Template-Type: ReDIF-Article 1.0 Title: Physical activity patterns associated with cardiorespiratory fitness and reduced mortality: The aerobics center longitudinal study Journal: American Journal of Public Health Author-Name: Stofan, J.R. Author-Name: DiPietro, L. Author-Name: Davis, D. Author-Name: Kohl III, H.W. Author-Name: Blair, S.N. Year: 1998 Volume: 88 Issue: 12 Pages: 1807-1813 Abstract: Objectives. This study examined cross sectionally the physical activity patterns associated with low, moderate, and high levels of cardiorespiratory fitness. Methods. Physical activity was assessed by questionnaire in a clinic population of 13 444 men and 3972 women 20 to 87 years of age. Estimated energy expenditure (kcal · wk -1) and volume (min · wk -1) of reported activities were calculated among individuals at low, moderate, and high fitness levels (assessed by maximal exercise tests). Results. Average leisure time energy expenditures of 525 to 1650 kcal · wk -1 for men and 420 to 1260 kcal · wk -1 for women were associated with moderate to high levels of fitness. These levels of energy expenditure can be achieved with a brisk walk of approximately 30 minutes on most days of the week. In fact, men in the moderate and high fitness categories walked between 130 and 138 min · wk - 1, and women in these categories walked between 148 and 167 min · wk -1. Conclusions. Most individuals should be able to achieve these physical activity goals and thus attain a cardiorespiratory fitness level sufficient to result in substantial health benefits. Handle: RePEc:aph:ajpbhl:1998:88:12:1807-1813_8 Template-Type: ReDIF-Article 1.0 Title: Changes in dental fluorosis and dental caries in Newburgh and Kingston, New York Journal: American Journal of Public Health Author-Name: Kumar, J.V. Author-Name: Swango, P.A. Author-Name: Lininger, L.L. Author-Name: Leske, G.S. Author-Name: Green, E.L. Author-Name: Haley, V.B. Year: 1998 Volume: 88 Issue: 12 Pages: 1866-1870 Abstract: Objectives. This study sought to determine whether the prevalence of dental fluorosis and dental caries had changed in a fluoridated community and a nonfluoridated community since an earlier study conducted in 1986. Methods. Dental fluorosis and dental caries data were collected on 7- to 14-year-old lifelong residents (n = 1493) of Newburgh and Kingston, NY. Results. Estimated dental fluorosis prevalence rates were 19.6% in Newburgh and 11.7% in Kingston. The greatest disparity in caries scores was observed between poor and nonpoor children in nonfluoridated Kingston. Conclusions. The prevalence of dental fluorosis has not declined in Newburgh and Kingston, whereas the prevalence of dental caries has continued to decline. Handle: RePEc:aph:ajpbhl:1998:88:12:1866-1870_3 Template-Type: ReDIF-Article 1.0 Title: Restaurant smoking restrictions and environmental tobacco smoke exposure Journal: American Journal of Public Health Author-Name: Brauer, M. Author-Name: 'T Mannetje, A. Year: 1998 Volume: 88 Issue: 12 Pages: 1834-1836 Abstract: Objectives. This study evaluated the effectiveness of smoking restrictions. Methods. We measured particulate concentrations in restaurants with different levels of allowable smoking. Results. Mean particulate concentrations were 70% higher in establishments without smoking restrictions compared with those with partial smoking restrictions. Concentrations in nonsmoking restaurants were reduced by an additional 20% to 30%. Measurements of cadmium, an environmental tobacco smoke (ETS) marker, implicated ETS as the major source of particulate in restaurants that allowed smoking. Conclusions. Partial smoking restrictions substantially reduce, but do not eliminate. ETS exposure in restaurants. Occupants of nonsmoking restaurants avoid ETS exposure but may experience substantial particulate exposures from cooking emissions. Handle: RePEc:aph:ajpbhl:1998:88:12:1834-1836_3 Template-Type: ReDIF-Article 1.0 Title: Health effects associated with sulfuryl fluoride and methyl bromide exposure among structural fumigation workers Journal: American Journal of Public Health Author-Name: Calvert, G.M. Author-Name: Mueller, C.A. Author-Name: Fajen, J.M. Author-Name: Chrislip, D.W. Author-Name: Russo, J. Author-Name: Briggle, T. Author-Name: Fleming, L.E. Author-Name: Suruda, A.J. Author-Name: Steenland, K. Year: 1998 Volume: 88 Issue: 12 Pages: 1774-1780 Abstract: Objectives. This study assessed the health effects associated with occupational exposure to methyl bromide and sulfuryl fluoride among structural fumigation workers. Methods. A cross-sectional study of 123 structural fumigation workers and 120 referents in south Florida was conducted. Nerve conduction, vibration, neurobehavioral, visual, olfactory, and renal function testing was included. Results. The median lifetime duration of methyl bromide and sulfuryl fluoride exposure among workers was 1.20 years and 2.85 years, respectively. Sulfuryl fluoride exposure over the year preceding examination was associated with significantly reduced performance on the Pattern Memory Test and on olfactory testing. In addition, fumigation workers had significantly reduced performance on the Santa Ana Dexterity Test of the dominant hand and a nonsignificantly higher prevalence of carpal tunnel syndrome than did the referents. Conclusions. Occupational sulfuryl fluoride exposures may be associated with subclinical effects on the central nervous system, including effects on olfactory and some cognitive functions. However, no widespread pattern of cognitive deficits was observed. The peripheral nerve effects were likely caused by ergonomic stresses experienced by the fumigation workers. Handle: RePEc:aph:ajpbhl:1998:88:12:1774-1780_6 Template-Type: ReDIF-Article 1.0 Title: Declining seroprevalence in a very large HIV epidemic: Injecting drug users in New York City, 1991 to 1996 Journal: American Journal of Public Health Author-Name: Des Jarlais, D.C. Author-Name: Perlis, T. Author-Name: Friedman, S.R. Author-Name: Deren, S. Author-Name: Chapman, T. Author-Name: Sotheran, J.L. Author-Name: Tortu, S. Author-Name: Beardsley, M. Author-Name: Paone, D. Author-Name: Torian, L.V. Author-Name: Beatrice, S.T. Author-Name: DeBernardo, E. Author-Name: Monterroso, E. Author-Name: Marmor, M. Year: 1998 Volume: 88 Issue: 12 Pages: 1801-1806 Abstract: Objectives. This study assessed recent trends in HIV seroprevalence among injecting drug users in New York City. Methods. We analyzed temporal trends in HIV seroprevalence from 1991 through 1996 in 5 studies of injecting drug users recruited from a detoxification program, a methadone maintenance program, research store-fronts in the Lower East Side and Harlem areas, and a citywide network of sexually transmitted disease clinics. A total of 11 334 serum samples were tested. Results. From 1991 through 1996, HIV seroprevalence declined substantially among subjects in all 5 studies: from 53% to 36% in the detoxification program, from 45% to 29% in the methadone program, from 44% to 22% at the Lower East Side storefront, from 48% to 21% at the Harlem storefront, and from 30% to 21% in the sexually transmitted disease clinics (all P < .002 by x 2 tests for trend). Conclusions. The reductions in HIV seroprevalence seen among injecting drug users in New York City from 1991 through 1996 indicate a new phase in this large HIV epidemic. Potential explanatory factors include the loss of seropositive individuals through disability and death and lower rates of risk behavior leading to low HIV incidence. Handle: RePEc:aph:ajpbhl:1998:88:12:1801-1806_2 Template-Type: ReDIF-Article 1.0 Title: Residential magnetic fields and childhood leukemia: A meta-analysis Journal: American Journal of Public Health Author-Name: Wartenberg, D. Year: 1998 Volume: 88 Issue: 12 Pages: 1787-1794 Abstract: Objectives. This article uses meta-analysis methodology to examine the statistical consistency and importance of random variation among results of epidemiologic studies of residential magnetic field exposure and childhood leukemia. Methods. A variety of meta-analytic statistical methods were applied to all available studies combined and on sub-groups of studies chosen by exposure characteristics. Sample sizes and fail-safe n's were calculated to determine the robustness of results and the potential role of publication bias. Results. Most studies show elevated but not statistically significant odds ratios. Results for exposures assessed by wire codes, distance, and/or historically reconstructed fields are relatively consistent, homogeneous, and positive, while those for direct magnetic field measurements are consistent, homogeneous, and marginally protective. Several unpublished studies, or a single unpublished study with several hundred subjects, would be needed to nullify the observed data. Conclusions. The observed results identify a consistent risk that cannot be explained by random variation. The data supporting magnetic fields as the principal risk factor are suggestive but inconsistent. Additional studies using innovative designs that focus on highly exposed children offer the most hope of untangling this issue. Handle: RePEc:aph:ajpbhl:1998:88:12:1787-1794_9 Template-Type: ReDIF-Article 1.0 Title: Rear seat belt accessibility and occupant seat belt use in New York City taxicabs [1] Journal: American Journal of Public Health Author-Name: Manoach, S.M. Author-Name: Bruno, G.R. Author-Name: Grasso-Knight, G. Author-Name: Goldfrank, L.R. Year: 1998 Volume: 88 Issue: 12 Pages: 1878 Handle: RePEc:aph:ajpbhl:1998:88:12:1878_5 Template-Type: ReDIF-Article 1.0 Title: Childhood lead poisoning: The promise and abandonment of primary prevention Journal: American Journal of Public Health Author-Name: Needleman, H.L. Year: 1998 Volume: 88 Issue: 12 Pages: 1871-1877 Abstract: In 1991, the Public Health Service published the Strategic Plan for the Elimination of Childhood Lead Poisoning. This document marked a fundamental shift in federal policy from finding and treating lead-poisoned children to authentic primary prevention. It spelled out a 15-year strategy to achieve this goal and provided a cost-benefit analysis showing that the monetized benefits far exceeded the costs of abatement. A strong national effort to eliminate the disease developed. Now, 7 years after publication of the plan, primary prevention of lead exposure has been abandoned. This article examines the role of some prevailing attitudes and institutions in derailing the effort. Some institutions - the lead industry, real estate interests, and insurance interests - behaved as anticipated. Others, including private pediatricians, the American Academy of Pediatrics, some federal agencies, and a public interest group ostensibly dedicated to eliminating lead poisoning, also played an unexpected part in detailing the plan. Handle: RePEc:aph:ajpbhl:1998:88:12:1871-1877_6 Template-Type: ReDIF-Article 1.0 Title: A community-initiated study of blood lead levels of Nicaraguan children living near a battery factory Journal: American Journal of Public Health Author-Name: Bonilla, C.M. Author-Name: Mauss, E.A. Year: 1998 Volume: 88 Issue: 12 Pages: 1843-1845 Abstract: Objectives. In response to requests by parents in Managua, Nicaragua, whose neighborhood borders a battery factory, 97 children were tested for blood lead, as were 30 children in a neighborhood without an obvious source of environmental lead. Methods. Venous blood was examined by atomic absorption spectrophotometry. Educational workshops were conducted. Results. Mean blood lead levels were 17.21 ± 9.92 μg/dL in the index children and 7.40 ± 5.37 μg/dL in the controls (P < 0.001). Conclusions. Children living near the battery factory are at increased risk of lead poisoning. The parents were able to petition the government to control the factory emissions and to improve appropriate health services. The factory is now closed. Handle: RePEc:aph:ajpbhl:1998:88:12:1843-1845_2 Template-Type: ReDIF-Article 1.0 Title: 'Lifeguard lung': Endemic granulomatous pneumonitis in an indoor swimming pool Journal: American Journal of Public Health Author-Name: Rose, C.S. Author-Name: Martyny, J.W. Author-Name: Newman, S.L. Author-Name: Milton, D.K. Author-Name: King, T.E. Author-Name: Beebe, J.L. Author-Name: McCammon, J.B. Author-Name: Hoffman, R.E. Author-Name: Kreiss, K. Year: 1998 Volume: 88 Issue: 12 Pages: 1795-1800 Abstract: Objectives. Two sequential outbreaks of respiratory disease among lifeguards at an indoor swimming pool with water spray features were investigated. Methods. Questionnaires were administered to recreation center employees following each outbreak. Respondents reporting 2 or more pool- related symptoms were offered clinical evaluation, including bronchoscopy with bronchoalveolar lavage and trans-bronchial biopsy. Pool air and water were sampled for fungi, bacteria, amoebae, endotoxin, and respirable particulates. Results. Thirty-three lifeguards had noncaseating granulomas on biopsy and/or bronchoalveolar lavage lymphocytosis. Attack rates for the outbreaks were 27% and 65%. Case patients had higher cumulative hours of work and tended to work more hours per week. Analyses indicated increased levels of endotoxin in pool air and water (relative to control pools) and gram- negative bacterial colonization of water sprays. Use of water spray features generated a 5.2-fold increase in the number of respirable particles and up to an 8-fold increase in air endotoxin levels. Conclusions. Lifeguards in this indoor swimming pool developed granulomatous lung disease associated with endotoxin-containing respirable bioaerosols from water spray features, which ventilation system improvements did not prevent. Handle: RePEc:aph:ajpbhl:1998:88:12:1795-1800_9 Template-Type: ReDIF-Article 1.0 Title: Hair-color products and risk for non-Hodgkin's lymphoma: A population- based study in the San Francisco Bay area Journal: American Journal of Public Health Author-Name: Holly, E.A. Author-Name: Lele, C. Author-Name: Bracci, P.M. Year: 1998 Volume: 88 Issue: 12 Pages: 1767-1773 Abstract: Objectives. As part of a large, epidemiologic study of non-Hodgkin's lymphoma, this study investigated a possible association between use of hair- color products and non-Hodgkin's lymphoma. Methods. A population-based case- control study was conducted in the San Francisco Bay area. Of 4108 participants, 2544 were questioned about use of hair-color products. Control subjects were identified by use of random-digit dialing. Results. Ever use of hair-color products was reported by 56% of case and 56% of control women and 10% of case and 9% of control men. Risks were not elevated for women for use of any hair-color products. Men who ever used semipermanent hair color had slightly elevated risks for non-Hodgkin's lymphoma, with trends associated with greater lifetime frequency of use and frequency of use per year, although individual confidence intervals overlapped unity. These elevated risks were diminished with exclusive use of semipermanent products, and confidence intervals overlapped unity. Conclusions. Integration of our results with those from experimental animal studies and other epidemiologic studies provides little convincing evidence linking non-Hodgkin's lymphoma with normal use of hair-color products in humans. Handle: RePEc:aph:ajpbhl:1998:88:12:1767-1773_1 Template-Type: ReDIF-Article 1.0 Title: The effectiveness of a tobacco prevention program with adolescents living in a tobacco-producing region Journal: American Journal of Public Health Author-Name: Noland, M.P. Author-Name: Kryscio, R.J. Author-Name: Riggs, R.S. Author-Name: Linville, L.H. Author-Name: Ford, V.Y. Author-Name: Tucker, T.C. Year: 1998 Volume: 88 Issue: 12 Pages: 1862-1865 Abstract: Objectives. This study investigated the efficacy of a social-influences tobacco prevention program conducted with adolescents living in a high tobacco production area. Methods. Students in 10 experimental schools completed the tobacco prevention program and a booster intervention. Control students received health education as usual. Results. After 2 years of treatment, smoking rates in the treatment group (vs the control group) were lower for 30-day, 7-day, and 24-hour smoking. The intervention had more of an impact on those who were involved in raising tobacco than it did on those not involved in raising tobacco. Conclusions. Although modest, effects were achieved with minimal intervention time in a high-risk group, indicating that social-influences prevention programs may be effective in such groups. Handle: RePEc:aph:ajpbhl:1998:88:12:1862-1865_2 Template-Type: ReDIF-Article 1.0 Title: Public health and brownfields: Reviving the past to protect the future Journal: American Journal of Public Health Author-Name: Greenberg, M. Author-Name: Lee, C. Author-Name: Powers, C. Year: 1998 Volume: 88 Issue: 12 Pages: 1759-1760 Handle: RePEc:aph:ajpbhl:1998:88:12:1759-1760_2 Template-Type: ReDIF-Article 1.0 Title: Lead effects research [2] (multiple letters) Journal: American Journal of Public Health Author-Name: Ernhart, C.B. Author-Name: Wasserman, G.A. Author-Name: Graziano, J. Author-Name: Factor-Litvak, P. Year: 1998 Volume: 88 Issue: 12 Pages: 1879-1880 Handle: RePEc:aph:ajpbhl:1998:88:12:1879-1880_9 Template-Type: ReDIF-Article 1.0 Title: Breast-feeding initiation in New York City, 1979 to 1996 Journal: American Journal of Public Health Author-Name: Rosenberg, K.D. Author-Name: McMurtrie, C. Author-Name: Kerker, B.D. Author-Name: Na, Y. Author-Name: Graham, E.H. Year: 1998 Volume: 88 Issue: 12 Pages: 1850-1852 Abstract: Objectives. The purpose of this study was to explore changes in breast- feeding initiation from 1979 to 1996 among infants born in New York City hospitals. Methods. All New York City hospitals were surveyed every 2 years. Hospital staff reported feeding method at newborn discharge. Results. New York City breast-feeding initiation rates increased consistently from 1979 to 1996 (from 29% to 58%, P < .0001), including 1984 to 1990, when rates decreased nationally. Conclusions. A 1984 New York State regulation requiring each hospital to designate a lactation coordinator may have been associated with the continuing increases in breast-feeding initiation. Handle: RePEc:aph:ajpbhl:1998:88:12:1850-1852_2 Template-Type: ReDIF-Article 1.0 Title: Quality of life in relation to overweight and body fat distribution Journal: American Journal of Public Health Author-Name: Han, T.S. Author-Name: Tijhuis, M.A.R. Author-Name: Lean, M.E.J. Author-Name: Seidell, J.C. Year: 1998 Volume: 88 Issue: 12 Pages: 1814-1820 Abstract: Objectives. This study quantified the impairment of quality of life attributable to body fatness by using the standardized SF-36 Health Survey. Methods. Tertiles of waist circumference and body mass index (BMI) in 1885 men and 2156 women aged 20 to 59 years in the Netherlands in 1995 were compared. Results. The odds ratios and 95% confidence intervals of subjects- with the largest waist circumferences, compared with those in the lowest tertile, were 1.8 (1.3, 2.4) in men and 2.2 (1.7, 2.9) in women with difficulties in bending, kneeling, or stooping; 2.2 (1.4, 3.7) in men and 1.7 (1.2, 2.6) in women with difficulties in walking 500 m; and 1.3 (1.0, 1.9) in men and 1.5 (1.1, 1.9) in women with difficulties in lifting or carrying groceries. Anthropometric measures were less strongly associated with social functioning, role limitations due to physical or emotional problems, mental health, vitality, pain, or health change in 1 year. The relationship between quality of life measures and BMI were similar to those between quality of life measures and waist circumference. Conclusions. Large waist circumferences and high BMIs are more likely to be associated with impaired quality of life and disability affecting basic activities of daily living. Handle: RePEc:aph:ajpbhl:1998:88:12:1814-1820_4 Template-Type: ReDIF-Article 1.0 Title: Children's exposure to traffic and pedestrian injuries Journal: American Journal of Public Health Author-Name: Macpherson, A. Author-Name: Roberts, I. Author-Name: Barry Pless, I. Year: 1998 Volume: 88 Issue: 12 Pages: 1840-1843 Abstract: Objectives. The purpose of this study was to estimate children's exposure to traffic (number of streets crossed) and to determine the role of exposure in pedestrian injury. Methods. Questionnaires were distributed to a random sample of 4080 first- and fourth-grade children in 43 Montreal schools. Results. When analyzed by police district, injury and exposure rates were positively correlated (r 2 = 0.53). Crossings were similar by sex but increased with age and were inversely related to socioeconomic status. Conclusions. These results suggest that although children's exposure to traffic could be reduced by transporting them to school, a more reasonable prevention strategy involves environmental changes. Handle: RePEc:aph:ajpbhl:1998:88:12:1840-1843_5 Template-Type: ReDIF-Article 1.0 Title: Soil lead abatement and children's blood lead levels in an urban setting Journal: American Journal of Public Health Author-Name: Farrell, K.P. Author-Name: Brophy, M.C. Author-Name: Chisolm Jr., J.J. Author-Name: Rohde, C.A. Author-Name: Strauss, W.J. Year: 1998 Volume: 88 Issue: 12 Pages: 1837-1839 Abstract: Objectives. The effect of abating soil lead was assessed among Baltimore children. The hypothesis was that a reduction of 1000 parts per million would reduce children's blood lead levels by 0.14 to 0.29 μmol/L (3-6 μg/dL). Methods. In 2 neighborhoods (study and control), 187 children completed the protocol. In the study area, contaminated soil was replaced with clean soil. Results. Soil lead abatement in this study did not lower children's blood lead. Conclusions. Although it did not show an effect in this study, soil lead abatement may be useful in certain areas. Handle: RePEc:aph:ajpbhl:1998:88:12:1837-1839_7 Template-Type: ReDIF-Article 1.0 Title: Air pollution and hospital admissions in Sydney, Australia, 1990 to 1994 Journal: American Journal of Public Health Author-Name: Morgan, G. Author-Name: Corbett, S. Author-Name: Wlodarczyk, J. Year: 1998 Volume: 88 Issue: 12 Pages: 1761-1766 Abstract: Objectives. This study examined the effects of outdoor air pollutants on daily hospital admissions in Sydney, Australia. Methods. A time-series analysis of counts of daily hospital admissions and outdoor air pollutants (1990 to 1994) was performed, by means of Poisson regression that allowed for overdispersion and autocorrelation. Results. An increase in daily maximum 1- hour concentration of nitrogen dioxide from the 10th to the 90th percentile was associated with an increase of 5.29% (95% confidence interval = 1.07, 9.68) in childhood asthma admissions and 4.60% (-0.17, 9.61) in chronic obstructive pulmonary disease (COPD) admissions. A similar increase in daily maximum 1-hour particulate concentration was associated with an increase of 3.01% (-0.38, 6.52) in COPD admissions. An increase from the 10th to the 90th percentile in daily maximum 1-hour nitrogen dioxide, daily maximum 1-hour ozone, and daily mean particulate was associated with an increase in heart disease admissions among those 65 years and older of 6.71% (4.25, 9.23), 2.45% (-0.37, 5.35), and 2.82% (0.90, 4.77), respectively. Heart disease and childhood asthma were primarily associated with nitrogen dioxide; COPD was associated with both nitrogen dioxide and particulates. Conclusions. Current levels of air pollution in Sydney are associated with increased hospitalization for respiratory and heart disease. Handle: RePEc:aph:ajpbhl:1998:88:12:1761-1766_6 Template-Type: ReDIF-Article 1.0 Title: The effects of differential unemployment rate increases of occupation groups on changes in mortality Journal: American Journal of Public Health Author-Name: Martikainen, P.T. Author-Name: Valkonen, T. Year: 1998 Volume: 88 Issue: 12 Pages: 1859-1861 Abstract: Objectives. This study estimated the effects of changes in unemployment rates of occupation groups on changes in mortality in a period of increasing unemployment. Methods. Census records for all 20- to 64-year-old economically active Finnish men in 1985 were linked to information on unemployment and deaths in 1987 through 1993. Results. Change in mortality was similar in occupation groups in which unemployment rates increased at a different pace. These relationships were similar for all age groups and for mortality from diseases as well as accidents and violence. Conclusions. Unemployment does not seem to cause mortality in the short team. Excess mortality rates among unemployed individuals observed in previous studies may have been due in part to selection. Handle: RePEc:aph:ajpbhl:1998:88:12:1859-1861_1 Template-Type: ReDIF-Article 1.0 Title: Potential barriers to the removal of norplant among family planning clinic patients Journal: American Journal of Public Health Author-Name: Kalmuss, D. Author-Name: Davidson, A. Author-Name: Cushman, L. Author-Name: Heartwell, S. Author-Name: Rulin, M. Year: 1998 Volume: 88 Issue: 12 Pages: 1846-1849 Abstract: Objectives. This study examined the prevalence and effects of potential barriers to removal of levonorgestrel implants (Norplant) among low-income women. Methods. A sample of 687 women who received Norplant at hospital- based family planning clinics were interviewed before Norplant insertion and 6 months after Norplant insertion (or at Norplant removal if removal occurred earlier). Those who continued to use Norplant were reinterviewed at 2 years or at removal. Results. In a multivariate analysis, only 1 of the 4 potential barriers - cost - significantly impeded Norplant discontinuation. Conclusions. Family planning clinics need to make clear that they follow a policy of Norplant removal on demand, regardless of the patient's ability to pay. Handle: RePEc:aph:ajpbhl:1998:88:12:1846-1849_9 Template-Type: ReDIF-Article 1.0 Title: Claims incidence of work-related disorders of the upper extremities: Washington State, 1987 through 1995 Journal: American Journal of Public Health Author-Name: Silverstein, B. Author-Name: Welp, E. Author-Name: Nelson, N. Author-Name: Kalat, J. Year: 1998 Volume: 88 Issue: 12 Pages: 1827-1833 Abstract: Objectives. This study examined the claim incidence rate, cost, and industry distribution of work-related upper extremity disorders in Washington. Methods. Washington State Fund workers' compensation claims from 1987 to 1995 were abstracted and categorized into general and specific disorders of gradual or sudden onset. Results. Accepted claims included 100 449 for hand/wrist disorders (incidence rate: 98.2/10000 full-time equivalents; carpal tunnel syndrome rate: 27.3), 30 468 for elbow disorders (incidence rate: 29.7; epicondylitis rate: 11.7), and 55315 for shoulder disorders (incidence rate: 54.0; rotator cuff syndrome rate: 19.9). Average direct workers' compensation claims costs (medical treatment and indemnity) were $15 790 (median: $6774) for rotator cuff syndrome, $12 794 for carpal tunnel syndrome (median: $4190), and $6593 for epicondylitis (median: $534). Construction and food processing were among the industries with the highest rate ratios for all disorders (> 4.0). Conclusions. Upper extremity disorders represent a large and costly problem in Washington State industry. Industries characterized by manual handling and repetitive work have high rate ratios. The contingent workforce appears to be at high risk. Handle: RePEc:aph:ajpbhl:1998:88:12:1827-1833_2 Template-Type: ReDIF-Article 1.0 Title: Scales of geography, time, and population: The study of violence as a public health problem Journal: American Journal of Public Health Author-Name: Wallace, D. Author-Name: Wallace, R. Year: 1998 Volume: 88 Issue: 12 Pages: 1853-1858 Abstract: Objectives. In this study, data on violent deaths in the Bronx, New York City, from the 1970, 1980, and 1990 censuses were analyzed. Methods. The incidence and areal density of intentional deaths were mapped by health area. Simple and stepwise regressions between violent death measures and other factors were performed. Results. The incidence of deaths at levels of those in the highest 1970 quintile spread so that by 1990 only 2 areas saw incidences at levels of the lowest 1970 quintile. Overcrowding, socioeconomic status, population, population change, and drug deaths in simple regressions and overcrowding, socio-economic status, and low-weight births in stepwise regressions correlated significantly with violent death incidence or density. Conclusions. Understanding the spatiotemporal development of violence can contribute to public policy on violence. Handle: RePEc:aph:ajpbhl:1998:88:12:1853-1858_5 Template-Type: ReDIF-Article 1.0 Title: Immunization status and sociodemographic characteristics: The mediating role of beliefs, attitudes, and perceived control Journal: American Journal of Public Health Author-Name: Prislin, R. Author-Name: Dyer, J.A. Author-Name: Blakely, C.H. Author-Name: Johnson, C.D. Year: 1998 Volume: 88 Issue: 12 Pages: 1821-1826 Abstract: Objectives. This study examined how immunization-related beliefs, attitudes, and perceived control mediate up-to-date immunization among various sociodemographic groups. Methods. Statewide estimates of immunization rates among children up to the age of 2 years were obtained via a multistage cluster sample. In-person interviews were conducted with 4832 parents. Information about immunization was obtained from official records or from health care providers. Results. Differences in immunization among sociodemographic groups were mediated by beliefs about objective barriers to immunization, protection, medical contraindication, safety concerns, distrust, and natural immunity. Protection beliefs contributed to positive attitudes toward immunization; beliefs in natural immunity and safety concerns contributed by negative attitudes. Beliefs about objective barriers, distrust, safety concerns, and medical contraindications influenced perceived control over immunization. Positive attitudes and a strong sense of control contributed to higher immunization rates. Conclusions. These findings provide a basis for efficient educational campaigns by specifying which beliefs should be bolstered (because they facilitate proper immunization) and which should be targeted for change (because they hinder proper immunization) in various sociodemographic groups. Handle: RePEc:aph:ajpbhl:1998:88:12:1821-1826_5 Template-Type: ReDIF-Article 1.0 Title: Determinants of nitrogen dioxide concentrations in indoor ice skating rinks Journal: American Journal of Public Health Author-Name: Levy, J.I. Author-Name: Lee, K. Author-Name: Yanagisawa, Y. Author-Name: Hutchinson, P. Author-Name: Spengler, J.D. Year: 1998 Volume: 88 Issue: 12 Pages: 1781-1786 Abstract: Objectives. The combination of poor ventilation and fuel-powered ice resurfacers has resulted in elevated nitrogen dioxide (NO2) concentrations in many indoor ice skating rinks. This study examined the factors influencing concentrations and the effects of various engineering controls in ice rinks with different resurfacer fuels. Methods. Indoor NO2 concentrations were measured in 19 enclosed ice skating rinks over 3 winters by means of passive samplers, with 1-week average measurements during the first winter pilot study and single-day working-hour measurements in the final 2 winters. Personal exposures to drivers also were assessed during the last winter. Results. Rinks in which propane-fueled resurfacers were used had a daily mean indoor NO2 concentration of 206 ppb, compared with 132 ppb for gasoline- fueled and 37 ppb for electric-powered resurfacers. Engineering controls, such as increased ventilation and resurfacer tuning, reduced NO2 concentrations by 65% on average, but outcomes varied widely, and concentrations increased in subsequent months. Conclusions. Electric ice resurfacers, increased ventilation, or emission control systems are recommended to protect the health of workers and patrons, with surveillance programs proposed to track implementation and maintain an observer effect. Handle: RePEc:aph:ajpbhl:1998:88:12:1781-1786_8 Template-Type: ReDIF-Article 1.0 Title: A vision of social justice as the foundation of public health: Commemorating 150 years of the spirit of 1848 Journal: American Journal of Public Health Author-Name: Krieger, N. Author-Name: Birn, A.-E. Year: 1998 Volume: 88 Issue: 11 Pages: 1603-1606 Handle: RePEc:aph:ajpbhl:1998:88:11:1603-1606_6 Template-Type: ReDIF-Article 1.0 Title: Comment: The past and future of national comprehensive tobacco control legislation Journal: American Journal of Public Health Author-Name: Akhter, M.N. Author-Name: Myers, M.L. Author-Name: Novelli, W.D. Author-Name: Seffrin, J. Author-Name: Wheeler, C. Year: 1998 Volume: 88 Issue: 11 Pages: 1606-1607 Handle: RePEc:aph:ajpbhl:1998:88:11:1606-1607_6 Template-Type: ReDIF-Article 1.0 Title: Costs and cost-effectiveness of a universal, school-based hepatitis B vaccination program Journal: American Journal of Public Health Author-Name: Krahn, M. Author-Name: Guasparini, R. Author-Name: Sherman, M. Author-Name: Detsky, A.S. Year: 1998 Volume: 88 Issue: 11 Pages: 1638-1644 Abstract: Objectives. This study evaluated the costs and cost-effectiveness of a school-based grade 6 universal vaccination program against hepatitis B. Methods. We performed a descriptive cost study and cost-effectiveness analysis of British Columbia's vaccination program for 1994 and 1995. Since 1992, public health nurses have administered hepatitis B vaccine to grade 6 students in schools. We measured costs of vaccine, vaccine administration, and net program costs and used a validated Markov model to calculate the cost-effectiveness of the program. Results. Vaccinating each student cost $44, $24 of which was the cost of vaccine administration. The net cost was $9 per person; considering productivity costs, net savings were $75 per person. Marginal cost per life year gained was $2100. Universal adolescent vaccination is also economically attractive in the United States but less attractive in regions with incidence rates below 3 cases per 100 000 per year. Conclusions. Hepatitis B vaccine can be delivered in North American schools at a reasonable cost. Adolescent vaccination is economically attractive in North American regions of high and average incidence rates. Our analysis supports vaccination in adolescents who remain at risk for hepatitis B virus infection. Handle: RePEc:aph:ajpbhl:1998:88:11:1638-1644_6 Template-Type: ReDIF-Article 1.0 Title: Correlates of injury to women with partners enrolled in batterer treatment programs Journal: American Journal of Public Health Author-Name: Forjuoh, S.N. Author-Name: Coben, J.H. Author-Name: Gondolf, E.W. Year: 1998 Volume: 88 Issue: 11 Pages: 1705-1708 Abstract: Objectives. This study examined correlates of injury in a cohort of women who were partners of men enrolled in batterer treatment programs. Methods. Cross-sectional data of 670 pairs of battered women and their partners were analyzed. Prevalence rates of women's self-reports of injury due to their partners' abusive behavior were computed and compared by couples' demographic and behavioral characteristics. Results. Men's use of severe tactics of abuse was the characteristic most significantly associated with injury (odds ratio = 15.47; 95% confidence interval = 9.02, 26.55). Conclusions. Our findings underscore the need to obtain information on the specific tactics used by couples to settle their disputes during universal screening by practitioners. Handle: RePEc:aph:ajpbhl:1998:88:11:1705-1708_7 Template-Type: ReDIF-Article 1.0 Title: Predictors of homelessness among families in New York City: From shelter request to housing stability Journal: American Journal of Public Health Author-Name: Shinn, M. Author-Name: Weitzman, B.C. Author-Name: Stojanovic, D. Author-Name: Knickman, J.R. Author-Name: Jiménez, L. Author-Name: Duchon, L. Author-Name: James, S. Author-Name: Krantz, D.H. Year: 1998 Volume: 88 Issue: 11 Pages: 1651-1657 Abstract: Objectives. This study examined predictors of entry into shelter and subsequent housing stability for a cohort of families receiving public assistance in New York City. Methods. Interviews were conducted with 266 families as they requested shelter and with a comparison sample of 298 families selected at random from the welfare caseload. Respondents were reinterviewed 5 years later. Families with prior history of shelter use were excluded from the follow-up study. Results. Demographic characteristics and housing conditions were the most important risk factors for shelter entry; enduring poverty and disruptive social experiences also contributed. Five years later, four fifths of sheltered families had their own apartment. Receipt of subsidized housing was the primary predictor of housing stability among formerly homeless families (odds ratio [OR] = 20.6, 95% confidence interval [CI] = 9.9, 42.9). Conclusions. Housing subsidies are critical to ending homelessness among families. Handle: RePEc:aph:ajpbhl:1998:88:11:1651-1657_8 Template-Type: ReDIF-Article 1.0 Title: Socioeconomic status, neighborhood social conditions, and neural tube defects Journal: American Journal of Public Health Author-Name: Wasserman, C.R. Author-Name: Shaw, G.M. Author-Name: Selvin, S. Author-Name: Gould, J.B. Author-Name: Syme, S.L. Year: 1998 Volume: 88 Issue: 11 Pages: 1674-1680 Abstract: Objectives. This study evaluated the contributions of lower socioeconomic status (SES) and neighborhood socioeconomic characteristics to neural tube defect etiology. The influence of additional factors, including periconceptional multivitamin use and race/ethnicity, was also explored. Methods. Data derived from a case-control study of California pregnancies from 1989 to 1991. Mothers of 538 (87.8% of eligible) case infants/fetuses with neural tube defects and mothers of 539 (88.2%) nonmalformed infants were interviewed about their SES. Reported addresses were linked to 1990 US census information to characterize neighborhoods. Results. Twofold elevated risks were observed for several SES indicators. Risks were somewhat confounded by vitamin sue, race/ethnicity, age, body mass index, and fever but remained elevated after adjustment. A risk gradient was seen with increasing number of lower SES indicators. Women with 1 to 3 and 4 to 6 lower SES indicators had adjusted odds ratios of 1.6 (1.1-2.2) and 3.2 (1.9-5.4), respectively, compared with women with no lower SES indicators. Conclusions. Both lower SES and residence in a SES-lower neighborhood increased the risk of an neural tube defect-affected pregnancy, with risks increasing across a gradient of SES indicators. Handle: RePEc:aph:ajpbhl:1998:88:11:1674-1680_4 Template-Type: ReDIF-Article 1.0 Title: Return to work following injury: The role of economic, social, and job- related factors Journal: American Journal of Public Health Author-Name: MacKenzie, E.J. Author-Name: Morris Jr., J.A. Author-Name: Jurkovich, G.J. Author-Name: Yasui, Y. Author-Name: Cushing, B.M. Author-Name: Burgess, A.R. Author-Name: DeLateur, B.J. Author-Name: McAndrew, M.P. Author-Name: Swiontkowski, M.F. Year: 1998 Volume: 88 Issue: 11 Pages: 1630-1637 Abstract: Objectives. This study examined factors influencing return to work (RTW) following severe fracture to a lower extremity. Methods. This prospective cohort study followed 312 individuals treated for a lower extremity fracture at 3 level-1 trauma centers. Kaplan-Meier estimates of the proportion of RTW were computed, and a Cox proportional hazards model was used to examine the contribution of multiple risk factors on RTW. Results. Cumulative proportions of RTW at 3, 6, 9, and 12 months post-injury were 0.26, 0.49, 0.60, and 0.72. After accounting for the extent of impairment, characteristics of the patient that correlated with higher rates of RTW included younger age, higher education, higher income, the presence of strong social support, and employment in a white-collar job that was not physically demanding. Receipt of disability compensation had a strong negative effect on RTW. Conclusions. Despite relatively high rates of recovery, one quarter of persons with lower extremity fractures did not return to work by the end of 1 year. The analysis points to subgroups of individuals who are at high risk of delayed RTW, with implications for interventions at the patient, employer, and policy levels. Handle: RePEc:aph:ajpbhl:1998:88:11:1630-1637_2 Template-Type: ReDIF-Article 1.0 Title: Economic organization of medicine and the Committee on the Costs of Medical Care Journal: American Journal of Public Health Author-Name: Perkins, B.B. Year: 1998 Volume: 88 Issue: 11 Pages: 1721-1726 Abstract: Recent strategies in managed care and managed competition illustrate how health care reforms may reproduce the patterns of economic organization of their times. Such a reform approach is not a new development in the United States. The work of the 1927-1932 Committee on the Costs of Medical Care exemplifies an earlier effort that applied forms of economic organization to medical care. The committee tried to restructure medicine along lines consistent with its economic environment while attributing its models variously to science, profession, and business. Like current approaches, the committee's reports defined costs as the major problem and business models of organization as the major solution. The reports recommended expanded financial management and group medicine, which would include growth in self- supporting middle-class services such as fee clinics and middle-rate hospital units. Identifying these elements as corporate practice of medicine, the American Medical Association-based minority dissented from the final report in favor of conserving individual entrepreneurial practice. This continuum in forms of economic organization has limited structural reform strategies in medicine for the remainder of the century. Handle: RePEc:aph:ajpbhl:1998:88:11:1721-1726_9 Template-Type: ReDIF-Article 1.0 Title: Physician financial incentives and feedback: Failure to increase cancer screening in Medicaid managed care Journal: American Journal of Public Health Author-Name: Hillman, A.L. Author-Name: Ripley, K. Author-Name: Goldfarb, N. Author-Name: Nuamah, I. Author-Name: Weiner, J. Author-Name: Lusk, E. Year: 1998 Volume: 88 Issue: 11 Pages: 1699-1701 Abstract: Objectives. A randomized controlled trial evaluated the impact of feedback and financial incentives on physician compliance with cancer screening guidelines for women 50 years of age and older in a Medicaid health maintenance organization (HMO). Methods. Half of 52 primary care sites received the intervention, which included written feedback and a financial bonus. Mammography, breast exam, colorectal screening, and Pap testing compliance rates were evaluated. Results. From 1993 to 1995, screening rates doubled overall (from 24% to 50%), with no significant differences between intervention and control group sites. Conclusions. Financial incentives and feedback did not improve physician compliance with cancer screening guidelines in a Medicaid HMO. Handle: RePEc:aph:ajpbhl:1998:88:11:1699-1701_5 Template-Type: ReDIF-Article 1.0 Title: Service system integration, access to services, and housing outcomes in a program for homeless persons with severe mental illness Journal: American Journal of Public Health Author-Name: Rosenheck, R. Author-Name: Morrissey, J. Author-Name: Lam, J. Author-Name: Galloway, M. Author-Name: Johnsen, M. Author-Name: Goldman, H. Author-Name: Randolph, F. Author-Name: Blasinsky, M. Author-Name: Fontana, A. Author-Name: Calsyn, R. Author-Name: Teague, G. Year: 1998 Volume: 88 Issue: 11 Pages: 1610-1615 Abstract: Objectives. This study evaluated the hypothesis that greater integration and coordination between agencies within service systems is associated with greater accessibility of services and improved client housing outcomes. Methods. As part of the Access to Community Care and Effective Services and Supports program, data were obtained on baseline client characteristics, service us, and 3-month and 12-month outcomes from 1832 clients seen at 18 sites during the first year of program operation. Data on interorganizational relationships were obtained from structured interviews with key informants from relevant organizations in each community (n = 32-82 at each site). Results. Complete follow-up data were obtained from 1340 clients (73%). After control for baseline characteristics, service system integration was associated with superior housing outcomes at 12 months, and this relationship was mediated through greater access to housing agencies. Conclusions. Service system integration is related to improved access to housing services and better housing outcomes among homeless people with mental illness. Handle: RePEc:aph:ajpbhl:1998:88:11:1610-1615_6 Template-Type: ReDIF-Article 1.0 Title: The use of mammography by survivors of breast cancer Journal: American Journal of Public Health Author-Name: Andersen, M.R. Author-Name: Urban, N. Year: 1998 Volume: 88 Issue: 11 Pages: 1713-1715 Abstract: Objectives. Survivors of breast cancer are at high risk for development of a second breast cancer and are thus a group for whom annual mammography screening is recommended. However, survivor's use of mammography rarely has been examined. Methods. We surveyed a representative population sample of survivors who lived in rural communities about their mammography use after cancer. Results. Of these women, 30% had not received a mammogram in the preceding year. Predictors of mammography use included physician recommendation and whether the original cancer had been detected by mammography. Conclusions. Physicians should recommend mammography to survivors of breast cancer to ensure regular use. Handle: RePEc:aph:ajpbhl:1998:88:11:1713-1715_8 Template-Type: ReDIF-Article 1.0 Title: Substance abuse and the course of welfare dependency Journal: American Journal of Public Health Author-Name: Schmidt, L. Author-Name: Weisner, C. Author-Name: Wiley, J. Year: 1998 Volume: 88 Issue: 11 Pages: 1616-1622 Abstract: Objectives. New provisions in welfare reform target recipients with addictions, even though there is limited research on how substance abuse affects people's experiences on welfare. This prospective study examined substance abuse as a determinant of subsequent welfare dependency. Methods. Representative samples of clients on Aid to Families with Dependent Children (AFDC) and general assistance in a California county were interviewed while applying for services in 1989 and were reinterviewed in 1995. Results Among AFDC recipients substance abuse was not a significant determinant of long welfare stays, repeat welfare use, or the total time a person remained on welfare during the 6-year period. However, substance abuse was a strong predictor of repeat welfare use among general assistance recipients. Conclusions. Alcohol and drug problems have played dramatically different roles in welfare dependency within the AFDC and general assistance populations. Under welfare reform, local general assistance programs will be the final safety net for recipients removed from federal entitlement programs. These programs will probably be confronted with clients with more complex disabilities related to addiction, as well as with greater family needs for cash assistance. Handle: RePEc:aph:ajpbhl:1998:88:11:1616-1622_7 Template-Type: ReDIF-Article 1.0 Title: Neighbors for a smoke free north side: Evaluation of a community organization approach to promoting smoking cessation among African Americans Journal: American Journal of Public Health Author-Name: Fisher, E.B. Author-Name: Auslander, W.F. Author-Name: Munro, J.F. Author-Name: Arfken, C.L. Author-Name: Brownson, R.C. Author-Name: Owens, N.W. Year: 1998 Volume: 88 Issue: 11 Pages: 1658-1663 Abstract: Objectives. This study evaluated a community organization approach that emphasized involvement of audiences in program planning and implementation in promoting nonsmoking among African American residents of low-income neighborhoods. Methods. The quasi-experimental design involved a 24-month intervention is 3 low-income, predominantly African American neighborhoods in St. Louis. Intervention neighborhoods were compared with comparable, untreated neighborhoods in Kansas City. Results. The program was successful in engaging audience members in its governance and in instigating numerous and diverse neighborhood activities to promote nonsmoking. The prevalence of smoking declined from 34% to 27% in program neighborhoods but only from 34% to 33% in comparison neighborhoods. This difference was apparent within all demographically defined subsamples, indicating that observed changes were consistent and not attributable to confounding by demographic characteristics. Conclusions. A community organization approach emphasizing local authority for program decisions and involvement of informal networks may have an appreciable impact on smoking among residents of low-income, African American neighborhoods. Handle: RePEc:aph:ajpbhl:1998:88:11:1658-1663_5 Template-Type: ReDIF-Article 1.0 Title: Poverty area residence and changes in physical activity level: Evidence from the Alameda County Study Journal: American Journal of Public Health Author-Name: Yen, I.H. Author-Name: Kaplan, G.A. Year: 1998 Volume: 88 Issue: 11 Pages: 1709-1712 Abstract: Objectives. Evidence from the Alameda County Study indicated that residential area has an independent effect on mortality risk. The current research examined the effect of poverty area residence on change in physical activity (n = 1737). Methods. Data were from a longitudinal population-based cohort. Multiple linear regression analyses were used. Results. Age- and sex- adjusted change scores between 1965 and 1974 for physical activity were 0.67 units lower for people living in poverty areas (P = .0001). Independent of individual income, education, smoking status, body mass index, and alcohol consumption, poverty area residence remained associated with physical activity change. Conclusion. These results further support the hypothesis that place affects health behaviors. Handle: RePEc:aph:ajpbhl:1998:88:11:1709-1712_0 Template-Type: ReDIF-Article 1.0 Title: The gender gap in reporting household gun ownership Journal: American Journal of Public Health Author-Name: Ludwig, J. Author-Name: Cook, P.J. Author-Name: Smith, T.W. Year: 1998 Volume: 88 Issue: 11 Pages: 1715-1718 Abstract: Objectives. This study examined errors in estimating household gun ownership that result from interviewing only 1 adult per household. Methods. Data from 2 recent telephone surveys and a series of in-person surveys were used to compare reports of household gun ownership by husbands and wives. Results. In the telephone surveys, the rate of household gun ownership reported by husbands exceeded wives' reports by an average of 12 percentage points; husbands' reports also implied 43.3 million more guns. The median 'gender gap' in recent in-person surveys is 7 percentage points. Conclusions. Future research should focus on respondents' reports about personally owned guns. Handle: RePEc:aph:ajpbhl:1998:88:11:1715-1718_2 Template-Type: ReDIF-Article 1.0 Title: The effects of a health promotion-health protection intervention on behavior change: The wellworks study Journal: American Journal of Public Health Author-Name: Sorensen, G. Author-Name: Stoddard, A. Author-Name: Hunt, M.K. Author-Name: Hebert, J.R. Author-Name: Ockene, J.K. Author-Name: Avrunin, J.S. Author-Name: Himmelstein, J. Author-Name: Hammond, S.K. Year: 1998 Volume: 88 Issue: 11 Pages: 1685-1690 Abstract: Objectives. This study assessed the effects of a 2-year integrated health promotion-health protection work-site intervention on changes in dietary habits and cigarette smoking. Methods. A randomized, controlled intervention study used the work site as the unit of intervention and analysis; it included 24 predominantly manufacturing work sites in Massachusetts (250-2500 workers per site). Behaviors were assessed in self- administered surveys (n = 2386; completion rates = 61% at baseline, 62% at final). Three key intervention elements targeted health behavior change: (1) joint worker-management participation in program planning and implementation, (2) consultation with management on work-site environmental changes, and (3) health education programs. Results. Significant differences between intervention and control work sites included reductions in the percentage of calories consumed as fat (2.3% vs 1.5% kcal) and increases in servings of fruit and vegetables (10% vs 4% increase). The intervention had a significant effect on fiber consumption among skilled and unskilled laborers. No significant effects were observed for smoking cessation. Conclusions. Although the size of the effects of this intervention are modest, on a populationwide basis effects of this size could have a large impact on cancer-related and coronary heart disease end points. Handle: RePEc:aph:ajpbhl:1998:88:11:1685-1690_6 Template-Type: ReDIF-Article 1.0 Title: Rates of intimate partner violence in the United States Journal: American Journal of Public Health Author-Name: Schafer, J. Author-Name: Caetano, R. Author-Name: Clark, C.L. Year: 1998 Volume: 88 Issue: 11 Pages: 1702-1704 Abstract: Objectives. Estimates of intimate partner violence in the United States based on representative samples have relied on data from one person per household or limited numbers of indicators from both partners. The purpose of this study was to estimate nationwide rates of intimate partner violence with data from both couple members by using a standardized survey instrument, the Conflict Tactics Scale. Methods. A multistage probability sampling design was used to conduct separate face-to-face interviews in respondents' homes with both members of 1635 representative couples living in the 48 contiguous states. Results. Both partners' reports were used to estimate the following lower- and upper-bound rates: 5.21% and 13.61% for male-to-female partner violence, 6.22% and 18.21% for female-to-male partner violence, and 7.84% to 21.48% for any partner-to-partner violence. Conclusions. High rates of intimate partner violence in the United States corroborate previous claims that the amount of intimate partner violence is substantial. Handle: RePEc:aph:ajpbhl:1998:88:11:1702-1704_1 Template-Type: ReDIF-Article 1.0 Title: A longitudinal study of schoolchildren's experience in the North Carolina dental Medicaid program, 1984 through 1992 Journal: American Journal of Public Health Author-Name: Robison, V.A. Author-Name: Rozier, R.G. Author-Name: Weintraub, J.A. Year: 1998 Volume: 88 Issue: 11 Pages: 1669-1673 Abstract: Objectives. This evaluation of a state Medicaid dental program describes dental treatment received, relates treatment needed to treatment received, and describes enrollment and use over an 8-year period. Methods. Three databases were linked: (1) clinical records from a 1986/87 statewide epidemiological survey, providing data on treatment need; (2) Medicaid dental claims from 1984 through 1992, providing data on treatment received; and (3) Medicaid enrollment flies from 1984 through 1992. Results. Half of Medicaid- enrolled children never used dental services. Among users of dental services, 45% and 25% of children needed restorations in primary and permanent teeth, respectively. In this group, 29% had all needs met, 28% had needs partially met, and 43% had no needs met. Forty-six percent of children sought care for only 1 year. Conclusions. Federal guidelines for dental care are not met in this typical Medicaid population of short-term enrollees who use services sporadically. Programs should aim to increase use and ensure that all needed services, especially preventive procedures such as sealants, can be completed within the short period of time a child attends for care. Handle: RePEc:aph:ajpbhl:1998:88:11:1669-1673_2 Template-Type: ReDIF-Article 1.0 Title: Social factors, treatment, and survival in early-stage non-small cell lung cancer Journal: American Journal of Public Health Author-Name: Greenwald, H.P. Author-Name: Polissar, N.L. Author-Name: Borgatta, E.F. Author-Name: McCorkle, R. Author-Name: Goodman, G. Year: 1998 Volume: 88 Issue: 11 Pages: 1681-1684 Abstract: Objectives. This study assessed the importance of socioeconomic status, race, and likelihood of receiving surgery in explaining mortality among patients with stage-I non-small Cell lung cancer. Methods. Analyses focused on Black and White individuals 75 years of age and younger (n = 5189) diagnosed between 1980 and 1982 with stage-I non-small cell lung cancer in Detroit, San Francisco, and Seattle. The main outcome measure was months of survival after diagnosis. Results. Patients in the highest income decile were 45% more likely to receive surgical treatment and 102% more likely to attain 5-year survival than those in the lowest decile. Whites were 20% more likely to undergo surgery than Blacks and 31% more likely to survive 5 years. Multivariate procedures controlling for age and sex confirmed these observations. Conclusions. Socioeconomic status and race appear to independently influence likelihood of survival. Failure to receive surgery explains much excess mortality. Handle: RePEc:aph:ajpbhl:1998:88:11:1681-1684_6 Template-Type: ReDIF-Article 1.0 Title: Use of multiple surveys to estimate mortality among never, current, and former smokers: Changes over a 20-year interval Journal: American Journal of Public Health Author-Name: Rosenbaum, W.L. Author-Name: Sterling, T.D. Author-Name: Weinkam, J.J. Year: 1998 Volume: 88 Issue: 11 Pages: 1664-1668 Abstract: Objectives. This study sought to demonstrate how data from publicly available large-scale cross-sectional health surveys can be combined to analyze changes in mortality risks among never, current, and former smokers. Methods. Data from the 1966/68 and 1986 National Mortality Follow-back Surveys and the 1970 and 1987 National Health Interview Surveys were used to estimate the distribution of never, current, and former smokers among the US population at risk and decedents. Standardized mortality ratios and quotients of standardized mortality ratios were used to estimate mortality risks. Results. Generally, during the period from 1966 through 1986, mortality rates in the United States for most causes of death declined among all smoking groups. However, mortality rates from respiratory diseases increased for current and former smokers. Conclusions. The reported changes in never and current smokers mortality risks are similar in magnitude and direction to those reported in a previous study based on longitudinal data. The use of combined data from the National Mortality Followback Survey and the National Health Interview Survey offers several advantages as an epidemiological tool. Handle: RePEc:aph:ajpbhl:1998:88:11:1664-1668_0 Template-Type: ReDIF-Article 1.0 Title: A method for estimating solid organ donor potential by organ procurement region Journal: American Journal of Public Health Author-Name: Christiansen, C.L. Author-Name: Gortmaker, S.L. Author-Name: Williams, J.M. Author-Name: Beasley, C.L. Author-Name: Brigham, L.E. Author-Name: Capossela, C. Author-Name: Matthiesen, M.E. Author-Name: Gunderson, S. Year: 1998 Volume: 88 Issue: 11 Pages: 1645-1650 Abstract: Objectives. This study sought to develop a methodology for estimating potential solid organ donors and measuring donation performance in a geographic region based on readily available data on the hospitals in that region. Methods. Medical records were reviewed in a stratified random sample of 89 hospitals from 3 regions to attain a baseline of donor potential. Data on a range of hospital characteristics were collected and tested as predictors of donor potential through the use of hierarchical Poisson regression modeling. Results. Five hospital characteristics predicted donor potential: hospital deaths, hospital Medicare case-mix index, total hospital staffed beds, medical school affiliation. and trauma center certification. Regional estimates were attained by aggregating individual hospital estimates. Confidence intervals for these regional estimates indicated that actual donations represented from 28% to 44% of the potential in the regions studied. Conclusions. This methodology accurately estimates organ donor potential within 3 geographic regions and lays the foundation for evaluating organ donation effectiveness nationwide. Additional research is needed to test the validity of the model in other geographic regions and to further explore organ donor potential in hospitals with fewer than 50 beds. Handle: RePEc:aph:ajpbhl:1998:88:11:1645-1650_9 Template-Type: ReDIF-Article 1.0 Title: The effect of expanding Medicaid prenatal services on birth outcomes Journal: American Journal of Public Health Author-Name: Baldwin, L.-M. Author-Name: Larson, E.H. Author-Name: Connell, F.A. Author-Name: Nordlund, D. Author-Name: Cain, K.C. Author-Name: Cawthon, M.L. Author-Name: Byrns, P. Author-Name: Rosenblatt, R.A. Year: 1998 Volume: 88 Issue: 11 Pages: 1623-1629 Abstract: Objectives. Over 80% of US states have implemented expansions in prenatal services for Medicaid-enrolled women, including case management, nutritional and psychosocial counseling, health education, and home visiting. This study evaluates the effect of Washington State's expansion of such services on prenatal care use and low, birthweight rates. Methods. The Change in prenatal care use and low-birthweight rates among Washington's Medicaid- enrolled pregnant women before and apter initiation of expanded prenatal services was compared with the change in these outcomes in Colorado, a control state. Results. The percentage of expected prenatal visits completed increased significantly, from 84% to 87%, in both states Washington's low- birthweight rate decreased (7.1% to 6.4%, P = .12), while Colorado's rate increased slightly (10.4% to 10.6%, P = .74). Washington's improvement was largely due to decreases in low-birthweight rates for medically high-risk women (18.0% to 13.7%, P= .01, for adults; 22.5% to 11.5%, P =.03, for teenagers), especially those with preexisting medical conditions. Conclusions. A Statewide Medicaid-sponsored support Service and case management program was associated with a decrease in the low-birthweight rate of medically high-risk women. Handle: RePEc:aph:ajpbhl:1998:88:11:1623-1629_8 Template-Type: ReDIF-Article 1.0 Title: Hypertension control and access to medical care in the inner city Journal: American Journal of Public Health Author-Name: Kotchen, J.M. Author-Name: Shakoor-Abdullah, B. Author-Name: Walker, W.E. Author-Name: Chelius, T.H. Author-Name: Hoffmann, R.G. Author-Name: Kotchen, T.A. Year: 1998 Volume: 88 Issue: 11 Pages: 1696-1699 Abstract: Objectives. This study assessed hypertension control among high-risk African Americans. Methods. We interviewed 583 African Americans aged 18 years and older residing in 438 randomly selected inner-city households. Results. Forty-two percent of the respondents were hypertensive. Blood pressure was uncontrolled in 74% of hypertensive persons, although 64% of hypertensive persons reported having seen a physician within the previous 3 months. Hypertension control was associated with female gender and higher socioeconomic strata but not with public versus private sources of medical care. Conclusions. Hypertension control is inadequate in this population, although health care services are used frequently. Hypertension control efforts should focus on the effectiveness of health care delivery. Handle: RePEc:aph:ajpbhl:1998:88:11:1696-1699_1 Template-Type: ReDIF-Article 1.0 Title: Nighttime observations of safety belt use: An evaluation of California's primary law Journal: American Journal of Public Health Author-Name: Lange, J.E. Author-Name: Voas, R.B. Year: 1998 Volume: 88 Issue: 11 Pages: 1718-1720 Abstract: Objectives. An analysis was conducted to determine what effect California's change to a primary safety belt law had on safety belt use among nighttime weekend drivers. Methods. Observations of 18 469 drivers in 2 California communities were made during voluntary roadside surveys conducted every other Friday and Saturday night from 9 PM to 2 AM for 4 years. Results. Rates of safety belt use rose from 73.0% to 95.6% (P < .0005). For drivers with blood alcohol concentrations of 0.10 or higher, rates rose from 53.4% to 92.1% (P < .0005). Conclusions. Because substantial improvement in safety belt use was seen even in a group of high-risk drivers, the injury reduction benefits of this law may be high. Handle: RePEc:aph:ajpbhl:1998:88:11:1718-1720_6 Template-Type: ReDIF-Article 1.0 Title: Occupational injuries among older workers with disabilities: A prospective cohort study of the health and retirement survey, 1992 to 1994 Journal: American Journal of Public Health Author-Name: Zwerling, C. Author-Name: Sprince, N.L. Author-Name: Davis, C.S. Author-Name: Whitten, P.S. Author-Name: Wallace, R.R. Author-Name: Heeringa, S.G. Year: 1998 Volume: 88 Issue: 11 Pages: 1691-1695 Abstract: Objectives. We tested the hypothesis that among older workers, disabilities in general, and heating and visual impairments in particular, are risk factors for occupational injuries. Methods. Using the first 2 interviews of the Health and Retirement Study, a nationally representative Survey of Americans aged 51 to 61 years, we conducted a prospective cohort study of 5600 employed nonfarmers. Results. Testing a logistic regression model developed in a previous cross-sectional study, we found that the following occupations and risk factors were associated with occupational injury as estimated by odds ratios: Service personnel, odds ratio= 1.71 (95% confidence interval = 1.13, 2.57); mechanics and repairers, 3.47 (1.98, 6.10); operators and assemblers, 2.33 (1.51, 3.61); laborers, 3.16 (1.67, 5.98); jobs requiring heavy lifting, 2.05 (1.55, 2.70); self-employment, 0.50 (0.34, 0.73); and self-reported disability, 1.58 (1.14, 2.19). Replacing the general disability variable with specific hearing and visual impairment variables, we found that poor hearing (1.35 [0.95, 1.93]) and poor sight (1.45 [0.94, 2.22]) both had elevated odds ratios. Conclusions. Poor sight and poor heating, as well as work disabilities in general, are associated with occupational injuries among older workers. Handle: RePEc:aph:ajpbhl:1998:88:11:1691-1695_8 Template-Type: ReDIF-Article 1.0 Title: First aid training: The hidden dimension of injury control for school- based injuries [3] Journal: American Journal of Public Health Author-Name: Nguyen, L.H. Year: 1998 Volume: 88 Issue: 10 Pages: 1557 Handle: RePEc:aph:ajpbhl:1998:88:10:1557_3 Template-Type: ReDIF-Article 1.0 Title: Maternal smoking and deformities of the foot: Results of the EUROCAT study [1] Journal: American Journal of Public Health Author-Name: Reefhuis, J. Author-Name: De Walle, H.E.K. Author-Name: Cornel, M.C. Year: 1998 Volume: 88 Issue: 10 Pages: 1554-1555 Handle: RePEc:aph:ajpbhl:1998:88:10:1554-1555_4 Template-Type: ReDIF-Article 1.0 Title: A new twist in ecological studies Journal: American Journal of Public Health Author-Name: Feinleib, M. Year: 1998 Volume: 88 Issue: 10 Pages: 1445-1446 Handle: RePEc:aph:ajpbhl:1998:88:10:1445-1446_2 Template-Type: ReDIF-Article 1.0 Title: Issues in comparing survival rates for Detroit and Toronto [2] Journal: American Journal of Public Health Author-Name: Weiss, L.K. Author-Name: Severson, R.K. Author-Name: Swanson, G.M. Author-Name: Gorey, K. Author-Name: Holowaty, E.J. Year: 1998 Volume: 88 Issue: 10 Pages: 1556-1557 Handle: RePEc:aph:ajpbhl:1998:88:10:1556-1557_7 Template-Type: ReDIF-Article 1.0 Title: Religion and mortality among the community-dwelling elderly Journal: American Journal of Public Health Author-Name: Oman, D. Author-Name: Reed, D. Year: 1998 Volume: 88 Issue: 10 Pages: 1469-1475 Abstract: Objectives. This study analyzed the prospective association between attending religious services and all-cause mortality to determine whether the association is explainable by 6 confounding factors: demographics, health status, physical functioning, health habits, social functioning and support, and psychological state. Methods. The association between self-reported religious attendance and subsequent mortality over 5 years for 1931 older residents of Marin County, California, was examined by proportional hazards regression. Interaction terms of religion with social support were used to explore whether other forms of social support could substitute for religion and diminish its protective effect. Results. Persons who attended religious services had lower mortality than those who did not (age- and sex-adjusted relative hazard [RH] = 0.64; 95% confidence interval [CI] = 0.52, 0.78). Multivariate adjustment reduced this relationship only slightly (RH = 0.76; 95% CI = 0.62, 0.94), primarily by including physical functioning and social support. Contrary to hypothesis, religious attendance tended to be slightly more protective for those with high social support. Conclusions. Lower mortality rates for those who attend religious services are only partly explained by the 6 possible confounders listed above. Psychodynamic and other explanations need further investigation. Handle: RePEc:aph:ajpbhl:1998:88:10:1469-1475_3 Template-Type: ReDIF-Article 1.0 Title: Dementia is the major cause of functional dependence in the elderly: 3- year follow-up data from a population-based study Journal: American Journal of Public Health Author-Name: Agüero-Torres, H. Author-Name: Fratiglioni, L. Author-Name: Guo, Z. Author-Name: Viitanen, M. Author-Name: Von Strauss, E. Author-Name: Winblad, B. Year: 1998 Volume: 88 Issue: 10 Pages: 1452-1456 Abstract: Objectives. The purpose of this investigation was to study the role of dementia and other common age-related diseases as determinants of dependence in activities of daily living (ADL) in the elderly. Methods. The study population consisted of 1745 persons, aged 75 years and older, living in a district of Stockholm. They were examined at baseline and after a 3-year follow-up interval. Katz's index was used to measure functional status. Functional dependence at baseline, functional decline, and development of functional dependence at follow-up were examined in relation to sociodemographic characteristics and chronic conditions. Results. At baseline, factors associated with functional dependence were age, dementia, cerebrovascular disease, heart disease, and hip fracture. However, only age and dementia were associated with the development of functional dependence and decline after 3 years. In a similar analysis, including only nondemented subjects. Mini-Mental State Examination scores emerged as one of the strongest determinants. The population-attributable risk percentage of dementia in the development of functional dependence was 49%. Conclusions. In a very old population, dementia and cognitive impairment make the strongest contribution to both the development of long-term functional dependence and decline in function. Handle: RePEc:aph:ajpbhl:1998:88:10:1452-1456_3 Template-Type: ReDIF-Article 1.0 Title: Depression, anxiety, and smoking initiation: A prospective study over 3 years Journal: American Journal of Public Health Author-Name: Patton, G.C. Author-Name: Carlin, J.B. Author-Name: Coffey, C. Author-Name: Wolfe, R. Author-Name: Hibbert, M. Author-Name: Bowes, G. Year: 1998 Volume: 88 Issue: 10 Pages: 1518-1522 Abstract: Objectives. This report considers the extent to which depression and anxiety predict smoking onset in adolescence. Methods. A 6-wave cohort design was used to study a sample of 14- and 15-year-old students (n = 2032) drawn from 44 secondary schools in the state of Victoria, Australia. The students were surveyed between 1992 and 1995 with a computerized questionnaire that included a 7-day retrospective diary for tobacco use and a structured psychiatric interview. Results. Experimental smokers were 29 times more likely than nonsmokers to make a transition into daily use in the subsequent 6 months. Depression and anxiety, along with peer smoking, predicted initiation of experimental smoking. Specifically, depression and anxiety accentuated risks associated with peer smoking and predicted experimentation only in the presence of peer smoking. Conclusions. The finding that experimental smoking is an overwhelming strong predictor of later daily smoking focuses attention on smoking initiation. Depressive an anxiety symptoms are associated with higher risks for initiation through an increased susceptibility to peer smoking influences. Promoting the psychological well- being of adolescents and addressing perceived interpersonal benefits of smoking may play a role in the prevention of adolescent tobacco use. Handle: RePEc:aph:ajpbhl:1998:88:10:1518-1522_9 Template-Type: ReDIF-Article 1.0 Title: Targeting the underserved for breast and cervical cancer screening: The utility of ecological analysis using the national health interview survey Journal: American Journal of Public Health Author-Name: Wells, B.L. Author-Name: Horm, J.W. Year: 1998 Volume: 88 Issue: 10 Pages: 1484-1489 Abstract: Objectives. This study tested the utility of ecological variables created from the National Health Interview Survey (NHIS) for strategic targeting of health services for the underserved. Methods. Ecological variables were created using the 1989-1991 survey years of the NHIS public use data files. Segments, the NHIS secondary sampling units, permit computation of secondary sampling characteristics by percentage Black, percentage Hispanic, percentage below poverty percentage unemployed, median education, median income, median age, and percentage residing in the United States for 5-years or less. These variables were analyzed with the NHIS Health Promotion and Disease Prevention 1990 supplement reporting mammogram, clinical breast examination, and Pap test use. Results. Median education of areas was inversely related to never having mammograms. Areas with a high proportion (70%-100%) of Hispanic respondents also were more likely not to have mammograms. Women residing in areas with moderate or high proportions of Hispanic respondents were more likely never to have clinical breast examinations and Pap tests, as were those in areas with low income, poverty, and respondents who had resided in the United States 5 years or less. Conclusions. The new methodology of constructing ecological variables using the NHIS demonstrates an application that may help identify underserved areas or areas with underutilized services. More studies using this methodology are warranted. Handle: RePEc:aph:ajpbhl:1998:88:10:1484-1489_3 Template-Type: ReDIF-Article 1.0 Title: Understanding trends in functional limitations among older Americans Journal: American Journal of Public Health Author-Name: Freedman, V.A. Author-Name: Martin, L.G. Year: 1998 Volume: 88 Issue: 10 Pages: 1457-1462 Abstract: Objectives. This report documents trends in functional limitations among older Americans from 1984 to 1993 and investigates reasons for such trends. Methods. We applied logistic regression to data for noninstitutionalized Americans aged 50 years and older from the Survey of Income and Program Participation. We focused on 4 functional limitation measures unlikely to be affected by changes in role expectations and living environments: reported difficulty seeing words in a newspaper, lifting and carrying 10 pounds, climbing a flight of stairs, and walking a quarter of a mile. Results. We found large declines in the crude prevalence of functional limitations, especially for those 80 years and older. Generally, changes in population composition explained only a small portion of the downward trends. Once changes in population composition and mobility-related device use were considered for difficulty walking, significant improvements of functioning remained for the 65- to 79-year-old group. Conclusions. Changes in population composition, device use, survey design, role expectations, and living environments do not appear to account completely for improvements in functioning. We infer that changes in underlying physiological capability - whether real or perceived - likely underlie such trends. Handle: RePEc:aph:ajpbhl:1998:88:10:1457-1462_8 Template-Type: ReDIF-Article 1.0 Title: Maternal anthropometric factors and risk of primary cesarean delivery Journal: American Journal of Public Health Author-Name: Shepard, M.J. Author-Name: Saftlas, A.F. Author-Name: Leo-Summers, L. Author-Name: Bracken, M.B. Year: 1998 Volume: 88 Issue: 10 Pages: 1534-1538 Abstract: Objectives. This study examined absolute and proportional gestational weight gain and prepregnancy body mass index as predictors of primary cesarean delivery. Methods. Data were derived from a prospective study of pregnancy outcome risk factors in 2301 women in greater New Haven, Conn, who had singleton deliveries by primary cesarean (n = 312) or vaginal delivery (n = 1989) and for whom height, prepregnancy weight, and weight gain were available. Women were divided into 4 body mass index groups (underweight, low average, high average, and obese) and further subdivided into 8 groups according to median proportional or absolute weight gain. Results. Risk of cesarean delivery increased with increasing body mass index and gestational weight gain greater than the median for one's body mass index. Proportional weight gain was more predictive of cesarean delivery than absolute weight gain. Underweight women gaining more than 27.8% of their pregnancy weight had a 2-fold adjusted relative risk of cesarean delivery. Conclusions. Proportional weight gain is an important predict of cesarean delivery for underweight women; high body mass index is also predictive of increased risk. Handle: RePEc:aph:ajpbhl:1998:88:10:1534-1538_8 Template-Type: ReDIF-Article 1.0 Title: The evolving epidemiology of chlamydial and gonococcal infections in response to control programs in Winnipeg, Canada Journal: American Journal of Public Health Author-Name: Blanchard, J.F. Author-Name: Moses, S. Author-Name: Greenaway, C. Author-Name: Orr, P. Author-Name: Hammond, G.W. Author-Name: Brunham, R.C. Year: 1998 Volume: 88 Issue: 10 Pages: 1496-1502 Abstract: Objectives. The purpose of this study was to describe and compare the transmission dynamics of chlamydia and gonorrhea in Winnipeg, Manitoba, Canada, and to assess implications for control programs. Methods. Chlamydia and gonorrhea surveillance case reports (1988 through 1995) and contact- tracing reports (1991 through 1995) were examined. Results. High incidence rates of both chlamydia and gonorrhea clustered in geographic core areas characterized by low socioeconomic status. A decline in the number of reported cases of chlamydia (61%) and gonorrhea (64%) occurred between 1988 and 1995. For chlamydia, the decline was most prominent in non-core area cases, while for gonorrhea it was similar in core and noncore areas. Conclusions. Chlamydia and gonorrhea appear to be evolving through different epidemic phases, with chlamydia transmission, in response to a newly introduced control program, becoming more core dependent and gonorrhea transmission becoming more sporadic in the face of a sustained control effort. Focused control programs, based on an understanding of the transmission dynamics of chlamydia and gonorrhea, may make their elimination a feasible goal. Handle: RePEc:aph:ajpbhl:1998:88:10:1496-1502_4 Template-Type: ReDIF-Article 1.0 Title: The importance of continuity of care in the likelihood of future hospitalization: Is site of care equivalent to a primary clinician? Journal: American Journal of Public Health Author-Name: Mainous III, A.G. Author-Name: Gill, J.M. Year: 1998 Volume: 88 Issue: 10 Pages: 1539-1541 Abstract: Objectives. This study examined the effect of continuity with clinicians and health care sites on likelihood of future hospitalization. Methods. Delaware Medicaid patient data were analyzed. Logistic regression models supplied adjusted effects of continuity on hospitalization. Results. Patients in the high clinician continuity group had lower odds of hospitalization than patients in the high site/low clinician continuity group (odds ratio [OR] = 0.75, 95% confidence interval [CI] = 0.66, 0.87). The latter group did not differ from the low site/low clinician continuity group (OR = 0.93, 95% CI = 0.80, 1.08). Conclusions. A location providing health care without clinician continuity may not be sufficient to ensure cost-effective care. Handle: RePEc:aph:ajpbhl:1998:88:10:1539-1541_8 Template-Type: ReDIF-Article 1.0 Title: Does passive smoking in early pregnancy increase the risk of small-for- gestational-age infants? Journal: American Journal of Public Health Author-Name: Dejin-Karlsson, E. Author-Name: Hanson, B.S. Author-Name: Östergren, P.-O. Author-Name: Sjöberg, N.-O. Author-Name: Marsal, K. Year: 1998 Volume: 88 Issue: 10 Pages: 1523-1527 Abstract: Objectives. This study tested the hypothesis that women who deliver small-for-gestational-age infants are more often exposed to passive smoking at home or at work. Methods. Among a 1-year-cohort of nulliparous women in the city of Malmo, Sweden, 872 (87.7%) women completed a questionnaire during their first prenatal visit. The study was carried out among women whose pregnancies resulted in a singleton live birth (n = 826); 6.7% of infants were classified as small for their gestational age. Results. Passive smoking in early pregnancy was shown to double a woman's risk of delivering a small- for-gestational-age infant, independent of potential confounding factors such as age, height, weight, nationality, educational level, and the mother's own active smoking (odds ratio [OR] = 2.7). A stratified analysis indicated interactional effects of maternal smoking and passive smoking on relative small for-gestational-age risk. Conclusions. Based on an attributable risk estimate, a considerable reduction in the incidence of small-for-gestational- age birth could be reached if pregnant women were not exposed to passive smoking. Handle: RePEc:aph:ajpbhl:1998:88:10:1523-1527_6 Template-Type: ReDIF-Article 1.0 Title: Predictors of healthy aging in men with high life expectancies Journal: American Journal of Public Health Author-Name: Reed, D.M. Author-Name: Foley, D.J. Author-Name: White, L.R. Author-Name: Heimovitz, H. Author-Name: Burchfiel, C.M. Author-Name: Masaki, K. Year: 1998 Volume: 88 Issue: 10 Pages: 1463-1468 Abstract: Objective. The purpose of this study was to identify risk factors that consistently predict saying healthy in contrast to developing clinical illness and/or physical and mental impairments. Methods. More than 8000 men of Japanese ancestry were followed for 28 years with repeat examinations and surveillance for deaths and incident clinical illness. Physical and cognitive functions were measured in 1993. Measures of healthy aging included surviving and remaining free of major chronic illnesses and physical and cognitive impairments. Results. Of 6505 healthy men at baseline, 2524 (39%) died prior to the final exam. Of the 3263 available survivors, 41% remained free of major clinical illnesses, 40% remained free of both physical and cognitive impairment and 19% remained free of both illness and impairment. The most consistent predictors of healthy aging were low blood pressure, low serum glucose, not smoking cigarettes, and not being obese. Conclusions. Beyond the biological effects of aging, much of the illness and disability in the elderly is related to risk factors present at midlife. Handle: RePEc:aph:ajpbhl:1998:88:10:1463-1468_9 Template-Type: ReDIF-Article 1.0 Title: Ex-smokers and risk of hip fracture Journal: American Journal of Public Health Author-Name: Forsén, L. Author-Name: Bjartveit, K. Author-Name: Bjørndal, A. Author-Name: Edna, T.-H. Author-Name: Meyer, H.E. Author-Name: Schei, B. Year: 1998 Volume: 88 Issue: 10 Pages: 1481-1483 Abstract: Objectives. The purpose of this study was to examine the reversibility of the effect of smoking on hip fracture incidence rates. Methods. A 3-year follow-up cohort study was conducted involving 35 767 adults 50 years of age or older. Of these individuals, 421 suffered a hip fracture. Results. Among participants less than 75 years of age, the relative risk (RR) of hip fracture was elevated for ex-smokers, even for those who had quit smoking more than 5 years previously (men: RR = 4.4, 95% confidence interval [CI] = 1.2, 15.3; women: RR: 1.3, 95% CI = 0.6, 3.0), but was not as high as that for current smokers (men: RR = 5.0, 95% CI = 1.5, 16.9; women: RR = 1.9, 95% CI = 1.2, 3.1). Conclusions. The effect of smoking on risk of hip fracture was not reversed completely 5 years after smoking cessation. Handle: RePEc:aph:ajpbhl:1998:88:10:1481-1483_5 Template-Type: ReDIF-Article 1.0 Title: A rivalry of foulness: Official and unofficial investigations of the London cholera epidemic of 1854 Journal: American Journal of Public Health Author-Name: Paneth, N. Author-Name: Vinten-Johansen, P. Author-Name: Brody, H. Author-Name: Rip, M. Year: 1998 Volume: 88 Issue: 10 Pages: 1545-1553 Abstract: Contemporaneous with John Snow's famous study of the 1854 London cholera epidemic were 2 other investigations: a local study of the Broad Street outbreak and an investigation of the entire epidemic, undertaken by England's General Board of Health. More than a quarter-century prior to Koch's description of Vibrio comma, a Board of Health investigator saw microscopic 'vibriones' in the rice-water stools of cholera patients that, in his later life, he concluded had been cholera bacilli. Although this finding was potential evidence of Snow's view that cholera was due to a contagious and probably live agent transmitted in the water supply, the Board of Health rejected Snow's conclusions. The Board of Health amassed a huge amount of information which it interpreted as supportive of its conclusion that the epidemic was attributable not so much to water as to air. Snow, by contrast, systematically tested his hypothesis that cholera was water-borne by exploring evidence that at first glance ran contrary to his expectations. Snow's success provides support for using a hypothetico-deductive approach in epidemiology, based on tightly focused hypotheses strongly grounded in pathophysiology. Handle: RePEc:aph:ajpbhl:1998:88:10:1545-1553_0 Template-Type: ReDIF-Article 1.0 Title: Targeting early antecedents to prevent tobacco smoking: Findings from an epidemiologically based randomized field trial Journal: American Journal of Public Health Author-Name: Kellam, S.G. Author-Name: Anthony, J.C. Year: 1998 Volume: 88 Issue: 10 Pages: 1490-1495 Abstract: Objectives. This study examined whether interventions aimed at aggressive/disruptive classroom behavior and poor academic achievement would reduce the incidence of initiation of smoking. Methods. An epidemiologically based, universal randomized preventive trial involved 2311 children in 2 classroom-based preventive interventions or controls. Each intervention was directed at 1 of the aforementioned 2 antecedents over first and second grades in 19 urban schools. Results. Smoking initiation was reduced in both cohorts for boys assigned to the behavioral intervention. Conclusions. Targeting early risk antecedents such as aggressive behavior appears to be an important smoking prevention strategy. Handle: RePEc:aph:ajpbhl:1998:88:10:1490-1495_8 Template-Type: ReDIF-Article 1.0 Title: Misclassification rates for current smokers misclassified as nonsmokers Journal: American Journal of Public Health Author-Name: Wells, A.J. Author-Name: English, P.B. Author-Name: Posner, S.F. Author-Name: Wagenknecht, L.E. Author-Name: Perez-Stable, E.J. Year: 1998 Volume: 88 Issue: 10 Pages: 1503-1509 Abstract: Objectives. This paper provides misclassification rates for current cigarette smokers who report themselves as nonsmokers. Such rates are important in determining smoker misclassification bias in the estimation of relative risks in passive smoking studies. Methods. True smoking status, either occasional or regular, was determined for individual current smokers in 3 existing studies of nonsmokers by inspecting the cotinine levels of body fluids. The new data, combined with an approximately equal amount in the 1992 Environmental Protection Agency (EPA) report on passive smoking and lung cancer, yielded misclassification rates that not only had lower standard errors but also were stratified by sex and US minority/majority status. Results. The misclassification rates for the important category of female workers misclassified as never smokers were, respectively, 0.8%, 6.0%, 2.8%, and 15.3% for majority regular, majority occasional, US minority regular, and US minority occasional smokers. Misclassification rates for males were mostly somewhat higher. Conclusions. The new information supports EPA's conclusion that smoker misclassification bias is small. Also, investigators are advised to pay attention to minority/majority status of cohorts when correcting for smoker misclassification bias. Handle: RePEc:aph:ajpbhl:1998:88:10:1503-1509_8 Template-Type: ReDIF-Article 1.0 Title: News media coverage and the epidemiology of homicide Journal: American Journal of Public Health Author-Name: Sorenson, S.B. Author-Name: Peterson Manz, J.G. Author-Name: Berk, R.A. Year: 1998 Volume: 88 Issue: 10 Pages: 1510-1514 Abstract: Objectives. This study assessed how newspaper coverage of homicides corresponds to the epidemiology of homicide. Methods. Stories in the Los Angeles Times about homicide (n = 2782) were compared with the homicides that occurred in Los Angeles County from 1990 through 1994 (n = 9442). The generalized linear model assessed how victim, incident, and suspect characteristics related to coverage. Results. Even when multiple variables were taken into account, some homicides (those with female, child, or elderly victims; those in which the suspect was a stranger to the victim; those in wealthier neighborhoods) received more coverage and others (those with Black or Hispanic victims or victims with less than a high school education; those committed with nonfirearm weapons; those in which the suspect was an intimate of the victim) received less coverage than expected. Conclusions. Some homicides are more newsworthy than others. Potential implications of not providing the public with representative data are discussed. Handle: RePEc:aph:ajpbhl:1998:88:10:1510-1514_7 Template-Type: ReDIF-Article 1.0 Title: Patterns of condom use among adolescents: The impact of mother- adolescent communication Journal: American Journal of Public Health Author-Name: Miller, K.S. Author-Name: Levin, M.L. Author-Name: Whitaker, D.J. Author-Name: Xu, X. Year: 1998 Volume: 88 Issue: 10 Pages: 1542-1544 Abstract: Objectives. The association between the timing of discussions about condoms between mother and adolescent and adolescents' condom use during their first and subsequent sexual encounters was examined. Methods. Sexually active adolescents reported whether and when they discussed condoms with their mother and answered questions about their own condom use. Results. Mother-adolescent discussions about condoms that occurred prior to sexual debut were strongly associated with greater condom use during first intercourse and most recent intercourse, along with greater lifetime regular condom use. Conclusions. Discussions about condoms prior to sexual debut are important in promoting condom use among adolescents. Handle: RePEc:aph:ajpbhl:1998:88:10:1542-1544_6 Template-Type: ReDIF-Article 1.0 Title: Race and sex differences in long-term survival rates for elderly patients with pulmonary embolism Journal: American Journal of Public Health Author-Name: Siddique, R.M. Author-Name: Amini, S.B. Author-Name: Connors Jr., A.F. Author-Name: Rimm, A.A. Year: 1998 Volume: 88 Issue: 10 Pages: 1476-1480 Abstract: Objectives. The goal of this study was to provide estimates of race- and sex-specific survival rates over a 10-year period for a cohort of 49 752 Medicare patients admitted to the hospital in 1984 with a diagnosis of pulmonary embolism. Methods. Data were derived from Medicare Provider Analysis and Review Record inpatient claims files and the National Death Index file. Results. For a primary diagnosis of pulmonary embolism, median survival times among Black men and women were 2.5 years and 5.2 years, respectively; for White men and women, the median survival times were 4.3 years and 5.9 years, respectively. Median survival times for Black men and women and White men and women with a secondary diagnosis of pulmonary embolism were 0.4 years, 0.7 years, 0.8 years, and 1.4 years, respectively. Survival rates declined with advancing age. Conclusions. Overall, survival rates among Blacks were lower than those among Whites, and men had lower survival rates than women. These survival estimates provide new insights into outcomes following pulmonary embolism in hospitalized elderly people. Handle: RePEc:aph:ajpbhl:1998:88:10:1476-1480_5 Template-Type: ReDIF-Article 1.0 Title: Prevalence of adult domestic violence among women seeking routine care in a Native American health care facility Journal: American Journal of Public Health Author-Name: Fairchild, D.G. Author-Name: Fairchild, M.W. Author-Name: Stoner, S. Year: 1998 Volume: 88 Issue: 10 Pages: 1515-1517 Abstract: Objectives. The purpose of this study was to determine the prevalence of, and sociodemographic factors associated with, adult domestic violence within a Native American community. Methods. Adult women in the community were surveyed. Results. Of 371 eligible women, 341 (92%) were surveyed. Among respondents, 179 reported a history of at least 1 episode of domestic violence. Fifty-six (16.4%) reported violence within the previous 12 months. Age under 40 years and living in a household receiving governmental financial assistance were independently associated with 1-year prevalence of adult domestic violence. Conclusions. Adult domestic violence is prevalent within this Native American community. Additional research is required to characterize further the relationship between domestic violence and socioeconomic status. Handle: RePEc:aph:ajpbhl:1998:88:10:1515-1517_0 Template-Type: ReDIF-Article 1.0 Title: Consensus criteria for the classification of carpal tunnel syndrome in epidemiologic studies Journal: American Journal of Public Health Author-Name: Rempel, D. Author-Name: Evanoff, B. Author-Name: Amadio, P.C. Author-Name: De Krom, M. Author-Name: Franklin, G. Author-Name: Franzblau, A. Author-Name: Gray, R. Author-Name: Gerr, F. Author-Name: Hagberg, M. Author-Name: Hales, T. Author-Name: Katz, J.N. Author-Name: Pransky, G. Year: 1998 Volume: 88 Issue: 10 Pages: 1447-1451 Abstract: Criteria for the classification of carpal tunnel syndrome for use in epidemiologic studies were developed by means of a consensus process. Twelve medical researchers with experience in conducting epidemiologic studies of carpal tunnel syndrome participated in the process. The group reached agreement on several conceptual issues. First, there is no perfect gold standard for carpal tunnel syndrome. The combination of electrodiagnostic study findings and symptom characteristics will provide the most accurate information for classification of carpal tunnel syndrome. Second, use of only electrodiagnostic study findings is not recommended. Finally, in the absence of electrodiagnostic studies, specific combinations of symptom characteristics and physical examination findings may be useful in some settings but are likely to result in greater misclassification of disease status. Handle: RePEc:aph:ajpbhl:1998:88:10:1447-1451_0 Template-Type: ReDIF-Article 1.0 Title: Maternal leisure-time exercise and timely delivery Journal: American Journal of Public Health Author-Name: Hatch, M. Author-Name: Levin, B. Author-Name: Shu, X.-O. Author-Name: Susser, M. Year: 1998 Volume: 88 Issue: 10 Pages: 1528-1533 Abstract: Objectives. This study investigated whether, in a general obstetric population, exercise in pregnancy affects the timeliness of delivery. The hypothesis was that maternal exercise would not raise the risk of preterm birth. Methods. A community cohort of 557 prenatal patients was followed up until the time of delivery. Data were collected on exercise in each trimester none, low-moderate (<1000 kcal [4184 kJ]/wk in energy expenditure), or heavy (≤1000 kcal/wk). Timely delivery was adopted as an outcome criterion. Thus, in the analysis, a term birth was treated as optimal and survival techniques were used to estimate risks for both preterm and postdates delivery. Results. No association was found between low-moderate exercise and gestational length. Heavier exercise appeared to reduce, rather than raise, the risk of preterm birth. The adjusted relative risk among conditioned heavy exercisers was 0.11 (95% confidence interval = 0.02, 0.81). After term, conditioned heavy exercisers delivered faster than nonexercisers. Conclusions. The most important finding was the lack of evidence that vigorous maternal exercise is a risk factor for preterm delivery. A promising finding was that conditioned heavy exercisers have timely deliveries. Handle: RePEc:aph:ajpbhl:1998:88:10:1528-1533_6 Template-Type: ReDIF-Article 1.0 Title: Comment: Ethnic cleansing in the groves of academe Journal: American Journal of Public Health Author-Name: Geiger, H.J. Year: 1998 Volume: 88 Issue: 9 Pages: 1299-1300 Handle: RePEc:aph:ajpbhl:1998:88:9:1299-1300_1 Template-Type: ReDIF-Article 1.0 Title: Hawaii's statewide syringe exchange program Journal: American Journal of Public Health Author-Name: Vogt, R.L. Author-Name: Breda, M.C. Author-Name: Des Jarlais, D.C. Author-Name: Gates, S. Author-Name: Whiticar, P. Year: 1998 Volume: 88 Issue: 9 Pages: 1403-1404 Handle: RePEc:aph:ajpbhl:1998:88:9:1403-1404_6 Template-Type: ReDIF-Article 1.0 Title: Comment: Abandoning 'race' as a variable in public health research - An idea whose time has come Journal: American Journal of Public Health Author-Name: Fullilove, M.T. Year: 1998 Volume: 88 Issue: 9 Pages: 1297-1298 Handle: RePEc:aph:ajpbhl:1998:88:9:1297-1298_2 Template-Type: ReDIF-Article 1.0 Title: The neglected lesson of the Tuskegee study [1] Journal: American Journal of Public Health Author-Name: Yankauer, A. Year: 1998 Volume: 88 Issue: 9 Pages: 1406 Handle: RePEc:aph:ajpbhl:1998:88:9:1406_5 Template-Type: ReDIF-Article 1.0 Title: A geographic information systems application for disease surveillance [2] Journal: American Journal of Public Health Author-Name: Devasundaram, J.K. Author-Name: Rohn, D. Author-Name: Dwyer, D.M. Author-Name: Israel, E. Year: 1998 Volume: 88 Issue: 9 Pages: 1406-1407 Handle: RePEc:aph:ajpbhl:1998:88:9:1406-1407_1 Template-Type: ReDIF-Article 1.0 Title: The developmental status and adaptive behavior of homeless and low- income housed infants and toddlers Journal: American Journal of Public Health Author-Name: Coll, C.G. Author-Name: Buckner, J.C. Author-Name: Brooks, M.G. Author-Name: Weinreb, L.F. Author-Name: Bassuk, E.L. Year: 1998 Volume: 88 Issue: 9 Pages: 1371-1374 Abstract: Objectives. This study describes the developmental status of 127 homeless and 91 low-income housed infants and toddlers. Methods. The Bayley Scales of Infant Development and the Vineland Screener were used to gather data. Results. There were no differences between homeless and low-income housed children. However, younger children in both groups performed better than the older children on most summary scores. Conclusions. Homeless and low-income housed children did not differ in their cognitive and motor skills. However, older children scored lower than younger children on most measures of developmental status, suggesting that the cumulative effects of poverty may increase with time. Handle: RePEc:aph:ajpbhl:1998:88:9:1371-1374_6 Template-Type: ReDIF-Article 1.0 Title: Foster care children and family homelessness Journal: American Journal of Public Health Author-Name: Zlotnick, C. Author-Name: Kronstadt, D. Author-Name: Klee, L. Year: 1998 Volume: 88 Issue: 9 Pages: 1368-1370 Abstract: Objectives. This study examined the association between family homelessness and children's placement in foster care. Methods. The prevalence of homelessness in a random sample of 195 young foster children was examined. Results. Almost half of the birth parents of the foster children had experienced homelessness. Those children were more likely than other foster children to have siblings in foster are and to be placed with nonrelatives. Conclusions. An extremely high prevalence of family homelessness was found among children in foster care. Policy implications of the association between family homelessness and placement into foster care are discussed. Handle: RePEc:aph:ajpbhl:1998:88:9:1368-1370_6 Template-Type: ReDIF-Article 1.0 Title: Social class, ethnicity, and mental illness: The importance of being more than earnest Journal: American Journal of Public Health Author-Name: Stoep, A.V. Author-Name: Link, B. Year: 1998 Volume: 88 Issue: 9 Pages: 1396-1402 Abstract: This paper revisits a landmark study of the prevalence of mental illness in the state of Massachusetts conducted by Edward Jarvis in the 19th century. Jarvis drew an improper conclusion about the relationship between social class, ethnicity, and insanity, asserting that the Irish foreign-born had a higher prevalence of insanity in each social stratum. A reanalysis of Jarvis' data shows that in both the pauper and independent social classes in Massachusetts, the prevalence of insanity was significantly lower among foreign-born persons than among native born persons. On the basis of his misperception, Jarvis constructed elaborate etiological theories. These theories made a strong impact on the mental health service policies of his day. The effects of incomplete examination of data on etiological theories and mental health policy in current times are highlighted in this article. Handle: RePEc:aph:ajpbhl:1998:88:9:1396-1402_9 Template-Type: ReDIF-Article 1.0 Title: Projections of Alzheimer's disease in the United States and the public health impact of delaying disease onset Journal: American Journal of Public Health Author-Name: Brookmeyer, R. Author-Name: Gray, S. Author-Name: Kawas, C. Year: 1998 Volume: 88 Issue: 9 Pages: 1337-1342 Abstract: Objectives. The goal of this study was to project the future prevalence and incidence of Alzheimer's disease in the United States and the potential impact of interventions to delay disease onset. Methods. The numbers of individuals in the United States with Alzheimer's disease and the numbers of newly diagnosed cases that can be expected over the next 50 years were estimated from a model that used age-specific incidence rates summarized from several epidemiological studies, US mortality rates, and US Bureau of the Census projections. Results. In 1997, the prevalence of Alzheimer's disease in the United States was 2.32 million (range: 1.09 to 4.58 million); of these individuals, 68% were female. It is projected that the prevalence will nearly quadruple in the next 50 years, by which time approximately 1 in 45 Americans will be afflicted with the disease. Currently, the annual number of new incident cases is 360 000. If interventions could delay onset of the disease by 2 years, after 50 years there would be nearly 2 million fewer cases than projected; if onset could be delayed by 1 year, there would be nearly 800 000 fewer prevalent cases. Conclusions. As the US population ages, Alzheimer's disease will become an enormous public health problem. Interventions that could delay disease onset even modestly would have a major public health impact. Handle: RePEc:aph:ajpbhl:1998:88:9:1337-1342_6 Template-Type: ReDIF-Article 1.0 Title: Increasing social variation in birth outcomes in the Czech Republic after 1989 Journal: American Journal of Public Health Author-Name: Koupilová, I. Author-Name: Bobák, M. Author-Name: Holčík, J. Author-Name: Pikhart, H. Author-Name: Leon, D.A. Year: 1998 Volume: 88 Issue: 9 Pages: 1343-1347 Abstract: Objectives. This study investigated variation in birth outcome in the Czech Republic after the political change of 1989. Methods. Routinely collected records on singleton live births in 1989, 1990, and 1991 (n = 380 633) and 1994, 1995, and 1996 (n = 286 907) were individually linked to death records. Results. Mean birthweight fell from 3323 g to 3292 g (P < .001) between 1989 and 1991 and then increased to 3353 g by 1996. The gap in mean birthweight between mothers with a primary education and those with a university education, adjusted for age, parity, and sex of infants, widened from 182 g (95% confidence interval [CI] = 169, 194) in 1989 to 256 g (95% CI = 240, 272) in 1996. Similar trends were found for preterm births. Postneonatal mortality declined most among the better educated and the married. The odds ratio for post-neonatal death for infants of mothers with a primary (vs. university) education, adjusted for birthweight, increased from 1.99 (95% CI = 1.52, 2.60) in 1989 through 1991 to 2.39 (95% CI = 1.55, 3.70) in 1994 through 1995. Conclusions. Despite general improvement in the indices of fetal growth and infant survival in the most recent years, social variation in birth outcome in the Czech Republic has increased. Handle: RePEc:aph:ajpbhl:1998:88:9:1343-1347_2 Template-Type: ReDIF-Article 1.0 Title: Entry into primary care and continuity: The effects of access Journal: American Journal of Public Health Author-Name: Forrest, C.B. Author-Name: Starfield, B. Year: 1998 Volume: 88 Issue: 9 Pages: 1330-1336 Abstract: Objectives. This study examined the relationship between access and use of primary care physicians as sources of first contact and continuity with the medical system. Methods. Data from 1987 National Medical Expenditure Survey were used to examine the effects of access on use of primary care physicians as sources of first contact for new episodes of care (by logistic regression) and as sources of continuity for all ambulatory visits (by multivariate linear regression). Results. No after-hours care, longer office waits, and longer travel times reduced the chances of a first-contact visit with a primary care physician for acute health problems. Longer appointment waits, no insurance, and no after-hours care were associated with lower levels of continuity. Generalists provided more first-contact care than specialists acting as primary care physicians, largely because of their more accessible practices. Conclusions. These data provide support for the linkage between access and care seeking with primary care physicians. Handle: RePEc:aph:ajpbhl:1998:88:9:1330-1336_1 Template-Type: ReDIF-Article 1.0 Title: The development of sex differences in cardiovascular disease mortality: A historical perspective Journal: American Journal of Public Health Author-Name: Nikiforov, S.V. Author-Name: Mamaev, V.B. Year: 1998 Volume: 88 Issue: 9 Pages: 1348-1353 Abstract: Objectives. Little is known about why males have higher cardiovascular disease (CVD) mortality rates than do females. An important factor that has hampered efforts in this regard is the lack of clarity about whether male excess mortality from CVD has existed throughout history. To answer this question, an investigation was conducted of trends in CVD mortality differences between the sexes from the time when data first became available until the present, including the full range of age groups. Methods. Mortality statistics for CVD in England and Wales from 1861 through 1992 and in the United States from 1900 through 1991 were used. Results. Three stages in the relationship between male and female CVD mortality were found: (1) An early stages of equal male and female mortality, (2) a stage of the appearance of sex differences in mortality, and (3) a stage with consistently present male excess mortality. Conclusion. Male excess mortality from CVD has not always been present in the historical record. Further research is needed to elucidate the causes of this excess mortality. Handle: RePEc:aph:ajpbhl:1998:88:9:1348-1353_4 Template-Type: ReDIF-Article 1.0 Title: Hyaline membrane disease is underreported in a linked birth-infant death certificate database Journal: American Journal of Public Health Author-Name: Hamvas, A. Author-Name: Kwong, P. Author-Name: DeBaun, M. Author-Name: Schramm, W. Author-Name: Cole, F.S. Year: 1998 Volume: 88 Issue: 9 Pages: 1387-1389 Abstract: Objective. This study compared the Missouri State Department of Health linked birth-infant death certificate database and medical records with respect to recording hyaline membrane disease in very low-birth-weight infants. Methods. We reviewed the records for all 976 infants weighing 500 to 1500 g who were born to St. Louis, Mo, residents in 1989, 1991, and 1992. Results. Eighteen percent of the birth certificates and 54% of the medical records documented hyaline membrane disease, resulting in 34% sensitivity and 99% specificity. Conclusions. The Missouri State Department of Health birth- infant death certificate database underestimates the incidence of hyaline membrane disease, which suggests that national statistics for the disease are also underestimated. Handle: RePEc:aph:ajpbhl:1998:88:9:1387-1389_5 Template-Type: ReDIF-Article 1.0 Title: White, European, Western, Caucasian, or what? Inappropriate labeling in research on race, ethnicity, and health Journal: American Journal of Public Health Author-Name: Bhopal, R. Author-Name: Donaldson, L. Year: 1998 Volume: 88 Issue: 9 Pages: 1303-1307 Abstract: The quest for scientifically appropriate terminology in research on race, ethnicity, and health has largely bypassed the term White. This and other words, such as Caucasian, are embedded in clinical and epidemiological discourse, yet they are rarely defined. This commentary analyzes the issue from the perspective of the epidemiology of the health of minority ethnic and racial groups in Europe and the United States. Minority groups are usually compared with populations described as White, Caucasian, European, Europid, Western, Occidental, indigenous, native, and majority. Such populations are heterogeneous, the labels nonspecific, and the comparisons misleading. Terminology that reflects the research purpose - for example, reference, control, or comparison - is better (unlike White, these terms imply no norm), allowing neither writers nor readers to make stereo-typed assumptions about the comparison populations. This paper widens the debate on nomenclature for racial and ethnic groups. Many issues need exploration, including whether there is a shared understanding among the international research community of the terms discussed. Handle: RePEc:aph:ajpbhl:1998:88:9:1303-1307_6 Template-Type: ReDIF-Article 1.0 Title: The effect of WIC and Medicaid on infant mortality in the United States Journal: American Journal of Public Health Author-Name: Moss, N.E. Author-Name: Carver, K. Year: 1998 Volume: 88 Issue: 9 Pages: 1354-1361 Abstract: Objectives. This study examined the impact of participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and Medicaid on risk of infant death in the United States. Methods. The 1988 National Maternal and Infant Health Survey was used to consider the risk of endogenous and exogenous deaths among infants of women participating in WIC and Medicaid during pregnancy and the infant's first year. Results. Participation in the WIC program during pregnancy and infancy was associated with a reduced risk of endogenous and exogenous infant death (odds ratios [ORs] = 0.68 and 0.62, respectively). The risk of endogenous death among infants whose mothers participated in Medicaid during pregnancy was equal to that of the privately insured (OR = 1.04). Uninsured infants faced higher risks of endogenous death (OR = 1.42). Conclusions. These results show that it is important to consider the net effect of WIC and Medicaid participation and to differentiate both the timing of program receipt and cause of death. Evidence suggests that WIC and Medicaid programs have beneficial effects for poor women and their infants. Handle: RePEc:aph:ajpbhl:1998:88:9:1354-1361_8 Template-Type: ReDIF-Article 1.0 Title: Atopy in children and parental social class Journal: American Journal of Public Health Author-Name: Heinrich, J. Author-Name: Popescu, M.A. Author-Name: Wjst, M. Author-Name: Goldstein, I.F. Author-Name: Wichmann, H.-E. Year: 1998 Volume: 88 Issue: 9 Pages: 1319-1324 Abstract: Objectives. This analysis was conducted to determine whether atopic disorders were related to social class in a pediatric population of a former socialist country. Methods. A cross-sectional study of 2471 schoolchildren was carried out in 1992 and 1993 in 3 towns in the former East Germany. Parents completed a standardized questionnaire regarding health events and lifestyle factors. In addition, skin-prick tests were performed and total serum immunoglobulin (IgE) was determined. Results. Lifetime prevalence rates for atopic diseases and rates of allergic sensitization were highest in children from social class III (in which parents had more than 10 years of formal education) and lowest in social class I (less than 10 years of parental education), while rates in social class II (10 years of parental education) were constant at an intermediate level. Conclusions. The data confirmed the assumption that in formerly socialist countries social inequalities existed under the socialist system, which were reflected by a social gradient in health outcomes. The findings support the hypothesis that increased access to modern lifestyle could be one reason for the increasing rates of atopic disorders during the last 3 decades. Handle: RePEc:aph:ajpbhl:1998:88:9:1319-1324_0 Template-Type: ReDIF-Article 1.0 Title: Racial discrimination and skin color in the CARDIA study: Implications for public health research Journal: American Journal of Public Health Author-Name: Krieger, N. Author-Name: Sidney, S. Author-Name: Coakley, E. Year: 1998 Volume: 88 Issue: 9 Pages: 1308-1313 Abstract: Objectives. This study assessed whether skin color and ways of handling anger can serve as markers for experiences of racial discrimination and responses to unfair treatment in public health research. Methods. Survey data on 1844 Black women and Black men (24 to 42 years old), collected in the year 5 (1990-1991) and year 7 (1992-1993) examinations of the Coronary Artery Risk Development in Young Adults (CARDIA) study, were examined. Results. Skin color was not associated with self-reported experiences of racial discrimination in 5 of 7 specified situations (getting a job, at work, getting housing, getting medical care, in a public setting). Only moderate associations existed between darker skin color and being working class, having low income or low education, and being male (risk ratios under 2). Comparably moderate associations existed between internalizing anger and typically responding to unfair treatment as a fact of life or keeping such treatment to oneself. Conclusions. Self-reported experiences of racial discrimination and responses to unfair treatment should be measured directly in public health research; data on skin color and ways of handling anger are not sufficient. Handle: RePEc:aph:ajpbhl:1998:88:9:1308-1313_7 Template-Type: ReDIF-Article 1.0 Title: The prevalence of homelessness among adolescents in the United States Journal: American Journal of Public Health Author-Name: Ringwalt, C.L. Author-Name: Greene, J.M. Author-Name: Robertson, M. Author-Name: McPheeters, M. Year: 1998 Volume: 88 Issue: 9 Pages: 1325-1329 Abstract: Objectives. Homeless adolescents represent one of the nation's most vulnerable populations. This study reports the 12-month prevalence of homeless episodes among US adolescents. Methods. Personal, audiotaped interviews were conducted in 1992 and 1993 with a representative household sample of 6496 adolescents aged 12 to 17 as part of the Youth Risk Behavior Survey sponsored by the Centers for Disease Control and Prevention. Respondents reported whether they had spent the night in any of a variety of locations other than home during the previous 12 months. Results. Altogether, 7.6% of the youths questioned reported that they had spent at least 1 night in a youth or adult shelter (3.3%), a public place (2.2%), an abandoned building (1.0%), outside (2.2%), underground (0.4%), or with a stranger (1.1%). Boys were much more likely than girls to report having experienced a homeless episode. Conclusions. This study suggests that homelessness among adolescents is not simply an urban problem and that prevention programs targeting homeless youths should be implemented nationwide. Additional research is needed to assess the frequency and duration of homeless experiences. Future studies of homelessness in the general population should include questions pertinent to adolescents. Handle: RePEc:aph:ajpbhl:1998:88:9:1325-1329_3 Template-Type: ReDIF-Article 1.0 Title: Reactions of adult and teenaged smokers to the Massachusetts tobacco tax Journal: American Journal of Public Health Author-Name: Biener, L. Author-Name: Aseltine Jr., R.H. Author-Name: Cohen, B. Author-Name: Anderka, M. Year: 1998 Volume: 88 Issue: 9 Pages: 1389-1391 Abstract: Objectives. This study assessed smokers' reactions to a 25 cents cigarette tax imposed in Massachusetts. Methods. A statewide telephone survey of 1783 adult smokers and 216 teenaged smokers was conducted. Results. Among adult smokers, 3.5% reported that they had stopped smoking, owing in part to the price increase; 35% had considered quitting and 19% had attempted to cut the cost of smoking by switching to cheaper brands or cutting down. Among teenagers, 21% had considered quitting and 26% had cut costs. Low-income smokers were more responsive to the price increase than more affluent smokers. Conclusions. A modest and temporary price increase promoted quitting among adult smokers and reduced cigarette consumption among low-income teenagers. Handle: RePEc:aph:ajpbhl:1998:88:9:1389-1391_8 Template-Type: ReDIF-Article 1.0 Title: Dispensation of emergency contraceptive pills in Michigan Title X clinics Journal: American Journal of Public Health Author-Name: Brown, J.W. Author-Name: Boulton, M.L. Year: 1998 Volume: 88 Issue: 9 Pages: 1380-1383 Abstract: Objectives. Emergency contraceptive pill dispensation was estimated in Michigan Title X family planning programs. Methods. Logistic regression and tobit estimation models were used to predict whether and to what extent emergency contaceptive pills are dispensed. Results. Of the 530 programs studied, 32 dispensed emergency contraceptive pills, averaging fewer than one client per month. Total dispensation was skewed toward a few programs, and the contribution of health departments to this total was small. Emergency contraceptive pill services appeared to be randomly distributed across programs, although most dispensers reported having provided the pills for less than 12 months. Conclusions. Recent policy advances should lead to more consistent emergency contraceptive pill dispensation in Title X programs. Handle: RePEc:aph:ajpbhl:1998:88:9:1380-1383_4 Template-Type: ReDIF-Article 1.0 Title: The effect of WIC participation on small-for-gestational-age births: Michigan, 1992 Journal: American Journal of Public Health Author-Name: Ahluwalia, I.B. Author-Name: Hogan, V.K. Author-Name: Grummer-Strawn, L. Author-Name: Colville, W.R. Author-Name: Peterson, A. Year: 1998 Volume: 88 Issue: 9 Pages: 1374-1377 Abstract: Objectives. This study examined the relationship between enrollment in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and delivery of small-for-gestational-age infants. Methods. WIC records were linked with birth certificates for 1992 fullterm births; 41 234 WIC records and 18 534 non-WIC records were identified. Length of participation was defined by gestational age at enrollment. Logistic regression was used to examine the association between WIC participation and small-for-gestational- age births. Results. Odds ratios for small-for-gestational-age births decreased with increasing length of enrollment in WIC. Conclusions. Enrollment in WIC is associated with a lower prevalence of small-for- gestational-age deliveries. Handle: RePEc:aph:ajpbhl:1998:88:9:1374-1377_7 Template-Type: ReDIF-Article 1.0 Title: Evaluating cluster alarms: A space-time scan statistic and brain cancer in Los Alamos, New Mexico Journal: American Journal of Public Health Author-Name: Kulldorff, M. Author-Name: Athas, W.F. Author-Name: Feuer, E.J. Author-Name: Miller, B.A. Author-Name: Key, C.R. Year: 1998 Volume: 88 Issue: 9 Pages: 1377-1380 Abstract: Objectives. This article presents a space-time scan statistic, useful for evaluating space-time cluster alarms, and illustrates the method on a recent brain cancer cluster alarm in Los Alamos, NM. Methods. The space-time scan statistic accounts for the preselection bias and multiple testing inherent in a cluster alarm. Confounders and time trends can be adjusted for. Results. The observed excess of brain cancer in Los Alamos was not statistically significant. Conclusions. The space-time scan statistic is useful as a screening tool for evaluating which cluster alarms merit further investigation and which clusters are probably chance occurrences. Handle: RePEc:aph:ajpbhl:1998:88:9:1377-1380_5 Template-Type: ReDIF-Article 1.0 Title: The entry of underrepresented minority students into US medical schools: An evaluation of recent trends Journal: American Journal of Public Health Author-Name: Carlisle, D.M. Author-Name: Gardner, J.E. Author-Name: Liu, H. Year: 1998 Volume: 88 Issue: 9 Pages: 1314-1318 Abstract: Objectives. Recent challenges to affirmative action suggest the need to reassess the status of the admission of underrepresented minority students to US medical schools. Methods. The Association of American Medical Colleges provided US medical school enrollment data and characteristics. Five measures of underrepresented minority enrollment and an overall performance scale were constructed for each school. Multivariate regression identified significant overall performance predictors. Predicted and observed values were compared. Results. Underrepresented minority enrollment increased by 43% after 1986, peaked at 2014 in 1994, did not increase in 1995, and decreased by 5% in 1996. Enrollment was associated with increasing federal research funding and with percentage of underrepresented minorities in the source population (P < .001). The 1996 decline was almost entirely limited to public medical schools. Those in California, Texas, Mississippi, and Louisiana accounted for 18% of 1995 enrollment but 44% of the 1996 decline. Conclusions. Recent gains in medical school enrollment of underrepresented minorities are being reversed, particularly at public institutions. Implications exist for the health of poor, minority, and underserved communities, which are more likely to be cared for by underrepresented minority physicians. Handle: RePEc:aph:ajpbhl:1998:88:9:1314-1318_0 Template-Type: ReDIF-Article 1.0 Title: An assessment of US and Canadian smoking reduction objectives for the year 2000 Journal: American Journal of Public Health Author-Name: Pechmann, C. Author-Name: Dixon, P. Author-Name: Layne, N. Year: 1998 Volume: 88 Issue: 9 Pages: 1362-1367 Abstract: Objectives. This study assessed whether US and Canadian smoking reduction objectives for the year 2000 are attainable. The United States seeks to cut smoking in its population to 15%; the Canadian goal is 24%. Methods. Smoking data were obtained for the United States (1974-1994) and Canada (1970-1995) for the overall populations and several age-sex subpopulations. Analyses estimated trends, future prevalences, and the likelihood of goal attainment. Structural time-series models were used because of their ability to fit a variety of trends. Results. The findings indicate that smoking has been declining steadily since the 1970s, by approximately 0.7 percentage points a year, in both countries. Extrapolating these trends to the year 2000, the US prevalence will be 21% and the Canadian prevalence 24%. Conclusions. If the current trends continue, the Canadian goal seems attainable, but the US goal does not. The US goal is reachable only for 65 to 80-year-olds, who already have low smoking prevalences. It appears that both countries must increase their commitment to population- based tobacco control. Handle: RePEc:aph:ajpbhl:1998:88:9:1362-1367_6 Template-Type: ReDIF-Article 1.0 Title: Telephone coverage and measurement of health risk indicators: Data from the National Health Interview Survey Journal: American Journal of Public Health Author-Name: Anderson, J.E. Author-Name: Nelson, D.E. Author-Name: Wilson, R.W. Year: 1998 Volume: 88 Issue: 9 Pages: 1392-1395 Abstract: Objectives. This study compared health behavior variables for all US households and households with telephones to measure the potential impact of telephone coverage on estimates from telephone surveys. Methods. Data were derived from the 1991 through 1994 versions of the National Health Interview Survey. Results. Ninety-five percent of respondents lived in households with telephones. Differences in health indicators were small (<1%) in comparisons between all households and those with telephones. Results were similar when only respondents below the poverty level were included. Conclusions. Telephone noncoverage effects appear to be small, supporting the use of telephone surveys for health risk behavior surveillance with most population groups. Handle: RePEc:aph:ajpbhl:1998:88:9:1392-1395_1 Template-Type: ReDIF-Article 1.0 Title: Changes in indications for cesarean delivery: United States, 1985 and 1994 Journal: American Journal of Public Health Author-Name: Gregory, K.D. Author-Name: Curtin, S.C. Author-Name: Taffel, S.M. Author-Name: Notzon, F.C. Year: 1998 Volume: 88 Issue: 9 Pages: 1384-1387 Abstract: Objectives. The percentages of cesarean deliveries attributable to specific indications (breech, dystocia, fetal distress, and elective repeat cesarean) were computed for 1985 and 1994. Methods. Data were derived from the 1985 and 1994 National Hospital Discharge Surveys. Results. Dystocia was the leading indication for cesarean delivery in both years. In comparison with 1985, cesareans performed in 1994 that were attributable to dystocia and breech presentation increased, those attributable to fetal distress did not change significantly, and elective repeat cesareans declined. Conclusions. Studying indications for cesareans can be useful for hospitals, clinicians, and researchers in determining strategies to lower primary and repeat cesarean rates. Handle: RePEc:aph:ajpbhl:1998:88:9:1384-1387_6 Template-Type: ReDIF-Article 1.0 Title: Increasing access to contraceptives: On the map and in the bag Journal: American Journal of Public Health Author-Name: Fisher, J.L. Author-Name: Harris, K.J. Author-Name: Ransom, M.V. Author-Name: Paine-Andrews, A. Author-Name: Pulliam, S. Year: 1998 Volume: 88 Issue: 8 Pages: 1248-1249 Handle: RePEc:aph:ajpbhl:1998:88:8:1248-1249_8 Template-Type: ReDIF-Article 1.0 Title: Anal sex and HIV transmission in women Journal: American Journal of Public Health Author-Name: Karim, S.S.A. Author-Name: Ramjee, G. Year: 1998 Volume: 88 Issue: 8 Pages: 1265-1266 Handle: RePEc:aph:ajpbhl:1998:88:8:1265-1266_0 Template-Type: ReDIF-Article 1.0 Title: Salicylate intake and cardiovascular disease: Ingster and Feinleib respond to Hu and Willett [3] Journal: American Journal of Public Health Author-Name: Ingster, L.M. Author-Name: Feinleib, M. Year: 1998 Volume: 88 Issue: 8 Pages: 1268-1269 Handle: RePEc:aph:ajpbhl:1998:88:8:1268-1269_4 Template-Type: ReDIF-Article 1.0 Title: Difficult, dangerous, and drug seeking: The 3D way to better patient care Journal: American Journal of Public Health Author-Name: Carlson, M.J. Author-Name: Baker, L.H. Year: 1998 Volume: 88 Issue: 8 Pages: 1250-1252 Handle: RePEc:aph:ajpbhl:1998:88:8:1250-1252_7 Template-Type: ReDIF-Article 1.0 Title: Managed public health in a county jail Journal: American Journal of Public Health Author-Name: Alemagno, S.A. Author-Name: Wolfe, S.A. Author-Name: Pace, R.B. Author-Name: Shobert, R.L. Author-Name: Butts, J.M. Year: 1998 Volume: 88 Issue: 8 Pages: 1265 Handle: RePEc:aph:ajpbhl:1998:88:8:1265_8 Template-Type: ReDIF-Article 1.0 Title: A public health model to connect correctional health care with communities Journal: American Journal of Public Health Author-Name: Conklin, T.J. Author-Name: Lincoln, T. Author-Name: Flanigan, T.P. Year: 1998 Volume: 88 Issue: 8 Pages: 1249-1250 Handle: RePEc:aph:ajpbhl:1998:88:8:1249-1250_6 Template-Type: ReDIF-Article 1.0 Title: A note on policymakers as research subjects Journal: American Journal of Public Health Author-Name: Fox, D.M. Year: 1998 Volume: 88 Issue: 8 Pages: 1262-1263 Handle: RePEc:aph:ajpbhl:1998:88:8:1262-1263_7 Template-Type: ReDIF-Article 1.0 Title: Revisiting the intersection between domestic abuse and HIV risk [2] (multiple letters) Journal: American Journal of Public Health Author-Name: Molina, L.D. Author-Name: Basinait-Smith, C. Author-Name: Wingood, G.M. Author-Name: DiClemente, R.J. Year: 1998 Volume: 88 Issue: 8 Pages: 1267-1268 Handle: RePEc:aph:ajpbhl:1998:88:8:1267-1268_3 Template-Type: ReDIF-Article 1.0 Title: Locally based surveys, unite! The EURALIM example Journal: American Journal of Public Health Author-Name: Morabia, A. Author-Name: Beer-Borst, S. Author-Name: Hercberg, S. Year: 1998 Volume: 88 Issue: 8 Pages: 1153-1155 Handle: RePEc:aph:ajpbhl:1998:88:8:1153-1155_8 Template-Type: ReDIF-Article 1.0 Title: Lay health advisors: Sexually transmitted disease prevention through community involvement Journal: American Journal of Public Health Author-Name: Thomas, J.C. Author-Name: Eng, E. Author-Name: Clark, M. Author-Name: Robinson, J. Author-Name: Blumenthal, C. Year: 1998 Volume: 88 Issue: 8 Pages: 1252-1253 Handle: RePEc:aph:ajpbhl:1998:88:8:1252-1253_1 Template-Type: ReDIF-Article 1.0 Title: Anonymous HIV testing [4] Journal: American Journal of Public Health Author-Name: Moser, M. Year: 1998 Volume: 88 Issue: 4 Pages: 683 Handle: RePEc:aph:ajpbhl:1998:88:4:683_8 Template-Type: ReDIF-Article 1.0 Title: Outbreak of serogroup C meningococcal disease among preschool-aged children: Illinois, 1996 [7] Journal: American Journal of Public Health Author-Name: Austin, C.C. Author-Name: Fingar, A.R. Author-Name: Langkop, C. Year: 1998 Volume: 88 Issue: 4 Pages: 685 Handle: RePEc:aph:ajpbhl:1998:88:4:685_3 Template-Type: ReDIF-Article 1.0 Title: Trends in cigarette smoking: The Minnesota Heart Survey, 1980 through 1992 Journal: American Journal of Public Health Author-Name: Arnett, D.K. Author-Name: Sprafka, J.M. Author-Name: McGovern, P.G. Author-Name: Jacobs Jr., D.R. Author-Name: Shahar, E. Author-Name: McCarty, M. Author-Name: Luepker, R.V. Year: 1998 Volume: 88 Issue: 8 Pages: 1230-1233 Abstract: Objectives. The purpose of this study was to describe trends in the prevalence of cigarette smoking between 1980 through 1982 and 1990 through 1992 in Minneapolis and St. Paul, Minn. Methods. Three population-based surveys were conducted among adults 25 to 74 years of age in 1980 through 1982, 1985 through 1987, and 1990 through 1992. Results. Overall age-adjusted prevalences of cigarette smoking declined significantly between 1980-1982 and 1985-1987 and between 1985-1987 and 1990-1992. Serum thiocyanate, a biochemical marker for tobacco use, also declined significantly over the 3 periods. Conclusions. Favorable trends in smoking prevalence and cigarette consumption among smokers were observed, but disturbing trends in some smoking behaviors were also noted. Handle: RePEc:aph:ajpbhl:1998:88:8:1230-1233_5 Template-Type: ReDIF-Article 1.0 Title: Breast cancer detection: Maps of 2 San Francisco Bay Area counties Journal: American Journal of Public Health Author-Name: Selvin, S. Author-Name: Merrill, D.W. Author-Name: Erdmann, C. Author-Name: White, M. Author-Name: Ragland, K. Year: 1998 Volume: 88 Issue: 8 Pages: 1186-1192 Abstract: Objectives. This study describes the incidence of late-stage and in situ breast cancer among White women, using specialized mapping techniques that reflect incidence adjusted for the population at risk, and applies these maps to characterize areas with high and low risk of breast cancer. Methods. Data from the Surveillance, Epidemiology, and End Results (SEER) database and the US Census Bureau were used to study the geographic distribution of breast cancer at the census-tract level in 2 San Francisco Bay Area counties for the years 1978 through 1982. Sociodemographic characteristics of areas with high and low incidence of the stage-specific disease were compared by means of a linear discriminant function. Results. For late-stage breast cancer, the most important variables in discriminating high-risk from low-risk areas were college education, percentage of residents over age 65, and median income. The strongest ecologic indicators of high risk for in situ breast cancer were median income and percentage unemployed. Conclusions. This study demonstrates the usefulness of census tracts and sociodemographic measures of income and education in describing in situ and late-stage breast cancer. Handle: RePEc:aph:ajpbhl:1998:88:8:1186-1192_1 Template-Type: ReDIF-Article 1.0 Title: Perinatal mortality and its relationship to the reporting of low- birthweight infants Journal: American Journal of Public Health Author-Name: Phelan, S.T. Author-Name: Goldenberg, R. Author-Name: Alexander, G. Author-Name: Cliver, S.P. Year: 1998 Volume: 88 Issue: 8 Pages: 1236-1239 Abstract: Objectives. This study examined changes in the reporting of very low- birthweight infants in Alabama from 1974 to 1994 and the impact on perinatal mortality rates. Methods. Linked live birth, neonatal death, and stillbirth records of infants born weighing less than 1500 g were compared. Results. The changes in mortality over time ranged from a drop from 100% to 92% in the under-500-g group to a drop from 39% to 4% in the 1000- to 1499-g group. The percentage of total births weighing less than 500 g increased by 155%; the percentage of 1000- to 1499-g births increased by only 7%. As a result, the percentage of neonatal mortality attributable to live births below 500 g increased from 3% to 32%. Conclusions. Increased reporting of births below 500 g has masked improvements in neonatal mortality. Handle: RePEc:aph:ajpbhl:1998:88:8:1236-1239_2 Template-Type: ReDIF-Article 1.0 Title: Region of birth and black diets: The Harlem household survey Journal: American Journal of Public Health Author-Name: Greenberg, M.R. Author-Name: Schneider, D. Author-Name: Northridge, M.E. Author-Name: Ganz, M.L. Year: 1998 Volume: 88 Issue: 8 Pages: 1199-1202 Abstract: Objectives. This study compared dietary risk factors among Southern- born and other Blacks in Central Harlem. Methods. A survey of residents of Central Harlem was used to compute a 'healthy diet' score for 261 subjects. Results. Southern-born respondents had the highest-risk diets. Although their numbers were small, Caribbean-born respondents, particularly those younger than 45 years, had the lowest-risk diets. Conclusions. The variation in diets in Central Harlem was considerable, with Southern-born Blacks at highest dietary risk for chronic diseases. These results remain to be tested elsewhere, as does the contribution of other chronic disease risk factors. Handle: RePEc:aph:ajpbhl:1998:88:8:1199-1202_9 Template-Type: ReDIF-Article 1.0 Title: The association of non-insulin-dependent diabetes mellitus with perceived quality of life in a biethnic populations: The San Luis Valley Diabetes Study Journal: American Journal of Public Health Author-Name: Caldwell, E.M. Author-Name: Baxter, J. Author-Name: Mitchell, C.M. Author-Name: Shetterly, S.M. Author-Name: Hamman, R.F. Year: 1998 Volume: 88 Issue: 8 Pages: 1225-1229 Abstract: Objectives. This study evaluated the association between quality of life and non-insulin-dependent diabetes mellitus (NIDDM) status, and whether this association differs between Hispanics and non-Hispanic Whites. Methods. Between 1986 and 1989, cross-sectional data on perceived quality of life (PQOL) were collected from 223 persons with NIDDM and 753 non-diabetic subjects. Results. After adjustment, persons with NIDDM rated their PQOL significantly lower than did control subjects. The relationship of diabetes and PQOL did not differ by ethnicity. The number of complications of diabetes was not associated with lower PQOL scores. Conclusions. Control and treatment strategies should reflect an understanding of the impact that diabetes has on social functioning, leisure activities, and physical and mental health. Handle: RePEc:aph:ajpbhl:1998:88:8:1225-1229_7 Template-Type: ReDIF-Article 1.0 Title: Hip fracture incidence among elderly Hispanics Journal: American Journal of Public Health Author-Name: Lauderdale, D.S. Author-Name: Jacobsen, S.J. Author-Name: Furner, S.E. Author-Name: Levy, P.S. Author-Name: Brody, J.A. Author-Name: Goldberg, J. Year: 1998 Volume: 88 Issue: 8 Pages: 1245-1247 Abstract: Objectives. This study estimated hip fracture incidence for elderly Hispanics in the United States. Methods. A cohort of Spanish-surnamed 1992 Medicare enrollees was followed for 2 years. Hip fractures were identified by inpatient diagnostic code. Results. For Hispanic women, the national age- adjusted hip fracture rate was 7.3 per 1000 person-years; for men, the rate was 3.3. Rates varied markedly, with higher rates for the predominantly Mexican-American southwestern states than for Puerto Ricans. Conclusions. Nationally, the Hispanic population is at intermediate risk of hip fracture between Blacks and Whites, but geographic variation suggests that Mexican Americans are at higher risk than Puerto Ricans. Handle: RePEc:aph:ajpbhl:1998:88:8:1245-1247_4 Template-Type: ReDIF-Article 1.0 Title: The epidemiology of raw milk-associated foodborne disease outbreaks reported in the United States, 1973 through 1992 Journal: American Journal of Public Health Author-Name: Headrick, M.L. Author-Name: Korangy, S. Author-Name: Bean, N.H. Author-Name: Angulo, F.J. Author-Name: Altekruse, S.F. Author-Name: Potter, M.E. Author-Name: Klontz, K.C. Year: 1998 Volume: 88 Issue: 8 Pages: 1219-1221 Abstract: Objectives. This study describes the epidemiology of raw milk-associated outbreaks reported to the Centers for Disease Control and Prevention from 1973 through 1992. Methods. Surveillance data for each reported raw milk- associated outbreak were reviewed. A national survey was conducted to determine the legal status of intrastate raw milk sales for the period 1973 through 1995. Results. Forty-six raw milk-associated outbreaks were reported during the study period; 40 outbreaks (87%) occurred in states where the intrastate sale of raw milk was legal. Conclusions. Consumption of raw milk remains a preventable cause of foodborne disease outbreaks. Handle: RePEc:aph:ajpbhl:1998:88:8:1219-1221_7 Template-Type: ReDIF-Article 1.0 Title: Final results of the Maryland WIC 5-a-day promotion program Journal: American Journal of Public Health Author-Name: Havas, S. Author-Name: Anliker, J. Author-Name: Damron, D. Author-Name: Langenberg, P. Author-Name: Ballesteros, M. Author-Name: Feldman, R. Year: 1998 Volume: 88 Issue: 8 Pages: 1161-1167 Abstract: Objectives. This National Cancer Institute-funded study sought to increase fruit and vegetable consumption among women served by the WIC program in Maryland. Methods. Over a 2-year period, a multifaceted intervention program using a randomized crossover design sought to increase fruit and vegetable consumption at 16 WIC program sites in Baltimore City and 6 Maryland counties. Participants were surveyed at baseline, 2 months postintervention, and 1 year later. Results. Two months postintervention, mean daily consumption had increased by 0.56 ± 0.11 servings in intervention participants and 0.13 ± 0.07 servings in control participants (P = .002). Intervention participants also showed greater changes in stages of change, knowledge, attitudes, and self-efficacy. Changes in consumption were closely related to number of nutrition sessions attended, baseline stage of change, race, and education. One year later, mean consumption had increased by an additional 0.27 servings in both intervention and control participants. Conclusions. Dietary changes to prevent cancer can be achieved and sustained in this hard-to-reach, low-income population. However, many obstacles must be overcome to achieve such changes. Handle: RePEc:aph:ajpbhl:1998:88:8:1161-1167_8 Template-Type: ReDIF-Article 1.0 Title: The socially constructed breast: Breast implants and the medical construction of need Journal: American Journal of Public Health Author-Name: Jacobson, N. Year: 1998 Volume: 88 Issue: 8 Pages: 1254-1261 Abstract: When silicone gel breast implants became the subject of a public health controversy in the early 1990s, the most pressing concern was safety. This paper looks at another, less publicized issue: the need for implants. Using a symbolic interactionist approach, the author explores the social construction of the need for implants by tracing the history of the 3 surgical procedures for which implants were used. Stakeholders in this history constructed need as legitimized individual desire, the form of which shifted with changes in the technological and social context. Handle: RePEc:aph:ajpbhl:1998:88:8:1254-1261_5 Template-Type: ReDIF-Article 1.0 Title: Pregnant women as a reservoir of undetected sexually transmitted diseases in rural South Africa: Implications for disease control Journal: American Journal of Public Health Author-Name: Sturm, A.W. Author-Name: Wilkinson, D. Author-Name: Ndovela, N. Author-Name: Bowen, S. Author-Name: Connolly, C. Year: 1998 Volume: 88 Issue: 8 Pages: 1243-1245 Abstract: Objectives. This study was undertaken to determine the prevalence of sexually transmitted diseases (STDs) in pregnant women in rural South Africa and to determine the value of using abnormal urogenital symptoms to identify infected women. Methods. This was a cross-sectional study of 327 patients attending prenatal clinics. Results. Of the 271 women with complete data, 141 (52%) had at least 1 STD and 49 (18%) had more than 1. Abnormal symptoms were common (n = 225; 83%), but associations were weak, and the positive predictive value of different symptoms for infection ranged from 2% to 54%. Conclusions. Most STDs in rural South African women remain undetected and untreated. As the scope for laboratory diagnosis in resource-poor settings is limited, presumptive treatment of pregnant women and their partners may be a cost-effective option to reduce transmission of STDs and HIV infection. Handle: RePEc:aph:ajpbhl:1998:88:8:1243-1245_4 Template-Type: ReDIF-Article 1.0 Title: Norplant selection and satisfaction among low-income women Journal: American Journal of Public Health Author-Name: Clarke, L.L. Author-Name: Schmitt, K. Author-Name: Bono, C.A. Author-Name: Steele, J. Author-Name: Miller, M.K. Year: 1998 Volume: 88 Issue: 8 Pages: 1175-1181 Abstract: Objectives. This study examined correlates of Norplant selection and satisfaction among low-income women. Methods. Interviews were completed in family planning clinics in 4 Florida counties with 1152 Norplant users and 1268 nonusers, with follow-up interviews with a subsample up to 1 year later. Logistic regression models estimated the associations of socio-demographic and medical characteristics with Norplant selection and method satisfaction. Results. Odds ratios for Norplant selection were significantly greater among women who planned to have children in 5 or more years, those who were 'offered' Norplant, those who lived in Palm Beach County, those who were using drugs, and those who were Medicaid clients. Women younger than 17 and those who learned about Norplant from a friend were twice as likely as others to select Norplant. Ninety-two percent of Norplant users were satisfied with the method; women with side effects and those who felt pressure to select a method were significantly less likely than others to be satisfied. Conclusions. Norplant provides an acceptable and satisfying method of birth control for many low-income women. Proper counseling about all methods of birth control and about Norplant's side effects remains critical to the appropriate delivery of this method. Handle: RePEc:aph:ajpbhl:1998:88:8:1175-1181_8 Template-Type: ReDIF-Article 1.0 Title: Cost-effectiveness of a community-level HIV risk reduction intervention Journal: American Journal of Public Health Author-Name: Pinkerton, S.D. Author-Name: Holtgrave, D.R. Author-Name: DiFranceisco, W.J. Author-Name: Stevenson, L.Y. Author-Name: Kelly, J.A. Year: 1998 Volume: 88 Issue: 8 Pages: 1239-1242 Abstract: Objectives. The authors evaluated the cost-effectiveness of a community- level HIV prevention intervention that used peer leaders to endorse risk reduction among gay men. Methods. A mathematical model of HIV transmission was used to translate reported changes in sexual behavior into an estimate of the number of HIV infections averted. Results. The intervention cost $17 150, or about $65 000 per infection averted, and was therefore cost-saving, even under very conservative modeling assumptions. Conclusions. For this intervention, the cost of HIV prevention was more than offset by savings in averted future medical care costs. Community-level interventions to prevent HIV transmission that use existing social networks can be highly cost- effective. Handle: RePEc:aph:ajpbhl:1998:88:8:1239-1242_5 Template-Type: ReDIF-Article 1.0 Title: The impact of short interpregnancy intervals on pregnancy outcomes in a low-income population Journal: American Journal of Public Health Author-Name: Klerman, L.V. Author-Name: Cliver, S.P. Author-Name: Goldenberg, R.L. Year: 1998 Volume: 88 Issue: 8 Pages: 1182-1185 Abstract: Objectives. The objective of this study was to determine whether the length of the interval between pregnancies was associated with either preterm birth or intrauterine growth retardation in a low-income, largely Black population. Methods. The study population consisted of 4400 women who had received prenatal care in county clinics and had two consecutive singleton births between 1980 and 1990. Results. Interpregnancy intervals were positively associated with age and negatively associated with the trimester in which care was initiated in the second pregnancy. Whites had shorter intervals than non-Whites. The percentage of preterm births increased as the length of the interpregnancy interval decreased, but only for women who had not had a previous preterm birth. The association between interval and preterm birth was maintained when other factors associated with preterm birth were controlled. There was no significant relationship between intrauterine growth retardation and interpregnancy interval. Conclusions. Women, particularly those who are poor and young, should be advised of the potential harm to their infants of short interpregnancy intervals. Handle: RePEc:aph:ajpbhl:1998:88:8:1182-1185_8 Template-Type: ReDIF-Article 1.0 Title: Trends in food label use associated with new nutrition labeling regulations Journal: American Journal of Public Health Author-Name: Kristal, A.R. Author-Name: Levy, L. Author-Name: Patterson, R.E. Author-Name: Li, S.S. Author-Name: White, E. Year: 1998 Volume: 88 Issue: 8 Pages: 1212-1215 Abstract: Objectives. This study compared use of food labels before an after implementation of new Food and Drug Administration regulation in 1994. Methods. Data were obtained by random-digit-dial surveys of Washington State residents in 1993 (n = 1001) and 1996 (n = 1450). Results. After implementation of the new regulations, usual label use increased significantly, by 8.5 percentage points in women and 11.3 percentage points in men. More respondents looked for information on fat content and fewer failed to use labels because they 'take too much time' or 'are too hard to understand.' Conclusions. Use of food labels and satisfaction with their content have increased, but 70% of adults still want labels to be easier to understand. Handle: RePEc:aph:ajpbhl:1998:88:8:1212-1215_9 Template-Type: ReDIF-Article 1.0 Title: 1996 congressional campaign priorities of the AMA: Tackling tobacco or limiting malpractice awards? Journal: American Journal of Public Health Author-Name: Sharfstein, J. Year: 1998 Volume: 88 Issue: 8 Pages: 1233-1236 Abstract: Objectives. This study sought to determine whether the political action committee of the American Medical Association (AMA) contributed more to pro- or anti-tobacco members of Congress in the 1995/96 campaign and whether representatives' voting records on malpractice reform could explain the AMA's contribution patterns. Methods. Campaign contributions to House members were analyzed. Results. The AMA's political action committee contributed averages of $5382 to pro-tobacco representatives and $2103 to anti-tobacco representatives (P < .0005). This contribution pattern can be fully explained by representatives' votes to limit malpractice awards. Conclusions. In seeking malpractice reform, the AMA contributed significantly more to pro- tobacco representatives, potentially undermining tobacco control legislation. Handle: RePEc:aph:ajpbhl:1998:88:8:1233-1236_7 Template-Type: ReDIF-Article 1.0 Title: Dietary cardiovascular risk factors and serum cholesterol in an old order Mennonite community Journal: American Journal of Public Health Author-Name: Glick, M. Author-Name: Michel, A.C. Author-Name: Dorn, J. Author-Name: Horwitz, M. Author-Name: Rosenthal, T. Author-Name: Trevisan, M. Year: 1998 Volume: 88 Issue: 8 Pages: 1202-1205 Abstract: Objectives. Dietary and coronary heart disease risk factors in Old Order Mennonite men and women were examined. Methods. A food frequency questionnaire was mailed to 250 Mennonites who had participated in a previous study of coronary heart disease risk factors. Results. Mennonites consumed a diet high in total fat, saturated fats, and cholesterol. Men had lower average serum cholesterol levels (174 mg/dL) than women (191 mg/dL). Conclusions. The Mennonites diet was similar to that of the overall US population in saturated fat percentage and higher in cholesterol. Serum cholesterol levels, adiposity, and blood pressure were lower than expected among Mennonite men, perhaps because of their higher levels of physical activity. Handle: RePEc:aph:ajpbhl:1998:88:8:1202-1205_4 Template-Type: ReDIF-Article 1.0 Title: Health care reform in Croatia: For better or for worse? Journal: American Journal of Public Health Author-Name: Chen, M.-S. Author-Name: Mastilica, M. Year: 1998 Volume: 88 Issue: 8 Pages: 1156-1160 Abstract: Along with the rest of Central and Eastern Europe, Croatia has begun to dismantle its long-standing socialists health care system and to replace it with a market-based approach. Marketization's advocates maintain that the market will bring efficiency and quality to the Croatian health care system. Nevertheless, data from consumer surveys and official statistics reflect the reform's hidden costs: limited access to care, heightened costs, growing inequality, and the deemphasis of preventive and proactive care in favor of costly therapeutic medicine. Handle: RePEc:aph:ajpbhl:1998:88:8:1156-1160_0 Template-Type: ReDIF-Article 1.0 Title: Is anorexia nervosa associated with elevated rates of suicide? Journal: American Journal of Public Health Author-Name: Coren, S. Author-Name: Hewitt, P.L. Year: 1998 Volume: 88 Issue: 8 Pages: 1206-1207 Abstract: Objectives. The purpose of this study was to ascertain whether individuals with anorexia nervosa are more likely to commit suicide, as suggested by previously noted associations between anorexia nervosa and mood disorders. Methods. Data from death records representing over 5 million women were examined, yielding 571 cases in which anorexia nervosa was mentioned as an existing condition. The women with anorexia were compared with 1713 control subjects matched for age, sex, and race. Results. The percentage of suicides among those listed as having anorexia nervosa was only 1.4%, compared with 4.1% for the controls. Conclusions. These findings suggest that the suicide rate is not elevated among individuals currently suffering from anorexia nervosa. Handle: RePEc:aph:ajpbhl:1998:88:8:1206-1207_4 Template-Type: ReDIF-Article 1.0 Title: Comparison of 4 questionnaires for assessment of fruit and vegetable intake Journal: American Journal of Public Health Author-Name: Field, A.E. Author-Name: Colditz, G.A. Author-Name: Fox, M.K. Author-Name: Byers, T. Author-Name: Serdula, M. Author-Name: Bosch, R.J. Author-Name: Peterson, K.E. Year: 1998 Volume: 88 Issue: 8 Pages: 1216-1218 Abstract: Objective. This study compared fruit and vegetable assessments derived from 4 self-administered questionnaires. Methods. Among 102 adolescents, servings of fruits and vegetables assessed by 4 questionnaires were compared with estimates from 24-hour recalls. Results. The prevalence of consuming 5 or more servings of fruits and vegetables a day was underestimated by the questionnaires. Questionnaires asking subjects to recall their diet over the previous year were more effective in ranking subjects (r's ≤ .42) than those assessing previous-day diet (r's ≤ .30). Conclusions. Brief assessments of fruit and vegetable intake are more useful for ranking subjects than for estimating prevalence of consumption of 5 or more servings per day. Handle: RePEc:aph:ajpbhl:1998:88:8:1216-1218_9 Template-Type: ReDIF-Article 1.0 Title: The effects of community policies to reduce youth access to tobacco Journal: American Journal of Public Health Author-Name: Forster, J.L. Author-Name: Murray, D.M. Author-Name: Wolfson, M. Author-Name: Blaine, T.M. Author-Name: Wagenaar, A.C. Author-Name: Hennrikus, D.J. Year: 1998 Volume: 88 Issue: 8 Pages: 1193-1198 Abstract: Objectives. This study tested the hypothesis that adoption and implementation of local policies regarding youth access to tobacco can affect adolescent smoking. Methods. A randomized community trial was conducted in 14 Minnesota communities. Seven intervention communities participated in a 32- month community-organizing effort to mobilize citizens and activate the community. The goal was to change ordinances, merchant policies and practices, and enforcement practices to reduce youth access to tobacco. Outcome measures were derived from surveys of students before and after the intervention and from tobacco purchase attempts in all retail outlets in the communities. Data analyses used mixed-model regression to account for the clustering within communities and to adjust for covariates. Results. Each intervention community passed a comprehensive youth access ordinance. Intervention communities showed less pronounced increases in adolescent daily smoking relative to control communities. Tobacco purchase success declined somewhat more in intervention than control communities during the study period, but this difference was not statistically significant. Conclusions. This study provides compelling evidence that policies designed to reduce youth access to tobacco can have a significant effect on adolescent smoking rates. Handle: RePEc:aph:ajpbhl:1998:88:8:1193-1198_4 Template-Type: ReDIF-Article 1.0 Title: Serum ascorbic acid and other correlates of gallbladder disease among US adults Journal: American Journal of Public Health Author-Name: Simon, J.A. Author-Name: Hudes, E.S. Year: 1998 Volume: 88 Issue: 8 Pages: 1208-1212 Abstract: Objectives. This study examined the correlates of clinical gallbladder disease among US adults and whether serum ascorbic acid levels are associated with a decreased prevalence of gallbladder disease. Methods. Cross-sectional analyses of data from the Second National Health and Nutrition Examination Survey were conducted. Results. A total of 384 women (8%) and 107 men (3%) reported a history of gallstone disease, and 347 women (7%) and 81 men (2%) reported a history of cholecystectomy. An inverted U-shaped relation was found between serum ascorbic acid level and clinical gallbladder disease among women but not among men. Conclusions. Ascorbic acid, which affects the catabolism of cholesterol to bile acids and, in turn, the development of gallbladder disease in experimental animals, may reduce the risk of clinical gallbladder disease in humans. Handle: RePEc:aph:ajpbhl:1998:88:8:1208-1212_6 Template-Type: ReDIF-Article 1.0 Title: Implications of the Institute of Medicine weight gain recommendations for preventing adverse pregnancy outcomes in Black and White women Journal: American Journal of Public Health Author-Name: Caulfield, L.E. Author-Name: Stoltzfus, R.J. Author-Name: Witter, F.R. Year: 1998 Volume: 88 Issue: 8 Pages: 1168-1174 Abstract: Objectives. This study examined the relation between gestational weight gain and risk of delivering a small-for-gestational-age or large-for- gestational-age infant by race, along with the implications of gaining weight according to the Institute of Medicine guidelines. Methods. Logistic regression methods were used to identify risk factors for small- and large- for-gestational-age births among 2617 Black and 1253. White women delivering at the Johns Hopkins Hospital between 1987 and 1989. Results. Rate of total weight gain was related to risk of small- and large for-gestational-age births; the relationship differed according to maternal body mass index but not race. No differences in outcome by race were evident for women with low body mass indexes, among those with average or high indexes, however. Black women were at higher risk of small-for-gestational-age births and at lower risk of large-for-gestational-age births. Conclusions. Having Black women gain at the upper end of the recommended range is unlikely to produce measurable reductions in small-for-gestational-age births. Some beneficial reductions in the risk of large-for-gestational-age births may occur if weight gain recommendations are lowered for average-weight and overweight White women. Handle: RePEc:aph:ajpbhl:1998:88:8:1168-1174_5 Template-Type: ReDIF-Article 1.0 Title: Milk consumption in older Americans Journal: American Journal of Public Health Author-Name: Elbon, S.M. Author-Name: Johnson, M.A. Author-Name: Fischer, J.G. Year: 1998 Volume: 88 Issue: 8 Pages: 1221-1224 Abstract: Objectives. The purpose of this study was to identify individual characteristics associated with types and frequency of milk consumption in older American adults. Methods. A national probability-based sample (response rate = 91%) completed a telephone survey. Generalized logit and cumulative logit analyses were used to identify predictors of and barriers to fluid milk consumption in 494 elderly people. Results. The likelihood of drinking skim or 1% milk rather than whole milk increased with nutrition knowledge, income, trying to reduce cholesterol intake, and being female (P < .05). Frequency of milk consumption was higher with nutrition knowledge, frequency of milk consumption during adolescence, and following a diabetic diet but was lower with milk intolerance. Conclusions. The present results could be used to develop intervention strategies for improving milk consumption rates among older adults. These strategies might focus on increasing elderly people's awareness of milk intolerance and lactose-reduced milk products and their concern about cholesterol. The relationship between current and adolescent milk consumption suggests that intervention strategies should begin early in life. Handle: RePEc:aph:ajpbhl:1998:88:8:1221-1224_9 Template-Type: ReDIF-Article 1.0 Title: A model for the efficient and effective enforcement of tobacco sales laws Journal: American Journal of Public Health Author-Name: DiFranza, J.R. Author-Name: Celebucki, C.C. Author-Name: Hong Gwan Seo Year: 1998 Volume: 88 Issue: 7 Pages: 1100-1101 Handle: RePEc:aph:ajpbhl:1998:88:7:1100-1101_9 Template-Type: ReDIF-Article 1.0 Title: Topics for our times: New health care data - New horizons for public health Journal: American Journal of Public Health Author-Name: Harman, J. Year: 1998 Volume: 88 Issue: 7 Pages: 1019-1021 Handle: RePEc:aph:ajpbhl:1998:88:7:1019-1021_4 Template-Type: ReDIF-Article 1.0 Title: Integration of service, education, and research in local official public health agencies Journal: American Journal of Public Health Author-Name: Chambers, L.W. Author-Name: Hoey, J. Author-Name: Underwood, J. Author-Name: Bains, N. Year: 1998 Volume: 88 Issue: 7 Pages: 1102-1104 Handle: RePEc:aph:ajpbhl:1998:88:7:1102-1104_7 Template-Type: ReDIF-Article 1.0 Title: Ethical dilemmas in polio eradication [6] Journal: American Journal of Public Health Author-Name: Taylor, C.E. Author-Name: Cutts, F. Year: 1998 Volume: 88 Issue: 7 Pages: 1125 Handle: RePEc:aph:ajpbhl:1998:88:7:1125_9 Template-Type: ReDIF-Article 1.0 Title: Taking chances: Problem gamblers and mental health disorders - Results from the St. Louis epidemiologic catchment area study Journal: American Journal of Public Health Author-Name: Cunningham-Williams, R.M. Author-Name: Cottler, L.B. Author-Name: Compton III, W.M. Author-Name: Spitznagel, E.L. Year: 1998 Volume: 88 Issue: 7 Pages: 1093-1095 Abstract: Objectives. This study determined prevalence estimates of problem gambling and relationships to other psychiatric and substance use disorders. Methods. In 1981, the Diagnostic Interview Schedule was used to collect epidemiological information on problem gambling and other disorders from 3004 adults in St. Louis, Mo. Results. The lifetime prevalence of pathological gambling was 0.9%; 46% of those surveyed gambled recreationally. Problem gamblers (those reporting at least one gambling-related problem) were 92% of the sample and predominately White (69%), male (78.2%), and younger than nongamblers. They were at increased risk for several psychiatric diagnoses, especially for antisocial personality disorder, alcoholism, and tobacco dependence. Conclusions. Clinicians treating alcoholism and tobacco dependence may need to screen for problem gambling. Additional research in the context of increased gambling opportunities is needed. Handle: RePEc:aph:ajpbhl:1998:88:7:1093-1095_4 Template-Type: ReDIF-Article 1.0 Title: Medicaid and immunization coverage [3] Journal: American Journal of Public Health Author-Name: Dunn, R.A. Author-Name: McCardel, L. Author-Name: Fasano, N. Author-Name: Thelen, J. Author-Name: Johnson, D.R. Year: 1998 Volume: 88 Issue: 7 Pages: 1123-1124 Handle: RePEc:aph:ajpbhl:1998:88:7:1123-1124_1 Template-Type: ReDIF-Article 1.0 Title: Salicylate intake and cardiovascular disease [4] Journal: American Journal of Public Health Author-Name: Hu, F.B. Author-Name: Willett, W.C. Year: 1998 Volume: 88 Issue: 7 Pages: 1124 Handle: RePEc:aph:ajpbhl:1998:88:7:1124_0 Template-Type: ReDIF-Article 1.0 Title: Has the US mortality differential by socioeconomic status increased over time? [5] Journal: American Journal of Public Health Author-Name: Duleep, H.O. Year: 1998 Volume: 88 Issue: 7 Pages: 1125 Handle: RePEc:aph:ajpbhl:1998:88:7:1125_0 Template-Type: ReDIF-Article 1.0 Title: Promoting skin cancer prevention counseling by pharmacists Journal: American Journal of Public Health Author-Name: Mayer, J.A. Author-Name: Eckhardt, L. Author-Name: Stepanski, B.M. Author-Name: Sallis, J.F. Author-Name: Elder, J.P. Author-Name: Slymen, D.J. Author-Name: Creech, L. Author-Name: Graf, G. Author-Name: Palmer, R.C. Author-Name: Rosenberg, C. Author-Name: Souvignier, S.T. Year: 1998 Volume: 88 Issue: 7 Pages: 1096-1099 Abstract: Objectives. This study evaluated the effects of an intervention on rates of skin cancer prevention counseling by pharmacists. Methods. Fifty-four pharmacies were randomly assigned to intervention or control conditions. Intervention consisted of training, feedback, and prompts. Counseling rates before and after the intervention were obtained from study confederates. Results. At pretest, the proportions of control and intervention sites providing counseling at last once were 7.4% and 0%, respectively (NS). At posttest, these proportions were 3.7% and 66.7%, respectively (P < .001). Conclusions. The results indicated that the intervention was successful and that pharmacists can play an important role in educating the public about skin cancer prevention strategies. Handle: RePEc:aph:ajpbhl:1998:88:7:1096-1099_8 Template-Type: ReDIF-Article 1.0 Title: Topics for our times: Welfare reform and women's health Journal: American Journal of Public Health Author-Name: Chavkin, W. Author-Name: Wise, P.H. Author-Name: Elman, D. Year: 1998 Volume: 88 Issue: 7 Pages: 1017-1018 Handle: RePEc:aph:ajpbhl:1998:88:7:1017-1018_3 Template-Type: ReDIF-Article 1.0 Title: Reducing the incidence of congenital syphilis in Milwaukee: A public/private partnership Journal: American Journal of Public Health Author-Name: Swain, G.R. Author-Name: Kowalewski, S.J. Author-Name: Schubot, D.B. Year: 1998 Volume: 88 Issue: 7 Pages: 1101-1102 Handle: RePEc:aph:ajpbhl:1998:88:7:1101-1102_5 Template-Type: ReDIF-Article 1.0 Title: Methylphenidate in the United States, 1990 through 1995 [1] Journal: American Journal of Public Health Author-Name: Morrow, R.C. Author-Name: Morrow, A.L. Author-Name: Haislip, G. Year: 1998 Volume: 88 Issue: 7 Pages: 1121 Handle: RePEc:aph:ajpbhl:1998:88:7:1121_9 Template-Type: ReDIF-Article 1.0 Title: California trends reveal teenage violence myths [2] Journal: American Journal of Public Health Author-Name: Males, M. Year: 1998 Volume: 88 Issue: 7 Pages: 1123 Handle: RePEc:aph:ajpbhl:1998:88:7:1123_8 Template-Type: ReDIF-Article 1.0 Title: Differences between completers and early dropouts from 2 HIV intervention trials: A health belief approach to understanding prevention program attrition Journal: American Journal of Public Health Author-Name: DiFranceisco, W. Author-Name: Kelly, J.A. Author-Name: Sikkema, K.J. Author-Name: Somlai, A.M. Author-Name: Murphy, D.A. Author-Name: Stevenson, L.Y. Year: 1998 Volume: 88 Issue: 7 Pages: 1068-1073 Abstract: Objectives. The purpose of this study was to identify factors predicting program attrition among participants in human immunodeficiency virus (HIV) risk reduction trials. Methods. Participants were gay/bisexual men and severely mentally ill adults recruited to take part in HIV risk reduction small-group interventions. Program completers were compared with participants who were assessed at baseline but then failed to attend any sessions. The health belief model provided a framework for selection of possible predictors of program attrition. Results. Younger age was associated with early dropout in both samples. Other predictors among gay/bisexual men included involvement in an exclusive sexual relationship, minority ethnicity, injection drug use, and higher perceived severity of AIDS. Severely mentally ill dropouts were less knowledgeable about safer sex methods and more likely to hold positive outcome expectancies for condom use. Conclusions. Evaluation of intervention effectiveness among vulnerable population segments is threatened if there is selective attrition. Better methods are needed to attract and maintain participation in HIV prevention programs. Alternatively, wider application of 'intention to treat' analysis of intervention outcomes is recommended to minimize selection bias due to program dropout. Handle: RePEc:aph:ajpbhl:1998:88:7:1068-1073_8 Template-Type: ReDIF-Article 1.0 Title: Prevalence of cigar use in 22 North American communities: 1989 and 1993 Journal: American Journal of Public Health Author-Name: Hyland, A. Author-Name: Cummings, K.M. Author-Name: Shopland, D.R. Author-Name: Lynn, W.R. Year: 1998 Volume: 88 Issue: 7 Pages: 1086-1089 Abstract: Objectives. This study examined the prevalence rate of and characteristics associated with cigar use. Methods. Data were derived from population-based telephone surveys of adults conducted in 22 North American communities in 1989 and 1993 as part of the National Cancer Institute's Community Intervention Trial for Smoking Cessation. Results. Averaged across the 22 communities, the prevalence rate of regular cigar use increased 133% from 1989 to 1993. Regular cigar use increased in every gender, age, race, income, education, and smoking status category. Conclusion. These results confirm other data indicating that cigar use is increasing. Handle: RePEc:aph:ajpbhl:1998:88:7:1086-1089_8 Template-Type: ReDIF-Article 1.0 Title: The effect of work status on initiation and duration of breast-feeding Journal: American Journal of Public Health Author-Name: Fein, S.B. Author-Name: Roe, B. Year: 1998 Volume: 88 Issue: 7 Pages: 1042-1046 Abstract: Objectives. In this study, longitudinal data are used to examine the effect of work status on breast-feeding initiation and duration. Methods. Mothers from a mail panel completed questionnaires during late pregnancy and 10 times in the infant's first year. Mother's work status was categorized for initiation by hours she expected, before delivery, to work and for duration by hours she worked at month 3. Covariates were demographics; parity; medical, delivery, and hospital experiences; social support, embarrassment; and health promotion. Results. Expecting to work part-time neither decreased nor increased the probability of breast-feeding relative to expecting not to work (odds ratios [ORs] = .83 and .89, P > .50), but expecting to work full- time decreased the probability of breast-feeding (OR = .47, P<.01). Working full-time at 3 months postpartum decreased breast-feeding duration by an average of 8.6 weeks (P<.001) relative to not working, but part-time work of 4 or fewer hours per day did not affect duration, and part-time work of more than 4 hours per day decreased duration less than full-time work. Conclusion. Part-time work is an effective strategy to help mothers combine breast- feeding and employment. Handle: RePEc:aph:ajpbhl:1998:88:7:1042-1046_7 Template-Type: ReDIF-Article 1.0 Title: Directly observed therapy and treatment completion for tuberculosis in the United States: Is universal supervised therapy necessary? Journal: American Journal of Public Health Author-Name: Bayer, R. Author-Name: Stayton, C. Author-Name: Desvarieux, M. Author-Name: Healton, C. Author-Name: Landesman, S. Author-Name: Tsai, W.-Y. Year: 1998 Volume: 88 Issue: 7 Pages: 1052-1058 Abstract: Objectives. This study examined the relationship between directly observed therapy and treatment completion rates in the years before and after infusion of federal funding for tuberculosis (TB) control in 1993. Methods. An ecological study of estimated directly observed therapy rates and 12- month treatment completion rates from 1990 through 1994 was undertaken for TB control programs in all 25 cities and counties across the nation with 100 or more incident TB cases in any year from 1990 to 1993. Three cohorts were formed: high treatment completion, intermediate completion, and low completion. Results. In 1990, the median 12-month treatment completion rate was 80% for the entire study population, with a median estimated directly observed therapy rate of 16.8%. By 1994, those rates had increased to 87% and 49.4%, respectively, and increases were shown in all 3 cohorts. Conclusions. Directly observed therapy has had a marked impact on treatment completion rates in jurisdictions with historically low rates. But TB treatment completion rates of more than 90% can be attained with directly observed therapy rates far lower than those proposed by advocates of universal supervised therapy. Handle: RePEc:aph:ajpbhl:1998:88:7:1052-1058_6 Template-Type: ReDIF-Article 1.0 Title: Distinct trends in tuberculosis morbidity among foreign-born and US- born persons in New Jersey, 1986 through 1995 Journal: American Journal of Public Health Author-Name: Liu, Z. Author-Name: Shilkret, K.L. Author-Name: Tranotti, J. Author-Name: Freund, C.G. Author-Name: Finelli, L. Year: 1998 Volume: 88 Issue: 7 Pages: 1064-1067 Abstract: Objectives. This study evaluated tuberculosis (TB) morbidity trends among foreign born and US-born persons. Methods. TB surveillance data in New Jersey from 1986 to 1995 were analyzed. Results. The overall TB incidence rate in New Jersey declined 15% from 1992 to 1995 after 7 years of increase. However, the incidence rate of TB in foreign-born persons increased 75% from 1986 through 1995. The proportion of foreign-born persons with TB increased from 20% in 1986 to 37% in 1995. Conclusions. TB morbidity among foreign- born persons had continued to increase, despite the decline in overall TB morbidity since 1992. Targeted TB prevention and control strategies should be developed to effectively reduce TB morbidity in foreign-born persons. Handle: RePEc:aph:ajpbhl:1998:88:7:1064-1067_0 Template-Type: ReDIF-Article 1.0 Title: Public health nihilism vs pragmatism: History, politics, and the control of tuberculosis Journal: American Journal of Public Health Author-Name: Fairchild, A.L. Author-Name: Oppenheimer, G.M. Year: 1998 Volume: 88 Issue: 7 Pages: 1105-1117 Abstract: Tuberculosis (TB) began to decline in the Western world in the mid- to late 1800s. In the United States, the disease receded until the mid-1980s, when that trend was reversed. Although the TB epidemic in the United States subsided in response to public health interventions, it sparked a controversy regarding the relative value of targeted public health measures vs broad social reform. That controversy, which echoed earlier debates calling for structural reform over public health programs, was further strengthened by the historical and demographic studies of Thomas McKeown. His influential thesis maintains that clinical and primary prevention efforts had little effect on TB mortality. In this paper, the historical literature is used to example whether public health had a significant impact on the decline of TB mortality rates in several countries. Specifically, the paper describes the arguments for and data affirming the efficacy of 2 major public health interventions over time: segregation of those infected with pulmonary TB and eradication of bovine TB. This review finds support for the hypothesis that public health measures, along with other factors, led to falling rates of TB mortality beginning in the late 19th century. Handle: RePEc:aph:ajpbhl:1998:88:7:1105-1117_9 Template-Type: ReDIF-Article 1.0 Title: Lung cancer from passive smoking at work Journal: American Journal of Public Health Author-Name: Wells, A.J. Year: 1998 Volume: 88 Issue: 7 Pages: 1025-1029 Abstract: Objectives. This study was undertaken to determine whether exposure at work to environmental tobacco smoke is associated with an increased risk of lung cancer. Methods. Data from 14 studies providing information on lung cancer and exposure to environmental tobacco smoke at work were examined. Six quality criteria were developed for determining usable data. A meta-analysis was performed to obtain a combined risk for those data that met the quality restrictions. Results. Five studies met the quality standards. Their combined relative risk was 1.39 (95% confidence interval [CI] = 1.15, 1.68) based on 835 lung cancer cases. In various meta-analyses prepared by tobacco industry employees or consultants, no increase in risk was found. The main reason for this difference is that the earlier analysts failed to find errors in 2 underlying studies that resulted in overweighing of the odds ratios from those studies, both of which were less than unity. Conclusions. When appropriate cognizance is taken of the quality of data inputs, the increase in lung cancer risk from workplace exposure to environmental tobacco smoke is about the same as that from household exposure. Handle: RePEc:aph:ajpbhl:1998:88:7:1025-1029_0 Template-Type: ReDIF-Article 1.0 Title: Effects of a Dutch work-site wellness-health program: The Brabantia project Journal: American Journal of Public Health Author-Name: Maes, S. Author-Name: Verhoeven, C. Author-Name: Kittel, F. Author-Name: Scholten, H. Year: 1998 Volume: 88 Issue: 7 Pages: 1037-1041 Abstract: Objectives. This study examined a project designed to improve the health and wellness of employees of Brabantia, a Dutch manufacturer of household goods, by means of lifestyle changes and changes in working conditions. Methods. The workers at one Brabantia site constituted the experimental group, and the workers from two other sites formed the control group. Biomedical variables, lifestyles, general stress reactions, and quality of work were measured identically in both groups at baseline and 1, 2, and 3 years later. During this period, there was continuous registration of absenteeism. Results. The interventions brought about favorable short-term changes in terms of health risks, and there were stable effects on working conditions (especially decision latitude) and absenteeism. Conclusions. A combination of interventions directed at both lifestyles and the work environment can produce extensive and stable effects on health-related variables, wellness, and absenteeism. Handle: RePEc:aph:ajpbhl:1998:88:7:1037-1041_8 Template-Type: ReDIF-Article 1.0 Title: The effect of cigarette taxes on cigarette consumption Journal: American Journal of Public Health Author-Name: Showalter, M.H. Year: 1998 Volume: 88 Issue: 7 Pages: 1118-1119 Abstract: Objectives. This paper reexamines the work of Meier and Licari in a previous issue of the Journal. Methods. The impact of excise taxes on cigarette consumption and sales was measured via standard regression analysis. Results. The 1983 federal tax increase is shown to have an anomalous effect on the regression results. When those data are excluded, there is no significant difference between state and federal tax increases. Further investigation suggests that firms raised cigarette prices substantially in the years surrounding the 1983 federal tax increase, which accounts for the relatively large decrease in consumption during this period. Conclusions. Federal excise taxes per se do not appear to be more effective than state excise taxes in terms of reducing cigarette consumption. The reaction of cigarette firms to government policies appears to be an important determinant of the success of antismoking initiatives. Handle: RePEc:aph:ajpbhl:1998:88:7:1118-1119_2 Template-Type: ReDIF-Article 1.0 Title: The case for stronger OSHA enforcement - Evidence from evaluation research Journal: American Journal of Public Health Author-Name: McQuiston, T.H. Author-Name: Zakocs, R.C. Author-Name: Loomis, D. Year: 1998 Volume: 88 Issue: 7 Pages: 1022-1024 Handle: RePEc:aph:ajpbhl:1998:88:7:1022-1024_4 Template-Type: ReDIF-Article 1.0 Title: Social heterogeneity in smoking among African Americans Journal: American Journal of Public Health Author-Name: King, G. Author-Name: Bendel, R. Author-Name: Delaronde, S.R. Year: 1998 Volume: 88 Issue: 7 Pages: 1081-1085 Abstract: Objectives. This study assessed the effects of sociodemographic variables on the smoking behavior of African Americans. Methods. Data for 14397 African-American respondents (18-64 years old) to the National Health Interview Survey in the years 1990 through 1993 were examined in multivariate models. Results. Age was the strongest predictor of smoking, and men were at least 1.75 times as likely as women to be smokers (P<.001). Conclusions. The Year 2000 goal of an 18% prevalence rate among African-American adults may not be attained without major community interventions focusing on male and middle-aged African Americans. Handle: RePEc:aph:ajpbhl:1998:88:7:1081-1085_0 Template-Type: ReDIF-Article 1.0 Title: Differences in the effect of patients' socioeconomic status on the use of invasive cardiovascular procedures across health insurance categories Journal: American Journal of Public Health Author-Name: Carlisle, D.M. Author-Name: Leake, B.D. Year: 1998 Volume: 88 Issue: 7 Pages: 1089-1092 Abstract: Objectives. This study evaluated the effect of patients' socioeconomic status on use of coronary angiography, bypass grafting, and angioplasty across health insurance categories. Methods. Multiple logistic regression was used to compute the odds of receiving each procedure among 206 233 ischemic heart disease patients residing in urban California zip codes from 1991 through 1993. Results. Residents of high socioeconomic status areas were more likely (odds ratios [ORs] = 1.20-1.41) and residents of low socioeconomic status areas were less likely (ORs = 0.79-0.84) than residents of middle socioeconomic status areas to undergo each procedure. These effects were common among Medicare and health maintenance organization patients and uncommon for privately insured and uninsured patients. Conclusions. The effect of socioeconomic status varies across health insurance categories. Handle: RePEc:aph:ajpbhl:1998:88:7:1089-1092_6 Template-Type: ReDIF-Article 1.0 Title: Income inequality and mortality in metropolitan areas of the United States Journal: American Journal of Public Health Author-Name: Lynch, J.W. Author-Name: Kaplan, G.A. Author-Name: Pamuk, E.R. Author-Name: Cohen, R.D. Author-Name: Heck, K.E. Author-Name: Balfour, J.L. Author-Name: Yen, I.H. Year: 1998 Volume: 88 Issue: 7 Pages: 1074-1080 Abstract: Objectives. This study examined associations between income inequality and mortality in 282 US metropolitan areas. Methods. Income inequality measures were calculated from the 1990 US Census. Mortality was calculated from National Center for Health Statistics data and modeled with weighted linear regressions of the log age-adjusted rate. Results. Excess mortality between metropolitan areas with high and low income inequality ranged from 64.7 to 95.8 deaths per 100 000 depending on the inequality measure. In age- specific analyses, income inequality was most evident for infant mortality and for mortality between ages 15 and 64. Conclusions. Higher income inequality is associated with increased mortality at all per capita income levels. Areas with high income inequality and low average income had excess mortality of 139.8 deaths per 100 000 compared with areas with low inequality and high income. The magnitude of this mortality difference is comparable to the combined loss of life from lung cancer, diabetes, motor vehicle crashes, human immunodeficiency virus (HIV) infection, suicide, and homicide in 1995. Given the mortality burden associated with income inequality, public and private sector initiatives to reduce economic inequalities should be a high priority. Handle: RePEc:aph:ajpbhl:1998:88:7:1074-1080_3 Template-Type: ReDIF-Article 1.0 Title: The fall after the rise: Tuberculosis in the United States, 1991 through 1994 Journal: American Journal of Public Health Author-Name: McKenna, M.T. Author-Name: McCray, E. Author-Name: Jones, J.L. Author-Name: Onorato, I.M. Author-Name: Castro, K.G. Year: 1998 Volume: 88 Issue: 7 Pages: 1059-1063 Abstract: Objectives. Factors associated with decreases in tuberculosis cases observed in the United States in 1993 and 1994 were analyzed. Methods. Changes in case counts reported to the national surveillance system were evaluated by dividing the number of incident cases of TB reported in 1993 and 1994 by the number of cases reported in 1991 and 1992 and stratifying these ratios by demographic factors, AIDS incidence, and changes in program performance. Results. Case counts decreased from 52 956 in 1991 and 1992 to 49 605 in 1993 and 1994 (case count ratio = 0.94, 95% confidence interval [CI] = 0.93, 0.95). The decrease, confined to US-born patients, was generally associated with AIDS incidence and improvements in completion of therapy, conversion of sputum, and increases in the number of contacts identified per case. Conclusions. Recent TB epidemiology patterns suggest that improvements in treatment and control activities have contributed to the reversal in the resurgence of this disease in US-born persons. Continued success in preventing the occurrence of active TB will require sustained efforts to ensure appropriate treatment of cases. Handle: RePEc:aph:ajpbhl:1998:88:7:1059-1063_7 Template-Type: ReDIF-Article 1.0 Title: An uncertain future: The health effects of threats to employment security in white-collar men and women Journal: American Journal of Public Health Author-Name: Ferrie, J.E. Author-Name: Shipley, M.J. Author-Name: Marmot, M.G. Author-Name: Stansfeld, S.A. Author-Name: Smith, G.D. Year: 1998 Volume: 88 Issue: 7 Pages: 1030-1036 Abstract: Objectives. This study examined changes in the health status of civil servants whose employment security was threatened. Methods. Data were derived from a longitudinal cohort of 10 308 men and women, office staff in 20 British civil service departments. Physiological measurements, self-reported morbidity, and health-related behaviors for 530 members of the department under threat were compared with those of 19 other departments, during the period of uncertainty and during stable employment 5 years earlier. Results. From a position of advantage or no difference at baseline, self-reported morbidity and physiological risk factors tended to increase among respondents from the threatened department compared with those from other departments. For both sexes, increases were significant for body mass index (P<.001) and sleeping 9 or more hours (odds ratio [OR] = 1.88; 95% confidence interval [Cl] ] 1.3, 2.8; P<.01); modest but significant increases were seen in ischemia (Or=1.45; 95% CI=1.0,2.1) and cholesterol concentration (0.08 mmol/L; 95% Cl=0.01, 0.14). Among women only, a significant relative increase in blood pressure (P<.01) was recorded. Over the same period health-related behaviors changed little. Conclusions. Threats to employment security have adverse consequences for health status that are unexplained by health selection or health-related behaviors. Handle: RePEc:aph:ajpbhl:1998:88:7:1030-1036_7 Template-Type: ReDIF-Article 1.0 Title: Occupational skin diseases in Washington State, 1989 through 1993: Using workers' compensation data to identify cutaneous hazards Journal: American Journal of Public Health Author-Name: Kaufman, J.D. Author-Name: Cohen, M.A. Author-Name: Sama, S.R. Author-Name: Shields, J.W. Author-Name: Kalat, J. Year: 1998 Volume: 88 Issue: 7 Pages: 1047-1051 Abstract: Objectives. This study sought to characterize occupational dermatoses and cutaneous hazards. Methods. Workers' compensation claims filed for skin disease in the Washington State Fund were analyzed for 1989 through 1993; incidence rates for industries and employers were calculated, and cutaneous hazards associated with the highest rates were identified. Results. A total of 7445 claims were filed for skin disorders, principally contact dermatitis; 675 (9.1%) involved more than 3 missed workdays. The rate of accepted skin disorder claims was 1.0 per 1000 full-time employee-years. The highest incidence rates (4.6 to 30.7 accepted claims per 1000 full-time employee- years) were in certain manufacturing industries (plastics related, concrete products, aircraft parts, sporting goods, and boat building), wholesale farm product raw materials, automotive glass replacement, and beauty shops. Seven of the 10 employers with the highest incidence rates (19.6 to 85.5 accepted claims per 1000 full-time employee-years) used fiber-reinforced plastics (composites) and exposed workers to epoxy and other resin systems associated with contact dermatitis. Conclusions. Workers' compensation data identify known and emerging workplace cutaneous hazards and show promise for targeting prevention efforts. Handle: RePEc:aph:ajpbhl:1998:88:7:1047-1051_6 Template-Type: ReDIF-Article 1.0 Title: Topics for our times: Managed care and public health opportunities Journal: American Journal of Public Health Author-Name: Mechanic, D. Year: 1998 Volume: 88 Issue: 6 Pages: 874-875 Handle: RePEc:aph:ajpbhl:1998:88:6:874-875_6 Template-Type: ReDIF-Article 1.0 Title: Do shall-issue laws save lives? Journal: American Journal of Public Health Author-Name: Lott J.R., Jr. Year: 1998 Volume: 88 Issue: 6 Pages: 980-982 Handle: RePEc:aph:ajpbhl:1998:88:6:980-982_7 Template-Type: ReDIF-Article 1.0 Title: Annotation: Prevention of HIV, other sexually transmitted diseases, and unwanted pregnancy - Testing physical barriers available to women Journal: American Journal of Public Health Author-Name: Stein, Z. Author-Name: Susser, M. Year: 1998 Volume: 88 Issue: 6 Pages: 872-874 Abstract: In summary, consideration of the 3 issues argued briefly here yields guidelines for research into barrier methods that women might adopt. We conclude, at this point in time, that trials might best test program effect rather than efficacy; that the experimental intervention, to be measured against male condoms in the control group, should offer a choice between a hierarchy of methods; and that the design should encompass the group level rather than solely the individual level. Handle: RePEc:aph:ajpbhl:1998:88:6:872-874_8 Template-Type: ReDIF-Article 1.0 Title: State variations in supplemental security income enrollment for children and adolescents Journal: American Journal of Public Health Author-Name: Perrin, J.M. Author-Name: Ettner, S.L. Author-Name: McLaughlin, T.J. Author-Name: Gortmaker, S.L. Author-Name: Bloom, S.R. Author-Name: Kuhlthau, K. Year: 1998 Volume: 88 Issue: 6 Pages: 928-931 Abstract: Objectives. The purpose of this study was to determine the effects of poverty, program generosity, and health on state variations in enrollment of children and adolescents in the Supplemental Security Income (SSI) program during recent program expansions. Methods. The relationship of state SSI rates for 1989 and 1992 to child poverty, health, and program generosity were determined by multiple regression. Results. The mean percentage of children enrolled grew from 0.36% (1989) to 0.75% (1992). Poverty rates accounted for 78% of the variance among states in 1989 and 53% in 1992. Other indicators accounted for little variance. Conclusions. Differences in state poverty levels explained almost all variation in SSI enrollment. Handle: RePEc:aph:ajpbhl:1998:88:6:928-931_5 Template-Type: ReDIF-Article 1.0 Title: Adolescents engaging in unhealthy weight control behaviors: Are they at risk for other health-comprising behaviors? Journal: American Journal of Public Health Author-Name: Neumark-Sztainer, D. Author-Name: Story, M. Author-Name: Dixon, L.B. Author-Name: Murray, D.M. Year: 1998 Volume: 88 Issue: 6 Pages: 952-955 Abstract: Objectives. This study sought to determine whether adolescent engaging in weight control behaviors are at increased risk for tobacco, alcohol, and marijuana use suicide, ideation and attempts, and unprotected sexual activity. Methods. Data were collected from nationally representative sample of 16 296 adolescents taking part in the 1993 Youth Risk Behavior Survey. Results. Adolescents using extreme weight controlled behaviors were at increased risk for health-compromising behaviors while associations with other way control behavior were weak and inconsistent. Conclusions. The findings have relevance to clinical work with youth provide a better understanding of disordered eating and open up a number of opportunities for future research. Handle: RePEc:aph:ajpbhl:1998:88:6:952-955_1 Template-Type: ReDIF-Article 1.0 Title: Immigration reporting laws: Ethical dilemmas in pediatric practice Journal: American Journal of Public Health Author-Name: Geltman, P.L. Author-Name: Meyers, A.F. Year: 1998 Volume: 88 Issue: 6 Pages: 967-968 Abstract: Objectives. This study assessed the potential impact of immigration reporting reach requirements on pediatricians referrals to child protective services. Methods. A random sample of 200 Massachusetts pediatricians were surveyed. Chi-square and logistic regression analyses were performed. Results. Asked whether potential deportation of the family would cause them to question or alter a decision to refer 50% of the respondents said yes. Conclusions. Pediatricians, as mandated reporters of child abuse, will face ethical dilemmas if laws requiring reporting of immigration status are enacted. Handle: RePEc:aph:ajpbhl:1998:88:6:967-968_8 Template-Type: ReDIF-Article 1.0 Title: Injury and anomie: Effects of violence in an inner-city community Journal: American Journal of Public Health Author-Name: Fullilove, M.T. Author-Name: Héon, V. Author-Name: Jimenez, W. Author-Name: Parsons, C. Author-Name: Green, L.L. Author-Name: Fullilove, R.E. Year: 1998 Volume: 88 Issue: 6 Pages: 924-927 Abstract: Objectives. Widespread violence affects individuals but also alters group life. This study was designed to examine the effects of violence on an inner city community. Methods. A qualitative study was undertaken that included field observation and semistructured interviews. The study took place in Washington Heights, a New York City neighborhood with a high rate of violence largely by secondary to the drug trade. Results. The 100 people interviewed differed widely in their definitions of violence and in their likelihood of having experienced violence acts in the course of daily life. High medium and low violence microenvironments were identified risk of exposure to violence, but not individual definitions of violence differed by location. Violence in all parts of the neighborhood inhibited social interactions but the intensity of this effect differed by microenvironment. Conclusions. In Washington Heights violence has injured individuals and fractured social relationships leading to the state of social disarray referred to as 'anomie.' The public health response to the violence epidemics should address anomie through community organizing efforts. Handle: RePEc:aph:ajpbhl:1998:88:6:924-927_5 Template-Type: ReDIF-Article 1.0 Title: Utility of percentage of births to teenagers as a surrogate for the teen birth rate Journal: American Journal of Public Health Author-Name: Gould, J. Author-Name: Blackwell, T. Author-Name: Heilig, C. Author-Name: Axley, M. Year: 1998 Volume: 88 Issue: 6 Pages: 908-912 Abstract: Objectives. The teen birth rate is commonly used in comparing regional variation in teen pregnancies, but local teen birth rates are not always available. In this study the percentage of all births that are to teen waste was evaluated for utility a surrogate for the teen birth rate. Methods. Rank correlation and sensitivity and specificity analyses were used. Results. The Spearman rank correction between percentage of teen births (PTB) and teen birth rate (TBR) were .995, .906, and .841 for the 3 age groups suggesting that it may be reasonable to employ PTB to prioritize zip codes. Zip codes with upper quartile levels of percentage of teen births identified zip codes with upper quartile levels of TBR with a sensitivity of 83.8%, 68.8%, and 65%; a false-positive rate of 2.1%, 8.6%, and 10% and a positive product value of 89.3%, 67.6% and 67.5% for the age groups 10 through 14, 15 through 17 and 18 through 19 years. Conclusions. The percentage of birth to teens is a useful surrogate for the birth rate in California, especially among younger teenagers. Handle: RePEc:aph:ajpbhl:1998:88:6:908-912_9 Template-Type: ReDIF-Article 1.0 Title: Teenage smoking, attempts to quit, and school performance Journal: American Journal of Public Health Author-Name: Hu, T.-W. Author-Name: Lin, Z. Author-Name: Keeler, T.E. Year: 1998 Volume: 88 Issue: 6 Pages: 940-943 Abstract: Objectives. This study examined the relationship between school performances, smoking and quitting attempts among teenagers. Methods. A logistic regression model was used to predict the probability of being a current smoker or a former smoker. Data were derived from the 1990 California Youth Tobacco Survey. Results. Students school performance was a key factor in predicting smoking and quitting attempt when other sociodemographic and family income factors were controlled. Conclusions. Developing academic on remedial classes designed to improve students school performance may lead to a reduction in smoking rates among teenagers while simultaneously providing a human capital investment in their futures. Handle: RePEc:aph:ajpbhl:1998:88:6:940-943_3 Template-Type: ReDIF-Article 1.0 Title: Exposure of young infants to environmental tobacco smoke: Breast- feeding among smoking mothers Journal: American Journal of Public Health Author-Name: Mascola, M.A. Author-Name: Van Vunakis, H. Author-Name: Tager, I.B. Author-Name: Speizer, F.E. Author-Name: Hanrahan, J.P. Year: 1998 Volume: 88 Issue: 6 Pages: 893-896 Abstract: Objectives. This study examined the degree to which breast-feeding and cigarette smoking by mothers and smoking by other household and smoking by other household members contribute to the exposure of infants to the products of tobacco smoke. Methods. The subjects were 330 mother-infant pairs derived from a cohort of 100 pairs enrolled in a longitudinal study of the pulmonary effects of prenatal and postnatal smoking. The main outcome measure was corrected urinary cotinine levels. Results. Urinary cotinine levels were 10- fold higher in breast-fed infants of smoking mothers than among bottle-fed infants of smoking mothers. Among infants of non-smoking mothers, urine cotinine levels were significantly increased in infants living in homes with other smokers; in this group there was not significant difference between bottle-fed and breast-fed infants. Infants whose mothers smoked in the same room as the infant had only non-significant increases in cotinine levels compared with infants whose mothers restricted their smoking to other rooms. Conclusions. Breast-fed infants of smoking mothers have urine cotinine levels 10-fold higher than bottle-fed infants whose mothers smoke, suggesting that breast-feeding, rather than direct inhalation of environmental tobacco smoke, is the primary determinant of continue levels in infants whose mothers smoke. Handle: RePEc:aph:ajpbhl:1998:88:6:893-896_3 Template-Type: ReDIF-Article 1.0 Title: Neighbor to neighbor: working together for healthy families through an urban community partnership. Journal: American Journal of Public Health Author-Name: Homan, S.M. Author-Name: Oleskevich, D. Author-Name: Foster, P. Author-Name: Domahidy, M.R. Author-Name: Hogan, M.E. Year: 1998 Volume: 88 Issue: 6 Pages: 977-978 Handle: RePEc:aph:ajpbhl:1998:88:6:977-978_4 Template-Type: ReDIF-Article 1.0 Title: Duration of protective immunity conferred by maternal tetanus toxoid immunization: Further evidence from Matlab, Bangladesh Journal: American Journal of Public Health Author-Name: Koenig, M.A. Author-Name: Roy, N.C. Author-Name: McElrath, T. Author-Name: Shahidullah Author-Name: Wojtyniak, B. Year: 1998 Volume: 88 Issue: 6 Pages: 903-907 Abstract: Objectives. Although maternal tetanus immunization has been shown to be highly effective in the prevention of neonatal tetanus, unresolved questions remain concerning the required minimum number of doses and the resulting duration of effective immunity. This study examined the duration of effective immunity against neonatal tetanus provided by maternal tetanus immunization. Methods. A randomized, double-blind cholera vaccine trial of 41 571 children and nonpregnant adult women carried out in 1974 in the Matlab comparison area of rural Bangladesh provided a unique opportunity to address dose and immunity issues. Results. Children of women who received either 1 or 2 injections of tetanus toxoid experiences 4- to 14-day mortality levels consistently lower than those of children of unimmunized mothers. Analysis of neonatal-tetanus-related mortality showed that 2 injections of tetanus toxoid provided significant protection for subsequent durations of up to 12 or 13 years. Conclusions. The data demonstrate that a limited-dose regimen of maternal tetanus toxoid provides significant and extended protection against the risk of neonatal tetanus death. Handle: RePEc:aph:ajpbhl:1998:88:6:903-907_6 Template-Type: ReDIF-Article 1.0 Title: Explaining recent increases in students' marijuana use: Impacts of perceived risks and disapproval, 1976 through 1996 Journal: American Journal of Public Health Author-Name: Bachman, J.G. Author-Name: Johnston, L.D. Author-Name: O'Malley, P.M. Year: 1998 Volume: 88 Issue: 6 Pages: 887-892 Abstract: Objectives. Marijuana use among high school seniors increased during most of the 1970s, decreased throughout the 1980s, and has been increasing again during the 1990s. Earlier analysis of the classes of 1976 through 1986 attributed the historic trends during that period to specific changes in views about marijuana. This study examined whether recent increases in marijuana use among seniors and among students in earlier grades reflect similar processes. Methods. Multivariate regression analyses were conducted on data from large annual nationwide surveys of high school seniors from 1976 through 1996 (approximate n = 61 000) and 8th and 10th graders from 1991 through 1996 (n's = 87 911 and 82 475, respectively). Results. Individual lifestyle factors (grades, truancy, religious commitment, evenings out for recreation) correlated substantially with marijuana use but did not explain the historic changes in marijuana use. Rather, decreases in perceived risk of harmfulness and in disapproval can account for the recent increases in all 3 grades and for earlier decreases among seniors. Conclusions. These findings indicate that perceived risks and disapproval are important determinants of marijuana use. Accordingly, prevention efforts should risk and consequences of marijuana use. Handle: RePEc:aph:ajpbhl:1998:88:6:887-892_9 Template-Type: ReDIF-Article 1.0 Title: Health benefits and risks of reporting HIV-infected individuals by name Journal: American Journal of Public Health Author-Name: Colfax, G.N. Author-Name: Bindman, A.B. Year: 1998 Volume: 88 Issue: 6 Pages: 876-879 Abstract: With more treatment options emerging for human immunodeficiency virus (HIV) infection, the policy of reporting HIV-infected individuals by name merits reevaluation. This paper views the benefits and risks of name reporting of persons infected with HIV. Public health departments have linked name reporting with medical referrals, risk reduction counseling, and partner notification programs. Yet some studies indicate that people are less likely to be tested for HIV infection when name reporting is implemented. Whether name reporting actually improves individual or public health, therefore justifying the increased risk of loss of confidentiality and possibly reduced testing rates, remains unknown. The lack of health outcome data on name reporting allows beliefs rather than facts to dominate debate about this policy. Before this practice is more widely adopted, a determination should be made as to whether the potential benefits of name reporting outweigh the risks. Handle: RePEc:aph:ajpbhl:1998:88:6:876-879_9 Template-Type: ReDIF-Article 1.0 Title: Effects of school-based aerobic exercise on blood pressure in adolescent girls at risk for hypertension Journal: American Journal of Public Health Author-Name: Ewart, C.K. Author-Name: Young, D.R. Author-Name: Hagberg, J.M. Year: 1998 Volume: 88 Issue: 6 Pages: 949-951 Abstract: Objectives. This study evaluated the effects of aerobic exercise physical education on blood pressure in high risk predominantly African American adolescent girls. Methods. Ninth-grade girls (n = 99) with blood pressure above the 67th percentile were randomized on semester aerobic exercise classes or standard physical education classes. Results. The study was completed by 88 girls. At posttest, only members of the aerobiology exercise group increased their estimated cardiorespiratory fitness. The aerobic exercise group had a greater decrease in systolic blood pressure than the standard physical education group (P < .03). Conclusions: Aerobic exercise physical education is a feasible and effective health promotion strategy for high risk adolescent girls. Handle: RePEc:aph:ajpbhl:1998:88:6:949-951_6 Template-Type: ReDIF-Article 1.0 Title: Project HAPPEN: where law enforcement and housing code enforcement meet. Journal: American Journal of Public Health Author-Name: Remmel, R. Year: 1998 Volume: 88 Issue: 6 Pages: 978-979 Handle: RePEc:aph:ajpbhl:1998:88:6:978-979_4 Template-Type: ReDIF-Article 1.0 Title: Children in special education programs: Attention deficit hyperactivity disorder, use of services, and unmet needs Journal: American Journal of Public Health Author-Name: Bussing, R. Author-Name: Zima, B.T. Author-Name: Perwien, A.R. Author-Name: Belin, T.R. Author-Name: Widawski, M. Year: 1998 Volume: 88 Issue: 6 Pages: 880-886 Abstract: Objectives. Attention deficit hyperactivity disorder (ADHD) a common psychiatric condition may impair child ability to learn and to form social relationships tasks critical to healthy development. This study described the prevalence of the disorder among children in special education programs and identifies the extent and predictors of unmet service needs. Methods. A 2- stage screening protocol of a county wide population of second- through fourth grader students in special education was conducted to (1) screen for ADHD employing standardized parents and teacher questionnaires, and determine health services use (n = 499) and (2) perform diagnostic assessment of ADHD (n = 318). Results. Almost half of the children qualified for a diagnosis of ADHD yet only half of those were reportedly receiving care for the condition mainly in the general health care sector. Girls were more than 3 times as likely as boys to have unmet service needs; minority status, low income and health maintenance organization coverage also emerged as possible risk factors for unmet service needs. Conclusions. ADHD is a commonly yet often untreated condition among children in special education. Mental health services for children with this disorders should be integrated with general health care and special education programs. Handle: RePEc:aph:ajpbhl:1998:88:6:880-886_0 Template-Type: ReDIF-Article 1.0 Title: Are tobacco industry campaign contributions influencing state legislative behavior? Journal: American Journal of Public Health Author-Name: Monardi, F. Author-Name: Glantz, S.A. Year: 1998 Volume: 88 Issue: 6 Pages: 918-923 Abstract: Objectives. This study tested the hypothesis that tobacco industry campaign contributions influence state legislators behavior. Methods. Multivariate simultaneous equations regression was used to analyze data on tobacco industry campaign contributions to state legislators and legislators tobacco control policy scores to states. Campaign contributions were obtained from disclosure statements available in the specific state agency that gathers such information in each states. Tobacco policy scores were derived from a survey of key informants working on tobacco issues in each states. Results. As tobacco industry contributions increase, a legislator's tobacco policy score tends to decrease (i.e. become more pro-tobacco industry). A more pro-tobacco position was associated with large contributions from the industry. These results were significant even after control for partisanship, majority party status, and leadership effects. In California campaign contributions were still significantly related to tobacco policy scores after control for constituent attitudes and legislators personal characteristics. Conclusions. Tobacco industry campaign contributions influence state legislators in terms of tobacco control policy-making. Handle: RePEc:aph:ajpbhl:1998:88:6:918-923_4 Template-Type: ReDIF-Article 1.0 Title: Evaluation of an enforcement program to reduce tobacco sales to minors Journal: American Journal of Public Health Author-Name: Cummings, K.M. Author-Name: Hyland, A. Author-Name: Saunders-Martin, T. Author-Name: Perla, J. Author-Name: Coppola, P.R. Author-Name: Pechacek, T.F. Year: 1998 Volume: 88 Issue: 6 Pages: 932-936 Abstract: Objectives. This study evaluated an active enforcement program to increase retailers compliance with the law prohibiting tobacco sales to minors. Methods. Tobacco sales to minors were monitored in 319 outlets in 16 pairs of communities in the Erie County New York. One community in each pair was randomly assigned to an enforcement intervention. Results. Retailers compliance with the law increased from 35% in 1994 to 73% in 1995. However, the change in compliance rates was roughly the same for stores in the enforcement and nonenforcement communities. Conclusions. Active compliance checking of retail outlets as a strategy to reduce illegal tobacco sales to minors may only be necessary insofar as it contributes to an increase in retailers' perception that the threat of enforcement is real. Handle: RePEc:aph:ajpbhl:1998:88:6:932-936_4 Template-Type: ReDIF-Article 1.0 Title: Changes in sexual behavior and condom use among teenaged males: 1988 to 1995 Journal: American Journal of Public Health Author-Name: Sonenstein, F.L. Author-Name: Ku, L. Author-Name: Lindberg, L.D. Author-Name: Turner, C.F. Author-Name: Pleck, J.H. Year: 1998 Volume: 88 Issue: 6 Pages: 956-959 Abstract: Objectives. This study examines shifts in sexual experienced and condom used among US teenaged males. Methods. Results from the 1988 and 1995 National Surveys of Adolescent Males were compared. Results. The proportion of never-married 16 to 19-years-old males who had had sex with a female declined from 60% to 55% (P = .06). The share of those sexually active using a condom at last intercourse rose from 57% to 67% (P < .01). Overall, the proportion of males who had sex without condoms last year declined from 37% to 27% (P < .001). Conclusions. Although protective behaviors among teenagers have increased, significant proportions of teenagers - especially Black and Hispanic males remain unprotected. Handle: RePEc:aph:ajpbhl:1998:88:6:956-959_5 Template-Type: ReDIF-Article 1.0 Title: Association between duration of residence and access to ambulatory care among Caribbean immigrant adolescents Journal: American Journal of Public Health Author-Name: Sonis, J. Year: 1998 Volume: 88 Issue: 6 Pages: 964-966 Abstract: Objectives. The purpose of this study was to determine the association between duration of residence and access to ambulatory care among Caribbean immigrant adolescents. Methods. A cross-sectional survey of adolescent at a New York City high school was conducted. Multivariate modeling methods were used to adjust for demographic and socioeconomic covariates. Results. Duration of residence was strongly and directly associated with access to ambulatory care after adjustment for ethnicity. Conclusions. Caribbean immigrant adolescents, particularly recent immigrants, have reduced access to ambulatory care. Handle: RePEc:aph:ajpbhl:1998:88:6:964-966_3 Template-Type: ReDIF-Article 1.0 Title: Use of health services by children of smokers and nonsmokers in a health maintenance organization Journal: American Journal of Public Health Author-Name: McBride, C.M. Author-Name: Lozano, P. Author-Name: Curry, S.J. Author-Name: Rosner, D. Author-Name: Grothaus, L.C. Year: 1998 Volume: 88 Issue: 6 Pages: 897-902 Abstract: Objectives. Use of health services by children of smokers and nonsmokers was compared to assess whether exposure to environmental tobacco smoke resulted in greater use of health services among children of smokers. Methods. Primary care and emergency from visits, asthma-related prescriptions, and inpatient stays over the 42-month study period were compared for children of smokers (n = 498) and nonsmokers (n = 1062) who were enrolled in a health maintenance organization. Parents of children aged 1 through 11 years were identified from participants in 2 randomized smoking cessation trials. Results. After adjustment for parental age, education, and health status and for child's age, there were no differences between children of smokers and children of nonsmokers in use of primary care or emergency room visits, asthma-related prescriptions, or inpatient stays. However, among those with any preventive care visits, children of smokers had significantly fewer visits than children of nonsmokers. Conclusions. Further study is needed to elucidate whether parents who smoke underutilize health services for their children or use services differently from nonsmoking parents and whether these differences have cost implications. Handle: RePEc:aph:ajpbhl:1998:88:6:897-902_3 Template-Type: ReDIF-Article 1.0 Title: State estimates of household exposure to firearms, loaded firearms, and handguns, 1991 through 1995 Journal: American Journal of Public Health Author-Name: Powell, K.E. Author-Name: Jacklin, B.C. Author-Name: Nelson, D.E. Author-Name: Bland, S. Author-Name: Lysne, R. Year: 1998 Volume: 88 Issue: 6 Pages: 969-972 Abstract: Objectives. Variations among states in household exposure to firearms, loaded firearms, and handguns were examined. Methods. Data from the Behavioral Risk Factor Surveillance System in 92 states were used to estimate the prevalence of adults and children exposed to household firearms. Results. The prevalence of adults living in households with firearms ranged from 12% to 57%; the corresponding ranges were 1% to 23% for loaded firearms and 5% to 36% for handguns. The prevalence of children less than 18 years of age living in households with loaded firearms ranged from 2% to 12%. Conclusions. Important variations among states exist in the prevalence of adults and children living with households with firearms loaded firearms, and handguns. Handle: RePEc:aph:ajpbhl:1998:88:6:969-972_2 Template-Type: ReDIF-Article 1.0 Title: Prospective psychosocial, interpersonal, and behavioral predictors of handgun carrying among adolescents Journal: American Journal of Public Health Author-Name: Simon, T.R. Author-Name: Richardson, J.L. Author-Name: Dent, C.W. Author-Name: Chou, C.-P. Author-Name: Flay, B.R. Year: 1998 Volume: 88 Issue: 6 Pages: 960-965 Abstract: Objectives. This study identified behavioral and psychosocial/interpersonal factors in young adolescence that are associated with handgun carrying in later adolescence. Methods. A sample of 2200 high school students was surveyed at 9th grade and again at 12th grade. Results. Multivariate logistic regression analyses indicated that measures of risk- taking preference, depression, stress, temper, and drug use assessed while the students were in 9th grade were predicted of handgun carrying in 12th grade for both male and female students. Conclusion. These findings suggest the need for a comprehensive approach to prevention that focuses on both individual and interpersonal factors associated with adolescents' decision to carry a handgun. Handle: RePEc:aph:ajpbhl:1998:88:6:960-965_2 Template-Type: ReDIF-Article 1.0 Title: Coronary heart disease risk factors and attributable risks in African- American women and men: NHANES I epidemiologic follow-up study Journal: American Journal of Public Health Author-Name: Gillum, R.F. Author-Name: Mussolino, M.E. Author-Name: Madans, J.H. Year: 1998 Volume: 88 Issue: 6 Pages: 913-917 Abstract: Objectives. This study assessed associations of risk factors with coronary heart disease incidence in African Americans. Methods. The participants in the NHANES I Epidemiologic Follow-Up Study included in this analysis were 1641 Black and 9660 White persons who were aged 25 to 74 years when examined and who did not have a history of coronary heart disease. Average follow-up for survivors was 19 years. Results. Significant, independent risk factors for coronary heart disease were age, systolic blood pressure, and smoking in Black women and age, systolic blood pressure, serum cholesterol, low education, and low family income in Black men. In this cohort, 19% of incident coronary heart disease in Black women and 34% in Black men might be prevented if systolic blood pressure were below 140 mm Hg. In Black men, attributable risk for low education (46%) was even higher than that for elevated blood pressure. Conclusions. Elevated systolic blood pressure and smoking were predictive of coronary heart disease incidence in African Americans. Estimates of population attributable risk were highest for elevated systolic blood pressure in women and education less than high school in men. Further studies of serum lipids, education, and coronary heart disease in Black women are needed. Handle: RePEc:aph:ajpbhl:1998:88:6:913-917_2 Template-Type: ReDIF-Article 1.0 Title: Laying down the law: Reducing illegal tobacco sales to minors in central Harlem Journal: American Journal of Public Health Author-Name: Gemson, D.H. Author-Name: Moats, H.L. Author-Name: Watkins, B.X. Author-Name: Ganz, M.L. Author-Name: Robinson, S. Author-Name: Healton, E. Year: 1998 Volume: 88 Issue: 6 Pages: 936-939 Abstract: Objectives. This study compared the impact of educational and enforcement interventions on retailers sale of tobacco to minors in Central Harlem, New York. Methods. In randomized trial with repeated measures. 142 stores were randomly divided to control, education and enforcement groups. Results. Overall tobacco sales to 12- and 13-years-old minors at baseline (98%) were among the highest in the nation. At 6-month and 1-year follow-ups decreases in rates of tobacco sales to minors were modest among education stores and substantial among enforcement stores. Conclusions. Effective reduction of tobacco sales to minors may require ongoing enforcement measures including fines for retailers who violate states and local laws. Handle: RePEc:aph:ajpbhl:1998:88:6:936-939_8 Template-Type: ReDIF-Article 1.0 Title: Effects of a community-based prevention program on decreasing drug use in high-risk adolescents Journal: American Journal of Public Health Author-Name: Chou, C.-P. Author-Name: Montgomery, S. Author-Name: Pentz, M.A. Author-Name: Rohrbach, L.A. Author-Name: Johnson, C.A. Author-Name: Flay, B.R. Author-Name: MacKinnon, D.P. Year: 1998 Volume: 88 Issue: 6 Pages: 944-948 Abstract: Objectives. This study investigated the secondary prevention effects of a substance abuse primary prevention program. Methods. Logistic regression analyses were conducted on 4 waves of follow-up data from sixth- and seventh- grade baseline users of cigarettes, alcohol, and marijuana taking part in a school-based program in Indianapolis. Results: The program demonstrated significant reductions in cigarette use at the initial follow-up (6 months) and alcohol use at the first 2 follow-ups (up to 1.5 years). Models considering repeated measures also showed effects on all 3 substances. Conclusions. Primary prevention programs are able to reach and influence high-risk adolescents in a non-stigmatizing manner. Handle: RePEc:aph:ajpbhl:1998:88:6:944-948_2 Template-Type: ReDIF-Article 1.0 Title: Phantom of the area: Poverty-area residence and mortality in the United States Journal: American Journal of Public Health Author-Name: Waitzman, N.J. Author-Name: Smith, K.R. Year: 1998 Volume: 88 Issue: 6 Pages: 973-976 Abstract: Objectives. The purpose of the study was to conduct a national multivariate analysis on poverty-area residence and mortality in the United States. Methods. Proportional hazards analyses were performed of the effect of poverty area residence on the risk of mortality among adult examinees in the 1971 through 1974 National Health and Nutrition Examination Survey who were followed through 1987. Results. Poverty-area residence was associated with significantly elevated risk of all cause mortality (rate ratio) 78-95% confidence interval = 1.33, 2.38) and some cause specific mortality among those aged 25 through 54 years, but not among those aged 55 through 74 years at baseline after adjustment for several individual and household characteristic. Conclusions. Residence in poverty areas contributes to socio- economic gradients in mortality among nonelderly adults in the United States. Handle: RePEc:aph:ajpbhl:1998:88:6:973-976_2 Template-Type: ReDIF-Article 1.0 Title: Smoking in the home: Changing attitudes and current practices Journal: American Journal of Public Health Author-Name: Ashley, M.J. Author-Name: Cohen, J. Author-Name: Ferrence, R. Author-Name: Bull, S. Author-Name: Bondy, S. Author-Name: Poland, B. Author-Name: Pederson, L. Year: 1998 Volume: 88 Issue: 5 Pages: 797-800 Abstract: Objectives. Trends in attitudes and current practices concerning smoking in the home were examined. Methods. Data from population-based surveys of adults in Ontario, Canada, were analyzed. Results. Between 1992 and 1996, the percentage of respondents who agreed that parents spending time at home with small children should not smoke increased from 51% to 70%. In 1996, 34% of the homes surveyed were smoke-free. Smoke-free homes were associated with nonsmoking respondents and with the presence of children and no daily smokers in the home. Only 20% of homes with children and any daily smokers were smoke-free. Conclusions. Efforts are needed to assist parents in reducing children's exposure to environmental tobacco smoke in the home. Handle: RePEc:aph:ajpbhl:1998:88:5:797-800_0 Template-Type: ReDIF-Article 1.0 Title: Contraception and induced abortion in Armenia: A critical need for family planning programs in Eastern Europe Journal: American Journal of Public Health Author-Name: Dolian, G. Author-Name: Lüdicke, F. Author-Name: Katchatrian, N. Author-Name: Morabia, A. Year: 1998 Volume: 88 Issue: 5 Pages: 803-805 Abstract: Objectives. The purpose of this study was to determine the number of induced abortions per woman and the reasons for selecting induced abortion among parous Armenian women. Methods. A consecutive series of 200 women attending an abortion clinic in Yerevan, Armenia, were queried by a physician about their reproductive histories. Results. Women younger than 20 years of age reported a median of 1 and women older than 40 years reported a median of 8 induced abortions in their lifetimes (overall median = 3). Lack of contraceptive information was the major reason cited for using contraception. Conclusions. Induced abortion is the major form of birth control among porous Armenian women. Concerted public health campaigns are needed to inform women and their physicians in Armenia and other Eastern European countries about alternative contraceptive methods. Handle: RePEc:aph:ajpbhl:1998:88:5:803-805_2 Template-Type: ReDIF-Article 1.0 Title: Re: authors and authorship. Journal: American Journal of Public Health Author-Name: Jung, B.C. Year: 1998 Volume: 88 Issue: 5 Pages: 827 Handle: RePEc:aph:ajpbhl:1998:88:5:827_6 Template-Type: ReDIF-Article 1.0 Title: Correlation is not causation. Journal: American Journal of Public Health Author-Name: Rimer, B.K. Year: 1998 Volume: 88 Issue: 5 Pages: 832-833 Handle: RePEc:aph:ajpbhl:1998:88:5:832-833_7 Template-Type: ReDIF-Article 1.0 Title: Attribution of authors' contributions. Journal: American Journal of Public Health Author-Name: Winkelstein Jr., W. Year: 1998 Volume: 88 Issue: 5 Pages: 830 Handle: RePEc:aph:ajpbhl:1998:88:5:830_1 Template-Type: ReDIF-Article 1.0 Title: Re: authors and authorship. Journal: American Journal of Public Health Author-Name: Smith, R. Year: 1998 Volume: 88 Issue: 5 Pages: 830 Handle: RePEc:aph:ajpbhl:1998:88:5:830_9 Template-Type: ReDIF-Article 1.0 Title: Anemia in young children of the Muynak district of Karakalpakistan, Uzbekistan: Prevalence, type, and correlates Journal: American Journal of Public Health Author-Name: Giebel, H.N. Author-Name: Suleymanova, D. Author-Name: Evans, G.W. Year: 1998 Volume: 88 Issue: 5 Pages: 805-807 Abstract: Objectives. This study examined prevalence and correlates of anemia in the Muynak District of Uzbekistan, an area of rapidly changing social and economic conditions following the collapse of the Soviet Union. Methods. Questionnaire data and blood samples were collected on a random sample of 433 children aged 1 through 4 years. Results. The prevalence of anemia ranged from 89% in 1-year-olds to 48% in 4-year-olds. Correlates for anemia included younger age, a communal water source, and a history of pica. Conclusions. Anemia is a wide-spread problem in young children in this district. An aggressive attempt to reverse this problem is needed. Handle: RePEc:aph:ajpbhl:1998:88:5:805-807_7 Template-Type: ReDIF-Article 1.0 Title: Tuberculosis screening and compliance with return for skin test reading among active drug users Journal: American Journal of Public Health Author-Name: Malotte, C.K. Author-Name: Rhodes, F. Author-Name: Mais, K.E. Year: 1998 Volume: 88 Issue: 5 Pages: 792-796 Abstract: Objectives. This study assessed the independent and combined effects of different levels of monetary incentives and a theory-based educational intervention on return for tuberculosis (TB) skin test reading in a sample of active injection drug and crack cocaine users. Prevalence of TB infection in this sample was also determined. Methods. Active or recent drug users (n = 1004), recruited via street outreach techniques, were skin tested for TB. They were randomly assigned to 1 and 2 levels of monetary incentive ($5 and $10) provided at return for skin test reading, alone or in combination with a brief motivational education session. Results. More than 90% of those who received $10 returned for skin test reading, in comparison with 85% of those who received $5 and 33% of those who received no monetary incentive. The education session had no impact on return for skin test reading. The prevalence of a positive tuberculin test was 18.3%. Conclusions. Monetary incentives dramatically increase the return rate for TB skin test reading among drug users who are at high risk of TB infection. Handle: RePEc:aph:ajpbhl:1998:88:5:792-796_2 Template-Type: ReDIF-Article 1.0 Title: Re: authors and authorship. Journal: American Journal of Public Health Author-Name: Yankauer, A. Year: 1998 Volume: 88 Issue: 5 Pages: 831 Handle: RePEc:aph:ajpbhl:1998:88:5:831_3 Template-Type: ReDIF-Article 1.0 Title: Healthy valley 2000. Journal: American Journal of Public Health Author-Name: Burger, A. Author-Name: McMahon, A.M. Author-Name: Sellaro, C.L. Author-Name: Stefanak, M. Year: 1998 Volume: 88 Issue: 5 Pages: 821-822 Handle: RePEc:aph:ajpbhl:1998:88:5:821-822_7 Template-Type: ReDIF-Article 1.0 Title: A method for preserving confidentiality when linking computerized registries. Journal: American Journal of Public Health Author-Name: Rabinowitz, J. Year: 1998 Volume: 88 Issue: 5 Pages: 836 Handle: RePEc:aph:ajpbhl:1998:88:5:836_4 Template-Type: ReDIF-Article 1.0 Title: From assurance to insurance in Russian Health Care: The Problematic transition Journal: American Journal of Public Health Author-Name: Burger Jr., E.J. Author-Name: Field, M.G. Author-Name: Twigg, J.L. Year: 1998 Volume: 88 Issue: 5 Pages: 755-758 Abstract: Objectives. Given the declining health status of the Russian population and the negative social impact of ongoing economic reforms, it is important to understand the nature and scope of Russia's innovations in health care financing. Methods. Data on Russian health care and its financing were gathered from Russian newspapers and journals, US governmental agency reports, recent press accounts, and the authors' observations and interviews in Russia. Results. The 1991 statutory basis for the Russian mandatory medical insurance system replaced the traditional, state-funded medical care system with a regional system principally reliant on an enterprise-based with holding tax plus supplementation by local government and, to a minor extent, federal funds. The regional agent for distribution and management of these funds is a series of Territorial Health Insurance Funds, Implementation thus far has been highly uneven among territories. Conclusions. An insurance model patterned after the Western example may not be the optimal solution to Russia's current health financing problems. Given the chaotic nature of political and economic reform, Russia may simply not be ready for market- based medical insurance. Handle: RePEc:aph:ajpbhl:1998:88:5:755-758_5 Template-Type: ReDIF-Article 1.0 Title: Use of chiropractic services from 1985 through 1991 in the United States and Canada Journal: American Journal of Public Health Author-Name: Hurwitz, E.L. Author-Name: Coulter, I.D. Author-Name: Adams, A.H. Author-Name: Genovese, B.J. Author-Name: Shekelle, P.G. Year: 1998 Volume: 88 Issue: 5 Pages: 771-776 Abstract: Objectives. The purpose of this paper is to describe the demographic and clinical characteristics of chiropractic patients and to document chiropractic visit rates in 6 sites in the United States and Canada. Methods. Random samples of chiropractors from 5 US sites and 1 Canadian site were selected. A record abstraction system was developed to obtain demographic and clinical data from office charts. Results. Of the 185 eligible chiropractors sampled, 131 (71%) participated. Sixty-eight percent of the selected charts showed that care was sought for low back pain, while 32% recorded care for other reasons. Spinal manipulative therapy was recorded in 83% of all charts. There was a greater than 2-fold difference in the median number of visits related to low back pain per episode of care across sites. The chiropractic visit rates in the US sites and Ontario are estimated to be 101.2 and 140.9 visits per 100 person-years, respectively. Conclusions. The chiropractic use rate in these sites is twice that of estimates made 15 years ago. The great majority of patients receive care for musculoskeletal conditions of the back and neck. The number of visits per episode varies appreciably by site. Handle: RePEc:aph:ajpbhl:1998:88:5:771-776_3 Template-Type: ReDIF-Article 1.0 Title: Socioeconomic differences in the use of physician services in Nova Scotia Journal: American Journal of Public Health Author-Name: Kephart, G. Author-Name: Thomas, V.S. Author-Name: MacLean, D.R. Year: 1998 Volume: 88 Issue: 5 Pages: 800-803 Abstract: Objectives. Socioeconomic differences in use of physician services in Nova Scotia, Canada were examined. Methods. The study was based on survey data, containing information on socioeconomic status, linked to physician claims data. Socioeconomic differences in use of physician services were estimated, adjusted for age, sex, and region of residence. Results. Large socioeconomic differences were observed in the use of physician services, with use inversely related to both household income and education. These differences remained after adjustment for age, sex, and region. Conclusions. Use of physician services is inversely associated with socioeconomic status. Handle: RePEc:aph:ajpbhl:1998:88:5:800-803_5 Template-Type: ReDIF-Article 1.0 Title: Decrease in infant mortality in New York City after 1989 Journal: American Journal of Public Health Author-Name: Kalter, H.D. Author-Name: Na, Y. Author-Name: O'Campo, P. Year: 1998 Volume: 88 Issue: 5 Pages: 816-820 Abstract: Objectives. This study identified factors contributing to the rapid decline in infant mortality in New York City from 1989 to 1992. Methods. Changes in birthweight distributions and in birthweight/age-, cause-, and birthweight/age/cause-specific mortality rates from 1988/89 (before the mortality reduction) to 1990/91 were identified from New York City vital statistics data. Results. Infant, neonatal, and postneonatal mortality of very-low-birthweight (<1500 g) and normal-birthweight infants decreased significantly. The declines were almost entirely due to decreases in birthweight-specific mortality rates, rather than increased birthweights. All races experienced most of these reductions. Mortality decreased significantly for 6 causes of death. These decreases were consistent with the birthweight/age groups experiencing mortality declines. Conclusions. Widespread, multiple perinatal and postnatal factors contributed to the declined in infant mortality. Handle: RePEc:aph:ajpbhl:1998:88:5:816-820_9 Template-Type: ReDIF-Article 1.0 Title: Effects of radon mitigation vs smoking cessation in reducing radon- related risk of lung cancer Journal: American Journal of Public Health Author-Name: Mendez, D. Author-Name: Warner, K.E. Author-Name: Courant, P.N. Year: 1998 Volume: 88 Issue: 5 Pages: 811-812 Abstract: Objectives. The purpose of this paper is to provide smokers with information on the relative benefits information on the relative benefits of mitigating radon and quitting smoking in reducing radon-related lung cancer risk. Methods. The standard radon risk model, linked with models characterizing residential radon exposure and patterns of moving to new homes, was used to estimate the risk reduction produced by remediating high- radon homes, quitting smoking, or both. Results. Quitting smoking reduces lung cancer risk from radon more than does reduction of radon exposure itself. Conclusions. Smokers should understand that, in addition to producing other health benefits, quitting smoking dominates strategies to deal with the problem posed by radon. Handle: RePEc:aph:ajpbhl:1998:88:5:811-812_9 Template-Type: ReDIF-Article 1.0 Title: The globalization of public health, I: Threats and opportunities Journal: American Journal of Public Health Author-Name: Yach, D. Author-Name: Bettcher, D. Year: 1998 Volume: 88 Issue: 5 Pages: 735-738 Abstract: The globalization of public health poses new threat to health but also holds important opportunities in the coming century. This commentary identifies the major threats and opportunities presented by the process globalization an emphasizes the need for transnational public health approaches to take advantage of the positive aspects of global change and to minimize the negative ones. Transnational public health issues are areas of mutual concern for the foreign policies of all countries. These trends indicate a need for cross-national comparisons (e.g., in the areas of health financing and policy development) and for the development of a transnational research agenda in public health. Handle: RePEc:aph:ajpbhl:1998:88:5:735-738_7 Template-Type: ReDIF-Article 1.0 Title: Mortality in a large population-based cohort of patients with drug- treated diabetes mellitus Journal: American Journal of Public Health Author-Name: Koskinen, S.V.P. Author-Name: Reunanen, A.R.S. Author-Name: Martelin, T.P. Author-Name: Valkonen, T. Year: 1998 Volume: 88 Issue: 5 Pages: 765-770 Abstract: Objectives: This paper presents detailed cause-specific data about excess mortality among diabetic persons in Finland, by age and sex. Methods: Five-year follow-up data on the Finnish population aged 30 through 74 years were analyzed. During these 5 years, 11,215 persons with diabetes and 102,843 persons without diabetes died. The diabetic population was defined as people who were entitled to free medication for diabetes at the beginning of the follow-up period, that is, at the end of 1980. Results: The relative mortality of persons with drug-treated diabetes compared with nondiabetic persons was higher among women (3.4) than among men (2.4). Almost three quarters of the mortality excess was due to circulatory diseases. For most other causes of death, too, diabetic persons had higher than average mortality. The exceptions were lung cancer, chronic obstructive pulmonary disease, and alcohol poisoning. Conclusions: Diabetes is a general risk factor for untimely death and makes a significant contribution to overall national death rates, particularly for circulatory diseases. Lower than average mortality from smoking-related diseases and alcohol poisoning, however, warrant optimism about the effects of health education among diabetic persons. Handle: RePEc:aph:ajpbhl:1998:88:5:765-770_4 Template-Type: ReDIF-Article 1.0 Title: Re: authors and authorship. Journal: American Journal of Public Health Author-Name: Fortney, J.A. Year: 1998 Volume: 88 Issue: 5 Pages: 827 Handle: RePEc:aph:ajpbhl:1998:88:5:827_4 Template-Type: ReDIF-Article 1.0 Title: Respiratory diphtheria in the United States, 1980 through 1995 Journal: American Journal of Public Health Author-Name: Bisgard, K.M. Author-Name: Hardy, I.R.B. Author-Name: Popovic, T. Author-Name: Strebel, P.M. Author-Name: Wharton, M. Author-Name: Chen, R.T. Author-Name: Hadler, S.C. Year: 1998 Volume: 88 Issue: 5 Pages: 787-791 Abstract: Objectives. The purpose of this study was to describe the epidemiologic, laboratory, and clinical features of respiratory diphtheria cases reported in the United States during 1980 through 1995. Methods. Respiratory diphtheria cases reported to the Centers for Disease Control and Prevention were reviewed. Cases were defined as physician-diagnosed cases with signs and symptoms compatible with respiratory diphtheria, including the presence of a pseudomembrane without other apparent cause. Results. From 1980 through 1994, 41 respiratory diphtheria cases were reported, none were reported in 1995, and no secondary cases were identified. Nine (225) case patients were 4 years of age or younger, and 28 (68%) were 15 years of age or older. None of the case patients were put to date with diphtheria vaccination, 4 unvaccinated children died. Seventeen (43%) of 40 case patients had positive culture results. Conclusions. Available surveillance data suggest that respiratory diphtheria has become a rare disease in the United States. However, Importation and circulation of toxigenic strains continue to present a threat and require achieving and maintaining high coverage with diphtheria toxoid- containing vaccines in both children and adults. Handle: RePEc:aph:ajpbhl:1998:88:5:787-791_8 Template-Type: ReDIF-Article 1.0 Title: Validity of insurance information on California birth certificates Journal: American Journal of Public Health Author-Name: Braveman, P. Author-Name: Pearl, M. Author-Name: Egerter, S. Author-Name: Marchi, K. Author-Name: Williams, R. Year: 1998 Volume: 88 Issue: 5 Pages: 813-816 Abstract: Objectives. This study assessed the validity of health insurance information on California birth certificates. Methods. Insurance informations from birth certificates and linked face to face interviews compared for 7428 postpartum women in California. Results. There was excellent agreement between insurance information in birth certificate and interview data, especially when capitated plans were grouped with all other private coverage. Analysis using both data sources produced similar estimates of the likelihood of untimely prenatal care according to type of insurance coverage. Conclusions. Birth certificate data including insurance information appear to be an appropriate resource for examining both the extent of coverage for maternity care and associations between prenatal care use and insurance status. Handle: RePEc:aph:ajpbhl:1998:88:5:813-816_4 Template-Type: ReDIF-Article 1.0 Title: Keeping competition fair for health insurance: How the Irish beat back risk-rated policies Journal: American Journal of Public Health Author-Name: Light, D.W. Year: 1998 Volume: 88 Issue: 5 Pages: 745-748 Abstract: Objectives: This paper describes how ireland created a level playing field for competition in health insurance, the strategies of a major insurer to introduce risk-rated policies that would segment the market, the successful campaign to block these policies, and the policy implications of the European Union requirement of competition in health insurance. Methods. Policy documents, interviews, and press reports were analyzed. Results. The minister of health forced the commercial insurer to withdraw its policies and replace them with community-rated policies. Conclusions. Because it is easier and more profitable for insurers to engage in risk selection than to become more efficient, beneficial competition in health insurance markets is extremely difficult to create. Carefully drawn rules and monitoring are required to overcome inherent causes of market failure. The current enthusiasm for saving money through competitive schemes in health insurance seems likely to produce higher costs and greater inequality. Handle: RePEc:aph:ajpbhl:1998:88:5:745-748_4 Template-Type: ReDIF-Article 1.0 Title: Air pollution and daily mortality in Sydney, Australia, 1989 through 1993 Journal: American Journal of Public Health Author-Name: Morgan, G. Author-Name: Corbett, S. Author-Name: Wlodarczyk, J. Author-Name: Lewis, P. Year: 1998 Volume: 88 Issue: 5 Pages: 759-764 Abstract: Objectives. This study examined effects of outdoor air pollutants in Sydney, Australia, on daily mortality. Methods. Time-series analysis was performed on counts of daily mortality and major outdoor air pollutants (particulates, ozone, and nitrogen dioxide) in Sydney (1989 to 1993) with adjustment for seasonal and cyclical factors. Poisson regression was calculated with allowance for overdispersion and autocorrelation. The effects of lagging exposure by 0 to 2 days were assessed with single- and multiple- pollutant models. Results. An increase in daily mean particulate concentration from the 10th to the 90th centile was associated with an increase of 2.63% (95% confidence interval 0.87 to 4.41) in all-cause mortality and 2.68% (0.25 to 5.16) in cardiovascular mortality. An increase in daily maximum 1-hour ozone concentration from from the 10th to the 90th centile was associated with an increase of 2.04% (0.37 to 3.73) in all-cause mortality and 2.52% (-0.25 to 5.38) cardiovascular mortality. An increase in the daily mean nitrogen dioxide concentration from the 10th to the 90th centile was associated with an increase of 7.71% (-0.34 to 16.40) in respiratory mortality. Multiple-pollutant models suggest that the effects of particulates and ozone on all-cause and cardiovascular mortality, and of nitrogen dioxide on respiratory mortality, are independent of the effects of the other pollutants. Conclusions. Current levels of air pollution in Sydney are associated with daily mortality. Handle: RePEc:aph:ajpbhl:1998:88:5:759-764_5 Template-Type: ReDIF-Article 1.0 Title: Private sexual behavior, public opinion, and public health policy related to sexually transmitted diseases: A US-British comparison Journal: American Journal of Public Health Author-Name: Michael, R.T. Author-Name: Wadsworth, J. Author-Name: Feinleib, J. Author-Name: Johnson, A.M. Author-Name: Laumann, E.O. Author-Name: Wellings, K. Year: 1998 Volume: 88 Issue: 5 Pages: 749-754 Abstract: Objectives. The purpose of this study was to characterize sexual behavior and opinions about sex in the United States and Britain; implications are discussed for effective public health policy regarding sexually transmitted diseases (STDs) in the United States. Methods. Large- scale national probability surveys conducted in the 2 countries detailed sexual behavior, opinions, and the prevalence of STDs. Results. In comparison with that of Britain, the US population has greater variability in sexual behavior, less tolerant opinions about sexual behavior, and a higher STD prevalence and lower condom usage among men. Conclusions. The survey data show compelling evidence from both countries of a strong association between number of sex partners and STD risk. In the United States relative to Britain, there is both greater dispersion in sexual behavior and a greater incidence of unconditional opposition to certain sexual practices. The former implies a need for strong public health policy to address the risks of STDs, but the latter implies strong opposition to that policy. This disjuncture between public health need and feasibility may contribute to the high US rate of STDs. Handle: RePEc:aph:ajpbhl:1998:88:5:749-754_6 Template-Type: ReDIF-Article 1.0 Title: Mammography screening for women in their 40s: facilitating truly informed decision making. Journal: American Journal of Public Health Author-Name: Unger, J.B. Year: 1998 Volume: 88 Issue: 5 Pages: 840-841 Handle: RePEc:aph:ajpbhl:1998:88:5:840-841_6 Template-Type: ReDIF-Article 1.0 Title: Increased cesarean section rates and emerging patterns of health insurance in Shanghai, China Journal: American Journal of Public Health Author-Name: Cai, W.-W. Author-Name: Marks, J.S. Author-Name: Chen, C.H.C. Author-Name: Zhuang, Y.-X. Author-Name: Morris, L. Author-Name: Harris, J.R. Year: 1998 Volume: 88 Issue: 5 Pages: 777-780 Abstract: Objectives. This study examined the trend in cesarean section deliveries and the factors associated with it in the Minhang District of Shanghai, China. Methods. A representative sample of the members of 2716 households in the district were interviewed in the fall of 1993. This study analyzed the data from 1959 married women of reproductive age with at least one live birth. Results. During the past 3 decades, the proportion of infants born by cesarean section increased from 4.7% to 22.5%. Logistic regression analysis revealed that the highest cesarean section rate, which occurred in the most recent period of 1988 through 1993, was associated with form of medical payment, self-reported complications during pregnancy, higher birthweight, and maternal age. Government insurance pays all costs of cesarean sections and accounted for the highest proportion of the cesarean section rate. Conclusions. The high rates of cesarean sections in China are surprising given the lack of the factors that usually lead to cesarean sections. The increasing cesarean section rates may be an early indication that emerging forms of health insurance and fee-for-service payments to physicians will lead to an excessive emphasis on costly, high-technology medical care in China. Handle: RePEc:aph:ajpbhl:1998:88:5:777-780_9 Template-Type: ReDIF-Article 1.0 Title: Fetal alcohol syndrome in Alaska, 1977 through 1992: An administrative prevalence derived from multiple data sources Journal: American Journal of Public Health Author-Name: Egeland, G.M. Author-Name: Perham-Hester, K.A. Author-Name: Gessner, B.D. Author-Name: Ingle, D. Author-Name: Berner, J.E. Author-Name: Middaugh, J.P. Year: 1998 Volume: 88 Issue: 5 Pages: 781-786 Abstract: Objectives. The prevalence and characteristics of fetal alcohol syndrome cases and the usefulness of various data sources in surveillance were examined in Alaska to guide prevention and future surveillance efforts. Methods. Sixteen data sources in Alaska were sued to identify children with fetal alcohol syndrome. Medical charts were reviewed to verify cases and records were reviewed to provide descriptive data. Results. Fetal alcohol syndrome rates varied markedly by birth year and race, with the highest prevalence (4.1 per 1000 live births) found among Alaska Natives born between 1985 and 1988. Screening and referral programs to diagnostic clinics identified 70% of all recorded cases. The intervention program for children 0 to 3 years of age detected 29% of age appropriate cases, and medical data identified 11% of all cases birth certificates detected only 9% of the age appropriate cases. Conclusions. Our findings indicate a high prevalence of fetal alcohol syndrome in Alaska and illustrate that reliance on any one data source would lead to underestimates of the extent of the fetal alcohol syndrome in a population. Handle: RePEc:aph:ajpbhl:1998:88:5:781-786_5 Template-Type: ReDIF-Article 1.0 Title: Re: authors and authorship. Journal: American Journal of Public Health Author-Name: Comstock, G.W. Year: 1998 Volume: 88 Issue: 5 Pages: 831 Handle: RePEc:aph:ajpbhl:1998:88:5:831_4 Template-Type: ReDIF-Article 1.0 Title: Incorporating asthma education into a traditional school curriculum. Journal: American Journal of Public Health Author-Name: Lurie, N. Author-Name: Straub, M.J. Author-Name: Goodman, N. Author-Name: Bauer, E.J. Year: 1998 Volume: 88 Issue: 5 Pages: 822-823 Handle: RePEc:aph:ajpbhl:1998:88:5:822-823_8 Template-Type: ReDIF-Article 1.0 Title: The globalization of public health, II: The convergence of self-interest and altruism Journal: American Journal of Public Health Author-Name: Yach, D. Author-Name: Bettcher, D. Year: 1998 Volume: 88 Issue: 5 Pages: 738-741 Abstract: The transnationalization of disease and health risks will require global awareness, analysis, and action and indicates a need for global cooperation. Transnational actions must be built on firm local and national foundations, but they also require new forms of transnational collaboration in order to minimize risks and build on opportunities. In a world characterized by the globalization of public health, countries, and communities will need to look beyond their narrow self-interests in defining and confronting the shared problems that are emerging. In fact, a strong case can be made that enlightened self-interest and altruism will converge in the increasingly interdependent world being shaped by the process of globalization. Handle: RePEc:aph:ajpbhl:1998:88:5:738-741_0 Template-Type: ReDIF-Article 1.0 Title: High birthweights among infants of North African immigrants in Belgium Journal: American Journal of Public Health Author-Name: Buekens, P. Author-Name: Masuy-Stroobant, G. Author-Name: Delvaux, T. Year: 1998 Volume: 88 Issue: 5 Pages: 808-811 Abstract: Objectives. This study was examined birthweights of North African immigrants in Belgium. Methods. Analyses focused on Belgian single live birth certificates from 1981 to 1988. Results. Low-birthweight (<2500 g) rates were 3.1% among 34 686 newborns of North African origin and 4.8% among 804 286 newborns of Belgian origin. The entire North African birthweight distribution was shifted toward higher birthweights than the Belgian distribution. Low frequencies of low birthweights among North Africans were still observed after marital status, occupation of the father, and parity had been taken into account. Conclusions. Despite their low socioeconomic status, North African immigrants have high birthweights. Handle: RePEc:aph:ajpbhl:1998:88:5:808-811_4 Template-Type: ReDIF-Article 1.0 Title: Public health response to rabies exposure: Greene county, Missouri, March 1996 Journal: American Journal of Public Health Author-Name: Goddard, W.C. Author-Name: Gipson, K.S. Author-Name: Hunter, B. Year: 1998 Volume: 88 Issue: 2 Pages: 304-305 Handle: RePEc:aph:ajpbhl:1998:88:2:304-305_7 Template-Type: ReDIF-Article 1.0 Title: Mortality patterns among adult Hispanics: Findings from the NHIS 1986 to 1990 Journal: American Journal of Public Health Author-Name: Liao, Y. Author-Name: Cooper, R.S. Author-Name: Cao, G. Author-Name: Durazo-Arvizu, R. Author-Name: Kaufman, J.S. Author-Name: Luke, A. Author-Name: McGee, D.L. Year: 1998 Volume: 88 Issue: 2 Pages: 227-232 Abstract: Objectives. The purpose of this study was to assess the mortality pattern of the adult Hispanic population in the United States. Methods. This was a cohort study using data from the National Health Interview Survey from 1986 through 1990. Deaths were ascertained by matching to the National Death Index through 1991. Results. This representative national sample included 297 640 non-Hispanic Whites, 53 552 Blacks, and 27 239 Hispanics, all aged 18 years or older at baseline. Different matching criteria resulted in modest differential estimates of the number of deaths by ethnic group; these differences were quantitatively more important for Hispanics. Overall age- standardized mortality was lower among Hispanics. A prominent age by race interaction was apparent. The Hispanic:White mortality ratio was 1.33, 0.92, and 0.76 among men aged 18 through 44, 45 through 64, and 65 and older, respectively. Among women in the same age groups the Hispanic:White mortality ratio was 1.22, 0.75, and 0.70, respectively. Conclusions. Longitudinal cohorts provide an important source of health status information on Hispanics. These results suggest that overall mortality is lower among Hispanics than among non-Hispanic Whites, especially in the oldest age group. Among younger and middle-aged persons, the mortality of Hispanics is similar to or even higher than that of Whites. Handle: RePEc:aph:ajpbhl:1998:88:2:227-232_7 Template-Type: ReDIF-Article 1.0 Title: Screening for tuberculosis in jail and clinic follow-up after release Journal: American Journal of Public Health Author-Name: Tulsky, J.P. Author-Name: White, M.C. Author-Name: Dawson, C. Author-Name: Hoynes, T.M. Author-Name: Goldenson, J. Author-Name: Schecter, G. Year: 1998 Volume: 88 Issue: 2 Pages: 223-226 Abstract: Objectives. The purpose of this study was to describe tuberculosis (TB) screening and preventive therapy in the San Francisco County Jail and to measure the follow-up rate at the public health department TB clinic. Methods. The records of male inmates screened for 6 months in 1994 were reviewed. Those prescribed isoniazid and released before therapy ended were matched with TB clinic records. Inmates were considered to have followed up if they came to the TB clinic within 1 month of release. Results. Of 3352 inmates screened, 553 (16.5%) reported a prior positive skin test, and 330 (26.9%) of 1229 tests placed and read were positive. Of those with positive tests, 151 (45.8%) began isoniazid. Most of the inmates were foreign-born Hispanics (80.8%). Ninety-three (61.6%) inmates were released before completion, after an average of 68.5 days. Three (3.2%) went to the TB clinic within a month. Conclusion. Jail represents an important screening site for TB, but care is not continued after release. Strategies are needed to enhance the continuity of isoniazid preventive care. Handle: RePEc:aph:ajpbhl:1998:88:2:223-226_7 Template-Type: ReDIF-Article 1.0 Title: Preterm birth: From prediction to prevention Journal: American Journal of Public Health Author-Name: Holzman, C. Author-Name: Paneth, N. Year: 1998 Volume: 88 Issue: 2 Pages: 183-184 Handle: RePEc:aph:ajpbhl:1998:88:2:183-184_9 Template-Type: ReDIF-Article 1.0 Title: Differences in preconceptional and prenatal behaviors in women with intended and unintended pregnancies Journal: American Journal of Public Health Author-Name: Hellerstedt, W.L. Author-Name: Pirie, P.L. Author-Name: Lando, H.A. Author-Name: Curry, S.J. Author-Name: McBride, C.M. Author-Name: Grothaus, L.C. Author-Name: Nelson, J.C. Year: 1998 Volume: 88 Issue: 4 Pages: 663-666 Abstract: Objectives. This study examined whether pregnancy intention was associated with cigarette smoking, alcohol drinking, use of vitamins, and consumption of caffeinated drinks prior to pregnancy and in early pregnancy. Methods. Data from a telephone survey of 7174 pregnant women were analyzed. Results. In comparison with women whose pregnancies were intended, women with unintended pregnancies were more likely to report cigarette smoking and less likely to report daily vitamin use. Women with unintended pregnancies were also less likely to decrease consumption of caffeinated beverages or increase daily vitamin use. Conclusions. Pregnancy intention was associated with health behaviors, prior to pregnancy and in early pregnancy, that may influence pregnancy course and birth outcomes. Handle: RePEc:aph:ajpbhl:1998:88:4:663-666_6 Template-Type: ReDIF-Article 1.0 Title: Modeling all-cause mortality: Projections of the impact of smoking cessation based on the NHEFS Journal: American Journal of Public Health Author-Name: Russell, L.B. Author-Name: Carson, J.L. Author-Name: Taylor, W.C. Author-Name: Milan, E. Author-Name: Dey, A. Author-Name: Jagannathan, R. Year: 1998 Volume: 88 Issue: 4 Pages: 630-636 Abstract: Objectives. A model that relates clinical risk factors to subsequent mortality was used to simulate the impact of smoking cessation. Methods. Survivor functions derived from multivariate hazard regressions fitted to data from the first National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Follow-up Study, a longitudinal survey of a representative sample of US adults, were used to project deaths from all causes. Results. Validation tests showed that the hazard regressions agreed with the risk relationships reported by others, that reported deaths for baseline risk factors closely matched observed mortality, and that the projections attributed deaths to the appropriate levels of important risk factors. Projections of the impact of smoking cessation showed that the number of cumulative deaths would be 15% lower after 5 years and 11% lower after 20 years. Conclusions. The model produced realistic projections of the effects of risk factor modification of subsequent mortality in adults. Comparison of the projections for smoking cessation with estimates of the risk attributable to smoking published by the Centers for Disease Control and Prevention suggests that cessation could capture most of the benefit possible from eliminating smoking. Handle: RePEc:aph:ajpbhl:1998:88:4:630-636_8 Template-Type: ReDIF-Article 1.0 Title: The impact of mammography quality improvement legislation in Michigan: Implications for the national mammography quality standards act Journal: American Journal of Public Health Author-Name: Fintor, L. Author-Name: Brown, M. Author-Name: Fischer, R. Author-Name: Suleiman, O. Author-Name: Garlinghouse, C. Author-Name: Camburn, J. Author-Name: Frazier, E. Author-Name: Houn, F. Year: 1998 Volume: 88 Issue: 4 Pages: 667-671 Abstract: Objectives. This study examined the impact of state legislation art mammography quality and access in Michigan. Methods. The impact of state legislation was analyzed with respect to utilization, numbers of machines and facilities, and image quality. Results. The legislation had a positive effect on image quality improvement, had no impact on utilization by women aged 50 years and above, and resulted in few facility closures. Conclusions. Michigan's legislative intervention appears to have had a positive effect on efforts to improve mammography quality assurance with implications for other federal and state efforts to achieve quality assurance in health care delivery. Handle: RePEc:aph:ajpbhl:1998:88:4:667-671_2 Template-Type: ReDIF-Article 1.0 Title: The protective effect of condoms and nonoxynol-9 against HIV infection Journal: American Journal of Public Health Author-Name: Wittkowski, K.M. Author-Name: Susser, E. Author-Name: Dietz, K. Year: 1998 Volume: 88 Issue: 4 Pages: 590-596 Abstract: Objectives. Whether or not spermicides can reduce the risk of human immunodeficiency virus (HIV) transmission remains an important question for the control of heterosexual HIV transmission. The authors provide estimates from a reanalysis of one of the few observational studies on the efficacy of condoms and spermicides, used separately and together, per vaginal contact. Methods. In this reanalysis, three different models were used to assess the efficacy of spermicides and condoms: linear (Pearl index), exponential (maximum likelihood), and monotonic (marginal likelihood). Results. Reported use of barrier methods among 27 432 contacts was as follows: condoms plus nonoxynol-9, 39%; condoms alone, 25%; nonoxynol-9 alone, 24%; and unprotected, 11%. Under all three models, the results indicate a strong protective effect for spermicidal suppositories. The Pearl index indicated that spermicide alone is apparently efficacious, but the efficacy per contact cannot be quantified with this approach. Maximum likelihood estimates for the efficacy of nonoxynol-9 alone and condoms (with or without nonoxynol-9) were 100% (95% confidence interval [CI.95] = 43%, 100%) and 92% (95% CI.95 = 79%, 100%), respectively. Conclusions. The data from this observational study suggest that spermicides may be efficacious in reducing the risk of HIV transmission. Handle: RePEc:aph:ajpbhl:1998:88:4:590-596_3 Template-Type: ReDIF-Article 1.0 Title: Unemployment and the likelihood of detecting early-stage breast cancer Journal: American Journal of Public Health Author-Name: Catalano, R.A. Author-Name: Satariano, W.A. Year: 1998 Volume: 88 Issue: 4 Pages: 586-589 Abstract: Objectives. The objective of this study was to test the hypothesis that unexpectedly high unemployment in a community is associated with reduced odds that registered breast tumors are local. Methods. The hypothesis was tested with data from San Francisco for the 132 months beginning with January 1983. Results. Registered breast tumors were less likely to be local during periods of unexpectedly high unemployment (8% less likely among non-Hispanic White women and 24% less likely among African-American women). Conclusions. Job loss may restrict access to health services. Fear of job loss may also distract women from breast self-examination and the identification of suspicious breast signs. Handle: RePEc:aph:ajpbhl:1998:88:4:586-589_1 Template-Type: ReDIF-Article 1.0 Title: Substance use among nurses: Differences between specialties Journal: American Journal of Public Health Author-Name: Trinkoff, A.M. Author-Name: Storr, C.L. Year: 1998 Volume: 88 Issue: 4 Pages: 581-585 Abstract: Objectives. Valid data on factors that increase a health care worker's likelihood of substance use are integral in ensuring professional standards and quality health care for consumers. This study explored the association between nursing specialty and past-year substance use Methods. In an anonymous mailed survey, a balanced stratified sample of registered nurses (n4438) reported their use of marijuana, cocaine, and prescription-type drugs, as well as cigarette smoking and binge drinking. Results. Prevalence of use of all substances was 32%. Rates varied by specialty, even when sociodemographics were controlled. Compared with nurses in women's health, pediatrics, and general practice, emergency nurses were 3.5 times as likely to use marijuana or cocaine (odds ratio [OR] = 3.5; 95% confidence interval [CI] = 1.5, 8.2); oncology and administration nurses were twice as likely to engage in binge drinking; and psychiatric nurses were most likely to smoke (OR= 2.4; 95% CI=1.6, 3.8). No specialty differences appeared for prescription-type drug use. Conclusions. Certain nursing specialties were more likely than others to be associated with substance use. The differences were not explained by demographic characteristics. Inasmuch as a comparison of these results for nurses with prior work on physicians found considerable agreement by specialty, preventive initiatives should consider interdisciplinary approaches to substance use education. Handle: RePEc:aph:ajpbhl:1998:88:4:581-585_1 Template-Type: ReDIF-Article 1.0 Title: Trade-offs in prenatal detection of down syndrome Journal: American Journal of Public Health Author-Name: Serra-Prat, M. Author-Name: Gallo, P. Author-Name: Jovell, A.J. Author-Name: Aymerich, M. Author-Name: Dolors Estrada, M. Year: 1998 Volume: 88 Issue: 4 Pages: 551-557 Abstract: Objectives. This paper presents the results of different screening policies for prenatal detection of Down syndrome that would allow decision makers to make informed choices. Methods. A decision analysis model was built to compare 8 screening policies with regard to a selected set of outcome measures. Probabilities used in the analysis were obtained from official administrative data reports in Spain and Catalonia and from data published in the medical literature. Sensitivity analyses were carried out to test the robustness of screening policies' results to changes in uptake rates, diagnostic accuracy, and resources consumed. Results Selected screening policies posed major trades-offs regarding detection rates, false-positive results, fetal loss, and costs of the programs. All outcome measures considered were found quite robust to changes in uptake rates. Sensitivity and specificity rates of screening tests were shown to be the most influential factors in the outcome measures considered. Conclusions. The disclosed trade-offs emphasize the need to comprehensively inform decision makers about both positive and negative consequences of adopting one screening policy or another. Handle: RePEc:aph:ajpbhl:1998:88:4:551-557_5 Template-Type: ReDIF-Article 1.0 Title: Evaluation of a public-private certified nurse-midwife maternity program for indigent women Journal: American Journal of Public Health Author-Name: Lenaway, D. Author-Name: Koepsell, T.D. Author-Name: Vaughan, T. Author-Name: Van Belle, G. Author-Name: Shy, K. Author-Name: Cruz-Uribe, F. Year: 1998 Volume: 88 Issue: 4 Pages: 675-679 Abstract: Objectives. This study assessed the impact of a public-private certified nurse-midwife program on prenatal and delivery outcomes among medically indigent women. Methods. A population-based quasi-experimental design was used to compare 1 intervention county with 2 nonintervention counties. Results. The program significantly reduced the number of women who received no prenatal care and the risk of acquiring less than adequate prenatal care. Reductions in the proportion of infants born premature or with low birth- weights were of borderline significance. The use of induction and/or stimulation of labor was statistically elevated. Conclusions. These results suggest that the intervention program was instrumental in reducing some, but not all, negative prenatal and delivery outcomes. Handle: RePEc:aph:ajpbhl:1998:88:4:675-679_7 Template-Type: ReDIF-Article 1.0 Title: Rates and independent correlates of pap smear testing among Korean- American women Journal: American Journal of Public Health Author-Name: Wismer, B.A. Author-Name: Moskowitz, J.M. Author-Name: Chen, A.M. Author-Name: Kang, S.H. Author-Name: Novotny, T.E. Author-Name: Min, K. Author-Name: Lew, R. Author-Name: Tager, I.B. Year: 1998 Volume: 88 Issue: 4 Pages: 656-660 Abstract: Objectives. This study reports populations estimates of Pap smear testing among Korean-American women and evaluates correlates of testing. Methods. Korean Americans in 2 California counties were surveyed by telephone. Frequencies were age-adjusted to the 1990 census to produce population estimates of testing. Logistic regression models were used to evaluate independent correlates of testing. Results. Only 50% of the Korean- American women surveyed had a Pap test in the previous 2 years. The strongest independent correlated was having had a regular check-up in the previous 2 years (odds ratio 7.2, 95% confidence interval 4.2, 12.1). Conclusions. Rates of Pap testing among Korean-American women are well below national objectives. Collaboration and community-sensitivity research are essential to collect data and design programs to improve the health of ethnic minority communities. Handle: RePEc:aph:ajpbhl:1998:88:4:656-660_2 Template-Type: ReDIF-Article 1.0 Title: Deficient dietary iron intakes among women and children in Russia: Evidence from the Russian Longitudinal Monitoring Survey Journal: American Journal of Public Health Author-Name: Kohlmeier, L. Author-Name: Mendez, M. Author-Name: Shalnova, S. Author-Name: Martinchik, A. Author-Name: Chakraborty, H. Author-Name: Kohlmeier, M. Year: 1998 Volume: 88 Issue: 4 Pages: 576-580 Abstract: Objectives. This study evaluated the iron sufficiency of the Russian diet. Methods. Data were obtained from 24-hour dietary recalls conducted in 4 rounds (1992 through 1994) of a nationally representative longitudinal survey of 10 548 women and children. Iron bioavailability was estimated via algorithms adjusting for enhancers (heme, vitamin C) and inhibitors (tannins in tea, phytates in grains) consumed at the same meal. Results. Dietary iron intakes were deficient in the most vulnerable groups: young children and women of reproductive age. Poverty status was strongly associated with deficiency. After adjustment for enhancers and inhibitors, estimated bioavailable iron intakes at 3% to 4% of total iron were inadequate in all women and children. Conclusions. These dietary data suggest that Russian women and children are at high risk of iron deficiency. Grain products rich in phytates, which inhibit absorption, were the major food source of iron in Russia. High intakes of tea and low consumption of vitamin C also inhibited iron bioavailability. Since changes in eating behavior could potentially double iron bioavailability, educational programs should be explored as a strategy for improving iron nutriture. Handle: RePEc:aph:ajpbhl:1998:88:4:576-580_3 Template-Type: ReDIF-Article 1.0 Title: The debate over maternal-fetal HIV transmission prevention trials in Africa, Asia, and the Caribbean: Racist exploitation or exploitation of racism? Journal: American Journal of Public Health Author-Name: Bayer, R. Year: 1998 Volume: 88 Issue: 4 Pages: 567-570 Handle: RePEc:aph:ajpbhl:1998:88:4:567-570_9 Template-Type: ReDIF-Article 1.0 Title: Reducing pregnancy and induced abortion rates in China: Family planning with husband participation Journal: American Journal of Public Health Author-Name: Wang, C.C. Author-Name: Vittinghoff, E. Author-Name: Hua, L.S. Author-Name: Yun, W.H. Author-Name: Rong, Z.M. Year: 1998 Volume: 88 Issue: 4 Pages: 646-648 Abstract: Objectives. This study assessed the effectiveness of a family planning intervention with and without husband's participation in reducing pregnancy and abortion rates in Shanghai, China. Methods. In this 3-arm randomized trial among 1800 nonsterilized married women, educational interventions targeting both spouses and targeting the wife only were compared with usual family planning care. Results. Among women not using intrauterine devices (IUDs), the intervention with husband's participation had an effect in reducing pregnancy rates (adjusted odds ration [OR] = 0.36, 95% confidence interval [CI] = 0.12, 1.1) and abortion rates (adjusted OR = 0.29, CI = 0.09, 0.94) compared with control subjects, and a significant effect in reducing pregnancy rates (adjusted OR = 0.29, CI = 0.10, 0.85) and abortion rates (adjusted OR = 0.24, CI = 0.07, 0.77) compared with wife-only subjects. Conclusions. Family planning interventions involving husbands may reduce pregnancy and abortion rates among non-IUD users. Handle: RePEc:aph:ajpbhl:1998:88:4:646-648_0 Template-Type: ReDIF-Article 1.0 Title: Reporting sexual risk behavior for HIV: A practical risk index and a method for improving risk indices Journal: American Journal of Public Health Author-Name: Susser, E. Author-Name: Desvarieux, M. Author-Name: Wittkowski, K.M. Year: 1998 Volume: 88 Issue: 4 Pages: 671-674 Abstract: Objectives. As a means of enhancing public health efforts to control sexual transmission of human immunodeficiency virus (HIV), methods were developed to report on risk behavior in a manner that is comparable and widely interpretable. Methods. An elementary sexual behavior risk index (the vaginal episode equivalent index) that is in accord with some of the essential knowledge about sexual transmission of HIV is described, and a multivariate ordinal risk (MOR) method that can be used to improve such risk indices is introduced. Results. An example shows that these approaches are applicable to observational studies of seroconversion. Conclusions. The MOR represents a powerful new tool to develop valid comparable measures of sexual risk behavior and, thereby, to advance HIV prevention research. Handle: RePEc:aph:ajpbhl:1998:88:4:671-674_8 Template-Type: ReDIF-Article 1.0 Title: Differences in the risk of homicide and other fatal injuries between postpartum women and other women of childbearing age: Implications for prevention Journal: American Journal of Public Health Author-Name: Dietz, P.M. Author-Name: Rochat, R.W. Author-Name: Thompson, B.L. Author-Name: Berg, C.J. Author-Name: Griffin, G.W. Year: 1998 Volume: 88 Issue: 4 Pages: 641-643 Abstract: Objectives. This study compared injury deaths between postpartum women and other women aged 15 to 44. Methods. Risk ratios and 95% confidence intervals (CIs) were computed for injury fatality rates. Results. Fifty percent (29/58) of postpartum injury deaths were homicides, compared with 26% (427/1648) of injury deaths among nonpregnant, nonpostpartum women. For females aged 15 to 19, the homicide rate was 2.6 times higher (95% CI = 1.17, 5.95) for postpartum females than for other females. The motor-vehicle fatality rate was lower for postpartum females than for nonpregnant, nonpostpartum females (risk ratio=0.30, CI=0.18, 0.48). Conclusions. Postpartum females aged 15 to 19 years were at higher risk of homicide. Postpartum women were at reduced risk of motor-vehicle fatalities. Handle: RePEc:aph:ajpbhl:1998:88:4:641-643_9 Template-Type: ReDIF-Article 1.0 Title: Body mass index and mortality in nonsmoking older adults: The cardiovascular health study Journal: American Journal of Public Health Author-Name: Diehr, P. Author-Name: Bild, D.E. Author-Name: Harris, T.B. Author-Name: Duxbury, A. Author-Name: Siscovick, D. Author-Name: Rossi, M. Year: 1998 Volume: 88 Issue: 4 Pages: 623-629 Abstract: Objectives. This study assesses the relationship of body mass index to 5-year mortality in a cohort of 4317 nonsmoking men and women aged 65 to 100 years. Methods. Logistic regression analyses were conducted to predict mortality as a function of baseline body mass index, adjusting for demographic, clinical, and laboratory covariates. Results. There was an inverse relationship between body mass index and mortality; death rates were higher for those who weighed the least Inclusion of covariates had trivial effects on these results. People who had lost 10% or more of their body weight since age 50 had a relatively high death rate. When that group was excluded, there was no remaining relationship between body mass index and mortality. Conclusions. The association between higher body mass index and mortality often found in middle-aged populations was not observed in this large cohort of older adults. Overweight does not seem to be a risk factor for 5-year mortality in this age group. Rather, the risks associated with significant weight loss should be the primary concern. Handle: RePEc:aph:ajpbhl:1998:88:4:623-629_9 Template-Type: ReDIF-Article 1.0 Title: Family planning in China: Out of control? Journal: American Journal of Public Health Author-Name: Bogg, L. Year: 1998 Volume: 88 Issue: 4 Pages: 649-651 Abstract: Objectives. This study examined sex ratios in 6 counties in China. Methods. Data from a household survey (n = 5756) were retrospectively analyzed. Results. A normal sex ratio was found for children less than 18 years of age. Significant differences in sex ratios and family size were observed between the household survey data and population registers. Conclusions. The findings indicate a high number of unregistered female births and are consistent with calls for a rethinking of Chinese population policies in the direction of a more collaborative policy based on female education and participation. Handle: RePEc:aph:ajpbhl:1998:88:4:649-651_0 Template-Type: ReDIF-Article 1.0 Title: Contraception and abortion in two Vietnamese communes Journal: American Journal of Public Health Author-Name: Gorbach, P.M. Author-Name: Khanh Hoa, D.T. Author-Name: Nhan, V.Q. Author-Name: Tsui, A. Year: 1998 Volume: 88 Issue: 4 Pages: 660-663 Abstract: Objectives. The authors examined factors predicting abortion use in two communes in northern Vietnam. Methods. A survey of 504 rural and 523 urban women of childbearing age was conducted. Results. For the 13.6% of urban and 19% of rural commune women having had an abortion in the previous year, logistic regression analyses demonstrated that use of an intrauterine device reduced the likelihood of subsequent abortion in both communes. Traditional method use in the rural commune, however, increased women's likelihood of a subsequent abortion. Conclusions. Contraceptive use in these 2 communes affected abortion more than sociodemographic factors. Traditional method use by rural women is a risk for abortion. Handle: RePEc:aph:ajpbhl:1998:88:4:660-663_3 Template-Type: ReDIF-Article 1.0 Title: Changing fruit and vegetable consumption among children: The 5-a-day power plus program in St. Paul, Minnesota Journal: American Journal of Public Health Author-Name: Perry, C.L. Author-Name: Bishop, D.B. Author-Name: Taylor, G. Author-Name: Murray, D.M. Author-Name: Mays, R.W. Author-Name: Dudovitz, B.S. Author-Name: Smyth, M. Author-Name: Story, M. Year: 1998 Volume: 88 Issue: 4 Pages: 603-609 Abstract: Objectives. A randomized school-based trial sought to increase fruit and vegetable consumption among children using a multicomponent approach. Methods. The intervention, conducted in 20 elementary schools in St. Paul, targeted a multiethnic group of children who were in the fourth grade in spring 1995 and the fifth grade in fall 1995. The intervention consisted of behavioral curricula in classrooms, parental involvement, school food service changes, and industry support and involvement. Lunchroom observations and 24- hour food recalls measured food consumption. Parent telephone surveys and a health behavior questionnaire measured psychosocial factors. Results. The intervention increased lunchtime fruit consumption and combined fruit and vegetable consumption, lunchtime vegetable consumption among girls, and daily fruit consumption as well as the proportion of total daily calories attributable to fruits and vegetables. Conclusions. Multicomponent school- based programs can increase fruit and vegetable consumption among children. Greater involvement of parents and more attention to increasing vegetable consumption, especially among boys, remain challenges in future intervention research. Handle: RePEc:aph:ajpbhl:1998:88:4:603-609_4 Template-Type: ReDIF-Article 1.0 Title: Prevalence and impact of disabling chronic conditions in childhood Journal: American Journal of Public Health Author-Name: Newacheck, P.W. Author-Name: Halfon, N. Year: 1998 Volume: 88 Issue: 4 Pages: 610-617 Abstract: Objectives. This study provides a current national profile of the prevalence and impact of chronic conditions causing childhood disability. Disability is defined as a long-term reduction in ability to conduct social role activities, such as school or play, because of a chronic physical or mental condition. Methods. A cross-sectional descriptive analysis was performed on data from 99 513 children younger than 18 years who were included in the 1992-1994 National Health Interview Survey. The response rate exceeded 93% during each year. Results. A significant proportion of children, estimated at 6.5% of all US children, experienced some degree of disability. The most common causes of childhood disability were respiratory diseases and mental impairments. Prevalence of disability was higher for older children, boys, and children from low-income and single-parent families. Childhood disability is estimated to result in 66 million restricted activity days annually, including 24 million days lost from school. Furthermore, disability in childhood results in an added 26 million physician contacts and 5 million hospital days annually. Conclusions. Childhood disability has profound impacts on children, the education system, and the health care system. Handle: RePEc:aph:ajpbhl:1998:88:4:610-617_4 Template-Type: ReDIF-Article 1.0 Title: Informed consent for HIV testing in a South African hospital: Is it truly informed and truly voluntary? Journal: American Journal of Public Health Author-Name: Abdool Karim, Q. Author-Name: Abdool Karim, S.S. Author-Name: Coovadia, H.M. Author-Name: Susser, M. Year: 1998 Volume: 88 Issue: 4 Pages: 637-640 Abstract: Objective. The purpose of this study was to assess informed consent to human immunodeficiency virus (HIV) testing in a perinatal HIV transmission study in a major referral hospital serving a largely Black population in South Africa. Methods. First-time antenatal clinic attenders who were randomly selected from those enrolled in the perinatal HIV study (n = 56) answered questionnaires before and after counseling. Results. Knowledge of HIV transmission and prevention, high at the outset, was little improved after counseling. The acceptance rate for HIV testing was high. Despite assurances that participation was voluntary, 88% of the women said they felt compelled to participate in the study. Conclusions. Informed consent in this setting was truly informed but not truly voluntary. Handle: RePEc:aph:ajpbhl:1998:88:4:637-640_3 Template-Type: ReDIF-Article 1.0 Title: Variation between studies in reported relative risks associated with hypertension: Time trends and other explanatory variables Journal: American Journal of Public Health Author-Name: Marang-Van De Mheen, P.J. Author-Name: Gunning-Schepers, L.J. Year: 1998 Volume: 88 Issue: 4 Pages: 618-622 Abstract: Objectives. This study examined the variation in reported relative risks of coronary heart disease and stroke associated with hypertension and determined reasons for the interstudy variation. Methods. Studies published since 1972 were examined that reported the absolute number of events and person-years for men by age and hypertensive status. The data were pooled in Poisson regression models with the coronary heart disease or stroke rate as the dependent variable. Independent variables were hypertensive status, age at entry, age of study, duration of follow-up, diastolic blood pressure cut- off point, and interactions of all these variables with hypertensive status. Results. The reported relative risks associated with hypertension ranged from 1.45 to 2.77 for coronary heart disease and from 1.86 to 5.78 for stroke. Smaller relative risks were found in more recent studies, in studies using a lower cut-off point to define hypertension. Conclusions: Part of the interstudy variation in relative risks associated with hypertension can be attributed to differences in duration of follow-up, blood pressure cutoff point, and time at which blood pressure was measured, suggesting declining relative risks over time. Handle: RePEc:aph:ajpbhl:1998:88:4:618-622_4 Template-Type: ReDIF-Article 1.0 Title: Ethical dilemmas in polio eradication Journal: American Journal of Public Health Author-Name: Lee, J.W. Author-Name: Melgaard, B. Author-Name: Hull, H.F. Author-Name: Barakamfitiye, D. Author-Name: Okwo-Bele, J.M. Author-Name: Hyder, A.A. Year: 1998 Volume: 88 Issue: 1 Pages: 130-132 Handle: RePEc:aph:ajpbhl:1998:88:1:130-132_8 Template-Type: ReDIF-Article 1.0 Title: Persons with disabilities (multiple letters) Journal: American Journal of Public Health Author-Name: Pfeiffer, D. Author-Name: Gilson, S.F. Author-Name: Chilcoat, H.D. Author-Name: Stapleton, J.M. Year: 1998 Volume: 88 Issue: 1 Pages: 134 Handle: RePEc:aph:ajpbhl:1998:88:1:134_8 Template-Type: ReDIF-Article 1.0 Title: Atrial fibrillation as a risk factor for stroke: A retrospective cohort study of hospitalized medicare beneficiaries Journal: American Journal of Public Health Author-Name: Yuan, Z. Author-Name: Bowlin, S. Author-Name: Einstadter, D. Author-Name: Cebul, R.D. Author-Name: Conners Jr., A.R. Author-Name: Rimm, A.A. Year: 1998 Volume: 88 Issue: 3 Pages: 395-400 Abstract: Objectives. This study examined the relationship between atrial fibrillation and (1) stroke and (2) all-cause mortality. Methods. All eligible Medicare patients older than 65 years of age hospitalized in 1985 were followed up for 4 years. Kaplan-Meier and Cox proportional hazards models were used for assessment of risk of stroke and mortality. Results. A total of 4 282 607 eligible Medicare patients were hospitalized in 1985. The mean age was 76.1 (±7.7) years; 58.7% were female; 7.2% were Black; and 8.4% had a diagnosis of atrial fibrillation. During the follow-up period, 66 063 patients (32.6/1000 person-years) developed nonembolic stroke and 7285 (3.6- 1000 person-years) developed embolic stroke. After adjustment for age, race, sex, and comorbid conditions, atrial fibrillation remained a significant risk factor for both nonembolic stroke (relative risk [RR] = 1.56) and embolic stroke (RR = 5.80) and for mortality (RR = 1.31). Approximately 4.5% of nonembolic and 28.7% of embolic strokes among hospitalized Medicare patients aged 65 years and older were attributable to atrial fibrillation. Conclusions. This study demonstrates that atrial fibrillation is associated with an appreciable increase in the risk of stroke (both embolic and nonembolic) and in the risk of mortality from all causes. Handle: RePEc:aph:ajpbhl:1998:88:3:395-400_5 Template-Type: ReDIF-Article 1.0 Title: Hospital volume differences and five-year survival from breast cancer Journal: American Journal of Public Health Author-Name: Roohan, P.J. Author-Name: Bickell, N.A. Author-Name: Baptiste, M.S. Author-Name: Therriault, G.D. Author-Name: Ferrara, E.P. Author-Name: Siu, A.L. Year: 1998 Volume: 88 Issue: 3 Pages: 454-457 Abstract: Objectives: The purpose of this study was to determine the effect of hospital volume on long-term survival for women with breast cancer. Methods: Survival analysis and proportional-hazard modeling were used to assess 5- year survival and risk of death, adjusting for clinical and sociodemographic variables. Results: At 5 years, patients from very low-volume hospitals had a 60% greater risk of all-cause mortality than patients from high-volume hospitals. Conclusions: Hospital volume of breast cancer surgical cases has a strong positive effect on 5-year survival. Research is needed to identify whether processes of care, especially postsurgical adjuvant treatments, contribute survival differences. Handle: RePEc:aph:ajpbhl:1998:88:3:454-457_0 Template-Type: ReDIF-Article 1.0 Title: Can Medicaid managed care provide continuity of care to new medicaid enrollees? An analysis of tenure on Medicaid Journal: American Journal of Public Health Author-Name: Carrasquillo, O. Author-Name: Himmelstein, D.U. Author-Name: Woolhandler, S. Author-Name: Bor, D.H. Year: 1998 Volume: 88 Issue: 3 Pages: 464-466 Abstract: Objectives. The purpose of this study was to analyze duration of coverage among new Medicaid enrollees. Methods. The 1991 Survey of Income and Program Participation was used to examined the duration of coverage for individuals who did not have Medicaid in January 1991 and obtained coverage by May 1993. Results. Of new Medicaid enrollees, 38% (90% confidence interval [CI] = 34%, 42%) remained covered 1 year later, 26% (90% CI = 21%, 31%) remained covered at 28 months. Of those older than 65 years, 54% (90% CI = 31%, 77%) retained Medicaid for 28 months, vs 20% (90% CI = 14%, 26%) of children. Of people who lost Medicaid 54% (90% CI = 31%, 77%) had no insurance the following month. Conclusions. Almost two thirds of new Medicaid recipients lose coverage within 12 months. It is unlikely that Medicaid managed care will enhance continuity of care for new recipients. Handle: RePEc:aph:ajpbhl:1998:88:3:464-466_9 Template-Type: ReDIF-Article 1.0 Title: Inequalities in mortality by social class measured at 3 stages of the lifecourse Journal: American Journal of Public Health Author-Name: Hart, C.L. Author-Name: Smith, G.D. Author-Name: Blane, D. Year: 1998 Volume: 88 Issue: 3 Pages: 471-474 Abstract: Objectives. This study examined how social class, measured at 3 stages of life, contributes to mortality risk. Methods. A cohort of employed Scottish men (n = 5567) provided their fathers' occupation and their own first and current occupations, from which social class in childhood, at labor-market entry, and at screening (1970 to 1973) was determined. Relative rates of mortality and relative indices of inequality were calculated from 21 years of follow-up. Results. Mortality risk was similar at each stage of life, with men in the higher social classes having the lowest risk. Social class at screening produced the greatest relative indices of inequality. Conclusions. The widening of inequalities in mortality in adulthood suggests the importance of the accumulation of poor socioeconomic circumstances throughout life. Handle: RePEc:aph:ajpbhl:1998:88:3:471-474_9 Template-Type: ReDIF-Article 1.0 Title: Health insurance coverage among Chinese Americans in Los Angeles County Journal: American Journal of Public Health Author-Name: Takeuchi, D.T. Author-Name: Chung, R.C.-Y. Author-Name: Shen, H. Year: 1998 Volume: 88 Issue: 3 Pages: 451-453 Abstract: Objectives. This paper examines the factors associated with health insurance coverage among Chinese Americans in Los Angeles County. Methods. Data were obtained through interviews conducted in 1993 and 1994 with Chinese Americans (aged 18 through 65 years) residing in Los Angeles County. A multistage probability sample was used to select respondents. Results. The final sample consisted of 1747 respondents, which represented an 82% response rate. Thirty-nine percent of the respondents in the survey were without health insurance at the time of the survey. Conclusions. Logistic regression analysis showed that marital status, length of residence in the United States, education, employment, and household income were associated with health insurance coverage among Chinese Americans. Handle: RePEc:aph:ajpbhl:1998:88:3:451-453_0 Template-Type: ReDIF-Article 1.0 Title: Insurance or a regular physician: Which is the most powerful predictor of health care? Journal: American Journal of Public Health Author-Name: Sox, C.M. Author-Name: Swartz, K. Author-Name: Burstin, H.R. Author-Name: Brennan, T.A. Year: 1998 Volume: 88 Issue: 3 Pages: 364-370 Abstract: Objectives. This study compared the relative effects on access to health care of relationship with a regular physician and insurance status. Methods. The subjects were 1952 nonretired, non-Medicare patients aged 18 to 64 years who presented with 1 of 6 chief complaints to 5 academic hospital emergency departments in Boston and Cambridge, Mass, during a 1-month study period in 1995. Access to care was evaluated by 3 measures: delay in seeking care for the current complaint, no physician visit in the previous year, and no emergency department visit in the previous year. Results. After clinical and socioeconomic characteristics were controlled, lacking a regular physician was a stronger, more consistent predictor than insurance status of delay in seeking care (odds ratio [OR] = 1.6, 95% confidence interval [CI] = 1.2, 2.1), no physician visit (OR = 4.5, 95% CI = 3.3, 6.1), and no emergency department visit (OR = 1.8, 95% CI = 1.4, 2.4). For patients with a regular physician, access was no different between the uninsured and the privately insured. For privately insured patients, those with no regular physician had worse access than those with a regular physician. Conclusions. Among patients presenting to emergency departments, relationship with a regular physician is a stronger predictor than insurance status of access to care. Handle: RePEc:aph:ajpbhl:1998:88:3:364-370_5 Template-Type: ReDIF-Article 1.0 Title: Does low socioeconomic status potentiate the effects of heightened cardiovascular responses to stress on the progression of carotid atherosclerosis? Journal: American Journal of Public Health Author-Name: Lynch, J.W. Author-Name: Everson, S.A. Author-Name: Kaplan, G.A. Author-Name: Salonen, R. Author-Name: Salonen, J.T. Year: 1998 Volume: 88 Issue: 3 Pages: 389-394 Abstract: Objectives. This study examined whether heightened cardiovascular reactivity and low socioeconomic status had synergistic effects on the progression of carotid atherosclerosis in a population of eastern Finnish men. Methods. Data from the Kuopio Ischemic Heart Disease Risk Factor Study were used to measure 4-year progression of intima-media thickness in 882 men according to cardiovascular reactivity and socioeconomic status. Associations were examined in relation to risk factors and were stratified by base-line levels of atherosclerosis and prevalent ischemic heart disease. Results. The effect of reactivity on atherosclerotic progression depended on socioeconomic status. Men who had heightened cardiovascular responsiveness to stress and were born into poor families, received little education, or had low incomes had the greatest atherosclerotic progression. Conclusions. An understanding of associations between individual risk factors and disease should be based on etiologic hypotheses that are conceived at the population level and involve fundamental social and economic causes of disease. This study demonstrates how examining the interaction of an individual biological predisposition with low socioeconomic status over the life course is etiologically informative for understanding the progression of atherosclerotic vascular disease. Handle: RePEc:aph:ajpbhl:1998:88:3:389-394_7 Template-Type: ReDIF-Article 1.0 Title: Voting with their feet: Public hospitals, health reform, and patient choices Journal: American Journal of Public Health Author-Name: Ansell, D. Author-Name: Schiff, G. Author-Name: Dick, S. Author-Name: Cwiak, C. Author-Name: Wright, K. Year: 1998 Volume: 88 Issue: 3 Pages: 439-441 Abstract: Objectives. This study identified public hospital patients' preferences under managed care and health reform. Methods. A cross-sectional survey of 348 ambulatory public hospital patients was conducted. Results. Patients reported a high degree of loyalty to the public hospital given several hypothetical reform scenarios. Those patients who stated they would remain at the hospital increased (from 74.2% to 85.5%) when care elsewhere required copayment for medications and physician visits. Conclusions. Patients at one public hospital reported a high likelihood of remaining in the public system, and this likelihood increased when copayment for services was required elsewhere. Handle: RePEc:aph:ajpbhl:1998:88:3:439-441_4 Template-Type: ReDIF-Article 1.0 Title: The effects of Florida's Medicaid eligibility expansion for pregnant women Journal: American Journal of Public Health Author-Name: Long, S.H. Author-Name: Marquis, M.S. Year: 1998 Volume: 88 Issue: 3 Pages: 371-376 Abstract: Objectives. This is a study of the effects on prenatal care and birth outcomes of Florida's July 1989 expansion in the Medicaid income eligibility threshold for pregnant women. Methods. Concurrent and longitudinal comparisons were performed with matched birth and death certificates, hospital discharge data, Medicaid eligibility records, and records from county health departments for women giving birth from July 1988 to June 1989 (n = 56 101) or in calendar year 1991 (n = 78 421). Measures included amount and timing of prenatal care and rates of low birth-weight and infant deaths. Results. The Medicaid expansion led to greater access and improved birth outcomes. For example, the rate of low-birthweight infants among low-income women without private insurance fell from 67.9 to 61.8 per 1000, while it remained unchanged for low-income women with private insurance. Women in the expansion group who used county health departments had fewer low-birthweight infants than those using other delivery systems. Conclusions. The benefits from the Florida expansion appear to be greater than those reported for other states. The role of the public health delivery system may account for some of Florida's success. Handle: RePEc:aph:ajpbhl:1998:88:3:371-376_9 Template-Type: ReDIF-Article 1.0 Title: Food insufficiency exists in the United States: Results from the Third National Health and Nutrition Examination Survey (NHANES III) Journal: American Journal of Public Health Author-Name: Alaimo, K. Author-Name: Briefel, R.R. Author-Name: Frongillo Jr., E.A. Author-Name: Olson, C.M. Year: 1998 Volume: 88 Issue: 3 Pages: 419-426 Abstract: Objectives. The purpose of this study was to estimate the prevalence of food insufficiency in the United States and to examine sociodemographic characteristics related to food insufficiency. Methods. Data were analyzed from the third National Health and Nutrition Examination Survey, a cross- sectional representative sample of the civilian noninstitutionalized population living in households. Individuals were classified as 'food insufficient' if a family respondent reported that the family sometimes or often did not get enough food to eat. Results. From 1988 through 1994, the overall prevalence of food insufficiency was 4.1% and was primarily related to poverty status. In the low-income population, food insufficiency was positively associated with being Mexican American, being under the age of 60, having a family head who had not completed high school, participating in the Food Stamp Program, and not having health insurance. It was not related to family type or employment status of the family head. Over half of food- insufficient individuals lived in employed families. Conclusions. Food insufficiency is not limited to very low-income persons, specific racial/ethnic groups, family types, or the unemployed. Understanding food insufficiency is critical to formulating nutrition programs and policies. Handle: RePEc:aph:ajpbhl:1998:88:3:419-426_0 Template-Type: ReDIF-Article 1.0 Title: Geographic variations in breach cancer mortality: Do higher rates imply elevated incidence or poorer survival? Journal: American Journal of Public Health Author-Name: Goodwin, J.S. Author-Name: Freeman, J.L. Author-Name: Freeman, D. Author-Name: Nattinger, A.B. Year: 1998 Volume: 88 Issue: 3 Pages: 458-460 Abstract: Objectives. Mortality rates from breast cancer are approximately 25% higher for women in the northeastern United States than for women in the South or West. This study examined the hypothesis that the elevation is due to decreased survival rather than increased incidence. Methods. Data on breast Cancer incidence, treatment, and mortality were reviewed. Results. The elevated mortality in the Northeast is apparent only in older women. For women aged 65 years and older, breast cancer mortality is 26% higher in New England than in the South, while incidence is only 3% higher. Breast cancer mortality for older women by state correlates poorly with incidence (r = 0.28). Conclusions. Those seeking to explain the excess breast cancer mortality in the Northeast should assess survival and should examine differences in cancer control practices that affect survival. Handle: RePEc:aph:ajpbhl:1998:88:3:458-460_4 Template-Type: ReDIF-Article 1.0 Title: State funding of comprehensive primary medical care service programs for medically underserved populations Journal: American Journal of Public Health Author-Name: Rosenbaum, S. Author-Name: Hawkins Jr., D.R. Author-Name: Rosenbaum, E. Author-Name: Blake, S. Year: 1998 Volume: 88 Issue: 3 Pages: 357-363 Abstract: Objectives. This study examined the availability of state funding for comprehensive primary care programs and the need for primary care subsidies for medically underserved communities. Methods. A brief questionnaire was used to ask health agencies in all 50 states whether their state funded a program that met our definition of comprehensive primary medical care practice programs. An in-depth written survey instrument was then administered to the states with programs. Results. Almost half of all states provide some funds for the development and/or operation of comprehensive primary medical care practices. Expenditures in most states were found to be relatively modest in comparison with both federal funding and the total level of unmet need for primary care. States that subsidize primary care practices tend to follow the model established under the federal health centers program. Conclusions. The findings suggest the continued viability of the health center model of care, as well as the presence of some state support for such a program. However, in light of limited state resources for the development and operation of comprehensive practices, a continued and significant federal effort is imperative. Handle: RePEc:aph:ajpbhl:1998:88:3:357-363_4 Template-Type: ReDIF-Article 1.0 Title: The racial segregation of hospital care revisited: Medicare discharge patterns and their implications Journal: American Journal of Public Health Author-Name: Smith, D.B. Year: 1998 Volume: 88 Issue: 3 Pages: 461-463 Abstract: Objectives. This paper measures current patterns of hospital segregation among Medicare beneficiaries. Methods. Data from the fiscal year 1993 Medicare Provider Analysis and Review (MEDPAR) file, the index of dissimilarity, and a linear regression model are used to test the effects of standard metropolitan area characteristics on hospital segregation. Results. The overall hospital segregation index was 0.529, ranging by state from 0.154 to 0.746. Hospital segregation in 126 standard metropolitan areas was positively related to population size, hospital density, and residential segregation and negatively related to income inequities and location in the South. Conclusions. Racial segregation remains high and may produce both reporting biases and unequal effects of public policy. Handle: RePEc:aph:ajpbhl:1998:88:3:461-463_8 Template-Type: ReDIF-Article 1.0 Title: Quality of reviews in epidemiology Journal: American Journal of Public Health Author-Name: Breslow, R.A. Author-Name: Ross, S.A. Author-Name: Weed, D.L. Year: 1998 Volume: 88 Issue: 3 Pages: 475-477 Abstract: Objectives. This study examined the quality of recent reviews in epidemiology. Methods. All 1995 issues of 7 widely read epidemiology journals were searched to identify reviews. Results. Twenty-nine reviews were identified. Methodology was not specified or incomplete for literature searches in 79% or reviews, the same was true for inclusion criteria in 83% and for combining studies in 62%. More than 60% of the reviews were not methodologically systematic. Conclusions. There is a need to improve the quality of review papers in epidemiology. If systematic methodology were followed more frequently, epidemiologic science and its application could be improved. Handle: RePEc:aph:ajpbhl:1998:88:3:475-477_6 Template-Type: ReDIF-Article 1.0 Title: Correcting for bias in relative risk estimates due to exposure measurement error: A case study of occupational exposure to antineoplastics in pharmacists Journal: American Journal of Public Health Author-Name: Spiegelman, D. Author-Name: Valanis, B. Year: 1998 Volume: 88 Issue: 3 Pages: 406-412 Abstract: Objectives. This paper describes 2 statistical methods designed to correct for bias from exposure measurement error in point and interval estimates of relative risk. Methods. The first method takes the usual point and interval estimates of the log relative risk obtained from logistic regression and corrects them for nondifferential measurement error using an exposure measurement error model estimated from validation data. The second, likelihood-based method fits an arbitrary measurement error model suitable for the data at hand and then derives the model for the outcome of interest. Results. Data from Valanis and colleagues' study of the health effects of antineoplastics exposure among hospital pharmacists were used to estimate the prevalence ratio of fever in the previous 3 months from this exposure. For an interdecile increase in weekly number of drags mixed, the prevalence ratio, adjusted for confounding, changed from 1.06 to 1.17 (95% confidence interval [CI] = 1.04, 1.26) after correction for exposure measurement error. Conclusions. Exposure measurement error is often an important source of bias in public health research. Methods are available to correct such biases. Handle: RePEc:aph:ajpbhl:1998:88:3:406-412_5 Template-Type: ReDIF-Article 1.0 Title: A regression analysis estimating the number of drug-using arrestees in 185 US cities Journal: American Journal of Public Health Author-Name: Hser, Y.-I. Author-Name: Prendergast, M. Author-Name: Anglin, M.D. Author-Name: Chen, J.K. Author-Name: Hsieh, S.-C. Year: 1998 Volume: 88 Issue: 3 Pages: 487-490 Abstract: Objectives. This study sought to provide population-based estimates of drug-using arrestees in the 185 largest US cities. Methods. A prevalence model for drug-using arrestees was developed by relating selected social indicators (from 1990 census data) and drug use rates (from Drug Use Forecasting program data) via logistic regression analysis. Results. It was estimated that in 1990, across the 185 cities, about 925 000 arrestees used cocaine, 317 000 used opiates, 213 000 used amphetamines, 389 000 were drug injectors, and 1 296 000 used an illicit drug. Conclusions. This approach represents a cost-efficient method for prevalence estimation based on empirically demonstrable relationships between social indicators and drug use rates. Handle: RePEc:aph:ajpbhl:1998:88:3:487-490_2 Template-Type: ReDIF-Article 1.0 Title: Risk of ectopic pregnancy and previous induced abortion Journal: American Journal of Public Health Author-Name: Tharaux-Deneux, C. Author-Name: Bouyer, J. Author-Name: Job-Spira, N. Author-Name: Coste, J. Author-Name: Spira, A. Year: 1998 Volume: 88 Issue: 3 Pages: 401-405 Abstract: Objectives. This study investigated the role of prior history of induced abortion in subsequent ectopic pregnancies. Methods. Data from two French case-control studies were used to examine the effect of induced abortion on ectopic pregnancy risk. Case patients (n = 570) were women admitted for ectopic pregnancy during the study period; controls (n = 1385) were women who delivered in the same center. Results. The analysis among women with no previous ectopic pregnancy showed that, after control for the main ectopic pregnancy risk factors, prior induced abortion was associated with an increased risk of ectopic pregnancy (odds ratio [OR] = 1.5, 95% confidence interval [CI] = 1.0, 2.0); there was a significant trend between number of previous induced abortions and ectopic pregnancy risk (ORs = 1.4 for 1 previous induced abortion and 1.9 for 2 or more). Conclusions. This study suggests that induced abortion may be a risk factor for ectopic pregnancy for women with no previous ectopic pregnancy, particularly in the case of women who have had several induced abortions. Handle: RePEc:aph:ajpbhl:1998:88:3:401-405_7 Template-Type: ReDIF-Article 1.0 Title: Decision latitude, job strain, and myocardial infarction: A study of working men in Stockholm Journal: American Journal of Public Health Author-Name: Theorell, T. Author-Name: Tsutsumi, A. Author-Name: Hallquist, J. Author-Name: Reuterwall, C. Author-Name: Hogstedt, C. Author-Name: Fredlund, P. Author-Name: Emlund, N. Author-Name: Johnson, J.V. Year: 1998 Volume: 88 Issue: 3 Pages: 382-388 Abstract: Objectives. This study examined the role of decision latitude and job strain in the etiology of a first myocardial infarction. Methods. Eligible case patients were all full-time working men 45 to 64 years of age who suffered a first myocardial infarction during the period January 1992 to January 1993 in the greater Stockholm region. Referents were selected from the general population. Participation rates were 82% (case patients) and 75% (referents). Results. Both inferred and self-reported low decision latitude were associated with increased risk of a first myocardial infarction, although this association was weakened after adjustment for social class. A decrease in inferred decision latitude during the 10 years preceding the myocardial infarction was associated with increased risk after all adjustments, including chest pain and social class. The combination of high self-reported demands and low self-reported decision latitude was an independent predictor of risk after all adjustments. Conclusions. Both negative change in inferred decision latitude and self-reported job strain are important risk indicators in men less than 55 years of age and in blue- collar workers. Handle: RePEc:aph:ajpbhl:1998:88:3:382-388_4 Template-Type: ReDIF-Article 1.0 Title: The National Occupational Research Agenda: A model of broad stakeholder input priority setting Journal: American Journal of Public Health Author-Name: Rosenstock, L. Author-Name: Olenec, C. Author-Name: Wagner, G.R. Year: 1998 Volume: 88 Issue: 3 Pages: 353-356 Abstract: Objectives. No single organization has the resources necessary to conduct occupational safety and health research to adequately serve the needs of workers in the United States. The National Institute for Occupational Safety and Health (NIOSH) undertook the task of setting research priorities in response to a broadly perceived need to systematically address those topics most pressing and most likely to yield gains to workers and to the nation. Methods. NIOSH and its public and private partners used a consensus- building process to set priorities for the next decade for occupational safety and health research - the National Occupational Research Agenda. Results. The process resulted in the identification of 21 research priorities grouped into 3 categories: disease and injury, work environment and workforce, and research tools and approaches. Conclusions. Although the field of occupational safety and health is often contentious and adversarial, these research priorities reflect a remarkable degree of concurrence among a broad range of stakeholders who provided input into a clearly defined and open process. Handle: RePEc:aph:ajpbhl:1998:88:3:353-356_5 Template-Type: ReDIF-Article 1.0 Title: How safe are our schools? Journal: American Journal of Public Health Author-Name: Miller, T.R. Author-Name: Spicer, R.S. Year: 1998 Volume: 88 Issue: 3 Pages: 413-418 Abstract: Objectives. The goal of this study was to provide national estimates of the frequency and cost of school injuries. Methods. Six years of National Health Interview Survey data were used to estimate nonfatal injury incidence rates, multiple sources were used to estimate fatalities, and national highway crash data were used to estimate school bus injury incidence. Results. Each year, 3.7 million children suffer a substantial injury at school, resulting in an estimated $3.2 billion in medical spending and $115 billion in good health lost. Nonschool fatalities greatly exceed school fatalities; from an incidence per hour perspective, however, school hours are no safer than non-school hours despite greater formal supervision. School bus injuries account for half of school injury deaths but less than 1% of total school injury costs. Conclusions. Nonfatal injury is a problem in schools. The concentration of injury at secondary schools suggests that interventions there may be most cost-effective. Data on school injury causes are greatly needed. Handle: RePEc:aph:ajpbhl:1998:88:3:413-418_3 Template-Type: ReDIF-Article 1.0 Title: The demographic characteristics of Medicaid-eligible uninsured children Journal: American Journal of Public Health Author-Name: Avruch, S. Author-Name: Machlin, S. Author-Name: Bonin, P. Author-Name: Ullman, F. Year: 1998 Volume: 88 Issue: 3 Pages: 445-447 Abstract: Objectives. This study estimated the number of uninsured children in 1993 who were eligible for Medicaid. Methods. Data from the March 1990 and 1994 Current Population Surveys were analyzed. Results. At least 2.3 million Medicaid-eligible children were uninsured in 1993. These children were more likely to have a working parent than children on Medicaid. Higher proportions of uninsured children less than 6 years of age, children who lived in female- headed single-parent families, and African-American and Hispanic children were eligible for Medicaid. Conclusions. Many eligible children do not enroll in Medicaid, and they differ in specific ways from enrolled children. Handle: RePEc:aph:ajpbhl:1998:88:3:445-447_1 Template-Type: ReDIF-Article 1.0 Title: The effect of lead exposure on behavior problems in preschool children Journal: American Journal of Public Health Author-Name: Washerman, G.A. Author-Name: Staghezza-Jaramillo, B. Author-Name: Shrout, P. Author-Name: Popovac, D. Author-Name: Graziano, J. Year: 1998 Volume: 88 Issue: 3 Pages: 481-486 Abstract: Objectives. Interpreting associations between lead exposure and child behavior problems is difficult because studies have not controlled for sociodemographic confounders or have used shed teeth to mark exposure. This study explored associations between blood lead and preschool behavior. Methods. Children from a smelter town and a non-lead-exposed town in Yugoslavia were followed up prospectively from pregnancy through age 3. The Child Behavior Checklist was used to assess behavior problems in 379 3-year- olds, controlling for sociodemographic factors and difficult infant temperament. Results. Multiple regression revealed the expected significant associations between checklist subscales and sociodemographic factors, which explained 7% to 18% of the variance on the subscales. Concurrent blood lead explained a significant 1% to 4% of the variance on the Destructive and Withdrawn subscales. Earlier difficult temperament explained an additional 2% to 5% of the checklist variance. Scores on the Destructive subscale were consistently associated with blood lead. As blood lead increased from 10 to 20 μg/dL, subscale scores increased by approximately 0.5 points. Conclusions. Lead/behavior associations are significant but small compared with the effects of social factors. Handle: RePEc:aph:ajpbhl:1998:88:3:481-486_1 Template-Type: ReDIF-Article 1.0 Title: Designing messages to reduce infant mortality: from talking posters to public service announcements. Journal: American Journal of Public Health Author-Name: Hatcher, B.J. Author-Name: Alexander, L. Author-Name: Abrar, L. Year: 1998 Volume: 88 Issue: 2 Pages: 305-306 Handle: RePEc:aph:ajpbhl:1998:88:2:305-306_7 Template-Type: ReDIF-Article 1.0 Title: The decline in Rh hemolytic disease: Should Rh prophylaxis get all the credit? Journal: American Journal of Public Health Author-Name: Joseph, K.S. Author-Name: Kramer, M.S. Year: 1998 Volume: 88 Issue: 2 Pages: 209-215 Abstract: Objectives. This study sought to quantify the magnitude of Rh disease reduction occurring secondary to Rh prophylaxis and other determinants. Methods. Outcomes considered included maternal Rh sensitization, neonatal Rh disease, and perinatal deaths from Rh disease. Analysis was based on Poisson regression modeling of ecological data form Manitoba, Canada, and conditional probability modeling. Results. The ecological analysis showed that changes in birth order and Rh prophylaxis resulted in 24% (95% confidence interval [CI] = 1%, 42%) and 69% (95% CI = 61%, 76%), decrease respectively, in Rh sensitizations (D and non-D) in Manitoba between 1963 and 1988, Rh prophylaxis, and nonprogram factors were responsible for 83% (95% CI = 44%, 95%) and 78% (95% CI = 42%, 91%), respectively, of the reduction in perinatal deaths from Rh disease. Similar results were obtained with conditional probability modeling, which also provided estimates for the effects of changes in abortion rates and racial composition. Conclusions, In addition Rh prophylaxis, changes in other determinants were responsible for an important fraction of the decline in Rh disease. These results provide a historical perspective on the conquest of Rh disease and also have important implication for public health policy, particularly in developing countries. Handle: RePEc:aph:ajpbhl:1998:88:2:209-215_6 Template-Type: ReDIF-Article 1.0 Title: The preterm prediction study: The value of new vs standard risk factors in predicting early and all spontaneous preterm births Journal: American Journal of Public Health Author-Name: Goldenberg, R.L. Author-Name: Iams, J.D. Author-Name: Mercer, B.M. Author-Name: Meis, P.J. Author-Name: Moawad, A.H. Author-Name: Copper, R.L. Author-Name: Das, A. Author-Name: Thom, E. Author-Name: Johnson, F. Author-Name: McNellis, D. Author-Name: Miodovnik, M. Author-Name: Van Dorsten, J.P. Author-Name: Caritis, S.N. Author-Name: Thurnau, G.R. Author-Name: Bottoms, S.F. Year: 1998 Volume: 88 Issue: 2 Pages: 233-238 Abstract: Objective. This study was undertaken to determine the relationship between fetal fibronectin, short cervix, bacterial vaginosis, other traditional risk factors, and spontaneous preterm birth. Methods. From 1992 through 1994, 2929 women were screened at the gestational age of 22 to 24 weeks. Results. The odds ratios for spontaneous preterm birth were highest for fetal fibronectin, followed by a short cervix and history of preterm birth. These factors, as well as bacterial vaginosis, were more strongly associated with early than with late spontaneous preterm birth. Bacterial vaginosis was more common - and a stronger predictor of spontaneous preterm birth - in Black women, while body mass index less than 19.8 was a stronger predictor in non-Black women. This analysis suggests a pathway leading from Black race through bacterial vaginosis and fetal fibronectin to spontaneous preterm birth. Prior preterm birth is associated with spontaneous preterm birth through a short cervix. Conclusions. Fetal fibronectin and a short cervix are stronger predictors of spontaneous preterm birth than traditional risk factors. Bacterial vaginosis was found more often in Black than in non- Black women and accounted for 40% of the attributable risk for spontaneous preterm birth at less than 32 weeks. Handle: RePEc:aph:ajpbhl:1998:88:2:233-238_0 Template-Type: ReDIF-Article 1.0 Title: An ecological study of the effectiveness of mammography in reducing breast cancer mortality Journal: American Journal of Public Health Author-Name: Cooper, G.S. Author-Name: Yuan, Z. Author-Name: Bowlin, S.J. Author-Name: Dennis, L.K. Author-Name: Kelly, R. Author-Name: Chen, H. Author-Name: Rimm, A.A. Year: 1998 Volume: 88 Issue: 2 Pages: 281-284 Abstract: Objectives. The purpose of this study was to determine the relation of screening mammography to breast cancer incidence and case fatality. Methods. In a sample of White female Medicare beneficiaries hospitalized in 1990- 1991, age-adjusted breast cancer incidence and 2-year case fatality rates were estimated and compared with the frequency, of mammographic screening from a population-based survey. Results. The average rates for incidence, case fatality, and mammography within 5 years in 29 states were 414/100 000, 18.8%, and 59.2%, respectively. There was a positive state-level correlation between mammography rates and incidence and an inverse correlation between mammography and ease fatality. Conclusions. High screening mammography rates in some states are associated with reduced breast cancer case fatality rates, presumably as a result of diagnosis of earlier stage cancers. Handle: RePEc:aph:ajpbhl:1998:88:2:281-284_0 Template-Type: ReDIF-Article 1.0 Title: Early detection of developmental dysplasia of the hip in the Netherlands: The validity of a standardized assessment protocol in infants Journal: American Journal of Public Health Author-Name: Boere-Boonekamp, M.M. Author-Name: Kerkhoff, T.H.M. Author-Name: Schuil, P.B. Author-Name: Zielhuis, G.A. Year: 1998 Volume: 88 Issue: 2 Pages: 285-288 Abstract: Objective. This study evaluated the validity of the traditionally recommended screening protocol for developmental dysplasia of the hip in infants. Methods. Study children (n = 1968) underwent a standardized screening examination. Results. The incidence of developmental dysplasia of the hip was 3.7%. The sensitivity of the test protocol was 86%, the specificity was 82%, and the predictive values of positive and negative tests were 16% and 99%, respectively. Conclusions. The validity of the screening protocol for developmental dysplasia of the hip is disappointingly low. The yield of adding an ultrasonographic examination to current screening activities needs further study. Handle: RePEc:aph:ajpbhl:1998:88:2:285-288_9 Template-Type: ReDIF-Article 1.0 Title: Violence during pregnancy: Measurement issues Journal: American Journal of Public Health Author-Name: Ballard, T.J. Author-Name: Saltzman, L.E. Author-Name: Gazmararian, J.A. Author-Name: Spitz, A.M. Author-Name: Lazorick, S. Author-Name: Marks, J.S. Year: 1998 Volume: 88 Issue: 2 Pages: 274-276 Abstract: Objectives. Standardized quantitative methods are needed to study occurence and timing of violence in relation to pregnancy and to to study the context in which pregnancy-related violence occurs. Methods. Data from three published studies of prevalence of violence during pregnancy are used to illustrate ways to measure the association of violence-in relation to pregnancy. Results. Four patterns of violence in relation to pregnancy are identified, and related research issues are discussed. Also, 2 population- base surveys that address the suggestion presented here are discussed. Conclusions. Better measurement of the association between violence and pregnancy will facilitate development of data-base prevention and intervention programs. Handle: RePEc:aph:ajpbhl:1998:88:2:274-276_6 Template-Type: ReDIF-Article 1.0 Title: Identifying condom users at risk for breakage and slippage: Findings from three international sites Journal: American Journal of Public Health Author-Name: Spruyt, A. Author-Name: Steiner, M.J. Author-Name: Joanis, C. Author-Name: Glover, L.H. Author-Name: Piedrahita, C. Author-Name: Alvarado, G. Author-Name: Ramos, R. Author-Name: Maglaya, C. Author-Name: Cordero, M. Year: 1998 Volume: 88 Issue: 2 Pages: 239-244 Abstract: Objectives. This study examined whether past condom failure (breakage, slippage, or both) can predict future failure and evaluated other predictors of condom failure. Methods. At each of 3 international sites, approximately 130 male condom users were enrolled and given 5 condoms to use for vaginal intercourse over a 3-week period. Results. Men at increased risk (history of 1 or more condoms that broke or slipped off) reported approximately twice as many condom failures as those not in this group. Condom failure increased with the number of adverse condom use behaviors reported per participant. Opening condom packages with sharp objects and unrolling condoms before donning were associated with breakage. Unrolling condoms before donning and lengthy or intense intercourse were associated with slippage. Of background characteristics evaluated, having less education was associated with condom failure. Conclusions. These data suggest that a history of condom failure predicts future failure, a finding that may be used for targeted intervention. Moreover, these data provide further evidence that certain behaviors and lower educational attainment are associated with condom failure. Handle: RePEc:aph:ajpbhl:1998:88:2:239-244_3 Template-Type: ReDIF-Article 1.0 Title: Measuring the burden of disease: Healthy life-years Journal: American Journal of Public Health Author-Name: Hyder, A.A. Author-Name: Rotllant, G. Author-Name: Morrow, R.H. Year: 1998 Volume: 88 Issue: 2 Pages: 196-202 Abstract: Objectives. This paper presents the background and rationale for a composite indicator, healthy life-year (HeaLY), that incorporates mortality and morbidity into a single number. HeaLY is compared with the disability- adjusted life-year (DALY) indicator, to demonstrate the relative simplicity and ease of use of the former. Methods. Data collected by the Ghana Health Assessment team from census records, death certificates, medical records, and special studies were used to create a spread sheet. HeaLYs lost as a result of premature mortality and disability from 56 conditions were estimated. Results. Two thirds of HeaLYs lost in Ghana were from maternal and communicable diseases and were largely preventable. The age weighting in DALYs leads to a higher value placed on deaths at younger ages than in HeaLYs. This spreadsheet can be used as a template for assessing changes in health status attributable to interventions. Conclusions. HeaLYs can aid in setting health priorities and identifying disadvantaged groups. The disaggregated approach of the HeaLY spreadsheet tool is simpler for decision makers and useful for country application. Handle: RePEc:aph:ajpbhl:1998:88:2:196-202_9 Template-Type: ReDIF-Article 1.0 Title: The green prescription study: A randomized controlled trial of written exercise advice provided by general practitioners Journal: American Journal of Public Health Author-Name: Swinburn, B.A. Author-Name: Walter, L.G. Author-Name: Arroll, B. Author-Name: Tilyard, M.W. Author-Name: Russell, D.G. Year: 1998 Volume: 88 Issue: 2 Pages: 288-291 Abstract: Objectives. The purpose of this study was to determine whether written advice from general practitioners increases physical activity among sedentary people more than verbal advice alone. Methods. Sedentary patients (n = 456) received verbal advice on increasing physical activity and were then randomized to an exercise prescription (green prescription) group or a verbal advice group. Results. The number of people engaging in any recreational physical activity at 6 weeks increased substantially, but significantly more so in the green prescription group. Also, more participants in the green prescription group increased their activity over the period. Conclusions. A written goal-oriented exercise prescription, in addition to verbal advice, is a useful tool for general practitioners in motivating their patients to increase physical activity. Handle: RePEc:aph:ajpbhl:1998:88:2:288-291_3 Template-Type: ReDIF-Article 1.0 Title: Differences in fertility associated with caffeinated beverage consumption Journal: American Journal of Public Health Author-Name: Caan, B. Author-Name: Quesenberry Jr., C.P. Author-Name: Coates, A.O. Year: 1998 Volume: 88 Issue: 2 Pages: 270-274 Abstract: Objectives. The effect of caffeine consumption on fertility was examined prospectively in 210 women. Methods. Women reported on caffeinated beverage consumption and pregnancy status monthly. Odds ratios for becoming pregnant were calculated for both high and moderate vs low consumption. Results. No significant association was found for any of the caffeinated beverages except tea. Drinking one-half cup or more of tea daily approximately doubled the odds of conception per cycle. Conclusions. These data suggest that caffeine may not be the responsible agent for the variation in fertility associated with consumption of the beverage examined. Handle: RePEc:aph:ajpbhl:1998:88:2:270-274_6 Template-Type: ReDIF-Article 1.0 Title: HIV infection and AIDS in China. Journal: American Journal of Public Health Author-Name: Su, L. Author-Name: Du, F. Year: 1998 Volume: 88 Issue: 2 Pages: 307 Handle: RePEc:aph:ajpbhl:1998:88:2:307_4 Template-Type: ReDIF-Article 1.0 Title: Results of the TeachWell worksite wellness program Journal: American Journal of Public Health Author-Name: Resnicow, K. Author-Name: Davis, M. Author-Name: Smith, M. Author-Name: Baranowski, T. Author-Name: Lin, L.S. Author-Name: Baranowski, J. Author-Name: Doyle, C. Author-Name: Wang, D.T. Year: 1998 Volume: 88 Issue: 2 Pages: 250-257 Abstract: Objectives. This study examined whether providing a school-based teacher wellness program enhances the impact of a health curriculum on student outcomes and improves cognitive, behavioral, and physiological outcomes among participating teachers. Methods. Thirty-two elementary schools were randomly assigned to experimental or comparison conditions. Comparison group schools received the Gimme-5 program, a curriculum designed to increase fourth and fifth graders' consumption of fruits and vegetables. Experimental schools received Gimme-5 and the teacher wellness program, which included 54 workshops over 2 years, along with several schoolwide health activities. Physiological, behavioral, and cognitive outcomes were assessed in teachers and students. Results. There was no evidence that the intervention favorably modified any student or teacher end points; nor did intervention teachers deliver the Gimme-5 program with greater fidelity than comparison teachers. Conclusion. Confidence in the null results is bolstered by the randomized design, baseline sample equivalence, appropriate mixed-model analyses, and lack of selective or differential attrition. Insufficient participation in the wellness program appears a likely explanation for the lack of teacher and student effects. Factors specific to the school setting and the intervention may have diminished participation and, thus, intervention effects. Handle: RePEc:aph:ajpbhl:1998:88:2:250-257_7 Template-Type: ReDIF-Article 1.0 Title: One-year follow-up of nutrition education for hypercholesterolemic children Journal: American Journal of Public Health Author-Name: Tershakovec, A.M. Author-Name: Shannon, B.M. Author-Name: Achterberg, C.L. Author-Name: McKenzie, J.M. Author-Name: Martel, J.K. Author-Name: Smiciklas-Wright, H. Author-Name: Pammer, S.E. Author-Name: Cortner, J.A. Year: 1998 Volume: 88 Issue: 2 Pages: 258-261 Abstract: Objectives. This study evaluated retention of the effect of a home- based, practitioner-initiated nutrition education model. Methods. Children with elevated low-density lipoprotein (LDL) cholesterol levels were randomly assigned to one of two nutrition interventions or to an at-risk control group. Intervention effects were evaluated 3, 6, and 12 months postbaseline. Results. The parent-child autotutorial group demonstrated significant increases in knowledge and, along with the counseling group, decreases in total and saturated fat intake. Also, the autotutorial and counseling groups retained a majority of their initial LDL cholesterol decrease. Conclusions: Knowledge of heart-healthful eating and dietary fat intake as well as dietary change can be affected and retained via home-based, practitioner-initiated nutrition interventions with hypercholesterolemic children, although some form of ongoing intervention may be necessary to produce lasting decreases in LDL cholesterol levels. Handle: RePEc:aph:ajpbhl:1998:88:2:258-261_1 Template-Type: ReDIF-Article 1.0 Title: Epidemic obesity in the United States: Are fast foods and television viewing contributing? Journal: American Journal of Public Health Author-Name: Jeffery, R.W. Author-Name: French, S.A. Year: 1998 Volume: 88 Issue: 2 Pages: 277-280 Abstract: Objectives. This study examined the association between TV viewing, fast food eating, and body mass index. Methods. Associations between hours of TV viewing, frequency of eating at fast food restaurants, body mass index, and behaviors were assessed cross sectionally and longitudinally over 1 year in 1059 men and women. Results. Fast food meals and TV viewing hours were positively Associated with energy intake and body mass index in women but not in men. TV viewing predicted weight gain in high-income women. Conclusions. Secular increases in fast food availability and access to televised entertainment may contribute to increasing obesity rates in the United States. Handle: RePEc:aph:ajpbhl:1998:88:2:277-280_5 Template-Type: ReDIF-Article 1.0 Title: Young maternal age and depressive symptoms: Results from the 1988 National Maternal and Infant Health Survey Journal: American Journal of Public Health Author-Name: Deal, L.W. Author-Name: Holt, V.L. Year: 1998 Volume: 88 Issue: 2 Pages: 266-270 Abstract: Objectives. The goal of this study was to provide population-based estimates of the prevalence of depressive symptoms among primiparous US adolescent mothers. Methods. Data from the live-birth component of the 1988 National Maternal and Infant Health Survey were analyzed. Results. The prevalence of depressive symptoms varied by age and races from 14% among White adult mothers to 48% among Black mothers 15 to 17 years old. After control for income and marital status, the increased prevalence of depressive symptoms associated with adolescent motherhood was greatly diminished (for 15-to 17-year-old Black women and 18-to 19-year-old White women) or eliminated (for 18- to 19-year-old Black women and 15- to 17-year-old White women). Conclusions. Adolescent mothers experience high rates of depressive symptoms relative to adult mothers, and mental health and other interventions that alleviate the exacerbating influence of poverty and unmarried stares are warranted. Handle: RePEc:aph:ajpbhl:1998:88:2:266-270_4 Template-Type: ReDIF-Article 1.0 Title: Correlates of same-sex sexual behavior in a random sample of Massachusetts high school students Journal: American Journal of Public Health Author-Name: Faulkner, A.H. Author-Name: Cranston, K. Year: 1998 Volume: 88 Issue: 2 Pages: 262-266 Abstract: Objectives. This study documented risk behaviors among homosexually and bisexually experienced adolescents. Methods. Data were obtained from a random sample of high school students in Massachusetts. Violence, substance use, and suicide behaviors were compared between students with same-sex experience and those reporting only heterosexual contact. Differences in prevalence and standard errors of the differences were calculated. Results. Students reporting same-sex contact were more likely to report fighting and victimization, frequent use of alcohol, other drug use, and recent suicidal behaviors. Conclusions. Students with same-sex experience may be at elevated risk of injury, disease, and death resulting from violence, substance abuse, and suicidal behaviors. Handle: RePEc:aph:ajpbhl:1998:88:2:262-266_2 Template-Type: ReDIF-Article 1.0 Title: Commentary: Medicaid reform issues affecting the Indian Health Care System Journal: American Journal of Public Health Author-Name: Wellever, A. Author-Name: Hill, G. Author-Name: Casey, M. Year: 1998 Volume: 88 Issue: 2 Pages: 193-195 Abstract: Substantial numbers of Indian people rely on Medicaid for their primary health insurance coverage. When state Medicaid programs enroll Indians in managed care programs, several unintended consequences may ensue. This paper identifies some of the perverse consequences of Medicaid reform for Indians and the Indian health care system and suggests strategies for overcoming them. It discusses the desire of Indian people to receive culturally appropriate services, the need to maintain or improve Indian health care system funding, and the duty of state governments to respect tribal sovereignty. Because of their relatively small numbers, Indians may be treated differently under Medicaid managed care systems without significantly endangering anticipated program savings. Failure of Medicaid programs to recognize the uniqueness of Indian people, however, may severely weaken the Indian health care system. Handle: RePEc:aph:ajpbhl:1998:88:2:193-195_0 Template-Type: ReDIF-Article 1.0 Title: Vitamin K prophylaxis in less developed countries: Policy issues and relevance to breastfeeding promotion Journal: American Journal of Public Health Author-Name: Victora, C.G. Author-Name: Van Haecke, P. Year: 1998 Volume: 88 Issue: 2 Pages: 203-209 Abstract: Vitamin K prophylaxis prevents hemorrhagic disease of the newborn. The present review estimates the potential magnitude of this problem in less developed countries, assessing the need for prophylaxis, along with its cost- effectiveness and feasibility. Late hemorrhagic disease, occurring between 2 and 12 weeks, often leads to death or permanent disability. Its median incidence in developed countries is 7 per 100 000 births. Incidences in less developed countries may be much higher. Three incidence scenarios are proposed and the corresponding losses of disability-adjusted life-years (DALYs) calculated. Under the intermediate scenario, late hemorrhagic disease accounts for 0.1% to 0.20% of DALYs lost to children less than 5 years of age. Assuming a cost of $1.00 per injection, each DALY saved would cost $1.33. Decisions on prophylaxis must be made on a national basis, considering mortality levels and causes, health budgets, and feasibility. Comparison with the impact of diseases prevented by breast-feeding shows that concern with hemorrhagic disease should not affect breast-feeding promotion efforts, although strategies for supplementing breast-fed infants must be explored. Handle: RePEc:aph:ajpbhl:1998:88:2:203-209_0 Template-Type: ReDIF-Article 1.0 Title: Global disparities in health and human rights: A critical commentary Journal: American Journal of Public Health Author-Name: Benatar, S.R. Year: 1998 Volume: 88 Issue: 2 Pages: 295-303 Abstract: Widening disparities in health and human rights at a global level represent the dark side of progress associated with escalation of economic and military exploitation and exponential population growth in the 20th century. Even the most basic universal human rights cannot be achieved for all under these circumstances. The goal of improved population health will be similarly elusive while medical care is commodified and exploited for commercial gain in the marketplace. Recognition of the powerful forces that polarize our world and commitment to reversing them are essential for the achievement of human rights for all, for the improvement of public health, and for the peaceful progress required to protect the 'rational self- interest' of the most privileged people on earth against the escalation of war, disease, and other destructive forces arising from widespread poverty and ecological degradation. Handle: RePEc:aph:ajpbhl:1998:88:2:295-303_7 Template-Type: ReDIF-Article 1.0 Title: Blood pressure measurement and antihypertensive treatment in a low- income African-American population Journal: American Journal of Public Health Author-Name: Hyman, D.J. Author-Name: Pavlik, V.N. Author-Name: Vallbona, C. Author-Name: Dunn, J.K. Author-Name: Louis, K. Author-Name: Dewey, C.M. Author-Name: Wieck, L. Year: 1998 Volume: 88 Issue: 2 Pages: 292-294 Abstract: Objectives. The purpose of this study was to describe blood pressure measurement and hypertension treatment in an inner-city African-American community. Methods. A random-digit dialing telephone survey of adults more than 18 years of age was carded out in 12 predominantly African-American zip code areas in Houston, Texas. Results. More than 90% of subjects reported a blood pressure measurement within the past 2 years, and 87% of known hypertensives reported current medication use. Conclusions. Further improvements in hypertension control among African Americans in this country are likely to depend primarily on changes in diagnosis and management practices of health care providers find on maintaining primary care access for all socioeconomic groups. Handle: RePEc:aph:ajpbhl:1998:88:2:292-294_8 Template-Type: ReDIF-Article 1.0 Title: Bringing context back into epidemiology: Variables and fallacies in multilevel analysis Journal: American Journal of Public Health Author-Name: Diez-Roux, A.V. Year: 1998 Volume: 88 Issue: 2 Pages: 216-222 Abstract: A large portion of current epidemiologic research is based on methodologic individualism: the notion that the distribution of health and disease in populations can be explained exclusively in terms of the characteristics of individuals. The present paper discusses the need to include group- or macro-level variables in epidemiologic studies, thus incorporating multiple levels of determination in the study of health outcomes. These types of analyses, which have been called contextual or multilevel analyses, challenge epidemiologists to develop theoretical models of disease causation that extend across levels and explain how group-level and individual-level variables interact in shaping health and disease. They also raise a series of methodological issues, including the need to select the appropriate contextual unit and contextual variables, to correctly specify the individual-level model, and, in some cases, to account for residual correlation between individuals within contexts. Despite its complexities, multilevel analysis holds potential for reemphasizing the role of macro-level variables in shaping health and disease in populations. Handle: RePEc:aph:ajpbhl:1998:88:2:216-222_2 Template-Type: ReDIF-Article 1.0 Title: Trends in safety belt use by demographics and by type of state safety belt law, 1987 through 1993 Journal: American Journal of Public Health Author-Name: Nelson, D.E. Author-Name: Bolen, J. Author-Name: Kresnow, M.-J. Year: 1998 Volume: 88 Issue: 2 Pages: 245-249 Abstract: Objectives. This study examined trends in safety belt use by age, sex, race/ethnicity, education, and type of safety belt law. Methods. We analyzed Behavioral Risk Factor Surveillance System data on safety belt use from 33 states for 1987 through 1993 and used linear regression models to determine trends in prevalence. Results. Asian/Pacific Islanders and Hispanics had the highest safety belt use among racial/ethnic groups. Prevalence varied little from age 25 through 64 years in all years, but averaged 25 percentage points higher in states with primary laws than in states with no belt laws. Overall safety belt use increased by an average of 2.7 ± 0.1 percentage points per year and varied little across most demographic groups, but there was no significant increase for Black males aged 18 through 29 years. Conclusions. The generally consistent increase in safety belt use across demographic groups is in sharp contrast to trends in other health-risk behaviors. States should enact primary safety belt laws and focus safety belt use efforts towards young Black males. Handle: RePEc:aph:ajpbhl:1998:88:2:245-249_8 Template-Type: ReDIF-Article 1.0 Title: Placebo controls in HIV perinatal transmission trials: A South African's viewpoint Journal: American Journal of Public Health Author-Name: Abdool Karim, S.S. Year: 1998 Volume: 88 Issue: 4 Pages: 564-566 Handle: RePEc:aph:ajpbhl:1998:88:4:564-566_0 Template-Type: ReDIF-Article 1.0 Title: Eliminating iodine deficiency in rural Sarawak, Malaysia: The relevance of water iodization [1] Journal: American Journal of Public Health Author-Name: Foo, L.-C. Author-Name: Mahmud, N. Author-Name: Satgunasingam, N. Year: 1998 Volume: 88 Issue: 4 Pages: 680-681 Handle: RePEc:aph:ajpbhl:1998:88:4:680-681_3 Template-Type: ReDIF-Article 1.0 Title: Erratum: National survey of the states: Policies and practices regarding drug-using pregnant women (American Journal of Public Health (1998) 88 (117- 119)) Journal: American Journal of Public Health Author-Name: Chavkin, W. Author-Name: Breitbart, V. Author-Name: Elman, D. Author-Name: Wise, P.H. Year: 1998 Volume: 88 Issue: 3 Pages: 438 Handle: RePEc:aph:ajpbhl:1998:88:3:438_4 Template-Type: ReDIF-Article 1.0 Title: Policy research: development process determines success. Journal: American Journal of Public Health Author-Name: de Leeuw, E. Year: 1998 Volume: 88 Issue: 5 Pages: 838-839 DOI: 10.2105/AJPH.88.5.838-a File-URL: http://hdl.handle.net/10.2105/AJPH.88.5.838-a Handle: RePEc:aph:ajpbhl:10.2105/AJPH.88.5.838-a_1 Template-Type: ReDIF-Article 1.0 Title: On nurses. Journal: American Journal of Public Health Author-Name: Jenkins, M. Year: 1998 Volume: 88 Issue: 1 Pages: 135-136 DOI: 10.2105/AJPH.88.1.135 File-URL: http://hdl.handle.net/10.2105/AJPH.88.1.135 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.88.1.135_7 Template-Type: ReDIF-Article 1.0 Title: Promoting the selection of low-fat milk in elementary school cafeterias in an inner-city Latino community: Evaluation of an intervention Journal: American Journal of Public Health Author-Name: Wechsler, H. Author-Name: Basch, C.E. Author-Name: Zybert, P. Author-Name: Shea, S. Year: 1998 Volume: 88 Issue: 3 Pages: 427-433 Abstract: Objectives. This study examined the effects of a school based intervention designed to promote the consumption of low-fat white milk at lunchtime in 6 elementary schools in an inner-city, primarily Latino neighborhood. Methods. A multifaceted intervention based on social marketing techniques was delivered at 3 randomly selected schools. The school was the unit of assignment and analysis; 6902 children were involved in the study. Milk selection and consumption were measured by sampling discarded milk and/or tallying milk carton disappearance at baseline, immediately postintervention, and at 3 to 4 months follow-up. Results. Immediately postintervention, the mean proportion of sampled milk cartons that contained low-fat milk increased in the intervention schools, from 25% to 57%, but remained constant at 28% in the control schools. Differences between intervention and control schools remained significant at 3 to 4 months follow-up. The intervention was not associated with a decrease in overall milk consumption. Conclusions. A school-based intervention can lead to significant increases in student consumption of low-fat milk. Handle: RePEc:aph:ajpbhl:1998:88:3:427-433_2 Template-Type: ReDIF-Article 1.0 Title: The influence of program acceptability on the effectiveness of public health policy: A study of directly observed therapy for tuberculosis Journal: American Journal of Public Health Author-Name: Heymann, S.J. Author-Name: Sell, R. Author-Name: Brewer, T.F. Year: 1998 Volume: 88 Issue: 3 Pages: 442-445 Abstract: Objectives. This study examined how patient acceptability influences the effectiveness of directly observed therapy for tuberculosis. Methods. Decision and sensitivity analysis were used assessing influences. Results. If mandatory directly observed therapy discourages 6% of initial tuberculosis patients (range 4% to 10%) from seeking care, then such therapy will be less effective than self-administered therapy. Directly observed therapy is more effective than repeated self-administered therapy for patients failing to complete initial treatment unless 32% - (range 27% to 38%) - of patients avoid seeking care. Conclusions. Patient acceptability must be taken into consideration before selecting public health strategies. Handle: RePEc:aph:ajpbhl:1998:88:3:442-445_1 Template-Type: ReDIF-Article 1.0 Title: Hospital- and patient-related characteristics determining maternity length of stay: A hierarchical linear model approach Journal: American Journal of Public Health Author-Name: Leung, K.-M. Author-Name: Elashoff, R.M. Author-Name: Rees, K.S. Author-Name: Hasan, M.M. Author-Name: Legorreta, A.P. Year: 1998 Volume: 88 Issue: 3 Pages: 377-381 Abstract: Objectives. The purpose of this study was to identify factors related to pregnancy and childbirth that might be predictive of a patient's length of stay after delivery and to model variations in length of stay. Methods. California hospital discharge data on maternity patients (n = 499 912) were analyzed. Hierarchical linear modeling was used to adjust for patient case mix and hospital characteristics and to account for the dependence of outcome variables within hospitals. Results. Substantial variation in length of stay among patients was observed. The variation was mainly attributed to delivery type (vaginal or cesarean section), the patient's clinical risk factors, and severity of complications (if any). Furthermore, hospitals differed significantly in maternity lengths of stay even after adjustment for patient case mix. Conclusions. Developing risk-adjusted models for length of stay is a complex process but is essential for understanding variation. The hierarchical linear model approach described here represents a more efficient and appropriate way of studying interhospital variations than the traditional regression approach. Handle: RePEc:aph:ajpbhl:1998:88:3:377-381_6 Template-Type: ReDIF-Article 1.0 Title: If authors became contributors, everyone would gain, especially the reader. Journal: American Journal of Public Health Author-Name: Rennie, D. Author-Name: Yank, V. Year: 1998 Volume: 88 Issue: 5 Pages: 828-830 DOI: 10.2105/AJPH.88.5.828 File-URL: http://hdl.handle.net/10.2105/AJPH.88.5.828 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.88.5.828_1 Template-Type: ReDIF-Article 1.0 Title: Meier and Licari respond Journal: American Journal of Public Health Author-Name: Meier, K.J. Author-Name: Licari, M.J. Year: 1998 Volume: 88 Issue: 7 Pages: 1120 Handle: RePEc:aph:ajpbhl:1998:88:7:1120_2 Template-Type: ReDIF-Article 1.0 Title: Erratum: Contraception and induced abortion in Armenia: A critical need for family planning programs in Eastern Europe (American Journal of Public Health (1998) 88 (803-805)) Journal: American Journal of Public Health Author-Name: Dolian, G. Author-Name: Ludicke, F. Author-Name: Katchatrian, N. Author-Name: Campana, A. Author-Name: Morabia, A. Year: 1998 Volume: 88 Issue: 7 Pages: 1122 Handle: RePEc:aph:ajpbhl:1998:88:7:1122_0 Template-Type: ReDIF-Article 1.0 Title: Perceived parental burden and service use for child and adolescent psychiatric disorders Journal: American Journal of Public Health Author-Name: Angold, A. Author-Name: Farmer, E.M.Z. Author-Name: Costello, E.J. Author-Name: Burns, B.J. Author-Name: Stangl, D. Author-Name: Messer, S.C. Year: 1998 Volume: 88 Issue: 1 Pages: 75-80 Abstract: Objectives. Pediatric chronic physical illness and adult psychiatric disorders are substantial sources of burden for family caretakers, but little attention has been paid to parental burden resulting from children's or adolescents' psychiatric disorders. This paper describes the predictors of perceived parental burden and its impact on the use of specialty mental health and school services. Methods. A representative general population sample of 1015 9-, 11-, and 13-year-olds and their parents completed structured psychiatric diagnostic interviews and the Child and Adolescent Burden Assessment. Results. Weighted estimates indicated that 10.7% of parents in the general population perceived burden resulting from their children's symptomatology. Significant predictors of perceived burden were levels of child symptomatology and impairment and parental mental health problems. Children's depressive and anxiety disorders were associated with less burden than other diagnoses. The effects of child disorder severity on specialty mental health service use appeared to be mediated by the level of burden induced. Conclusions. Substantial levels of parental burden resulted from child psychiatric disorders and were a major reason for specialist mental health service use. Handle: RePEc:aph:ajpbhl:1998:88:1:75-80_4 Template-Type: ReDIF-Article 1.0 Title: An evaluation of safe dates, an adolescent dating violence prevention program Journal: American Journal of Public Health Author-Name: Foshee, V.A. Author-Name: Bauman, K.E. Author-Name: Arriaga, X.B. Author-Name: Helms, R.W. Author-Name: Koch, G.G. Author-Name: Linder, G.F. Year: 1998 Volume: 88 Issue: 1 Pages: 45-50 Abstract: Objectives. This study assessed the effects of the Safe Dates program on the primary and secondary prevention of adolescent dating violence. Methods. Fourteen schools were randomly allocated to treatment conditions. Eighty percent (n = 1886) of the eighth and ninth graders in a rural county completed baseline questionnaires, and 1700 (90%) completed follow-up questionnaires. Results. Treatment and control groups were comparable at baseline. In the full sample at follow-up, less psychological abuse, sexual violence, and violence perpetrated against the current dating partner were reported in treatment than in control schools. In a subsample of adolescents reporting no dating violence at baseline (a primary prevention subsample), there was less initiation of psychological abuse in treatment than in control schools. In a subsample of adolescents reporting dating violence at baseline (a secondary prevention subsample), there was less psychological abuse and sexual violence perpetration reported at follow-up in treatment than in control schools. Most program effects were explained by changes in dating violence norms, gender stereotyping, and awareness of services. Conclusions. The Safe Dates program shows promise for preventing dating violence among adolescents. Handle: RePEc:aph:ajpbhl:1998:88:1:45-50_8 Template-Type: ReDIF-Article 1.0 Title: Norplant coercion. Journal: American Journal of Public Health Author-Name: Brady, M. Year: 1998 Volume: 88 Issue: 1 Pages: 136-137 DOI: 10.2105/AJPH.88.1.136-c File-URL: http://hdl.handle.net/10.2105/AJPH.88.1.136-c Handle: RePEc:aph:ajpbhl:10.2105/AJPH.88.1.136-c_7 Template-Type: ReDIF-Article 1.0 Title: Abuse during pregnancy: progress, policy, and potential. Journal: American Journal of Public Health Author-Name: Campbell, J.C. Year: 1998 Volume: 88 Issue: 2 Pages: 185-187 DOI: 10.2105/AJPH.88.2.185 File-URL: http://hdl.handle.net/10.2105/AJPH.88.2.185 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.88.2.185_4 Template-Type: ReDIF-Article 1.0 Title: Initiation of use of alcohol, cigarettes, marijuana, cocaine, and other substances in US birth cohorts since 1919 Journal: American Journal of Public Health Author-Name: Johnson, R.A. Author-Name: Gerstein, D.R. Year: 1998 Volume: 88 Issue: 1 Pages: 27-33 Abstract: Objectives. This study examined recent trends in initiation of psychoactive drug use. Methods. Data from the 1991 through 1993 National Household Surveys on Drug Abuse were used to compare the percentages of US cohorts born from 1919 through 1975 who began using drugs before the ages of 15, 21, and 35. Results. Initiation of cigarette smoking by males peaked in the 1941-1945 cohort, then declined steadily. For females, early smoking initiation rose through the 1951-1955 cohort and then stabilized. Initiation of alcohol use was less common than smoking for pre1950 cohorts but increased steadily, approaching cigarette use for cohorts born in the early 1970s. Only 2% of teenagers born in 1930-1940 tried marijuana; half the teenagers born in 1956-1965 did so. The percentage initiating marijuana use declined in the 1980s, more so among young adults than among teenagers. The use of cocaine and other illicit drugs echoed the rise of marijuana use but peaked later and showed less evidence of subsequent decline. Sex differences declined over time for every drug. Conclusions. Cohorts born since World War II have had much higher rates of illicit drug use initiation, but trends have varied by drug type, possibly reflecting changes in relative prices. Handle: RePEc:aph:ajpbhl:1998:88:1:27-33_6 Template-Type: ReDIF-Article 1.0 Title: Editor's note: The prevention of perinatal HIV transmission in the less- developed world Journal: American Journal of Public Health Author-Name: Susser, M. Year: 1998 Volume: 88 Issue: 4 Pages: 547-548 Handle: RePEc:aph:ajpbhl:1998:88:4:547-548_5 Template-Type: ReDIF-Article 1.0 Title: Erratum: Motor-vehicle crash fatalities among American Indians and non- Indians in Arizona, 1979 through 1988 (American Journal of Public Health) (1997) 87 (282-285)) Journal: American Journal of Public Health Author-Name: Campos-Outcalt, D. Author-Name: Prybylski, D. Author-Name: Watkins, A.J. Author-Name: Rothfuss, G. Author-Name: Dellapenna, A. Year: 1998 Volume: 88 Issue: 5 Pages: 820 Handle: RePEc:aph:ajpbhl:1998:88:5:820_8 Template-Type: ReDIF-Article 1.0 Title: Smoking cessation, weight gain, and changes in cardiovascular risk factors during menopause: The healthy women study Journal: American Journal of Public Health Author-Name: Burnette, M.M. Author-Name: Meilahn, E. Author-Name: Wing, R.R. Author-Name: Kuller, L.H. Year: 1998 Volume: 88 Issue: 1 Pages: 93-96 Abstract: Objectives. The relationship between smoking cessation, subsequent weight gain, and cardiovascular disease risk factors from premenopause to postmenopause was studied. Methods: Healthy Women Study participants were assessed for changes in coronary heart disease risk factors from a premenopausal baseline assessment to first- and second-year postmenopausal assessments. Results. Although ex-smokers gained substantially more weight than nonsmokers and smokers, they did not experience a greater increase in cardiovascular risk factors. In fact, the results indicated a trend toward ex-smokers' high-density lipoprotein cholesterol levels increasing slightly more than those of nonsmokers and smokers. Conclusions: Smoking cessation in perimenopausal to postmenopausal women is associated with greater weight gain but appears to be modestly associated with certain positive changes in cardiovascular risk factors. Handle: RePEc:aph:ajpbhl:1998:88:1:93-96_8 Template-Type: ReDIF-Article 1.0 Title: Mammography screening for women aged 40 through 49. Journal: American Journal of Public Health Author-Name: Johnstone, T. Year: 1998 Volume: 88 Issue: 5 Pages: 841-842 DOI: 10.2105/AJPH.88.5.841 File-URL: http://hdl.handle.net/10.2105/AJPH.88.5.841 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.88.5.841_6 Template-Type: ReDIF-Article 1.0 Title: HIV seroprevalence among street-recruited injection drug and crack cocaine users in 16 US municipalities Journal: American Journal of Public Health Author-Name: Kral, A.H. Author-Name: Bluthenthal, R.N. Author-Name: Booth, R.E. Author-Name: Watters, J.K. Year: 1998 Volume: 88 Issue: 1 Pages: 108-113 Abstract: Objectives. This study determined human immunodeficiency virus (HIV) seroprevalence and factors associated with HIV infection among street- recruited injection drug users and crack cocaine smokers. Methods. An analysis was performed on HIV serologies and risk behaviors of 6402 injection drug users and 3383 crack smokers in 16 US municipalities in 1992 and 1993. Results. HIV seroprevalence was 12.7% among injection drug users and 7.5% among crack smokers. Most high-seroprevalence municipalities (>25%) were located along the eastern seaboard of the United States. In high- seroprevalence municipalities, but not in others, HIV seroprevalence was higher for injection drug users than for crack smokers. Among injection drug users, cocaine injection, use of speedballs (cocaine or amphetamines with heroin), and sexual risk behaviors were independently associated with HIV infection. Among crack smokers, sexual risk behaviors were associated with HIV infection. Conclusions. Injection drug users and crack smokers are at high risk for HIV infection. Handle: RePEc:aph:ajpbhl:1998:88:1:108-113_5 Template-Type: ReDIF-Article 1.0 Title: Means and ends: cost-effectiveness and overall costs. Journal: American Journal of Public Health Author-Name: Wildner, M. Year: 1998 Volume: 88 Issue: 1 Pages: 133 Handle: RePEc:aph:ajpbhl:1998:88:1:133_5 Template-Type: ReDIF-Article 1.0 Title: Cross-national comparisons of sexual behavior surveys--methodological difficulties and lessons for prevention. Journal: American Journal of Public Health Author-Name: Spira, A. Author-Name: Bajos, N. Author-Name: Giami, A. Author-Name: Michaels, S. Year: 1998 Volume: 88 Issue: 5 Pages: 730-731 DOI: 10.2105/AJPH.88.5.730 File-URL: http://hdl.handle.net/10.2105/AJPH.88.5.730 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.88.5.730_8 Template-Type: ReDIF-Article 1.0 Title: International health services need an interorganizational policy. Journal: American Journal of Public Health Author-Name: Silver, G.A. Year: 1998 Volume: 88 Issue: 5 Pages: 727-729 DOI: 10.2105/AJPH.88.5.727-a File-URL: http://hdl.handle.net/10.2105/AJPH.88.5.727-a Handle: RePEc:aph:ajpbhl:10.2105/AJPH.88.5.727-a_7 Template-Type: ReDIF-Article 1.0 Title: Trends in pulmonary embolism mortality in the US elderly population: 1984 through 1991 Journal: American Journal of Public Health Author-Name: Siddique, R.M. Author-Name: Siddique, M.I. Author-Name: Rimm, A.A. Year: 1998 Volume: 88 Issue: 3 Pages: 478-480 Abstract: Objective. This study determined race, age and sex specific trends in 30-day pulmonary embolism mortality rates. Methods. Medicare beneficiaries with a primary or secondary discharge diagnosis of pulmonary embolism from 1984 to 1991 (n = 391 991) were examined. Results. For a primary diagnosis of pulmonary embolism mortality rates declined by 15.2% and 16.0%, respectively, for White male patients 65 to 74 years old and 75 years older. There was a corresponding decline in mortality rates for White women. For a secondary diagnosis of pulmonary embolism mortality rates declined by 14.7% and 9.8%, respectively for White male patients 65 to 74 years old and 75 years or older. Conclusions. The White mortality rate declines revealed in this study did not translate, in all cases to Black patient groups. Handle: RePEc:aph:ajpbhl:1998:88:3:478-480_6 Template-Type: ReDIF-Article 1.0 Title: NORA--more than a name. Journal: American Journal of Public Health Author-Name: Wegman, D.H. Year: 1998 Volume: 88 Issue: 3 Pages: 349-351 DOI: 10.2105/AJPH.88.3.349 File-URL: http://hdl.handle.net/10.2105/AJPH.88.3.349 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.88.3.349_4 Template-Type: ReDIF-Article 1.0 Title: Validity of adolescent self-reports of cigarette smoking. Journal: American Journal of Public Health Author-Name: Bauman, K.E. Author-Name: Ennett, S.T. Year: 1998 Volume: 88 Issue: 2 Pages: 309-310 DOI: 10.2105/AJPH.88.2.309 File-URL: http://hdl.handle.net/10.2105/AJPH.88.2.309 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.88.2.309_5 Template-Type: ReDIF-Article 1.0 Title: Rational down syndrome screening policy Journal: American Journal of Public Health Author-Name: Cuckle, H. Year: 1998 Volume: 88 Issue: 4 Pages: 558-559 Handle: RePEc:aph:ajpbhl:1998:88:4:558-559_0 Template-Type: ReDIF-Article 1.0 Title: Erratum: Rational down syndrome screening policy (American Journal of Public Health (1998) 88 (558-559)) Journal: American Journal of Public Health Author-Name: Cuckle, H. Year: 1998 Volume: 88 Issue: 6 Pages: 972 Handle: RePEc:aph:ajpbhl:1998:88:6:972_2 Template-Type: ReDIF-Article 1.0 Title: Predictors of smoking among US college students Journal: American Journal of Public Health Author-Name: Emmons, K.M. Author-Name: Wechsler, H. Author-Name: Dowdall, G. Author-Name: Abraham, M. Year: 1998 Volume: 88 Issue: 1 Pages: 104-107 Abstract: Objectives. This study explored predictors of smoking among a large, representative national sample of students enrolled in American 4-year colleges. Methods. A sample of undergraduate students, randomly selected from 140 colleges, was sent a detailed questionnaire that included questions about smoking status. Results. The 30-day smoking prevalence was 22.3%; 25% of the participants were former smokers. Multivariate analyses suggested that, among college students, men are less likely to smoke than women. In addition, high- risk behaviors (e.g., marijuana use) and lifestyle choices (e.g., nonparticipation in athletics) increased the likelihood of being a smoker. Conclusions. This study's findings have important implications for health education and promotion among college populations. Handle: RePEc:aph:ajpbhl:1998:88:1:104-107_2 Template-Type: ReDIF-Article 1.0 Title: Topics for our times: public health--community or commodity? Reflections on healthy communities. Journal: American Journal of Public Health Author-Name: Citrin, T. Year: 1998 Volume: 88 Issue: 3 Pages: 351-352 DOI: 10.2105/AJPH.88.3.351 File-URL: http://hdl.handle.net/10.2105/AJPH.88.3.351 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.88.3.351_7 Template-Type: ReDIF-Article 1.0 Title: A voluntary smokers' registry: Characteristics of joiners and non- joiners in the Community Intervention Trial for Smoking Cessation (COMMIT) Journal: American Journal of Public Health Author-Name: Thompson, B. Author-Name: Rich, L.E. Author-Name: Lynn, W.R. Author-Name: Shields, R. Author-Name: Corle, D.K. Year: 1998 Volume: 88 Issue: 1 Pages: 100-103 Abstract: Objectives. This paper examines differences between joiners and nonjoiners of a voluntary smokers' registry. Methods. A baseline prevalence survey was used to identify characteristics of smokers who joined or did not join a smokers' registry. Results. Communities varied significantly in registry enrollment rates. Heavy-smoking joiners expressed more desire to quit, were more likely to live with nonsmokers, and were older than nonjoiners. Light-to-moderate joiners smoked more, were more addicted to cigarettes, and expressed more desire to quit than nonjoiners. Conclusions. Few baseline characteristics differentiated joiners from nonjoiners. Nonjoiners were significantly more likely to achieve cessation than joiners. Handle: RePEc:aph:ajpbhl:1998:88:1:100-103_1 Template-Type: ReDIF-Article 1.0 Title: Incidence and predictors of smokeless tobacco use among US youth Journal: American Journal of Public Health Author-Name: Tomar, S.L. Author-Name: Giovino, G.A. Year: 1998 Volume: 88 Issue: 1 Pages: 20-26 Abstract: Objectives. The purpose of this study was to provide estimates of the cumulative incidence of initiation of smokeless tobacco use in a cohort of young persons and to explore sociodemographic, environmental, behavioral, and personal predictors of experimentation with and regular use of snuff or chewing tobacco. Methods. The data for this cohort study were derived from the 1989 Teenage Attitudes and Practices Survey and its 1993 follow-up. The study included 7830 young people 11 through 19 years of age at baseline. Results. During the 4 years, 12.7% of participants (20.9% of male participants) first tried smokeless tobacco, and 4.0% (8.0% of male participants) became self-classified regular users. This suggests that, each year, approximately 824 000 young people in the United States 11 to 9 years of age experiment with smokeless tobacco and about 304 000 become regular users. Cumulative incidence was highest for male non-Hispanic Whites. Predictors of regular use included age, geographic region, cigarette smoking, participation in organized sports, and perceived friends' approval or indifference. Conclusions. Public health approaches to preventing use of smokeless tobacco should include development of skills for responding to pressures to use tobacco. Handle: RePEc:aph:ajpbhl:1998:88:1:20-26_1 Template-Type: ReDIF-Article 1.0 Title: CDC at 50: lessons to be learned. Journal: American Journal of Public Health Author-Name: Darrow, W.W. Year: 1998 Volume: 88 Issue: 2 Pages: 308-309 DOI: 10.2105/AJPH.88.2.308 File-URL: http://hdl.handle.net/10.2105/AJPH.88.2.308 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.88.2.308_8 Template-Type: ReDIF-Article 1.0 Title: Few smokers know their cigarettes have filter vents [3] Journal: American Journal of Public Health Author-Name: Kozlowski, L.T. Author-Name: White, E.L. Author-Name: Sweeney, C.T. Author-Name: Yost, B.A. Author-Name: Ahern, F.M. Author-Name: Goldberg, M.E. Year: 1998 Volume: 88 Issue: 4 Pages: 681-682 Handle: RePEc:aph:ajpbhl:1998:88:4:681-682_0 Template-Type: ReDIF-Article 1.0 Title: Breast milk compounds. Journal: American Journal of Public Health Author-Name: Sternberg, S.S. Year: 1998 Volume: 88 Issue: 1 Pages: 134-135 DOI: 10.2105/AJPH.88.1.134-b File-URL: http://hdl.handle.net/10.2105/AJPH.88.1.134-b Handle: RePEc:aph:ajpbhl:10.2105/AJPH.88.1.134-b_4 Template-Type: ReDIF-Article 1.0 Title: Schulman and colleagues respond Journal: American Journal of Public Health Author-Name: Schulman, E.D. Author-Name: Sheriff, D.J. Author-Name: Momany, E.T. Year: 1998 Volume: 88 Issue: 8 Pages: 1263-1264 Handle: RePEc:aph:ajpbhl:1998:88:8:1263-1264_9 Template-Type: ReDIF-Article 1.0 Title: Serving the medically underserved. Journal: American Journal of Public Health Author-Name: Alpert, J.J. Year: 1998 Volume: 88 Issue: 3 Pages: 347-348 DOI: 10.2105/AJPH.88.3.347 File-URL: http://hdl.handle.net/10.2105/AJPH.88.3.347 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.88.3.347_7 Template-Type: ReDIF-Article 1.0 Title: Editorial: Substance abuse and addiction - The need to know Journal: American Journal of Public Health Author-Name: Califano J.A., Jr. Year: 1998 Volume: 88 Issue: 1 Pages: 9-11 Handle: RePEc:aph:ajpbhl:1998:88:1:9-11_7 Template-Type: ReDIF-Article 1.0 Title: Erratum: Salicylate intake and cardiovascular disease: Ingster and Feinleib respond to Hu and Willet (American Journal of Public Health (1998) 88 (1268-1269)) Journal: American Journal of Public Health Author-Name: Ingster, L.M. Author-Name: Feinleib, M. Year: 1998 Volume: 88 Issue: 9 Pages: 1407 Handle: RePEc:aph:ajpbhl:1998:88:9:1407_3 Template-Type: ReDIF-Article 1.0 Title: Infant mortality differences between whites and African Americans: The effect of maternal education Journal: American Journal of Public Health Author-Name: Din-Dzietham, R. Author-Name: Hertz-Picciotto, I. Year: 1998 Volume: 88 Issue: 4 Pages: 651-656 Abstract: Objectives. Despite decreasing infant mortality in North Carolina, the gap between African Americans and Whites persists. This study examined how racial differences in infant mortality vary by maternal education. Methods. Data came from Linked Birth and Infant Death files for 1988 through 1993. Multiple logistic regression models adjusted for confounders. Results. Infant mortality risk ratios comparing African Americans and Whites increased with higher levels of maternal education. Education beyond high school reduced risk of infant mortality by 20% among Whites but had little effect among African Americans. Conclusions. Higher education magnifies racial differences in infant mortality on a multiplicative scale. Possible reasons include greater stress, fewer economic resources, and poorer quality of prenatal care among African Americans. Handle: RePEc:aph:ajpbhl:1998:88:4:651-656_8 Template-Type: ReDIF-Article 1.0 Title: Unwanted pregnancy in Armenia--the larger context. Journal: American Journal of Public Health Author-Name: Chavkin, W. Year: 1998 Volume: 88 Issue: 5 Pages: 732-733 DOI: 10.2105/AJPH.88.5.732 File-URL: http://hdl.handle.net/10.2105/AJPH.88.5.732 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.88.5.732_0 Template-Type: ReDIF-Article 1.0 Title: Erratum: Informed consent for HIV testing in a South African hospital: Is it truly informed and truly voluntary? (American Journal of Public Health (1998) 88 (637-340)) Journal: American Journal of Public Health Author-Name: Karim, Q.A. Author-Name: Karim, S.S.A. Author-Name: Coovadia, H.M. Author-Name: Susser, M. Year: 1998 Volume: 88 Issue: 6 Pages: 972 Handle: RePEc:aph:ajpbhl:1998:88:6:972_8 Template-Type: ReDIF-Article 1.0 Title: Erratum: Phantom of the area: Poverty-area residence and mortality in the United States (American Journal of Public Health (1998) 88 (973-976)) Journal: American Journal of Public Health Author-Name: Waitzman, N.J. Author-Name: Smith, K.R. Year: 1998 Volume: 88 Issue: 7 Pages: 1122 Handle: RePEc:aph:ajpbhl:1998:88:7:1122_5 Template-Type: ReDIF-Article 1.0 Title: Human rights and maternal-fetal HIV transmission prevention trials in Africa Journal: American Journal of Public Health Author-Name: Annas, G.J. Author-Name: Grodin, M.A. Year: 1998 Volume: 88 Issue: 4 Pages: 560-563 Abstract: The human rights issues raised by the conduct of maternal-fetal human immunodeficiency virus transmission trials in Africa are not unique to either acquired immunodeficiency syndrome or Africa, but public discussion of these trials presents an opportunity for the United States and other wealthy nations to take the rights and welfare of impoverish populations seriously. The central issue at stake when developed countries perform research on subjects in developing countries in exploitation. The only way to prevent exploitation of a research population is to insist not only that informed consent by obtained but also that, should an intervention be proven beneficial, the intervention will be delivered to the impoverished population. Human rights are universal and cannot be compromised solely on the basis of beliefs or practices of any one country or group. The challenge to the developed countries is to implement programs to improve the health of the people in developing countries both by improving public health infrastructure and by delivering effective drugs and vaccines to the people. Handle: RePEc:aph:ajpbhl:1998:88:4:560-563_7 Template-Type: ReDIF-Article 1.0 Title: The relationship between suicide risk and sexual orientation: Results of a population-based study Journal: American Journal of Public Health Author-Name: Remafedi, G. Author-Name: French, S. Author-Name: Story, M. Author-Name: Resnick, M.D. Author-Name: Blum, R. Year: 1998 Volume: 88 Issue: 1 Pages: 57-60 Abstract: Objectives. This study examined the relationship between sexual orientation and suicide risk in a population-based sample of adolescents. Methods. Participants were selected from a cross-sectional, statewide survey of junior and senior public high school students. All males (n = 212) and females (n = 182) who described themselves as bisexual/homosexual were compared with 336 gender-matched heterosexual respondents on three outcome measures: suicidal ideation, intent, and self-reported attempts. Logistic regression analyses were used to examine the association between sexual orientation and outcome measures with adjustment for demographic characteristics. Results. Suicide attempts were reported by 28.1% of bisexual/homosexual males, 20.5% of bisexual/homosexual females, 14.5% of heterosexual females, and 4.2% of heterosexual males. For males, but not females, bisexual/homosexual orientation was associated with suicidal intent (odds ratio [OR] = 3.61; 95% confidence interval [CI] = 1.40, 9.36) and attempts (OR = 7.10; 95% CI = 3.05, 16.53). Conclusions: There is evidence of a strong association between suicide risk and bisexuality or homosexuality in males. Handle: RePEc:aph:ajpbhl:1998:88:1:57-60_0 Template-Type: ReDIF-Article 1.0 Title: Annotation: new rules for authorship in the journal: your contributions are recognized--and published! Journal: American Journal of Public Health Author-Name: Northridge, M. Year: 1998 Volume: 88 Issue: 5 Pages: 733-734 DOI: 10.2105/AJPH.88.5.733 File-URL: http://hdl.handle.net/10.2105/AJPH.88.5.733 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.88.5.733_4 Template-Type: ReDIF-Article 1.0 Title: Prevention of neonatal tetanus. Journal: American Journal of Public Health Author-Name: Glezen, W.P. Year: 1998 Volume: 88 Issue: 6 Pages: 871-872 DOI: 10.2105/AJPH.88.6.871 File-URL: http://hdl.handle.net/10.2105/AJPH.88.6.871 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.88.6.871_9 Template-Type: ReDIF-Article 1.0 Title: Editorial: What it takes to control tuberculosis Journal: American Journal of Public Health Author-Name: Horsburgh C.R., Jr. Year: 1998 Volume: 88 Issue: 7 Pages: 1015-1016 Handle: RePEc:aph:ajpbhl:1998:88:7:1015-1016_3 Template-Type: ReDIF-Article 1.0 Title: Use and misuse of population attributable fractions. Journal: American Journal of Public Health Author-Name: Rockhill, B. Author-Name: Newman, B. Author-Name: Weinberg, C. Year: 1998 Volume: 88 Issue: 1 Pages: 15-19 DOI: 10.2105/AJPH.88.1.15 File-URL: http://hdl.handle.net/10.2105/AJPH.88.1.15 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.88.1.15_8 Template-Type: ReDIF-Article 1.0 Title: Promoting sunscreen in a community drugstore [2] Journal: American Journal of Public Health Author-Name: Palmer, R.C. Author-Name: Mayer, J.A. Author-Name: Eckhardt, L. Author-Name: Sallis, J.F. Year: 1998 Volume: 88 Issue: 4 Pages: 681 Handle: RePEc:aph:ajpbhl:1998:88:4:681_3 Template-Type: ReDIF-Article 1.0 Title: Persons with disabilities. Journal: American Journal of Public Health Author-Name: Pfeiffer, D. Year: 1998 Volume: 88 Issue: 1 Pages: 134 Handle: RePEc:aph:ajpbhl:1998:88:1:134_7 Template-Type: ReDIF-Article 1.0 Title: Race and the risk of fatal injury at work Journal: American Journal of Public Health Author-Name: Loomis, D. Author-Name: Richardson, D. Year: 1998 Volume: 88 Issue: 1 Pages: 40-44 Abstract: Objectives. This study examined employment patterns of African-American and White workers and rates of unintentional fatal injuries. Methods. Medical examiner and census data were used to compare occupational fatality rates for African Americans and Whites in North Carolina and to adjust for racial differences in employment patterns. Results. African Americans' occupational fatality rate was higher by a factor of 1.3 to 1.5. Differences in employment structure appear to explain much of this disparity. However, the fatality rate for African-American men would have been elevated even if they had had the same employment patterns as White men. Conclusions. Inequalities in access to the labor market, unequal distribution of risk within jobs, and explicit discrimination are all potential explanations for racial disparities in occupational injury mortality. These conditions can be addressed through a combination of social and workplace interventions, including efforts to improve conditions for the most disadvantaged workers. Handle: RePEc:aph:ajpbhl:1998:88:1:40-44_0 Template-Type: ReDIF-Article 1.0 Title: Erratum: The effect of ordinances requiring smokefree restaurants and bars on revenues: A follow-up (American Journal of Public Health (1997) 87 (1687-1693)) Journal: American Journal of Public Health Author-Name: Glantz, S.A. Author-Name: Smith, L.R.A. Year: 1998 Volume: 88 Issue: 7 Pages: 1122 Handle: RePEc:aph:ajpbhl:1998:88:7:1122_6 Template-Type: ReDIF-Article 1.0 Title: The era of health promotion for children and adolescents--a cross-sectional survey of strategies and new knowledge. Journal: American Journal of Public Health Author-Name: Earls, F. Year: 1998 Volume: 88 Issue: 6 Pages: 869-871 DOI: 10.2105/AJPH.88.6.869 File-URL: http://hdl.handle.net/10.2105/AJPH.88.6.869 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.88.6.869_3 Template-Type: ReDIF-Article 1.0 Title: International health and APHA Journal: American Journal of Public Health Author-Name: Roemer, M.I. Year: 1998 Volume: 88 Issue: 11 Pages: 1727 Handle: RePEc:aph:ajpbhl:1998:88:11:1727_4 Template-Type: ReDIF-Article 1.0 Title: Intermittent smokers: A descriptive analysis of persons who have never smoked daily Journal: American Journal of Public Health Author-Name: Husten, C.G. Author-Name: McCarty, M.C. Author-Name: Giovino, G.A. Author-Name: Chrismon, J.H. Author-Name: Zhu, B.-P. Year: 1998 Volume: 88 Issue: 1 Pages: 86-89 Abstract: Objectives. This study assessed the prevalence of and demographic variables associated with lifetime never-daily smoking in the United States. Methods. Descriptive demographic data and logistic regression analyses were used to examine associations with never-daily smoking. Results. Lifetime never-daily smokers constituted a significant minority of non-White smokers. There was a strong association between never-daily smoking and college education among young adults, particularly men. Although never-daily smoking was associated with initiation behavior among young smokers, it also represented a persistent pattern for some smokers, particularly non-Whites and Hispanics. Conclusions. The demographic distribution of never-daily smoking may have implications for developing culturally appropriate smoking prevention and cessation strategies. Handle: RePEc:aph:ajpbhl:1998:88:1:86-89_7 Template-Type: ReDIF-Article 1.0 Title: National survey of the States: Policies and practices regarding drug- using pregnant women Journal: American Journal of Public Health Author-Name: Chavkin, W. Author-Name: Breitbart, V. Author-Name: Elman, D. Author-Name: Wise, P.H. Year: 1998 Volume: 88 Issue: 1 Pages: 117-119 Abstract: Objectives. This study assessed the impact of national policy shifts on state policies and practices regarding substance-using mothers. Methods. A 1995 telephone survey of substance abuse and child protective services directors in all 50 states and the District of Columbia was compared with a similar 1992 survey. Results. There have been significant increases in state interventions for drug-using pregnant women (e.g., criminal prosecution, toxicology testing of women and neonates). Federal resources for treatment and oversight are being replaced by state control of reduced funds for treatment. Conclusions. The earlier policy of expanding treatment for addicted women is being replaced by reduction of services and increased state intervention. Handle: RePEc:aph:ajpbhl:1998:88:1:117-119_5 Template-Type: ReDIF-Article 1.0 Title: Risk of assaultive violence and alcohol availability in New Jersey Journal: American Journal of Public Health Author-Name: Gorman, D.M. Author-Name: Speer, P.W. Author-Name: Labouvie, E.W. Author-Name: Subaiya, A.P. Year: 1998 Volume: 88 Issue: 1 Pages: 97-100 Abstract: Objectives. This study examined the relationship between rate of assaultive violence and density of alcohol outlets in New Jersey. Methods. Data pertaining to assaultive violence, alcohol outlet density, and sociodemographic factors were obtained from municipalities in New Jersey (n = 223) and assessed through bivariate and multivariate analyses. Results. Sociodemographic factors accounted for 70% (R2 = .70) of the variance in the rate of assaultive violence. Outlet density did not add significantly to the explained variance of this model. Conclusions. In New Jersey, alcohol outlet density is not geographically associated with higher rates of violence. Alternative methodological and analytic techniques are required to better specify the relationship between alcohol availability and violence. Handle: RePEc:aph:ajpbhl:1998:88:1:97-100_3 Template-Type: ReDIF-Article 1.0 Title: Are patients capable of attributing functional impairments to specific diseases? Journal: American Journal of Public Health Author-Name: Ren, X.S. Author-Name: Kazis, L. Year: 1998 Volume: 88 Issue: 5 Pages: 837-838 DOI: 10.2105/AJPH.88.5.837 File-URL: http://hdl.handle.net/10.2105/AJPH.88.5.837 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.88.5.837_3 Template-Type: ReDIF-Article 1.0 Title: Facilitating condom use with clients during commercial sex in Nevada's legal brothels Journal: American Journal of Public Health Author-Name: Albert, A.E. Author-Name: Warner, D.L. Author-Name: Hatcher, R.A. Year: 1998 Volume: 88 Issue: 4 Pages: 643-646 Abstract: Objectives. This study examined condom use in legal Nevada brothels. Methods. Forty female prostitutes in two brothels were interviewed about client resistance to condoms and techniques for facilitating condom use. Results. Of 3290 clients in the previous month, 2.7% (95% confidence interval [CI] = 2.2%, 3.4%) were reluctant to use condoms. Of these individuals, 72% ultimately used condoms, while 12% chose nonpenetrative sex without condoms. The remaining 16% left the brothels without services. Condom use rates were markedly lower with nonpaying sex partners (lovers) than with clients. Conclusions. Brothel prostitutes may be at greater risk for acquiring HIV and other sexually transmitted diseases from lovers than from clients. Handle: RePEc:aph:ajpbhl:1998:88:4:643-646_3 Template-Type: ReDIF-Article 1.0 Title: Topics for our times: If we have the money, why is it so hard? Journal: American Journal of Public Health Author-Name: DeChiara, M. Author-Name: Wolff, T. Year: 1998 Volume: 88 Issue: 9 Pages: 1300-1302 Handle: RePEc:aph:ajpbhl:1998:88:9:1300-1302_6 Template-Type: ReDIF-Article 1.0 Title: Colombian field epidemiology training program Journal: American Journal of Public Health Author-Name: Cardenas, V. Author-Name: Sanchez, C. Author-Name: De la Hoz, F. Author-Name: Jara, J.H. Author-Name: Velandia, M. Author-Name: Martinez, M. Author-Name: Raad, J. Year: 1998 Volume: 88 Issue: 9 Pages: 1404-1405 Handle: RePEc:aph:ajpbhl:1998:88:9:1404-1405_8 Template-Type: ReDIF-Article 1.0 Title: Not all behavior change is equivalent [6] Journal: American Journal of Public Health Author-Name: Pinkerton, S.D. Author-Name: Abramson, P.R. Year: 1998 Volume: 88 Issue: 4 Pages: 684 Handle: RePEc:aph:ajpbhl:1998:88:4:684_7 Template-Type: ReDIF-Article 1.0 Title: Erratum: Reducing pregnancy and induced abortion rates in China: Family planning with husband participation (American Journal of Public Health (1998) 88 (646-648)) Journal: American Journal of Public Health Author-Name: Wang, C.C. Author-Name: Vittinghoff, E. Author-Name: Lu, S.H. Author-Name: Wang, H.Y. Author-Name: Zhou, M.R. Year: 1998 Volume: 88 Issue: 7 Pages: 1122 Handle: RePEc:aph:ajpbhl:1998:88:7:1122_7 Template-Type: ReDIF-Article 1.0 Title: Preventing scientific misconduct Journal: American Journal of Public Health Author-Name: Weed, D.L. Year: 1998 Volume: 88 Issue: 1 Pages: 125-129 Abstract: Disease prevention frameworks sometimes include a category of tertiary prevention, which typically involves rehabilitation and other aspects of long-term care. Tertiary prevention can also be applied to scientific misconduct, inasmuch as those who commit such misconduct may require rehabilitation before they return to scientific practice. A more complete analysis will likely lead, as it did in the case of primary and secondary prevention, to questions with answers based on relatively little empirical information. Indeed, in the foregoing analysis, a host of such questions have emerged. Answers will be difficult to obtain, especially if precise scientific methodologies are to be employed. But then, we are scientists, and solving difficult empirical problems is what we do best. Perhaps the essential question is less methodological than motivational: Are we as scientists willing to study our conduct as scientists? If so, then one day we may discover why we suffer from an important and sometimes disabling professional affliction and what works to prevent it. I am not suggesting, however, that we should postpone interventions until we fully understand the etiology, including the underlying biological, behavioral, and social mechanisms involved in the range of activities we call scientific misconduct. We need fair investigative procedures. We can accept (perhaps) on faith that the discussion of the role of ethics in the conduct of science and medicine should be expanded. Those of us who act as mentors can and should conduct ourselves virtuously. For the sake of those we train, and especially for those whose lives are improved by our scientific results, we must exhibit excellence, self-effacement, and, perhaps above all, an unwavering commitment to the truth. Handle: RePEc:aph:ajpbhl:1998:88:1:125-129_1 Template-Type: ReDIF-Article 1.0 Title: At-risk drinking in an HMO primary care sample: Prevalence and health policy implications Journal: American Journal of Public Health Author-Name: Fleming, M.F. Author-Name: Manwell, L.B. Author-Name: Barry, K.L. Author-Name: Johnson, K. Year: 1998 Volume: 88 Issue: 1 Pages: 90-93 Abstract: Objectives. This study was designed to determine the prevalence of at- risk drinking using varying alcohol use criteria. Methods. A period prevalence survey was conducted in 22 primary care practices (n = 19 372 adults). Results. The frequency of at-risk alcohol use varied from 7.5% (World Health Organization criteria) to 19.7% (National Institute on Alcohol Abuse and Alcoholism criteria). A stepwise logistic model using National Institute on Alcohol Abuse and Alcoholism criteria found male gender, current tobacco use, never married status, retirement, and unemployment to be significant predictors of at-risk alcohol use. Conclusions. Public health policy needs to move to a primary care paradigm focusing on identification and treatment of at-risk drinkers. Handle: RePEc:aph:ajpbhl:1998:88:1:90-93_9 Template-Type: ReDIF-Article 1.0 Title: Separating authorship responsibility and authorship credit: a proposal for biomedical journals. Journal: American Journal of Public Health Author-Name: Paneth, N. Year: 1998 Volume: 88 Issue: 5 Pages: 824-826 DOI: 10.2105/AJPH.88.5.824 File-URL: http://hdl.handle.net/10.2105/AJPH.88.5.824 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.88.5.824_1 Template-Type: ReDIF-Article 1.0 Title: Ethical challenges in efficacy trials of vaginal microbicides for HIV prevention Journal: American Journal of Public Health Author-Name: De Zoysa, I. Author-Name: Elias, C.J. Author-Name: Bentley, M.E. Year: 1998 Volume: 88 Issue: 4 Pages: 571-575 Abstract: This paper discusses some of the ethical challenges raised by advanced clinical trials designed to assess the safety and efficacy of vaginal microbicides in protecting women from HIV infection. The ethical principles that guide clinical research involving human subjects require that all participants in such trials be provided available measures known to reduce the risk of HIV infection. However, this will reduce the ability of the study to assess the protective effect of the test microbicide. In addition, providing extensive services to trial participants may be construed as an undue inducement if the study is being conducted among vulnerable groups- such as sex workers or women from disadvantaged communities. Suggestions are provided to resolve this dilemma in the planning and implementation of HIV prevention services for trial participants. Handle: RePEc:aph:ajpbhl:1998:88:4:571-575_7 Template-Type: ReDIF-Article 1.0 Title: Breast cancer mortality declining but screening among subpopulations lags. Journal: American Journal of Public Health Author-Name: Skaer, T.L. Author-Name: Robison, L.M. Author-Name: Sclar, D.A. Author-Name: Harding, G.H. Year: 1998 Volume: 88 Issue: 2 Pages: 307-308 DOI: 10.2105/AJPH.88.2.307-a File-URL: http://hdl.handle.net/10.2105/AJPH.88.2.307-a Handle: RePEc:aph:ajpbhl:10.2105/AJPH.88.2.307-a_9 Template-Type: ReDIF-Article 1.0 Title: Editorial: Nihilism and pragmatism in tuberculosis control Journal: American Journal of Public Health Author-Name: Farmer, P. Author-Name: Nardell, E. Year: 1998 Volume: 88 Issue: 7 Pages: 1014-1015 Handle: RePEc:aph:ajpbhl:1998:88:7:1014-1015_7 Template-Type: ReDIF-Article 1.0 Title: Obstetric care and payment source: Do low-risk Medicaid women get less care? Journal: American Journal of Public Health Author-Name: Dobie, S. Author-Name: Hart, L.G. Author-Name: Fordyce, M. Author-Name: Andrilla, C.H.A. Author-Name: Rosenblatt, R.A. Year: 1998 Volume: 88 Issue: 1 Pages: 51-56 Abstract: Objectives. This study examined whether Medicaid-insured women at low risk receive less adequate obstetrical care than privately insured women. Methods. Low-risk women who were cared for by a random sample of obstetrical providers in Washington State were randomly selected. Information on all prenatal and intrapartum services was abstracted from medical records. Service information was aggregated into standardized resource-use units. Results compared Medicaid-insured women with those who were privately insured. Results. Medicaid-insured women were significantly younger (22.5 years vs 26.9 years) and averaged 6% fewer visits than privately insured women. Nonetheless, Medicaid status had no meaningful association with prenatal, intrapartum, or overall resource use. Some variation occurred in individual resources received. Medicaid-insured women had 38.8% more resources expended on testing for sexually transmitted diseases. Privately insured women had more resources expended on alpha-fetoprotein testing and on amniocentesis. There were no meaningful differences in birthweight or gestational age at delivery. Conclusions. In this study of women who entered obstetrical care at low risk, similar care and resources were expended on Medicaid-insured and on privately insured women. Handle: RePEc:aph:ajpbhl:1998:88:1:51-56_7 Template-Type: ReDIF-Article 1.0 Title: A cost-benefit analysis of a cardiovascular disease prevention trial, using folate supplementation as an example Journal: American Journal of Public Health Author-Name: Hornberger, J. Year: 1998 Volume: 88 Issue: 1 Pages: 61-67 Abstract: Objectives. This study illustrates a cost-benefit analysis of clinical trial design, using as an example a trial of folate supplementation to prevent cardiovascular disease. Methods. Bayesian statistical and decision- analytic techniques were used to estimate the cost-benefit and sample size of a placebo-controlled trial of folate targeted to US citizens, aged 35 to 84 years, with elevated serum homocysteine levels. The main end point is event- free survival (i.e., survival without new ischemic heart disease or stroke) at 5 years. Results. Because the screening cost and annual cost and inconvenience of taking folate is small compared with the consequences of stroke, ischemic heart disease, or death, the increase in 5-year event-free survival with folate that should compel the use of folate is just 1.1%. The sample size per group needed to establish this level of folate's medical effectiveness is estimated to be 17 310. Such a trial would provide an expected societal cost-benefit savings exceeding $11 billion within 15 years. Conclusions. This study illustrates how Bayesian methods may help in assessing the societal cost-benefit consequences of proposed disease prevention trials, deciding which trials are worth sponsoring, and designing cost-effective trials. Handle: RePEc:aph:ajpbhl:1998:88:1:61-67_6 Template-Type: ReDIF-Article 1.0 Title: The use of state of general hospitals for inpatient psychiatric care Journal: American Journal of Public Health Author-Name: Banks, S.M. Author-Name: Pandiani, J.A. Year: 1998 Volume: 88 Issue: 3 Pages: 448-451 Abstract: Objectives. This paper explores the relationship of state hospital and general hospital psychiatric case-loads in a statewide system of care. Methods. Probabilistic population estimation was applied to general hospital and state hospital data sets. Results. General hospitals provide inpatient psychiatric services to more people than do state hospitals, and a significant number are served in both sectors. There were notable differences in use patterns related to patient gender and age. Conclusions. These results demonstrate that probabilistic methodologies can significantly enhance the value of existing databases for epidemiological research. Handle: RePEc:aph:ajpbhl:1998:88:3:448-451_4 Template-Type: ReDIF-Article 1.0 Title: Re: authors and authorship. Journal: American Journal of Public Health Author-Name: Feinleib, M. Year: 1998 Volume: 88 Issue: 5 Pages: 830-831 DOI: 10.2105/AJPH.88.5.830-b File-URL: http://hdl.handle.net/10.2105/AJPH.88.5.830-b Handle: RePEc:aph:ajpbhl:10.2105/AJPH.88.5.830-b_4 Template-Type: ReDIF-Article 1.0 Title: Erratum: The protective effect of condoms and nonoxynol-9 against HIV infection (American Journal of Public Health (1998) 88 (590-596)) Journal: American Journal of Public Health Author-Name: Wittowski, K.M. Author-Name: Susser, E. Author-Name: Dietz, K. Year: 1998 Volume: 88 Issue: 6 Pages: 972 Handle: RePEc:aph:ajpbhl:1998:88:6:972_3 Template-Type: ReDIF-Article 1.0 Title: Erratum: Taking chances: Problem gamblers and mental health disorders - Results from the St. Epidemiologic Catchment Area Study (American Journal of Public Health (1998) 88 (1093-1096)) Journal: American Journal of Public Health Author-Name: Cunningham-Williams, R.M. Author-Name: Cottler, L.B. Author-Name: Compton III, W.M. Author-Name: Spitznagel, E.L. Year: 1998 Volume: 88 Issue: 9 Pages: 1407 Handle: RePEc:aph:ajpbhl:1998:88:9:1407_1 Template-Type: ReDIF-Article 1.0 Title: HIV testing [5] Journal: American Journal of Public Health Author-Name: Dubois-Arber, F. Year: 1998 Volume: 88 Issue: 4 Pages: 683-684 Handle: RePEc:aph:ajpbhl:1998:88:4:683-684_2 Template-Type: ReDIF-Article 1.0 Title: Metropolitan governance, residential segregation, and mortality among African Americans Journal: American Journal of Public Health Author-Name: Hart, K.D. Author-Name: Kunitz, S.J. Author-Name: Sell, R.R. Author-Name: Mukamel, D.B. Year: 1998 Volume: 88 Issue: 3 Pages: 434-438 Abstract: Objectives. This study tested the hypothesis that the degree to which local government is metropolitanized is associated with mortality rates for African Americans and with residential segregation, which has itself previously been shown to be positively associated with mortality among African Americans. Methods. One hundred fourteen US standard metropolitan statistical areas were examined. The primary dependent variable was the age- adjusted, race- and sex-specific all-cause mortality rate, averaged for 1990 and 1991. The 2 primary independent variables were residential segregation, as measured by the index of dissimilarity, and metropolitanization of government, as measured by the central city's elasticity score. Results. Mortality rates for male and female African Americans were lower in metropolitan statistical areas with more metropolitanized local governments and lower levels of residential segregation. Mortality for male and female Whites was not associated in either direction with residential segregation. White male mortality showed no association with level of metropolitanization, but lower White female mortality rates were associated with less metropolitanization. Conclusions. This study suggests the need for further research into whether policy changes in areas not traditionally thought of as 'health policy' areas can improve the health of urban minorities. Handle: RePEc:aph:ajpbhl:1998:88:3:434-438_4 Template-Type: ReDIF-Article 1.0 Title: Editorial: Significance of workplace smoking Journal: American Journal of Public Health Author-Name: Breslow, L. Author-Name: Elashoff, R. Year: 1998 Volume: 88 Issue: 7 Pages: 1011-1012 Handle: RePEc:aph:ajpbhl:1998:88:7:1011-1012_4 Template-Type: ReDIF-Article 1.0 Title: Fifteen-year follow-up of smoking prevention effects in the North Karelia Youth Project Journal: American Journal of Public Health Author-Name: Vartiainen, E. Author-Name: Paavola, M. Author-Name: McAlister, A. Author-Name: Puska, P. Year: 1998 Volume: 88 Issue: 1 Pages: 81-85 Abstract: Objectives. This study evaluated the long-term effects of a school- and community-based smoking prevention program in Finland. Methods. Four intervention schools from North Karelia and two control schools from another province were chosen for the evaluation. Students who received the intervention were taught to resist social pressures to smoke. The program began in 1978 with seventh-grade students and ran through 1980, with a 15- year follow-up. In North Karelia, a community-based smoking cessation program for adults was also carried out. Results. Mean lifetime cigarette consumption was 22% lower among program subjects than among control subjects. Smoking and prevalence were lower up to the age of 21. Conclusions. Long-term smoking prevention effects can be achieved if a school-based program using a social influence model is combined with community and mass media interventions. Handle: RePEc:aph:ajpbhl:1998:88:1:81-85_8 Template-Type: ReDIF-Article 1.0 Title: Whatever happened to politicians' concerns about the nation's uninsured? Journal: American Journal of Public Health Author-Name: Blendon, R.J. Author-Name: Benson, J.M. Year: 1998 Volume: 88 Issue: 3 Pages: 345-346 DOI: 10.2105/AJPH.88.3.345 File-URL: http://hdl.handle.net/10.2105/AJPH.88.3.345 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.88.3.345_9 Template-Type: ReDIF-Article 1.0 Title: Creating the future of public health: values, vision, and leadership. Journal: American Journal of Public Health Author-Name: Levy, B.S. Year: 1998 Volume: 88 Issue: 2 Pages: 188-192 DOI: 10.2105/AJPH.88.2.188 File-URL: http://hdl.handle.net/10.2105/AJPH.88.2.188 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.88.2.188_5 Template-Type: ReDIF-Article 1.0 Title: Ethical dilemmas in polio eradication. Hyder responds. Journal: American Journal of Public Health Author-Name: Hyder, A.A. Year: 1998 Volume: 88 Issue: 1 Pages: 131-132 DOI: 10.2105/AJPH.88.1.131 File-URL: http://hdl.handle.net/10.2105/AJPH.88.1.131 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.88.1.131_2 Template-Type: ReDIF-Article 1.0 Title: Retention, HIV risk, and illicit drug use during treatment: Methadone dose and visit frequency Journal: American Journal of Public Health Author-Name: Rhoades, H.M. Author-Name: Creson, D. Author-Name: Elk, R. Author-Name: Schmitz, J. Author-Name: Grabowski, J. Year: 1998 Volume: 88 Issue: 1 Pages: 34-39 Abstract: Objectives. This study examined two major methadone treatment factors, visit frequency and methadone dose, posited to be important in reducing intravenous drug use and human immunodeficiency virus (HIV) transmission. Methods: One hundred fifty opiate-dependent subjects randomly assigned to four groups received 50 or 80 mg of methadone and attended a clinic 2 or 5 days per week. Results. Survival analysis indicated higher dropout rates for groups having five vs two visits per week (χ2 [1] = 7.76). Higher proportions of opiate-positive results on urine screens were associated with lower methadone doses (F [1,91] = 4.74). Conclusions. Receiving take-home doses early in treatment enhanced treatment retention. The 50-mg dose combined with five visits per week produced the worst outcome. Fewer visits enhanced retention at 50 mg, but opiate use rates were higher at this dose than they were for either 80-mg group. The HIV infection rate at entry was 9%. No subjects seroconverted during the study. Risk behaviors for acquired immunodeficiency syndrome declined over time regardless of group/dose assignment. These results have important implications for modification of regulatory and clinic policy changes. Handle: RePEc:aph:ajpbhl:1998:88:1:34-39_0 Template-Type: ReDIF-Article 1.0 Title: Two alternative job stress models and the risk of coronary heart disease Journal: American Journal of Public Health Author-Name: Bosma, H. Author-Name: Peter, R. Author-Name: Siegrist, J. Author-Name: Marmot, M. Year: 1998 Volume: 88 Issue: 1 Pages: 68-74 Abstract: Objectives. This study examined the association between two alternative job stress models-the effort-reward imbalance model and the job strain model- and the risk of coronary heart disease among male and female British civil servants. Methods. The logistic regression analyses were based on a prospective cohort study (Whitehall II study) comprising 6895 men and 3413 women aged 35 to 55 years. Baseline measures of both job stress models were related to new reports of coronary heart disease over a mean 5.3 years of follow-up. Results. The imbalance between personal efforts (competitiveness, work-related overcommitment, and hostility) and rewards (poor promotion prospects and a blocked career) was associated with a 2.15-fold higher risk of new coronary heart disease. Job strain and high job demands were not related to coronary heart disease; however, low job control was strongly associated with new disease. The odds ratios for low job control were 2.38 and 1.56 for self-reported and externally assessed job control, respectively. Work characteristics were simultaneously adjusted and controlled for employment grade level, negative affectivity, and coronary risk factors. Conclusions. This is apparently the first report showing independent effects of components of two alternative job stress models-the effort-reward imbalance model and the job strain model (job control only)-on coronary heart disease. Handle: RePEc:aph:ajpbhl:1998:88:1:68-74_4 Template-Type: ReDIF-Article 1.0 Title: Histories of substance use and risk behavior: Precursors to HIV seroconversion in homosexual men Journal: American Journal of Public Health Author-Name: Chesney, M.A. Author-Name: Barrett, D.C. Author-Name: Stall, R. Year: 1998 Volume: 88 Issue: 1 Pages: 113-116 Abstract: Objectives. This study compared history of substance use and episodic use in terms of HIV seroconversion. Methods. A sample of 337 baseline HIV- negative gay men was followed for 6 years. Bivariate and survival analyses were used to compare 39 converters with nonconverters on substance use behaviors. Results. Seroconverters were consistently more likely to report use of marijuana, nitrite inhalants, amphetamines, and cocaine than nonconverters. Consistent use of nitrite inhalants and amphetamines increases the relative risk of seroconversion, while episodic use does not. Both patterns of cocaine use increase seroconversion risk. Conclusions. There are three potential mechanisms for an increased risk of conversion due to consistent substance use. Handle: RePEc:aph:ajpbhl:1998:88:1:113-116_7 Template-Type: ReDIF-Article 1.0 Title: Erratum: Inequalities in mortality by social class measured at 3 stages of the lifecourse (American Journal of Public Health (1998) 88 (471-474)) Journal: American Journal of Public Health Author-Name: Hart, C.L. Author-Name: Smith, G.D. Author-Name: Blane, D. Year: 1998 Volume: 88 Issue: 4 Pages: 575 Handle: RePEc:aph:ajpbhl:1998:88:4:575_6 Template-Type: ReDIF-Article 1.0 Title: Problem gamblers, problem substance users, and dual-problem individuals: An epidemiological study Journal: American Journal of Public Health Author-Name: Feigelman, W. Author-Name: Wallisch, L.S. Author-Name: Lesieur, H.R. Year: 1998 Volume: 88 Issue: 3 Pages: 467-470 Abstract: Objectives. This study compared problem gamblers, problem substance users, dual-problem individuals, and persons without these problems in the general population. Methods. On the basis of computer-assisted telephone interviews of a random sample of Texas adults (n = 6308) standard instruments were used to gauge substance use and gambling problems in the general population. Results. Compared with those having a substance use or gambling problem only, dual-problem individuals were more likely to be young, never- married men, without conventional religious affiliations. There was more dysfunctionality (as evidenced by treatment-seeking and problems with the law) among dual-problem respondents than among those troubled exclusively by gambling or substance use problems. Conclusions. Screening and treatment for gambling problems should be offered in drug treatment and criminal justice arenas. Handle: RePEc:aph:ajpbhl:1998:88:3:467-470_8 Template-Type: ReDIF-Article 1.0 Title: Risk factors for congenital syphilis in infants of women with syphilis in South Carolina Journal: American Journal of Public Health Author-Name: Mobley, J.A. Author-Name: McKeown, R.E. Author-Name: Jackson, K.L. Author-Name: Sy, F. Author-Name: Parham, J.S. Author-Name: Brenner, E.R. Year: 1998 Volume: 88 Issue: 4 Pages: 597-602 Abstract: Objectives. This study examined risk factors for congenital syphilis in South Carolina. Methods. Case infants with presumptive and confirmed congenital syphilis were compared with control infants born to women with reactive serologies during pregnancy, allowing investigation of risk factors for congenital rather than acquired transmission of syphilis. Data were collected from congenital syphilis report forms and birth certificates for 186 case infants and 487 controls born from 1991 to 1993. Odds ratios were calculated for maternal risk factors. Results. Significant statistical trends were found for timing of first prenatal visit and number of visits. Other significant factors included rural residence (odds ratio [OR] = 2.0, 95% confidence interval [CI]1.4, 2.9) and previous pregnancy loss (OR=0.3, 95% CI=0.2, 0.6). Conclusions. Prevention of congenital syphilis may be less effective among pregnant women with syphilis in South Carolina who have fewer prenatal care visits. Health care providers need further education on maternal/child syphilis management and techniques for motivating and educating patients. Handle: RePEc:aph:ajpbhl:1998:88:4:597-602_3 Template-Type: ReDIF-Article 1.0 Title: Making health, not war--musings on global disparities in health and human rights: a critical commentary by Solomon R. Benatar. Journal: American Journal of Public Health Author-Name: Somerville, M.A. Year: 1998 Volume: 88 Issue: 2 Pages: 301-303 DOI: 10.2105/AJPH.88.2.301 File-URL: http://hdl.handle.net/10.2105/AJPH.88.2.301 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.88.2.301_2 Template-Type: ReDIF-Article 1.0 Title: Editorial: Are you certain? - Uncertainty, health, and safety in contemporary work Journal: American Journal of Public Health Author-Name: Hurrell J.J., Jr. Year: 1998 Volume: 88 Issue: 7 Pages: 1012-1013 Handle: RePEc:aph:ajpbhl:1998:88:7:1012-1013_6 Template-Type: ReDIF-Article 1.0 Title: Webster and colleagues respond: No proof that shall-issue laws reduce violence Journal: American Journal of Public Health Author-Name: Webster, D.W. Author-Name: Vernick, J.S. Author-Name: Ludwig, J. Year: 1998 Volume: 88 Issue: 6 Pages: 982-983 Handle: RePEc:aph:ajpbhl:1998:88:6:982-983_1 Template-Type: ReDIF-Article 1.0 Title: Multiple authorship for community intervention trials. Journal: American Journal of Public Health Author-Name: Baranowski, T. Author-Name: Cullen, K.W. Author-Name: Baranowski, J. Year: 1998 Volume: 88 Issue: 5 Pages: 827-828 DOI: 10.2105/AJPH.88.5.827-b File-URL: http://hdl.handle.net/10.2105/AJPH.88.5.827-b Handle: RePEc:aph:ajpbhl:10.2105/AJPH.88.5.827-b_1 Template-Type: ReDIF-Article 1.0 Title: Editorial: HIV research, ethics, and the developing world Journal: American Journal of Public Health Author-Name: Faden, R. Author-Name: Kass, N. Year: 1998 Volume: 88 Issue: 4 Pages: 548-550 Handle: RePEc:aph:ajpbhl:1998:88:4:548-550_9 Template-Type: ReDIF-Article 1.0 Title: Politics and policy making. Journal: American Journal of Public Health Author-Name: Dievler, A. Author-Name: Cassady, C. Year: 1998 Volume: 88 Issue: 5 Pages: 839-840 DOI: 10.2105/AJPH.88.5.839 File-URL: http://hdl.handle.net/10.2105/AJPH.88.5.839 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.88.5.839_2 Template-Type: ReDIF-Article 1.0 Title: Beyond black box epidemiology. Journal: American Journal of Public Health Author-Name: Weed, D.L. Year: 1998 Volume: 88 Issue: 1 Pages: 12-14 DOI: 10.2105/AJPH.88.1.12 File-URL: http://hdl.handle.net/10.2105/AJPH.88.1.12 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.88.1.12_0 Template-Type: ReDIF-Article 1.0 Title: Continuity of insurance coverage--a precondition for continuity of primary care. Journal: American Journal of Public Health Author-Name: Grumbach, K. Year: 1998 Volume: 88 Issue: 3 Pages: 348-349 DOI: 10.2105/AJPH.88.3.348 File-URL: http://hdl.handle.net/10.2105/AJPH.88.3.348 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.88.3.348_9 Template-Type: ReDIF-Article 1.0 Title: Nicotine concentration in the hair of nonsmoking mothers and size of offspring Journal: American Journal of Public Health Author-Name: Nafstad, P. Author-Name: Fugelseth, D. Author-Name: Qvigstad, E. Author-Name: Zahlsen, K. Author-Name: Magnus, P. Author-Name: Lindemann, R. Year: 1998 Volume: 88 Issue: 1 Pages: 120-124 Abstract: Objectives. The purpose of this study was to estimate the risk of small- for-gestational-age birth by levels of nicotine in the hair of mothers and offspring. Methods. In a sample of 58 case subjects and 105 control subjects, hair nicotine concentrations were measured by gas chromatography and mass spectrometry. Results. With women whose hair nicotine concentrations were in the lowest quartile as the reference group, the odds ratio (OR) for small- for-gestational-age birth was increased among women with concentrations in the upper and two middle quartiles (OR = 4.2, 95% confidence interval [CI] = 1.5, 11.5, and OR = 3.2, 95% CI = 1.3, 8.0). When smoking mothers were excluded from the analysis, the corresponding odds ratios were 2.1 (95% CI = 0.4, 10.1) and 3.4 (95% CI = 1.3, 8.6). Conclusion. The results suggest that passive maternal smoking increases the risk of small-for-gestational-age births. Handle: RePEc:aph:ajpbhl:1998:88:1:120-124_3 Template-Type: ReDIF-Article 1.0 Title: Mortality and the media [1] Journal: American Journal of Public Health Author-Name: Jacobsen, P. Year: 1998 Volume: 88 Issue: 8 Pages: 1267 Handle: RePEc:aph:ajpbhl:1998:88:8:1267_5 Template-Type: ReDIF-Article 1.0 Title: Re: authors and authorship. Journal: American Journal of Public Health Author-Name: Henenway, D. Year: 1998 Volume: 88 Issue: 5 Pages: 826-827 DOI: 10.2105/AJPH.88.5.826 File-URL: http://hdl.handle.net/10.2105/AJPH.88.5.826 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.88.5.826_6