Name: Beiser, A. Author-Name: Bellinger, D. Author-Name: Copenhafer, D. Author-Name: Weitzman, M. Year: 1997 Volume: 87 Issue: 10 Pages: 1698-1702 Abstract: Objectives. This prospective study describes the impact of residential lead-based-paint hazard remediations on children with mildly elevated blood lead levels. Methods. Changes in blood lead levels were observed following paint hazard remediation alone and in combination with soil abatement. Results. After adjustment for the confounding variables, paint hazard remediation alone was associated with a blood lead increase of 6.5 μg/dL (P = .05), and paint hazard remediation combined with soil abatement was associated with an increase of 0.9 μg/dL (P = .36). Conclusions. Lead- based-paint hazard remediation, as performed in this study, is not an effective secondary prevention strategy among children with mildly elevated blood lead levels. Handle: RePEc:aph:ajpbhl:1997:87:10:1698-1702_3 Template-Type: ReDIF-Article 1.0 Title: State variations in Medicare expenditures Journal: American Journal of Public Health Author-Name: Kane, R.L. Author-Name: Friedman, B. Year: 1997 Volume: 87 Issue: 10 Pages: 1611-1619 Abstract: Objectives. This study examined variations in Medicare expenditures across states. Methods. 1992 data on average Medicare expenditures per enrollee, users of services per 1000 enrollees, service use per user, and payment per unit of service were compared across stales for various services. Weighted least squares regression analysis was employed to examine total Medicare expenditures per enrollee by state. Results. Variation in Medicare expenditures across states is driven more by average number of service users per 1000 enrollees and average service units per user than by average payment per service unit. Medicare expenditures per enrollee by state are primarily a function of Medicare HMO penetration rate (P = .000), urban area (P = .001), hospital bed supply (P = .005), elderly mortality rate (P = .012), Medicare physician assignment rate (P = .026), percentage of primary care practitioners (P = .042), and interactions between urban elderly and percentage of primary care physicians (P = .005) and Black elderly and nursing home bed supply (P = .012). Conclusions. Before sweeping Medicare cuts are undertaken or excessive reliance on managed care occurs, attention should be focused on the current disproportionate distribution of expenditures across states. Handle: RePEc:aph:ajpbhl:1997:87:10:1611-1619_2 Template-Type: ReDIF-Article 1.0 Title: The effects of planned duration of residential drug abuse treatment on recovery and HIV risk behavior Journal: American Journal of Public Health Author-Name: McCusker, J. Author-Name: Bigelow, C. Author-Name: Frost, R. Author-Name: Garfield, F. Author-Name: Hindin, R. Author-Name: Vickers-Lahti, M. Author-Name: Lewis, B. Year: 1997 Volume: 87 Issue: 10 Pages: 1637-1644 Abstract: Objective. This study assessed the effects of planned duration of residential drug abuse treatment on recovery from drug use and on human immunodeficiency virus (HIV) risk behaviors. Methods. Two concurrent randomized controlled trials of programs differing in planned duration were conducted: 6-month vs 12-month versions of a traditional therapeutic community program, and 3-month vs 6-month versions of a modified therapeutic community incorporating a relapse prevention and health education program. Outcomes, measured at least 16.5 months after admission, included time from admission to first drug use; severity of drug, alcohol, legal, and employment problems; and risky drug injection and sexual behaviors. Results. Among 539 clients (86% of those enrolled), there were no significant effects of planned duration of treatment upon Addiction Severity Index scores or HIV risk behavior. In the relapse prevention program, clients randomized to the 6- month program had a longer time to first drug use than those in the 3-month program (hazard ratio = 0.74: 95% confidence interval = 0.58, 0.93). Employment problems at follow-up were significantly less severe among clients treated in the therapeutic community than among those in the relapse prevention program. Conclusions. No overall benefit of extending treatment beyond 6 months was found. Handle: RePEc:aph:ajpbhl:1997:87:10:1637-1644_5 Template-Type: ReDIF-Article 1.0 Title: Injury and death associated with hospital bed side-rails: Reports to the US food and drag administration from 1985 to 1995 Journal: American Journal of Public Health Author-Name: Todd, J.F. Author-Name: Ruhl, C.E. Author-Name: Gross, T.P. Year: 1997 Volume: 87 Issue: 10 Pages: 1675-1677 Abstract: Objectives. Hospital bed side-rails, while intended for patient protection, can contribute to injury and death. Reports to the Food and Drug Administration (FDA) of hospital bed side-rail entrapment have increased. In this paper entrapment cases are reviewed and the population potentially at risk identified. Methods. FDA's database was searched for events involving hospital beds from January 1985 to August 1995 and entrapment cases were identified. Results. Of 111 entrapments, 65% were associated with death and 23% with injury. Conclusions. Advanced age, female sex, low body weight, and cognitive impairment may be associated with increased risk. Preventive measures are detailed. Handle: RePEc:aph:ajpbhl:1997:87:10:1675-1677_5 Template-Type: ReDIF-Article 1.0 Title: Excess mortality attributable to hip fracture in White women aged 70 years and older Journal: American Journal of Public Health Author-Name: Magaziner, J. Author-Name: Lydick, E. Author-Name: Hawkes, W. Author-Name: Fox, K.M. Author-Name: Zimmerman, S.I. Author-Name: Epstein, R.S. Author-Name: Hebel, J.R. Year: 1997 Volume: 87 Issue: 10 Pages: 1630-1636 Abstract: Objective. The purpose of this study was to estimate the excess mortality attributable to hip fracture. Methods. The 6-year survival rate of community-dwelling White female hip fracture patients aged 70 years and older entering one of seven hospitals from 1984 to 1986 (n = 578) was compared with that of White female respondents aged 70 years and older interviewed in 1984 for the Longitudinal Study on Aging (n = 3773). Results. After age, education, comorbidity, and functional impairment were controlled, the mortality differential between the two groups accumulated to an excess among hip fracture patients of 9 deaths per 100 women 5 years postfracture. Among those with throe or more functional impairments or one or more comorbidities, the excess was 7 deaths per 100; the effect of the fracture had disappeared in these groups by 4 years. In contrast those with two or fewer impairments and those with no comorbidities had a continuing trend of increased mortality, with an excess of 14 deaths per 100 by 5 years. Conclusions. There is an immediate increase in mortality following a hip fracture in medically ill and functionally impaired patients, whereas among those with no comorbidities and few impairments, there is a gradual increase in mortality that continues for 5 years postfracture. Handle: RePEc:aph:ajpbhl:1997:87:10:1630-1636_9 Template-Type: ReDIF-Article 1.0 Title: The impact of socioeconomic status on health functioning as assessed by the SF-36 questionnaire: The Whitehall II study Journal: American Journal of Public Health Author-Name: Hemingway, H. Author-Name: Nicholson, A. Author-Name: Stafford, M. Author-Name: Roberts, R. Author-Name: Marmot, M. Year: 1997 Volume: 87 Issue: 9 Pages: 1484-1490 Abstract: 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. Handle: RePEc:aph:ajpbhl:1997:87:9:1484-1490_2 Template-Type: ReDIF-Article 1.0 Title: Quantifying the future impact of disease on society: Life table-based measures of potential life lost Journal: American Journal of Public Health Author-Name: Lee, W.-C. Year: 1997 Volume: 87 Issue: 9 Pages: 1456-1460 Abstract: Objectives. Quantifying health status in human populations by means of an index such as 'years of potential life lost' has recently received attention. However, such an index, being cross-sectional in nature, only measures the current burden to society resulting from a specific cause of death. Methods. The author proposes new indices of potential life lost to quantify future impacts on society of particular causes of death. These indices also properly reflect the effects of competing risks. The computation is simple, requiring no more than a standard life-table calculation. Real- world as well as hypothetical data are used to illustrate the method. Results. The new indices convey valuable health status information about a population that is not revealed by traditional indices. Conclusions. The new indices are promising alternatives as measures of future potential life lost. Handle: RePEc:aph:ajpbhl:1997:87:9:1456-1460_4 Template-Type: ReDIF-Article 1.0 Title: Condom availability in New York City public high schools: Relationships to condom use and sexual behavior Journal: American Journal of Public Health Author-Name: Guttmacher, S. Author-Name: Lieberman, L. Author-Name: Ward, D. Author-Name: Freudenberg, N. Author-Name: Radosh, A. Author-Name: Jarlais, D.D. Year: 1997 Volume: 87 Issue: 9 Pages: 1427-1433 Abstract: Objectives. This study examines the impact of the condom availability program in New York City public high schools by comparing rates of sexual activity and condom use for New York students and similar students in Chicago. Methods. A total of 7119 students from 12 randomly selected New York schools and 5738 students from 10 Chicago schools participated in a cross- sectional survey. Results. New York students, compared with Chicago students, reported equal rates of sexual activity but higher rates of condom use at last intercourse (odds ratio [OR] = 1.36). For higher-risk students (those with three or more sexual partners in the past 6 months), condom use was greater in New York (OR = 1.85) than in Chicago. Conclusions. Condom availability has a modest but significant effect on condom use and does not increase rates of sexual activity. These findings suggest that school-based condom availability can lower the risk of HIV and other sexually transmitted diseases for urban teenagers in the United States. Handle: RePEc:aph:ajpbhl:1997:87:9:1427-1433_0 Template-Type: ReDIF-Article 1.0 Title: Factors associated with mental health, general health, and school-based service use for child psychopathology Journal: American Journal of Public Health Author-Name: Zahner, G.E.P. Author-Name: Daskalakis, C. Year: 1997 Volume: 87 Issue: 9 Pages: 1440-1448 Abstract: 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. Handle: RePEc:aph:ajpbhl:1997:87:9:1440-1448_1 Template-Type: ReDIF-Article 1.0 Title: Could salicylates in food have contributed to the decline in cardiovascular disease mortality? A new hypothesis Journal: American Journal of Public Health Author-Name: Ingster, L.M. Author-Name: Feinleib, M. Year: 1997 Volume: 87 Issue: 9 Pages: 1554-1557 Abstract: Objectives. The prophylactic effect of aspirin (at 80 mg/day) for the prevention of cardiovascular disease mortality has long been recognized. This study examined whether other salicylates are present in comparable quantities in the US food supply. Methods. To estimate the order of magnitude for salicylates in the food supply, annual production data for selected synthetic salicylates were analyzed. Results. Production figures for 1960 indicate exposure to salicylates of 259 mg/day per person, or 95 mg/day per person excluding aspirin. Trend data indicate a rise in the production of salicylates over time, reaching 341 mg/day per person, or 126 mg/day per person excluding aspirin, in 1970. Conclusion. The US ingestion of salicylates with aspirinlike properties may have increased to the point that many susceptible individuals have received a beneficial effect that has contributed to the decline in cardiovascular disease mortality. Handle: RePEc:aph:ajpbhl:1997:87:9:1554-1557_3 Template-Type: ReDIF-Article 1.0 Title: Shigellosis on Indian Reserves in Manitoba, Canada: Its relationship to crowded housing, lack of running water, and inadequate sewage disposal Journal: American Journal of Public Health Author-Name: Rosenberg, T. Author-Name: Kendall, O. Author-Name: Blanchard, J. Author-Name: Martel, S. Author-Name: Wakelin, C. Author-Name: Fast, M. Year: 1997 Volume: 87 Issue: 9 Pages: 1547-1551 Abstract: Objectives. This study compares incidence and hospitalization rates for shigellosis between Indians and die rest of the population in Manitoba, Canada. It examines die 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 die 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. Handle: RePEc:aph:ajpbhl:1997:87:9:1547-1551_9 Template-Type: ReDIF-Article 1.0 Title: Is incarceration during pregnancy associated with infant birthweight? Journal: American Journal of Public Health Author-Name: Martin, S.L. Author-Name: Kim, H. Author-Name: Kupper, L.L. Author-Name: Meyer, R.E. Author-Name: Hays, M. Year: 1997 Volume: 87 Issue: 9 Pages: 1526-1531 Abstract: Objectives. This study examined whether incarceration during pregnancy is associated with infant birthweight. Methods. Multivariable analyses compared infant birthweight outcomes among three groups of women: 168 women incarcerated during pregnancy, 630 women incarcerated at a time other than during pregnancy, and 3910 women never incarcerated. Results. After confounders were controlled for, infant birthweight among women incarcerated during pregnancy were not significantly different from women never incarcerated; however, infant birthweights were, significantly worse among women incarcerated at a time other than during pregnancy than among never- incarcerated women and women incarcerated during pregnancy. Conclusions. Certain aspects of the prison environment (shelter, food, etc.) may be health-promoting for high-risk pregnant women. Handle: RePEc:aph:ajpbhl:1997:87:9:1526-1531_5 Template-Type: ReDIF-Article 1.0 Title: Injectable contraceptive discontinuation and subsequent unintended pregnancy among low-income women Journal: American Journal of Public Health Author-Name: Davidson, A.R. Author-Name: Kalmuss, D. Author-Name: Cushman, L.F. Author-Name: Romero, D. Author-Name: Heartwell, S. Author-Name: Rulin, M. Year: 1997 Volume: 87 Issue: 9 Pages: 1532-1534 Abstract: Objectives. This study investigated rates of discontinuation of the recently introduced injectable contraceptive depot medroxyprogesterone acetate (DMPA) and postdiscontinuation rates of unprotected intercourse and unintended pregnancy. Methods. A sample of 402 low-income, urban, minority women were interviewed when they initiated DMPA use and 12 months later. Results. The 12-month life-table discontinuation rate was 58%, with half, of the discontinuers stopping after only one injection. Menstrual changes and other side effects were the most frequently cited reasons for discontinuation. Approximately half of the discontinuers at risk for unintended pregnancy either did not make the transition to another contraceptive or used contraception only sporadically. The cumulative unintended pregnancy rate by 9 months postdiscontinuation was 20%. Conclusions. DMPA initiators were at substantial risk for unintended pregnancy because most quickly discontinued use and did not make the transition to consistent use of another contraceptive. Handle: RePEc:aph:ajpbhl:1997:87:9:1532-1534_8 Template-Type: ReDIF-Article 1.0 Title: Can dietary interventions change diet and cardiovascular risk factors? A meta-analysis of randomized controlled trials Journal: American Journal of Public Health Author-Name: Brunner, E. Author-Name: White, I. Author-Name: Thorogood, M. Author-Name: Bristow, A. Author-Name: Curle, D. Author-Name: Marmot, M. Year: 1997 Volume: 87 Issue: 9 Pages: 1415-1422 Abstract: Objectives. This study evaluated the effectiveness of dietary advice in primary prevention of chronic disease. Methods. A meta-analysis was conducted of 17 randomized controlled trials of dietary behavior interventions of at least 3 months' duration. Results were analyzed as changes in reported dietary fat intakes and biomedical measures (serum cholesterol, urinary sodium, systolic and diastolic blood pressure) in the intervention group minus changes in the control group at 3 to 6 months and 9 to 18 months of follow-up. Results. After 3 to 6 months, mean net changes in each of the five outcomes favored intervention. For dietary fat as a percentage of food energy, the change was -2.5% (95% confidence interval [CI] = -3.9%, -1.1%). Mean net changes over 9 to 18 months were as follows: serum cholesterol, - 0.22 (95% CI = -0.39, -0.05) mmol/L; urinary sodium, -45.0 (95% CI = -57.1, - 32.8) mmol/24 hours; systolic blood pressure, -1.9 (95% CI = -3.0, 0.8) mm Hg; and diastolic blood pressure, -1.2 (95% CI = -2.6, 0.2) mm Hg. Conclusions. Individual dietary interventions in primary prevention can achieve modest improvements in diet and cardiovascular disease risk status that are maintained for 9 to 18 months. Handle: RePEc:aph:ajpbhl:1997:87:9:1415-1422_3 Template-Type: ReDIF-Article 1.0 Title: Social differences in health: Life-cycle effects between ages 23 and 33 in the 1958 British birth cohort Journal: American Journal of Public Health Author-Name: Power, C. Author-Name: Hertzman, C. Author-Name: Matthews, S. Author-Name: Manor, O. Year: 1997 Volume: 87 Issue: 9 Pages: 1499-1506 Abstract: Objectives. The purpose of this study was to determine whether social differences in health persist or widen during early adulthood. Methods. A longitudinal follow-up of the 1958 British birth cohort was investigated, using social class at birth and six health measures at ages 23 and 33. A slope of inequality was estimated to represent social differences in health. Results. Social gradients in health were evident by age 23: the prevalence of poor health increased with decreasing social position. This was observed for several but not all health indicators. Social gradients persisted to age 33. The slope of inequality was greatest for malaise (odds ratio [OR] = 3.37 for men, 3.21 for women) and obesity (OR = 4.80 for men and 2.84 for women), both at age 23, and for self-rated health in women at age 23 (OR = 2.94) and age 33 (OR = 3.22). Inequality increased significantly between ages 23 and 33 for limiting illness in men, and lessened, although not significantly, for malaise, overweight, and obesity; social gradients remained constant for self-rated health, respiratory symptoms, and asthma or wheezing. Conclusions. Social gradients in health evident in this sample by age 23 persisted to age 33. Inequalities did not appear to widen consistently, but variable findings for several health measures suggest that inequalities reproduce through different pathways. Handle: RePEc:aph:ajpbhl:1997:87:9:1499-1506_9 Template-Type: ReDIF-Article 1.0 Title: Occupationally acquired HIV: The vulnerability of health care workers under workers' compensation laws Journal: American Journal of Public Health Author-Name: Tereskerz, P.M. Author-Name: Jagger, J. Year: 1997 Volume: 87 Issue: 9 Pages: 1558-1562 Abstract: Approximately 800 000 needle-sticks and other sharp injuries from contaminated medical devices occur in health care settings each year, of which an estimated 16 000 are contaminated by human immunodeficiency virus (HIV). Health care workers who are occupationally infected by HIV are at risk of being left without workers' compensation coverage. In some states, the definition of an occupational disease is so restrictive that infected health care workers are unlikely to qualify for benefits. For those who are able to meet the definition, compensation is often inadequate. Recourse is also limited by statutory provisions that preclude health care workers from bringing civil suits against their employers. We recommend the amendment of legislation to provide more equitable remedies, including: (1) broadening the definition of occupational disease; (2) eliminating provisions that require a claimant to prove that (a) a specific occupational incident resulted in infection and (b) HIV is not an ordinary disease of life; (3) expanding the time for filing a claim; (4) assuring that lifetime benefits will be provided to the disabled health care workers, and (5) assuring that claims will remain confidential. Handle: RePEc:aph:ajpbhl:1997:87:9:1558-1562_0 Template-Type: ReDIF-Article 1.0 Title: Risk for neural tube defect-affected pregnancies among women of Mexican descent and White women in California Journal: American Journal of Public Health Author-Name: Shaw, G.M. Author-Name: Velie, E.M. Author-Name: Wasserman, C.R. Year: 1997 Volume: 87 Issue: 9 Pages: 1467-1471 Abstract: Objectives. This study investigated a previously reported 50% or more increased risk for neural tube defect-affected pregnancies among Latina women compared with White women. Methods. Data were derived from a population- based case-control study of fetuses and live-born infants with neural tube defects in a 1989-through-1991 California birth cohort. Interviews were conducted with mothers of 538 (88% of eligible) infants/fetuses with neural tube defects and mothers of 539 (88%) nonmalformed control infants. Results. The risk for a neural tube defect-affected pregnancy was approximately twice as high among women of Mexican descent than among White women (odds ratio = 1.9, 95% confidence interval [(CI] = 1.5, 2.8). The odds ratio for Mexico- born Mexican women compared with White women was 2.4 (95% CI = 1.7, 3.2), whereas the risk for US-born women of Mexican and other racial/ethnic descent was not substantially higher than that for Whites. The higher risk among Mexico-born Mexican women was not attributable to differences in numerous studied parental characteristics and exposures. Conclusions. Given that nearly 20% of all California births are to Mexico-born Mexican women, the increased risks observed are relevant to the population burden of neural tube defects. Handle: RePEc:aph:ajpbhl:1997:87:9:1467-1471_0 Template-Type: ReDIF-Article 1.0 Title: Sudden cardiac death in Hispanic Americans and African Americans Journal: American Journal of Public Health Author-Name: Gillum, R.F. Year: 1997 Volume: 87 Issue: 9 Pages: 1461-1466 Abstract: 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 100000 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. Handle: RePEc:aph:ajpbhl:1997:87:9:1461-1466_3 Template-Type: ReDIF-Article 1.0 Title: Screening women for gonorrhea: Demographic screening criteria for general clinical use Journal: American Journal of Public Health Author-Name: Mertz, K.J. Author-Name: Levine, W.C. Author-Name: Mosure, D.J. Author-Name: Berman, S.M. Author-Name: Dorian, K.J. Author-Name: Hadgu, A. Year: 1997 Volume: 87 Issue: 9 Pages: 1535-1538 Abstract: Objectives. The purpose of this analysis was to derive potential gonorrhea screening criteria for women. Methods. Data corresponding to 44366 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. Handle: RePEc:aph:ajpbhl:1997:87:9:1535-1538_5 Template-Type: ReDIF-Article 1.0 Title: Income dynamics and adult mortality in the United States, 1972 through 1989 Journal: American Journal of Public Health Author-Name: McDonough, P. Author-Name: Duncan, G.J. Author-Name: Williams, D. Author-Name: House, J. Year: 1997 Volume: 87 Issue: 9 Pages: 1476-1483 Abstract: Objectives. The aim of this study was to examine relationships between income and mortality, focusing on the predictive utility of single-year and multiyear measures of income, the shape of the income gradient in mortality, trends in this gradient over time, the impact of income change on mortality, and the joint effects of income and age, race, and sex on mortality risk. Methods. Data were taken from the Panel Study of Income Dynamics for the years 1968 through 1989. Fourteen 10-year panels were constructed in which predictors were measured over the first 5 years and vital status over the subsequent 5 years. The panels were pooled and logistic regression was used in the analysis. Results. Income level was a strong predictor of mortality, especially for persons under the age of 65 years. Persistent low income was particularly consequential for mortality. Income instability was also important among middle-income individuals. Single-year and multiyear income measures had comparable predictive power. All effects persisted after adjustment for education and initial health status. Conclusions. The issues of low income and income instability should be addressed in population health policy. Handle: RePEc:aph:ajpbhl:1997:87:9:1476-1483_4 Template-Type: ReDIF-Article 1.0 Title: Rapid screening and treatment for sexually transmitted diseases in arrestees: A feasible control measure Journal: American Journal of Public Health Author-Name: Beltrami, J.F. Author-Name: Cohen, D.A. Author-Name: Hamrick, J.T. Author-Name: Farley, T.A. Year: 1997 Volume: 87 Issue: 9 Pages: 1423-1426 Abstract: Objectives. The purpose of this study was to determine the feasibility and usefulness of rapid screening and immediate presumptive treatment for sexually transmitted diseases among arrestees at a county jail. Methods. The rapid plasma reagin test (for syphilis) and the urine leukocyte esterase test (for urethritis) were used in establishing routine screening and presumptive treatment for sexually transmitted diseases among arrestees. Results. Of 4757 arrestees screened, 82 (1.7%) had untreated syphilis, and, of 4174 male arrestees screened, 541 (13%) had a positive leukocyte esterase test. The syphilis prevalence rate was higher among women than among men (3.1% vs 1.5%), and the rate was higher among Blacks than among Whites (2.3% vs 0.7%). Although leukocyte esterase test positivity was higher among persons reporting a urethral discharge (57% vs 12%), 88% of persons with a positive test result did not report such symptoms. Conclusions. The program described here has reached persons with sexually transmitted diseases who are unlikely to use traditional health care services and thus are likely to remain untreated. Rapid screening and treatment for sexually transmitted diseases among arrestees is feasible and should be considered in areas with high sexually transmitted disease rates. Handle: RePEc:aph:ajpbhl:1997:87:9:1423-1426_9 Template-Type: ReDIF-Article 1.0 Title: Mortality patterns among female nurses: A 27-state study, 1984 through 1990 Journal: American Journal of Public Health Author-Name: Peipins, L.A. Author-Name: Burnett, C. Author-Name: Alterman, T. Author-Name: Lalich, N. Year: 1997 Volume: 87 Issue: 9 Pages: 1539-1543 Abstract: 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. Re-doubled efforts are called for in overcoming obstacles to reducing workplace hazards. Handle: RePEc:aph:ajpbhl:1997:87:9:1539-1543_6 Template-Type: ReDIF-Article 1.0 Title: Aplastic anemia in rural Thailand: Its association with grain farming and agricultural pesticide exposure Journal: American Journal of Public Health Author-Name: Issaragrisil, S. Author-Name: Chansung, K. Author-Name: Kaufman, D.W. Author-Name: Sirijirachai, J. Author-Name: Thamprasit, T. Author-Name: Young, N.S. Year: 1997 Volume: 87 Issue: 9 Pages: 1551-1554 Abstract: Objectives. A population-based case-control study was conducted to elucidate the incidence and etiology o 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. Handle: RePEc:aph:ajpbhl:1997:87:9:1551-1554_0 Template-Type: ReDIF-Article 1.0 Title: The prevalence and morbidity of chronic fatigue and chronic fatigue syndrome: A prospective primary care study Journal: American Journal of Public Health Author-Name: Wessely, S. Author-Name: Chalder, T. Author-Name: Hirsch, S. Author-Name: Wallace, P. Author-Name: Wright, D. Year: 1997 Volume: 87 Issue: 9 Pages: 1449-1455 Abstract: Objectives. This study examined the prevalence and public health impact of chronic fatigue and chronic fatigue syndrome in primary care patients in England. Methods. There were 2376 subjects, aged 18 through 45 years. Of 214 subjects who fulfilled criteria for chronic fatigue, 185 (86%) were interviewed in the case-control study. Measures included chronic fatigue, psychological morbidity, depression, anxiety, somatic symptoms, symptoms of chronic fatigue syndrome, functional impairment, and psychiatric disorder. Results. The point prevalence of chronic fatigue was 11.3%, falling to 4.1% if comorbid psychological disorders were excluded. The point prevalence of chronic fatigue syndrome was 2.6%, falling to 0.5% if comorbid psychological disorders were excluded. Rates did not vary by social class. After adjustment for psychological disorder, being female was modestly associated with chronic fatigue. Functional impairment was profound and was associated with psychological disorder. Conclusions. Both chronic fatigue and chronic fatigue syndrome are common in primary care patients and represent a considerable public health burden. Selection bias may account for previous suggestions of a link with higher socioeconomic status. Handle: RePEc:aph:ajpbhl:1997:87:9:1449-1455_3 Template-Type: ReDIF-Article 1.0 Title: The relationship of cigarette prices and no-smoking bylaws to the prevalence of smoking in Canada Journal: American Journal of Public Health Author-Name: Stephens, T. Author-Name: Pederson, L.L. Author-Name: Koval, J.J. Author-Name: Kim, C. Year: 1997 Volume: 87 Issue: 9 Pages: 1519-1521 Abstract: Objectives. The aim of this study was to analyze the association of cigarette prices and no-smoking bylaws with the prevalence of smoking. Methods. Data on individual smoking status were taken from two national household surveys in Canada. Current cigarette price, the 1-year and 10-year increase in price, and the extent of local restrictions on public smoking were added to the model. Logistic regression was used to estimate the odds of being a smoker. Results. The odds ratio for being a smoker was 1.21 where no- smoking bylaws were relatively infrequent and 1.26 when cigarettes were relatively inexpensive, after adjusting for individual age, sex, education, and marital status. Conclusions. Both cigarette prices and no-smoking bylaws are effective in controlling smoking; either alone will likely have less impact than the two measures together. Handle: RePEc:aph:ajpbhl:1997:87:9:1519-1521_2 Template-Type: ReDIF-Article 1.0 Title: Socioeconomic differences in hysterectomy: The Wisconsin Longitudinal Study Journal: American Journal of Public Health Author-Name: Marks, N.F. Author-Name: Shinberg, D.S. Year: 1997 Volume: 87 Issue: 9 Pages: 1507-1514 Abstract: Objectives. This study evaluated the relative gross and net predictive value of multiple socioeconomic status indicators for the likelihood of undergoing hysterectomy. Methods. Data from a sample of Wisconsin Longitudinal Study women respondents (n = 3326) followed for 35 years were analyzed by means of multivariate logistic regression. Results. Women's own higher occupational status and greater family net worth were significant net predictors of a lower likelihood of hysterectomy. Women's own education was a significant bivariate predictor. Mental ability did not account for the education effect. Conclusions. Higher education's association with a lower rate of hysterectomy is not due to ability, but to the opportunities that more-educated women have for higher-status employment and its health-related benefits. Measures of women's own occupational status should be included in future health surveys. Handle: RePEc:aph:ajpbhl:1997:87:9:1507-1514_1 Template-Type: ReDIF-Article 1.0 Title: Mortality in Chicago attributed to the July 1995 heat wave Journal: American Journal of Public Health Author-Name: Whitman, S. Author-Name: Good, G. Author-Name: Donoghue, E.R. Author-Name: Benbow, N. Author-Name: Shou, W. Author-Name: Mou, S. Year: 1997 Volume: 87 Issue: 9 Pages: 1515-1518 Abstract: Objectives. This study assessed mortality associated with the mid-July 1995 heat wave in Chicago. Methods. Analyses focused on heat-related deaths, as designated by the medical examiner, and on the number of excess deaths. Results. In July 1995, there were 514 heat-related deaths and 696 excess deaths. People 65 years of age or older were overrepresented and Hispanic people underrepresented. During the most intense heat (July 14 through 20), there were 485 heat-related deaths and 739 excess deaths. Conclusions. The methods used here provide insight into the great impact of the Chicago heat wave on selected populations, but the lack of methodological standards makes comparisons across geographical areas problematic. Handle: RePEc:aph:ajpbhl:1997:87:9:1515-1518_0 Template-Type: ReDIF-Article 1.0 Title: The psychological consequences of cardiopulmonary resuscitation training for family members of patients at risk for sudden death Journal: American Journal of Public Health Author-Name: Dracup, K. Author-Name: Moser, D.K. Author-Name: Taylor, S.E. Author-Name: Guzy, P.M. Year: 1997 Volume: 87 Issue: 9 Pages: 1434-1439 Abstract: 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. Handle: RePEc:aph:ajpbhl:1997:87:9:1434-1439_0 Template-Type: ReDIF-Article 1.0 Title: The effects of occupation-based social position on mortality in a large American cohort Journal: American Journal of Public Health Author-Name: Gregorio, D.I. Author-Name: Walsh, S.J. Author-Name: Paturzo, D. Year: 1997 Volume: 87 Issue: 9 Pages: 1472-1475 Abstract: Objectives. Four occupation-based measures were used to derive estimates of social position's effect on all-cause mortality among men and women in a large national cohort. Methods. The National Longitudinal Mortality Study provided information on principal occupation and 9-year follow-up for 229 851 persons aged 25 through 64 years. Cox's proportional hazards model was used to estimate the age-adjusted risk of death relative to six ordinal categories of social position. The Slope Index of Inequality described average change in death rates across categories. Results. Risk of death was consistently elevated among persons at lower positions in the social hierarchy. Estimates comparing lowest with highest categories varied within a narrow range (1.47- 1.92 for men and 1.23-1.55 for women). However, several discrepancies among analyses were noted. The analysis by US census groups revealed nonlinear associations, whereas those using other scales found incremental increases in risk. Effect modification by sex was observed for analyses by two of the four measures. Race/ethnicity did not modify the underlying association between variables. Conclusions. Our analysis complements previous findings and supports, with few qualifications, the interchangeability of occupation based measures of social position in mortality studies. Explanations for why relative risk estimates were modified by sex are offered. Handle: RePEc:aph:ajpbhl:1997:87:9:1472-1475_1 Template-Type: ReDIF-Article 1.0 Title: Controlling tuberculosis in an urban emergency department: A rapid decision instrument for patient isolation Journal: American Journal of Public Health Author-Name: Redd, J.T. Author-Name: Susser, E. Year: 1997 Volume: 87 Issue: 9 Pages: 1543-1547 Abstract: Objective. This study examined whether data routinely available in emergency departments could be used to improve isolation decisions for tuberculosis patients. Methods. In a large emergency department in New York City, we compared the exposure histories of tuberculosis culture-positive and culture-negative patients and used these data to develop a rapid decision instrument to predict c emergency physicians. Results. The method had high sensitivity (.96) and moderate specificity (.54). Conclusions. The method is easily adaptable for a broad range of settings and illustrates the potential benefits of applying basic epidemiologic methods in a clinical setting. Handle: RePEc:aph:ajpbhl:1997:87:9:1543-1547_9 Template-Type: ReDIF-Article 1.0 Title: Social capital, income inequality, and mortality Journal: American Journal of Public Health Author-Name: Kawachi, I. Author-Name: Kennedy, B.P. Author-Name: Lochner, K. Author-Name: Prothrow-Stith, D. Year: 1997 Volume: 87 Issue: 9 Pages: 1491-1498 Abstract: Objectives. Recent studies have demonstrated that income inequality is related to mortality rates. It was hypothesized, in this study, that income inequality is related to reduction in social cohesion and that disinvestment in social capital is in turn associated with increased mortality. Methods. In this cross-sectional ecologic study based on data from 39 states, social capital was measured by weighted responses to two items from the General Social Survey: per capita density of membership in voluntary groups in each state and level of social trust, as gauged by the proportion of residents in each state who believed that people could be trusted. Age-standardized total and cause-specific mortality rates in 1990 were obtained for each state. Results. Income inequality was strongly correlated with both per capita group membership (r = -.46) and lack of social trust (r = .76). In turn, both social trust and group membership were associated with total mortality, as well as rates of death from coronary heart disease, malignant neoplasms, and infant mortality. Conclusions. These data support the notion that income inequality leads to increased mortality via disinvestment in social capital. Handle: RePEc:aph:ajpbhl:1997:87:9:1491-1498_6 Template-Type: ReDIF-Article 1.0 Title: Social class and premature mortality among men: A method for state- based surveillance Journal: American Journal of Public Health Author-Name: Barnett, E. Author-Name: Armstrong, D.L. Author-Name: Casper, M.L. Year: 1997 Volume: 87 Issue: 9 Pages: 1521-1525 Abstract: Objectives. This study examined trends in mortality by social class for Black and White men aged 35 through 54 years in North Carolina, for 1984 through 1993, using an inexpensive, newly developed state-based surveillance method. Methods. Data from death certificates and census files permitted examination of four social classes, defined on the basis of occupation. Results. Premature mortality was inversely associated with social class for both Blacks and Whites. Blacks were at least twice as likely to die as Whites within each social class. Conclusions. Adoption of state-specific surveillance of social class and premature mortality would provide data crucial for developing and evaluating public health programs to reduce social inequalities in health. Handle: RePEc:aph:ajpbhl:1997:87:9:1521-1525_5 Template-Type: ReDIF-Article 1.0 Title: A shipboard outbreak of tuberculosis in Mississippi and Louisiana, 1993 to 1994 Journal: American Journal of Public Health Author-Name: Penman, A.D. Author-Name: Kohn, M.A. Author-Name: Fowler, M. Year: 1997 Volume: 87 Issue: 7 Pages: 1234 Handle: RePEc:aph:ajpbhl:1997:87:7:1234_3 Template-Type: ReDIF-Article 1.0 Title: Universal radiographic screening for tuberculosis among inmates upon admission to jail Journal: American Journal of Public Health Author-Name: Layton, M.C. Author-Name: Henning, K.J. Author-Name: Alexander, T.A. Author-Name: Gooding, A.L. Author-Name: Reid, C. Author-Name: Heyman, B.M. Author-Name: Leung, J. Author-Name: Gilmore, D.M. Author-Name: Frieden, T.R. Year: 1997 Volume: 87 Issue: 8 Pages: 1335-1337 Abstract: Objectives. This study evaluated the efficacy of radiographic screening for tuberculosis in correctional facilities. Methods. Inmates at an admission facility in New York, NY, were screened for tuberculosis by registry, cross- match, symptom, interviews, tuberculin testing, and chest radiography. Results. Thirty-two cases of tuberculosis were detected among 4172 inmate admissions (767 cases per 100 000). Twenty-five inmates (78%) were previously diagnosed but incompletely treated; all were identified by registry cross- match. Seven inmates (22%) were newly diagnosed, of whom four (57%) were asymptomatic, had negative skin tests, and were detected only by their abnormal radiographs. Conclusions. Screening strategies that limit radiographic testing to inmates with either positive skin tests or symptoms may result in missed opportunities for diagnosing active tuberculosis. Handle: RePEc:aph:ajpbhl:1997:87:8:1335-1337_4 Template-Type: ReDIF-Article 1.0 Title: The impact of parental consent on the HIV testing of minors Journal: American Journal of Public Health Author-Name: Meehan, T.M. Author-Name: Hansen, H. Author-Name: Klein, W.C. Year: 1997 Volume: 87 Issue: 8 Pages: 1338-1341 Abstract: Objectives. This investigation assessed change in use of human immunodeficiency virus (HIV) testing by minors after removal of the parental consent requirement in Connecticut. Methods. HIV counseling and testing records for 13- to 17-year-olds who accessed publicly funded testing sites were analyzed. Results. The number of visits increased by 44% from the 12- month period before the statutory change (n = 656) to the 12-month, period thereafter (n = 965). The number of HIV tests increased twofold. Visits and tests of high-risk minors tripled. Conclusions. Minors should have the right to consent to HIV testing. Handle: RePEc:aph:ajpbhl:1997:87:8:1338-1341_9 Template-Type: ReDIF-Article 1.0 Title: Public participation in medical policy-making and the status of consumer autonomy: The example of newborn-screening programs in the United States Journal: American Journal of Public Health Author-Name: Hiller, E.H. Author-Name: Landenburger, G. Author-Name: Natowicz, M.R. Year: 1997 Volume: 87 Issue: 8 Pages: 1280-1288 Abstract: 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 test 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. Handle: RePEc:aph:ajpbhl:1997:87:8:1280-1288_8 Template-Type: ReDIF-Article 1.0 Title: Blood lead testing by pediatricians: Practice, attitudes, and demographics Journal: American Journal of Public Health Author-Name: Ferguson, S.C. Author-Name: Lieu, T.A. Year: 1997 Volume: 87 Issue: 8 Pages: 1349-1351 Abstract: Objectives. This study aimed to evaluate adherence and identify ways to improve concordance between blood lead testing guidelines and practice. Methods. One hundred fifty-five pediatricians responded to a questionnaire assessing demographic, knowledge and attitudinal factors relating to lead testing. Results. Only 27% of the respondents adhered to the guidelines and less than half knew all of the answers to three factual questions about the recommendations. Adherence was higher among physicians who knew the guidelines were more recently trained, or had high proportions of Medicaid or minority patients. Conclusions. Physician education and financial incentives hold the most promise for increasing adherence to blood lead testing guidelines. Handle: RePEc:aph:ajpbhl:1997:87:8:1349-1351_1 Template-Type: ReDIF-Article 1.0 Title: The deterioration in children's nutritional status in rural chad: The effect of mothers' influence on feeding Journal: American Journal of Public Health Author-Name: Bégin, F. Author-Name: Habicht, J.-P. Author-Name: Frongillo Jr., E.A. Author-Name: Delisle, H. Year: 1997 Volume: 87 Issue: 8 Pages: 1356-1359 Abstract: 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 stunded 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. Handle: RePEc:aph:ajpbhl:1997:87:8:1356-1359_6 Template-Type: ReDIF-Article 1.0 Title: Cigarette smoking attitudes and first use among third-through sixth- grade students: The Bogalusa Heart Study Journal: American Journal of Public Health Author-Name: Greenlund, K.J. Author-Name: Johnson, C.C. Author-Name: Webber, L.S. Author-Name: Berenson, G.S. Year: 1997 Volume: 87 Issue: 8 Pages: 1345-1348 Abstract: Objectives. This study examined cigarette smoking attitudes, peer and parental influence, and first use among children in southeastern Louisiana. Methods. Data from 933 children in grade 3 through 6 in the Bogalusa Heart Study (1993 through 1994) were analyzed. Results. Fifteen percent of the children had tried smoking. Of these, 40% first smoked with a family member and 46% obtained their first cigarette from a family member or from home Correlates of ever having smoked were race, sex, having a best friend or family member, who smoked, and attitudes that smoking is disgusting and that nonsmokers get better grades. Conclusions. Prevention programs should begin early and focus on family and peer influences as well as attitudes. Handle: RePEc:aph:ajpbhl:1997:87:8:1345-1348_4 Template-Type: ReDIF-Article 1.0 Title: Quality assessment of fetal death records in Georgia: A method for improvement Journal: American Journal of Public Health Author-Name: Gaudino Jr., J.A. Author-Name: Blackmore-Prince, C. Author-Name: Yip, R. Author-Name: Rochat, R.W. Year: 1997 Volume: 87 Issue: 8 Pages: 1323-1327 Abstract: 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 imputing problem data for analyses, researchers should consider efforts to verify them. Efforts to improve this information should include improve reporting, strict quality assurance, and procedures for routine verification and correction of records. Handle: RePEc:aph:ajpbhl:1997:87:8:1323-1327_8 Template-Type: ReDIF-Article 1.0 Title: Public and private academic medical partnerships in improving nutritional management in phenylketonuria. Journal: American Journal of Public Health Author-Name: Lewis, V. Author-Name: Krause, S. Author-Name: Myers, C. Year: 1997 Volume: 87 Issue: 8 Pages: 1379 Handle: RePEc:aph:ajpbhl:1997:87:8:1379_8 Template-Type: ReDIF-Article 1.0 Title: The effect of vitamin A supplementation on the growth of preschool children in the Sudan Journal: American Journal of Public Health Author-Name: Fawzi, W.W. Author-Name: Herrera, M.G. Author-Name: Willett, W.C. Author-Name: Nestel, P. Author-Name: El Amin, A. Author-Name: Mohamed, K.A. Year: 1997 Volume: 87 Issue: 8 Pages: 1359-1362 Abstract: Objectives. This study assessed the effect of vitamin A supplementation at 6-month intervals on child growth. Methods. Sudanese, children (n = 28 740) 6 to 72 months of age were weighted and measured at baseline, and at each of three follow-up, visits. Results. Periodic vitamin A supplementation had no effect on the rate of weight or height gain in the total population or on the incidence of wasting, stunting or wasting and stunting among children who were normally nourished at baseline. Conclusions. Reducing poverty and improving access to adequate diets should remain the goals of programs designed to improve the nutritional status of malnourished populations. Handle: RePEc:aph:ajpbhl:1997:87:8:1359-1362_7 Template-Type: ReDIF-Article 1.0 Title: National trends in the mortality of children with sickle cell disease, 1968 through 1992 Journal: American Journal of Public Health Author-Name: Davis, H. Author-Name: Schoendorf, K.C. Author-Name: Gergen, P.J. Author-Name: Moore Jr., R.M. Year: 1997 Volume: 87 Issue: 8 Pages: 1317-1322 Abstract: Objectives. This paper describes national trends in mortality of children with sickle cells 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-years-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. Handle: RePEc:aph:ajpbhl:1997:87:8:1317-1322_5 Template-Type: ReDIF-Article 1.0 Title: Elevated blood lead levels in children of construction workers Journal: American Journal of Public Health Author-Name: Whelan, E.A. Author-Name: Piacitelli, G.M. Author-Name: Gerwel, B. Author-Name: Schnorr, T.M. Author-Name: Mueller, C.A. Author-Name: Gittleman, J. Author-Name: Matte, T.D. Year: 1997 Volume: 87 Issue: 8 Pages: 1352-1355 Abstract: Objectives. This study examined whether children of lead-exposed construction workers had higher blood lead levels than neighborhood control children. Methods. Twenty-nine construction workers were identified from the New Jersey Adult Blood Lead Epidemiology and Surveillance (ABLES) registry. Eighteen control families were referred by workers. Venous blood samples were collected from 50 children (31 exposed, 19 control subjects) under age 6. Results. Twenty-six percent of workers' children had blood lead levels at or over the Centers for Disease Control and Prevention action level of 0.48 μmol/L (10 μg/dL), compared with 5% of control children (unadjusted odds ratio = 6.1; 95% confidence interval = 0.9, 147.2). Conclusions. Children of construction workers may be at risk for excessive lead exposure. Health care providers should assess parental occupation as a possible pathway for lead exposure of young children. Handle: RePEc:aph:ajpbhl:1997:87:8:1352-1355_7 Template-Type: ReDIF-Article 1.0 Title: The underreporting of deaths of American Indian children in California, 1979 through 1993 Journal: American Journal of Public Health Author-Name: Epstein, M. Author-Name: Moreno, R. Author-Name: Bacchetti, P. Year: 1997 Volume: 87 Issue: 8 Pages: 1363-1366 Abstract: Objectives. This study linked birth and death certificate to determine misclassifications 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, of 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. Handle: RePEc:aph:ajpbhl:1997:87:8:1363-1366_5 Template-Type: ReDIF-Article 1.0 Title: Youth and violence on local television news in California Journal: American Journal of Public Health Author-Name: Dorfman, L. Author-Name: Woodruff, K. Author-Name: Chavez, V. Author-Name: Wallack, L. Year: 1997 Volume: 87 Issue: 8 Pages: 1311-1316 Abstract: Objectives. This study explores how local television news structures the public and policy debate on youth violence. Methods. A content analysis was performed on 214 hours of local television news from California. Each of the 1791 stories concerning youth, violence, or both was coded and analyzed for whether it included a public health perspective. Results. There were five key findings. First, violence dominated local television news coverage. Second, the specifics of particular crimes dominated coverage of violence. Third, over half of the stories on youth involved violence, while more than two thirds of the violence stories concerned youth. Fourth, episodic coverage of violence was more than five times more frequent than thematic coverage, which included links to broader social factors. Finally, only one story had an explicit public health frame. Conclusions. Local television news provides extremely limited coverage of contributing etiological factors in stories on violence. If our nation's most popular source of news continues to report on violence primarily through crime stories isolated from their social context, the chance for widespread support for public health solutions to violence will be diminished. Handle: RePEc:aph:ajpbhl:1997:87:8:1311-1316_1 Template-Type: ReDIF-Article 1.0 Title: Screening for adolescent smoking among primary care physicians in California Journal: American Journal of Public Health Author-Name: Franzgrote, M. Author-Name: Ellen, J.M. Author-Name: Millstein, S.G. Author-Name: Irwin Jr., C.E. Year: 1997 Volume: 87 Issue: 8 Pages: 1341-1345 Abstract: 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. Handle: RePEc:aph:ajpbhl:1997:87:8:1341-1345_3 Template-Type: ReDIF-Article 1.0 Title: Job strain and blood pressure in African Americans: The pitt county study Journal: American Journal of Public Health Author-Name: Curtis, A.B. Author-Name: James, S.A. Author-Name: Raghunathan, T.E. Author-Name: Alcser, K.H. Year: 1997 Volume: 87 Issue: 8 Pages: 1297-1302 Abstract: Objectives. This report examined whether job strain (or its components, decision latitude and job demands) was associated with elevated blood pressure levels in a community-based sample of 726 African-American adults. Methods. Blood-pressure, anthropometric, behavioral, demographic, and psychosocial data were collected for the current cross-sectional analyses during home interviews conducted for the second were (1993) of the Pitt County Study (North Carolina), a prospective cohort study of hypertension among African Americans. Results. Job strain was not associated with blood pressure among men or women in this study. However, men in the 80th percentile of decision latitude had more than a 50% decrease in the prevalence of hypertension compared with men in the 20th percentile (odds ratio = .46, 95% confidence interval = 22, 96). Conclusions. These results indicate that decision latitude may be important for hypertension risk among African-American men. More research is needed on African Americans to determine why job strain and its two component variables differ in their associations with blood pressure for men and women. Handle: RePEc:aph:ajpbhl:1997:87:8:1297-1302_7 Template-Type: ReDIF-Article 1.0 Title: Sociometric risk networks and risk for HIV infection Journal: American Journal of Public Health Author-Name: Friedman, S.R. Author-Name: Neaigus, A. Author-Name: Jose, B. Author-Name: Curtis, R. Author-Name: Goldstein, M. Author-Name: Ildefonso, G. Author-Name: Rothenberg, R.B. Author-Name: Des Jarlais, D.C. Year: 1997 Volume: 87 Issue: 8 Pages: 1289-1296 Abstract: 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 component 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. Handle: RePEc:aph:ajpbhl:1997:87:8:1289-1296_5 Template-Type: ReDIF-Article 1.0 Title: Mandatory parental involvement in minor's abortions: Effects of the laws in Minnesota, Missouri, and Indiana Journal: American Journal of Public Health Author-Name: Ellertson, C. Year: 1997 Volume: 87 Issue: 8 Pages: 1367-1374 Abstract: Objectives. This study examined the effects of parental involvement laws on the birthrate, in-state abortion rate, odds of interstate travel, and odds of late abortion for minors. Methods. Poisson and logistic regression models fitted to vital records compared the periods before and after the laws were enforced. Results. In each state, the instate abortion rate for minors fell (relative to the rate for older women) when parental involvement laws took effect. Data offered no empirical support for the proposition that the laws drive up birthrates for minors. Although data were incomplete, the laws appeared to increase the odds of a minor's traveling out of state for her abortion. If one judges from the available data, minors who traveled out of state may have accounted for the entire observed rate, at least in Missouri. The laws appeared to delay minors' abortions past the eighth week, but probably not into the second trimester. Conclusions. Several empirical arguments used against and in support of parental involvement laws do not appear to be substantiated. Handle: RePEc:aph:ajpbhl:1997:87:8:1367-1374_8 Template-Type: ReDIF-Article 1.0 Title: The effects of a 2-year physical education program (SPARK) on physical activity and fitness in elementary school students Journal: American Journal of Public Health Author-Name: Sallis, J.F. Author-Name: McKenzie, T.L. Author-Name: Alcaraz, J.E. Author-Name: Kolody, B. Author-Name: Faucette, N. Author-Name: Hovell, M.F. Year: 1997 Volume: 87 Issue: 8 Pages: 1328-1334 Abstract: Objectives. This study evaluated a health-related physical education program for fourth- and fifth-grade students designed to increase physical activity during physical education classes and outside of school. Methods. Seven schools were assigned to three conditions in a quasi-experimental design. Health related physical education was taught by physical education specialists or trained classroom teachers. Students from these classes were compared with those in control classes. Analyses were conducted on 955 students with complete data. Results. Students spent more minutes per week being physically active in specialist-led (40 min) and teacher-led (33 min) physical education classes than in control classes, (18 min; P < .001). After 2 years, girls in the specialist-led condition were superior to girls in the control condition on abdominal strength and endurance (P < .001) and cardiorespiratory endurance (P < .001). There were no effects on physical activity outside of school. Conclusions. A health-related physical education curriculum can provide students with substantially more physical activity during physical education classes. Improved physical education classes can potentially benefit 97% of elementary school students. Handle: RePEc:aph:ajpbhl:1997:87:8:1328-1334_6 Template-Type: ReDIF-Article 1.0 Title: Psychiatric symptoms in adolescence as predictors of obesity in early adulthood: A longitudinal study Journal: American Journal of Public Health Author-Name: Pine, D.S. Author-Name: Cohen, P. Author-Name: Brook, J. Author-Name: Coplan, J.D. Year: 1997 Volume: 87 Issue: 8 Pages: 1303-1310 Abstract: Objectives. This study examined the longitudinal relationship between psychopathology and obesity in young adulthood. Methods. More than 700 youth in a population-based sample were psychiatrically assessed in 1983 (mean age = 14 years) and 1992 (mean age = 22 years). Self-reported body mass index (BMI) in 1992 was regressed on measures of depression and conduct disorder as well as a set of covariates including indices of physical health, social class, intelligence, and cigarette and alcohol use. Associations were examined with BMI treated as a continuous variable and with a binary index of obesity derived from the BMI distribution in each gender. Results. BMI in young adults was positively related to a number of covariates. With all covariates controlled, BMI was inversely related to adult depressive symptoms in males but not females. BMI was positively related to adolescent symptoms of conduct disorder in both sexes. Similar associations were found between psychiatric symptoms and obesity. Conclusions. Conduct disorder symptoms in adolescence predicted BMI and obesity in early adulthood. These associations remained after controlling for factors that can affect the association between psychopathology and obesity. Handle: RePEc:aph:ajpbhl:1997:87:8:1303-1310_9 Template-Type: ReDIF-Article 1.0 Title: Flawed gun policy research could endanger public safety Journal: American Journal of Public Health Author-Name: Webster, D.W. Author-Name: Vernick, J.S. Author-Name: Ludwig, J. Author-Name: Lester, K.J. Year: 1997 Volume: 87 Issue: 6 Pages: 918-921 Abstract: A highly publicized recent study by Lott and Mustard concludes that laws easing restrictions on licenses for carrying concealed firearms in public substantially reduce violent crime. Several serious flaws in the study render the authors conclusions insupportable. These flaws include misclassification of gun-carrying laws, endogeneity of predictor variables, omission of confounding variables, and failure to control for the cyclical nature of crime trends. Most of these problems should bias results toward overestimating the crime-reducing effects of laws making it easier to carry concealed firearms in public. Lott and Mustard's statistical models produce findings inconsistent with criminological theories and well-established facts about crime, and subsequent reanalysis of their data challenges their conclusions. Public health professionals should understand the methodological issues raised in this commentary, particularly when flawed research could influence the introduction of policies with potentially deleterious consequences. Handle: RePEc:aph:ajpbhl:1997:87:6:918-921_9 Template-Type: ReDIF-Article 1.0 Title: The distance to community medical care and the likelihood of hospitalization: Is closer always better? Journal: American Journal of Public Health Author-Name: Goodman, D.C. Author-Name: Fisher, E. Author-Name: Slukel, T.A. Author-Name: Chang, C.-H. Year: 1997 Volume: 87 Issue: 7 Pages: 1144-1150 Abstract: Objectives: This study examined the influence that distance from residence to the nearest hospital had on the likelihood of hospitalization and mortality. Methods: Hospitalizations were studied for Maine, New Hampshire, and Vermont during 1989 (adults) and for 1985 through 1989 (children) and for mortality (1989) in Medicare enrollees. Results: After other known predictors of hospitalization (age, sex, bed supply, median household income, rural residence, academic medical center, and presence of nursing home patients) were controlled for, the adjusted rate ratio of medical hospitalization for residents living more than 30 minutes away was 0.85 (95% confidence interval [CI] = 0.82, 0.88) for adults and 0.78 (95% CI = 0.74, 0.81) for children, compared with those Flying in a zip code with a hospital. Similar effects were seen for the four most common diagnosis- related groups for both adults and children. The likelihood of hospitalization for conditions usually requiring hospitalization and for mortality in the elderly did not differ by distance. Conclusions: Distance to the hospital exerts an important influence on hospitalization rates that is unlikely to be explained by illness rates. Handle: RePEc:aph:ajpbhl:1997:87:7:1144-1150_9 Template-Type: ReDIF-Article 1.0 Title: An association between the heat-humidity index and preterm labor and delivery: A preliminary analysis Journal: American Journal of Public Health Author-Name: Lajinian, S. Author-Name: Hudson, S. Author-Name: Applewhite, L. Author-Name: Feldman, J. Author-Name: Minkoff, H.L. Year: 1997 Volume: 87 Issue: 7 Pages: 1205-1207 Abstract: Objectives: The goal of this study was to determine whether a relationship exists between heat-humidity indexes and rates of preterm labor and preterm delivery. Methods: Preterm labor and delivery rates were compared during the 2 summer and 2 winter weeks with the highest and lowest heat- humidity indexes for each season. Results: The rate of preterm labor increased consistently from 1.23% to 3.00% as the heat-humidity index rose. When preterm births were examined, the trend was similar but not statistically significant. Conclusions: Given the public health import of preterm labor and the frequency with which pregnant women may be exposed to extremes of heat, studies designed to confirm or refute our preliminary observations are warranted. Handle: RePEc:aph:ajpbhl:1997:87:7:1205-1207_6 Template-Type: ReDIF-Article 1.0 Title: Hospital use and health status of women during the 5 years following the birth of a premature, low-birthweight infant Journal: American Journal of Public Health Author-Name: Haas, J. Author-Name: McCormick, M.C. Year: 1997 Volume: 87 Issue: 7 Pages: 1151-1155 Abstract: Objective. This study examined the health status and hospital use of women after the birth of a premature, low-birthweight infant. Methods: The subjects were women with infants who participated in a multisite, randomized trial of an early intervention program. The outcomes examined were (1) a maternal health rating of poor or fair (i.e., poorer health) 5 years following delivery and (2) hospital use for a non-pregnancy-related condition. Results: By the fifth year after delivery, 29.7% of the women had been hospitalized for a non-pregnancy-related condition. Women who reported poorer health status (adjusted relative risk [RR] = 2.39; 95% confidence interval [CI] = 1.86, 3.07) or who had asthma (RR = 2.24; CI = 1.31, 3.80) were at greatest risk. After 5 years, 16.9% of the women said they were in poorer health. The number of intervening years in poorer health (1 year, RR = 3.17; CI = 2.04, 4.94; >1 year, RR = 8.42; CI = 5.50, 12.88), more than 1 year of poverty (RR = 3.28; CI = 1.90, 5.66), obesity (RR = 3.30: CI = 1.44, 7.55), and more than 1 year of employment (RR = 0.55; CI = 0.36, 0.86) were all significantly associated with poorer health. Conclusions: The continued, substantial morbidity and hospital use of women with a premature, low- birthweight infant has not previously been reported. This observation needs to be verified. Handle: RePEc:aph:ajpbhl:1997:87:7:1151-1155_9 Template-Type: ReDIF-Article 1.0 Title: The use of outpatient mental health services in the United States and Ontario: The impact of mental morbidity and perceived need for care Journal: American Journal of Public Health Author-Name: Katz, S.J. Author-Name: Kessler, R.C. Author-Name: Frank, R.G. Author-Name: Leaf, P. Author-Name: Elizabeth, L. Author-Name: Edlund, M. Year: 1997 Volume: 87 Issue: 7 Pages: 1136-1143 Abstract: 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. Handle: RePEc:aph:ajpbhl:1997:87:7:1136-1143_4 Template-Type: ReDIF-Article 1.0 Title: Sunbathing habits and sunscreen use among white adults: Results of a national survey Journal: American Journal of Public Health Author-Name: Koh, H.K. Author-Name: Bak, S.M. Author-Name: Geller, A.C. Author-Name: Mangione, T.W. Author-Name: Hingson, R.W. Author-Name: Levenson, S. Author-Name: Miller, D.R. Author-Name: Lew, R.A. Author-Name: Howland, J. Year: 1997 Volume: 87 Issue: 7 Pages: 1214-1217 Abstract: 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. Handle: RePEc:aph:ajpbhl:1997:87:7:1214-1217_5 Template-Type: ReDIF-Article 1.0 Title: Tobacco and alcohol use behaviors portrayed in music videos: A content analysis Journal: American Journal of Public Health Author-Name: Durant, R.H. Author-Name: Rome, E.S. Author-Name: Rieh, M. Author-Name: Allred, E. Author-Name: Jean Ernans, S. Author-Name: Woods, E.R. Year: 1997 Volume: 87 Issue: 7 Pages: 1131-1135 Abstract: Objectives: Music videos from five genres of music were analyzed for portrayals of tobacco and alcohol use and for portrayals of such behaviors in conjunction with sexuality. Methods: Music videos (n = 518) were recorded during randomly selected days and times from four television networks. Four female and four male observers aged 17 to 24 years were trained to use a standardized content analysis instrument. All videos were observed by rotating two-person, male-female teams who were required to reach agreement on each behavior that was scored. Music genre and network differences in behaviors were analyzed with chisquared tests. Results: A higher percentage (25.7%) of MTV videos than other network videos portrayed tobacco use. The percentage of videos showing alcohol use was similar on all four networks. In videos that portrayed tobacco and alcohol use, the lead performer was most often the one smoking or drinking and the use of alcohol was associated with a high degree of sexuality on all the videos. Conclusions: These data indicate that even modest levels of viewing may result in substantial exposure to glamorized depictions of alcohol and tobacco use and alcohol use coupled with sexuality. Handle: RePEc:aph:ajpbhl:1997:87:7:1131-1135_8 Template-Type: ReDIF-Article 1.0 Title: Industrial workers' health and environmental pollution under the new international division of labor: The Taiwan experience Journal: American Journal of Public Health Author-Name: Chen, M.-S. Author-Name: Huang, C.-L. Year: 1997 Volume: 87 Issue: 7 Pages: 1223-1231 Abstract: 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. Handle: RePEc:aph:ajpbhl:1997:87:7:1223-1231_0 Template-Type: ReDIF-Article 1.0 Title: National health care reform and the 103rd Congress: The activities and influence of public health advocates Journal: American Journal of Public Health Author-Name: Schauffler, H.H. Author-Name: Wilkerson, J. Year: 1997 Volume: 87 Issue: 7 Pages: 1107-1112 Abstract: Objectives: This study examined the activities and influence of public health interest groups and coalitions on the national health care reform debates in the 103rd Congress. Methods: Congressional staff and representatives of public health interest groups, coalitions, and government health agencies were interviewed. Content analysis of eight leading national health care reform bills was performed. Results: The public health community coalesced around public health in health care reform; nearly all the major interest groups and government health agencies joined two or more public health or prevention coalitions, and half joined three or more. The most effective influence on health care reform legislation was early, sustained personal contact with Congress members and their staffs, accompanied by succinct written materials summarizing key points. Media campaigns and grassroots mobilization were less effective. Seven of the eight leading health care reform bills included one or more of the priorities supported by public health advocates. Conclusions: The public health community played an important role in increasing awareness and support for public health programs in the health care reform bills of the 103rd Congress. Handle: RePEc:aph:ajpbhl:1997:87:7:1107-1112_7 Template-Type: ReDIF-Article 1.0 Title: Survival rates for four forms of cancer in the United States and Ontario Journal: American Journal of Public Health Author-Name: Keller, D.M. Author-Name: Peîerson, E.A. Author-Name: Silbennan, G. Year: 1997 Volume: 87 Issue: 7 Pages: 1164-1167 Abstract: Objectives: In this study, cancer survival rates for patients diagnosed in Ontario and selected areas within the United States were compared. Methods: Relative survival rates were computed for patients aged 15 through 84 years diagnosed with any of four forms of cancer (breast, colon, lung, and Hodgkin's disease). The cohorts represented those diagnosed over the years 1978 through 1986 in the Canadian province of Ontario and in nine regions covered by the US National Cancer Institute's Surveillance Epidemiology and End Results program. Patients were followed through the end of 1990. Results: The cumulative relative survival rates were similar for American and Canadian patients. The largest difference was observed for breast cancer, where patients in the United States enjoyed a survival advantage throughout the follow-up period. Conclusions: Patients in the United States and Ontario with the diseases studied, except for breast cancer, experience very similar survival. The greater use of mammographic screening in the United States could account for that country's higher breast cancer survival rate by promoting earlier and therefore more efficacious treatment, by introducing bias, or by a combination of both treatment and bias factors. Handle: RePEc:aph:ajpbhl:1997:87:7:1164-1167_6 Template-Type: ReDIF-Article 1.0 Title: The costs and effects of cervical and breast cancer screening in a public hospital emergency room Journal: American Journal of Public Health Author-Name: Mandelblatt, J. Author-Name: Freeman, H. Author-Name: Winczewski, D. Author-Name: Cagney, K. Author-Name: Williams, S. Author-Name: Trowern, R. Author-Name: Tang, J. Author-Name: Gold, K. Author-Name: Lin Hsiang, T. Author-Name: Kemer, J. Year: 1997 Volume: 87 Issue: 7 Pages: 1182-1189 Abstract: Objectives: This study assessed the cost-effectiveness of cervix and breast cancer screening in a public hospital emergency room. Methods: Age- eligible women with nonurgent conditions and without recent screening were offered screening by a nurse. A decision analysis compared the costs and outcomes of emergency room screening and standard hospital screening efforts. Results: The undiscounted cost-effectiveness results for establishing new programs were $4050 (cervical cancer), $403 203 (breast cancer), and $4375 (joint cervix and breast cancer) per year of life saved. If screening is added to an existing program, results are more favorable ($429, $21 324, and $479 per year of life saved for cervix, breast, and joint screening, respectively). Results were most sensitive to volume and probability of receiving treatment after an abnormal screen. Conclusions: Emergency room screening was cost-effective for cervical cancer; breast cancer screening was relatively expensive given the low number of women reached. More intensive recruitment and follow-up strategies are needed to maximize the cost- effectiveness of such programs. Handle: RePEc:aph:ajpbhl:1997:87:7:1182-1189_1 Template-Type: ReDIF-Article 1.0 Title: Socioeconomic status and breast cancer mortality, 1989 through 1993: An analysis of education data from death certificates Journal: American Journal of Public Health Author-Name: Heck, K.E. Author-Name: Wagener, D.K. Author-Name: Schatzkin, A. Author-Name: Devesa, S.S. Author-Name: Breen, N. Year: 1997 Volume: 87 Issue: 7 Pages: 1218-1222 Abstract: Objectives: This study examined whether more highly educated women were at greater risk of dying of breast cancer during 1989 through 1993. Methods: Breast cancer mortality rates were calculated through death certificates and Current Population Survey data. Results: Breast cancer mortality rates were highest among women with 12 and with 16 or more years of education. Non- Hispanic Black women had the highest mortality rates and Asian women the lowest. Positive relationships between mortality and education were found for Hispanic women as well as non-Hispanic Black and Asian women. Conclusions: The previously seen positive relationship between breast cancer mortality and education was found among US women of color but not non-Hispanic White women. Handle: RePEc:aph:ajpbhl:1997:87:7:1218-1222_6 Template-Type: ReDIF-Article 1.0 Title: An international comparison of cancer survival: Toronto, Ontario, and Detroit, Michigan, metropolitan areas Journal: American Journal of Public Health Author-Name: Gorey, K.M. Author-Name: Holowaty, E.J. Author-Name: Fehringer, G. Author-Name: Laukkanen, E. Author-Name: Moskowitz, A. Author-Name: Webster, D.J. Author-Name: Richter, N.L. Year: 1997 Volume: 87 Issue: 7 Pages: 1156-1163 Abstract: 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. Handle: RePEc:aph:ajpbhl:1997:87:7:1156-1163_6 Template-Type: ReDIF-Article 1.0 Title: Neighborhood risk factors for low birthweight in Baltimore: A multilevel analysis Journal: American Journal of Public Health Author-Name: O'Campo, P. Author-Name: Xue, X. Author-Name: Wang, M.-C. Author-Name: Brien Caughy, M.O. Year: 1997 Volume: 87 Issue: 7 Pages: 1113-1118 Abstract: Objectives: Past research on low birthweight has focused on individual- level risk factors. We sought to assess the contribution of macrolevel social factors by using census tract-level data oil social stratification, community empowerment, and environmental stressors. Methods: Census tract-level information on social risk was linked to birth certificate records from Baltimore, Md, for the period 1985 through 1989. Individual-level factors included maternal education, maternal age, medical assistance health insurance (Medicaid), and trimester of prenatal care initiation. Methods of multilevel modeling using two-stage regression analyses were employed. Results: Macrolevel factors had both direct associations and interactions with low birthweight. All individual risk factors showed interaction with macrolevel variables; that is, individual-level risk factors for low birthweight behaved differently depending upon the characteristics of the neighborhood of residence. For example, women living in high-risk neighborhoods benefited less from prenatal care than did women living in lower-risk neighborhoods. Conclusions: Multilevel modeling is an important tool that allows simultaneous study of macro- and individual-level risk factors. Multilevel analyses should play a larger role in the formulation of public health policies. Handle: RePEc:aph:ajpbhl:1997:87:7:1113-1118_4 Template-Type: ReDIF-Article 1.0 Title: Evaluating OSHA's ethylene oxide standard: Employer exposure-monitoring activities in Massachusetts hospitals from 1985 through 1993 Journal: American Journal of Public Health Author-Name: Lamonîagne, A.D. Author-Name: Kelsey, K.T. Year: 1997 Volume: 87 Issue: 7 Pages: 1119-1125 Abstract: 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 perfomed 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. Handle: RePEc:aph:ajpbhl:1997:87:7:1119-1125_5 Template-Type: ReDIF-Article 1.0 Title: The association of drinking water source and chlorination by-products with cancer incidence among postmenopausal women in Iowa: A prospective cohort study Journal: American Journal of Public Health Author-Name: Doyle, T.J. Author-Name: Zheng, W. Author-Name: Cerhan, J.R. Author-Name: Hong, C.-P. Author-Name: Sellers, T.A. Author-Name: Kushi, L.H. Author-Name: Folsam, A.R. Year: 1997 Volume: 87 Issue: 7 Pages: 1168-1176 Abstract: 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 sed municipal groundwater 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. Handle: RePEc:aph:ajpbhl:1997:87:7:1168-1176_2 Template-Type: ReDIF-Article 1.0 Title: An evaluation of educational outreach to general practitioners as part of a statewide cervical screening program Journal: American Journal of Public Health Author-Name: Stevens, S.A. Author-Name: Cockburn, J. Author-Name: Hirst, S. Author-Name: Jolley, D. Year: 1997 Volume: 87 Issue: 7 Pages: 1177-1181 Abstract: 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, them was a statistically significant increase in number of Pap tests performed. Them 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. Handle: RePEc:aph:ajpbhl:1997:87:7:1177-1181_0 Template-Type: ReDIF-Article 1.0 Title: State-imposed limits on Medicaid reimbursement for nursing facility care Journal: American Journal of Public Health Author-Name: Swan, J.H. Author-Name: Harrington, C. Author-Name: De Wit, S.K. Author-Name: Zhong, M. Year: 1997 Volume: 87 Issue: 7 Pages: 1211-1213 Abstract: 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. Handle: RePEc:aph:ajpbhl:1997:87:7:1211-1213_5 Template-Type: ReDIF-Article 1.0 Title: The effect of cigarette taxes on cigarette consumption, 1955 through 1994 Journal: American Journal of Public Health Author-Name: Meier, K.J. Author-Name: Licari, M.J. Year: 1997 Volume: 87 Issue: 7 Pages: 1126-1130 Abstract: 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. Handle: RePEc:aph:ajpbhl:1997:87:7:1126-1130_7 Template-Type: ReDIF-Article 1.0 Title: A smoking cessation program at a public antenatal clinic Journal: American Journal of Public Health Author-Name: Walsh, R.A. Author-Name: Redman, S. Author-Name: Brinsmead, M.W. Author-Name: Byme, J.M. Author-Name: Melmelh, A. Year: 1997 Volume: 87 Issue: 7 Pages: 1201-1204 Abstract: 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. Handle: RePEc:aph:ajpbhl:1997:87:7:1201-1204_4 Template-Type: ReDIF-Article 1.0 Title: The delivery of preventive services in primary care practices according to chronic disease status Journal: American Journal of Public Health Author-Name: Fontana, S.A. Author-Name: Baumann, L.C. Author-Name: Helberg, C. Author-Name: Love, R.R. Year: 1997 Volume: 87 Issue: 7 Pages: 1190-1196 Abstract: Objectives: The current study examined the relationship between chronic disease status and the receipt of cancer preventive services over a 3-year period. Methods: Adults (n = 4320) cared for by 167 nonacademic physicians in 42 primary care group practices were studied. Medical records were audited for each patient, as were patient responses to two questionnaires assessing health and socio-demographic characteristics. Results: While the odds of having received counseling to obtain regular checkups were increased for men (1.56) and women (1.46) with hypertension, the odds were reduced (range = 0.32 to 0.81) for having received a sigmoidoscopy (women with diabetes or hypertension, men with hypertension or heart disease), fecal occult blood test (men with diabetes or heart disease, women with heart disease), mammogram or counseling about smoking (women with diabetes), clinical breast exam (women with heart disease), and Pap test (women with diabetes or heart disease). Conclusions: The presence of common chronic health problems in older adults is associated with lower levels of cancer screening services. Handle: RePEc:aph:ajpbhl:1997:87:7:1190-1196_6 Template-Type: ReDIF-Article 1.0 Title: State legislators' attitudes and voting intentions toward tobacco control legislation Journal: American Journal of Public Health Author-Name: Goldstein, A.O. Author-Name: Cohen, J.E. Author-Name: Flynn, B.S. Author-Name: Gottlieb, N.H. Author-Name: Solomon, L.J. Author-Name: Dana, G.S. Author-Name: Bauman, K.E. Author-Name: Munger, M.C. Year: 1997 Volume: 87 Issue: 7 Pages: 1197-1200 Abstract: 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. Handle: RePEc:aph:ajpbhl:1997:87:7:1197-1200_7 Template-Type: ReDIF-Article 1.0 Title: Vaginal douching and adverse health effects: A meta-analysis Journal: American Journal of Public Health Author-Name: Zliang, J. Author-Name: George Thomas, A. Author-Name: Leybovich, E. Year: 1997 Volume: 87 Issue: 7 Pages: 1207-1211 Abstract: 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. Handle: RePEc:aph:ajpbhl:1997:87:7:1207-1211_0 Template-Type: ReDIF-Article 1.0 Title: Policy research for disease prevention: Challenges and practical recommendations Journal: American Journal of Public Health Author-Name: Brownson, R.C. Author-Name: Newschaffer, C.J. Author-Name: Ali-Abarghoui, F. Year: 1997 Volume: 87 Issue: 5 Pages: 735-739 Abstract: Policy approaches to health promotion and disease prevention hold great potential, as several community-based projects have illustrated. Policy interventions, despite their widespread use, frequently lack a systematic framework for implementation and evaluation. The authors propose a four- stage framework for the formation and evaluation of public health policy. The stages are identification of health risks and preventive options; intervention development; policy development; and policy enactment and assurance. A strong focus on evaluation is included within the framework. In addition, a series of practical implications and recommendations are given under the broad headings of evaluation issues and linkages. It is hoped that the issues described will lead to more systematic implementation and evaluation of public health policy measures. Handle: RePEc:aph:ajpbhl:1997:87:5:735-739_0 Template-Type: ReDIF-Article 1.0 Title: Infant survival, HIV infection, and feeding alternatives in to less- developed countries Journal: American Journal of Public Health Author-Name: Kuhn, L. Author-Name: Stein, Z. Year: 1997 Volume: 87 Issue: 6 Pages: 926-931 Abstract: Objectives. This study examines, in the context of the human immunodeficiency virus (HIV) epidemic, the effects of optimal breast-feeding, complete avoidance of breast-feeding, and early cessation of breast-feeding. Methods. The three categories of breast-feeding were weighed in terms of HIV transmission and infant mortality. Estimates of the frequency of adverse outcomes were obtained by simulation. Results. Avoidance of all breastfeeding by the whole population always produces the worst outcome. The lowest frequency of adverse outcomes occurs if no HIV-seropositive women breast- feed and all seronegative women breast-feed optimally, given infant mortality rates below 100 per 1000 and relative risks of dying set at 2.5 for non- breast-fed compared with optimally breast-fed infants. For known HIV- seropositive mothers, fewer adverse outcomes result from early cessation than from prolonged breast-feeding if the hazard of HIV transmission through breast-feeding after 3 months is 7% or more, even at high mortality rates, given relative risks of dying set at 1.5 for early cessation compared with optimal duration of breast-feeding. Conclusions. The risk of HIV transmission through breast-feeding at various ages needs to be more precisely quantified. The grave issues that may accompany a possible decline in breast-feeding in the less developed world demand evaluation. Handle: RePEc:aph:ajpbhl:1997:87:6:926-931_6 Template-Type: ReDIF-Article 1.0 Title: Routine prenatal screening for congenital heart disease: What can be expected? A decision-analytic approach Journal: American Journal of Public Health Author-Name: Buskens, E. Author-Name: Steyerberg, E.W. Author-Name: Hess, J. Author-Name: Wladimiroff, J.W. Author-Name: Grobbee, D.E. Year: 1997 Volume: 87 Issue: 6 Pages: 962-967 Abstract: Objectives. This study assessed the potential impact of fetal ultrasound screening on the number of newborns affected by cardiac anomalies. Methods. A decision model was developed that included the prevalence and history of congenital heart disease. characteristics of ultrasound, risk of abortion, and attitude toward pregnancy termination. Probabilities were obtained with a literature survey; sensitivity analysis showed their influence on expected outcomes. Results. Presently, screening programs may prevent the birth of approximately 1300 severely affected newborns per million second-trimester pregnancies. However, over 2000 terminations of pregnancy would be required, 750 of which would have ended in intrauterine death or spontaneous abortion. Further, 9900 false-positive screening results would occur, requiring referral. Only the sensitivity of routine screening and attitude toward termination of pregnancy appeared to influence the yield substantially. Conclusions. The impact of routine screening for congenital heart disease appeared relatively small. Further data may be required to fully assess the utility of prenatal screening. Handle: RePEc:aph:ajpbhl:1997:87:6:962-967_1 Template-Type: ReDIF-Article 1.0 Title: The campaign to raise the tobacco tax in Massachusetts Journal: American Journal of Public Health Author-Name: Heiser, P.F. Author-Name: Begay, M.E. Year: 1997 Volume: 87 Issue: 6 Pages: 968-973 Abstract: Objectives. Question 1 raised the Massachusetts state tobacco tax to fund tobacco education programs. This paper examines the process of qualifying and passing Question 1. Methods. Information was gathered from internal memoranda, meeting minutes, newspaper articles, internal documents, letters, newsletters, news and press releases, and personal interviews. Data about campaign contributions were obtained from the Massachusetts Office of Campaign and Political Finance. Results. Three factors help explain why Question 1 passed: (1) the policy environment was favorable because of the social unacceptability of smoking; (2) the activists assembled a large coalition of supporters: and (3) the activists countered industry claims that the new tax would hurt small business and lower-income smokers and would be wasted by the legislature. The ballot initiative passed despite the industry's $7 million campaign to defeat it. Conclusions. The apparent influence of the tobacco industry on the legislature was the driving force behind the decision of public health activists to qualify Question 1. Moving policy-making out of the legislature into the public arena widened the scope of conflict and enabled public health activists to win. Handle: RePEc:aph:ajpbhl:1997:87:6:968-973_5 Template-Type: ReDIF-Article 1.0 Title: Improving Americans' diet. Journal: American Journal of Public Health Author-Name: Jarka, E. Year: 1997 Volume: 87 Issue: 6 Pages: 1061 Handle: RePEc:aph:ajpbhl:1997:87:6:1061_8 Template-Type: ReDIF-Article 1.0 Title: The effectiveness of a school-based curriculum for reducing violence among urban sixth-grade students Journal: American Journal of Public Health Author-Name: Farrell, A.D. Author-Name: Meyer, A.L. Year: 1997 Volume: 87 Issue: 6 Pages: 979-984 Abstract: Objectives. In this study, we examine the impact of a school-based curriculum designed to reduce violence among urban sixth-grade students. Methods. This study used a staggered implementation design in which sixth- graders in six middle schools were taught an 18-session violence-prevention curriculum during either the fall or spring semester. Outcome measures were completed at the beginning, middle, and end of the school year. Results. For boys, participation in the program during the fall resulted in significant postintervention differences in the self-reported frequency of violence and several other problem behaviors. Most of these differences were maintained at the end of the school year. Girls, in contrast, did not appear to benefit from the program. Conclusion. These results support the use of a school- based curriculum for reducing violence among sixth-grade boys. They also underscore the importance of early intervention and the necessity of examining gender effects in evaluating such programs. Handle: RePEc:aph:ajpbhl:1997:87:6:979-984_0 Template-Type: ReDIF-Article 1.0 Title: The association between the purchase of a handgun and homicide or suicide Journal: American Journal of Public Health Author-Name: Cummings, P. Author-Name: Koepsell, T.D. Author-Name: Grossman, D.C. Author-Name: Savarino, J. Author-Name: Thompson, R.S. Year: 1997 Volume: 87 Issue: 6 Pages: 974-978 Abstract: 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 for 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. Handle: RePEc:aph:ajpbhl:1997:87:6:974-978_6 Template-Type: ReDIF-Article 1.0 Title: Profiles of violent youth: Substance use and other concurrent problems Journal: American Journal of Public Health Author-Name: Ellickson, P. Author-Name: Saner, H. Author-Name: McGuigan, K.A. Year: 1997 Volume: 87 Issue: 6 Pages: 985-991 Abstract: Objectives. This study examined the prevalence of various violent behaviors among high schoolage adolescents, the co-occurrence of teenage violence with other public health problems, and gender differences in violence. Methods. Longitudinal data for more than 4500 high school seniors and dropouts from California and Oregon were used to develop weighted estimates of the prevalence of violent behavior and its co-occurrence with other emotional and behavioral problems. Results. More than half the sample had engaged in violence during the last year, and one in four had committed predatory violence. Boys were more likely than girls to engage in most types of violence, but both were equally prone to violence within the family. Violent youth were more likely than their peers to have poor mental health, use drugs, drop out of school, and be delinquent. Violent boys were more likely than violent girls to commit nonviolent felonies and sell drugs, but less likely to have poor mental health or become a parent. Prevalence estimates for violence co-occurring with three or more other problems ranged from 4% to 21%. Conclusions. Teenage violence typically coexists with additional emotional and behavioral problems. Programs must consider the broader public health context in which violence occurs. Handle: RePEc:aph:ajpbhl:1997:87:6:985-991_1 Template-Type: ReDIF-Article 1.0 Title: Weapon carrying among black adolescents: A social network perspective Journal: American Journal of Public Health Author-Name: Myers, G.P. Author-Name: McGrady, G.A. Author-Name: Marrow, C. Author-Name: Mueller, C.W. Year: 1997 Volume: 87 Issue: 6 Pages: 1038-1040 Abstract: Objectives. This report describes the salience of social networks to the phenomena of adolescent weapon carrying. Methods. A random-walk network sampling design was used to survey 113 adolescents about topics, including weapon carrying. Results. In a probability sample of 12- to 15-year-olds, 20.9% reported ever carrying a weapon. Carriers were eight times as likely as noncarriers to report weapon carrying by an older associate, and 19 times as likely to report weapon carrying by a peer. A significant dose-response effect was present. Conclusions. This evidence supports the interpretation that modeling of weapon carrying by personal network members is important for its initiation and maintenance in adolescence. Handle: RePEc:aph:ajpbhl:1997:87:6:1038-1040_9 Template-Type: ReDIF-Article 1.0 Title: Assessing children's ultraviolet radiation exposure: The use of parental recall via telephone interviews Journal: American Journal of Public Health Author-Name: Mayer, J.A. Author-Name: Sallis, J.F. Author-Name: Eckhardt, L. Author-Name: Creech, L. Author-Name: Johnston, M.R. Author-Name: Elder, J.P. Author-Name: Lui, K.J. Year: 1997 Volume: 87 Issue: 6 Pages: 1046-1049 Abstract: Objectives. This study evaluated the validity of a parental report measure of children's solar protection behaviors. Methods. Fifty-eight children had skin color assessed twice with a colorimeter. Between measurement sessions, parents were interviewed by telephone to assess children's indoor-outdoor status and solar protection across 40 hourly intervals. Results. Parental report of child's indoor-outdoor status was significantly correlated with the colorimeter values, whereas the use of sunscreen and protective clothing was not. Conclusions. This measure was feasible for assessing ultraviolet exposure in young children. The component that assessed the number of intervals spent outdoors evidenced predictive validity. Handle: RePEc:aph:ajpbhl:1997:87:6:1046-1049_5 Template-Type: ReDIF-Article 1.0 Title: Frequent attendance at religious services and mortality over 28 years Journal: American Journal of Public Health Author-Name: Strawbridge, W.J. Author-Name: Cohen, R.D. Author-Name: Shema, S.J. Author-Name: Kaplan, G.A. Year: 1997 Volume: 87 Issue: 6 Pages: 957-961 Abstract: Objectives. This study analyzed the long-term association between religious attendance anti 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 County 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. Handle: RePEc:aph:ajpbhl:1997:87:6:957-961_5 Template-Type: ReDIF-Article 1.0 Title: Milk, dietary calcium, and bone fractures in women: A 12-year prospective study Journal: American Journal of Public Health Author-Name: Feskanich, D. Author-Name: Willett, W.C. Author-Name: Stampfer, M.J. Author-Name: Colditz, G.A. Year: 1997 Volume: 87 Issue: 6 Pages: 992-997 Abstract: Objectives. This study examined whether higher intakes of milk and other calcium-rich foods during adult years can reduce the risk of osteoporotic fractures. Methods. This was a 12-year prospective study among 77761 women, aged 34 through 59 years in 1980, who had never used calcium supplements. Dietary intake was assessed with a food-frequency questionnaire in 1980, 1984, and 1986. Fractures of the proximal femur (n = 133) and distal radius (n = 1046) from low or moderate trauma were serf-reported on biennial questionnaires. Results. We found no evidence that higher intakes of milk or calcium from food sources reduce fracture incidence. Women who drank two or more glasses of milk per day had relative risks of 1.45 for hip fracture (95% confidence interval [CI] = 0.87, 2.43) and 1.05 for forearm fracture (95% CI = 0.88, 1.25) when compared with women consuming one glass or less per week. Likewise, higher intakes of total dietary calcium or calcium from dairy foods were not associated with decreased risk of hip or forearm fracture. Conclusions. These data do not support the hypothesis that higher consumption of milk or other food sources of calcium by adult women protects against hip or forearm fractures. Handle: RePEc:aph:ajpbhl:1997:87:6:992-997_6 Template-Type: ReDIF-Article 1.0 Title: Ethical dilemmas in current planning for polio eradication Journal: American Journal of Public Health Author-Name: Taylor, C.E. Author-Name: Cutts, F. Author-Name: Taylor, M.E. Year: 1997 Volume: 87 Issue: 6 Pages: 922-925 Abstract: Intensification of polio eradication efforts worldwide raises concerns about costs and benefits for poor countries. A major argument for global funding is the high benefit-cost ratio of eradication; however, financial benefits are greatest for rich countries. By contrast, the greatest costs are borne by poor countries; the Pan American Health Organization has estimated that host countries bore 80% of costs for polio eradication in the Americas. The 1988 World Health Assembly resolution setting up the Polio Eradication Initiative carried the proviso that programs should strengthen health infrastructures. Drastic cuts in donor funding for health make this commitment even more important. Two international evaluations have reported both positive and negative effects of polio and Expanded Programme on Immunization programs on the functioning and sustainability of primary health care. Negative effects were greatest in poor countries with many other diseases of public health importance. If poor countries are expected to divert funds from their own urgent priorities, donors should make solid commitments to long-term support for sustainable health development. Handle: RePEc:aph:ajpbhl:1997:87:6:922-925_4 Template-Type: ReDIF-Article 1.0 Title: Some correlates of self-rated health for australian women Journal: American Journal of Public Health Author-Name: Shadbolt, B. Year: 1997 Volume: 87 Issue: 6 Pages: 951-956 Abstract: 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. Handle: RePEc:aph:ajpbhl:1997:87:6:951-956_0 Template-Type: ReDIF-Article 1.0 Title: The effect of high altitude and other risk factors on birthweight: Independent or interactive effects? Journal: American Journal of Public Health Author-Name: Jensen, G.M. Author-Name: Moore, L.G. Year: 1997 Volume: 87 Issue: 6 Pages: 1003-1007 Abstract: Objectives. This study examined whether the decline in birthweight with increasing altitude is due to an independent effect of altitude or an exacerbation of other risk factors. Methods. Maternal, paternal, and infant characteristics were obtained from 3836 Colorado birth certificates from 1989 through 1991. Average altitude of residence for each county was determined. Results. None of the characteristics related to birthweight (gestational age, maternal weight gain, parity, smoking, prenatal care visits, hypertension, previous small-forgestational-age infant, female newborn) interacted with the effect of altitude. Birthweight declined an average of 102 g per 3300 ft (1000 m) elevation when the other characteristics were taken into account, increasing the percentage of low birthweight by 54% from the lowest to the highest elevations in Colorado. Conclusions. High altitude acts independently from other factors to reduce birthweight and accounts for Colorado's high rate of low birthweight. Handle: RePEc:aph:ajpbhl:1997:87:6:1003-1007_2 Template-Type: ReDIF-Article 1.0 Title: Determining injury at work on the california death certificate Journal: American Journal of Public Health Author-Name: Peek-Asa, C. Author-Name: McArthur, D.L. Author-Name: Kraus, J.F. Year: 1997 Volume: 87 Issue: 6 Pages: 998-1002 Abstract: Objectives. This study examined decisions of California County 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. Nonpayment, 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. Handle: RePEc:aph:ajpbhl:1997:87:6:998-1002_0 Template-Type: ReDIF-Article 1.0 Title: Maternal employment and breast-feeding: Findings from the 1988 national maternal and infant health survey Journal: American Journal of Public Health Author-Name: Visness, C.M. Author-Name: Kennedy, K.I. Year: 1997 Volume: 87 Issue: 6 Pages: 945-950 Abstract: Objectives. This analysis uses nationally representative data from the 1988 National Maternal and Infant Health Survey to explore the factors, including employment, associated with breast-feeding initiation and duration. Methods. Multiple logistic regression was used to model the determinants of breast-feeding initiation among 9087 US women. Multiple linear regression was used to model the duration of breast-feeding among women who breast-fed. Results. Fifty-three percent of mothers initiated breast-feeding in 1988, and the decision to breast-feed was not associated with maternal employment. However, among breast-feeders, returning to work within a year of delivery was associated with a shorter duration of breast-feeding when other factors were controlled. Among employed mothers, the duration of maternity leave was positively associated with the duration of breast-feeding. Conclusions. The low rates of breast-feeding initiation in the United States are not attributable to maternal participation in the labor force. However, returning to work is associated with earlier weaning among women who breast-feed. Handle: RePEc:aph:ajpbhl:1997:87:6:945-950_7 Template-Type: ReDIF-Article 1.0 Title: The decentralization of syphilis screening for improved care in Jamaican public clinics Journal: American Journal of Public Health Author-Name: Behets, F.M.-T. Author-Name: Brathwaite, A. Author-Name: Bennett, L. Author-Name: Douglas, K.-G. Author-Name: Dallabetta, G.A. Author-Name: Figueroa, J.P. Year: 1997 Volume: 87 Issue: 6 Pages: 1019-1021 Abstract: 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. Handle: RePEc:aph:ajpbhl:1997:87:6:1019-1021_6 Template-Type: ReDIF-Article 1.0 Title: The effects of an abusive primary partner on the condom use and sexual negotiation practices of African-American women Journal: American Journal of Public Health Author-Name: Wingood, G.M. Author-Name: DiClemente, R.J. Year: 1997 Volume: 87 Issue: 6 Pages: 1016-1018 Abstract: Objectives. This study examined the consequences of having a physically abusive primary partner on the condom use and sexual negotiation practices of young African-American women. Methods. Interviews were conducted with 165 sexually active African-American women aged 18 through 29 in San Francisco, Calif. Results. Women in abusive relationships were less likely than others to use condoms and were more likely to experience verbal abuse, emotional abuse, or threats of physical abuse when they discussed condoms. They were more fearful of asking their partners to use condoms, worried more about acquiring the human immunodeficiency virus (HIV), and felt more isolated than did women not in abusive relationships. Conclusions. HIV prevention programs for women should address domestic violence prevention strategies. Handle: RePEc:aph:ajpbhl:1997:87:6:1016-1018_8 Template-Type: ReDIF-Article 1.0 Title: Increasing car seat use for toddlers from inner-city families Journal: American Journal of Public Health Author-Name: Louis, B. Author-Name: Lewis, M. Year: 1997 Volume: 87 Issue: 6 Pages: 1044-1045 Abstract: Objectives. The purpose of this project was to increase toddler car seat use in low-income minority families. Methods. Families from Newark, NJ, were divided into two study groups. Both groups were given car seats; one group also received education regarding car restraint use. Observations were made of car seat use before car seat distribution, immediately after distribution, 4 to 5 months later, and 1 year later. Results. Car seat use increased markedly immediately after distribution and remained high I year later, regardless of education. Conclusions. These results indicate that distributing car seats results in long-term use among a currently low-use population. Handle: RePEc:aph:ajpbhl:1997:87:6:1044-1045_3 Template-Type: ReDIF-Article 1.0 Title: Mortality related to sexually transmitted diseases in US women, 1973 through 1992 Journal: American Journal of Public Health Author-Name: Ebrahim, S.H. Author-Name: Peterman, T.A. Author-Name: Zaidi, A.A. Author-Name: Kamb, M.L. Year: 1997 Volume: 87 Issue: 6 Pages: 938-944 Abstract: Objectives. This study estimated the trends in mortality related to sexually transmitted diseases (STDs) and their sequelae in US women from 1973 through 1992. Methods. The total number of deaths was obtained from US national mortality data and from AIDS surveillance data, and current literature was reviewed to estimate proportions of diseases attributable to sexual transmission. Results. From 1973 through 1984, total STD-related deaths decreased 24%. However, from 1985 through 1992, STD-related deaths increased by 31%, primarily because of increasing numbers of deaths from, sexually transmitted human immunodeficiency virus (HIV) infection. The most important changes during the 20-year period were the emergence of and continued increase in the number of deaths related to heterosexually transmitted HIV. Conclusions. The leading causes of STD-related mortality in women, vital STDs and their sequelae, are generally not recognized as being sexually transmitted. Increases in STD-related mortality are primarily due to sexually transmitted HIV, which will soon surpass cervical cancer as the leading cause. Handle: RePEc:aph:ajpbhl:1997:87:6:938-944_9 Template-Type: ReDIF-Article 1.0 Title: Trends in fatal occupational injuries and industrial restructuring in north carolina in the 1980s Journal: American Journal of Public Health Author-Name: Richardson, D. Author-Name: Loomis, D. Year: 1997 Volume: 87 Issue: 6 Pages: 1041-1043 Abstract: Objectives. This study examined the relationship between changes in employment in North Carolina in the 1980s and fatal occupational injury rates. Methods. Unintentional fatal occupational injuries (n = 1989) in North Carolina between 1978 and 1991 were identified via the medical examiner's system. Results. Overall fatal injury rates declined during the 1980s, but rates increased 9.6% per year among manufacturing industries that declined in employment size; rates fell among service sector and manufacturing industries that grew. Conclusions. Increasing occupational fatal injury rates accompanied the decline in workforce in North Carolina's traditional, labor- intensive manufacturing industries during the 1980s, while service sector and expanding manufacturing industries have experienced declining fatal injury rates. Handle: RePEc:aph:ajpbhl:1997:87:6:1041-1043_9 Template-Type: ReDIF-Article 1.0 Title: Prenatal health behaviors and psychosocial risk factors in pregnant women of mexican origin: The role of acculturation Journal: American Journal of Public Health Author-Name: Zambrana, R.E. Author-Name: Scrimshaw, S.C.M. Author-Name: Collins, N. Author-Name: Dunkel-Schetter, C. Year: 1997 Volume: 87 Issue: 6 Pages: 1022-1026 Abstract: Objectives. This study examined the association between acculturation of Mexican-origin women and factors in low birthweight and preterm delivery. Methods. Interviews were conducted with 911 Mexican-origin respondents in Los Angeles prenatal care clinics. Infant outcome data were retrieved from delivery records. Results. Mexican-American women had generally more undesirable prenatal behaviors mad risk factors than Mexican-immigrant women. Although higher acculturation was significantly associated with behavioral risk factors, there were no direct effects of acculturation on infant gestational age or birthweight. Conclusions. Future research needs to measure multiple factors to assess their effects on culture-specific protective factors. Handle: RePEc:aph:ajpbhl:1997:87:6:1022-1026_3 Template-Type: ReDIF-Article 1.0 Title: Reduced probability of HIV infection among crack cocaine-using injection drag users Journal: American Journal of Public Health Author-Name: Iguchi, M.Y. Author-Name: Bux Jr., D.A. Year: 1997 Volume: 87 Issue: 6 Pages: 1008-1012 Abstract: Objectives. This study examined in greater detail the authors' previously reported finding that crack use among injection drug users is associated with lower levels of infection with the human immunodeficiency virus (HIV). Methods. Self-reported data and blood tests for HIV antibodies from 4840 out-of-treatment injection drug users were used to examine relationships among crack use, HIV risk behavior, and HIV infection. Results. Crack use was significantly associated with higher levels of many sexual risk and needle use behaviors and was consistently associated, independently of all behavioral variables examined, with lower rates of HIV infection. Conclusions. Crack use among injection drug users appears to be associated with lower risk for HIV infection independently of other behavioral variables. Handle: RePEc:aph:ajpbhl:1997:87:6:1008-1012_1 Template-Type: ReDIF-Article 1.0 Title: The effectiveness of a media-led intervention to reduce smoking among vietnamese-american men Journal: American Journal of Public Health Author-Name: Jenkins, C.N.H. Author-Name: McPhee, S.J. Author-Name: Le, A. Author-Name: Pham, G.Q. Author-Name: Ha, N.-T. Author-Name: Stewart, S. Year: 1997 Volume: 87 Issue: 6 Pages: 1031-1034 Abstract: 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 u 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 am needed to reduce smoking among Vietnamese American men. Handle: RePEc:aph:ajpbhl:1997:87:6:1031-1034_7 Template-Type: ReDIF-Article 1.0 Title: Preventing unintended pregnancy: The cost-effectiveness of three methods of emergency contraception Journal: American Journal of Public Health Author-Name: Trussell, J. Author-Name: Koenig, J. Author-Name: Ellertson, C. Author-Name: Stewart, F. Year: 1997 Volume: 87 Issue: 6 Pages: 932-937 Abstract: Objectives. This study examined the cost-effectiveness of emergency contraceptive pills, minipills, and the copper-T intrauterine device (IUD) as emergency contraception. Methods. Cost savings were modeled for both (1) a single contraceptive treatment following unprotected intercourse and (2) emergency contraceptive pills provided in advance. Results. In a managed care (public payer) setting a single treatment of emergency contraception after unprotected intercourse saves $142 ($54) with emergency contraceptive pills and $119 ($29) with minipills. The copper-T IUD is not cost-effective as an emergency contraceptive alone, but savings quickly accrue as use continues. Advance provision of emergency contraceptive pills to women using barrier contraceptives, spermicides, withdrawal, or periodic abstinence saves from $263 to $498 ($99 to $205) annually. Conclusions. Emergency contraception is cost-effective whether provided when the emergency arises or in advance to be used as needed. Greater use of emergency contraception could reduce the considerable medical and social costs of unintended pregnancies. Handle: RePEc:aph:ajpbhl:1997:87:6:932-937_5 Template-Type: ReDIF-Article 1.0 Title: The relationship of patient reading ability to self-reported health and use of health services Journal: American Journal of Public Health Author-Name: Baker, D.W. Author-Name: Parker, R.M. Author-Name: Williams, M.V. Author-Name: Clark, W.S. Author-Name: Nurss, J. Year: 1997 Volume: 87 Issue: 6 Pages: 1027-1030 Abstract: Objectives. This study examined the relationship of functional health literacy to self-reported health and use of health services. Methods. Patients presenting to two large, urban public hospitals in Atlanta, Ga, and Torrance, Calif, were administered a health literacy test about their overall health and use of health care services during the 3 months preceding their visit. Results. Patients with inadequate functional health literacy were more likely than patients with adequate literacy to report their health as poor. Number of years of school completed was less strongly associated with serf- reported health. Literacy was not related to regular source of care or physician visits, but patients in Atlanta with inadequate literacy were more likely than patients with adequate literacy to report a hospitalization in the previous year. Conclusions. Low literacy is strongly associated with self-reported poor health and is more closely associated with self-reported health than number of years of school completed. Handle: RePEc:aph:ajpbhl:1997:87:6:1027-1030_3 Template-Type: ReDIF-Article 1.0 Title: Injuries to bicyclists in Wuhan, People's Republic of China Journal: American Journal of Public Health Author-Name: Li, G. Author-Name: Baker, S.P. Year: 1997 Volume: 87 Issue: 6 Pages: 1049-1052 Abstract: Objectives. This study examined the morbidity and mortality from bicycling injuries in Wuhan, China. Methods. Police department data for the year 1993 complemented by data from emergency room interviews were analyzed. Results. The death rate from bicycling injuries was estimated as 2.2 per 100000 population, more than seven times the rate for the United States. At least 79% of the fatalities and 17% of the emergency room cases sustained head injuries, the majority (71%) of which resulted from contact of the head with the concrete or asphalt road. None of the patients was wearing a helmet at the time of injury, and helmet use among the general bicyclist population was nonexistent. Conclusions. Bicycle-related head injury is an important public health issue in China. The effectiveness of safety helmets in developing countries needs to be evaluated. Handle: RePEc:aph:ajpbhl:1997:87:6:1049-1052_6 Template-Type: ReDIF-Article 1.0 Title: Employee and public responses to simulated violations of no-smoking regulations in spain Journal: American Journal of Public Health Author-Name: Bonfill, X. Author-Name: Serra, C. Author-Name: López, V. Year: 1997 Volume: 87 Issue: 6 Pages: 1035-1037 Abstract: Objectives. This study evaluated compliance with regulations prohibiting smoking in public places by using a new method of smoking simulation. Methods. Sites in Sabadell, Spain, were visited by observers who lit a cigarette, simulating the act of smoking, and noted the placement and content of signs indicating smoking restrictions. Results. A warning was given in only 17% of sites. A significant association was observed between the presence of signs banning smoking and the elicitation of a warning from people present. Conclusions. Simulating the violation of smoking restrictions may be used as an efficient method of assessing enforcement of the prohibition of public smoking. Handle: RePEc:aph:ajpbhl:1997:87:6:1035-1037_7 Template-Type: ReDIF-Article 1.0 Title: Low prevalences of HIV infection and sexually transmitted disease among female commercial sex workers in Mexico City Journal: American Journal of Public Health Author-Name: Uribe-Salas, F. Author-Name: Hernández-Avila, M. Author-Name: Conde-Glez, C.J. Author-Name: Juárez-Figueroa, L. Author-Name: Allen, B. Author-Name: Anaya-Ocampo, R. Author-Name: Del Río-Chiriboga, C. Author-Name: Uribe-Zúñiga, P. Author-Name: De Zalduondo, B. Year: 1997 Volume: 87 Issue: 6 Pages: 1012-1015 Abstract: 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. Handle: RePEc:aph:ajpbhl:1997:87:6:1012-1015_7 Template-Type: ReDIF-Article 1.0 Title: Medical necessity and defined coverage benefits in the oregon health plan Journal: American Journal of Public Health Author-Name: Glassman, P.A. Author-Name: Jacobson, P.D. Author-Name: Asch, S. Year: 1997 Volume: 87 Issue: 6 Pages: 1053-1058 Abstract: The policy debate in Oregon has primarily focused on the Prioritized List of Services. However, little information is available on how defined coverage benefits and managed care affect the role of medical necessity in determining care for Medicaid patients. This issue is important because medical necessity determinations are currently used by many states to limit extraneous health care costs but require resource-intensive oversight, are open to wide variance, and frequently prompt litigation challenging interpretations of what is necessary and what is not. The qualitative study described here addressed whether medical necessity remains a salient and useful concept in the Oregon Health Plan. Our results indicate that defined coverage benefits, as described by the funded portion of the Prioritized List of Services, supplant medical necessity determinations for coverage, while managed care incentives limit the need for medical necessity determinations at the provider level. Clinical choices are, for the most part guided by providers' judgment within the financial constraints of capitation and by targeted use management techniques. The combination of capitated care and Oregon's defined coverage benefits package has marginalized the use of medical necessity, albeit with consequences for state oversight of Medicaid services. Handle: RePEc:aph:ajpbhl:1997:87:6:1053-1058_3 Template-Type: ReDIF-Article 1.0 Title: Underestimating cocaine use during pregnancy [1] Journal: American Journal of Public Health Author-Name: Rosenberg, K.D. Author-Name: Bateman, D.M. Author-Name: Des Jarlais, D.C. Year: 1997 Volume: 87 Issue: 4 Pages: 687 Handle: RePEc:aph:ajpbhl:1997:87:4:687_4 Template-Type: ReDIF-Article 1.0 Title: Asbestos-related cancer and the amphibole hypothesis 1. The first documentation of the association [2] Journal: American Journal of Public Health Author-Name: Wagner, J.C. Year: 1997 Volume: 87 Issue: 4 Pages: 687-688 Handle: RePEc:aph:ajpbhl:1997:87:4:687-688_4 Template-Type: ReDIF-Article 1.0 Title: Integrating HIV prevention, STD, and family planning services 1. The availability of HIV services at different types of clinics: A survey [5] Journal: American Journal of Public Health Author-Name: Chavkin, W. Author-Name: Breitbart, V. Author-Name: Elman, D. Year: 1997 Volume: 87 Issue: 4 Pages: 691-692 Handle: RePEc:aph:ajpbhl:1997:87:4:691-692_9 Template-Type: ReDIF-Article 1.0 Title: Injection drag use among homeless adults with severe mental illness Journal: American Journal of Public Health Author-Name: Susser, E. Author-Name: Betne, P. Author-Name: Valencia, E. Author-Name: Goldfinger, S.M. Author-Name: Lehman, A.F. Year: 1997 Volume: 87 Issue: 5 Pages: 854-856 Abstract: Objectives. This study examined injection drag use among homeless men and women with severe mental illness in two sites. Methods. The data were drawn from related clinical trials conducted in Baltimore (101 men, 49 women) and Boston (85 men, 33 women). Results. The percentages of homeless men with a history of injection drug use were 26% in Baltimore and 16% in Boston; the corresponding rates among homeless women were 8% and 6%. Conclusions. Taken together, these and previous results suggest high lifetime prevalences of injection drug use- and associated risks of HIV transmission-in this elusive population. Handle: RePEc:aph:ajpbhl:1997:87:5:854-856_1 Template-Type: ReDIF-Article 1.0 Title: Cross-cultural measurements of psychological well-being: The psychometric equivalence of Cantonese, Vietnamese, and Laotian translations of the Affect Balance Scale Journal: American Journal of Public Health Author-Name: Devins, G.M. Author-Name: Beiser, M. Author-Name: Dion, R. Author-Name: Pelletier, L.G. Author-Name: Edwards, R.G. Year: 1997 Volume: 87 Issue: 5 Pages: 794-799 Abstract: Objectives. This paper evaluates the cultural equivalence of Cantonese, Vietnamese, and Laotian translations of the Affect Balance Scale. Methods. The scale was completed by 399 Vietnamese, 193 Laotian, 756 Cantonese, and 319 English speakers who were participants in the Clarke Institute-University of Toronto Refugee Resettlement Project (n = 1667). Results. Confirmatory factor analyses indicated a good fit between the hypothesized two-factor model (separate factors for positive and negative affect) across the original English-language version and each of the Asian-language translations. Factorial invariance (numbers and patterns of factor loadings) was evident across all versions of the scale. No evidence of item bias was detected by mixed Language x Item analyses of variance. Acceptable reliability was observed; coefficient alphas ranged from .62 to .72 for positive affect and from .62 to .70 for negative affect items. Conclusions. These findings substantiate the cultural equivalence of the three translations of the scale for population health research. Important future research directions made possible by the availability of culturally equivalent instruments are discussed. Handle: RePEc:aph:ajpbhl:1997:87:5:794-799_9 Template-Type: ReDIF-Article 1.0 Title: Ethnic differences in the prevalence of nonmalignant respiratory disease among uranium miners Journal: American Journal of Public Health Author-Name: Mapel, D.W. Author-Name: Coultas, D.B. Author-Name: James, D.S. Author-Name: Hunt, W.C. Author-Name: Stidley, C.A. Author-Name: Gilliland, F.D. Year: 1997 Volume: 87 Issue: 5 Pages: 833-838 Abstract: Objectives. This study (1) investigates the relationship of nonmalignant respiratory disease to underground uranium mining and to cigarette smoking in Native American, Hispanic, and non-Hispanic White miners in the Southwest and (2) evaluates the criteria for compensation of ethnic minorities. Methods. Risk for mining-related lung disease was analyzed by stratified analysis, multiple linear regression, and logistic regression with data on 1359 miners. Results. Uranium mining is more strongly associated with obstructive lung disease and radiographic pnuemoconiosis in Native Americans than in Hispanics and non-Hispanic Whites. Obstructive lung disease in Hispanic and non- Hispanic White miners is mostly related to cigarette smoking. Current compensation criteria excluded 24% of Native Americans who, by ethnic- specific standards, had restrictive lung disease and 4.8% who had obstructive lung disease. Native Americans have the highest prevalence of radiographic pneumoconiosis, but are less likely to meet spirometry criteria for compensation. Conclusions. Native American miners have more nonmalignant respiratory disease from underground uranium mining, and less disease from smoking, than the other groups, but are less likely to receive compensation for mining-related disease. Handle: RePEc:aph:ajpbhl:1997:87:5:833-838_4 Template-Type: ReDIF-Article 1.0 Title: Region of birth and mortality from circulatory diseases among Black Americans Journal: American Journal of Public Health Author-Name: Schneider, D. Author-Name: Greenberg, M.R. Author-Name: Lu, L.L. Year: 1997 Volume: 87 Issue: 5 Pages: 800-804 Abstract: Objectives. This study examines the relationship between birthplace and mortality from circulatory diseases among American Blacks. Methods. All Black deaths flora 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 ganders, 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. Handle: RePEc:aph:ajpbhl:1997:87:5:800-804_8 Template-Type: ReDIF-Article 1.0 Title: Recent trends in breast cancer mortality among White and Black US women Journal: American Journal of Public Health Author-Name: Chevarley, F. Author-Name: White, E. Year: 1997 Volume: 87 Issue: 5 Pages: 775-781 Abstract: Objectives. Time trends in breast cancer mortality were analyzed from 1970 to 1992 among White and Black US women aged 25 and over. Methods. Mortality data from the National Center for Health Statistics were summarized within three periods: 1970 to 1979, 1980 to 1988, and 1989 to 1992. The annual change was calculated as the average yearly percentage of change based on the logistic model. Results. For White women of all ages, breast cancer mortality decreased by 1.6% (95% confidence interval = -2.0%, -1.1%) per year on average during 1989 to 1992, in contrast to the flat mortality rates observed during the 1970s and a 0.5% average annual increase during 1980 to 1988. The decline was observed for White women under age 60, among whom breast cancer mortality had been decreasing, and for White women aged 60 to 79, among whom breast cancer mortality had been increasing, but it was not observed among Black women. Conclusions. The long-awaited decline in US breast cancer mortality has finally appeared, although only among White women. The possible contributions are changes in inherent risk of disease, changes in treatment effectiveness, and increased use of screening mammography. Handle: RePEc:aph:ajpbhl:1997:87:5:775-781_7 Template-Type: ReDIF-Article 1.0 Title: A pricing strategy to promote low-fat snack choices through vending machines Journal: American Journal of Public Health Author-Name: French, S.A. Author-Name: Jeffery, R.W. Author-Name: Story, M. Author-Name: Hannan, P. Author-Name: Snyder, M.P. Year: 1997 Volume: 87 Issue: 5 Pages: 849-851 Abstract: 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. Handle: RePEc:aph:ajpbhl:1997:87:5:849-851_4 Template-Type: ReDIF-Article 1.0 Title: The AIDS epidemic among spanish drug users: A birth cohort-associated phenomenon Journal: American Journal of Public Health Author-Name: Castilla, J. Author-Name: Pollán, M. Author-Name: López-Abente, G. Year: 1997 Volume: 87 Issue: 5 Pages: 770-774 Abstract: Objectives. In Spain the number of new acquired immunodeficiency syndrome (AIDS) cases among injection drug users continues to rise. The time trend up to 1994 has been analysed, with special attention paid to the different generations. Methods. The source for injection drug use-related cases was the Spanish AIDS Register. Independent analyses of annual specific rates were run for each sex with the use of an age-period log-linear model. Results. After adjustment for age and year of diagnosis, AIDS incidence related to injection drug use is associated with specific birth cohorts. Rising values are observed in the successive generations born during the 1950s, peaking in men born in 1962 and women born in 1964. In subsequent cohorts, there is a marked falloff in incidence for both sexes, but this decline is seen to halt in men from the 1972 birth cohort onwards. The overall period effect is upward, yet the trend flattens in the last years. There is a pronounced age effect with maximum values in men and women at ages 29 and 27, respectively. Conclusions. It is essential to urge avoidance of risk behaviors in new generations. Handle: RePEc:aph:ajpbhl:1997:87:5:770-774_1 Template-Type: ReDIF-Article 1.0 Title: Stable behaviors associated with adults' 10-year change in body mass index and likelihood of gain at the waist Journal: American Journal of Public Health Author-Name: Kahn, H.S. Author-Name: Tatham, L.M. Author-Name: Rodriguez, C. Author-Name: Calle, E.E. Author-Name: Thun, M.J. Author-Name: Heath Jr., C.W. Year: 1997 Volume: 87 Issue: 5 Pages: 747-754 Abstract: Objectives. The purpose of this study was to identify behaviors associated with change in body mass index or with weight gain at the waist. Methods. A cohort of 79 236 White, non-Hispanic, healthy adults was questioned in 1982 and 1992 about diet and 10 physical activities. Estimates were made of the mean effects of stable behaviors on 10-year change in body mass index and on odds ratios for gain at the waist. Results. Ten-year change in body mass index was associated positively with meat consumption and smoking cessation and inversely with vegetable consumption, vitamin E supplementation, continued smoking, and some vigorous activities (e.g., jogging/running). Women's body mass index decreased with walking 4 or more hours per week and with regular alcohol intake, but these behaviors had a smaller effect on men's body mass index. Waist gain was inversely associated with high vegetable consumption, walking 4 or more hours per week, and jogging/running 1 to 3 hours per week but not with less demanding physical activities. Conclusions. Simple description of behaviors associated with weight loss or reduced abdominal obesity may enhance programs designed to prevent obesity and chronic diseases. Handle: RePEc:aph:ajpbhl:1997:87:5:747-754_5 Template-Type: ReDIF-Article 1.0 Title: Socioeconomic status and racial and ethnic differences in functional status associated with chronic diseases Journal: American Journal of Public Health Author-Name: Kington, R.S. Author-Name: Smith, J.P. Year: 1997 Volume: 87 Issue: 5 Pages: 805-810 Abstract: 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. Handle: RePEc:aph:ajpbhl:1997:87:5:805-810_9 Template-Type: ReDIF-Article 1.0 Title: Interpreting HIV prevalence and incidence among Americans: Bridging data and public policy Journal: American Journal of Public Health Author-Name: Mills, T.C. Author-Name: Stall, R. Author-Name: Catania, J.A. Author-Name: Coates, T.J. Year: 1997 Volume: 87 Issue: 5 Pages: 864-866 Handle: RePEc:aph:ajpbhl:1997:87:5:864-866_1 Template-Type: ReDIF-Article 1.0 Title: Relative risk in the news media: A quantification of misrepresentation Journal: American Journal of Public Health Author-Name: Frost, K. Author-Name: Frank, E. Author-Name: Maibach, E. Year: 1997 Volume: 87 Issue: 5 Pages: 842-845 Abstract: Objectives. This study quantifies the representativeness with which the print news media depict mortality. Methods. The proportion of mortality- related copy in samples of national print media was compared with the proportion of actual deaths attributable to the leading causes of US mortality over a 1-year period. Results. For every tested cause of death, a significant disproportion was found between amount of text devoted to the cause and the actual number of attributable deaths. Under-represented causes included tobacco use (23% of expected copy) and heart disease (33%); overrepresented causes included illicit use of drugs (1740%), motor vehicles (1280%), and toxic agents (1070%). Conclusions. The news media significantly misrepresent the prevalence of leading causes of death and their risk factors. This misrepresentation may contribute to the public's distorted perceptions of health threats. Handle: RePEc:aph:ajpbhl:1997:87:5:842-845_5 Template-Type: ReDIF-Article 1.0 Title: A persistent rise in mortality among injection drug users in Rome, 1980 through 1992 Journal: American Journal of Public Health Author-Name: Davoli, M. Author-Name: Perucci, C.A. Author-Name: Rapiti, E. Author-Name: Bargagli, A.M. Author-Name: D'Ippoliti, D. Author-Name: Forastiere, F. Author-Name: Abeni, D. Year: 1997 Volume: 87 Issue: 5 Pages: 851-853 Abstract: Objectives. The purpose of the study was to analyze overall and cause- specific mortality among injection drug users in Rome. Methods. A cohort of 4200 injection drug users was enrolled in drug treatment centers from 1980 through 1988 and followed up until December 1992. Results. The age-adjusted mortality rate from all causes increased from 7.8/1000 person-years in 1985/86 to 27.7/1000 in 1991/92. The rise was mainly attributable to acquired immunodeficiency syndrome (AIDS), but mortality from overdose and other causes as well. The cumulative risk of death by the age of 40 was 29.3%. Conclusions. The impact of AIDS deaths appears to be additional to a persistent increase of mortality for all other causes. Handle: RePEc:aph:ajpbhl:1997:87:5:851-853_1 Template-Type: ReDIF-Article 1.0 Title: Operation Tot Shots: an awareness campaign for parents during kindergarten registration. Journal: American Journal of Public Health Author-Name: Cicirello, H.G. Author-Name: Le Comb, J. Author-Name: Ewing, J. Author-Name: Birkhead, G.S. Year: 1997 Volume: 87 Issue: 5 Pages: 861-862 Handle: RePEc:aph:ajpbhl:1997:87:5:861-862_8 Template-Type: ReDIF-Article 1.0 Title: Alcohol, tobacco, and other drug use among rural/small town and urban youth: A secondary analysis of the monitoring the future data set Journal: American Journal of Public Health Author-Name: Cronk, C.E. Author-Name: Sarvela, P.D. Year: 1997 Volume: 87 Issue: 5 Pages: 760-764 Abstract: Objectives. This study compared prevalence of substance use among high school seniors in rural and urban areas from 1976 through 1992. Methods. We used data collected for these years from urban (n = 75 916) and rural (n = 51 182) high school seniors. Thirty-day prevalence for alcohol, cigarettes, marijuana, cocaine, LSD, and inhalant use, binge drinking, smoking a pack or more of cigarettes a day, and daily alcohol and marijuana use were evaluated. Results. Substance use declined from 1976 through 1992. In 1976, urban students had greater prevalence for most substances, but by 1992, rural and urban students were similar, with rural students having higher prevalence for alcohol and cigarette use (particularly excessive use). Trends were similar for both sexes, though rural girls showed a later catch-up to use levels of urban girls. Conclusions. Rural students are currently at risk approximately equal to that of urban students. Other studies have demonstrated the association of substance use with increased morbidity and mortality. Policy alterations and health education programs should address this pattern in the nation's rural areas. Handle: RePEc:aph:ajpbhl:1997:87:5:760-764_5 Template-Type: ReDIF-Article 1.0 Title: An experimental analysis of sociocultural variables in sales of cigarettes to minors Journal: American Journal of Public Health Author-Name: Klonoff, E.A. Author-Name: Landrine, H. Author-Name: Alcaraz, R. Year: 1997 Volume: 87 Issue: 5 Pages: 823-826 Abstract: 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. Handle: RePEc:aph:ajpbhl:1997:87:5:823-826_9 Template-Type: ReDIF-Article 1.0 Title: Psychiatric disorders among American Indian and white youth in Appalachia: The great smoky mountains study Journal: American Journal of Public Health Author-Name: Costello, E.J. Author-Name: Farmer, E.M.Z. Author-Name: Angold, A. Author-Name: Burns, B.J. Author-Name: Erkanli, A. Year: 1997 Volume: 87 Issue: 5 Pages: 827-832 Abstract: Objectives. This study examined prevalence of psychiatric disorders, social and family risk factors for disorders, and met and unmet needs for mental health cam among Appalachian youth. Methods. All 9-, 11-, and 13- year-old American Indian children in an 11-county area of the southern Appalachians were recruited, together with a representative sample of the surrounding population of White children. Results. Three-month prevalences of psychiatric disorders were similar (American Indian, 16.7%; White, 19.2%). Substance use was more common in American Indian children (9.0% vs 3.8% in White children), as was comorbidity of substance use and psychiatric disorder (2.5% vs 0.9%). American Indian poverty, family adversity (e.g., parental unemployment, welfare dependency), and family deviance (parental violence, substance abuse, and crime) rates were higher, but the rate of family mental illness, excluding substance abuse, was lower. Child psychiatric disorder and mental health service use were associated with family mental illness in both ethnic groups but were associated with poverty and family deviance only in White children. Despite lower financial barriers, American Indian children used fewer mental health services. Conclusions. This study suggests that poverty and crime play different roles in different communities in the etiology of child psychiatric disorder. Handle: RePEc:aph:ajpbhl:1997:87:5:827-832_6 Template-Type: ReDIF-Article 1.0 Title: US trends in nutrient intake: The 1987 and 1992 National Health Interview Surveys Journal: American Journal of Public Health Author-Name: Norris, J. Author-Name: Harnack, L. Author-Name: Carmichael, S. Author-Name: Pouane, T. Author-Name: Wakimoto, P. Author-Name: Block, G. Year: 1997 Volume: 87 Issue: 5 Pages: 740-746 Abstract: Objectives. This study examined US trends in nutrient intake, using almost identical methods and nutrient databases in two time periods. Methods. An extensive dietary intake questionnaire was included in supplements to the 1987 and 1992 National Health Interview Surveys. Dietary data from approximately 11 000 persons in each of those years were analyzed. Results. The total and saturated fat intake and the percentage of energy from fat declined among Whites and Hispanics, but only minimal changes were seen in Black Americans. The changes in fat intake were attributable principally to behavioral changes in frequency and type of fat-containing foods consumed rather than to the increased availability of leaner cuts of meat. Dietary cholesterol showed one of the largest declines of the nutrients examined. Less desirable changes were also seen. Cereal fortification played an important role in the observed changes in several micronutrients. Conclusions. Educational campaigns on dietary fat and cholesterol have been moderately effective, but not in all racial/ethnic groups. Future campaigns should emphasize maintaining or increasing micronutrient intake. Handle: RePEc:aph:ajpbhl:1997:87:5:740-746_0 Template-Type: ReDIF-Article 1.0 Title: No butts about it: public smoking ends in Vermont. Journal: American Journal of Public Health Author-Name: Carney, J.K. Author-Name: Hamrell, M.C. Author-Name: Wargo, W.E. Year: 1997 Volume: 87 Issue: 5 Pages: 860-861 Handle: RePEc:aph:ajpbhl:1997:87:5:860-861_7 Template-Type: ReDIF-Article 1.0 Title: Potentially avoidable hospitalizations: Inequalities in rates between US socioeconomic groups Journal: American Journal of Public Health Author-Name: Pappas, G. Author-Name: Hadden, W.C. Author-Name: Kozak, L.J. Author-Name: Fisher, G.F. Year: 1997 Volume: 87 Issue: 5 Pages: 811-816 Abstract: Objectives. The National Hospital Discharge Survey (NHDS) was used to evaluate potentially avoidable hospital conditions as an indicator of equity and efficiency in the US health care system. Methods. With the use of 1990 data from the NHDS, the National Health Interview Survey, and the census, national rates of hospitalization were calculated for avoidable conditions by age, race, median income of zip code, and insurance status. Results. An estimated 3.1 million hospitalizations were for potentially avoidable conditions. This was 12% of all hospitalizations in 1990 (excluding psychiatric admissions, women with deliveries, and newborns). Rates of potentially avoidable hospitalizations were higher for persons living in middle- and low-income areas than for persons living in high-income areas, and were higher among Blacks than among Whites. These class and racial differences were also found among the privately insured. Differences among income and racial groups for persons aged 65 and over were not significant. Conclusions. Inequalities in potentially avoidable hospitalizations suggest inequity and inefficiency in the health care delivery system. Avoidable hospital conditions are a useful national indicator to monitor access to care. Handle: RePEc:aph:ajpbhl:1997:87:5:811-816_2 Template-Type: ReDIF-Article 1.0 Title: Do smokers understand the mortality effects of smoking? Evidence from the health and retirement survey Journal: American Journal of Public Health Author-Name: Schoenbaum, M. Year: 1997 Volume: 87 Issue: 5 Pages: 755-759 Abstract: Objectives. This study examined whether smokers recognize that smoking is likely to shorten their lives and, if so, whether they understand the magnitude of this effect. Methods. People's expectations about their chances of reaching age 75 were compared with epidemiological predictions from life tables for never, former, current light, and current heavy smokers. Data on expectations of reaching age 75 came from the Health and Retirement Survey, a national probability sample of adults aged 50 through 62 years. Predictions came from smoking-specific life tables constructed from the 1986 National Mortality Follow-back Survey and the 1985 and 1987 National Health Interview Surveys. Results. Among men and women, the survival expectations of never, former, and current light smokers were close to actuarial predictions. However, among current heavy smokers, expectations of reaching age 75 were nearly twice as high as actuarial predictions. Conclusions. These findings suggest that at least heavy smokers significantly underestimate their risk of premature mortality. Handle: RePEc:aph:ajpbhl:1997:87:5:755-759_9 Template-Type: ReDIF-Article 1.0 Title: Race and mammography use in two North Carolina counties Journal: American Journal of Public Health Author-Name: O'Malley, M.S. Author-Name: Earp, J.A.L. Author-Name: Harris, R.P. Year: 1997 Volume: 87 Issue: 5 Pages: 782-786 Abstract: Objectives. This study investigated racial differences in mammography use and their associations with physicians' recommendations and other factors. Methods. The study used 1988 survey data for 948 women 50 years of age and older from the New Hanover Breast Cancer Screening Program. Racial differences in terms of physician recommendation, personal characteristics, health characteristics, and attitudes toward breast cancer and mammography were examined. Factors at least minimally associated with race and use were included in multivariate logistic regression analyses to examine the effect of race while controlling for other factors. Results. In comparison with White women, Black women were half as likely to report ever having had a mammogram (27% vs 52%) and having a mammogram in the past year (17% vs 36%). Black women also significantly less often reported physician recommendation (25% vs 52%). Although Black and White women differed significantly in other characteristics, multivariate logistic regression analyses indicated that physician recommendation accounted for 60% to 75% of the initial racial differences in mammography use. Conclusions. Understanding physicians' recommendations for breast cancer screening is a critical first step to increasing mammography use in disadvantaged populations. Handle: RePEc:aph:ajpbhl:1997:87:5:782-786_1 Template-Type: ReDIF-Article 1.0 Title: The impact of public assistance factors on the immunization levels of children younger than 2 years Journal: American Journal of Public Health Author-Name: Suarez, L. Author-Name: Simpson, D.M. Author-Name: Smith, D.R. Year: 1997 Volume: 87 Issue: 5 Pages: 845-848 Abstract: Objectives. This study examined how children's immunization status varied with enrollment in the Women, Infants, and Children (WIC); Aid to Families with Dependent Children (AFDC); food stamp; and Medicaid programs. Methods. A statewide survey was used to determine the percentage of children less than 2 years of age who were up to date for diphtheria, tetanus, and pertussis; polio; and measles, mumps, and rubella vaccines. Results. WIC and uninsured children were more likely and AFDC and Medicaid children less likely to be up to date than others. Conclusions. The higher immunization status of WIC and uninsured children suggests that integrating immunization practices with government programs may be effective. Handle: RePEc:aph:ajpbhl:1997:87:5:845-848_7 Template-Type: ReDIF-Article 1.0 Title: The relationship between the race/ethnicity of generalist Physicians and their care for underserved populations Journal: American Journal of Public Health Author-Name: Xu, G. Author-Name: Fields, S.K. Author-Name: Laine, C. Author-Name: Veloski, J.J. Author-Name: Barzansky, B. Author-Name: Martini, C.J.M. Year: 1997 Volume: 87 Issue: 5 Pages: 817-822 Abstract: Objectives. The purpose of this study was to examine empirically the relationship between physicians' race or ethnicity and their care for medically underserved populations. Methods. Generalist physicians who received the MD degree in 1983 or 1984 (n = 1581) were surveyed. The personal and background characteristics of four racial/ethnic groups of physicians were compared with the characteristics of their patients. Results. When the potentially confounding variables of gender, childhood family income, childhood residence, and National Health Services Corps financial aid obligations were controlled, generalist physicians from underrepresented minorities were more likely than their nonminority counterparts to care for medically underserved populations. Conclusions. Physicians from underrepresented minorities are more likely than others to care for medically underserved populations. Handle: RePEc:aph:ajpbhl:1997:87:5:817-822_0 Template-Type: ReDIF-Article 1.0 Title: Motor vehicle rollover and static stability: An exposure study Journal: American Journal of Public Health Author-Name: Robertson, L.S. Author-Name: Maloney, A. Year: 1997 Volume: 87 Issue: 5 Pages: 839-841 Abstract: Objectives. This study examined vehicle rollovers in terms of site- specific exposure and speeds of vehicles of varying stability. Methods. Fifty-one rollover sites in two states were visited at the same time of day and day of week as the rollover. A sample of vehicles moving in the same direction as the rollover were observed, and vehicle-specific data were obtained from identification numbers. Results. Low stability, exacerbated by the addition of passengers, increased the risk of rollover. Speed was not correlated with stability and is not a confounder. Conclusions. Rollovers could be substantially reduced if motor vehicles were manufactured with a static stability of 1.2 or greater. Handle: RePEc:aph:ajpbhl:1997:87:5:839-841_0 Template-Type: ReDIF-Article 1.0 Title: Childhood abuse and the use of inhalants: Differences by degree of use Journal: American Journal of Public Health Author-Name: Fendrich, M. Author-Name: Mackesy-Amiti, M.E. Author-Name: Wislar, J.S. Author-Name: Goldstein, P.J. Year: 1997 Volume: 87 Issue: 5 Pages: 765-769 Abstract: Objectives. Using two existing ethnographic studies of drug-involved adults, this study evaluates the association between child-abuse victimization and levels of involvement in inhalant use. Methods. Historical accounts of childhood exposure to physical or sexual abuse were compared among nonusers of inhalants (n = 197), light inhalant users (n = 64), and heavy inhalant users (n = 24). Crude and adjusted odds ratios were used to compare informants with no history of inhalant use with those having a history of light inhalant use and those having a history of heavy inhalant use. Results. Heavy inhalant use was associated with history of any child abuse (adjusted odds ratio [OR] = 4.6) and physical abuse (adjusted OR = 3.8). Light inhalant use showed no association with child-abuse history. Conclusions. Child abuse may be an important correlate of extensive involvement in inhalant use. The findings invite speculation with respect to a hypothetical causal role for child abuse in the etiology of inhalant use. The lack of support for causality in this study underscores the need for replication and more carefully designed longitudinal research. Handle: RePEc:aph:ajpbhl:1997:87:5:765-769_9 Template-Type: ReDIF-Article 1.0 Title: Ethnic differences in birthweight: The role of lifestyle and other factors Journal: American Journal of Public Health Author-Name: Shiono, P.H. Author-Name: Rauh, V.A. Author-Name: Park, M. Author-Name: Lederman, S.A. Author-Name: Zuskar, D. Year: 1997 Volume: 87 Issue: 5 Pages: 787-793 Abstract: Objectives. The purpose of this study was to expand the search for risk factors for low birthweight and to find new explanations for the ethnic- group disparities in birth outcomes. Methods. The subjects were 1150 pregnant women from six ethnic groups (African American, Chinese, Dominican, Puerto Rican, Mexican, and White) who received prenatal care at clinics in New York and Chicago between December 1987 and December 1989. Two interviews were conducted during the second and third trimesters of pregnancy. Results. The study, after controlling for poverty and other birth-weight correlates, showed that living in public housing and believing that chance plays a major role in determining one's health status were negatively associated with birthweight. Having a stable residence was positively related to birthweight. Material hardship, social adversity, perceived racial discrimination, physical abuse, anxiety, and depression were not associated with birthweight. Conclusions. The negative role of an impoverished living environment and feelings of helplessness, as well as the positive rule of having a stable form of social support, suggest new directions for research on the causes of low birthweight and the ethnic disparities in US birth outcomes. Handle: RePEc:aph:ajpbhl:1997:87:5:787-793_3 Template-Type: ReDIF-Article 1.0 Title: Antibody testing and condom use among heterosexual African Americans at risk for HIV infection: The national AIDS behavioral surveys Journal: American Journal of Public Health Author-Name: Grinstead, O.A. Author-Name: Peterson, J.L. Author-Name: Faigeles, B. Author-Name: Catania, J.A. Year: 1997 Volume: 87 Issue: 5 Pages: 857-859 Abstract: Objectives. This study describes predictors 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. Handle: RePEc:aph:ajpbhl:1997:87:5:857-859_5 Template-Type: ReDIF-Article 1.0 Title: Tuberculosis screening at a syringe exchange program. Journal: American Journal of Public Health Author-Name: Perlman, D.C. Author-Name: Perkins, M.P. Author-Name: Solomon, N. Author-Name: Kochems, L. Author-Name: Des Jarlais, D.C. Author-Name: Paone, D. Year: 1997 Volume: 87 Issue: 5 Pages: 862-863 Handle: RePEc:aph:ajpbhl:1997:87:5:862-863_1 Template-Type: ReDIF-Article 1.0 Title: The duration of the effect of vitamin A supplementation [2] Journal: American Journal of Public Health Author-Name: Sommer, A. Author-Name: West K.P., Jr. Year: 1997 Volume: 87 Issue: 3 Pages: 467-468 Handle: RePEc:aph:ajpbhl:1997:87:3:467-468_8 Template-Type: ReDIF-Article 1.0 Title: Pertussis containment in schools and day care centers during the Cincinnati epidemic of 1993 Journal: American Journal of Public Health Author-Name: Christie, C.D.C. Author-Name: Marx, M.L. Author-Name: Daniels, J.A. Author-Name: Adcock, M.P. Year: 1997 Volume: 87 Issue: 3 Pages: 460-462 Handle: RePEc:aph:ajpbhl:1997:87:3:460-462_8 Template-Type: ReDIF-Article 1.0 Title: Carbon monoxide poisoning from gasoline-powered engines: Risk perception among midwest flood victims [1] Journal: American Journal of Public Health Author-Name: Greife, A.L. Author-Name: Goldenhar, L.M. Author-Name: Fruend, E. Author-Name: Stock, A. Author-Name: Halperin, W. Year: 1997 Volume: 87 Issue: 3 Pages: 466-467 Handle: RePEc:aph:ajpbhl:1997:87:3:466-467_4 Template-Type: ReDIF-Article 1.0 Title: Increased condom use without other major changes in sexual behavior among the general population in Switzerland Journal: American Journal of Public Health Author-Name: Dubois-Arber, F. Author-Name: Jeannin, A. Author-Name: Konings, E. Author-Name: Paccaud, F. Year: 1997 Volume: 87 Issue: 4 Pages: 558-566 Abstract: Objectives. This study is part of a continuous evaluation of the Swiss AIDS prevention strategy from 1987 through 1994. Methods. Annual telephone surveys of samples representative of the general population aged 17 through 45 years have been conducted since 1987 to monitor behavioral change. Results. No major changes in level of sexual activity (lifetime number of partners, frequency of sexual encounters in the past week) or potential exposure to risk of HIV transmission (acquisition of a new steady partner during the year or of casual partners in the last 6 months) were observed. Systematic condom use with a new steady partner increased between 1988 and 1994, from 40% to 64% among 17- to 30-year-olds and from 57% to 72% among those aged 31 to 45. Systematic condom use with casual partners increased from 8% to 56% between 1987 and 1994 among 17- to 30-year-olds and from 22% to 42% between 1989 and 1994 among those aged 31 to 45. Condom use was higher among those with multiple partners. Conclusions. A general-population approach to AIDS prevention was able to achieve large-scale improvements in condom-based protection against HIV infection without inducing other major changes in sexual behavior. Handle: RePEc:aph:ajpbhl:1997:87:4:558-566_1 Template-Type: ReDIF-Article 1.0 Title: Hysterectomy, oophorectomy, and heart disease risk factors in older women Journal: American Journal of Public Health Author-Name: Kritz-Silverstein, D. Author-Name: Barrett-Connor, E. Author-Name: Wingard, D.L. Year: 1997 Volume: 87 Issue: 4 Pages: 676-680 Abstract: Objectives. This study examined the relation of hysterectomy and oophorectomy to heart disease risk factors. Methods. Data were collected and analyzed for 1150 women aged 50 through 89. Results. Of these women, 21.8% reported hysterectomy with bilateral oophorectomy; 22.1%, hysterectomy with ovarian conservation. Compared with women without hysterectomy, oophorectomized women, especially those 20 or more years post-menopause, had increased lipids, lipoproteins, glucose, and insulin; blood pressures were increased among current estrogen users. Women with hysterectomies with ovarian conservation had similar or more favorable risk factors than nonhysterectomized women. Conclusions. Bilateral oophorectomy, but not hysterectomy, may have long-term negative consequences for heart disease risk factors not totally ameliorated by estrogen use. Handle: RePEc:aph:ajpbhl:1997:87:4:676-680_6 Template-Type: ReDIF-Article 1.0 Title: Cigarette sales to African-American and White minors in low-income areas of Baltimore Journal: American Journal of Public Health Author-Name: Voorhees, C.C. Author-Name: Swank, R.T. Author-Name: Stillman, F.A. Author-Name: Harris, D.X. Author-Name: Watson Jr., H.W. Author-Name: Becker, D.M. Year: 1997 Volume: 87 Issue: 4 Pages: 652-654 Abstract: Objectives. This study documented illegal sales of cigarettes to minors in low-income African-American and White urban areas in East Baltimore. Methods. Six youths, aged 14 through 16 years, were sent to a random sample of 83 comer stores to attempt to purchase cigarettes. The youths provided the investigators with data on merchant, store, and purchase characteristics. Results. The youths successfully purchased cigarettes in 85.5% of the stores; 58% of the stores displayed five or more cigarette advertisements outside their premises. Conclusions. Cigarette sales to minors and associated advertising remain prevalent in this urban community. Handle: RePEc:aph:ajpbhl:1997:87:4:652-654_3 Template-Type: ReDIF-Article 1.0 Title: Adolescent smokers' provision of tobacco to other adolescents Journal: American Journal of Public Health Author-Name: Wolfson, M. Author-Name: Forster, J.L. Author-Name: Claxton, A.J. Author-Name: Murray, D.M. Year: 1997 Volume: 87 Issue: 4 Pages: 649-651 Abstract: Objectives. This study examined adolescent smokers' provision of tobacco to other adolescents. Methods. Data from a survey of 8th-, 9th-, and 10th- grade students in Minnesota were analyzed by using mixed-model logistic regression. Results. More than two thirds (68.8%) of adolescent smokers had provided tobacco to another adolescent in the previous 30 days. Mother's smoking, number of friends who smoke, owning tobacco merchandise, number of cigarettes smoked in the past week, source of last cigarette (commercial), and recent attempt to buy cigarettes were associated with providing. Conclusions. The social availability of tobacco to youth needs further examination. Handle: RePEc:aph:ajpbhl:1997:87:4:649-651_3 Template-Type: ReDIF-Article 1.0 Title: A dietary intervention in primary care practice: The Eating Patterns Study Journal: American Journal of Public Health Author-Name: Beresford, S.A.A. Author-Name: Curry, S.J. Author-Name: Kristal, A.R. Author-Name: Lazovich, D. Year: 1997 Volume: 87 Issue: 4 Pages: 610-616 Abstract: Objectives. This study evaluated the effectiveness of a low-intensity dietary intervention in primary care practice in lowering dietary fat intake and raising dietary fiber intake. Methods. A randomized controlled trial of 28 physician practices in six primary care clinics enrolled, by telephone, adult patients who had appointments for nonurgent nonacute visits. Of 3490 eligible patients contacted, 2111 completed baseline interview; 86.1% also completed a 12-month follow-up. Physicians gave intervention participants a self-help booklet and a brief motivational message. Changes in fat and fiber from baseline to 12-month follow-up were evaluated. Results. Intervention and control groups both reported a decrease in fat intake and an increase in fiber intake. The differential change and 95% confidence interval (CI) for the percentage of energy obtained from fat was -1.2 (CI = -0.71, -1.7) (P = .0015), for grams fiber/1000 kcal 0.32 (CI = -0.066, -0.71) (P = .086), for fat score -0.044 (CI = -0.016, -0.072) (P = .010), and for fiber score 0.036 (CI = 0.011, 0.061) (P = .014), with greater reductions in fat and greater increases in fiber in the intervention group. Conclusions. This low- intensity intervention was effective in dietary behavior change. Handle: RePEc:aph:ajpbhl:1997:87:4:610-616_3 Template-Type: ReDIF-Article 1.0 Title: The feasibility of a street-intercept survey method in an African- American community Journal: American Journal of Public Health Author-Name: Miller, K.W. Author-Name: Wilder, L.B. Author-Name: Stillman, F.A. Author-Name: Becker, D.M. Year: 1997 Volume: 87 Issue: 4 Pages: 655-658 Abstract: Objectives. This study evaluates the feasibility of a nonquota, street- intercept survey method that utilized random selection of interview sites. Methods. The street-intercept survey was compared with a random-digit-dial telephone survey conducted in the same catchment area among African-American adults aged 18 or older. Results. The street-intercept survey's response rate was 80.2%; residence rate, 85.3%; interview completion rate, 97.9%; interference rate, 4.0%; and yield rate, 2.5 interviews per interviewer per hour. The street-intercept method produced more representative distributions of age and sex than the random-digit-dial survey. Conclusions. The street- intercept method is a feasible alternative to traditional population survey methods and may provide better access to harder-to-reach segments of the urban population in a safe manner. Handle: RePEc:aph:ajpbhl:1997:87:4:655-658_9 Template-Type: ReDIF-Article 1.0 Title: Neighborhood social environments and the distribution of low birthweight in Chicago Journal: American Journal of Public Health Author-Name: Roberts, E.M. Year: 1997 Volume: 87 Issue: 4 Pages: 597-603 Abstract: Objectives. This study examined the socioeconomic precursors of disparities in maternal health by measuring the associations of nine neighborhood-level indicators of social phenomena with low infant birthweight. Methods. Vital records and census data for the Chicago metropolitan area in 1990 were merged (n = 112 327); a logistic regression model predicting low birthweight was estimated by backward elimination. Results. With individual-level variables held constant, six neighborhood- level indicators predicted low birthweight, together contributing to a variation in rate of 5.5%. Community economic hardship and housing costs were positively associated with low birthweight, while community socioeconomic status, crowded housing, and high percentages of young and African-American residents were negatively associated with low birthweight. Conclusions. Maternal health inequalities should be explored in the context of historical segregation, social stratification, the dynamics of social support, and resource sharing among communities. Several community characteristics associated with poverty are negatively associated with low birthweight. The traditional focus on individual risk factors for low birthweight limits our understanding. Handle: RePEc:aph:ajpbhl:1997:87:4:597-603_9 Template-Type: ReDIF-Article 1.0 Title: Factors contributing to the hospitalization of patients with congestive heart failure Journal: American Journal of Public Health Author-Name: Chin, M.H. Author-Name: Goldman, L. Year: 1997 Volume: 87 Issue: 4 Pages: 643-648 Abstract: Objectives. This study identifies acute precipitants of hospitalization and evaluates utilization of angiotensin-converting enzyme inhibitors in patients admitted with congestive heart failure. Methods. Cross-sectional chart-review study was done of 435 patients admitted nonelectively from February 1993 to February 1994 to an urban university hospital with a complaint of shortness of breath or fatigue and evidence of congestive heart failure. Results. The most common identifiable abnormalities associated with clinical deterioration prior to admission were acute anginal chest pain (33%), respiratory infection (16%), uncontrolled hypertension with initial systolic blood pressure ≤180 mm Hg (15%), atrial arrhythmia with heart rate ≤120 (8%), and noncompliance with medications (15%) or diet (6%); in 34% of patients, no clear cause could be identified. After exclusion of those who were already on a different vasodilator or who had relative contraindications, 18 (32%) of the patients with ejection fractions ≤0.35 measured prior to admission were not taking an angiotensin-converting enzyme inhibitor on presentation to the hospital. Conclusions. Interventions to improve compliance, the control of hypertension, and the appropriate use of angiotensin-converting enzyme inhibitors may prevent many hospitalizations of heart-failure patients. Handle: RePEc:aph:ajpbhl:1997:87:4:643-648_7 Template-Type: ReDIF-Article 1.0 Title: A community waterborne outbreak of salmonellosis and the effectiveness of a boil water order Journal: American Journal of Public Health Author-Name: Angulo, F.J. Author-Name: Tippen, S. Author-Name: Sharp, D.J. Author-Name: Payne, B. Author-Name: Collier, C. Author-Name: Hill, J.E. Author-Name: Barrett, T.J. Author-Name: Clark, R.M. Author-Name: Geldreich, E.E. Author-Name: Denny Donnell Jr., H. Author-Name: Swerdlow, D.L. Year: 1997 Volume: 87 Issue: 4 Pages: 580-584 Abstract: Objectives. A 1993 large water-borne outbreak of Salmonella typhimurium infections in Gideon, Mo, a city of 1100 with an unchlorinated community water supply, was investigated to determine the source of contamination and the effectiveness of an order to boil water. Methods. A survey of household members in Gideon and the surrounding township produced information on diarrheal illness, water consumption, and compliance with the boil water order. Results. More than 650 persons were ill; 15 were hospitalized, and 7 died. Persons consuming city water were more likely to be ill (relative risk [RR] = 9.1, 95% confidence interval [CI] = 2.9, 28.4), and the attack rate increased with increased water consumption. S. typhimurium was recovered from samples taken from a city fire hydrant and a water storage tower. Persons in 31% (30/98) of city households had drunk unboiled water after being informed about the boil water order, including 14 individuals who subsequently became ill. Reasons for noncompliance included 'not remembering' (44%) and 'disbelieving' (25%) the order. Conclusions. Communities with deteriorating water systems risk widespread illness unless water supplies are properly operated and maintained. Effective education to improve compliance during boil water orders is needed. Handle: RePEc:aph:ajpbhl:1997:87:4:580-584_8 Template-Type: ReDIF-Article 1.0 Title: Integrating HIV prevention, STD, and family planning services. The need for integrated government funding and services. Journal: American Journal of Public Health Author-Name: Sable, M. Year: 1997 Volume: 87 Issue: 4 Pages: 693 Handle: RePEc:aph:ajpbhl:1997:87:4:693_1 Template-Type: ReDIF-Article 1.0 Title: Rural hospitals' experience with the National Practitioner Data Bank Journal: American Journal of Public Health Author-Name: Neighbor, W.E. Author-Name: Baldwin, L.-M. Author-Name: West, P.A. Author-Name: Gary Hart, L. Year: 1997 Volume: 87 Issue: 4 Pages: 663-666 Abstract: Objectives. This study examined hospital administrators' experiences with the National Practitioner Data Bank. Methods. One hundred forty-nine rural hospital administrators completed questionnaires assessing their perceptions of the data bank. Results. Nearly 90% of respondents rated the data bank as an important source of information for credentialing. Three percent indicated it had directly affected privileging decisions; 43% and 34%, respectively, believed the costs exceeded or equaled the benefits. Twenty percent reported changes that could decrease disciplinary action reports to the data bank. Conclusions. While the National Practitioner Data Bank is an important source of information to rural hospitals, it may affect few credentialing decisions and motivate behavioral changes that could have a paradoxical effect on quality assurance. Handle: RePEc:aph:ajpbhl:1997:87:4:663-666_5 Template-Type: ReDIF-Article 1.0 Title: Asbestos-related cancer and the amphibole hypothesis. The amphibole hypothesis: neither gone nor forgotten. Journal: American Journal of Public Health Author-Name: Langer, A.M. Author-Name: Nolan, R.P. Year: 1997 Volume: 87 Issue: 4 Pages: 688-689 Handle: RePEc:aph:ajpbhl:1997:87:4:688-689_3 Template-Type: ReDIF-Article 1.0 Title: The effectiveness of a hospital-based program to promote exclusive breast-feeding among low-income women in Brazil Journal: American Journal of Public Health Author-Name: Lutter, C.K. Author-Name: Perez-Escamilla, R. Author-Name: Segall, A. Author-Name: Sanghvi, T. Author-Name: Teniya, K. Author-Name: Wickham, C. Year: 1997 Volume: 87 Issue: 4 Pages: 659-663 Abstract: Objectives. This study examined the effectiveness of a hospital program to promote exclusive breast-feeding in Santos, Brazil. Methods. In a prospective design, women who delivered at a hospital with an active breast- feeding promotion program (n = 236) were compared with women who delivered at a nearby control hospital (n = 206). Results. The two groups had similar demographic characteristics and previous breast-feeding histories. Exposure to breast-feeding activities, assessed by maternal recall prior to discharge, was universally high at the program hospital and universally low at the control hospital. Multivariate survival analysis showed that exclusive breast-feeding lasted 53 days longer among women who delivered at the program hospital. Conclusions. Hospital-based breast-feeding promotion programs may be effective in extending the duration of exclusive breast-feeding. Handle: RePEc:aph:ajpbhl:1997:87:4:659-663_4 Template-Type: ReDIF-Article 1.0 Title: Low blood pressure and five-year mortality in a Stockholm cohort of the very old: Possible confounding by cognitive impairment and other factors Journal: American Journal of Public Health Author-Name: Guo, Z. Author-Name: Viitanen, M. Author-Name: Winblad, B. Year: 1997 Volume: 87 Issue: 4 Pages: 623-628 Abstract: Objectives. Low blood pressure has often been reported to be related to excess mortality in people over the age of 75 years. This study examined whether other predictors may account for the association. Methods. A community-based cohort of 1810 people who were aged 75 years and older was followed for 5 years. Results. The relative risk of death was 1.39 (95% confidence interval [CI] = 1.11, 1.73) for people with systolic pressure lower than 130 mm Hg and 1.21 (95% CI = 1.02, 1.43) for those with diastolic pressure lower than 75 mm Hg, compared with corresponding reference groups, when all other variables were simultaneously considered in Cox proportional hazards models. The observed association was present mainly in subjects with at least two of the three conditions (cardiovascular disease, limitation in activities of daily living, or cognitive impairment). The effect of low diastolic pressure on mortality was also significant in those with only cognitive impairment. Conclusions. Preexisting cardiovascular disease, limitation in activities of dally living, and, more important, cognitive impairment may be responsible for the association of low blood pressure with increased mortality in the very old in that they cause both reductions in blood pressure and excess deaths. Handle: RePEc:aph:ajpbhl:1997:87:4:623-628_4 Template-Type: ReDIF-Article 1.0 Title: Asbestos-related cancer and the amphibole hypothesis. The hypothesis is still supported by scientists and scientific data. Journal: American Journal of Public Health Author-Name: Mossman, B.T. Author-Name: Gee, J.B. Year: 1997 Volume: 87 Issue: 4 Pages: 689-690 Handle: RePEc:aph:ajpbhl:1997:87:4:689-690_4 Template-Type: ReDIF-Article 1.0 Title: The role of diabetes mellitus in the higher prevalence of tuberculosis among Hispanics Journal: American Journal of Public Health Author-Name: Pablos-Méndez, A. Author-Name: Blustein, J. Author-Name: Knirsch, C.A. Year: 1997 Volume: 87 Issue: 4 Pages: 574-579 Abstract: Objectives. This research studied the relative contribution of diabetes mellitus to the increased prevalence of tuberculosis in Hispanics. Methods. A case-control study was conducted involving all 5290 discharges from civilian hospitals in California during 1991 who had a diagnosis of tuberculosis, and 37 366 control subjects who had a primary discharge diagnosis of deep venous thrombosis, pulmonary embolism, or acute appendicitis. Risk of tuberculosis was estimated as the odds ratio (OR) across race/ethnicity, with adjustment for other factors. Results. Diabetes mellitus was found to be an independent risk factor for tuberculosis. The association of diabetes and tuberculosis was higher among Hispanics (adjusted OR [OR(adj)] = 2.95; 95% confidence interval [CI] = 2.61, 3.33) than among non-Hispanic Whites (OR(adj) = 1.31; 95% CI = 1.19, 1.45); among non-Hispanic Blacks, diabetes was not found to be associated with tuberculosis (OR(adj) = 0.93; 95% CI = 0.78, 1.09). Among Hispanics aged 25 to 54, the estimated risk of tuberculosis attributable to diabetes (25.2%) was equivalent to that attributable to HIV infection (25.5%). Conclusions. Diabetes mellitus remains a significant risk factor for tuberculosis in the United States. The association is especially notable in middle-aged Hispanics. Handle: RePEc:aph:ajpbhl:1997:87:4:574-579_7 Template-Type: ReDIF-Article 1.0 Title: Workplace conditions, socioeconomic status, and the risk of mortality and acute myocardial infarction: The Kuopio Ischemic Heart Disease Risk Factor Study Journal: American Journal of Public Health Author-Name: Lynch, J. Author-Name: Krause, N. Author-Name: Kaplan, G.A. Author-Name: Tuomilehto, J. Author-Name: Salonen, J.T. Year: 1997 Volume: 87 Issue: 4 Pages: 617-622 Abstract: Objectives. This study investigated whether the association between workplace conditions and the risk of all-cause and cardiovascular mortality and acute myocardial infarction differed by socioeconomic status. Methods. Prospective data were used to examine these associations in 2297 Finnish men, with adjustment for prevalent diseases and biological, behavioral, and psychosocial covariates, and stratified by employment status and workplace social support. Results. Elevated age-adjusted relative hazards for all- cause mortality were found for men who reported high demands, low resources, and low income; high demands, high resources, and low income; and low demands, high resources, and low income. Similar patterns were found for cardiovascular mortality. In contrast, elevated age-adjusted relative hazards for acute myocardial infarction were observed only in men who reported high demands, low resources, and low income. These results did not differ by level of workplace social support or employment status. Conclusions. The negative effects of workplace conditions on mortality and of myocardial infarction risk depended on income level and were largely mediated by known risk factors. Handle: RePEc:aph:ajpbhl:1997:87:4:617-622_5 Template-Type: ReDIF-Article 1.0 Title: Composite cardiovascular risk outcomes of a work-site intervention trial Journal: American Journal of Public Health Author-Name: Gomel, M.K. Author-Name: Oldenburg, B. Author-Name: Simpson, J.M. Author-Name: Chilvers, M. Author-Name: Owen, N. Year: 1997 Volume: 87 Issue: 4 Pages: 673-676 Abstract: Objectives. Two composite outcome measures were used to assess the efficacy of work-site risk factor interventions: the Framingham multiple logistic function and a standardized composite equation that was an unweighted combination of risk factors. Methods. Twenty-eight work sites in Sydney, Australia, were randomly assigned to health risk assessment, risk factor education, behavioral counseling, or behavioral counseling plus incentives. Results. Over 12 months, scores on the multiple logistic function increased for the behavioral counseling plus incentives condition relative to the other conditions. Standardized scores decreased for behavioral counseling relative to the incentive condition and the average of all other conditions. Conclusions. Behavioral counseling produces larger changes in the life-style behaviors contributing to coronary heart disease risk than other commonly used interventions. Handle: RePEc:aph:ajpbhl:1997:87:4:673-676_5 Template-Type: ReDIF-Article 1.0 Title: The Boston AIDS Survival Score (BASS): A multidimensional AIDS severity instrument Journal: American Journal of Public Health Author-Name: Seage III, G.R. Author-Name: Gatsonis, C. Author-Name: Weissman, J. Author-Name: Haas, J. Author-Name: Cleary, P. Author-Name: Fowler, F. Author-Name: Massagli, M.P. Author-Name: Stone, V.E. Author-Name: Craven, D.E. Author-Name: Makadon, H. Author-Name: Goldberg, J. Author-Name: Coltin, K. Author-Name: Levin, K.S. Author-Name: Epstein, A.M. Year: 1997 Volume: 87 Issue: 4 Pages: 567-573 Abstract: Objectives. This study developed a new acquired immunodeficiency syndrome (AIDS) severity system by including diagnostic, physiological, functional, and sociodemographic factors predictive of survival. Methods. Three-hundred five persons with AIDS in Boston were interviewed; their medical records were reviewed and vital status ascertained. Results. Overall median (±SD) survival for the cohort from the first interview until death was 560 ± 14.4 days. The best model for predicting survival, the Boston AIDS Survival Score, included the Justice score (stage 2 relative hazard [RH] = 1.25, 95% confidence interval [CI] = 0.80, 1.96; stage 3 RH = 1.76. 95% CI = 1.15, 2.70), a newly developed opportunistic disease score (Boston Opportunistic Disease Survival Score; stage 2 RH = 1.35, 95% CI = 0.90, 2.02; stage 3 RH = 2.10, 95% CI = 1.38, 3.18), and measures of activities of daily living (any intermediate limitations, RH = 1.84, 95% CI = 1.05, 3.21; any basic limitations, RH = 2.60, 95% CI = 1.44, 4.69). This model had substantially greater predictive power (R 2 = .17, C statistic = .68) than the Justice score alone (R 2 = .09, C statistic = .61). Conclusions. Incorporating data on clinically important events and functional status into a physiologically based system can improve the prediction of survival with AIDS. Handle: RePEc:aph:ajpbhl:1997:87:4:567-573_2 Template-Type: ReDIF-Article 1.0 Title: Seven-year trends in body weight and associations with lifestyle and behavioral characteristics in Black and White young adults: The CARDIA study Journal: American Journal of Public Health Author-Name: Lewis, C.E. Author-Name: Smith, D.E. Author-Name: Wallace, D.D. Author-Name: Dale Williams, O. Author-Name: Bild, D.E. Author-Name: Jacobs Jr., D.R. Year: 1997 Volume: 87 Issue: 4 Pages: 635-642 Abstract: Objectives. This study estimated the amount of weight change in a biracial cohort of young adults and the separate components attributable to time-related and aging-related changes, as well as identified possible determinants of weight change. Methods. In this population-based prospective study of 18- to 30-year-old African-American and White men and women, body weight and prevalence of overweight were measured from 1985/86 to 1992/93. Results. Average weight increased over the 7 years, increases ranging from 5.2 kg (SE = 0.2, n = 811) in White women to 8.5 kg (SE = 0.3, n = 882) in African-American women. Significant time-related increases in weight, ranging from 2.0 kg (SE = 1.0) in White women to 4.8 kg (SE = 1.0, n = 711) in African-American men, accounted for 40% to 60% of the average total weight gain. Aging-related increases were also significant, ranging from 2.6 kg (SE = 0.8, n = 944) in White men to 5.0 kg (SE = 1.1) in African-American women. The prevalence of overweight increased progressively in each group. Decreased physical fitness was most strongly associated with weight gain in both sexes. Conclusions. The observed dramatic time-related weight gains, most likely due to secular (period-related) trends, are a serious public health concern. Handle: RePEc:aph:ajpbhl:1997:87:4:635-642_6 Template-Type: ReDIF-Article 1.0 Title: The effectiveness of family planning programs evaluated with true experimental designs Journal: American Journal of Public Health Author-Name: Bauman, K.E. Year: 1997 Volume: 87 Issue: 4 Pages: 666-669 Abstract: Objectives. This paper describes the magnitude of effects for family planning programs evaluated with true experimental designs. Methods. Studies that used true experimental designs to evaluate family planning programs were identified and their results subjected to meta-analysis. Results. For the 14 studies with the information needed to calculate effect size, the Pearson r between program and effect variables ranged from -.08 to .19 and averaged .08. Conclusions. The programs evaluated in the studies considered have had, on average, smaller effects than many would assume and desire. Handle: RePEc:aph:ajpbhl:1997:87:4:666-669_0 Template-Type: ReDIF-Article 1.0 Title: Marijuana use and mortality Journal: American Journal of Public Health Author-Name: Sidney, S. Author-Name: Beck, J.E. Author-Name: Tekawa, I.S. Author-Name: Quesenberry Jr., C.P. Author-Name: Friedman, G.D. Year: 1997 Volume: 87 Issue: 4 Pages: 585-590 Abstract: Objectives. The purpose of this study was to examine the relationship of marijuana use to mortality. Methods. The study population comprised 65 171 Kaiser Permanente Medical Care Program enrollees, aged 15 through 49 years, who completed questionnaires about smoking habits, including marijuana use, between 1979 and 1985. Mortality follow-up was conducted through 1991. Results. Compared with nonuse or experimentation (lifetime use six or fewer times), current marijuana use was not associated with a significantly increased risk of non-acquired immunodeficiency syndrome (AIDS) mortality in men (relative risk [RR] = 1.12, 95% confidence interval [CI] = 0.89, 1.39) or of total mortality in women (RR = 1.09, 95% CI = 0.80, 1.48). Current marijuana use was associated with increased risk of AIDS mortality in men (RR = 1.90, 95% CI = 1.33, 2.73), an association that probably was not causal but most likely represented uncontrolled confounding by male homosexual behavior. This interpretation was supported by the lack of association of marijuana use with AIDS mortality in men from a Kaiser Permanente AIDS database. Relative risks for ever use of marijuana were similar. Conclusions. Marijuana use in a prepaid health care-based study cohort had little effect on non-AIDS mortality in men and on total mortality in women. Handle: RePEc:aph:ajpbhl:1997:87:4:585-590_7 Template-Type: ReDIF-Article 1.0 Title: Mentally disordered women in jail: Who receives services? Journal: American Journal of Public Health Author-Name: Teplin, L.A. Author-Name: Abram, K.M. Author-Name: McClelland, G.M. Year: 1997 Volume: 87 Issue: 4 Pages: 604-609 Abstract: Objectives. Many jail inmates have severe psychiatric disorders (e.g., schizophrenia, major affective disorders). The courts have mandated that detainees have a constitutional right to treatment. We investigated what proportion of female jail detainees needed mental health services, what proportion received services, and what variables predicted who received services. Methods. Trained interviewers administered a psychiatric evaluation (the NIMH Diagnostic Interview Schedule) to 1272 randomly selected female jail detainees during jail intake in a large Midwestern city. Project staff then documented whether women subsequently received services, using records and case files. Results. Of the women who needed services, 23.5% received them while they were in jail. Type of disorder, treatment history, and sociodemographic variables all affected the odds of a mentally ill woman's receiving services. Conclusions. Correctional health care is a growing national public health problem. The magnitude of mental health service needs far exceeds current resources. Handle: RePEc:aph:ajpbhl:1997:87:4:604-609_9 Template-Type: ReDIF-Article 1.0 Title: The case of the missing secretary: DHEW's failed efforts to create a Cabinet secretary of health Journal: American Journal of Public Health Author-Name: Silver, G.A. Year: 1997 Volume: 87 Issue: 4 Pages: 681-686 Abstract: In response to professional and political pressures in 1967, an incident occurred at the Department of Health, Education, and Welfare that illustrates the delicacy and complexity of the legislative process. In an effort to bypass interest group influences, the undersecretary of the Department undertook a maneuver that backfired and frustrated an opportunity that might have resulted in the establishment of a Cabinet office of Health. In addition to demonstrating the sensitivity of the legislative process, and the dangers of overconfidence in dealing with the process, the events also offer moral guidance: too stubborn, idealistic convictions of good people, however well intentioned the actions, may serve to defeat the desired ends. Handle: RePEc:aph:ajpbhl:1997:87:4:681-686_9 Template-Type: ReDIF-Article 1.0 Title: Lifetime cocaine use and cardiovascular characteristics among young adults: The CARDIA study Journal: American Journal of Public Health Author-Name: Braun, B.L. Author-Name: Murray, D.M. Author-Name: Sidney, S. Year: 1997 Volume: 87 Issue: 4 Pages: 629-634 Abstract: Objectives. Cocaine is a central nervous system stimulant associated with cardiovascular disease risk factors, morbidity, and mortality. Despite these demonstrated relationships, it has been difficult to assess the long- term cardiovascular consequences of cocaine use. Methods. The Coronary Artery Risk Development in Young Adults study provides an opportunity to evaluate the association of lifetime cocaine use with cardiovascular disease risk factors in a randomly sampled biethnic cohort of men and women of varied socioeconomic status, aged 20 to 32 in 1987. Results. More extensive cocaine use experience was associated with being White, older, and less educated, regardless of sex. Higher levels of licit and illicit substance use behavior were reported by those reporting more extensive cocaine experience; however, most cardiovascular disease risk factors such as systolic and diastolic blood pressure, heart rate, hypertension, physical activity, and anthropometric measurements were not related to lifetime cocaine experience. Conclusions. In this age group, the detrimental cardiovascular effects of cocaine may be limited to acute effects. Further studies are needed to determine whether continued exposure is related to cardiovascular disease risk factors later in life. Handle: RePEc:aph:ajpbhl:1997:87:4:629-634_3 Template-Type: ReDIF-Article 1.0 Title: The effects of cigarette smoking and gestational weight change on birth outcomes in obese and normal-weight women Journal: American Journal of Public Health Author-Name: Hellerstedt, W.L. Author-Name: Hirnes, J.H. Author-Name: Story, M. Author-Name: Alton, I.R. Author-Name: Edwards, L.E. Year: 1997 Volume: 87 Issue: 4 Pages: 591-596 Abstract: Objectives. The associations of infant birth outcomes with maternal pregravid obesity, gestational weight gain, and prenatal cigarette smoking were examined. Methods. A retrospective analysis of 1343 obese and normal- weight gravidas evaluated the associations of cigarette smoking, gestational weight change, and pregravid body mass index with birthweight, low birthweight, and small- and large-for-gestational-age births. Results. Smoking was associated with the delivery of lower-birthweight infants for both obese and normal-weight women, and gestational weight gain did not eliminate the birthweight-lowering effects of smoking. Women at highest risk of delivering lower-birthweight infants were obese smokers whose gestational gains were less than 7 kg and normal-weight smokers whose gestational gains were less than 11.5 kg. Conclusions. To balance the risks of small and large- size infants, gains of 7 to 11.5 kg for obese women and 11.5 to 16 kg for normal-weight women appear appropriate. Handle: RePEc:aph:ajpbhl:1997:87:4:591-596_3 Template-Type: ReDIF-Article 1.0 Title: Exercise and depression in midlife: A prospective study Journal: American Journal of Public Health Author-Name: Cooper-Patrick, L. Author-Name: Ford, D.E. Author-Name: Mead, L.A. Author-Name: Chang, P.P. Author-Name: Klag, M.J. Year: 1997 Volume: 87 Issue: 4 Pages: 670-673 Abstract: Objectives. This study examined the relationship of self-reported physical activity with subsequent depression and psychiatric distress. Methods. Physical activity was assessed in medical school and midlife in 973 physicians as part of a prospective observational study. Outcome measures were the incidence of self-reported clinical depression and psychiatric distress on the General Health Questionnaire. Results. The risk of depression was similar for nonexercisers and exercisers. No relationship was observed between physical activity level and subsequent psychiatric distress. Conclusions. This study found no evidence that exercise reduces risk for depression or psychiatric distress. Handle: RePEc:aph:ajpbhl:1997:87:4:670-673_7 Template-Type: ReDIF-Article 1.0 Title: Integrating HIV prevention, STD, and family planning services. Comprehensive efforts in Philadelphia. Journal: American Journal of Public Health Author-Name: Mann, D. Year: 1997 Volume: 87 Issue: 4 Pages: 692 Handle: RePEc:aph:ajpbhl:1997:87:4:692_5 Template-Type: ReDIF-Article 1.0 Title: Characteristics of older pedestrians who have difficulty crossing the street Journal: American Journal of Public Health Author-Name: Langlois, J.A. Author-Name: Keyl, P.M. Author-Name: Guralnik, J.M. Author-Name: Foley, D.J. Author-Name: Marottoli, R.A. Author-Name: Wallace, R.B. Year: 1997 Volume: 87 Issue: 3 Pages: 393-397 Abstract: Objectives. This study examined the sociodemographic and health characteristics and problems of older pedestrians. Methods. Interviews and assessments were conducted with 1249 enrollees aged 72 or older from the New Haven, Conn, community of the Established Populations for Epidemiologic Studies of the Elderly who agreed to participate in a seventh follow-up. Results. Approximately 11% of the New Haven residents reported difficulty crossing the street. Older pedestrians needing help in one or more activities of daily living were more than 10 times as likely as others, and those with the slowest walking speeds were nearly 3 times as likely as others, to report difficulty crossing the street. Fewer than 1% of these pedestrians aged 72 or older had a normal walking speed sufficient to cross the street in the time typically allotted at signalized intersections (1.22 m/sec). Conclusions. Crossing times at signalized intersections in areas with large populations of elders should be extended, and the recommended walking speed for timing signalized crossings should be modified to reflect the range of abilities among older pedestrians. Handle: RePEc:aph:ajpbhl:1997:87:3:393-397_2 Template-Type: ReDIF-Article 1.0 Title: The effect of postmenopausal estrogen therapy on the risk of non- insulin-dependent diabetes mellitus Journal: American Journal of Public Health Author-Name: Gabal, L.L. Author-Name: Goodman-Gruen, D. Author-Name: Barrett-Connor, E. Year: 1997 Volume: 87 Issue: 3 Pages: 443-445 Abstract: Objectives. This study examined the effect of postmenopausal estrogen replacement therapy on the incidence of non-insulin-dependent diabetes in women. Methods. Postmenopausal women aged 50 through 70 years (n = 848) without diagnosed diabetes at baseline were followed for 10 to 15 years for incident diabetes. Results. Over the average 11.5 year follow-up, there were 105 new cases of diabetes. The age-adjusted relative-risk for development of diabetes was nonsignificantly lower for women with continuous estrogen replacement therapy use than for never users. After adjustment for major covariates, a nonsignificant linear trend with increasing duration of estrogen replacement therapy was reversed. Conclusions. This study suggests that previous results showing a reduced risk of diabetes in women using estrogen may have been due to selection bias regarding who is prescribed estrogen, confounding factors, or differential diagnostic efforts. Handle: RePEc:aph:ajpbhl:1997:87:3:443-445_7 Template-Type: ReDIF-Article 1.0 Title: Unmet health care needs and mortality among Spanish elderly Journal: American Journal of Public Health Author-Name: Alonso, J. Author-Name: Orfila, F. Author-Name: Ruigómez, A. Author-Name: Ferrer, M. Author-Name: Antó, J.M. Year: 1997 Volume: 87 Issue: 3 Pages: 365-370 Abstract: Objectives. This study estimates the prevalence of unmet health care needs among the elderly of Barcelona, Spain, and analyzes the association between unmet needs and mortality. Methods. Home interviews were conducted with 1315 elderly in Barcelona. Individuals were classified as having a 'health services need' if they reported being in fair, poor, or very poor health; suffering from two or more chronic conditions; or being dependent in at least one basic activity of daily living. Need was considered unmet if no visits to or from a physician in the previous 12 months were reported. Mortality was assessed from census data in August 1991. Results. Between 10% and 25% of the elderly in need reported no use of health services. After a median of 60.3 months, those with unmet health care needs presented a higher risk of mortality, adjusted for several confounding factors: relative risk [RR] = 2.55 (95% confidence interval [CI] = 1.22, 5.32) for unmet activity of daily living dependency; RR = 1.80 (95% CI = 1.20, 2.70) for unmet comorbidity; and odds ratio = 1.10 (95% CI = 0.59, 2.05) for unmet poor self- rated health. Conclusion. Noninstitutionalized elderly individuals with unmet health care needs are at increased risk of dying. Handle: RePEc:aph:ajpbhl:1997:87:3:365-370_2 Template-Type: ReDIF-Article 1.0 Title: Condom breakage and slippage during heterosexual intercourse: A French National Survey Journal: American Journal of Public Health Author-Name: Messiah, A. Author-Name: Dart, T. Author-Name: Spencer, B.E. Author-Name: Warszawski, J. Year: 1997 Volume: 87 Issue: 3 Pages: 421-424 Abstract: Objectives. This study examined condom failure rates in a representative sample of French men and women. Methods. Condom users who experienced breakage or slippage were compared with those who reported no difficulties. Results. The rate of breakage at last heterosexual intercourse was 3.4%, and the slippage rate was 1.1%. Significantly associated with breakage and slippage were being age 25 through 34, being sexually active for more than 5 years, condom use for less than 5 years, condom not used for contraception, and sexual intercourse 12 or more times per month. Conclusions. People who became sexually active before the era of acquired immunodeficiency syndrome, who began condom use in recent years, and who have frequent sex are at increased risk. The low risk observed among experienced condom users below age 25 supports condom promotion to youth. Handle: RePEc:aph:ajpbhl:1997:87:3:421-424_9 Template-Type: ReDIF-Article 1.0 Title: Adverse outcomes of planned and unplanned pregnancies among users of natural family planning: A prospective study Journal: American Journal of Public Health Author-Name: Bitto, A. Author-Name: Gray, R.H. Author-Name: Simpson, J.L. Author-Name: Queenan, J.T. Author-Name: Kambic, R.T. Author-Name: Perez, A. Author-Name: Mena, P. Author-Name: Barbato, M. Author-Name: Li, C. Author-Name: Jennings, V. Year: 1997 Volume: 87 Issue: 3 Pages: 338-343 Abstract: Objectives. The purpose of this study was to determine prospectively whether unplanned pregnancies are associated with adverse pregnancy outcomes among users of natural family planning. Methods. Women who became pregnant while using natural family planning were identified in five centers worldwide: there were 373 unplanned and 367 planned pregnancies in this cohort. The subjects were followed up at 16 and 32 weeks' gestation and after delivery. The risks of spontaneous abortion, low birthweight, and preterm birth were estimated after adjustment by logistic regression. Results. The women with unplanned pregnancies were more likely to be at the extremes of age, to report more medical problems before and during the index pregnancy, and to seek antenatal care later in gestation than the women with planned pregnancies. However, women with planned pregnancies reported a higher rate of spontaneous abortion in previous pregnancies (28.8%) than did women with unplanned pregnancies (12.9%). There were no significant differences in the rates of spontaneous abortion, low birthweight, or preterm birth between the two groups. Conclusions. No increased risk of adverse pregnancy outcomes was observed among women who experienced an unplanned pregnancy while using natural family planning. Handle: RePEc:aph:ajpbhl:1997:87:3:338-343_4 Template-Type: ReDIF-Article 1.0 Title: South Africa's early experiment in social medicine: Its pioneers and politics Journal: American Journal of Public Health Author-Name: Marks, S. Year: 1997 Volume: 87 Issue: 3 Pages: 452-459 Abstract: The election of a democratic, nonracial government in South Africa has moved the health needs of the majority of the population to center stage. In the search for precedents, health policymakers have turned to South Africa's pioneering of health centers and social medicine in the 1940s. This paper looks at the intellectual context in which these ideas were first developed; the particular political circumstances and relationships between doctors and the state in the late 1930s, which facilitated the establishment of health centers; the role that the health centers were intended to play in South Africa's wider postwar health plans; and the reasons for the centers' failure. Contrary to conventional wisdom, it argues that the failure of the health centers and the wider health plans predated the advent of the National Party to power in 1948, and resulted mainly from the marginalization of the centers as a low-cost option for the poor, which was itself a consequence of underfunding and the vested interests of local health authorities and private practitioners. Handle: RePEc:aph:ajpbhl:1997:87:3:452-459_3 Template-Type: ReDIF-Article 1.0 Title: Very-low-birthweight infants and income incongruity among African American and white parents in Chicago Journal: American Journal of Public Health Author-Name: Collins Jr., J.W. Author-Name: Herman, A.A. Author-Name: David, R.J. Year: 1997 Volume: 87 Issue: 3 Pages: 414-417 Abstract: Objectives. Illinois vital records for 1982/1983 and US census income data for 1980 were analyzed to ascertain the relationship of income incongruity, race, and very low birthweight. Methods. Positive income incongruity was considered present when study infants resided in wealthier neighborhoods than non-Latino Whites at the same level of parental education attainment and marital status. Results. The odds ratios of very low birthweight for African Americans (n = 44 266) and Whites (n = 27 139) who experienced positive income incongruity were 0.7 (95% confidence interval [CI] = 0.5, 0.9) and 0.6 (95% CI = 0.5, 0.9), respectively. Conclusions. Positive income incongruity is associated with lower race-specific rates of very low birthweight. Handle: RePEc:aph:ajpbhl:1997:87:3:414-417_2 Template-Type: ReDIF-Article 1.0 Title: Community mobilization for preschool immunizations: the "Shots by Two" Project. Journal: American Journal of Public Health Author-Name: Chiu, T.T. Author-Name: Barata, S.L. Author-Name: Unsicker, D.M. Author-Name: Brennan, L. Year: 1997 Volume: 87 Issue: 3 Pages: 462-463 Handle: RePEc:aph:ajpbhl:1997:87:3:462-463_1 Template-Type: ReDIF-Article 1.0 Title: Weak associations between hospital mortality rates for individual diagnoses: Implications for profiling hospital quality Journal: American Journal of Public Health Author-Name: Rosenthal, G.E. Year: 1997 Volume: 87 Issue: 3 Pages: 429-433 Abstract: Objectives. This study examined the consistency of hospital mortality rates across different diagnoses. Methods. Standardized mortality ratios for patients discharged in 1991 from US hospitals were determined via the Medicare Hospital Information Report. Results. Correlations between standardized mortality ratios for different diagnoses were relatively weak, ranging from .03 to .34. Agreement between hospital rankings (based on standardized mortality ratios), as measured by the weighted kappa statistic, was also weak. Conclusions. The present results indicate that hospital mortality rates for individual diagnoses are weakly associated. Thus, it may not be valid to generalize conclusions about hospital performance from a single diagnosis. Handle: RePEc:aph:ajpbhl:1997:87:3:429-433_7 Template-Type: ReDIF-Article 1.0 Title: Oral sex, crack smoking, and HIV infection among female sex workers who do not inject drugs. Journal: American Journal of Public Health Author-Name: Wallace, J.I. Author-Name: Porter, J. Author-Name: Weiner, A. Author-Name: Steinberg, A. Year: 1997 Volume: 87 Issue: 3 Pages: 470 Handle: RePEc:aph:ajpbhl:1997:87:3:470_3 Template-Type: ReDIF-Article 1.0 Title: The early use of alcohol and tobacco: Its relation to children's competence and parents' behavior Journal: American Journal of Public Health Author-Name: Jackson, C. Author-Name: Henriksen, L. Author-Name: Dickinson, D. Author-Name: Levine, D.W. Year: 1997 Volume: 87 Issue: 3 Pages: 359-364 Abstract: Objectives. Use of tobacco and alcohol during childhood predicts heavy use of these substances and use of illicit drags during adolescence. This study aims to identify developmental correlates of tobacco and alcohol use among elementary-school children. Methods. Cross-sectional surveys were used to measure tobacco and alcohol use, multiple indicators of child competence, parenting behaviors, and parental modeling of tobacco and alcohol use in a sample of 1470 third- and fifth-grade children. Both self-report and teacher- rated assessments were obtained, which allowed collateral testing of study hypotheses. Results. Children's tobacco and alcohol use was strongly related to low scores on several measures of child competence, both self-reported and teacher rated. Children's tobacco and alcohol use was also associated with less effective parenting behaviors and with parental use of tobacco and alcohol. Conclusions. Children's early experience with tobacco and alcohol is associated with weak competence development and exposure to socialization factors that promote risk taking. Interventions to prevent early use of tobacco and alcohol are needed. Handle: RePEc:aph:ajpbhl:1997:87:3:359-364_9 Template-Type: ReDIF-Article 1.0 Title: Inappropriate drug prescriptions for elderly residents of board and care facilities Journal: American Journal of Public Health Author-Name: Spore, D.L. Author-Name: Mor, V. Author-Name: Larrat, P. Author-Name: Hawes, C. Author-Name: Hiris, J. Year: 1997 Volume: 87 Issue: 3 Pages: 404-4O9 Abstract: Objectives. Using 1993 data this study examines the prevalence of presumptively inappropriate prescriptions among residents, aged 65 and older, of board and care homes. Methods. Inappropriate drug prescriptions were identified through the use of established criteria developed for application to older nursing home residents and to community-dwelling elderly. This research used a sample of 2054 elderly residents from 410 facilities in 10 states. Weighted analyses were performed with SUDAAN, which accounted for the complex, multistage sampling design. Results. Depending on the criterion applied, between 20% and 25% of residents had at least one inappropriate prescription. Propoxyphene, long-acting benzodiazepines, dipyridamole, and amitriptyline were prescribed most frequently. Residents with inappropriate drug prescriptions had more complex drug regimens prescribed on a routine basis. Conclusions. The results are a conservative estimate of the extent of inappropriate drug prescribing and utilization in board and care facilities. Increased involvement by pharmacists and physicians in systematic drug utilization review is warranted. Handle: RePEc:aph:ajpbhl:1997:87:3:404-4O9_8 Template-Type: ReDIF-Article 1.0 Title: Disability in activities of daily living: Patterns of change and a hierarchy of disability Journal: American Journal of Public Health Author-Name: Dunlop, D.D. Author-Name: Hughes, S.L. Author-Name: Manheim, L.M. Year: 1997 Volume: 87 Issue: 3 Pages: 378-383 Abstract: Objectives. This paper examines longitudinal data over 6 years to evaluate incidence rates of disability and the pattern of dependency in activities of daily living. Methods. The Longitudinal Study of Aging (n = 5151) was used to evaluate incidence of disability in activities of daily living; biennial interview data from 1984 through 1990 were used. The median age to disability onset for individual activities was estimated from survival analysis. A prevalent ordering of incident disability was identified from patterns of disability onset within individuals. Results. The progression of incident disability among the elderly supported by longitudinal data, based on both the ordering of median ages to disability onset and patterns of incident disability, was as follows: walking, bathing, transferring, dressing, toileting, feeding. Gender differences were found in disability incidence rates. Conclusions. This study provides a mathematical picture of physical functioning as people age. These findings, based on longitudinal data, indicate a different hierarchical structure of disability than found in previous reports using cross-sectional data. Furthermore, the study documents gender differences in incident impairment, which indicate that although women outlive men, they spend more time in a disabled state. Handle: RePEc:aph:ajpbhl:1997:87:3:378-383_2 Template-Type: ReDIF-Article 1.0 Title: The health status of elderly persons in the last year of life: A comparison of deaths by suicide, injury, and natural causes Journal: American Journal of Public Health Author-Name: Grabbe, L. Author-Name: Demi, A. Author-Name: Camann, M.A. Author-Name: Potter, L. Year: 1997 Volume: 87 Issue: 3 Pages: 434-437 Abstract: Objectives. This study identified health status variables related to suicide by elderly persons and compared the health status of suicide decedents with natural death and injury decedents. Methods. Data were obtained from the 1986 National Mortality Followback Survey. Results. When other variables were controlled for, suicide decedents were significantly more likely than injury decedents to have a history of cancer (odds ratio [OR] =51.94), moderate (OR= 29.37) or heavy (OR = 22.87) alcohol use, and mental or emotional disorder (OR- 10.91) and to be White (OR = 18.54) and male (OR - 9.12). Conclusions. The findings indicate that a history of cancer should be considered as a risk for suicide in the elderly. Handle: RePEc:aph:ajpbhl:1997:87:3:434-437_6 Template-Type: ReDIF-Article 1.0 Title: Health care seeking behaviors related to sexually transmitted diseases among adolescents Journal: American Journal of Public Health Author-Name: Fortenberry, J.D. Year: 1997 Volume: 87 Issue: 3 Pages: 417-420 Abstract: Objectives. This study identified social, cognitive, and behavioral factors associated with how adolescents seek health care for sexually transmitted diseases. Methods. Data for male and female adolescents (n = 208) attending a clinic specializing in sexually transmitted diseases were examined. Results. Symptomatic female adolescents required greater time to obtain care than asymptomatic female adolescents or symptomatic male adolescents. Factors affecting duration of care seeking interval included perception of barriers to care, lower self-efficacy for response to a sexually transmitted disease, greater perceived seriousness of sexually transmitted diseases, previous history of sexually transmitted diseases, and stigma. Conclusions. Improved secondary sexually transmitted disease prevention efforts among adolescents require reductions in barriers to care and improved symptom recognition by adolescents. Handle: RePEc:aph:ajpbhl:1997:87:3:417-420_0 Template-Type: ReDIF-Article 1.0 Title: Providing legal services to vulnerable populations through a clinic-law firm collaboration. Journal: American Journal of Public Health Author-Name: Deinard, A.S. Author-Name: Martin, A. Author-Name: Lindemann, S. Author-Name: Haynes, D. Year: 1997 Volume: 87 Issue: 3 Pages: 463-464 Handle: RePEc:aph:ajpbhl:1997:87:3:463-464_3 Template-Type: ReDIF-Article 1.0 Title: Living arrangements, changes in living arrangements, and survival among community dwelling older adults Journal: American Journal of Public Health Author-Name: Davis, M.A. Author-Name: Moritz, D.J. Author-Name: Neuhaus, J.M. Author-Name: Barclay, J.D. Author-Name: Gee, L. Year: 1997 Volume: 87 Issue: 3 Pages: 371-377 Abstract: Objectives. This study examines whether living arrangements and changes in living arrangements are associated with survival among older community- dwelling adults, and whether differences in health status account for observed differences in survival. Methods. The sample consisted of 51185 persons aged 70 years or older who had participated in the Longitudinal Study of Aging in 1984 and 1986. Proportional hazards models were used to examine associations of survival time through 1990 with living arrangements in 1984 and with changes in living arrangements from 1984 to 1986. Results. Women who lived with someone other than a spouse at baseline or who changed from living with a spouse to living with someone other than a spouse were at greater risk of dying than women in other living arrangements, independent of health status or functioning. Among men, survival time was not generally associated with baseline living arrangements. Conclusions. Older adults who live alone or who change from living with someone to living alone do not have an increased mortality risk. However, living with or changing to living with someone other than a spouse may be associated with increased mortality risk. Handle: RePEc:aph:ajpbhl:1997:87:3:371-377_7 Template-Type: ReDIF-Article 1.0 Title: The health and housing fellows program: recruiting returned Peace Corps volunteers. Journal: American Journal of Public Health Author-Name: Howland, J. Author-Name: Ollen, B. Author-Name: Dowley, S. Author-Name: Coombs, D.W. Author-Name: Stalker, V. Author-Name: Shiber, S. Year: 1997 Volume: 87 Issue: 3 Pages: 464-465 Handle: RePEc:aph:ajpbhl:1997:87:3:464-465_5 Template-Type: ReDIF-Article 1.0 Title: The effect of HIP fracture on mortality, hospitalization, and functional status: A prospective study Journal: American Journal of Public Health Author-Name: Wolinsky, F.D. Author-Name: Fitzgerald, J.F. Author-Name: Stump, T.E. Year: 1997 Volume: 87 Issue: 3 Pages: 398-403 Abstract: Objectives. The purpose of this study was to prospectively assess the independent effect of hip fracture on mortality, hospitalization, and functional status. Methods. Among 7527 members of the Longitudinal Study of Aging who were over age 70 at baseline, 368 persons with hip fracture occurring between 1984 and 1991 were identified. Median length of follow-up was 831 days. Results. Hip fracture was significantly related to mortality (adjusted hazards ratio [AHR] = 1.83; 95% confidence interval [CI] = 1.55, 2.16) when treated as a time-dependent covariate. This effect was concentrated in the first 6 months postfracture (AHR = 38.93, 95% CI = 29.58, 51.23, vs AHR= 1.17; 95% CI = 0.95, 1.44). Hip fracture significantly increased the likelihood of subsequent hospitalization (adjusted odds ratio = 3.31, 95% CI = 2.64, 4.15) and increased the number of subsequent episodes by 9.4%, the number of hospital days by 21.3%, and total charges by 16.3%. Hip fracture also increased the number of functional status dependencies. Conclusions. The health of older adults deteriorates after hip fracture, and efforts to reduce the incidence of hip fracture could lower subsequent mortality, morbidity, and health services use. Handle: RePEc:aph:ajpbhl:1997:87:3:398-403_5 Template-Type: ReDIF-Article 1.0 Title: Cocaine use during pregnancy: Sensitive detection by hair assay Journal: American Journal of Public Health Author-Name: Kline, J. Author-Name: Ng, S.K.C. Author-Name: Schittini, M. Author-Name: Levin, B. Author-Name: Susser, M. Year: 1997 Volume: 87 Issue: 3 Pages: 352-358 Abstract: Objectives. This paper compares the sensitivity of two tests of cocaine use, interview and urine test, with that of a radioimmunoassay of hair. Methods. Interviews and hair samples were provided by 397 obstetric patients in one New York City hospital; urine samples were obtained in 377. Of these patients, 241 were receiving prenatal care (were registered) and 156 delivered without prenatal care (were unregistered). The 241 registered patients were derived from 400, comprising all reporting use of cocaine ever ('everusers'), all reporting use by the father but not themselves ('lifestylers'), and a sample of women who were neither ever-users nor lifestylers. The 156 unregistered patients were derived from 352 women interviewed at delivery, unselected for reported use. Results. Thirty-two percent reported ever using cocaine, 45% of these within 6 months before interview. Urine tests were positive in 20%, hair tests in 59%. The estimated sensitivity of the hair test (92%) was 3.1 times higher than that of the urine test (95% confidence interval [CI] = 2.5, 3.8) and 4 times higher than that of reported use in the past 6 months (95% CI = 3.2, 5.0). Conclusions. Self-report and urine tests alone miss most of cocaine users during pregnancy. Hair tests greatly improve detection and thus can enhance evaluations of the effects of prenatal cocaine use on fetal and child development. Handle: RePEc:aph:ajpbhl:1997:87:3:352-358_8 Template-Type: ReDIF-Article 1.0 Title: Interspecialty differences in the obstetric care of low-risk women Journal: American Journal of Public Health Author-Name: Rosenblatt, R.A. Author-Name: Dobie, S.A. Author-Name: Hart, L.G. Author-Name: Schneeweiss, R. Author-Name: Gould, D. Author-Name: Raine, T.R. Author-Name: Benedetti, T.J. Author-Name: Pirani, M.J. Author-Name: Perrin, E.B. Year: 1997 Volume: 87 Issue: 3 Pages: 344-351 Abstract: Objectives. This study examined differences among obstetricians, family physicians, and certified nurse-midwives in the patterns of obstetric care provided to low-risk patients. Methods. For a random sample of Washington State obstetrician-gynecologists, family physicians, and certified nurse- midwives, records of a random sample of their low-risk patients beginning care between September 1, 1988, and August 31, 1989, were abstracted. Results. Certified nurse-midwives were less likely to use continuous electronic fetal monitoring and had lower rates of labor induction or augmentation than physicians. Certified nurse-midwives also were less likely than physicians to use epidural anesthesia. The cesarean section rate for patients of certified nurse-midwives was 8.8% vs 13.6% for obstetricians and 15.1% for family physicians. Certified nurse-midwives used 12.2% fewer resources. There was little difference between the practice patterns of obstetricians and family physicians. Conclusions. The low-risk patients of certified nurse-midwives in Washington State received fewer obstetrical interventions than similar patients cared for by obstetrician-gynecologists or family physicians. These differences are associated with lower cesarean section rates and less resource use. Handle: RePEc:aph:ajpbhl:1997:87:3:344-351_4 Template-Type: ReDIF-Article 1.0 Title: Strategies to improve the reporting of legal blindness in Massachusetts Journal: American Journal of Public Health Author-Name: El-Hashimy, M.M. Author-Name: Aubert, R.E. Author-Name: Alich, K. Author-Name: Warram, J.H. Author-Name: Harrigan, B.A. Author-Name: Herman, W.H. Year: 1997 Volume: 87 Issue: 3 Pages: 425-428 Abstract: Objectives. Registration practices were evaluated as the initial phase of a validation study of the Register of the Massachusetts Commission for the Blind. Methods. Massachusetts eye care providers were surveyed to determine factors associated with nonreporting of legal blindness to the commission. Results. Among ophthalmologists, factors associated with nonreporting were small practice size and practicing for 5 years or less in Massachusetts. Among optometrists, factors included small practice size and unawareness of the Massachusetts reporting law. Conclusions. Information should be disseminated to eye care providers, legally blind patients, and the public to ensure registration and sustain it. Handle: RePEc:aph:ajpbhl:1997:87:3:425-428_7 Template-Type: ReDIF-Article 1.0 Title: US trends in disability and institutionalization among older Blacks and Whites Journal: American Journal of Public Health Author-Name: Clark, D.O. Year: 1997 Volume: 87 Issue: 3 Pages: 438-440 Abstract: Objectives. This study estimated and compared the prevalence of disability and institutionalization in 1982, 1984, and 1989 among the older Black and White populations of the United States. Methods. Data on over 1100 Blacks and 14 000 Whites in each of a series of three National Long Term Care Surveys were used. Results. Diverging trends for Blacks and Whites led to statistically significant increases in the age- and sex-adjusted odds of disability (19%) and institutionalization (31%) for Blacks relative to Whites. Conclusions. Black and White disparities in disability appear to have widened, while disparities in institutionalization appear to have narrowed during the decade of the 1980s. Handle: RePEc:aph:ajpbhl:1997:87:3:438-440_7 Template-Type: ReDIF-Article 1.0 Title: The great efficacy of personal and equipment assistance in reducing disability Journal: American Journal of Public Health Author-Name: Verbrugge, L.M. Author-Name: Rennert, C. Author-Name: Madans, J.H. Year: 1997 Volume: 87 Issue: 3 Pages: 384-392 Abstract: Objectives. Personal and equipment assistance are common strategies to reduce disability. This study sought to determine how often assistance reduces or even completely resolves health-related difficulties in everyday tasks. Methods. Data are from the NHANES 1 Epidemiologic Followup Study. Adults aged 35 to 90 reported difficulty doing 12 everyday tasks on their own without assistance. Those stating that they had much difficulty or were unable were asked if they had personal assistance and/or equipment assistance, and their degree of difficulty with assistance. Use and efficacy of assistance are studied by gender, age, intrinsic (unassisted) degree of difficulty, and type of assistance. Results. Most people use assistance for the 12 tasks; 'personal assistance only' is the principal type used for upper-extremity and body transfer tasks; 'equipment only' ranks first for lower-extremity tasks. Assistance reduces difficulty for the great majority of persons (75% to 85%) and completely resolves difficulty for about 25%. Equipment only proves to be the most efficacious strategy for reducing and resolving limitations. Conclusions. Equipment's success may be due to greater perceived gains when people accomplish the assistance by themselves. Handle: RePEc:aph:ajpbhl:1997:87:3:384-392_4 Template-Type: ReDIF-Article 1.0 Title: Controlling tobacco advertising: The FDA regulations and the first amendment Journal: American Journal of Public Health Author-Name: Glantz, L.H. Year: 1997 Volume: 87 Issue: 3 Pages: 446-451 Handle: RePEc:aph:ajpbhl:1997:87:3:446-451_9 Template-Type: ReDIF-Article 1.0 Title: An increasing prevalence of heating impairment and associated risk factors over three decades of the Alameda County Study Journal: American Journal of Public Health Author-Name: Wallhagen, M.I. Author-Name: Strawbridge, W.J. Author-Name: Cohen, R.D. Author-Name: Kaplan, G.A. Year: 1997 Volume: 87 Issue: 3 Pages: 440-442 Abstract: Objectives. This study assessed changes in the prevalence of hearing impairment in persons aged 50 years and older over the past 30 years and identified risk factors. Methods. Age-adjusted hearing impairment prevalence rates at four time intervals were calculated from the Alameda County Study (n = 5108). Logistic regression models analyzed risk factors from 1974 for 1994 incident hearing impairment. Results. The prevalence of hearing impairment nearly doubled between 1965 and 1994. The increase was significantly greater for men. The higher incidence was associated with potentially high-noise- exposure occupations for men and with symptoms and conditions associated with ototoxic drug use for both men and women. Exercise was protective. Conclusions. Given the serious health and social consequences of hearing impairment, its increasing prevalence is cause for concern. Handle: RePEc:aph:ajpbhl:1997:87:3:440-442_1 Template-Type: ReDIF-Article 1.0 Title: Decreasing smoking prevalence during pregnancy in Sweden: The effect on small-for-gestational-age births Journal: American Journal of Public Health Author-Name: Cnattingius, S. Author-Name: Haglund, B. Year: 1997 Volume: 87 Issue: 3 Pages: 410-413 Abstract: Objectives. This study examined whether recent changes in smoking prevalence among pregnant women have affected risks of small-for-gestational- age births. Methods. With data for all live single births in Sweden from 1983 through 1992 (n = 1 048 139), odds ratios [ORs] and attributable risks of small-for-gestational-age births were calculated for 1983 through 1985, 1986 through 1989, and 1990 through 1992. Results. Daily smoking decreased from 29.4% in 1983 to 21.8% in 1992. For the three time periods, the odds ratios of small-for-gestational-age births by maternal smoking were almost identical: 1-9 cigarettes/day OR = 2.1 or 2.2; for ≤10 cigarettes/day, OR = 2.8. The attributable risk of smoking for small-for-gestational-age births declined from 26.2% in 1983 through 1985 to 20.9% in 1990 through 1992. Conclusions. The findings point to a true decrease in tobacco exposure during pregnancy and a reduction in the attributable risk for small-for- gestational-age births. Handle: RePEc:aph:ajpbhl:1997:87:3:410-413_0 Template-Type: ReDIF-Article 1.0 Title: The readability of HIV/AIDS educational materials targeted to drug users Journal: American Journal of Public Health Author-Name: Johnson, M.E. Author-Name: Mailloux, S.L. Author-Name: Fisher, D.G. Year: 1997 Volume: 87 Issue: 1 Pages: 112-113 Handle: RePEc:aph:ajpbhl:1997:87:1:112-113_0 Template-Type: ReDIF-Article 1.0 Title: The impact of the economic crisis and the US embargo on health in Cuba Journal: American Journal of Public Health Author-Name: Garfield, R. Author-Name: Santana, S. Year: 1997 Volume: 87 Issue: 1 Pages: 15-20 Abstract: Objectives. This paper examines the combined effects of a severe economic decline since 1989 and a tightening of the US embargo in 1992 on health and health care in Cuba. Methods. Data from surveillance systems for nutrition, reportable diseases, and hospital diagnoses were reviewed. These sources were supplemented with utilization data from the national health system and interviews with health leaders. Results. Changes in Cuba include declining nutritional levels, rising rates of infectious diseases and violent death, and a deteriorating public health infrastructure. But despite these threats, mortality levels for children and women remain low. Instead, much of the health impact of the economic decline of Cuba has fallen on adult men and the elderly. Conclusions. To be consistent with international humanitarian law, embargoes must not impede access to essential humanitarian goods. Yet this embargo has raised the cost of medical supplies and food. Rationing, universal access to primary health services, a highly educated population, and preferential access to scarce goods for women and children help protect most Cubans from what otherwise might have been a health disaster. Handle: RePEc:aph:ajpbhl:1997:87:1:15-20_1 Template-Type: ReDIF-Article 1.0 Title: The validity of recalled birthweight in developing countries Journal: American Journal of Public Health Author-Name: Gaskin, P. Author-Name: Walker, S.P. Author-Name: Forrester, T.E. Author-Name: Grantham-McGregor, S.M. Year: 1997 Volume: 87 Issue: 1 Pages: 114 Handle: RePEc:aph:ajpbhl:1997:87:1:114_8 Template-Type: ReDIF-Article 1.0 Title: Homelessness in female-headed families: Childhood and adult risk and protective factors Journal: American Journal of Public Health Author-Name: Bassuk, E.L. Author-Name: Buckner, J.C. Author-Name: Weinreb, L.F. Author-Name: Browne, A. Author-Name: Bassuk, S.S. Author-Name: Dawson, R. Author-Name: Perloff, J.N. Year: 1997 Volume: 87 Issue: 2 Pages: 241-248 Abstract: Objectives. To identify risk and protective factors for family homelessness, a case-control study of homeless and low-income, never-homeless families, all female-headed, was conducted. Methods. Homeless mothers (n = 220) were enrolled from family shelters in Worcester, Mass. Low-income housed mothers receiving welfare (n = 216) formed the comparison group. The women completed an interview covering socioeconomic, social support, victimization, mental health, substance use, and health domains. Results. Childhood predictors of family homelessness included foster care placement and respondent's mother's use of drags. Independent risk factors in adulthood included minority status, recent move to Worcester, recent eviction, interpersonal conflict, frequent alcohol or heroin use, and recent hospitalization for a mental health problem. Protective factors included being a primary tenant, receiving cash assistance or a housing subsidy, graduating from high school, and having a larger social network. Conclusions. Factors that compromise an individual's economic and social resources are associated with greater risk of losing one's home. Handle: RePEc:aph:ajpbhl:1997:87:2:241-248_5 Template-Type: ReDIF-Article 1.0 Title: The prevalence of hypertension in seven populations of West African origin Journal: American Journal of Public Health Author-Name: Cooper, R. Author-Name: Rotimi, C. Author-Name: Ataman, S. Author-Name: McGee, D. Author-Name: Osotimehin, B. Author-Name: Kadiri, S. Author-Name: Muna, W. Author-Name: Kingue, S. Author-Name: Fraser, H. Author-Name: Forrester, T. Author-Name: Bennett, F. Author-Name: Wilks, R. Year: 1997 Volume: 87 Issue: 2 Pages: 160-168 Abstract: Objectives. This study was undertaken to describe the distribution of blood pressures, hypertension prevalence, and associated risk factors among seven populations of West African origin. Methods. The rates of hypertension in West Africa (Nigeria and Cameroon), the Caribbean (Jamaica, St. Lucia, Barbados), and the United States (metropolitan Chicago, Illinois) were compared on the basis of a highly standardized collaborative protocol. After researchers were given central training in survey methods, population-based samples of 800 to 2500 adults over the age of 25 were examined in seven sites, yielding a total sample of 10 014. Results. A consistent gradient of hypertension prevalence was observed, rising from 16% in West Africa to 26% in the Caribbean and 33% in the United States. Mean blood pressures were similar among persons aged 25 to 34, while the increase in hypertension prevalence with age was twice as steep in the United States as in Africa. Environmental factors, most notably obesity and the intake of sodium and potassium, varied consistently with disease prevalence across regions. Conclusion. The findings demonstrate the determining role of social conditions in the evolution of hypertension risk in these populations. Handle: RePEc:aph:ajpbhl:1997:87:2:160-168_8 Template-Type: ReDIF-Article 1.0 Title: Competing priorities as a barrier to medical care among homeless adults in Los Angeles Journal: American Journal of Public Health Author-Name: Gelberg, L. Author-Name: Gallagher, T.C. Author-Name: Andersen, R.M. Author-Name: Koegel, P. Year: 1997 Volume: 87 Issue: 2 Pages: 217-220 Abstract: Objectives. The role of competing priorities as a barrier to the utilization of physical health services was assessed in a subset (n = 363) of a probability sample of homeless adults in Los Angeles. Methods. Unadjusted odds of four measures of health services utilization were calculated for those with frequent difficulty in meeting their subsistence needs. These odds were then adjusted for a range of characteristics assumed to affect the utilization of health services among the homeless. Results. Before and after adjustment, those with frequent subsistence difficulty were less likely to have a regular source of care (odds ratio [OR] = 0.30, 95% confidence interval [CI] = 0.16, 0.53) and more likely to have gone without needed medical care (OR = 1.77, 95% CI = 1.04, 3.00). Subsistence difficulty had no impact on the likelihood of having an outpatient visit or having been hospitalized. Conclusions remained the same after adjustment. Conclusions. Frequent subsistence difficulty appears to be an important nonfinancial barrier to the utilization of health services perceived as discretionary among homeless adults. Handle: RePEc:aph:ajpbhl:1997:87:2:217-220_7 Template-Type: ReDIF-Article 1.0 Title: Employment, job strain, and preterm delivery among women in North Carolina Journal: American Journal of Public Health Author-Name: Brett, K.M. Author-Name: Strogatz, D.S. Author-Name: Savitz, D.A. Year: 1997 Volume: 87 Issue: 2 Pages: 199-204 Abstract: Objectives. A population-based case-control study was conducted in central North Carolina to assess the relationship between occupational stress and preterm delivery. Methods. Four hundred twenty-one women delivering infants before 37 weeks' gestation and 612 women delivering infants at term were interviewed a median of 6 months after delivery. Exposure information was collected for all jobs held for at least I mouth during pregnancy. Results. Work in a 'high strain' job (i.e., high demand and low control) was not associated with increased risk of preterm delivery compared with work in 'low strain' jobs (all other combinations of job demand and control). Narrowing the exposure window to the third trimester did not modify the results. However, women who worked at a high-strain job full-time (odds ratio [OR] = 1.4, 95% confidence interval [CI] = 0.9, 2.0) or for 30 or more weeks (OR = 1.4, CI = 1.0, 2.2) had a modestly increased risk. Several analyses suggested that Black women were at greater risk from job strain than White women. Conclusions. This study suggests that chronic exposure during pregnancy to work characterized by high demand and low control may be modestly associated with preterm delivery. Handle: RePEc:aph:ajpbhl:1997:87:2:199-204_4 Template-Type: ReDIF-Article 1.0 Title: Using a brief household food inventory as an environmental indicator of individual dietary practices Journal: American Journal of Public Health Author-Name: Patterson, R.E. Author-Name: Kristal, A.R. Author-Name: Shannon, J. Author-Name: Hunt, J.R. Author-Name: White, E. Year: 1997 Volume: 87 Issue: 2 Pages: 272-275 Abstract: Objectives. This study examined whether foods in household pantries are an indicator of household members' diet. Methods. In a random-digit-dial survey, the presence in the house of 15 high-fat foods was assessed with whoever answered the phone. A randomly selected household member was surveyed about diet-related behaviors (n = 1002). Results. Individuals in the precontemplation stage of dietary change had more high-fat foods in their pantry than those in maintenance (means of 7.4 and 5.8, respectively). Individuals with low-fat pantries had an intake of 32% energy from fat vs 37% for those with high-fat pantries. Conclusions. Household food inventories are a practical and valid approach to monitoring dietary behaviors in community- based studies. Handle: RePEc:aph:ajpbhl:1997:87:2:272-275_2 Template-Type: ReDIF-Article 1.0 Title: Maternal smoking and medical expenditures for childhood respiratory illness Journal: American Journal of Public Health Author-Name: Stoddard, J.J. Author-Name: Gray, B. Year: 1997 Volume: 87 Issue: 2 Pages: 205-209 Abstract: Objectives. This study sought to assess the association between environmental tobacco smoke exposure from maternal smoking and health care expenditures for respiratory conditions among US children. Methods. Multivariate analysis of the 1987 National Medical Expenditure Survey was undertaken with a sample that included 2624 children 5 years of age and under. Results. After analysis that controlled for various sociodemographic factors associated with health care usage, respiratory-related health care expenditures among children whose mothers smoke were found to be significantly higher than those expenditures for children of nonsmoking mothers. Truncated regression techniques were used to estimate that maternal smoking was associated with increased health care expenditures averaging (in 1995 dollars) $120 per year for children aged 5 years and under and $175 per year for children aged 2 years and under. Our analysis indicates that passive smoking was associated with $661 million in annual medical expenditures in 1987, representing 19% of all expenditures for childhood respiratory conditions. Conclusions. Maternal smoking is associated with significantly increased child health expenditures and contributes significantly to the overall cost of medical care. Handle: RePEc:aph:ajpbhl:1997:87:2:205-209_9 Template-Type: ReDIF-Article 1.0 Title: Cultural orientation: an individual- or group-level variable? Journal: American Journal of Public Health Author-Name: Rhoads, G.G. Year: 1997 Volume: 87 Issue: 2 Pages: 301-302 Handle: RePEc:aph:ajpbhl:1997:87:2:301-302_7 Template-Type: ReDIF-Article 1.0 Title: Characteristics of automatic or semiautomatic firearm ownership in the United States Journal: American Journal of Public Health Author-Name: Hemenway, D. Author-Name: Richardson, E. Year: 1997 Volume: 87 Issue: 2 Pages: 286-288 Abstract: Objectives. This study examined ownership patterns of automatic/semiautomatic firearms in the United States. Methods. Data were derived from a national random-digit-dialing telephone survey of 800 gun owners. Results. Sixty percent of gun owners reported owning an automatic or semiautomatic firearm. In comparison with other gun owners, owners of automatics or semiautomatics were more likely to be male, live in the South, own a gun for protection, and have a gun for work. They were also more likely to report binge drinking. Conclusions. Owners of automatic or semiautomatic firearms differ from other gun owners in several respects, including frequency of binge drinking. Handle: RePEc:aph:ajpbhl:1997:87:2:286-288_3 Template-Type: ReDIF-Article 1.0 Title: A "clinic without walls": the Los Angeles Immunization Demonstration Project. Journal: American Journal of Public Health Author-Name: Westman, S. Author-Name: Halbert, R.J. Author-Name: Walton, L.G. Author-Name: Henneman, C.E. Year: 1997 Volume: 87 Issue: 2 Pages: 293-294 Handle: RePEc:aph:ajpbhl:1997:87:2:293-294_0 Template-Type: ReDIF-Article 1.0 Title: Infectious disease mortality among infants in the United States, 1983 through 1987 Journal: American Journal of Public Health Author-Name: Read, J.S. Author-Name: Troendle, J.F. Author-Name: Klebanoff, M.A. Year: 1997 Volume: 87 Issue: 2 Pages: 192-198 Abstract: Objectives. The purpose of this study was to determine the relative importance of infectious disease as a cause of infant mortality in the United States and to identify characteristics at birth associated with subsequent infectious disease mortality. Methods. Birth and infant death certificate data from the National Center for Health Statistics (NCHS) 1983 through 1987 Linked Birth/Infant Death Data Sets were analyzed. Results. Infection was the underlying cause of death for over 16 000 infants, representing the fourth leading cause of mortality in this cohort. Almost 90% of infectious disease deaths during infancy were due to noncongenital infections, and the majority of these deaths occurred during the postneonatal period. Low birthweight, preterm birth, and male gender were independently associated with postneonatal mortality due to noncongenital infection. Conclusions. NCHS should revise its classification system for causes of infant mortality to incorporate an 'Infectious Diseases' category. Future research should be directed toward clarifying the low birthweight-infectious disease mortality relationship and determining the degree to which infection-related infant deaths might be prevented by existing vaccines or improved access to health care. Handle: RePEc:aph:ajpbhl:1997:87:2:192-198_0 Template-Type: ReDIF-Article 1.0 Title: Research and the Internet: an e-mail survey of sexual orientation. Journal: American Journal of Public Health Author-Name: Sell, R.L. Year: 1997 Volume: 87 Issue: 2 Pages: 297 Handle: RePEc:aph:ajpbhl:1997:87:2:297_0 Template-Type: ReDIF-Article 1.0 Title: Racial and ethnic disparities in the use of cardiovascular procedures: Associations with type of health insurance Journal: American Journal of Public Health Author-Name: Carlisle, D.M. Author-Name: Leake, B.D. Author-Name: Shapiro, M.F. Year: 1997 Volume: 87 Issue: 2 Pages: 263-267 Abstract: Objectives. This study examined whether disparities in the use of cardiovascular procedures exist among African Americans, Latinos, and Asians relative to White patients, within health insurance categories. Methods. Hospital discharge records (n = 104 952) of Los Angeles County, California, residents with possible coronary artery disease were analyzed. Results. After adjustment for confounders, lower odds of procedure use were found for African American and Latino patients for most types of insurance. Asians and Pacific Islanders had odds of procedure use similar to those of White patients. Disparities were absent among the privately insured. Conclusions. Racial and ethnic disparities in procedure rates were evident in all types of insurance except private insurance. Handle: RePEc:aph:ajpbhl:1997:87:2:263-267_7 Template-Type: ReDIF-Article 1.0 Title: Substance use among runaway and homeless youth in three national samples Journal: American Journal of Public Health Author-Name: Greene, J.M. Author-Name: Ennett, S.T. Author-Name: Ringwalt, C.L. Year: 1997 Volume: 87 Issue: 2 Pages: 229-235 Abstract: Objectives. Standardized estimates of the prevalence of substance use by runaway and homeless youth between the ages of 12 and 21 in various settings were compared with each other and with estimates for youth in the general population. Methods. Four surveys were used: (1) a nationally representative survey of runaway and homeless youth residing in federally and non-federally funded shelters; (2) a multicity survey of street youth; (3) a nationally representative household survey of youth with and without recent runaway and homeless experiences; and (4) a nationally representative household survey of youth whose previous runaway/homeless status was unknown. Results. For almost every substance, substance use prevalence was highest among street youth. Shelter youth and household youth with recent runaway/homeless experiences reported similar rates. In the household surveys, substance use rates were lowest and were generally comparable. Conclusions. Many homeless and runaway youth use tobacco, alcohol, and other drags at rates substantially higher than nonrunaway and nonhomeless youth, indicating a need for comprehensive and intensive substance abuse prevention and treatment services for these youth. Handle: RePEc:aph:ajpbhl:1997:87:2:229-235_0 Template-Type: ReDIF-Article 1.0 Title: Carbonated beverage consumption and bone mineral density among older women: The Rancho Bernardo study Journal: American Journal of Public Health Author-Name: Kim, S.H. Author-Name: Morton, D.J. Author-Name: Barrett-Connor, E.L. Year: 1997 Volume: 87 Issue: 2 Pages: 276-279 Abstract: Objectives. The association between carbonated beverage consumption and bone mineral density was examined in a community-based cohort of older White women. Methods. One thousand women 44 to 98 years of age had bone mineral density measured at four sites and provided medical and behavioral histories, including type and quantity of carbonated beverages consumed. Results. Bone mineral density levels were not associated with intake of any type of carbonated beverage after adjustment for age, obesity, calcium intake, exercise, and current use of tobacco and alcohol, thiazides, estrogen, or thyroid hormone. Conclusions. Modest intake of carbonated beverages does not appear to have adverse effects on bone mineral density in older women. Handle: RePEc:aph:ajpbhl:1997:87:2:276-279_9 Template-Type: ReDIF-Article 1.0 Title: The impact of payor/provider type on health care use and expenditures among the frail elderly Journal: American Journal of Public Health Author-Name: Experton, B. Author-Name: Li, Z. Author-Name: Branch, L.G. Author-Name: Ozminkowski, R.J. Author-Name: Mellon-Lacey, D.M. Year: 1997 Volume: 87 Issue: 2 Pages: 210-216 Abstract: Objectives. This study examined whether health care expenditures and usage by the frail elderly differ under three payor/provides types: Medicare fee for service, Medicare health maintenance organization (HMO), and dual Medicare-Medicaid enrollment. Methods. In-home interviews were conducted among 450 frail elderly patients of a San Diego, Calif, health care system. Cost and use data were collected from providers. Results. Analyses revealed no difference in total expenditures between fee-for-service and HMO enrollees, but Medicare-Medicaid beneficiaries' expenditures were 46.8% higher than those for HMO enrollees and 52.2% higher than those for the fee- for-service group. Fee-for-service participants were less than half as likely as HMO enrollees to have two or more hospital admissions, but hospital usage rates between those two payor/provider groups did not differ. Nor were there payor/provider differences in access to home health care, but HMO home health care users received significantly fewer services than the others. Conclusions. The care provided to these HMO beneficiaries resulted in a combination of restricted home health use and higher multiple hospitalizations. This raises compelling questions for future research. For the dually enrolled, stronger cost containment may be required. Handle: RePEc:aph:ajpbhl:1997:87:2:210-216_1 Template-Type: ReDIF-Article 1.0 Title: The impact of lifestyle characteristics on carotenoid intake in the United States: The 1987 National Health Interview Survey Journal: American Journal of Public Health Author-Name: Nebeling, L.C. Author-Name: Forman, M.R. Author-Name: Graubard, B.I. Author-Name: Snyder, R.A. Year: 1997 Volume: 87 Issue: 2 Pages: 268-271 Abstract: Objectives. This study compared mean carotenoid intake in the United States by demographic and lifestyle variables to identify potential high- risk subgroups for disease. Methods. Adults 18 to 99 years of age (n = 22 080) completed a food frequency questionnaire in the 1987 National Health Interview Survey, and mean carotenoid intakes were estimated. Results. Carotenoid intakes were lower among Whites (vs Blacks), current smokers (vs nonsmokers), nondrinkers (vs drinkers), adults 18 to 39 years of age (vs those 40 to 69 years of age), frequent restaurant consumers (vs those who ate at home), and less educated (vs college-educated) persons. Conclusions. The benefits of a carotenoid-rich diet should be communicated to high-risk subgroups. Handle: RePEc:aph:ajpbhl:1997:87:2:268-271_0 Template-Type: ReDIF-Article 1.0 Title: The quality of data reported on birth certificates. Journal: American Journal of Public Health Author-Name: Kirby, R.S. Year: 1997 Volume: 87 Issue: 2 Pages: 301 Handle: RePEc:aph:ajpbhl:1997:87:2:301_4 Template-Type: ReDIF-Article 1.0 Title: Ensuring health care for foster children through Medicaid's EPSDT program. Journal: American Journal of Public Health Author-Name: Ruptier, N.M. Year: 1997 Volume: 87 Issue: 2 Pages: 290-291 Handle: RePEc:aph:ajpbhl:1997:87:2:290-291_6 Template-Type: ReDIF-Article 1.0 Title: Partnerships in school care: meeting the needs of New York city schoolchildren with complex medical conditions. Journal: American Journal of Public Health Author-Name: Lipper, E.G. Author-Name: Farr, M. Author-Name: Marchese, C. Author-Name: Palfrey, J. Author-Name: Darby, B.J. Year: 1997 Volume: 87 Issue: 2 Pages: 291-293 Handle: RePEc:aph:ajpbhl:1997:87:2:291-293_4 Template-Type: ReDIF-Article 1.0 Title: Dose-response analyses of women's alcohol use during pregnancy and children's cognitive functioning. Journal: American Journal of Public Health Author-Name: Decouflé, P. Author-Name: Boyle, C. Year: 1997 Volume: 87 Issue: 2 Pages: 299-300 Handle: RePEc:aph:ajpbhl:1997:87:2:299-300_0 Template-Type: ReDIF-Article 1.0 Title: Developing non-traditional print media for HIV prevention: role model stories for young urban women. Journal: American Journal of Public Health Author-Name: Bond, L. Author-Name: Bowden-Proctor, J. Author-Name: Lauby, J. Author-Name: Walls, C. Author-Name: Woll, M. Year: 1997 Volume: 87 Issue: 2 Pages: 289-290 Handle: RePEc:aph:ajpbhl:1997:87:2:289-290_2 Template-Type: ReDIF-Article 1.0 Title: Posttraumatic stress disorder among female Vietnam veterans: A causal model of etiology Journal: American Journal of Public Health Author-Name: Fontana, A. Author-Name: Schwartz, L.S. Author-Name: Rosenheck, R. Year: 1997 Volume: 87 Issue: 2 Pages: 169-175 Abstract: Objectives. The Vietnam and Persian Gulf wars have awakened people to the realization that military service can be traumatizing for women as well as men. This study investigated the etiological roles of both war and sexual trauma in the development of chronic posttraumatic stress disorder among female Vietnam veterans. Methods. Data from the National Vietnam Veterans Readjustment Study for 396 Vietnam theater women and 250 Vietnam era women were analyzed with structural equation modeling. Results. An etiological model with highly satisfactory fit and parsimony was developed. Exposure to war trauma contributed to the probability of posttraumatic stress disorder in theater women, as did sexual trauma in both theater and era women. Lack of social support at the time of homecoming acted as a powerful mediator of trauma for both groups of women. Conclusions. Within the constraints and assumptions of causal modeling, there is evidence that both war trauma and sexual trauma are powerful contributors to the development of posttraumatic stress disorder among female Vietnam veterans. Handle: RePEc:aph:ajpbhl:1997:87:2:169-175_0 Template-Type: ReDIF-Article 1.0 Title: Transmission of Mycobacterium tuberculosis in a California state prison, 1991 Journal: American Journal of Public Health Author-Name: Koo, D.T. Author-Name: Baron, R.C. Author-Name: Rutherford, G.W. Year: 1997 Volume: 87 Issue: 2 Pages: 279-282 Abstract: Objectives. An investigation was conducted to determine whether ongoing transmission of Mycobacterium tuberculosis was occurring in a California state prison. Method. Prison pharmacy records were used to identify cases of active tuberculosis (TB). Results. Ten of the 18 cases of active TB treated at the facility during 1991 were diagnosed at the prison that same year (an incidence of 184 per 100 000). Three inmates were infectious for a total of 7 months while imprisoned. The prevalence of TB skin test-positivity among inmates was 30%, and the incidence of new infection attributable to incarceration was 5.9 per 100 inmates per year. Conclusions. Transmission of M. tuberculosis may be occurring in the California prison system. Handle: RePEc:aph:ajpbhl:1997:87:2:279-282_5 Template-Type: ReDIF-Article 1.0 Title: Adverse childhood experiences: Are they risk factors for adult homelessness? Journal: American Journal of Public Health Author-Name: Herman, D.B. Author-Name: Susser, E.S. Author-Name: Struening, E.L. Author-Name: Link, B.L. Year: 1997 Volume: 87 Issue: 2 Pages: 249-255 Abstract: Objectives. We tested the hypothesis that adverse childhood experiences are risk factors for adult homelessness. Methods. We interviewed a nationally representative sample of 92 US household members who had previously been homeless and a comparison group of 395 individuals with no prior homelessness. We assessed childhood adversity with a structured protocol that included a previously validated scale indicating lack of care from parents and single-item measures of physical and sexual abuse. Results. Lack of care from a parent during childhood sharply increased the likelihood of subsequent homelessness (odds ratio [OR] = 13), as did physical abuse (OR = 16). Sexual abuse during childhood was associated with a nonsignificant trend toward homelessness (OR = 1.7). The risk of subsequent homelessness among individuals who experienced both lack of care and either type of abuse was dramatically increased compared with subjects reporting neither of these adversities (OR = 26). Conclusions. Adverse childhood experiences are powerful risk factors for adult homelessness. Effectively reducing child abuse and neglect may ultimately help prevent critical social problems including homelessness. Handle: RePEc:aph:ajpbhl:1997:87:2:249-255_7 Template-Type: ReDIF-Article 1.0 Title: The Northwest Lipid Research Clinic Fat Intake Scale: Validation and utility Journal: American Journal of Public Health Author-Name: Retzlaff, B.M. Author-Name: Dowdy, A.A. Author-Name: Walden, C.E. Author-Name: Bovbjerg, V.E. Author-Name: Knopp, R.H. Year: 1997 Volume: 87 Issue: 2 Pages: 181-185 Abstract: Objectives. This paper describes the Northwest Lipid Research Clinic Fat Intake Scale, a brief dietary questionnaire to screen and monitor dietary intake related to plasma cholesterol levels. Methods. The 12-item instrument assesses intake of foods high in fat, saturated fat, and cholesterol. Test- retest reliability was assessed on 194 men and 116 women with high cholesterol prior to a dietary intervention study. To measure validity and responsiveness to dietary change, scores were compared with 4-day food records before and after diet education classes. Results. Test-retest correlation coefficients were .88 for men and .90 for women (2 weeks between scores). Scores for men and women were correlated with nutrients shown by food records at baseline (.47 and .54, total fat: .50 and .51, saturated fat) and 18 months postintervention (.52 and .58, total fat; .56 and .64, saturated fat; all Ps < .001). Mean scores decreased from about 30 to 23 (P < .001, paired t test). Conclusions. The Fat Intake Scale, a qualitative instrument, has acceptable reliability and validity for estimating the level of cholesterol-related diet components and reflects dietary modification. The format of the instrument also lends itself to patient education and goal setting. Handle: RePEc:aph:ajpbhl:1997:87:2:181-185_3 Template-Type: ReDIF-Article 1.0 Title: Drug use disorders and treatment contact among homeless adults in Alameda County, California Journal: American Journal of Public Health Author-Name: Robertson, M.J. Author-Name: Zlotnick, C. Author-Name: Westerfelt, A. Year: 1997 Volume: 87 Issue: 2 Pages: 221-228 Abstract: Objectives. This study estimates the extent and distribution of specific drug problems among homeless adults. Methods. A countywide probability sample of 564 homeless adults received structured interviews that included a standardized assessment of substance use disorders. Results. Two thirds of the sample (69.1%) had a lifetime history of a substance use disorder (including abuse of or dependence on alcohol [52.6%] or drugs [52.2%]); half had a current (52.4%) substance use disorder (including alcohol [38.8%] or drugs [31.3%]). Current drug disorders were higher among respondents who were younger, homeless longer, or sampled from the city of Oakland, Calif. Alcohol use disorders were higher among men than among women; surprisingly, drug use disorders were not. Conclusion. Rates of current drug use disorders for homeless adults were more than eight times higher than general population estimates. However, estimates of drug problems among homeless adults vary as a function of case ascertainment and sampling strategy. Estimates based only on samples from urban areas may overestimate drug problems among the area's larger homeless populations. Handle: RePEc:aph:ajpbhl:1997:87:2:221-228_2 Template-Type: ReDIF-Article 1.0 Title: The adequacy of one sputum smear for diagnosing pulmonary tuberculosis. Journal: American Journal of Public Health Author-Name: Dujardin, B. Author-Name: Haelterman, E. Author-Name: Van Damme, W. Author-Name: Kegels, G. Year: 1997 Volume: 87 Issue: 7 Pages: 1234-1235 DOI: 10.2105/AJPH.87.7.1234-a File-URL: http://hdl.handle.net/10.2105/AJPH.87.7.1234-a Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.7.1234-a_5 Template-Type: ReDIF-Article 1.0 Title: Shifting Categories of the Social Harms Associated with Alcohol: Examples from Late Medieval and Early Modern England Journal: American Journal of Public Health Author-Name: Warner, J. Year: 1997 Volume: 87 Issue: 11 Pages: 1788-1797 DOI: 10.2105/AJPH.87.11.1788 File-URL: http://hdl.handle.net/10.2105/AJPH.87.11.1788 Abstract: This paper offers a historical perspective on our own attempts to define the social harms associated with the abuse of alcohol. Challenging the notion that categories are necessarily objective and constant, it instead emphasizes the extent to which even harms that are visible and thus susceptible to measurement are in fact socially constructed. English sources from the preindustrial era revealed six broad categories of social harms associated with the abuse of alcohol. Four of the categories consisted of visible harms in the form of income lost, domestic violence, brawling, and accidents, all of which are still recognized as social harms associated with the abuse of alcohol. The other two categories, reversal of the established moral order and susceptibility to trickery, were of an essentially intrinsic or subjective nature and have since dropped from the lexicon of social harms. Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.11.1788_7 Template-Type: ReDIF-Article 1.0 Title: Race, ethnicity, and health outcomes--unraveling the mediating role of socioeconomic status. Journal: American Journal of Public Health Author-Name: Guralnik, J.M. Author-Name: Leveille, S.G. Year: 1997 Volume: 87 Issue: 5 Pages: 728-730 DOI: 10.2105/AJPH.87.5.728 File-URL: http://hdl.handle.net/10.2105/AJPH.87.5.728 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.5.728_2 Template-Type: ReDIF-Article 1.0 Title: Alternative models for controlling smoking among adolescents. Journal: American Journal of Public Health Author-Name: Pletten, L.J. Year: 1997 Volume: 87 Issue: 5 Pages: 869-871 DOI: 10.2105/AJPH.87.5.869 File-URL: http://hdl.handle.net/10.2105/AJPH.87.5.869 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.5.869_8 Template-Type: ReDIF-Article 1.0 Title: Hepatitis C virus infection among Alaskan drug users. Journal: American Journal of Public Health Author-Name: Fisher, D.G. Author-Name: Fenaughty, A.M. Author-Name: Paschane, A.A. Author-Name: Paschane, D.M. Author-Name: Cagle, H.H. Author-Name: Orr, S.M. Year: 1997 Volume: 87 Issue: 10 Pages: 1722-1724 DOI: 10.2105/AJPH.87.10.1722 File-URL: http://hdl.handle.net/10.2105/AJPH.87.10.1722 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.10.1722_1 Template-Type: ReDIF-Article 1.0 Title: Sheltered homeless children: Their eligibility and unmet need for special education evaluations Journal: American Journal of Public Health Author-Name: Zima, B.T. Author-Name: Bussing, R. Author-Name: Forness, S.R. Author-Name: Benjamin, B. Year: 1997 Volume: 87 Issue: 2 Pages: 236-240 Abstract: Objectives. This study described the proportion of sheltered homeless children in Los Angeles, Calif, who were eligible for special education evaluations because of a probable behavioral disorder, learning disability, or mental retardation, and to explore their level of unmet need for special education services. Methods. This was a cross-sectional study of 118 parents and 169 children aged 6 through 12 years living in 18 emergency homeless family shelters in Los Angeles County, California. Parents and children were interviewed with standardized mental health and academic skill measures in English and Spanish. Results. Almost half (45%) of the children met criteria for a special education evaluation, yet less than one quarter (22%) had ever received special education testing or placement. The main point of contact for children with behavioral disorders and learning problems was the general health care sector. Conclusions. School-aged sheltered homeless children have a high level of unmet need for special education evaluations, the first step toward accessing special education programs. Interventions for homeless children should include integration of services across special education, general health care, and housing service sectors. Handle: RePEc:aph:ajpbhl:1997:87:2:236-240_9 Template-Type: ReDIF-Article 1.0 Title: Disparity in cancer survival and alternative health care financing systems. Journal: American Journal of Public Health Author-Name: Schatzkin, A. Year: 1997 Volume: 87 Issue: 7 Pages: 1095-1096 DOI: 10.2105/AJPH.87.7.1095 File-URL: http://hdl.handle.net/10.2105/AJPH.87.7.1095 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.7.1095_3 Template-Type: ReDIF-Article 1.0 Title: Goliath and some Davids in the tobacco wars. Journal: American Journal of Public Health Author-Name: Susser, M. Year: 1997 Volume: 87 Issue: 10 Pages: 1593-1595 DOI: 10.2105/AJPH.87.10.1593 File-URL: http://hdl.handle.net/10.2105/AJPH.87.10.1593 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.10.1593_5 Template-Type: ReDIF-Article 1.0 Title: Condom-carrying behavior among college students. Journal: American Journal of Public Health Author-Name: Dahl, D.W. Author-Name: Gorn, G.J. Author-Name: Weinberg, C.B. Year: 1997 Volume: 87 Issue: 6 Pages: 1059-1060 DOI: 10.2105/AJPH.87.6.1059 File-URL: http://hdl.handle.net/10.2105/AJPH.87.6.1059 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.6.1059_8 Template-Type: ReDIF-Article 1.0 Title: The House of Falk: The Paranoid Style in American Health Politics Journal: American Journal of Public Health Author-Name: Derickson, A. Year: 1997 Volume: 87 Issue: 11 Pages: 1836-1843 DOI: 10.2105/AJPH.87.11.1836 File-URL: http://hdl.handle.net/10.2105/AJPH.87.11.1836 Abstract: The onset of the Cold War had a blighting effect on the campaign for a national health insurance program in the United States. In the highly charged atmosphere of the late 1940s, proponents of social insurance spent considerable time and energy denying that they were agents of foreign powers. In one widely promoted conspiratorial formulation, some on the right traced the origins of subversion not only to Moscow but also to Geneva, Switzerland, home of the International Labor Organization. In the fractiously partisan context of the period, conservative political leaders amplified concerns over disloyal bureaucrats' manipulating the levers of legislative politics as well as the design of health policy. One federal official in particular, I. S. Falk, became the object of outright demonization. The paranoid attacks took their toll on the drive to extend social protection. The reformers' difficulties suggest the limitations of heavy dependence on bureaucratic expertise in the pursuit of health security. Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.11.1836_5 Template-Type: ReDIF-Article 1.0 Title: Correlates of tobacco use among Native American women in Western North Carolina Journal: American Journal of Public Health Author-Name: Spangler, J.G. Author-Name: Dignan, M.B. Author-Name: Michielutte, R. Year: 1997 Volume: 87 Issue: 1 Pages: 108-111 Abstract: Objectives. This study examined correlates of tobacco use among Cherokee women. Methods. Prevalence rates were analyzed for 614 randomly selected Eastern Band Cherokee women. Results. The prevalence rates for current smokeless tobacco use and smoking were 8% and 39%, respectively. Smokeless tobacco use correlates included lower education and having consulted an Indian healer. Smoking correlates included younger age, alcohol use, no yearly physical exam, separated or divorced marital status, and lack of friends or church participation. Conclusions. Smoking rates among these women were slightly above national rates. The association of smokeless tobacco use with having consulted an Indian healer may help in understanding Cherokee women's smokeless tobacco use. Handle: RePEc:aph:ajpbhl:1997:87:1:108-111_7 Template-Type: ReDIF-Article 1.0 Title: Annotation: HIV prevention challenges-realistic strategies and early detection programs. Journal: American Journal of Public Health Author-Name: Rotheram-Borus, M.J. Year: 1997 Volume: 87 Issue: 4 Pages: 544-546 DOI: 10.2105/AJPH.87.4.544 File-URL: http://hdl.handle.net/10.2105/AJPH.87.4.544 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.4.544_6 Template-Type: ReDIF-Article 1.0 Title: Annotation: wanted--a simple and meaningful HIV staging system. Journal: American Journal of Public Health Author-Name: el-Sadr, W. Author-Name: Neaton, J.D. Year: 1997 Volume: 87 Issue: 4 Pages: 546-548 DOI: 10.2105/AJPH.87.4.546 File-URL: http://hdl.handle.net/10.2105/AJPH.87.4.546 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.4.546_5 Template-Type: ReDIF-Article 1.0 Title: Mammography screening for women aged 40 through 49--a guidelines saga and a clarion call for informed decision making. Journal: American Journal of Public Health Author-Name: Ernster, V.L. Year: 1997 Volume: 87 Issue: 7 Pages: 1103-1106 DOI: 10.2105/AJPH.87.7.1103 File-URL: http://hdl.handle.net/10.2105/AJPH.87.7.1103 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.7.1103_4 Template-Type: ReDIF-Article 1.0 Title: Genetic screening and public health. Journal: American Journal of Public Health Author-Name: Holtzman, N.A. Year: 1997 Volume: 87 Issue: 8 Pages: 1275-1277 DOI: 10.2105/AJPH.87.8.1275 File-URL: http://hdl.handle.net/10.2105/AJPH.87.8.1275 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.8.1275_2 Template-Type: ReDIF-Article 1.0 Title: Under the Shadow of Tuskegee: African Americans and Health Care Journal: American Journal of Public Health Author-Name: Gamble, V.N. Year: 1997 Volume: 87 Issue: 11 Pages: 1773-1778 DOI: 10.2105/AJPH.87.11.1773 File-URL: http://hdl.handle.net/10.2105/AJPH.87.11.1773 Abstract: The Tuskegee Syphilis Study continues to cast its long shadow on the contemporary relationship between African Americans and the biomedical community. Numerous reports have argued that the Tuskegee Syphilis Study is the most important reason why many African Americans distrust the institutions of medicine and public health. Such an interpretation neglects a critical historical point: the mistrust pre-dated public revelations about the Tuskegee study. This paper places the syphilis study within a broader historical and social context to demonstrate that several factors have influenced - and continue to influence - African Americans' attitudes toward the biomedical community. Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.11.1773_3 Template-Type: ReDIF-Article 1.0 Title: The hypothesis is still supported by scientists and scientific data [4] Journal: American Journal of Public Health Author-Name: Mossman, B.T. Author-Name: Gee, J.B.L. Year: 1997 Volume: 87 Issue: 4 Pages: 689-690 Handle: RePEc:aph:ajpbhl:1997:87:4:689-690_5 Template-Type: ReDIF-Article 1.0 Title: Antigovernment sentiment and support for universal access to care: Are they incompatible? Journal: American Journal of Public Health Author-Name: Goldsteen, R.L. Author-Name: Goldsteen, K. Author-Name: Kronenfeld, J.J. Author-Name: Hann, N.E. Year: 1997 Volume: 87 Issue: 1 Pages: 25-28 Abstract: Objectives. Attitudes toward universal access to medical care were examined to determine whether support for it among people opposed to government involvement in health care was modified by three proxy measures of self-interest: being uninsured, in poor health, or a high user of medical care. Methods. Data on support for universal access, attitudes toward government involvement in health care, and the indicators of self-interest were obtained from a representative sample of adult Oklahomans (n = 1547) surveyed between October 1992 and December 1994. Forced-order multiple regression with interaction terms was the data analysis technique. Results. People opposed to government involvement in health care were found to be less likely to favor universal access to medical care, but poor health, lack of insurance, and high usage of medical care moderated this effect. Conclusions. The findings support the view that antigovernment sentiment need not foreclose the public option for health policymakers. Other considerations such as self-interest may modify the effect of unfavorable attitudes toward government. Handle: RePEc:aph:ajpbhl:1997:87:1:25-28_3 Template-Type: ReDIF-Article 1.0 Title: Erratum: The relationship between cigarette smoking and education revisited: Implications for categorizing persons' educational status (American Journal of Public Health (1996) 86 (1582-1589)) Journal: American Journal of Public Health Author-Name: Zhu, B.-P. Author-Name: Giovino, G.A. Author-Name: Mowery, P.D. Author-Name: Eriksen, M.P. Year: 1997 Volume: 87 Issue: 2 Pages: 168 Handle: RePEc:aph:ajpbhl:1997:87:2:168_0 Template-Type: ReDIF-Article 1.0 Title: Topics for our times: the medicine/public health initiative. Journal: American Journal of Public Health Author-Name: Reiser, S.J. Year: 1997 Volume: 87 Issue: 7 Pages: 1098-1099 DOI: 10.2105/AJPH.87.7.1098 File-URL: http://hdl.handle.net/10.2105/AJPH.87.7.1098 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.7.1098_3 Template-Type: ReDIF-Article 1.0 Title: Erratum: Tobacco and alcohol use behaviors portrayed in music videos: A content analysis (American Journal of Public Health (1997) 87 (1131-1135)) Journal: American Journal of Public Health Author-Name: DuRant, R.H. Author-Name: Rome, E.S. Author-Name: Rich, M. Author-Name: Allred, E. Author-Name: Emans, S.J. Author-Name: Woods, E.R. Year: 1997 Volume: 87 Issue: 9 Pages: 1514 Handle: RePEc:aph:ajpbhl:1997:87:9:1514_2 Template-Type: ReDIF-Article 1.0 Title: Mistaken assertions on reducing motor vehicle injury. Journal: American Journal of Public Health Author-Name: Robertson, L.S. Year: 1997 Volume: 87 Issue: 2 Pages: 295-296 DOI: 10.2105/AJPH.87.2.295 File-URL: http://hdl.handle.net/10.2105/AJPH.87.2.295 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.2.295_3 Template-Type: ReDIF-Article 1.0 Title: Racism and lead poisoning. Journal: American Journal of Public Health Author-Name: Weintraub, M. Year: 1997 Volume: 87 Issue: 11 Pages: 1871-1872 DOI: 10.2105/AJPH.87.11.1871-a File-URL: http://hdl.handle.net/10.2105/AJPH.87.11.1871-a Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.11.1871-a_9 Template-Type: ReDIF-Article 1.0 Title: Liver transplants and the decline in deaths from liver disease. Journal: American Journal of Public Health Author-Name: Evans, R.W. Year: 1997 Volume: 87 Issue: 5 Pages: 868-869 DOI: 10.2105/AJPH.87.5.868 File-URL: http://hdl.handle.net/10.2105/AJPH.87.5.868 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.5.868_9 Template-Type: ReDIF-Article 1.0 Title: Labor Insurance. 1904. Journal: American Journal of Public Health Author-Name: Rubinow, I.M. Year: 1997 Volume: 87 Issue: 11 Pages: 1862-1863 DOI: 10.2105/AJPH.87.11.1862-a File-URL: http://hdl.handle.net/10.2105/AJPH.87.11.1862-a Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.11.1862-a_9 Template-Type: ReDIF-Article 1.0 Title: Race, Foster Care, and the Politics of Abandonment in New York City Journal: American Journal of Public Health Author-Name: Rosner, D. Author-Name: Markowitz, G. Year: 1997 Volume: 87 Issue: 11 Pages: 1844-1849 DOI: 10.2105/AJPH.87.11.1844 File-URL: http://hdl.handle.net/10.2105/AJPH.87.11.1844 Abstract: Following the end of the GreatDepression of the 1930s, the sectarian system of foster care services in New York City practiced open discrimination. African-American children were generally segregated in a small number of overcrowded and understaffed all-Black institutions. As the African-American migration to the city accelerated in the years following the outbreak of World War II, a small group of psychologists, jurists, philanthropists, and social workers began a systematic challenge to this system. This paper explores the role of racism in shaping New York's foster care system and the experience of African-American children who were forced to depend on services originally organized to serve Whites. It also looks at the ways race affected the way children were typed - as mentally ill, delinquent, or even criminal - in response to the strucrural realities of a system that sorted children into separate types of institutions according to race. The paper also provides the background for understanding the landmark challenge to segregation of children in sectarian and public institutions represented by Wilder v Sugarman. Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.11.1844_6 Template-Type: ReDIF-Article 1.0 Title: Substance use in the US college-age population: Differences according to educational status and living arrangement Journal: American Journal of Public Health Author-Name: Gfroerer, J.C. Author-Name: Greenblatt, J.C. Author-Name: Wright, D.A. Year: 1997 Volume: 87 Issue: 1 Pages: 62-65 Abstract: Objectives. Substance use in the college-age population is an important public health and educational concern. This study compared rates of use among college students and nonstudents, including high school dropouts, from a single data source representative of the nation. Methods. Rates of use were estimated from the combined National Household Surveys on Drug Abuse from 1991 to 1993. Logistic regression models were used to test the effects of educational status and living arrangement. Results. Educational status and living arrangement were found to be significant predictors of substance use. Rates of illicit drug and cigarette use were highest among high school dropouts, while current and heavy alcohol use were highest among college students who did not live with their parents. Conclusions. Substantial variation in substance use patterns within the college-age population suggests that overall rates of use for young adults should not be used to characterize specific subgroups of young adults. These data from a single source will thus help planners more clearly distinguish the service needs of the diverse subgroups within this population. Handle: RePEc:aph:ajpbhl:1997:87:1:62-65_5 Template-Type: ReDIF-Article 1.0 Title: Motor-vehicle crash fatalities among American Indians and non-Indians in Arizona, 1979 through 1988 Journal: American Journal of Public Health Author-Name: Campos-Outcalt, D. Author-Name: Prybylski, D. Author-Name: Watkins, A.J. Author-Name: Rothfus, G. Author-Name: Dellapenna, A. Year: 1997 Volume: 87 Issue: 2 Pages: 282-285 Abstract: Objectives. This study evaluated the contributions of rural residence, alcohol use, and pedestrian fatalities to the high American Indian motor- vehicle crash mortality rate in Arizona. Methods. Records from the Fatal Accident Reporting System were used to examine mortality rates between 1979 and 1988. Results. American Indians had increased relative risks in all motor-vehicle crash categories in all residence-gender groups. The percentage of excess mortality associated with alcohol varied from 36.8% to 66.7%, and the percentage associated with pedestrian deaths ranged from 27.2% to 55.4%. Conclusions. Efforts to reduce excess motor-vehicle crash mortality among American Indians should concentrate on preventing pedestrian and alcohol- related fatalities. Handle: RePEc:aph:ajpbhl:1997:87:2:282-285_3 Template-Type: ReDIF-Article 1.0 Title: Annotation: evaluating OSHA's ethylene oxide standard and evaluating OSHA. Journal: American Journal of Public Health Author-Name: Yodaiken, R.E. Year: 1997 Volume: 87 Issue: 7 Pages: 1096-1097 DOI: 10.2105/AJPH.87.7.1096 File-URL: http://hdl.handle.net/10.2105/AJPH.87.7.1096 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.7.1096_1 Template-Type: ReDIF-Article 1.0 Title: The knowledge base for public health strategies. Journal: American Journal of Public Health Author-Name: Russell, L.B. Year: 1997 Volume: 87 Issue: 10 Pages: 1597-1598 DOI: 10.2105/AJPH.87.10.1597 File-URL: http://hdl.handle.net/10.2105/AJPH.87.10.1597 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.10.1597_3 Template-Type: ReDIF-Article 1.0 Title: Trends in overweight and obesity among Italian adults, 1983 through 1994. Journal: American Journal of Public Health Author-Name: Pagano, R. Author-Name: La Vecchia, C. Author-Name: Decarli, A. Author-Name: Negri, E. Author-Name: Franceschi, S. Year: 1997 Volume: 87 Issue: 11 Pages: 1869-1870 DOI: 10.2105/AJPH.87.11.1869 File-URL: http://hdl.handle.net/10.2105/AJPH.87.11.1869 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.11.1869_8 Template-Type: ReDIF-Article 1.0 Title: Directive counseling should emphasize disease protection not pregnancy prevention. Journal: American Journal of Public Health Author-Name: Pearson, C.A. Year: 1997 Volume: 87 Issue: 11 Pages: 1868-1869 DOI: 10.2105/AJPH.87.11.1868 File-URL: http://hdl.handle.net/10.2105/AJPH.87.11.1868 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.11.1868_2 Template-Type: ReDIF-Article 1.0 Title: Physical activity in a multiethnic population of third graders in four states Journal: American Journal of Public Health Author-Name: Simons-Morton, B.G. Author-Name: McKenzie, T.J. Author-Name: Stone, E. Author-Name: Mitchell, P. Author-Name: Osganian, V. Author-Name: Strikmiller, P.K. Author-Name: Ehlinger, S. Author-Name: Cribb, P. Author-Name: Nader, P.R. Year: 1997 Volume: 87 Issue: 1 Pages: 45-50 Abstract: Objectives. This research assessed the amount of daily physical activity in a multiethnic sample of US third-grade students. Methods. Physical activity interviews were conducted with 2410 third graders from 96 schools in four states. Blood pressure, cholesterol, body mass index, timed run for distance, physical-activity self-efficacy, and perceived support for physical activity were also assessed. Results. Students reported a daily average of 89.9 minutes of moderate to vigorous physical activity, 34.7 minutes of vigorous activity, and 120.4 minutes of sedentary behavior; however, 36.6% obtained less than 60 minutes of moderate to vigorous physical activity daily, and 12.8% reported less than 30 minutes. Boys reported more physical and sedentary activity than girls; White children reported more activity than Black or Hispanic children; California children reported the most activity and Louisiana children the least. Geographic location, male gender, lower cholesterol, higher perceived efficacy in physical activity, and higher social support were associated with more physical activity. Conclusions. Average reported activity met the Year 2000 objectives; however, many students reported less than recommended amounts of activity. These findings support the need for health promotion programs that increase the number of physically active children. Handle: RePEc:aph:ajpbhl:1997:87:1:45-50_7 Template-Type: ReDIF-Article 1.0 Title: Region of birth and mortality among black Americans. Journal: American Journal of Public Health Author-Name: Vågerö, D. Year: 1997 Volume: 87 Issue: 5 Pages: 724-726 DOI: 10.2105/AJPH.87.5.724 File-URL: http://hdl.handle.net/10.2105/AJPH.87.5.724 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.5.724_0 Template-Type: ReDIF-Article 1.0 Title: It's time for the public health community to declare war on homelessness. Journal: American Journal of Public Health Author-Name: Breakey, W.R. Year: 1997 Volume: 87 Issue: 2 Pages: 153-155 DOI: 10.2105/AJPH.87.2.153 File-URL: http://hdl.handle.net/10.2105/AJPH.87.2.153 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.2.153_9 Template-Type: ReDIF-Article 1.0 Title: Differences in the reported prevalence of adolescents who have never smoked. Journal: American Journal of Public Health Author-Name: Abernathy, T. Year: 1997 Volume: 87 Issue: 2 Pages: 298-299 DOI: 10.2105/AJPH.87.2.298 File-URL: http://hdl.handle.net/10.2105/AJPH.87.2.298 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.2.298_2 Template-Type: ReDIF-Article 1.0 Title: Quantifying the expected vs potential impact of a risk-factor intervention program. Journal: American Journal of Public Health Author-Name: Bulterys, M. Author-Name: Morgenstern, H. Author-Name: Weed, D.L. Year: 1997 Volume: 87 Issue: 5 Pages: 867-868 DOI: 10.2105/AJPH.87.5.867 File-URL: http://hdl.handle.net/10.2105/AJPH.87.5.867 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.5.867_0 Template-Type: ReDIF-Article 1.0 Title: Hamburger-associated Escherichia coli O157:H7 infection in Las Vegas: A hidden epidemic Journal: American Journal of Public Health Author-Name: Cieslak, P.R. Author-Name: Noble, S.J. Author-Name: Maxson, D.J. Author-Name: Empey, L.C. Author-Name: Ravenholt, O. Author-Name: Legarza, G. Author-Name: Tuttle, J. Author-Name: Doyle, M.P. Author-Name: Barren, T.J. Author-Name: Wells, J.G. Author-Name: McNamara, A.M. Author-Name: Griffin, P.M. Year: 1997 Volume: 87 Issue: 2 Pages: 176-180 Abstract: Objectives. This study sought to determine whether a multistate fast food hamburger-associated outbreak of Escherichia coli O157:H7 infection involved Las Vegas residents as well and, if so, why public health officials had not detected it. Methods. A matched case-control study was conducted among persons with bloody diarrhea and their healthy meal companions. Hamburger production, distribution, and cooking methods were reviewed. Unused hamburger patties were cultured, and E. coli O157:H7 isolates were characterized. Local laboratory stool culture practices were reviewed. Results. Fifty-eight cases of bloody diarrhea were identified. Illness was associated with eating regular hamburgers (matched odds ratio [OR] = 9.0, 95% confidence interval [CI] = 1.02, 433.4), but 25% of ill persons reported eating only jumbo hamburgers. Regular and jumbo hamburger patties yielded E. coli O157:H7 indistinguishable from the lone clinical isolate. No local laboratory cultured routinely for E. coli O157:H7 until after the outbreak. Conclusions. A large outbreak of E. coli O157:H7 infections escaped timely notice in Las Vegas because local laboratories did not culture for this pathogen. Health officials should encourage laboratories to screen at least all bloody stools on sorbitol-MacConkey medium. Handle: RePEc:aph:ajpbhl:1997:87:2:176-180_1 Template-Type: ReDIF-Article 1.0 Title: Sex trading and psychological distress among women recruited from the streets of Harlem Journal: American Journal of Public Health Author-Name: El-Bassel, N. Author-Name: Schilling, R.F. Author-Name: Irwin, K.L. Author-Name: Faruque, S. Author-Name: Gilbert, L. Author-Name: Von Bargen, J. Author-Name: Serrano, Y. Author-Name: Edlin, B.R. Year: 1997 Volume: 87 Issue: 1 Pages: 66-70 Abstract: Objectives. This study examines the relationship between sex trading and psychological distress and the implications of that relationship for prevention of human immunodeficiency virus among a sample of young women recruited from the streets of Harlem. Methods. Interviews were conducted with 346 predominantly drug-using women, aged 18 to 29 years, of whom 176 had exchanged sex for money or drugs in the previous 30 days and were categorized as 'sex traders.' Psychological distress was measured by using the Brief Symptom Inventory. Results. Sex traders scored significantly higher than non- sex traders on the General Severity Index and on eight of the nine subscales of the Brief Symptom Inventory. Multivariate analysis indicated that after adjustments were made for age; ethnicity; pregnancy; recent rape; perceived risk for acquired immunodeficiency syndrome; current, regular crack use; and current, regular alcohol use, sex traders scored 0.240 units higher on the General Severity Index than non-sex traders. Conclusions. Poor mental health and drug dependence may undermine the motivation and ability of these sex traders to adopt safer sex behavior. Therefore, interventions need to be integrated with mental health services and drug treatment to reduce risk behavior in this population. Handle: RePEc:aph:ajpbhl:1997:87:1:66-70_7 Template-Type: ReDIF-Article 1.0 Title: Environmental racism and public health. Journal: American Journal of Public Health Author-Name: Northridge, M.E. Author-Name: Shepard, P.M. Year: 1997 Volume: 87 Issue: 5 Pages: 730-732 DOI: 10.2105/AJPH.87.5.730 File-URL: http://hdl.handle.net/10.2105/AJPH.87.5.730 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.5.730_6 Template-Type: ReDIF-Article 1.0 Title: The disabilities of aging--looking to the physical environment. Journal: American Journal of Public Health Author-Name: Satariano, W.A. Year: 1997 Volume: 87 Issue: 3 Pages: 331-332 DOI: 10.2105/AJPH.87.3.331 File-URL: http://hdl.handle.net/10.2105/AJPH.87.3.331 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.3.331_0 Template-Type: ReDIF-Article 1.0 Title: Topics for our times: the increasing demand for tuberculosis services--a new encumbrance on tuberculosis control programs. Journal: American Journal of Public Health Author-Name: Nolan, C.M. Year: 1997 Volume: 87 Issue: 4 Pages: 551-553 DOI: 10.2105/AJPH.87.4.551 File-URL: http://hdl.handle.net/10.2105/AJPH.87.4.551 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.4.551_1 Template-Type: ReDIF-Article 1.0 Title: Hospital, heal thyself. Journal: American Journal of Public Health Author-Name: Schuchat, A. Year: 1997 Volume: 87 Issue: 9 Pages: 1413-1414 DOI: 10.2105/AJPH.87.9.1413 File-URL: http://hdl.handle.net/10.2105/AJPH.87.9.1413 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.9.1413_1 Template-Type: ReDIF-Article 1.0 Title: Comment: income, inequality, and social cohesion. Journal: American Journal of Public Health Author-Name: Wilkinson, R.G. Year: 1997 Volume: 87 Issue: 9 Pages: 1504-1506 DOI: 10.2105/AJPH.87.9.1504 File-URL: http://hdl.handle.net/10.2105/AJPH.87.9.1504 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.9.1504_1 Template-Type: ReDIF-Article 1.0 Title: Learning to recognize scarring among intravenous drug users: a tool for HIV risk reduction. Journal: American Journal of Public Health Author-Name: Horowitz, H.W. Year: 1997 Volume: 87 Issue: 7 Pages: 1233-1234 DOI: 10.2105/AJPH.87.7.1233 File-URL: http://hdl.handle.net/10.2105/AJPH.87.7.1233 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.7.1233_4 Template-Type: ReDIF-Article 1.0 Title: Public Health on the Railroad: William Freeman Snow and the California Sanitation Exhibit Journal: American Journal of Public Health Author-Name: Keller, T.M. Year: 1997 Volume: 87 Issue: 11 Pages: 1859-1861 DOI: 10.2105/AJPH.87.11.1859 File-URL: http://hdl.handle.net/10.2105/AJPH.87.11.1859 Abstract: This paper describes the California Sanitation Exhibit, a railroad car outfitted for instruction in public health that toured California in 1909 and 1910. The sanitation exhibit used display models, photographs, and lectures to educate the public about tuberculosis and other infectious diseases, waste contamination, and the dangers of bad milk. The success of the exhibit, which reached 5% of the state's population, resulted in the appointment of its creator, William Freeman Snow, as secretary of the California State Roard of Health. Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.11.1859_9 Template-Type: ReDIF-Article 1.0 Title: The Junior Red Cross Goes to Healthland Journal: American Journal of Public Health Author-Name: Hutchinson, J.F. Year: 1997 Volume: 87 Issue: 11 Pages: 1816-1823 DOI: 10.2105/AJPH.87.11.1816 File-URL: http://hdl.handle.net/10.2105/AJPH.87.11.1816 Abstract: An amusing reminder of earnest attempts to teach the principles of public health, Junior Red Cross Time brought plays and games about "Healthland" to schoolchildren in the 1920s. Explaining why health education became part of the mission of the Junior Red Cross raises larger issues, such as the ideology and practice of the American Red Cross in war and peace, the place of health in the moral education of children, and the transition from the activism of the Progressive Era to the markedly different social climate of the 1920s. The Junior Red Cross promoted Healthland largely because it was an innocuous concept that had been stripped of potentially controversial features to adapt it to the conservative mood of postwar America. This process of dilution mirrored the fate of the adult Red Cross, which briefly and unsuccessfully sought to reinvent itself as a national (and international) agency for the promotion of public health. The unreality of Healthland is no mere coincidence; its separation from the real world was a crucial part of its appeal to the Red Cross in the 1920s. Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.11.1816_8 Template-Type: ReDIF-Article 1.0 Title: The proliferation and risks of government DNA databases. Journal: American Journal of Public Health Author-Name: Sankar, P. Year: 1997 Volume: 87 Issue: 3 Pages: 336-337 DOI: 10.2105/AJPH.87.3.336 File-URL: http://hdl.handle.net/10.2105/AJPH.87.3.336 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.3.336_1 Template-Type: ReDIF-Article 1.0 Title: Can preventive gerontology be on the way? Journal: American Journal of Public Health Author-Name: Fries, J.F. Year: 1997 Volume: 87 Issue: 10 Pages: 1591-1593 DOI: 10.2105/AJPH.87.10.1591 File-URL: http://hdl.handle.net/10.2105/AJPH.87.10.1591 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.10.1591_0 Template-Type: ReDIF-Article 1.0 Title: The accurate measurement of gestational age--a critical step toward improving fetal death reporting and perinatal health. Journal: American Journal of Public Health Author-Name: Alexander, G.R. Year: 1997 Volume: 87 Issue: 8 Pages: 1278-1279 DOI: 10.2105/AJPH.87.8.1278 File-URL: http://hdl.handle.net/10.2105/AJPH.87.8.1278 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.8.1278_3 Template-Type: ReDIF-Article 1.0 Title: Federal public health, semi-reinvented. Journal: American Journal of Public Health Author-Name: Mullan, F. Year: 1997 Volume: 87 Issue: 1 Pages: 21-24 DOI: 10.2105/AJPH.87.1.21 File-URL: http://hdl.handle.net/10.2105/AJPH.87.1.21 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.1.21_3 Template-Type: ReDIF-Article 1.0 Title: Eugenics and Public Health in American History Journal: American Journal of Public Health Author-Name: Pernick, M.S. Year: 1997 Volume: 87 Issue: 11 Pages: 1767-1772 DOI: 10.2105/AJPH.87.11.1767 File-URL: http://hdl.handle.net/10.2105/AJPH.87.11.1767 Abstract: Supporters of eugenics, the powerful early 20th-century movement for improving human heredity, often attacked that era's dramatic improvements in public health and medicine for preserving the lives of people they considered hereditarily unfit. Eugenics and public health also battled over whether heredity played a significant role in infectious diseases. However, American public health and eugenics had much in common as well. Eugenic methods often were modeled on the infection control techniques of public health. The goals, values, and concepts of disease of these two movements also often overlapped. This paper sketches some of the key similarities and differences between eugenics and public health in the United States, and it examines how their relationship was shaped by the interaction of science and culture. The results demonstrate that eugenics was not an isolated movement whose significance is confined to the histories of genetics and pseudoscience, but was instead an important and cautionary part of past public health and a general medical history as well. Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.11.1767_4 Template-Type: ReDIF-Article 1.0 Title: Reproductive history, socioeconomic status, and self-reported health status of women aged 50 years or older Journal: American Journal of Public Health Author-Name: Kington, R. Author-Name: Lillard, L. Author-Name: Rogowski, J. Year: 1997 Volume: 87 Issue: 1 Pages: 33-37 Abstract: Objectives. This paper describes the relationship between self-reported general health status and several facets of reproductive history. Methods. We analyzed survey data on a national probability sample of 1341 women aged 50 and older from the Panel Study of Income Dynamics. We used multivariate regression techniques to control for differences in health indices that assessed health status and functioning. Results. Women with a history of six or more completed pregnancies were found to be disadvantaged in educational attainment, financial resources, and health status compared with women with no or fewer pregnancies. When current sociodemographic factors were controlled, six or more pregnancies were associated with worse general health and worse physical role functioning. When sociodemographic factors and number of births were controlled, among women with at least one delivery, women who had experienced an infant's death reported worse health as measured by all three indices. Women with a first delivery before the age of 18 were more likely to report a functional limitation. Conclusions. Women with high parity status, a history of an infant's death, and an early first pregnancy may be at greater risk of poor health in later life. Handle: RePEc:aph:ajpbhl:1997:87:1:33-37_3 Template-Type: ReDIF-Article 1.0 Title: Outercourse as a safe and sensible alternative to contraceptives. Journal: American Journal of Public Health Author-Name: Cobb, J.C. Year: 1997 Volume: 87 Issue: 8 Pages: 1380-1381 DOI: 10.2105/AJPH.87.8.1380 File-URL: http://hdl.handle.net/10.2105/AJPH.87.8.1380 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.8.1380_8 Template-Type: ReDIF-Article 1.0 Title: Identifying areas with vitamin A deficiency: The validity of a semiquantitative food frequency method Journal: American Journal of Public Health Author-Name: Sloan, N.L. Author-Name: Rosen, D. Author-Name: De La Paz, T. Author-Name: Arita, M. Author-Name: Temalilwa, C. Author-Name: Solomons, N.W. Year: 1997 Volume: 87 Issue: 2 Pages: 186-191 Abstract: Objectives. The prevalence of vitamin A deficiency has traditionally been assessed through xerophthalmia or biochemical surveys. The cost and complexity of implementing these methods limits the ability of nonresearch organizations to identify vitamin A deficiency. This study examined the validity of a simple, inexpensive food frequency method to identify areas with a high prevalence of vitamin A deficiency. Methods. The validity of the method was tested in 15 communities, 5 each from the Philippines, Guatemala, and Tanzania. Serum retinol concentrations of less than 20 μg/dL defined vitamin A deficiency. Results. Weighted measures of vitamin A intake six or fewer times per week and unweighted measures of consumption of animal sources of vitamin A four or fewer times per week correctly classified seven of eight communities as having a high prevalence of vitamin A deficiency (i.e., 15% or more of preschool-aged children in the community had the deficiency) (sensitivity = 87.5%) and four of seven communities as having a low prevalence (specificity = 57.1%). Conclusions. This method correctly classified the vitamin A deficiency status of 73.3% of the communities but demonstrated a high false-positive rate (42.9%). Handle: RePEc:aph:ajpbhl:1997:87:2:186-191_5 Template-Type: ReDIF-Article 1.0 Title: Can herd immunity influence the assessment of vaccine efficacy in nonrandomized studies? Journal: American Journal of Public Health Author-Name: Mühlemann, K. Author-Name: Weiss, N.S. Year: 1997 Volume: 87 Issue: 1 Pages: 113-114 DOI: 10.2105/AJPH.87.1.113 File-URL: http://hdl.handle.net/10.2105/AJPH.87.1.113 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.1.113_9 Template-Type: ReDIF-Article 1.0 Title: Ethical challenges posed by clinical progress in AIDS. Journal: American Journal of Public Health Author-Name: Bayer, R. Author-Name: Stryker, J. Year: 1997 Volume: 87 Issue: 10 Pages: 1599-1602 DOI: 10.2105/AJPH.87.10.1599 File-URL: http://hdl.handle.net/10.2105/AJPH.87.10.1599 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.10.1599_3 Template-Type: ReDIF-Article 1.0 Title: Comment: ethical dilemmas in worldwide polio eradication programs. Journal: American Journal of Public Health Author-Name: Sutter, R.W. Author-Name: Cochi, S.L. Year: 1997 Volume: 87 Issue: 6 Pages: 913-916 DOI: 10.2105/AJPH.87.6.913 File-URL: http://hdl.handle.net/10.2105/AJPH.87.6.913 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.6.913_8 Template-Type: ReDIF-Article 1.0 Title: Topics for our times: Norplant coercion--an overstated threat. Journal: American Journal of Public Health Author-Name: Davidson, A.R. Author-Name: Kalmuss, D. Year: 1997 Volume: 87 Issue: 4 Pages: 550-551 DOI: 10.2105/AJPH.87.4.550 File-URL: http://hdl.handle.net/10.2105/AJPH.87.4.550 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.4.550_7 Template-Type: ReDIF-Article 1.0 Title: Bottled water use in an immigrant community: a public health issue? Journal: American Journal of Public Health Author-Name: Weissman, A.M. Year: 1997 Volume: 87 Issue: 8 Pages: 1379-1380 DOI: 10.2105/AJPH.87.8.1379-a File-URL: http://hdl.handle.net/10.2105/AJPH.87.8.1379-a Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.8.1379-a_4 Template-Type: ReDIF-Article 1.0 Title: From public health science to prevention policy: placing science in its social and political contexts. Journal: American Journal of Public Health Author-Name: Atwood, K. Author-Name: Colditz, G.A. Author-Name: Kawachi, I. Year: 1997 Volume: 87 Issue: 10 Pages: 1603-1606 DOI: 10.2105/AJPH.87.10.1603 File-URL: http://hdl.handle.net/10.2105/AJPH.87.10.1603 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.10.1603_1 Template-Type: ReDIF-Article 1.0 Title: Comment: evaluating the effectiveness of hospital care. Journal: American Journal of Public Health Author-Name: Krakauer, H. Year: 1997 Volume: 87 Issue: 6 Pages: 916-917 DOI: 10.2105/AJPH.87.6.916 File-URL: http://hdl.handle.net/10.2105/AJPH.87.6.916 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.6.916_1 Template-Type: ReDIF-Article 1.0 Title: Ethical and health implications of directive counseling on long-acting contraception. Journal: American Journal of Public Health Author-Name: Gollub, E.L. Author-Name: Isaacs, S.L. Year: 1997 Volume: 87 Issue: 11 Pages: 1867-1868 DOI: 10.2105/AJPH.87.11.1867-a File-URL: http://hdl.handle.net/10.2105/AJPH.87.11.1867-a Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.11.1867-a_3 Template-Type: ReDIF-Article 1.0 Title: Erratum: The effect of ordinances requiring smoke-free restaurants on restaurant sales (American Journal of Public Health (1994) 84 (1081-1085)) Journal: American Journal of Public Health Author-Name: Glantz, S.A. Author-Name: Smith, L.R.A. Year: 1997 Volume: 87 Issue: 10 Pages: 1729-1730 Handle: RePEc:aph:ajpbhl:1997:87:10:1729-1730_7 Template-Type: ReDIF-Article 1.0 Title: Erratum: Directly observed therapy for tuberculosis (American Journal of Public Health (1996) 86 (1146-1149)) Journal: American Journal of Public Health Author-Name: El-Sadr, W. Author-Name: Medard, F. Author-Name: Barthaud, V. Year: 1997 Volume: 87 Issue: 2 Pages: 168 Handle: RePEc:aph:ajpbhl:1997:87:2:168_5 Template-Type: ReDIF-Article 1.0 Title: A call for consistency in defining breast-feeding. Journal: American Journal of Public Health Author-Name: Labbok, M.H. Author-Name: Belsey, M. Author-Name: Coffin, C.J. Year: 1997 Volume: 87 Issue: 6 Pages: 1060-1061 DOI: 10.2105/AJPH.87.6.1060 File-URL: http://hdl.handle.net/10.2105/AJPH.87.6.1060 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.6.1060_8 Template-Type: ReDIF-Article 1.0 Title: The driver's role in automobile safety. Journal: American Journal of Public Health Author-Name: Fisher, L. Year: 1997 Volume: 87 Issue: 5 Pages: 871-872 DOI: 10.2105/AJPH.87.5.871 File-URL: http://hdl.handle.net/10.2105/AJPH.87.5.871 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.5.871_8 Template-Type: ReDIF-Article 1.0 Title: Ross and colleagues respond [3] Journal: American Journal of Public Health Author-Name: Ross, D.A. Author-Name: Kirkwood, B.R. Year: 1997 Volume: 87 Issue: 3 Pages: 468 Handle: RePEc:aph:ajpbhl:1997:87:3:468_7 Template-Type: ReDIF-Article 1.0 Title: The validity of self-reports of smoking: Analyses by race/ethnicity in a school sample of urban adolescents Journal: American Journal of Public Health Author-Name: Wills, T.A. Author-Name: Cleary, S.D. Year: 1997 Volume: 87 Issue: 1 Pages: 56-61 Abstract: Objectives. This research compared the validity of self-reports of cigarette smoking for African-American, Hispanic, and White respondents. Previous research has raised a question about the validity of self-report for African Americans. Methods. A self-report of cigarette smoking was obtained together with a measure of carbon monoxide from expired air. Convergence between self-reported smoking and the biochemical measure was analyzed separately for three ethnic groups at 7th grade, 8th grade, 9th grade, and 10th grade. Results. Analyses indicated that the validity of self-reports of smoking was generally comparable across ethnic groups. Sensitivity and specificity were comparable with data reported in recent meta-analyses. Though sensitivity was slightly lower for minority adolescents than for White adolescents, prevalence rates corrected for group differences in sensitivity showed significantly lower smoking rates for African-American and Hispanic adolescents than for White adolescents. Conclusions. The lower smoking rates reported for African-American adolescents are real and are not substantially a consequence of reporting artifacts. Handle: RePEc:aph:ajpbhl:1997:87:1:56-61_6 Template-Type: ReDIF-Article 1.0 Title: Targeted tobacco markets: outdoor advertising in Los Angeles minority neighborhoods. Journal: American Journal of Public Health Author-Name: Stoddard, J.L. Author-Name: Johnson, C.A. Author-Name: Boley-Cruz, T. Author-Name: Sussman, S. Year: 1997 Volume: 87 Issue: 7 Pages: 1232-1233 DOI: 10.2105/AJPH.87.7.1232 File-URL: http://hdl.handle.net/10.2105/AJPH.87.7.1232 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.7.1232_0 Template-Type: ReDIF-Article 1.0 Title: Dealing with tobacco--the implications of a legislative settlement with the tobacco industry. Journal: American Journal of Public Health Author-Name: Warner, K.E. Year: 1997 Volume: 87 Issue: 6 Pages: 906-909 DOI: 10.2105/AJPH.87.6.906 File-URL: http://hdl.handle.net/10.2105/AJPH.87.6.906 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.6.906_4 Template-Type: ReDIF-Article 1.0 Title: Gun availability and violent death. Journal: American Journal of Public Health Author-Name: Morgenstern, H. Year: 1997 Volume: 87 Issue: 6 Pages: 899-901 DOI: 10.2105/AJPH.87.6.899 File-URL: http://hdl.handle.net/10.2105/AJPH.87.6.899 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.6.899_9 Template-Type: ReDIF-Article 1.0 Title: The "Black Report" of Spain--the Commission on Social Inequalities in Health. Journal: American Journal of Public Health Author-Name: Navarro, V. Year: 1997 Volume: 87 Issue: 3 Pages: 334-335 DOI: 10.2105/AJPH.87.3.334 File-URL: http://hdl.handle.net/10.2105/AJPH.87.3.334 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.3.334_9 Template-Type: ReDIF-Article 1.0 Title: US HIV prevalence estimates: why the delay in publication? Journal: American Journal of Public Health Author-Name: Lurie, P. Author-Name: DeCarlo, P. Year: 1997 Volume: 87 Issue: 5 Pages: 873-874 DOI: 10.2105/AJPH.87.5.873 File-URL: http://hdl.handle.net/10.2105/AJPH.87.5.873 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.5.873_1 Template-Type: ReDIF-Article 1.0 Title: Good news for everyone? Journal: American Journal of Public Health Author-Name: Stanton, B. Year: 1997 Volume: 87 Issue: 12 Pages: 1917-1919 DOI: 10.2105/AJPH.87.12.1917 File-URL: http://hdl.handle.net/10.2105/AJPH.87.12.1917 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.12.1917_2 Template-Type: ReDIF-Article 1.0 Title: Lead and other metals in play kit and craft items composed of vinyl and leather. Journal: American Journal of Public Health Author-Name: Hunt, A. Author-Name: Burnett, B.R. Author-Name: Basford, T.M. Author-Name: Abraham, J.L. Year: 1997 Volume: 87 Issue: 10 Pages: 1724-1727 DOI: 10.2105/AJPH.87.10.1724 File-URL: http://hdl.handle.net/10.2105/AJPH.87.10.1724 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.10.1724_8 Template-Type: ReDIF-Article 1.0 Title: Mortality of persons with mental retardation in institutions and in the community. Journal: American Journal of Public Health Author-Name: Strauss, D. Author-Name: Shavelle, R. Year: 1997 Volume: 87 Issue: 11 Pages: 1870-1871 DOI: 10.2105/AJPH.87.11.1870-a File-URL: http://hdl.handle.net/10.2105/AJPH.87.11.1870-a Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.11.1870-a_1 Template-Type: ReDIF-Article 1.0 Title: Nicotine content of the eclipse nicotine delivery device. Journal: American Journal of Public Health Author-Name: Benowitz, N.L. Author-Name: Jacob 3rd., P. Author-Name: Slade, J. Author-Name: Yu, L. Year: 1997 Volume: 87 Issue: 11 Pages: 1865-1866 DOI: 10.2105/AJPH.87.11.1865 File-URL: http://hdl.handle.net/10.2105/AJPH.87.11.1865 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.11.1865_2 Template-Type: ReDIF-Article 1.0 Title: Isaac Max Rubinow. Journal: American Journal of Public Health Author-Name: Brown, T.M. Year: 1997 Volume: 87 Issue: 11 Pages: 1863-1864 DOI: 10.2105/AJPH.87.11.1863 File-URL: http://hdl.handle.net/10.2105/AJPH.87.11.1863 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.11.1863_6 Template-Type: ReDIF-Article 1.0 Title: Issues in equalizing Medicare expenditures--the devil is in the details. Journal: American Journal of Public Health Author-Name: Feldman, P.H. Year: 1997 Volume: 87 Issue: 10 Pages: 1595-1596 DOI: 10.2105/AJPH.87.10.1595 File-URL: http://hdl.handle.net/10.2105/AJPH.87.10.1595 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.10.1595_5 Template-Type: ReDIF-Article 1.0 Title: Preventing recurrent homelessness among mentally ill men: A 'critical time' intervention after discharge from a shelter Journal: American Journal of Public Health Author-Name: Susser, E. Author-Name: Valencia, E. Author-Name: Conover, S. Author-Name: Felix, A. Author-Name: Tsai, W.-Y. Author-Name: Wyatt, R.J. Year: 1997 Volume: 87 Issue: 2 Pages: 256-262 Abstract: Objectives. This study examined a strategy to prevent homelessness among individuals with severe mental illness by providing a bridge between institutional and community care. Methods. Ninety-six men with severe mental illness who were entering community housing from a shelter institution were randomized to receive 9 months of a 'critical time' intervention plus usual services or usual services only. The primary analysis compared the mean number of homeless nights for the two groups during the 18-month follow-up period. To elucidate time trends, survival curves were used. Results. Over the 18-month follow-up period, the average number of homeless nights was 30 for the critical time intervention group and 91 for the usual services group. Survival curves showed that after the 9-month period of active intervention, the difference between the two groups did not diminish. Conclusions. Strategies that focus on a critical time of transition may contribute to the prevention of recurrent homelessness among individuals with mental illness, even after the period of active intervention. Handle: RePEc:aph:ajpbhl:1997:87:2:256-262_4 Template-Type: ReDIF-Article 1.0 Title: Topics for our times: affirmative action and women's health. Journal: American Journal of Public Health Author-Name: Chavkin, W. Year: 1997 Volume: 87 Issue: 5 Pages: 732-734 DOI: 10.2105/AJPH.87.5.732 File-URL: http://hdl.handle.net/10.2105/AJPH.87.5.732 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.5.732_7 Template-Type: ReDIF-Article 1.0 Title: The public health impact of hunger. Journal: American Journal of Public Health Author-Name: Sidel, V.W. Year: 1997 Volume: 87 Issue: 12 Pages: 1921-1922 DOI: 10.2105/AJPH.87.12.1921 File-URL: http://hdl.handle.net/10.2105/AJPH.87.12.1921 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.12.1921_4 Template-Type: ReDIF-Article 1.0 Title: Statistics in the journal--significance, confidence, and all that. Journal: American Journal of Public Health Author-Name: Northridge, M.E. Author-Name: Levin, B. Author-Name: Feinleib, M. Author-Name: Susser, M.W. Year: 1997 Volume: 87 Issue: 7 Pages: 1092-1095 DOI: 10.2105/AJPH.87.7.1092 File-URL: http://hdl.handle.net/10.2105/AJPH.87.7.1092 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.7.1092_3 Template-Type: ReDIF-Article 1.0 Title: Why history? Journal: American Journal of Public Health Author-Name: Fee, E. Author-Name: Brown, T.M. Year: 1997 Volume: 87 Issue: 11 Pages: 1763-1764 DOI: 10.2105/AJPH.87.11.1763 File-URL: http://hdl.handle.net/10.2105/AJPH.87.11.1763 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.11.1763_4 Template-Type: ReDIF-Article 1.0 Title: The uses of psychosocial epidemiology in promoting refugee health. Journal: American Journal of Public Health Author-Name: Neugebauer, R. Year: 1997 Volume: 87 Issue: 5 Pages: 726-728 DOI: 10.2105/AJPH.87.5.726 File-URL: http://hdl.handle.net/10.2105/AJPH.87.5.726 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.5.726_9 Template-Type: ReDIF-Article 1.0 Title: Health insurance coverage among foreign-born US residents: The impact of race, ethnicity, and length of residence Journal: American Journal of Public Health Author-Name: Thamer, M. Author-Name: Richard, C. Author-Name: Casebeer, A.W. Author-Name: Ray, N.F. Year: 1997 Volume: 87 Issue: 1 Pages: 96-102 Abstract: Objectives. This study examined the health insurance status of the US foreign-born population and the influence of race, ethnicity, and length of residence on health insurance status. Methods. Data were obtained from the 1989 and 1990 National Health Interview Surveys, including the Insurance and Family Resource Supplements. Results. In 1989 and 1990, the foreign-born population was twice as likely as the US-born population to be uninsured (26.2% vs 13.0%). The highest rate of uninsured status, 40.8%, was found among foreign-born Hispanics. Persons who had lived in the United States for less than 15 years were 1.5 to 4.7 times more likely to be uninsured than were US-born Whites. Conclusions. Foreign-born US residents - especially Hispanics and persons residing in the United States for less than 15 years - are vulnerable to not having health insurance, which may limit their access to medical services. The administrative criteria for public programs may explain rates of uninsured status among recent immigrants. Recently enacted federal legislation could substantially increase the number of uninsured among the US foreign-born population, with profound implications. Handle: RePEc:aph:ajpbhl:1997:87:1:96-102_9 Template-Type: ReDIF-Article 1.0 Title: Emergency department costs. Journal: American Journal of Public Health Author-Name: Dowling, P.T. Year: 1997 Volume: 87 Issue: 11 Pages: 1866-1867 DOI: 10.2105/AJPH.87.11.1866 File-URL: http://hdl.handle.net/10.2105/AJPH.87.11.1866 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.11.1866_1 Template-Type: ReDIF-Article 1.0 Title: Annotation: cigarette smoking, nutrition, and birthweight. Journal: American Journal of Public Health Author-Name: Rasmussen, K.M. Author-Name: Adams, B. Year: 1997 Volume: 87 Issue: 4 Pages: 543-544 DOI: 10.2105/AJPH.87.4.543 File-URL: http://hdl.handle.net/10.2105/AJPH.87.4.543 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.4.543_8 Template-Type: ReDIF-Article 1.0 Title: The body politic and the power of socioeconomic status. Journal: American Journal of Public Health Author-Name: Moss, N. Year: 1997 Volume: 87 Issue: 9 Pages: 1411-1413 DOI: 10.2105/AJPH.87.9.1411 File-URL: http://hdl.handle.net/10.2105/AJPH.87.9.1411 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.9.1411_1 Template-Type: ReDIF-Article 1.0 Title: HIV/AIDS surveillance in Italy: the potential misinterpretation of time trends. Journal: American Journal of Public Health Author-Name: Pezzotti, P. Author-Name: Piovesan, C. Author-Name: Rezza, G. Author-Name: Ferraro, P. Year: 1997 Volume: 87 Issue: 3 Pages: 469-470 DOI: 10.2105/AJPH.87.3.469 File-URL: http://hdl.handle.net/10.2105/AJPH.87.3.469 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.3.469_4 Template-Type: ReDIF-Article 1.0 Title: Adaptive responses among Dutch elderly: The impact of eight chronic medical conditions on health-related quality of life Journal: American Journal of Public Health Author-Name: Kempen, G.I.J.M. Author-Name: Ormel, J. Author-Name: Brilman, E.I. Author-Name: Relyveld, J. Year: 1997 Volume: 87 Issue: 1 Pages: 38-44 Abstract: Objectives. This study analyzed the impact of eight common chronic medical conditions on functional, social, and affective domains of health- related quality of life among community-based Dutch elderly (n = 5279). Methods. Health-related quality of life was measured with six domains of the MOS Short-Form General Health Survey. The impact of the selected chronic conditions on health-related quality of life was analyzed by means of Student's t tests, analyses of variance, and multiple regression analyses. Results. Compared with other domains of health-related quality of life, mental health was the least affected by chronic medical conditions. Back problems and rheumatoid arthritis/other joint complaints accounted for relatively high proportions of the variance in health-related quality of life (from 35.5% to 68.3%), except for health perceptions (22.6%), indicating that health-related quality of life is most affected by these two conditions. Conclusions. Subjective well-being is by far the domain least affected by chronic medical conditions, while physical functioning and health perceptions are most affected. Back problems and rheumatoid arthritis/other joint complaints affect health-related quality of life strongly. Handle: RePEc:aph:ajpbhl:1997:87:1:38-44_8 Template-Type: ReDIF-Article 1.0 Title: Underwood responds [4] Journal: American Journal of Public Health Author-Name: Underwood, B.A. Year: 1997 Volume: 87 Issue: 3 Pages: 468-469 Handle: RePEc:aph:ajpbhl:1997:87:3:468-469_8 Template-Type: ReDIF-Article 1.0 Title: Access to maternity care in rural Washington: Its effect on neonatal outcomes and resource use Journal: American Journal of Public Health Author-Name: Nesbitt, T.S. Author-Name: Larson, E.H. Author-Name: Rosenblatt, R.A. Author-Name: Hart, L.G. Year: 1997 Volume: 87 Issue: 1 Pages: 85-90 Abstract: Objectives. This study sought to ascertain the effects of poor local access to obstetric care on the risks of having a neonate diagnosed as non- normal, a long hospital stay, and/or high hospital charges. Methods. Washington State birth certificates linked with hospital discharge abstracts of mothers and neonates were used to study 29 809 births to residents of rural areas. Births to women from rural areas where more than two thirds of the women left for care were compared with births to women from rural areas where fewer than one third left for care. Results. Poor local access to providers of obstetric care was associated with a significantly greater risk of having a non-normal neonate for both Medicaid and privately insured patients. However, poor local access to care was consistently associated with higher charges and increased hospital length of stay only if the patient was privately insured. Conclusions. These results indicate that local maternity services may help prevent non-normal births to rural women and, among privately insured women, might decrease use of neonatal resources. Handle: RePEc:aph:ajpbhl:1997:87:1:85-90_6 Template-Type: ReDIF-Article 1.0 Title: Janus considers the HIV pandemic--harnessing recent advances to enhance AIDS prevention. Journal: American Journal of Public Health Author-Name: St Louis, M.E. Author-Name: Wasserheit, J.N. Author-Name: Gayle, H.D. Year: 1997 Volume: 87 Issue: 1 Pages: 10-12 DOI: 10.2105/AJPH.87.1.10 File-URL: http://hdl.handle.net/10.2105/AJPH.87.1.10 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.1.10_6 Template-Type: ReDIF-Article 1.0 Title: Cause-of-death categories. Journal: American Journal of Public Health Author-Name: MacDorman, M.F. Author-Name: Hoyert, D.L. Author-Name: Rosenberg, H.M. Year: 1997 Volume: 87 Issue: 12 Pages: 2054-2055 DOI: 10.2105/AJPH.87.12.2054 File-URL: http://hdl.handle.net/10.2105/AJPH.87.12.2054 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.12.2054_8 Template-Type: ReDIF-Article 1.0 Title: Primary care case management and birth outcomes in the Iowa Medicaid program Journal: American Journal of Public Health Author-Name: Schulman, E.D. Author-Name: Sheriff, D.J. Author-Name: Momany, E.T. Year: 1997 Volume: 87 Issue: 1 Pages: 80-84 Abstract: Objectives. This study compares prenatal care utilization and birth outcomes between Iowa Medicaid recipients receiving care in a primary care case management (PCCM) system and those receiving care in a fee-for-service (FFS) system. Methods. Birth certificates linked with Medicaid hospitalization claims were analyzed for seven PCCM and seven FFS counties. Results. From 1989 through 1992, them was (1) a 20% increase in the number of women who received adequate prenatal care in the FFS counties, vs a 5% increase in the PCCM counties; (2) a 17% increase in the number of women who initiated care within the first trimester in the FFS counties, vs a 6% increase in the PCCM counties; and (3) a 442% increase in the number of women who received enhanced prenatal services in the FFS counties, vs a 278% increase in the PCCM counties. There were no significant differences between groups in mean gestational age or birthweight; however, there was an increase of very-low-birthweight babies in both groups. Conclusions. PCCM, as implemented by the Iowa Medicaid program, has not appreciably improved prenatal care utilization or birth outcomes. Handle: RePEc:aph:ajpbhl:1997:87:1:80-84_7 Template-Type: ReDIF-Article 1.0 Title: Erratum: Annotation: Cigarette smoking, nutrition, and birthweight (American Journal of Public (1997) 87 (543-544) Journal: American Journal of Public Health Author-Name: Rasmussen, K.M. Author-Name: Adams, B. Year: 1997 Volume: 87 Issue: 6 Pages: 925 Handle: RePEc:aph:ajpbhl:1997:87:6:925_3 Template-Type: ReDIF-Article 1.0 Title: AIDS--an update on the global dynamics. Journal: American Journal of Public Health Author-Name: Stein, Z. Author-Name: Susser, M. Year: 1997 Volume: 87 Issue: 6 Pages: 901-904 DOI: 10.2105/AJPH.87.6.901 File-URL: http://hdl.handle.net/10.2105/AJPH.87.6.901 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.6.901_7 Template-Type: ReDIF-Article 1.0 Title: The effect of a community-supported alcohol ban on prenatal alcohol and other substance abuse. Journal: American Journal of Public Health Author-Name: Bowerman, R.J. Year: 1997 Volume: 87 Issue: 8 Pages: 1378-1379 DOI: 10.2105/AJPH.87.8.1378 File-URL: http://hdl.handle.net/10.2105/AJPH.87.8.1378 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.8.1378_2 Template-Type: ReDIF-Article 1.0 Title: The Federal Government's Use of Title VI and Medicare to Racially Integrate Hospitals in the United States, 1963 Through 1967 Journal: American Journal of Public Health Author-Name: Reynolds, P.P. Year: 1997 Volume: 87 Issue: 11 Pages: 1850-1858 DOI: 10.2105/AJPH.87.11.1850 File-URL: http://hdl.handle.net/10.2105/AJPH.87.11.1850 Abstract: Explicit discrimination against minorities existed in the 1960s in hospital patient admissions and physician and nurse staff appointments. With passage of the Civil Rights Act of 1964, along with Medicare legislation in 1965, civil rights advocates within the federal government had both a legislative mandate to guarantee equal access to programs funded by the federal government in Title VI and a federal program that affected every hospital in the country in Medicare. This study was conducted to determine the extent to which the Medicare hospital certification program was a major determinant in the racial integration of hospitals throughout the United States. In-depth interviews were conducted with individuals involved in hospital and health care policy in the 1950s and 1960s. Other primary resources include archival and personal manuscripts, government documents, newspapers, and periodicals. Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.11.1850_5 Template-Type: ReDIF-Article 1.0 Title: The Image and Advocacy of Public Health in American Caricature and Cartoons from 1860 to 1900 Journal: American Journal of Public Health Author-Name: Hansen, B. Year: 1997 Volume: 87 Issue: 11 Pages: 1798-1807 DOI: 10.2105/AJPH.87.11.1798 File-URL: http://hdl.handle.net/10.2105/AJPH.87.11.1798 Abstract: The decades just before and after the founding of the American Public Health Association in 1872 saw an efflorescence of political cartooning and caricature in national-circulation weeklies. Part of the political and social critique that cartoonists and their editors provided the public focused on needs or opportunities for preventing illness and accidents. This paper presents a small selection of editorial cartoons that agitated in support of public health activities over 4 decades. The goals are to illustrate several concerns that rose to national prominence in that era, to examine the kinds of imagery that newspapers and magazine editors offered their readers, and to observe how frequently the public was encouraged to see politicians and commercial interests as responsible for preventable health problems. This discussion focuses exclusively on propagandistic images, leaving aside the repertorial depictions of events in the news and the neutral illustrations of methods and machines in scientific and technical publications. Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.11.1798_0 Template-Type: ReDIF-Article 1.0 Title: Determinants of US local health department expenditures, 1992 through 1993 Journal: American Journal of Public Health Author-Name: Gordon, R.L. Author-Name: Gerzoff, R.B. Author-Name: Richards, T.B. Year: 1997 Volume: 87 Issue: 1 Pages: 91-95 Abstract: Objectives. This study examined local health department expenditures and their relationship to several departmental characteristics, including the size of the population in the department's jurisdiction. Methods. Local health department characteristics were obtained from a 1992/93 nationwide mail survey and modeled by means of multiple linear regression. Results. Great variability existed in the per capita expenditures of local health departments, and approximately 70% of the variability was accounted for by differences in jurisdiction population size. Additional characteristics of the health departments explained another 11%. The average unadjusted per capita expenditure by local health departments nationwide was $26. Conclusions. Local health department expenditures that support essential public health services average a dime a day per person. Handle: RePEc:aph:ajpbhl:1997:87:1:91-95_5 Template-Type: ReDIF-Article 1.0 Title: Annotation: the importance of transitional care in reducing homelessness. Journal: American Journal of Public Health Author-Name: Thornicroft, G. Year: 1997 Volume: 87 Issue: 2 Pages: 158-159 DOI: 10.2105/AJPH.87.2.158 File-URL: http://hdl.handle.net/10.2105/AJPH.87.2.158 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.2.158_5 Template-Type: ReDIF-Article 1.0 Title: Engendering the Dread Disease: Women, Men, and Cancer Journal: American Journal of Public Health Author-Name: Reagan, L.J. Year: 1997 Volume: 87 Issue: 11 Pages: 1779-1787 DOI: 10.2105/AJPH.87.11.1779 File-URL: http://hdl.handle.net/10.2105/AJPH.87.11.1779 Abstract: This paper, based on an analysis of cancer articles published in popular periodical literature since the early part of the century, argues that gender has played a key role in medical and popular understandings of cancer. Cancer education, the author finds, has taught women and men different things. Public health materials created with the intention of improving health through education actually send a multiplicity of messages, not all of them helpful. This essay suggests that public health messages targeted by sex are problematic, although perhaps neeessary. The paper also contributes to scholarship concerned with the question of how people develop their ideas about risk of disease. Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.11.1779_8 Template-Type: ReDIF-Article 1.0 Title: Hospital nurses' occupational exposure to blood: Prospective, retrospective, and institutional reports Journal: American Journal of Public Health Author-Name: Aiken, L.H. Author-Name: Sloane, D.M. Author-Name: Klocinski, J.L. Year: 1997 Volume: 87 Issue: 1 Pages: 103-107 Abstract: Objectives. This study examined nurses' risk of exposure to Mood resulting from injuries with needles and sharps, the methods of estimating those risks, and the factors affecting risks. Methods. Nurses on 40 medical units in 20 hospitals in cities with a high incidence of AIDS were studied. Percutaneous injuries were documented for every shift during a 30-day period. These prospective reports were compared with retrospective and institutional reports. Factors affecting the likelihood of injuries were also explored. Results. Based on the prospective reports, the rate of injuries to staff nurses was 0.8 per nurse-year. Prospective and retrospective rates were similar, while institutional rates were significantly lower. Factors associated with increased injuries included recapping needles and temporary work assignments. Working in hospitals characterized by professional nurse practice models and taking precautions to avoid blood contact were associated with fewer injuries. Conclusions. Injuries from needlesticks are more common than institutional reports suggest and do not occur at random. Diminishing the frequency with which nurses recap needles, increasing precautions they take, reducing use of temporary nursing personnel, and implementing organizational changes may lower the odds of nurses being injured. Handle: RePEc:aph:ajpbhl:1997:87:1:103-107_1 Template-Type: ReDIF-Article 1.0 Title: Whither studies on the socioeconomic foundations of population health? Journal: American Journal of Public Health Author-Name: Kaplan, G.A. Author-Name: Lynch, J.W. Year: 1997 Volume: 87 Issue: 9 Pages: 1409-1411 DOI: 10.2105/AJPH.87.9.1409 File-URL: http://hdl.handle.net/10.2105/AJPH.87.9.1409 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.9.1409_2 Template-Type: ReDIF-Article 1.0 Title: Discovering Environmental Cancer: Wilhelm Hueper, Post-World War II Epidemiology, and the Vanishing Clinician's Eye Journal: American Journal of Public Health Author-Name: Sellers, C. Year: 1997 Volume: 87 Issue: 11 Pages: 1824-1835 DOI: 10.2105/AJPH.87.11.1824 File-URL: http://hdl.handle.net/10.2105/AJPH.87.11.1824 Abstract: Today, our understanding of and approach to the exogenous causes of cancer are dominated by epidemiological practices that came into widespread use after World War II. This paper examines the forces, considerations, and controversies that shaped postwar risk factor epidemiology in the United States. It is argued that, for all of the new capabilities it brought, this risk factor epidemiology has left us with less of a clinical eye for unrecognized cancer hazards, especially from limited and localized exposures in the workplace. The focus here is on Wilhelm Hueper, author of the first textbook on occupational cancer (1942). Hueper became the foremost spokesman for earlier identification practices centering on occupational exposures. The new epidemiological methods and associated institutions that arose in the 1940s and 1950s bore an unsettled relation to earlier claims and methods that some, Hueper among them, interpreted as a challenge. Hueper's critique of the new epidemiology identified some of its limitations and potentially debilitating consequences that remain with us today. Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.11.1824_3 Template-Type: ReDIF-Article 1.0 Title: Mortality and cancer incidence among sawmill workers exposed to chlorophenate wood preservatives Journal: American Journal of Public Health Author-Name: Hertzman, C. Author-Name: Teschke, K. Author-Name: Ostry, A. Author-Name: Hershler, R. Author-Name: Dimich-Ward, H. Author-Name: Kelly, S. Author-Name: Spinelli, J.J. Author-Name: Gallagher, R.P. Author-Name: McBride, M. Author-Name: Marion, S.A. Year: 1997 Volume: 87 Issue: 1 Pages: 71-79 Abstract: Objectives. This study examined the association between exposure to chlorophenates and the risk of soft tissue sarcoma; non-Hodgkin's lymphoma; Hodgkin's disease; and cancers of the lung, nose, and nasopharynx. Methods. A retrospective cohort study was conducted of 26 487 workers employed for at least 1 year between 1950 and 1985 in 11 chlorophenate-using and 3 non-using sawmills in British Columbia, Canada. Exposures by job were ascertained with interviews of senior employees. Results. Probabilistic record linkage to the Canadian Mortality Data Base and the British Columbia Cancer Registry found 4710 deaths between 1950 and 1990, and 1547 incident cases of cancer between 1969 and 1989. None of the cancers of interest had elevated mortality related to chlorophenate exposure. Non-Hodgkin's lymphoma incidence (n = 65) increased with increasing chlorophenate exposure hours, yielding the following standardized incidence ratios: less than 120 hours 0.68; 120 to 1999 hours, 0.59; 2000 to 3999 hours, 1.04; 4000 to 9999 hours, 1.02; and 10000 or more hours, 1.30. Conclusions. These results are consistent with the borderline positive associations seen in other recently reported studies of chlorophenate-exposed workforces. Handle: RePEc:aph:ajpbhl:1997:87:1:71-79_4 Template-Type: ReDIF-Article 1.0 Title: Maternal smoking during pregnancy and limb reduction malformations in Sweden Journal: American Journal of Public Health Author-Name: Källén, K. Year: 1997 Volume: 87 Issue: 1 Pages: 29-32 Abstract: Objectives. This study was undertaken to investigate a possible connection between different types of limb reduction defects and maternal smoking during pregnancy. Methods. With the use of the Swedish health registries, 610 cases of limb reduction malformations were selected from among 1 109 299 infants born between 1983 and 1993 with known smoking exposure in early pregnancy. Confounders such as maternal age and parity were controlled for with the use of the Mantel-Haenszel technique. Results. The odds ratio for any maternal smoking among all cases of limb reductions was 1.26 (95% confidence interval = 1.06, 1.50). The main subgroups of limb reduction defects showed similar odds ratios, but in longitudinal reduction defect, only unilateral cases showed an association with maternal smoking. Conclusions. This study supports an association between maternal smoking and limb reduction malformations, but further work is needed before a causal inference can be made. Handle: RePEc:aph:ajpbhl:1997:87:1:29-32_5 Template-Type: ReDIF-Article 1.0 Title: Annotation: what can be done about missing data? Approaches to imputation. Journal: American Journal of Public Health Author-Name: Heitjan, D.F. Year: 1997 Volume: 87 Issue: 4 Pages: 548-550 DOI: 10.2105/AJPH.87.4.548 File-URL: http://hdl.handle.net/10.2105/AJPH.87.4.548 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.4.548_5 Template-Type: ReDIF-Article 1.0 Title: Integrating HIV prevention, STD, and family planning services. A sexual and reproductive health approach in Latin America and the Caribbean. Journal: American Journal of Public Health Author-Name: Becker, J. Author-Name: Kirberger, E. Year: 1997 Volume: 87 Issue: 4 Pages: 692-693 DOI: 10.2105/AJPH.87.4.692-a File-URL: http://hdl.handle.net/10.2105/AJPH.87.4.692-a Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.4.692-a_2 Template-Type: ReDIF-Article 1.0 Title: Authors and authorship--reform or abolition? Journal: American Journal of Public Health Author-Name: Susser, M. Year: 1997 Volume: 87 Issue: 7 Pages: 1091-1092 DOI: 10.2105/AJPH.87.7.1091 File-URL: http://hdl.handle.net/10.2105/AJPH.87.7.1091 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.7.1091_7 Template-Type: ReDIF-Article 1.0 Title: On 'accidents'. Journal: American Journal of Public Health Author-Name: Doege, T.C. Year: 1997 Volume: 87 Issue: 10 Pages: 1721-1722 DOI: 10.2105/AJPH.87.10.1721-a File-URL: http://hdl.handle.net/10.2105/AJPH.87.10.1721-a Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.10.1721-a_3 Template-Type: ReDIF-Article 1.0 Title: Health insurance coverage of foreign-born US residents--the implications of the new welfare reform law. Journal: American Journal of Public Health Author-Name: Ladenheim, K. Year: 1997 Volume: 87 Issue: 1 Pages: 12-14 DOI: 10.2105/AJPH.87.1.12 File-URL: http://hdl.handle.net/10.2105/AJPH.87.1.12 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.1.12_3 Template-Type: ReDIF-Article 1.0 Title: Misusing the term 'artificial fluoridation'. Journal: American Journal of Public Health Author-Name: Horowitz, H.S. Year: 1997 Volume: 87 Issue: 7 Pages: 1235-1236 DOI: 10.2105/AJPH.87.7.1235 File-URL: http://hdl.handle.net/10.2105/AJPH.87.7.1235 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.7.1235_7 Template-Type: ReDIF-Article 1.0 Title: Annotation: racism resurgent--building a bridge to the 19th century. Journal: American Journal of Public Health Author-Name: Geiger, H.J. Year: 1997 Volume: 87 Issue: 11 Pages: 1765-1766 DOI: 10.2105/AJPH.87.11.1765-a File-URL: http://hdl.handle.net/10.2105/AJPH.87.11.1765-a Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.11.1765-a_2 Template-Type: ReDIF-Article 1.0 Title: The road from managed care. Journal: American Journal of Public Health Author-Name: Silver, G. Year: 1997 Volume: 87 Issue: 1 Pages: 8-9 DOI: 10.2105/AJPH.87.1.8 File-URL: http://hdl.handle.net/10.2105/AJPH.87.1.8 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.1.8_4 Template-Type: ReDIF-Article 1.0 Title: The Eating Patterns Study--the importance of practical randomized trials in communities. Journal: American Journal of Public Health Author-Name: Green, S.B. Year: 1997 Volume: 87 Issue: 4 Pages: 541-543 DOI: 10.2105/AJPH.87.4.541 File-URL: http://hdl.handle.net/10.2105/AJPH.87.4.541 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.4.541_6 Template-Type: ReDIF-Article 1.0 Title: The end of the chronic disease era. Journal: American Journal of Public Health Author-Name: Scribner, R. Year: 1997 Volume: 87 Issue: 5 Pages: 872-873 DOI: 10.2105/AJPH.87.5.872-a File-URL: http://hdl.handle.net/10.2105/AJPH.87.5.872-a Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.5.872-a_9 Template-Type: ReDIF-Article 1.0 Title: Adolescent HIV testing--who says who signs? Journal: American Journal of Public Health Author-Name: Hein, K. Year: 1997 Volume: 87 Issue: 8 Pages: 1277-1278 DOI: 10.2105/AJPH.87.8.1277 File-URL: http://hdl.handle.net/10.2105/AJPH.87.8.1277 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.8.1277_9 Template-Type: ReDIF-Article 1.0 Title: Emergency contraception--parsimony and prevention in the medicine cabinet. Journal: American Journal of Public Health Author-Name: Cates Jr., W. Author-Name: Raymond, E.G. Year: 1997 Volume: 87 Issue: 6 Pages: 909-910 DOI: 10.2105/AJPH.87.6.909 File-URL: http://hdl.handle.net/10.2105/AJPH.87.6.909 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.6.909_6 Template-Type: ReDIF-Article 1.0 Title: The amphibole hypothesis: Neither gone nor forgotten [3] Journal: American Journal of Public Health Author-Name: Langer, A.M. Author-Name: Nolan, R.P. Year: 1997 Volume: 87 Issue: 4 Pages: 688-689 Handle: RePEc:aph:ajpbhl:1997:87:4:688-689_4 Template-Type: ReDIF-Article 1.0 Title: Current research in the epidemiology and public health of aging--the need for more diverse strategies. Journal: American Journal of Public Health Author-Name: Kasl, S.V. Year: 1997 Volume: 87 Issue: 3 Pages: 333-334 DOI: 10.2105/AJPH.87.3.333 File-URL: http://hdl.handle.net/10.2105/AJPH.87.3.333 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.3.333_3 Template-Type: ReDIF-Article 1.0 Title: Leadership to meet the challenges to the public's health. Journal: American Journal of Public Health Author-Name: Brown, E.R. Year: 1997 Volume: 87 Issue: 4 Pages: 554-557 DOI: 10.2105/AJPH.87.4.554 File-URL: http://hdl.handle.net/10.2105/AJPH.87.4.554 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.4.554_8 Template-Type: ReDIF-Article 1.0 Title: Of floors and ceilings--defining, assuring, and communicating vaccine safety. Journal: American Journal of Public Health Author-Name: Breiman, R.F. Author-Name: Zanca, J.A. Year: 1997 Volume: 87 Issue: 12 Pages: 1919-1920 DOI: 10.2105/AJPH.87.12.1919 File-URL: http://hdl.handle.net/10.2105/AJPH.87.12.1919 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.12.1919_4 Template-Type: ReDIF-Article 1.0 Title: Questionable data and preconceptions: Reconsidering the value of mammography for American Indian women Journal: American Journal of Public Health Author-Name: Partin, M.R. Author-Name: Köm, J.E. Author-Name: Slater, J.S. Year: 1997 Volume: 87 Issue: 7 Pages: 1100-1102 DOI: 10.2105/AJPH.87.7.1100 File-URL: http://hdl.handle.net/10.2105/AJPH.87.7.1100 Abstract: Although the benefits of mammography are well established, many remain skeptical of the value of niammography for American Indian women. This skepticism steins in from a belief that breast cancer is too an event among American Indians to warrant widespread screening. The validity of this assumption for Northern Plains Indians is challenged by a discussion of the limitations of available data on breast cancer in Anierican Indian populations (including lack of generalizability, underestimation, and an overreliance on relative rather than absolute measures of cancer incidence) and by findings from the Minnesota Breast and Cervical Caacer Control Program, a federally funded program providing free breast and cervical cancer screening to American Indian and other women in Minnesota. In light of this information, the authors recommend that the low priority of marnmography for American Indian women be reconsidered. Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.7.1100_8 Template-Type: ReDIF-Article 1.0 Title: The Maryland ban on the sale of assault pistols and high-capacity magazines: estimating the impact in Baltimore. Journal: American Journal of Public Health Author-Name: Weil, D.S. Author-Name: Knox, R.C. Year: 1997 Volume: 87 Issue: 2 Pages: 297-298 DOI: 10.2105/AJPH.87.2.297-a File-URL: http://hdl.handle.net/10.2105/AJPH.87.2.297-a Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.2.297-a_7 Template-Type: ReDIF-Article 1.0 Title: Taking the Cure to the Poor: Patients' Responses to New York City's Tuberculosis Program, 1894 to 1918 Journal: American Journal of Public Health Author-Name: Abel, E.K. Year: 1997 Volume: 87 Issue: 11 Pages: 1808-1815 DOI: 10.2105/AJPH.87.11.1808 File-URL: http://hdl.handle.net/10.2105/AJPH.87.11.1808 Abstract: Drawing on the case files of a major charitable agency, this paper explores how poor people experienced New York City's pioneering program of tuberculosis control. Although the program provided enormous benefits, poor New Yorkers often had pressing concerns that took priority over eradicating tuberculosis. Moreover, the program imposed extreme hardships even as it promised liberation from a terrible scourge. Poor people did not protest collectively, but many individually resisted. They delayed seeking diagnosis, disobeyed the advice promulgated by the Department of Health, attended clinics irregularly, and either refused to enroll in hospitals, sanatoria, and preventoria or fled soon after arrival. Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.11.1808_3 Template-Type: ReDIF-Article 1.0 Title: The "blockade" of Cuba: setting the record straight. Journal: American Journal of Public Health Author-Name: Perez-Stable, E. Author-Name: Boza, R. Year: 1997 Volume: 87 Issue: 12 Pages: 2053-2054 DOI: 10.2105/AJPH.87.12.2053 File-URL: http://hdl.handle.net/10.2105/AJPH.87.12.2053 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.12.2053_0 Template-Type: ReDIF-Article 1.0 Title: Comment: Gunsmoke--changing public attitudes toward smoking and firearms. Journal: American Journal of Public Health Author-Name: Kellermann, A.L. Year: 1997 Volume: 87 Issue: 6 Pages: 910-913 DOI: 10.2105/AJPH.87.6.910 File-URL: http://hdl.handle.net/10.2105/AJPH.87.6.910 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.6.910_6 Template-Type: ReDIF-Article 1.0 Title: Annotation: hypertension in populations of African origin. Journal: American Journal of Public Health Author-Name: Shaper, A.G. Author-Name: Whincup, P.H. Year: 1997 Volume: 87 Issue: 2 Pages: 155-156 DOI: 10.2105/AJPH.87.2.155 File-URL: http://hdl.handle.net/10.2105/AJPH.87.2.155 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.2.155_5 Template-Type: ReDIF-Article 1.0 Title: Annotation: developing and validating new methods for assessing community interventions. Journal: American Journal of Public Health Author-Name: Cassano, P.A. Author-Name: Frongillo Jr., E.A. Year: 1997 Volume: 87 Issue: 2 Pages: 157-158 DOI: 10.2105/AJPH.87.2.157 File-URL: http://hdl.handle.net/10.2105/AJPH.87.2.157 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.2.157_7 Template-Type: ReDIF-Article 1.0 Title: The effect of school dropout rates on estimates of adolescent substance use among three racial/ethnic groups Journal: American Journal of Public Health Author-Name: Swaim, R.C. Author-Name: Beauvais, F. Author-Name: Chavez, E.L. Author-Name: Oetting, E.R. Year: 1997 Volume: 87 Issue: 1 Pages: 51-55 Abstract: Objectives. This study examined, across three racial/ethnic groups, how the inclusion of data on drug use of dropouts can alter estimates of adolescent drag use rates. Methods. Self-report rates of lifetime prevalence and use in the previous 30 days were obtained from Mexican American, White non-Hispanic, and Native American students (n = 738) and dropouts (n = 774). Rates for the age cohort (students and dropouts) were estimated with a weighted correction formula. Results. Rates of use reported by dropouts were 1.2 to 6.4 times higher than those reported by students. Corrected rates resulted in changes in relative rates of use by different ethnic groups. Conclusions. When only in-school data are available, errors in estimating drag use among groups with high rates of school dropout can be substantial. Correction of student-based data to include drug use of dropouts leads to important changes in estimated levels of drug use and alters estimates of the relative rates of use for racial/ethnic minority groups with high dropout rates. Handle: RePEc:aph:ajpbhl:1997:87:1:51-55_7 Template-Type: ReDIF-Article 1.0 Title: Maternal considerations in formulating HIV-related breast-feeding recommendations. Journal: American Journal of Public Health Author-Name: Zimmer, P. Author-Name: Garza, C. Year: 1997 Volume: 87 Issue: 6 Pages: 904-906 DOI: 10.2105/AJPH.87.6.904 File-URL: http://hdl.handle.net/10.2105/AJPH.87.6.904 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.87.6.904_8