Template-Type: ReDIF-Article 1.0 Title: Technology assessment and accountable health services for women Journal: American Journal of Public Health Author-Name: Muller, C. Author-Name: Fahs, M.C. Year: 1999 Volume: 89 Issue: 12 Pages: 1895 Handle: RePEc:aph:ajpbhl:1999:89:12:1895_2 Template-Type: ReDIF-Article 1.0 Title: Building international public health vision through local community research: The El Puente-CIET partnership Journal: American Journal of Public Health Author-Name: Ledogar, R.J. Author-Name: Acosta, L.G. Author-Name: Penchaszadeh, A. Year: 1999 Volume: 89 Issue: 12 Pages: 1795-1797 Handle: RePEc:aph:ajpbhl:1999:89:12:1795-1797_0 Template-Type: ReDIF-Article 1.0 Title: Preventable inpatient time: Adequacy of electronic patient information systems Journal: American Journal of Public Health Author-Name: Katz, D.L. Author-Name: Mazhari, R. Author-Name: Kalus, R. Author-Name: Nawaz, H. Year: 1999 Volume: 89 Issue: 12 Pages: 1885-1889 Abstract: Objectives. This study assessed hospital electronic patient information systems (EPIS) for inclusion of variables associated with avoidable and extended hospitalization (preventable inpatient time). Methods. We searched MEDLINE and HealthSTAR databases to identify predictors of preventable inpatient time. We then audited the admissions process and the handwritten medical record at 1 hospital and the EPIS at all hospitals, affiliated with the Yale University School of Medicine for inclusion of the predictors. Results. Whereas the written medical record included all 58 predictors, the EPIS of the 10 hospitals surveyed included an average of only 38% of the predictors. Conclusions. The conventional approach to information gathering during hospital admission is highly inefficient. Revising EPIS to include predictors of preventable inpatient time could enhance efficiency and quality, while reducing costs, of hospital care. Handle: RePEc:aph:ajpbhl:1999:89:12:1885-1889_1 Template-Type: ReDIF-Article 1.0 Title: Possible associations between computed tomography scan and cataract: The blue mountains eye study Journal: American Journal of Public Health Author-Name: Hourihan, F. Author-Name: Mitchell, P. Author-Name: Cumming, R.G. Year: 1999 Volume: 89 Issue: 12 Pages: 1864-1866 Abstract: Objectives. This study examined possible associations between the presence of cataract and a history of computed tomography (CT) scan of the head in an older population. Methods. The Blue Mountains Eye Study examined 3654 people aged 49 to 97 years who lived west of Sydney, Australia. As part of a medical history, participants were asked whether they had ever had a head CT scan. Masked grading of lens photographs assessed conical, nuclear, and posterior subcapsular cataracts. Results. No significant associations were found between history of head CT scan and age- and sex-specific prevalence of any type of cataract. Conclusions. This study provided no evidence to support an association between routine head CT scans and development of cataract. Handle: RePEc:aph:ajpbhl:1999:89:12:1864-1866_6 Template-Type: ReDIF-Article 1.0 Title: Effectiveness of a comprehensive multisector campaign to increase seat belt use in the greater Athens area, Greece Journal: American Journal of Public Health Author-Name: Petridou, E. Author-Name: Trichopoulos, D. Author-Name: Stappa, M. Author-Name: Tsoufis, Y. Author-Name: Skalkidou, A. Year: 1999 Volume: 89 Issue: 12 Pages: 1861-1863 Abstract: Objectives. This study assessed the effectiveness of a comprehensive campaign to increase seat belt use in Athens. Methods. In 1996 a survey focusing on seat belt use was undertaken among occupants of 1400 passenger cars. From October 1997 to June 1998 the campaign was implemented; during the campaign, seat belt law enforcement was not intensified. In 1998 another inspection survey of 2250 cars was undertaken. Results. The program brought only a 6% increase in compliance, but there was an estimated gain of about 50 averted deaths and 1500 averted injuries. Conclusions. An intensive campaign to increase seat belt use, conducted in the absence of increased law enforcement, resulted in moderate gains. Handle: RePEc:aph:ajpbhl:1999:89:12:1861-1863_4 Template-Type: ReDIF-Article 1.0 Title: Future hospital care in a population-based series of twin pairs discordant for physical activity behavior Journal: American Journal of Public Health Author-Name: Kujala, U.M. Author-Name: Kaprio, J. Author-Name: Sarna, S. Author-Name: Koskenvuo, M. Year: 1999 Volume: 89 Issue: 12 Pages: 1869-1872 Abstract: Objectives. This study investigated the association between physical activity behavior and morbidity, taking into account genetic selection. Methods. Hospitalizations were followed from the beginning of 1977 to the end of 1986 in 710 same-sex healthy twin pairs discordant for leisure-time physical activity and in 151 pairs discordant for all physical activity at baseline in 1975. Results. During the follow-up, among twin pairs discordant for leisure activity, the active member spent, on o average, 43% fewer days in the hospital than the inactive member; the corresponding percentage was 55% among pairs discordant for all activity. Conclusions. Physically inactive behavior is associated with increased need for hospital treatments, even after genetic and other confounding factors are taken into account. Handle: RePEc:aph:ajpbhl:1999:89:12:1869-1872_5 Template-Type: ReDIF-Article 1.0 Title: Differences in program implementation between nurses and paraprofessionals providing home visits during pregnancy and infancy: A randomized trial Journal: American Journal of Public Health Author-Name: Korfmacher, J. Author-Name: O'Brien, R. Author-Name: Hiatt, S. Author-Name: Olds, D. Year: 1999 Volume: 89 Issue: 12 Pages: 1847-1851 Abstract: Objectives. This study examined differences between nurses and paraprofessionals in implementation of a home visiting program for low- income, first-time parents during pregnancy and the first 2 years of the child's life. Methods. Mothers were randomly assigned to either a nurse- visited (n = 236) or a paraprofessional-visited (n = 244) condition. Nurse- and paraprofessional-visited families were compared on number and length of visits, topics covered, number of program dropouts, and relationship with home visitor. Results. On average, nurses completed more visits than paraprofessionals (28 vs 23; P<.001) and spent a greater proportion of time on physical health issues during pregnancy (38% vs 27%; P <.001) and on parenting issues during infancy (46% vs 32%; P < .001). Paraprofessionals conducted visits that lasted longer and spent a greater proportion of time on environmental health and safety issues (15% vs 7% pregnancy; 15% vs 8% infancy; P<.001). While home visitors were viewed equally positively by mothers, nurses had fewer dropouts than did paraprofessionals (38% vs 48%; P= .04). More paraprofessional-visited families than nurse, visited families experienced staff turnover. Conclusions. Nurses and paraprofessionals, even when using the same model, provide home visiting services in different ways. Handle: RePEc:aph:ajpbhl:1999:89:12:1847-1851_4 Template-Type: ReDIF-Article 1.0 Title: Encouraging use of coupons to stimulate condom purchase Journal: American Journal of Public Health Author-Name: Dahl, D.W. Author-Name: Gorn, G.J. Author-Name: Weinberg, C.B. Year: 1999 Volume: 89 Issue: 12 Pages: 1866-1869 Abstract: Objectives. This study examined the feasibility of using high-value coupons to induce condom purchase and evaluated execution factors that can influence the effectiveness of this form of promotion. Methods. Two levels of coupon discount value (10% off and 75% off) were used to promote condom purchase among young adults. Coupons were distributed according to a wide spread strategy or a more focused in-store disbursement method. Results. Redemption of coupons distributed through the widespread disbursement strategy was negligible. In contrast, coupons from the in-store distribution method, particularly the higher value coupon, resulted in a high redemption rate. Conclusions. This research provides strong evidence that discount coupons, particularly high-value ones distributed at the purchase location, can be used successfully as a condom promotional incentive. Handle: RePEc:aph:ajpbhl:1999:89:12:1866-1869_8 Template-Type: ReDIF-Article 1.0 Title: Elimination and reintroduction of a sexually transmitted disease: Lessons to be learned? Journal: American Journal of Public Health Author-Name: Aral, S. Year: 1999 Volume: 89 Issue: 7 Pages: 995-997 Handle: RePEc:aph:ajpbhl:1999:89:7:995-997_2 Template-Type: ReDIF-Article 1.0 Title: Long-term trends in childhood infectious disease mortality rates Journal: American Journal of Public Health Author-Name: DiLiberti, J.H. Author-Name: Jackson, C.R. Year: 1999 Volume: 89 Issue: 12 Pages: 1883-1885 Abstract: Objectives. This study assessed long-term trends in US childhood infectious disease mortality rates (CIDMR). Methods. We calculated age- adjusted and age group specific US CIDMR (1968-1996) by using data from the Compressed Mortality File (1968 1992, 1996) and Multiple Cause of Death Files (1993 1995) of the National Center for Health Statistics and English data for historical comparison (1861-1964). Results. US CIDMR declined continuously from 1968 to 1996, although the rate of decline slowed after 1974. Respiratory and central nervous system categories declined most; HIV-related deaths offset these declines somewhat. Conclusions. CIDMR declined nearly 200-fold between 1861 and 1996, but no substantive improvement occurred after 1986. Handle: RePEc:aph:ajpbhl:1999:89:12:1883-1885_6 Template-Type: ReDIF-Article 1.0 Title: Mortality differentials among Israeli men Journal: American Journal of Public Health Author-Name: Manor, O. Author-Name: Eisenbach, Z. Author-Name: Peritz, E. Author-Name: Friedlander, Y. Year: 1999 Volume: 89 Issue: 12 Pages: 1807-1813 Abstract: Objectives. This study examined differentials in mortality among adult Israeli men with respect to ethnic origin, marital status, and several measures of social status. Methods. Data were based on a linkage of records from a 20% sample of the 1983 census to records of deaths occurring before the end of 1992. The study population included 72 527 men, and the number of deaths was 17378. Results. Differentials in mortality by origin show that mortality was higher among individuals of North African origin than among those of Asian and European origin. After allowance for several socioeconomic indicators, the excess mortality among North African Jews was eliminated. Substantial and consistent differences in mortality were found according to education, occupation, income, possession of a car, housing, and household amenities. Differentials among the elderly were markedly narrower than those among men younger than 70 years. Conclusions. Some sectors of Israeli society have higher risks of death than others, including, among the male population, these who are poor, less educated, unmarried, unskilled, out of the labor force, and of North African origin. Handle: RePEc:aph:ajpbhl:1999:89:12:1807-1813_2 Template-Type: ReDIF-Article 1.0 Title: Illness and treatment perceptions of ethiopian immigrants and their doctors in Israel Journal: American Journal of Public Health Author-Name: Reiff, M. Author-Name: Zakut, H. Author-Name: Weingarten, M.A. Year: 1999 Volume: 89 Issue: 12 Pages: 1814-1818 Abstract: Objectives. Patient-provider misunderstandings arising from disparate medical and cultural concepts can impede health care among immigrant populations. This study assessed the extent of disagreement and identified the salient problems of communication between Israeli doctors and Ethiopian. Methods. Semistructured interviews were conducted with 59 Ethiopian immigrants. Self-reports of health status and effectiveness of treatment were compared with evaluations by the primary care physician and supplemented by qualitative data from descriptions of illness, observations of medical visits, informant interviews, and participant observations conducted by the anthropologist. Results. Health status and effective ness of treatment were rated significantly higher by the doctor than by the occurred mainly for illnesses with stressrelated or culture-specific associations. long-term immigrants may alter their expectations of treatment but continue to experience symptom that are cuturally, but not biomedically, meaningful. Conclusions. Misunderstandings between immigrant patients and their doctors emerge from the biomedical relate illnesses and from culture-based discrepancies in concepts of illness and healing. Including trained translators in medical teams can reduce medical misunderstandings and increase patient satisfaction among immigrant population. Handle: RePEc:aph:ajpbhl:1999:89:12:1814-1818_2 Template-Type: ReDIF-Article 1.0 Title: Sexual and drug-use risk factors for HIV and STDS: A comparison of women with and without bisexual experiences Journal: American Journal of Public Health Author-Name: Gonzalez, V. Author-Name: Washienko, K.M. Author-Name: Krone, M.R. Author-Name: Chapman, L.I. Author-Name: Arredondo, E.M. Author-Name: Huckeba, H.J. Author-Name: Downer, A. Year: 1999 Volume: 89 Issue: 12 Pages: 1841-1846 Abstract: Objectives. This study was done to compare risk factors for HIV/STDs in women who reported having had sex with both men and women and women who reported having had sex with men only. Methods. Female participants in a multisite, randomized HIV/STD prevention study in the Seattle area reported both having had sex with a man in the 3 months before and having at least 1 risk factor for HIV/STDs during the year before the study. Of these women, 38% who reported ever having had sex with a woman were compared with those who reported having had sex with men only. Results. Women who had had sex with both men and women were more likely than women who had had sex with men only to report drug use in the 3 months before the study, a greater lifetime number of male partners, a sex partner who had had sex with a prostitute, an earlier age at sexual debut, and forced sexual contact (P < .01 for all comparisons). Women who had had sex with both men and women had a mean of 3.2 of these 5 risk factors, vs 2.1 among women who had had sex with men only (P<.001). Conclusion. Women who had had sex with both men and women were more likely than women who had had sex with men only to engage in multiple risk behaviors. Health workers should be aware of bisexual experience among women, since this may be a marker for multiple risk behaviors for HIV/STDs. Handle: RePEc:aph:ajpbhl:1999:89:12:1841-1846_5 Template-Type: ReDIF-Article 1.0 Title: The association between switching hand preference and the declining prevalence of left-handedness with age Journal: American Journal of Public Health Author-Name: Galobardes, B. Author-Name: Bernstein, M.S. Author-Name: Morabia, A. Year: 1999 Volume: 89 Issue: 12 Pages: 1873-1875 Abstract: Objectives. This study determined the prevalence of left-handedness and of switching hand preference among innately left-handed subjects. Methods. Subjects of Swiss nationality (n = 1692), participating in a population-based survey in Geneva, Switzerland, completed a questionnaire on innate hand preference and current hand preference for writing. Results. From 35 to 44 years of age to 65 to 74 years of age, the prevalence of innate left- handedness declined from 11.9% to 6.2% (trend P = .007). In these same age groups, the proportion of innately left-handed subjects who switched to the right hand for writing increased from 26.6% to 88.9% (trend P = .0001). Conclusions. Across generations, we found an increase in the prevalence of switching hand preference among innately left-handed subjects. This phenomenon could be explained by social and parental pressure to use the right hand. Handle: RePEc:aph:ajpbhl:1999:89:12:1873-1875_4 Template-Type: ReDIF-Article 1.0 Title: Sonomorphologic evaluation of goiter in an iodine deficiency area in the ivory coast Journal: American Journal of Public Health Author-Name: Franke, D. Author-Name: Filler, G. Author-Name: Zivicnjak, M. Author-Name: Kouamé, P. Author-Name: Ohde, I. Author-Name: Eckhardt, L. Author-Name: Doehring, E. Author-Name: Ehrich, J.H.H. Year: 1999 Volume: 89 Issue: 12 Pages: 1857-1861 Abstract: Objectives. This study evaluated the extent of thyroid abnormalities in a remote iodine-deficient area of the Ivory Coast. Methods. Ultrasonography was used in detecting the presence of goiter. Results. The overall prevalence rates of goiter were 64.7% among females and 53.3% among males. In children aged 6 to 15 years (n = 314), the prevalence of goiter was 62% regardless of sex. Thyroid volume increased steadily with age, with significantly larger goiters in women 25 years and older. Frequency of cysts and calcifications did not correlate with sex. Conclusions. Especially in developing countries, prophylaxis of iodine deficiency disorders must be improved in iodine- deficient areas to prevent substantial morbidity, which is more severe in women and elderly persons. Handle: RePEc:aph:ajpbhl:1999:89:12:1857-1861_4 Template-Type: ReDIF-Article 1.0 Title: Outcomes of 17137 pregnancies in 2 urban areas of Ukraine Journal: American Journal of Public Health Author-Name: Little, R.E. Author-Name: Monaghan, S.C. Author-Name: Gladen, B.C. Author-Name: Shkyryak-Nyzhnyk, Z.A. Author-Name: Wilcox, A.J. Year: 1999 Volume: 89 Issue: 12 Pages: 1832-1836 Abstract: Objectives: Frequent terminations of pregnancy and high rates of fetal loss have been reported, but not con firmed, in the former eastern bloc. A census of pregnancies in Ukraine, a former eastern bloc country, was conducted to determine the rates of these events. Methods. All pregnancies registered in 2 urban areas were enumerated. During a 19-month period between 1992 and 1994, 17137 pregnancies and their outcomes were recorded. Results. Sixty percent of the pregnancies were voluntarily terminated, generally before the 13th week. In pregnancies delivered at 20+ weeks, fetal mortality was 29 per 1000, nearly 5 times the rate among Whites in the United States. There was a greater proportion of very early deliveries (20-27 weeks) in Ukraine, as well as higher death rates at all gestational ages. Perinatal mortality was estimated to be 35 per 1000, about 3 times the US rate. Conclusions. This is believed to be the first study in the former eastern bloc to ascertain all of the clinically recognized pregnancies in a specified period and to determine their outcomes. The data document elevated reproductive risks in a former Soviet state. Handle: RePEc:aph:ajpbhl:1999:89:12:1832-1836_9 Template-Type: ReDIF-Article 1.0 Title: The impact of a community-based heart disease prevention program in a low-income, inner-city neighborhood Journal: American Journal of Public Health Author-Name: O'Loughlin, J.L. Author-Name: Paradis, G. Author-Name: Gray-Donald, K. Author-Name: Renaud, L. Year: 1999 Volume: 89 Issue: 12 Pages: 1819-1826 Abstract: Objectives. This study evaluated the impact of a 4-year, community-based cardiovascular disease prevention program among adults aged 18 to 65 years living in St-Henri, a low-income, inner-city neighborhood in Montreal, Quebec. Methods. Awareness of and participation in the program were monitored in 3 independent sample telephone surveys. Self-reported behaviors were compared in St-Henri and a nearby comparison community before and after program implementation in both a 3-year repeat independent sample survey and a 5-year longitudinal cohort telephone survey. Results. Awareness of the program reached 37.4%, but participation was low (2%-3%). There were no secular declines in smoking or high-fat diet; physical inactivity increased in both communities. There were no statistically significant program effects detected in the independent sample surveys, although physical inactivity increased more in the comparison community than in St-Henri. In the longitudinal cohort sample, there was a small, statistically significant increase favoring St-Henri in frequency of cholesterol checkups. Conclusions. Despite careful adaptation of the program to the local social context, there were few community-wide program effects. However, several component interventions showed promise in terms of community penetration and impact. Handle: RePEc:aph:ajpbhl:1999:89:12:1819-1826_0 Template-Type: ReDIF-Article 1.0 Title: Socioeconomic inequalities in mortality among women and among men: An international study Journal: American Journal of Public Health Author-Name: Mackenbach, J.P. Author-Name: Kunst, A.E. Author-Name: Groenhof, F. Author-Name: Borgan, J.-K. Author-Name: Costa, G. Author-Name: Faggiano, F. Author-Name: Józan, P. Author-Name: Leinsalu, M. Author-Name: Martikainen, P. Author-Name: Rychtarikova, J. Author-Name: Valkonen, T. Year: 1999 Volume: 89 Issue: 12 Pages: 1800-1806 Abstract: Objectives. This study compared differences in total and cause-specific mortality by educational level among women with those among men in 7 countries: the United States, Finland, Norway, Italy, the Czech Republic, Hungary, and Estonia. Methods. National data were obtained for the period ca. 1980 to ca. 1990. Age-adjusted rate ratios comparing a broad lower- educational group with a broad upper-educational group were calculated with Poisson regression analysis. Results. Total mortality rate ratios among women ranged from 1.09 in the Czech Republic to 1.31 in the United States and Estonia. Higher mortality rates among lower-educcated women were found for most causes of death, but not for neoplasms. Relative inequalities in total mortality tended to be smaller among women than among men. In the United States and Western Europe, but not in Central and Eastern Europe, this sex difference was largely due to differences between women and men in cause-of- death pattern. For specific causes of death, inequalities are usually larger among men. Conclusions. Further study of the interaction between socioeconomic factors, sex, and mortality may provide important clues to the explanation of inequalities in health. Handle: RePEc:aph:ajpbhl:1999:89:12:1800-1806_8 Template-Type: ReDIF-Article 1.0 Title: Radiation accident preparedness: Report of a training program involving the United States, Eastern Europe, and the newly independent States Journal: American Journal of Public Health Author-Name: Levy, K. Author-Name: Hirsch, E.F. Author-Name: Aghababian, R.V. Author-Name: Segall, A. Author-Name: Vanderschmidt, H. Year: 1999 Volume: 89 Issue: 7 Pages: 1115-1116 Handle: RePEc:aph:ajpbhl:1999:89:7:1115-1116_0 Template-Type: ReDIF-Article 1.0 Title: Mortality from infectious diseases in Israel, 1979-1992, based on revised ICD-9 codes: Implications for international comparisons Journal: American Journal of Public Health Author-Name: Shohat, T. Author-Name: Harari, G. Author-Name: Green, M.S. Year: 1999 Volume: 89 Issue: 12 Pages: 1855-1857 Abstract: Objectives. This study examined trends in infectious disease mortality rates in Israel between 1979 and 1992, using a traditional and a revised set of International Classification of Diseases, Ninth Revision (ICD-9) codes. Methods. A revised scheme of ICD-9 codes was used to compute mortality rates from infectious diseases for the period 1979 through 1992 by sex and for different age categories. Results. Age-adjusted infectious disease mortality rates based on the revised ICD-9 codes were 3 times higher than those based on traditional codes. Between 1979 and 1992, age-adjusted mortality rates declined more under the revised method than under the traditional method (20% vs 1.7%). Conclusions. The revised set of ICD-9 codes allows a more comprehensive view of the burden of infectious diseases on public health. Handle: RePEc:aph:ajpbhl:1999:89:12:1855-1857_7 Template-Type: ReDIF-Article 1.0 Title: History of APHA's international health section [3] (multiple letters) Journal: American Journal of Public Health Author-Name: Morgan R.E., Jr. Author-Name: Roemer, M.I. Year: 1999 Volume: 89 Issue: 7 Pages: 1126 Handle: RePEc:aph:ajpbhl:1999:89:7:1126_3 Template-Type: ReDIF-Article 1.0 Title: Tobacco smoking and depressed mood in late childhood and early adolescence Journal: American Journal of Public Health Author-Name: Wu, L.-T. Author-Name: Anthony, J.C. Year: 1999 Volume: 89 Issue: 12 Pages: 1837-1840 Abstract: Objectives. This study builds on previous observations about a suspected causal association linking tobacco smoking with depression. With prospective data, the study sheds new light on the temporal sequencing of tobacco smoking and depressed mood in late childhood and early adolescence. Methods. The epidemiologic sample that was studied consisted of 1731 youths (aged 8-9 to 13-14 years) attending public schools in a mid-Atlantic metropolitan area, who were assessed at least twice from 1989 to 1994. A survival analysis was used to examine the temporal relationship from antecedent tobacco smoking to subsequent onset of depressed mood, as well as from antecedent depressed mood to subsequent initiation of tobacco use. Results. Tobacco smoking signaled a modestly increased risk for the subsequent onset of depressed mood, but antecedent depressed mood was not associated with a later risk of starting to smoke tobacco cigarettes. Conclusions. This evidence is consistent with a possible causal link from tobacco smoking to later depressed mood in late childhood and early adolescence, but not vice versa. Handle: RePEc:aph:ajpbhl:1999:89:12:1837-1840_5 Template-Type: ReDIF-Article 1.0 Title: APHA's involvement in international health [2] Journal: American Journal of Public Health Author-Name: Pearson, C.E. Year: 1999 Volume: 89 Issue: 7 Pages: 1125-1126 Handle: RePEc:aph:ajpbhl:1999:89:7:1125-1126_4 Template-Type: ReDIF-Article 1.0 Title: Geographic information systems [1] Journal: American Journal of Public Health Author-Name: Khan, O.A. Year: 1999 Volume: 89 Issue: 7 Pages: 1125 Handle: RePEc:aph:ajpbhl:1999:89:7:1125_2 Template-Type: ReDIF-Article 1.0 Title: Linking health promotion with entertainment television Journal: American Journal of Public Health Author-Name: Langlieb, A.M. Author-Name: Cooper, C.P. Author-Name: Gielen, A. Year: 1999 Volume: 89 Issue: 7 Pages: 1116-1117 Handle: RePEc:aph:ajpbhl:1999:89:7:1116-1117_5 Template-Type: ReDIF-Article 1.0 Title: Effectiveness of a social influences smoking prevention program as a function of provider type, training method, and school risk Journal: American Journal of Public Health Author-Name: Cameron, R. Author-Name: Brown, K.S. Author-Name: Best, J.A. Author-Name: Pelkman, C.L. Author-Name: Madill, C.L. Author-Name: Manske, S.R. Author-Name: Payne, M.E. Year: 1999 Volume: 89 Issue: 12 Pages: 1827-1831 Abstract: Objectives. This study determined the effect of provider (nurse or teacher) and training method (workshop or self-preparation) on outcomes of a social influences smoking prevention program. Methods. One hundred elementary schools were stratified by school risk score (high risk = high smoking rate among senior students) and assigned randomly to conditions: (1) teacher/self- preparation, (2) teacher/workshop, (3) nurse/self-preparation, (4) nurse/workshop, and (5) control. Intervention occurred in grades 6 to 8. Smoking status at the end of grade 8 was the primary endpoint variable. Results. Intervention reduced grade 8 smoking rates in high-risk schools (smoking rates of 26.9% in control vs 16.0% in intervention schools) but not in low-risk schools. There were no significant differences in outcome as a function of training method and no significant differences in outcome between teacher-provided and nurse-provided interventions in high- and medium-risk schools. Although nurses achieved better outcomes than did teachers in love- risk schools, neither provider type achieved outcomes superior to the control condition in those schools. Conclusions. Workshop training did not affect outcomes. Teachers and nurses were equally effective providers. Results suggest that programming should target high-risk schools. Handle: RePEc:aph:ajpbhl:1999:89:12:1827-1831_8 Template-Type: ReDIF-Article 1.0 Title: Syringe vending machines for injection drug users: An experiment in Marseille, France Journal: American Journal of Public Health Author-Name: Obadia, Y. Author-Name: Feroni, I. Author-Name: Perrin, V. Author-Name: Vlahov, D. Author-Name: Moatti, J.-P. Year: 1999 Volume: 89 Issue: 12 Pages: 1852-1854 Abstract: Objectives. This study evaluated the usefulness of vending machines in providing injection drug users with access to sterile syringes in Marseille, France. Methods. Self-administered questionnaires were offered to 485 injection drug users obtaining syringes from 32 pharmacies, 4 needle exchange programs, and 3 vending machines. Results. Of the 343 respondents (response rate = 70.7%), 21.3% used the vending machines as their primary source of syringes. Primary users of vending machines were more likely than primary users of other sources to be younger than 30 years, to report no history of drug maintenance treatment, and to report no sharing of needles or injection paraphernalia. Conclusions. Vending machines may be an appropriate strategy for providing access to syringes for younger injection drug users, who have typically avoided needle exchange programs and pharmacies. Handle: RePEc:aph:ajpbhl:1999:89:12:1852-1854_9 Template-Type: ReDIF-Article 1.0 Title: Childhood lead poisoning prevention [4] Journal: American Journal of Public Health Author-Name: Ryan, D. Author-Name: Jacobs, D.E. Author-Name: Mushak, P. Author-Name: Vernon, T.M. Author-Name: Rosen, J.F. Author-Name: Piomelli, S. Author-Name: Schoenbrod, D. Author-Name: Needleman, H.L. Author-Name: Brown, T.M. Author-Name: Fee, E. Year: 1999 Volume: 89 Issue: 7 Pages: 1126-1131 Handle: RePEc:aph:ajpbhl:1999:89:7:1126-1131_5 Template-Type: ReDIF-Article 1.0 Title: Cigarette smoking among gay and bisexual men Journal: American Journal of Public Health Author-Name: Stall, R.D. Author-Name: Greenwood, G.L. Author-Name: Acree, M. Author-Name: Paul, J. Author-Name: Coates, T.J. Year: 1999 Volume: 89 Issue: 12 Pages: 1875-1878 Abstract: Objectives. This study measured the prevalence of cigarette smoking among gay men and identified associations with smoking. Methods. Household- based (n = 696) and bar-based (n = 1897) sampling procedures yielded 2593 gay male participants from Portland, Ore, and Tucson, Ariz, in the spring of 1992. Results. Forty-eight percent of the combined sample reported current smoking, a rate far above prevalence estimates for men in Arizona (z = 14.11, P < .001) or Oregon (z = 24.24, P < .001). Significant associations with smoking included heavy drinking, frequent gay bar attendance, greater AID- related losses, HIV seropositivity, lower health rating than members of same age cohort, lower educational attainment, and lower income. Conclusions. Rates of cigarette smoking are very high among gay men. Tobacco prevention and cessation campaigns should be designed to reach the gay male community. Handle: RePEc:aph:ajpbhl:1999:89:12:1875-1878_6 Template-Type: ReDIF-Article 1.0 Title: The effect of health education on the rate of ophthalmic examinations among African Americans with diabetes mellitus Journal: American Journal of Public Health Author-Name: Basch, C.E. Author-Name: Walker, E.A. Author-Name: Howard, C.J. Author-Name: Shamoon, H. Author-Name: Zybert, P. Year: 1999 Volume: 89 Issue: 12 Pages: 1878-1882 Abstract: Objectives. This study evaluated a multicomponent educational intervention to increase ophthalmic examination rates among African Americans with diabetes. Methods. A randomized trial was conducted with 280 African Americans with diabetes, enrolled from outpatient departments of 5 medical centers in the New York City metropolitan area, who had not had a dilated retinal examination within 14 months of randomization (65.7% female, mean age = 54.7 years [SD = 12.8 years]). Results. After site differences were controlled, the odds ratio for receiving a retinal examination associated with the intervention was 4.3 (95% confidence interval = 2.4, 7.8). The examination rate pooled across sites was 54.7% in the intervention group and 27.3% in the control group. Conclusions. The intervention was associated with a rate of ophthalmic examination double the rate achieved with routine medical care. Handle: RePEc:aph:ajpbhl:1999:89:12:1878-1882_6 Template-Type: ReDIF-Article 1.0 Title: A century of progress in public health? Journal: American Journal of Public Health Author-Name: Fee, E. Author-Name: Brown, T.M. Year: 1999 Volume: 89 Issue: 11 Pages: 1627-1629 Handle: RePEc:aph:ajpbhl:1999:89:11:1627-1629_2 Template-Type: ReDIF-Article 1.0 Title: Bioterrorism initiatives: Public health in reverse? Journal: American Journal of Public Health Author-Name: Cohen, H.W. Author-Name: Gould, R.M. Author-Name: Sidel, V.W. Year: 1999 Volume: 89 Issue: 11 Pages: 1629-1631 Handle: RePEc:aph:ajpbhl:1999:89:11:1629-1631_5 Template-Type: ReDIF-Article 1.0 Title: Telephone ownership and deaf people: Implications for telephone surveys Journal: American Journal of Public Health Author-Name: Barnett, S. Author-Name: Franks, P. Year: 1999 Volume: 89 Issue: 11 Pages: 1754-1756 Abstract: Objectives. This study was done to determine the prevalence of telephone ownership in different deaf populations and to explore its implications for telephone-based surveys. Methods. Multivariate analyses, with adjustments for sociodemographics and health status, were done of National Health Interview Survey (NHIS) data from 1990 and 1991, the years in which the NHIS Hearing Supplement was administered. Results. Prelingually deafened adults were less likely than members of the general population to own a telephone (adjusted odds ratio [AOR] = 0.35; 95% confidence interval [CI] = 0.15, 0.82), whereas postlingually deafened adults were as likely as members of the general population to own one (AOR = 1.00; 95% CI = 0.78, 1.28). Conclusions. Telephone surveys risk marginalizing prelingually deafened adults because of low telephone ownership and language barriers between the deaf and hearing communities. Handle: RePEc:aph:ajpbhl:1999:89:11:1754-1756_7 Template-Type: ReDIF-Article 1.0 Title: Evidence for decline in disability and improved health among persons aged 55 to 70 years: The Framingham Heart Study Journal: American Journal of Public Health Author-Name: Allaire, S.H. Author-Name: LaValley, M.P. Author-Name: Evans, S.R. Author-Name: O'Connor, G.T. Author-Name: Kelly-Hayes, M. Author-Name: Meenan, R.F. Author-Name: Levy, D. Author-Name: Felson, D.T. Year: 1999 Volume: 89 Issue: 11 Pages: 1678-1683 Abstract: Objectives. This study detected secular change in disability and health among persons aged 55 to 70 years, the life period when increases in disability and morbidity begin and retirement occurs. Methods. Cross- sectional comparisons were completed with data from similarly aged members of the original (n = 1760) and offspring (n = 1688) cohorts of the Framingham Heart Study which represent 2 generations. Analyses were conducted by gender and on chronic disease subgroups by logistic regression. Results. There was substantially less disability in the offspring cohort than in the original cohort. Thirty-six percent of offspring men were disabled vs 52% of original cohort men (P = .001); among women, these proportions were 54% vs 72% (P = .001). Fewer offspring perceived their health as fair or poor and fewer had chronic diseases. Offspring were more physically active and less likely to smoke or consume high amounts of alcohol, but their average weight was greater. The secular decline in disability was strongly evident among individuals with chronic diseases. Conclusions. Our findings depict a secular change toward a less disabled and globally healthier population in the period of life when retirement occurs. Handle: RePEc:aph:ajpbhl:1999:89:11:1678-1683_3 Template-Type: ReDIF-Article 1.0 Title: Prenatal diagnosis and selective abortion: A challenge to practice and policy Journal: American Journal of Public Health Author-Name: Asch, A. Year: 1999 Volume: 89 Issue: 11 Pages: 1649-1657 Abstract: Professionals should reexamine negative assumptions about the quality of life with prenatally detectable impairments and should reform clinical practice and public policy to improve informed decision making and genuine reproductive choice. Current data on children and families affected by disabilities indicate that disability does not preclude a satisfying life. Many problems attributed to the existence of a disability actually stem from inadequate social arrangements that public health professionals should work to change. This article assumes a pro-choice perspective but suggests that unreflective uses of prenatal testing could diminish, rather than expand, women's choices. This critique challenges the view of disability that lies behind the social endorsement of such testing and the conviction that women will or should end their pregnancies if they discover that the fetus has a disabling trait. Handle: RePEc:aph:ajpbhl:1999:89:11:1649-1657_9 Template-Type: ReDIF-Article 1.0 Title: A comparison of the effect of different bicycle helmet laws in 3 New York City suburbs Journal: American Journal of Public Health Author-Name: Puder, D.R. Author-Name: Visintainer, P. Author-Name: Spitzer, D. Author-Name: Casal, D. Year: 1999 Volume: 89 Issue: 11 Pages: 1736-1738 Abstract: Objectives. This study was conducted to evaluate the effectiveness of 3 different bicycle helmet laws. Methods. A direct observational study of nearly 1000 cyclists at 20 matched sites in each of 3 contiguous counties- Rockland and Westchester in New York and Fairfield in Connecticut-was carried out. Rockland's bicycle helmet law requires approved helmets for all cyclists regardless of age; Westchester's, by state law, requires cyclists younger than 14 years to wear helmets; and Fairfield's, also by state law, requires cyclists younger than 12 years to wear helmets when riding on highways. Results. Rockland cyclists had the highest helmet use rate (35%), followed by Westchester (24%) and Fairfield (14%) cyclists. As a subgroup, teenagers used helmets least, a trend that was seen in all 3 counties. Conclusions. Our study suggests a positive effect of bicycle helmet legislation with no age limitation. Handle: RePEc:aph:ajpbhl:1999:89:11:1736-1738_2 Template-Type: ReDIF-Article 1.0 Title: The legalization of abortion: A major public health issue [2] Journal: American Journal of Public Health Author-Name: Bajos, N. Author-Name: Leridon, H. Author-Name: Warszawski, J. Author-Name: Bouyer, J. Year: 1999 Volume: 89 Issue: 11 Pages: 1763 Handle: RePEc:aph:ajpbhl:1999:89:11:1763_2 Template-Type: ReDIF-Article 1.0 Title: The relation of wages to the public health. 1918. Journal: American Journal of Public Health Author-Name: Warren, B.S. Author-Name: Sydenstricker, E. Year: 1999 Volume: 89 Issue: 11 Pages: 1641-1644 DOI: 10.2105/AJPH.89.11.1641 File-URL: http://hdl.handle.net/10.2105/AJPH.89.11.1641 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.89.11.1641_9 Template-Type: ReDIF-Article 1.0 Title: Achieving a public health recommendation for preventing neural tube defects with folic acid Journal: American Journal of Public Health Author-Name: Werler, M.M. Author-Name: Louik, C. Author-Name: Mitchell, A.A. Year: 1999 Volume: 89 Issue: 11 Pages: 1637-1640 Abstract: Objectives. This study examined 3 approaches to achieving the public health recommendation that all women of childbearing age ingest 0.40 mg of folic acid per day to reduce the occurrence of neural tube defects (NTDs). Methods. A total of 1136 mothers of infants with major malformations from the Boston and Philadelphia areas, whose pregnancies began from 1993 to 1995. were interviewed within 6 months of delivery about vitamin supplementation, dietary intakes, and other factors. Results. Seventy-one percent of the 1136 women in the study did not take folic acid - containing supplements daily before conception, but the proportion decreased over the years of the study. Women not taking supplements consumed an average of 0.25 mg of naturally occurring folates daily. On the basis of dietary intakes reported by women not taking folic acid supplements, a simulation of cereal grain fortification with folic acid at the level required by the US Food and Drug Administration showed that an average of only 0.13 mg of folic acid would be ingested daily. Conclusions. With consumption of folic acid only through dietary intake, sizeable portions of the childbearing population would receive less than the level of folic acid recommended for preventing NTDs. Even with food fortification, women of childbearing age should be advised to take folic acid-containing supplements on a daily basis. Handle: RePEc:aph:ajpbhl:1999:89:11:1637-1640_5 Template-Type: ReDIF-Article 1.0 Title: A further analysis of race differences in the National Longitudinal Mortality Study Journal: American Journal of Public Health Author-Name: Ng-Mak, D.S. Author-Name: Dohrenwend, B.P. Author-Name: Abraido-Lanza, A.F. Author-Name: Turner, J.B. Year: 1999 Volume: 89 Issue: 11 Pages: 1748-1751 Abstract: Objectives. The purpose of this study was to investigate associations between race and specific causes of mortality among adults 25 years and older in the National Longitudinal Mortality Study. Methods. Mortality hazard ratios between races during 9 years of follow-up were estimated with Cox proportional hazards models, with control for multiple indicators of socioeconomic status (SES) and SES-relevant variables. Results. Black persons younger than 65 years were at higher risk than others for all-cause and cardiovascular mortality, the strongest effects were observed among persons aged 25 through 44 years. Conclusions. Race, independent of SES, is related to mortality in American society, but these effects vary by age and disease categories. Handle: RePEc:aph:ajpbhl:1999:89:11:1748-1751_2 Template-Type: ReDIF-Article 1.0 Title: Powerful connections for public health: The National Library of Medicine and the National Network of Libraries of Medicine Journal: American Journal of Public Health Author-Name: Humphreys, B.L. Author-Name: Ruffin, A.B. Author-Name: Cahn, M.A. Author-Name: Rambo, N. Year: 1999 Volume: 89 Issue: 11 Pages: 1633-1636 Abstract: As incorporated in Healthy People 2010 objectives, data and information systems and a skilled workforce are 2 of the critical components of public health infrastructure. The National Library of Medicine (NLM) and the National Network of Libraries of Medicine (NN/LM) are important resources for improving Internet access and providing related training to the public health workforce and to those in training for public health careers. The NLM and the NN/LM have joined forces with the Centers for Disease Control and Prevention, the Health Resources and Services Administration, the Association of State and Territorial Health Officials, the National Association of County and City Health Officials, and the Public Heath Foundation. The goal of this collaboration is to improve electronic resources useful in public health practice and increase awareness services, and to help public health agencies obtain the equipment and Internet connections needed to use these services effectively. The database, outreach programs, and connection grants available to public health professionals from the NLM, and the training and ongoing support available from the NN/LM for accessing these programs and services, are described. Handle: RePEc:aph:ajpbhl:1999:89:11:1633-1636_8 Template-Type: ReDIF-Article 1.0 Title: The Denver school-based adolescent hepatitis B vaccination program: A cost analysis with risk simulation Journal: American Journal of Public Health Author-Name: Deuson, R.R. Author-Name: Hoekstra, E.J. Author-Name: Sedjo, R. Author-Name: Bakker, G. Author-Name: Melinkovich, P. Author-Name: Daeke, D. Author-Name: Hammer, A.L. Author-Name: Goldsman, D. Author-Name: Judson, F.N. Year: 1999 Volume: 89 Issue: 11 Pages: 1722-1727 Abstract: Objectives. This study sought to compare the cost-effectiveness of a school-based hepatitis B vaccine delivery program with that of a vaccine delivery program associated with a network health maintenance organization (HMO). Methods. The vaccination program enrolled 3359 sixth-grade students from 18 middle schools in Denver, Colo. Immunization status and direct and indirect program costs were compiled. The sensitivity of the outcomes was assessed by simulation methods. Results. The per-dose cost-effectiveness ratio for the school-based delivery system was $31. This cost effectiveness ratio remained stable when the model was simulated with costs that were underestimated or over estimated by 20%. In the network HMO, the direct cost per dose was $68 and the societal cost was $118 when the child's father worked full-time and the mother worked part-time. There is less than a 5% chance that the network HMO-based vaccination program could be more cost- effective than the school-based program. Conclusions. The cost per dose of the school-based program was significantly less than that of the network HMO- based program, because in the school program government-purchased vaccine was available at a lower cost and parents did not incur work-loss costs. Handle: RePEc:aph:ajpbhl:1999:89:11:1722-1727_4 Template-Type: ReDIF-Article 1.0 Title: Use of reality 'female condoms' for anal sex by US men who have sex with men Journal: American Journal of Public Health Author-Name: Gross, M. Author-Name: Buchbinder, S.P. Author-Name: Holte, S. Author-Name: Celum, C.L. Author-Name: Koblin, B.A. Author-Name: Douglas Jr., J.M. Year: 1999 Volume: 89 Issue: 11 Pages: 1739-1741 Abstract: Objectives. This study assessed use of Reality 'female condoms' for anal sex by HIV-seronegative men who have sex with men and are at high risk for HIV infection. Methods. Self-administered questionnaires were completed by 2277 participants in a 6-city prospective cohort study. Results. Of the 1084 (48%) men who had heard of using the female condom for anal sex, 145 (13%) reported using it in the prior 6 months. Users were at greater risk than nonusers: 47 receptive and 35 insertive users reported problems, including bleeding by the receptive partner (4). Conclusions. Redesign of the female condom could increase acceptability and use by men who have sex with men and could address possible safety concerns. Handle: RePEc:aph:ajpbhl:1999:89:11:1739-1741_3 Template-Type: ReDIF-Article 1.0 Title: Community-level HIV intervention work for women means restructuring society and culture [1] Journal: American Journal of Public Health Author-Name: Gollub, E.L. Author-Name: Metzger, D. Year: 1999 Volume: 89 Issue: 11 Pages: 1762-1763 Handle: RePEc:aph:ajpbhl:1999:89:11:1762-1763_4 Template-Type: ReDIF-Article 1.0 Title: Correlates of urinary symptom scores in men Journal: American Journal of Public Health Author-Name: Klein, B.E.K. Author-Name: Klein, R. Author-Name: Lee Kristine, E. Author-Name: Bruskewitz, R.C. Year: 1999 Volume: 89 Issue: 11 Pages: 1745-1748 Abstract: Objectives. This Study determined the prevalence of urinary symptoms and their relationship to characteristics of a cohort of men in Beaver Dam, Wis, from 1993 to 1995. Methods. A standardized questionnaire concerning urinary symptoms (the American Urological Association Urinary Symptom Questionnaire) was administered. Results. All outcomes were associated with age and history of enlarged prostate. Urinary frequency (57%) and nocturia (65%) were the most common individual symptoms. Diuretic usage, diabetes, history of cardiovascular disease, and smoking were related to specific symptoms. Conclusions. While urinary symptoms are associated with age and history of enlarged prostate, symptoms may also be attributable to other diseases and exposures. Handle: RePEc:aph:ajpbhl:1999:89:11:1745-1748_6 Template-Type: ReDIF-Article 1.0 Title: Effects of a community-based intervention on physical activity: The Pawtuckett Heart Health Program Journal: American Journal of Public Health Author-Name: Eaton, C.B. Author-Name: Lapane, K.L. Author-Name: Garber, C.E. Author-Name: Gans, K.M. Author-Name: Lasater, T.M. Author-Name: Carleton, R.A. Year: 1999 Volume: 89 Issue: 11 Pages: 1741-1744 Abstract: Objectives. The effect of a community-based physical activity program in Pawtucket, RI, was evaluated relative to one in a comparison community. Methods. Cross-sectional surveys of 7529 residents of Pawtucket, RI, and 7732 residents of the comparison city were conducted at 2-year intervals during 7 years of intervention. Results. There were no differences in self-reported knowlege of the benefits of physical activity, attempts to increase exercise, or prevalence of physical inactivity between Pawtucket and the comparison community. Conclusions. Future community-based physical activity interventions should attempt to involve a wider range of individuals. Handle: RePEc:aph:ajpbhl:1999:89:11:1741-1744_0 Template-Type: ReDIF-Article 1.0 Title: Children on the move and vaccination coverage in a low-income, urban Latino population Journal: American Journal of Public Health Author-Name: Findley, S.E. Author-Name: Irlgoyen, M. Author-Name: Schulman, A. Year: 1999 Volume: 89 Issue: 11 Pages: 1728-1731 Abstract: Objectives. The purpose of this study was to determine the impact of childhood moves and foreign birth on vaccination coverage among Latino children in New York City. Methods. Vaccination coverage was assessed in a survey of 314 children younger than 5 years at 2 immunization clinics. Results. Forty-seven percent of the study children had moved abroad. After adjustment for health insurance, regular source of care, and country of birth, child moves had no independent effect on vaccination coverage. Foreign-born children and diphtheria-pertussis-tetanus, oral polio vaccine, and measles-mumps-rubella vaccination coverage rates similar to those of US- born children, but they were underimmunized in regard to Haemophilus influenzae type b and hepatitis B. Conclusions. Foreign birth, but not childhood moves, is a barrier to vaccinations among low-income, urban Latino children. Handle: RePEc:aph:ajpbhl:1999:89:11:1728-1731_6 Template-Type: ReDIF-Article 1.0 Title: Sex and race differences in cardiovascular disease risk factor changes in schoolchildren, 1975-1990: The Princeton School Study Journal: American Journal of Public Health Author-Name: Morrison, J.A. Author-Name: James, F.W. Author-Name: Sprecher, D.L. Author-Name: Khouty, P.R. Author-Name: Daniels, S.R. Year: 1999 Volume: 89 Issue: 11 Pages: 1708-1714 Abstract: Objectives. This study was done to assess changes in obesity and risk factors for cardiovascular disease (CVD) in Black and White children from 1975 through 1990. Methods. A cross-sectional study of body composition and CVD risk factors conducted in a school district as part of the Lipid Research Clinics (LRC) Program Prevalence Study (1973-1975) was compared with a later study (1989-1990) conducted in the same school district, which remained demographically stable. The studies included 1456 third- and fifth-grade students and 300 LRC subjects within the same age ranges. Results. Students in the 1989-1990 study had a significantly higher mean body mass index (BMI), total blood cholesterol concentration, and systolic and diastolic blood pressures and marginally higher resting heart rates than those in the earlier study. The prevalence of obesity increased from 12.5% to 25.3%, and of hypercholesterolemia from 8.0% to 14.8%. Black females had the largest increase in BMI and resting hear rate and the highest prevalence of elevated total cholesterol in the 1989-1990 study. Conclusions. The results of this study suggest a secular trend toward increased obesity in children and portend the potential development of a public health problem that could reverse the recent decline in morbidity from CVD. Handle: RePEc:aph:ajpbhl:1999:89:11:1708-1714_1 Template-Type: ReDIF-Article 1.0 Title: The association between state housing policy and lead poisoning in children Journal: American Journal of Public Health Author-Name: Sargent, J.D. Author-Name: Dalton, M. Author-Name: Demidenko, E. Author-Name: Simon, P. Author-Name: Klein, R.Z. Year: 1999 Volume: 89 Issue: 11 Pages: 1690-1695 Abstract: Objectives. This study examined the effect of an active program of household lead paint hazard abatement, applied over 22 years, on childhood lead poisoning in Massachusetts. Methods. A small areas analysis was used to compare screening blood lead levels of children in Worcester County, Mass (n = 27 590), with those in Providence County, RI (n = 19 071). Data were collapsed according to census tract. Results. The percentage of children with lead poisoning (blood lead level ≥ 20 μg/dL [Pe20]) was, on average, 3 times higher in Providence County census tracts (3.2% vs 0.9% in Worcester County census tracts, P < .0001), despite similar percentages of pre 1950s housing in both counties. The ratio of Pe20 in Providence vs Worcester County census tracts was 2.2 (95% confidence interval = 1.8, 2.7), after adjustment for differences in housing, sociodemographic, and screening characteristics. This estimate was robust to alternative regression methods and sensitivity analyses. Conclusions. Massachusetts policy, which requires lead paint abatement of children's homes and places liability for lead paint poisoning on property owners, may have substantially reduced childhood lead poisoning in that state. Handle: RePEc:aph:ajpbhl:1999:89:11:1690-1695_4 Template-Type: ReDIF-Article 1.0 Title: Psychotropic medication use among children in foster care: Relationship to severe psychiatric disorders Journal: American Journal of Public Health Author-Name: Zima, B.T. Author-Name: Bussing, R. Author-Name: Crecelius, G.M. Author-Name: Kaufman, A. Author-Name: Belin, T.R. Year: 1999 Volume: 89 Issue: 11 Pages: 1732-1735 Abstract: Objectives. This study sought to describe the level of psychotropic medication use and its relationship to severe psychiatric disorders among school-aged children in foster care. Methods. Home interviews with 302 foster parents and children aged 6 to 12 years and 266 follow-up clinical evaluations were conducted. Results. Thirteen percent of the children had taken psychotropic medication in the previous year, and 52% of those whose clinical status merited a medication evaluation had not received medication in the previous year. Conclusions. As the efficacy of psychotropic medication treatment for severe child psychiatric disorders becomes more established, research on the appropriateness of such care can begin. Handle: RePEc:aph:ajpbhl:1999:89:11:1732-1735_5 Template-Type: ReDIF-Article 1.0 Title: Public health at the crossroads. 1926. Journal: American Journal of Public Health Author-Name: Winslow, C.E. Year: 1999 Volume: 89 Issue: 11 Pages: 1645-1648 DOI: 10.2105/AJPH.89.11.1645 File-URL: http://hdl.handle.net/10.2105/AJPH.89.11.1645 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.89.11.1645_9 Template-Type: ReDIF-Article 1.0 Title: Breast implant verdicts resulted from corporate misconduct and legitimate science [3] Journal: American Journal of Public Health Author-Name: Egilman, D.S. Author-Name: Walta, M. Year: 1999 Volume: 89 Issue: 11 Pages: 1763-1764 Handle: RePEc:aph:ajpbhl:1999:89:11:1763-1764_6 Template-Type: ReDIF-Article 1.0 Title: Improving cancer incidence estimates for American Indians in Minnesota Journal: American Journal of Public Health Author-Name: Partin, M.R. Author-Name: Rith-Najarian, S.J. Author-Name: Slater, J.S. Author-Name: Korn, J.E. Author-Name: Cobb, N. Author-Name: Soler, J.T. Year: 1999 Volume: 89 Issue: 11 Pages: 1673-1677 Abstract: Objectives. The purpose of this study was to estimate cancer incidence for American Indians in Minnesota. Methods. Indian Health Service enrollment data were linked to the Minnesota rumor registry to identify cancers among American Indians in Minnesota, incidence rates for the 5 most common cancers in this population, estimated after the linkage, were compared with rates estimated before the linkage and with rates for the total population of Minnesota. Results. The linkage identified 302 cancer cases not previously identified as occurring among American Indians in Minnesota. Postlinkage estimates suggested that incidence rates for prostate and colorectal cancer are similar to those for the total population of Minnesota but that rates of lung and cervical cancer are significantly higher. Breast cancer rates are slightly lower than those for the total population of Minnesota but more than twice as high as previous estimates for American Indians. Conclusions. The postlinkage estimates suggest different priorities for cancer education, prevention, and control than might be assumed from either prelinkage estimates or previously published data, and underscore the importance of using accurate and specific data for setting these priorities. Handle: RePEc:aph:ajpbhl:1999:89:11:1673-1677_9 Template-Type: ReDIF-Article 1.0 Title: Progress in coverage with hepatitis B vaccine among US children, 1994- 1997 Journal: American Journal of Public Health Author-Name: Yusuf, H.R. Author-Name: Coronado, V.G. Author-Name: Averhoff, F.A. Author-Name: Maes, E.F. Author-Name: Rodewald, L.E. Author-Name: Battaglia, M.P. Author-Name: Mahoney, F.J. Year: 1999 Volume: 89 Issue: 11 Pages: 1684-1689 Abstract: Objectives. This study was done to assess progress in hepatitis B vaccination of children from 1994 through 1997. Methods. We used data from the National Immunization Survey (NIS), a random-digit-dialed telephone survey that includes a mail survey to verify vaccination providers' records. The NIS is conducted in 78 geographic areas (50 states and 28 selected urban areas) in the United States. Results. A total of 32 433 household interviews were completed in the 1997 NIS. An estimated 83.7% of children aged 19 to 35 months received 3 or more doses of hepatitis B vaccine. Coverage with 3 doses was greater (86.7%) among children in states that had day care entry requirements for hepatitis B vaccination than among children in states without such requirements (83.0%) and was greater among children from families with incomes at or above the poverty level (85.0%) than among children below the poverty level (80.6%). Hepatitis B vaccination of children increased from 1994 through 1996, from 41% to 84%, but coverage reached a constant level of 84% to 85% in 1996/97. Conclusion. Although substantial progress has been made in fully vaccinating children against hepatitis B, greater efforts are needed to ensure that all infants receive 3 doses of hepatitis B vaccine. Handle: RePEc:aph:ajpbhl:1999:89:11:1684-1689_2 Template-Type: ReDIF-Article 1.0 Title: Innovative methods for monitoring perinatal health outcomes in cities and in smaller geographic areas Journal: American Journal of Public Health Author-Name: O'Campo, P. Author-Name: Guyer, B. Year: 1999 Volume: 89 Issue: 11 Pages: 1667-1672 Abstract: Objectives. Monitoring health in small localities such as cities or local communities is important, because rates of adverse outcomes often vary widely by geographic area. This article explores the utility of CUSUM (cumulative summation), a method developed and refined in industry, for monitoring health outcomes in cities and smaller geographic areas. Methods. CUSUM monitoring methods were applied to rates of late or no prenatal care initiation and very low birthweight for the city of Baltimore as a whole and for a cluster of high-risk areas within the city. The performance of supplementary runs criteria was also assessed. The ability of both methods to flag significant increases of decreases in prenatal care initiation and very low birthweight rates was assessed. Results. CUSUM and runs criteria detected most significant rate changes. The 2 methods performed better in regard to outcomes with higher prevalence and in larger geographic areas. Conclusions. CUSUM methods are convenient and reliable for use in the monitoring of moderately low prevalence outcomes in small geographic areas. Future research should examine their applicability to other health outcomes and further refine these methods, especially for rarer outcomes. Handle: RePEc:aph:ajpbhl:1999:89:11:1667-1672_1 Template-Type: ReDIF-Article 1.0 Title: What is the leading cause of infant mortality? A note on the interpretation of official statistics Journal: American Journal of Public Health Author-Name: Sowards, K.A. Year: 1999 Volume: 89 Issue: 11 Pages: 1752-1754 Abstract: Objectives. According to vital statistics reports, congenital malformation is the leading cause of infant death in the United States and accounts for a much greater proportion of infant mortality than does premature birth. The purpose of this study was to examine the potential underestimation of prematurity-related mortality in current vital statistics reports. Methods. National mortality data from 1985, 1991, and 1996 were analyzed. Results. The official statistics significantly understate the role of prematurity-related mortality. An alternative etiology-based classification designates prematurity as the underlying cause in approximately one third of all infant deaths. Conclusions. Although no single scheme is suitable for every objective, analysts and policymakers should recognize the degree to which technical classification practices can influence the apparent importance of various causes of death. Handle: RePEc:aph:ajpbhl:1999:89:11:1752-1754_8 Template-Type: ReDIF-Article 1.0 Title: Over-the-counter nicotine patch therapy for smoking cessation: Results from randomized, double-blind, placebo-controlled, and open label trials Journal: American Journal of Public Health Author-Name: Hays, J.T. Author-Name: Croghan, I.T. Author-Name: Schroeder, D.R. Author-Name: Offord, K.P. Author-Name: Hurt, R.D. Author-Name: Wolter, T.D. Author-Name: Nides, M.A. Author-Name: Davidson, M. Year: 1999 Volume: 89 Issue: 11 Pages: 1701-1707 Abstract: Objectives. The purpose of this study was to determine the efficacy and safety of the nicotine patch for smoking cessation in an over-the-counter environment. The years of study were 1994 to 1995. Methods. Parallel 6-week trials were conducted: a placebo-controlled trial of no-cost 22-mg, 24-hour nicotine patch therapy and an open label trial of the same therapy with patches purchased by subjects. Participants (n = 958) were 18 years or older, had smoked at least 15 cigarettes daily for at least 6 months, and were enrolled at 3 study sites. The main outcome measure was self-reported smoking abstinence confirmed by expired carbon monoxide measurements. Results. Smoking cessation rates in the placebo-controlled trial were 16.8% and 9.6% at week 6 and 8.7% and 4.3% at week 24 for the active patch and placebo groups, respectively. Smoking cessation rates in the open label-pay trial were 19.0% and 10.8% at weeks 6 and 24, respectively. A slight increase in adverse cardiovascular events was noted only in the open label-pay group in comparison with the placebo group. Conclusions. In an over-the-counter environment, the 22-mg, 24-hour nicotine patch is effective and safe for smoking cessation treatment. Handle: RePEc:aph:ajpbhl:1999:89:11:1701-1707_3 Template-Type: ReDIF-Article 1.0 Title: Ethnicity, bioethics, and prenatal diagnosis: The amniocentesis decisions of Mexican-origin women and their partners Journal: American Journal of Public Health Author-Name: Browner, C.H. Author-Name: Preloran, H.M. Author-Name: Cox, S.J. Year: 1999 Volume: 89 Issue: 11 Pages: 1658-1666 Abstract: Bioethical standards and counseling techniques that regulate prenatal diagnosis in the United States were developed at a time when the principal constituency for fetal testing was a self-selected group of White, well- informed, middle-class women. The routine use of α-fetoprotein (AFP) testing, which has become widespread since the mid-1980s, introduced new constituencies to prenatal diagnosis. These new constituencies include ethnic minority women, who, with the exception of women from certain Asian groups, refuse amniocentesis at significantly higher rates than others. This study examines the considerations taken into account by a group of Mexican-origin women who had screened positive for AFP and were deciding whether to undergo amniocentesis. We reviewed 379 charts and interviewed 147 women and 120 partners to test a number of factors that might explain why some women accept amniocentesis and some refuse. A woman's attitudes toward doctors, medicine, and prenatal care and her assessment of the risk and uncertainty associated with the procedure were found to be most significant. Case summaries demonstrate the indeterminacy of the decision-making process. We concluded that established bioethical principles and counseling techniques need to be more sensitive to the way minority clients make their amniocentesis choices. Handle: RePEc:aph:ajpbhl:1999:89:11:1658-1666_1 Template-Type: ReDIF-Article 1.0 Title: Impact of diabetes mellitus on mortality associated with pneumonia and influenza among non-hispanic black and white US adults Journal: American Journal of Public Health Author-Name: Valdez, R. Author-Name: Venkat Narayan, K.M. Author-Name: Geiss, L.S. Author-Name: Engelgau, M.M. Year: 1999 Volume: 89 Issue: 11 Pages: 1715-1721 Abstract: Objectives. This study assessed the impact of diabetes on mortality associated with pneumonia and influenza among non-Hispanic Black and White US adults. Methods. Data were derived from the National Mortality Followback Survey (1986) and the National Health Interview Survey (1987-1989). Results. Regardless of race, sex, and socioeconomic status, people with diabetes who died at 25 to 64 years of age were more likely to have pneumonia and influenza recorded on the death certificate than people without diabetes who died at comparable ages (odds ratio [OR] = 4.0, 95% confidence interval [CI] = 2.3, 7.7). For those 65 years and older, the risk remained elevated among Whites with diabetes (OR = 2.2, 95% CI = 1.7, 2.7) but not among Blacks with diabetes (OR = 1.0, 95% CI = 0.6, 1.7). It was estimated that about 17000 (10.3%) of the 167000 deaths associated with pneumonia and influenza that occurred in 1986 were attributable to diabetes. Conclusions. The impact of diabetes on deaths associated with pneumonia and influenza is substantial. Targeted immunizations among people with diabetes may reduce unnecessary deaths associated with pneumonia and influenza. Handle: RePEc:aph:ajpbhl:1999:89:11:1715-1721_0 Template-Type: ReDIF-Article 1.0 Title: Effects of ignition interlock license restrictions on drivers with multiple alcohol offenses: A randomized trial in Maryland Journal: American Journal of Public Health Author-Name: Beck, K.H. Author-Name: Rauch, W.J. Author-Name: Baker, E.A. Author-Name: Williams, A.F. Year: 1999 Volume: 89 Issue: 11 Pages: 1696-1700 Abstract: Objectives. This investigation sought to test the effectiveness of a statewide ignition interlock license restriction program for drivers with multiple alcohol-related traffic offenses. Methods. A total of 1387 multiple offenders eligible for license reinstatement were randomly assigned to participate in an ignition interlock program (experimental group) or in the conventional postlicensing treatment program (control group). The arrest rates of these 2 groups for alcohol traffic offenses were compared for 1 year during the ignition interlock license restriction program and for 1 year after unrestricted driving privileges were returned. Results. Participation in the interlock program reduced offenders' risk of committing an alcohol traffic violation within the first year by about 65%. The alcohol traffic violation rate during the first year significantly less for participants in the interlock program (2.4%) than for those in the control group (6.7%). However, there was no statistically significant difference between these groups in the second year, after the interlock license restriction was lifted. Conclusions. Ignition interlock license restriction programs are effective at reducing recidivism among drivers with multiple alcohol offenses, at least while the restriction is in effect. Handle: RePEc:aph:ajpbhl:1999:89:11:1696-1700_0 Template-Type: ReDIF-Article 1.0 Title: Why 'Public Health Matters' Journal: American Journal of Public Health Author-Name: Elizabeth, F. Author-Name: Brown, T.M. Year: 1999 Volume: 89 Issue: 11 Pages: 1631-1632 Handle: RePEc:aph:ajpbhl:1999:89:11:1631-1632_1 Template-Type: ReDIF-Article 1.0 Title: Another perspective for disease prevention interventions [4] (multiple letters) Journal: American Journal of Public Health Author-Name: Winett, R. Author-Name: McKinlay, J.B. Author-Name: Marceau, L.D. Year: 1999 Volume: 89 Issue: 10 Pages: 1593-1594 Handle: RePEc:aph:ajpbhl:1999:89:10:1593-1594_6 Template-Type: ReDIF-Article 1.0 Title: Immunization practices [5] (multiple letters) Journal: American Journal of Public Health Author-Name: Bradford, B.J. Author-Name: Fairbrother, G. Author-Name: Hanson, K.L. Author-Name: Friedman, S. Author-Name: Butts, G.C. Year: 1999 Volume: 89 Issue: 10 Pages: 1594-1595 Handle: RePEc:aph:ajpbhl:1999:89:10:1594-1595_3 Template-Type: ReDIF-Article 1.0 Title: Research on violence in developing countries: Benefits and perils Journal: American Journal of Public Health Author-Name: Neugebauer, R. Year: 1999 Volume: 89 Issue: 10 Pages: 1473-1474 Handle: RePEc:aph:ajpbhl:1999:89:10:1473-1474_2 Template-Type: ReDIF-Article 1.0 Title: Prenatal diagnosis [3] (multiple letters) Journal: American Journal of Public Health Author-Name: Lippman, A. Author-Name: Kuppermann, M. Author-Name: Goldberg, J.D. Author-Name: Nease R.F., Jr. Author-Name: Washington, A.E. Year: 1999 Volume: 89 Issue: 10 Pages: 1592-1593 Handle: RePEc:aph:ajpbhl:1999:89:10:1592-1593_0 Template-Type: ReDIF-Article 1.0 Title: Retail trade incentives: How tobacco industry practices compare with those of other industries Journal: American Journal of Public Health Author-Name: Feighery, E.C. Author-Name: Ribisl, K.M. Author-Name: Achabal, D.D. Author-Name: Tyebjee, T. Year: 1999 Volume: 89 Issue: 10 Pages: 1564-1566 Abstract: Objectives. This study compared the incentive payments for premium shelf space and discounts on volume purchases paid to retailers by 5 types of companies. Methods. Merchants were interviewed at 108 randomly selected small retail outlets that sell tobacco in Santa Clara County, California. Results. Significantly more retailers reported receiving slotting/display allowances for tobacco (62.4%) than for any other product type. An average store participating in a retailer incentive program received approximately $3157 annually from all sampled product types, of which approximately $2462 (78%) came from tobacco companies. Conclusions. Future research should assess the impact of tobacco industry incentive programs on the in-store marketing and sales practices of retailers. Handle: RePEc:aph:ajpbhl:1999:89:10:1564-1566_5 Template-Type: ReDIF-Article 1.0 Title: Assessing the effects of welfare reform policies on reproductive and infant health Journal: American Journal of Public Health Author-Name: Wise, P. Author-Name: Chavkin, W. Author-Name: Romero, D. Year: 1999 Volume: 89 Issue: 10 Pages: 1514-1521 Abstract: Objectives: The welfare reform law of 1996 marked a historical moment in US policy toward the poor by ending the entitlement to cash assistance, by the requiring work, and by establishing time limits. This article examines the potential impact on the health of women and children, the primary recipients of welfare benefits. Methods: The authors outline the reproductive health outcomes most likely to be sensitive to welfare policies, identify indicators that might ne used to assess these outcomes, review empirical evidence, and suggest specific methods and data sources. Results: State welfare requirements could improve health outcomes or deter families from Medicard and food stamps, as well as income support, thus worsening health outcomes. National and state data may prove useful in detecting these effects; however, new data sources may be required for specific health- related questions. Conclusions: Assessing the effects of welfare policies on reproductive and infant health is possible, although challenging. Reauthorization of the legislation is required in 2002; it is essential that the consequences for health be included in the next round of public debate. Handle: RePEc:aph:ajpbhl:1999:89:10:1514-1521_5 Template-Type: ReDIF-Article 1.0 Title: Correlates of leisure-time physical activity in an elderly population in Singapore Journal: American Journal of Public Health Author-Name: Lian, W.M. Author-Name: Gan, G.L. Author-Name: Pin, C.H. Author-Name: Sharon, W. Author-Name: Ye, H.C. Year: 1999 Volume: 89 Issue: 10 Pages: 1578-1580 Abstract: Objectives. This study assessed correlates of leisure-time physical activity among the elderly in Singapore. Methods. A cross-sectional household survey was conducted in 1998 with 2494 subjects 60 years and older. Results. Regular leisure-time physical activity was practiced by 47.0% of men and 38.5% of women. It was significantly correlated with family support proportion of family members exercising, awareness of benefits of exercise, and healthy dietary habits. Other significant but negative correlates were smoking and barriers to exercise, such as lack of time and poor health. Conclusions. Exercise programs for the elderly should aim at helping them overcome barriers to exercise, informing them of the benefits of exercise, and involving their families. Handle: RePEc:aph:ajpbhl:1999:89:10:1578-1580_8 Template-Type: ReDIF-Article 1.0 Title: Pathologies of power: Rethinking health and human rights Journal: American Journal of Public Health Author-Name: Farmer, P. Year: 1999 Volume: 89 Issue: 10 Pages: 1486-1496 Abstract: The field of health and human rights has grown quickly, but its boundaries have yet to be traced. Fifty-one years after the Universal Declaration of Human Rights, consensus regarding the most promising directions for the future is lacking; however, outcome-oriented assessments lead us to question approaches that rely solely on recourse to formal legal and civil rights. Similarly unpromising are approaches that rely overmuch on appeals to governments: careful study reveals that state power has been responsible for most human rights violations and that most violations are embedded in 'structural violence' - social and economic inequities that determine who will be at risk for assaults and who will be shielded. This article advances an agenda for research and action grounded in the struggle for social and economic rights, an agenda suited to public health and medicine, whose central contributions to future progress in human rights will be linked to the equitable distribution of the fruits of scientific advancement. Such an approach is in keeping with the Universal Declaration but runs counter to several of the reigning ideologies of public health, including those favoring efficacy over equity. Handle: RePEc:aph:ajpbhl:1999:89:10:1486-1496_2 Template-Type: ReDIF-Article 1.0 Title: Mandatory HIV testing of infants and rates of follow-up care [1] Journal: American Journal of Public Health Author-Name: Wilson, T.E. Author-Name: Minkoff, H. Year: 1999 Volume: 89 Issue: 10 Pages: 1583 Handle: RePEc:aph:ajpbhl:1999:89:10:1583_9 Template-Type: ReDIF-Article 1.0 Title: A public health vs a risk-based intervention to improve cardiovascular health in elementary school children: The cardiovascular health in children study Journal: American Journal of Public Health Author-Name: Harrell, J.S. Author-Name: McMurray, R.G. Author-Name: Gansky, S.A. Author-Name: Bangdiwala, S.I. Author-Name: Bradley, C.B. Year: 1999 Volume: 89 Issue: 10 Pages: 1529-1535 Abstract: Objectives. This study sought to determine the population effects of both classroom-based and risk-based interventions designed to reduce cardiovascular disease risk factors in children. Methods. Elementary school children (n = 2109; age range: 7-12 years) were randomized by school to a classroom-based intervention for all third and fourth graders, a risk-based intervention only for those with 1 or more cardiovascular disease risk factors, or a control group. The 8-week interventions involved both knowledge-attitude and physical activity components. Results. School-level analyses showed that physical activity in the risk-based group and posttest knowledge in the classroom-based group were significantly higher than in the control group. With regard to trends shown by individual-level analyses, cholesterol dropped more in the classroom-based than in the control group, and skinfold thickness decreased 2.9% in the classroom-based group and 3.2% in the risk-based group (as compared with a 1.1% increase in the control group). Conclusions. Both classroom-based and risk-based interventions had positive effects on physical activity and knowledge, with trends toward reduced body fat and cholesterol. However, the classroom-based approach was easier to implement and evidenced stronger results than the risk-based intervention. Handle: RePEc:aph:ajpbhl:1999:89:10:1529-1535_9 Template-Type: ReDIF-Article 1.0 Title: The Latino mortality paradox: A test of the 'salmon bias' and healthy migrant hypotheses Journal: American Journal of Public Health Author-Name: Abraído-Lanza, A.F. Author-Name: Dohrenwend, B.P. Author-Name: Ng-Mak, D.S. Author-Name: Turner, J.B. Year: 1999 Volume: 89 Issue: 10 Pages: 1543-1548 Abstract: Objectives: Relative to non-Latino Whites, Latinos have a worse socioeconomic profile but a lower mortality rate, a finding that presents an epidemiologic paradox. This study tested the salmon bias hypothesis that Latinos engage in return migration to their country of origin and are thereby rendered 'statistically immortal' and the alternative hypothesis that selection of healthier migrants to the United States accounts for the paradox. Methods. National Longitudinal Mortality Study data were used to examine mortality rates of the following groups for whom the salmon hypothesis is not feasible: Cubans, who face barriers against return migration; Puerto Ricans, whose deaths in Puerto Rico are recorded in US national statistics; and US-born individuals, who are not subject to either salmon or healthy migrant effects. Results. The sample included 301 718 non- Latino Whites and 17 375 Latino Whites 25 years or older. Cubans and Puerto Ricans had lower mortality than non-Latino Whites. Moreover, US-born Latinos had lower mortality than US-born non-Latino Whites. Conclusions. Neither the salmon nor the healthy migrant hypothesis explains the pattern of findings. Other factors must be operating to produce the lower mortality. Handle: RePEc:aph:ajpbhl:1999:89:10:1543-1548_8 Template-Type: ReDIF-Article 1.0 Title: Patient satisfaction with care at directly observed therapy programs for tuberculosis in New York City Journal: American Journal of Public Health Author-Name: Davidson, H. Author-Name: Smirnoff, M. Author-Name: Klein, S.J. Author-Name: Burdick, E. Year: 1999 Volume: 89 Issue: 10 Pages: 1567-1570 Abstract: Objectives: The study examined patients' satisfaction with New York State's tuberculosis (TB) directly observed therapy (DOT) programs in New York City. Methods: A survey was conducted of 435 patients at 19 public, private, and community-based TB DOT clinics about their satisfaction with various aspects of the programs. Results: Patients identified the opportunity to receive good medical care as the most important aspect of TB DOT. Also significant was the supportiveness of DOT staff. Receiving incentives to encourage participation was statistically less important. Half of the patients reported being better off with DOT than with self-supervised care. Conclusions: This study confirms the value of patient-focused care among inner-city TB patients. Handle: RePEc:aph:ajpbhl:1999:89:10:1567-1570_8 Template-Type: ReDIF-Article 1.0 Title: Which adults do underaged youth ask for cigarettes? Journal: American Journal of Public Health Author-Name: Ribisl, K.M. Author-Name: Norman, G.J. Author-Name: Howard-Pitney, B. Author-Name: Howard, K.A. Year: 1999 Volume: 89 Issue: 10 Pages: 1561-1564 Abstract: Objectives. This study identified adults' demographic and smoking behavior characteristics that are related to being asked to provide tobacco to a minor. Methods. Telephone interviews were conducted with 6352 California adults. Predictors included age, sex, household income, and smoking status. Results. Only 10.1% of California adults had been asked to provide tobacco to a minor in the previous year. Fewer than 3% of individuals 55 years and older had been asked to provide tobacco, but among younger smokers 59.0% of 18- and 19-year-olds and 39.3% of 20-to 24-year-olds had been approached. Conclusions. Interventions to reduce the social availability of tobacco are needed. Handle: RePEc:aph:ajpbhl:1999:89:10:1561-1564_7 Template-Type: ReDIF-Article 1.0 Title: Public health and complex emergencies: New issues, new conditions Journal: American Journal of Public Health Author-Name: Waldman, R. Author-Name: Martone, G. Year: 1999 Volume: 89 Issue: 10 Pages: 1483-1485 Abstract: Public health practice in complex emergencies has become increasingly sophisticated and well informed over the course of the past quarter century. Humanitarian relief organizations have learned many lessons in the areas of food, water and sanitation, shelter, and primary health. However, closer scrutiny from the media and funding agencies, together with changing conditions and an increasingly insecure environment, will require that changes be made. First and foremost, nongovernmental organizations must recognize that an increasing proportion of morbidity and mortality is the consequence of widespread human rights abuses. These organizations should become more familiar with international human rights and humanitarian law, and their personnel should receive clear guidance as to how to recognize and report violations. At the same time, nongovernmental organizations will have to work more closely with military forces that have a very different organizational culture. In addition, as emergencies become more complex, nongovernmental organizations should do more to attract and retain seasoned professionals. Finally, advances in both technical and operational areas will occur only through carefully designed and implemented research. Handle: RePEc:aph:ajpbhl:1999:89:10:1483-1485_8 Template-Type: ReDIF-Article 1.0 Title: Prevalence of and factors associated with hormone replacement therapy counseling: Results from the 1994 National Health Interview Survey Journal: American Journal of Public Health Author-Name: Zhang, P. Author-Name: Tao, G. Author-Name: Anderson, L.A. Year: 1999 Volume: 89 Issue: 10 Pages: 1575-1577 Abstract: Objectives. This study estimated the prevalence of and the factors associated with hormone replacement therapy (HRT) counseling. Methods. We analyzed the responses of 3170 women, aged 40 to 60 years, from the 1994 National Health Interview Survey. Results. The prevalence of HRT counseling was 43.6%. Women were more likely to report having received HRT counseling if they were White, older, more educated, had had a hysterectomy, had experienced menopausal symptoms, and had a regular source of care. Conclusions. More attention should be directed at counseling non-White women and women with less formal education. Reducing the barriers to having a regular source of care appears to increase the likelihood of receiving HRT counseling. Handle: RePEc:aph:ajpbhl:1999:89:10:1575-1577_6 Template-Type: ReDIF-Article 1.0 Title: The need of community health centers for international medical graduates Journal: American Journal of Public Health Author-Name: Baer, L.D. Author-Name: Konrad, T.R. Author-Name: Miller, J.S. Year: 1999 Volume: 89 Issue: 10 Pages: 1570-1574 Abstract: Objectives. This study sought to determine whether community health centers need international medical graduates to fill staff positions. Methods. The authors surveyed 100 community health center administrators to learn about their perceptions of international medical graduates. Results. Nationally, about one quarter of community health centers depend on international medical graduates to fill physician vacancies; most of these centers foresee unfilled positions in the event of a cutback. Conclusions. Policies calling for a national reduction in the supply of international medical graduates need to be balanced by an understanding of these individuals' role in reducing local physician shortages. Handle: RePEc:aph:ajpbhl:1999:89:10:1570-1574_0 Template-Type: ReDIF-Article 1.0 Title: Coverage of beverage alcohol issues in the print media in the United States, 1985-1991 Journal: American Journal of Public Health Author-Name: Lemmens, P.H. Author-Name: Vaeth, P.A.C. Author-Name: Greenfield, T.K. Year: 1999 Volume: 89 Issue: 10 Pages: 1555-1560 Abstract: Objectives. This study assessed the portrayal of alcohol-related issues in the print media in the United States during the 7-year period bracketing implementation of the US alcohol warning label act in November 1988. Methods. All articles that appeared from 1985 to 1991 in 5 national newspapers and that were indexed as dealing with beverage alcohol were identified. Content analysis of a 15% sample of these articles allowed an in-depth assessment of the conceptualization of alcohol in the US print media. Results. A slight decrease in articles related to alcoholism was offset by an increase in articles about the more general health-related effects of alcohol. The warning label act received little attention. Most articles portrayed alcohol neutrally or negatively, using information from government sources. Conclusions. Portrayal of alcohol in the US print media has changed in recent decades. A general shift noted as early as the 1960s has increasingly emphasized public health issues and deemphasized clinical aspects of alcoholism. This has been accompanied by a continuing shift away from a biopsychological definition of alcohol-related behavior to a definition stressing external environmental factors. Handle: RePEc:aph:ajpbhl:1999:89:10:1555-1560_0 Template-Type: ReDIF-Article 1.0 Title: Sanctions and the struggle for health in South Africa Journal: American Journal of Public Health Author-Name: Coovadia, H.M. Year: 1999 Volume: 89 Issue: 10 Pages: 1505-1508 Abstract: This commentary describes the role of a major antiapartheid health organization, the National Medical and Dental Association (NAMDA), in reinforcing and maintaining international pressure on the racist South African government. NAMDA was a constituent of the Mass Democratic Movement (MDM), which was at the forefront in the struggle for freedom in South Africa. NAMDA endorsed the programs of the banned African National Congress (ANC), which included a range of sanctions. Debates within NAMDA on enlarging sanctions into an academic boycott are summarized. The development of a policy of selective academic support, which approved academic exchanges in accord with the aims of the MDM, is explained. Indirect evidence shows that international pressures created by specific types of economic sanctions and the forms of academic boycott decided on by NAMDA achieved their objectives. I have highlighted the tension between these strategies, which resulted in the isolation of the apartheid regime, as well as the responsibility to protect the most vulnerable from the burdens that resulted from these policies. Handle: RePEc:aph:ajpbhl:1999:89:10:1505-1508_2 Template-Type: ReDIF-Article 1.0 Title: Can sanctions be sanctioned? Journal: American Journal of Public Health Author-Name: Sidel, V.W. Year: 1999 Volume: 89 Issue: 10 Pages: 1497-1498 Handle: RePEc:aph:ajpbhl:1999:89:10:1497-1498_7 Template-Type: ReDIF-Article 1.0 Title: Economic sanctions as human rights violations: Reconciling political and public health imperatives Journal: American Journal of Public Health Author-Name: Marks, S.P. Year: 1999 Volume: 89 Issue: 10 Pages: 1509-1513 Abstract: The impact of economic sanctions on civilians has frequently been studied by public health specialists and specialized agencies of the United Nations (UN). This commentary explores some of the difficulties of the claim that sanctions constitute violations of human rights. The deprivation suffered by civilian populations under sanctions regimes often are violations of economic, social, and cultural human rights; however, the attribution of responsibility for those violations to the 'senders' of sanctions (the UN Security Council or the US government, for example) is difficult to sustain, particularly in light of the efforts made by these entities to provide for humanitarian exemptions and humanitarian aid. A more productive approach to avoiding civilian harm is to prefer, as a matter of policy, arms embargoes, severing of communications, and international criminal prosecutions over trade embargoes. Promising recommendations have been formulated regarding 'smart sanctions,' which target regimes rather than people, and 'positive sanctions' in the form of incentives. Health and human rights professionals have specific and important tasks in implementing such a restructured approach to sanctions. Handle: RePEc:aph:ajpbhl:1999:89:10:1509-1513_0 Template-Type: ReDIF-Article 1.0 Title: Human rights is a US problem, too: The case of women and HIV Journal: American Journal of Public Health Author-Name: Gollub, E.L. Year: 1999 Volume: 89 Issue: 10 Pages: 1479-1482 Abstract: Overall, US AIDS incidence and mortality have shown significant declines since 1996, probably because of new antiviral therapies. For women, however, these benefits have been much less pronounced than for men. At the heart of women's HIV risk is gender-based discrimination, which keeps women, and especially women of color, poor and dependent. Although human rights issues are often linked with AIDS issues abroad, in the US they receive insufficient attention in our response to women's HIV risk. Advocacy from public health professionals is needed to overcome the longstanding paternalistic attitudes of federal agencies toward women and to change the paradigm of women's HIV/AIDS prevention and care. Examples of unjust and punitive social policies that may affect women's HIV risk include the 1996 welfare policy legislation, drug treatment policies for women, and women's access to medical research and technology. The overriding public health response to AIDS consists of behavioral interventions aimed at the individual. But this approach will not successfully address the issues of women with AIDS until efforts are made to eliminate society's unjust and unhealthy laws, policies, and practices. Handle: RePEc:aph:ajpbhl:1999:89:10:1479-1482_2 Template-Type: ReDIF-Article 1.0 Title: The impact of economic sanctions on health and human rights in Haiti, 1991-1994 Journal: American Journal of Public Health Author-Name: Gibbons, E. Author-Name: Garfield, R. Year: 1999 Volume: 89 Issue: 10 Pages: 1499-1504 Abstract: Objectives. This report examines the impact of an economic embargo from 1991 to 1994 on health, well-being, and human rights in Haiti. Methods. Data from surveillance systems for nutrition, reportable diseases, and hospital diagnoses were combined with survey data and interviews with affected women, governmental representatives, diplomats, and staff of nongovernmental organizations. Results. Changes included declining income, rising unemployment, poorer nutrition, declining infant mortality, rising mortality among 1- to 4-year-olds, decreased attention to children's well-being and education, and family breakdown. Survival strategies among poor Haitians included changed dietary habits, informal-sector economic activity, moving in with relatives, selling domestic goods, increased informal unions among couples, decreased school attendance, and indentured servitude among children. Conclusions. The implementation of economic sanctions in Haiti resulted in extensive violations of rights; the impact was greatest on the most disadvantaged Haitians. Many Haitian and international supporters of democracy were unaware of the extensive negative impact that sanctions could have. The impact continues now, 5 years after sanctions ended. Modified policies reduced some of the burden of sanctions, and international assistance prevented what otherwise might have become a humanitarian disaster during sanctions. Handle: RePEc:aph:ajpbhl:1999:89:10:1499-1504_1 Template-Type: ReDIF-Article 1.0 Title: The impact of political conflict on women: The case of Afghanistan Journal: American Journal of Public Health Author-Name: Wali, S. Author-Name: Gould, E. Author-Name: Fitzgerald, P. Year: 1999 Volume: 89 Issue: 10 Pages: 1474-1476 Handle: RePEc:aph:ajpbhl:1999:89:10:1474-1476_9 Template-Type: ReDIF-Article 1.0 Title: Welfare reform as a human rights issue Journal: American Journal of Public Health Author-Name: Albisa, C. Year: 1999 Volume: 89 Issue: 10 Pages: 1476-1478 Handle: RePEc:aph:ajpbhl:1999:89:10:1476-1478_5 Template-Type: ReDIF-Article 1.0 Title: The role of socioeconomic status gradients in explaining differences in US adolescents' health Journal: American Journal of Public Health Author-Name: Goodman, E. Year: 1999 Volume: 89 Issue: 10 Pages: 1522-1528 Abstract: Objectives: This study sought to determine whether socioeconomic status (SES) gradients exist among US adolescents for self-rated health and for 5 diseases that cause serious adolescent and continuing adult morbidity. Methods: Baseline data from 15 483 adolescent and parental surveys from the National Longitudinal Study of Adolescent Health were used. SES indicators included parental education and occupation, and household income. Dependent variables included self-rated health and the presence of depression, obesity, asthma, suicide attempt in the past year, and prior sexually transmitted disease. Results: SES gradients were found for self-rated health, depression, and obesity (P<.01). Suicide attempt was linearly associated with income (P<.01). After adjustment for other SES and sociodemographic factors, education and income remained independent correlates of both depression and obesity; income remained an independent correlate of attempted suicide. Conclusions: Differences in susceptibility to socially mediated etiologic mechanisms of disease may exist during adolescence. Understanding the sociostructural context and patterning of adolescents' lives is crucial to clearly understanding health and disease etiology throughout the course of life. Handle: RePEc:aph:ajpbhl:1999:89:10:1522-1528_6 Template-Type: ReDIF-Article 1.0 Title: Lifetime health and economic benefits of weight loss among obese persons Journal: American Journal of Public Health Author-Name: Oster, G. Author-Name: Thompson, D. Author-Name: Edelsberg, J. Author-Name: Bird, A.P. Author-Name: Colditz, G.A. Year: 1999 Volume: 89 Issue: 10 Pages: 1536-1542 Abstract: Objectives. This study estimated the lifetime health and economic benefits of sustained modest weight loss among obese persons. Methods. We developed a dynamic model of the relationship between body mass index (BMI) and the risks and costs of 5 obesity-related diseases: hypertension, hypercholesterolemia, type 2 diabetes, coronary heart disease (CHD), and stroke. We then calculated the lifetime health and economic benefits of sustained 10% reduction in body weight for men and women aged 35 to 64 years with mild, moderate, and severe obesity. Results. Depending on age, gender, and initial BMI, a sustained 10% weight loss would (1) reduce the expected number of years of life with hypertension, hypercholesterolemia, and type 2 diabetes by 1.2 to 2.9, 0.3 to 0.8, and 0.5 to 1.7, respectively; (2) reduce the expected lifetime incidence of CHD and stroke by 12 to 38 cases per 1000 and 1 to 13 cases per 1000, respectively; (3) increase life expectancy by 2 to 7 months; and (4) reduce expected lifetime medical care costs of these 5 disease by $2200 to $5300. Conclusions. Sustained modest weight loss among obese persons would yield substantial health and economic benefits. Handle: RePEc:aph:ajpbhl:1999:89:10:1536-1542_0 Template-Type: ReDIF-Article 1.0 Title: Smoke alarm maintenance in low-income families [2] Journal: American Journal of Public Health Author-Name: Mickalide, A. Author-Name: Validzic, A. Year: 1999 Volume: 89 Issue: 10 Pages: 1584-1585 Handle: RePEc:aph:ajpbhl:1999:89:10:1584-1585_9 Template-Type: ReDIF-Article 1.0 Title: The risks for late adolescence of early adolescent marijuana use Journal: American Journal of Public Health Author-Name: Brook, J.S. Author-Name: Balka, E.B. Author-Name: Whiteman, M. Year: 1999 Volume: 89 Issue: 10 Pages: 1549-1554 Abstract: Objectives. The purpose of this study was to assess the relation of early adolescent marijuana use to late adolescent problem behaviors, drug- related attitudes, drug problems, and sibling and peer problem behavior. Methods. African American (n = 627) and Puerto Rican (n = 555) youths completed questionnaires in their classrooms initially and were individually interviewed 5 years later. Logistic regression analysis estimated increases in the risk of behaviors or attitudes in late adolescence associated with more frequent marijuana use in early adolescence. Results: Early adolescent marijuana use increased the risk in late adolescence of not graduating from high school; delinquency; having multiple sexual partners; not always using condoms; perceiving drugs as not harmful; having problems with cigarettes, alcohol, and marijuana; and having more friends who exhibit deviant behavior. These relations were maintained with controls for age, sex, ethnicity, and, when available, earlier psychosocial measures. Conclusions. Early adolescent marijuana use is related to later adolescent problems that limit the acquisition of skills necessary for employment and heighten the risks of contracting HIV and abusing legal and illegal substances. Hence, assessments of and treatments for adolescent marijuana use need to be incorporated ill clinical practice. Handle: RePEc:aph:ajpbhl:1999:89:10:1549-1554_7 Template-Type: ReDIF-Article 1.0 Title: TB net tracking network provides continuity of care for mobile TB patients Journal: American Journal of Public Health Author-Name: Harlow, T. Year: 1999 Volume: 89 Issue: 10 Pages: 1581-1582 Handle: RePEc:aph:ajpbhl:1999:89:10:1581-1582_4 Template-Type: ReDIF-Article 1.0 Title: A Safe Haven: An innovative approach to residential treatment of substance abuse Journal: American Journal of Public Health Author-Name: Uziel-Miller, N.D. Author-Name: Lyons, J.S. Author-Name: Rowland, B. Author-Name: Conrad, K.J. Year: 1999 Volume: 89 Issue: 9 Pages: 1430-1431 Handle: RePEc:aph:ajpbhl:1999:89:9:1430-1431_8 Template-Type: ReDIF-Article 1.0 Title: Household gun ownership [2] (multiple letters) Journal: American Journal of Public Health Author-Name: Trent, R.B. Author-Name: Van Court, J.C. Author-Name: Kim, A.N. Author-Name: Ludwig, J. Author-Name: Cook, P.J. Author-Name: Smith, T.W. Year: 1999 Volume: 89 Issue: 9 Pages: 1442 Handle: RePEc:aph:ajpbhl:1999:89:9:1442_7 Template-Type: ReDIF-Article 1.0 Title: A world behaving badly: The global challenge for behavioral surveillance Journal: American Journal of Public Health Author-Name: McQueen, D.V. Year: 1999 Volume: 89 Issue: 9 Pages: 1312-1314 Handle: RePEc:aph:ajpbhl:1999:89:9:1312-1314_7 Template-Type: ReDIF-Article 1.0 Title: Parental attitudes and childhood immunization [3] (multiple letters) Journal: American Journal of Public Health Author-Name: Strobino, D. Author-Name: Hughart, N. Author-Name: Guyer, B. Author-Name: Prislin, R. Author-Name: Dyer, J.A. Author-Name: Blakely, C.H. Author-Name: Johnson, C.D. Year: 1999 Volume: 89 Issue: 9 Pages: 1442-1443 Handle: RePEc:aph:ajpbhl:1999:89:9:1442-1443_7 Template-Type: ReDIF-Article 1.0 Title: Sex differences in cardiovascular disease mortality [1] Journal: American Journal of Public Health Author-Name: Oman, D. Author-Name: Thoresen, C.E. Year: 1999 Volume: 89 Issue: 9 Pages: 1441 Handle: RePEc:aph:ajpbhl:1999:89:9:1441_1 Template-Type: ReDIF-Article 1.0 Title: Countering pro-tobacco influences at the racetrack Journal: American Journal of Public Health Author-Name: Olson, C.K. Year: 1999 Volume: 89 Issue: 9 Pages: 1431-1432 Handle: RePEc:aph:ajpbhl:1999:89:9:1431-1432_9 Template-Type: ReDIF-Article 1.0 Title: Erratum: Drinking and driving among US high school seniors (American Journal of Public Health (1999) 89 (678-684)) Journal: American Journal of Public Health Author-Name: O'Malley, P.M. Author-Name: Johnston, L.D. Year: 1999 Volume: 89 Issue: 9 Pages: 1435 Handle: RePEc:aph:ajpbhl:1999:89:9:1435_2 Template-Type: ReDIF-Article 1.0 Title: Mind matters: The importance of mental disorders in public health's 21st century mission Journal: American Journal of Public Health Author-Name: Neugebauer, R. Year: 1999 Volume: 89 Issue: 9 Pages: 1309-1311 Handle: RePEc:aph:ajpbhl:1999:89:9:1309-1311_1 Template-Type: ReDIF-Article 1.0 Title: The global burden of mental disorders Journal: American Journal of Public Health Author-Name: Üstün, T.B. Year: 1999 Volume: 89 Issue: 9 Pages: 1315-1318 Abstract: Recent data on the burden of mental disorders worldwide demonstrates a major public health problem that affects patients, society, and nations as a whole. Research must be done to find effective ways to deal with the increasing burden of mental disorders. Given the growing evidence that mental disorders are disorders of the brain and that they can be treated effectively with both psychosocial counseling and psychotropic medications, intervention packages could be developed to deal with the increasing burden. Such packages should be tested for real-world effectiveness and their cost-effectiveness should be demonstrated to guide policymakers to choose from among many other non-mental health interventions. The transportability and sustainability of intervention packages should be studied in public health research and a link between efficacy, effectiveness, cost-effectiveness, generalizability, and sustainability should be demonstrated. The World Health Organization's initiative on the World Mental Health 2000 Survey will provide the first basic epidemiologic data. Together with other data, the initiative will provide solid evidence for including mental disorders into essential treatment packages. In this way, parity can be achieved for mental disorders and mental health can be mainstreamed into health and public health practice. Handle: RePEc:aph:ajpbhl:1999:89:9:1315-1318_8 Template-Type: ReDIF-Article 1.0 Title: Estimating the prevalence of disordered gambling behavior in the United States and Canada: A research synthesis Journal: American Journal of Public Health Author-Name: Shaffer, H.J. Author-Name: Hall, M.N. Author-Name: Vander Bilt, J. Year: 1999 Volume: 89 Issue: 9 Pages: 1369-1376 Abstract: Objectives. This study developed prevalence estimates of gambling- related disorders in the United States and Canada, identified differences in prevalence among population segments, and identified changes in prevalence over the past 20 years. Methods. A meta-analytic strategy was employed to synthesize estimates from 119 prevalence studies. This method produced more reliable prevalence rates than were available from any single study. Results. Prevalence estimates among samples of adolescents were significantly higher than estimates among samples of adults for both clinical (level 3) and subclinical (level 2) measures of disordered gambling within both lifetime and past-year time frames (e.g., 3.9% vs 1.6% for lifetime estimates of level 3 gambling). Among adults, prevalence estimates of disordered gambling have increased significantly during the past 20 years. Conclusions. Membership in youth, treatment, or prison population segments is significantly associated with experiencing gambling-related disorders. Understanding subclinical gamblers provides a meaningful opportunity to lower the public health burden associated with gambling disorders. Further research is necessary to determine whether the prevalence of disordered gambling will continue to increase among the general adult population and how prevalence among adolescents will change as this cohort ages. Handle: RePEc:aph:ajpbhl:1999:89:9:1369-1376_4 Template-Type: ReDIF-Article 1.0 Title: Minimum-age drinking laws and youth suicide, 1970-1990 Journal: American Journal of Public Health Author-Name: Birckmayer, J. Author-Name: Hemenway, D. Year: 1999 Volume: 89 Issue: 9 Pages: 1365-1368 Abstract: Objectives. This study examined the association between the minimum legal drinking age (MLDA) and suicides among youths aged 18 to 20 years. Methods. The study used pooled cross-sectional time-series data on youth suicide and the MLDA for the 48 contiguous states in the United States from 1970 to 1990. Poisson regression was used to estimate the association between MLDA and youth suicide. Results. A significant association exists between MLDA and youth suicide. Between 1970 and 1990, the suicide rate of 18- to 20- year-old youths living in states with an 18-year MLDA was 8% higher than the suicide rate among 18- to 20-year-old youths in states with a 21-year MLDA (P < .01). Conclusions. MLDA is associated not only with the motor-vehicle death rate among youths but also with the rate of youth suicide. We estimate that lowering the drinking age from 21 to 18 years in all states could increase the number of suicides in the 18- to 20-year-old population by approximately 125 each year. Handle: RePEc:aph:ajpbhl:1999:89:9:1365-1368_7 Template-Type: ReDIF-Article 1.0 Title: Public conceptions of mental illness: Labels, causes, dangerousness, and social distance Journal: American Journal of Public Health Author-Name: Link, B.G. Author-Name: Phelan, J.C. Author-Name: Bresnahan, M. Author-Name: Stueve, A. Author-Name: Pescosolido, B.A. Year: 1999 Volume: 89 Issue: 9 Pages: 1328-1333 Abstract: Objectives. The authors used nationwide survey data to characterize current public conceptions related to recognition of mental illness and perceived causes, dangerousness, and desired social distance. Methods. Data were derived from a vignette experiment include in the 1996 General Social Survey. Respondents (n = 1444) were randomly assigned to 1 of 5 vignette conditions. Four vignettes described psychiatric disorders meeting diagnostic criteria, and the fifth depicted a 'troubled person' with subclinical problems and worries. Results. Results indicate that the majority of the public identifies schizophrenia (88%) and major depression (69%) as mental illnesses and that most report multicausal explanations combining stressful circumstances with biologic and genetic factors. Results also show, however, that smaller proportions associate alcohol (49%) or drug (44%) abuse with mental illness and that symptoms of mental illness remain strongly connected with public fears about potential violence and with a desire for limited social interaction. Conclusions. While there is reason for optimism in the public's recognition of mental illness and causal attributions, a strong stereotype of dangerousness and desire for social distance persist. These latter conceptions are likely to negatively affect people with mental illness. Handle: RePEc:aph:ajpbhl:1999:89:9:1328-1333_0 Template-Type: ReDIF-Article 1.0 Title: Lobbying and advocacy for the public's health: What are the limits for nonprofit organizations? Journal: American Journal of Public Health Author-Name: Vernick, J.S. Year: 1999 Volume: 89 Issue: 9 Pages: 1425-1429 Abstract: Nonprofit organizations play an important role in advocating for the public's health in the United States. This article describes the rules under US law for lobbying by nonprofit organizations. The 2 most common kinds of nonprofits working to improve the public's health are 'public charities' and 'social welfare organizations.' Although social welfare organizations may engage in relatively unlimited lobbying, public charities may not engage in 'substantial' lobbying. Lobbying is divided into 2 main categories. Direct lobbying refers to communications with lawmakers that take a position on specific legislation, and grassroots lobbying includes attempts to persuade members of the general public to take action regarding legislation. Even public charities may engage in some direct lobbying and a smaller amount of grassroots lobbying. Much public health advocacy, however, is not lobbying, since there are several important exceptions to the lobbying rules. These exceptions include 'nonpartisan analysis, study, or research' and discussions of broad social problems. Lobbying with federal or earmarked foundation funds is generally prohibited. Handle: RePEc:aph:ajpbhl:1999:89:9:1425-1429_6 Template-Type: ReDIF-Article 1.0 Title: Effects of HIV counseling and testing on sexual risk behavior: A meta- analytic review of published research, 1985-1997 Journal: American Journal of Public Health Author-Name: Weinhardt, L.S. Author-Name: Carey, M.P. Author-Name: Johnson, B.T. Author-Name: Bickham, N.L. Year: 1999 Volume: 89 Issue: 9 Pages: 1397-1405 Abstract: Objectives. This study examined whether HIV counseling and testing leads to reductions in sexual risk behavior. Methods. The meta-analysis included 27 published studies that provided sexual behavior outcome data, assessed behavior before and after counseling and testing, and provided details sufficient for the calculation of effect sizes. The studies involved 19 597 participants. Results. After counseling and testing, HIV-positive participants and HIV-serodiscordant couples reduced unprotected intercourse and increased condom use more than HIV-negative and untested participants. HIV-negative participants did not modify their behavior more than untested participants. Participants' age, volition for testing, and injection drug use treatment status, as well as the sample seroprevalence and length of the follow-up, explained the variance in results. Conclusions. HIV counseling and testing appears to provide an effective means of secondary prevention for HIV-positive individuals but, as conducted in the reviewed studies, is not an effective primary prevention strategy for uninfected participants. Theory- driven research with attention given to the context of testing is needed to further explicate the determinants of behavior change resulting from HIV counseling and testing, and the effectiveness of specific counseling approaches. Handle: RePEc:aph:ajpbhl:1999:89:9:1397-1405_1 Template-Type: ReDIF-Article 1.0 Title: Blood pressure level and incidence of myocardial infarction among patients treated for hypertension Journal: American Journal of Public Health Author-Name: Kaplan, R.C. Author-Name: Psaty, B.M. Author-Name: Heckbert, S.R. Author-Name: Smith, N.L. Author-Name: Lemaitre, R.N. Year: 1999 Volume: 89 Issue: 9 Pages: 1414-1417 Abstract: Objectives. This study examined the relationship between achieved blood pressure and risk of myocardial infarction among patients treated for hypertension. Methods. Blood pressure and other cardiovascular risk factors were assessed among 718 myocardial infarction case patients and 2136 matched controls. Results. Blood pressure level was directly related to risk of myocardial infarction. Patients with treated hypertension who had mild elevations in blood pressure accounted for a larger share of the excess myocardial infarction incidence than those who had higher blood pressure readings. Conclusions. Achieving normotensive levels in treated hypertensive patients with uncontrolled blood pressure might prevent more than 15% of myocardial infarctions in the treated hypertensive population. Handle: RePEc:aph:ajpbhl:1999:89:9:1414-1417_7 Template-Type: ReDIF-Article 1.0 Title: The health of grandparents raising grandchildren: Results of a national study Journal: American Journal of Public Health Author-Name: Minkler, M. Author-Name: Fuller-Thomson, E. Year: 1999 Volume: 89 Issue: 9 Pages: 1384-1389 Abstract: Objectives. This study sought to compare the functional and self-rated health of grandparents raising grandchildren with that of noncaregiving grandparents. Methods. A secondary analysis of data from the 1992 to 1994 National Survey of Families and Households was conducted. Bivariate and logistic analyses compared 173 custodial and 3304 noncustodial grandparents in terms of functional health limitations, self-rated health, and satisfaction with health. Results. Custodial grandparents were significantly more likely to have limitations in 4 of the 5 activities of daily living (ADLs) examined, with more than half reporting some limitation in 1 of the 5 ADLs. A logistic regression analysis indicated that caregiving grandparents had 50% higher odds of having an ADL limitation. Caregivers were significantly more likely to report lower satisfaction with health, and a statistical trend indicated that the caregivers had lower self-rated health. Conclusions. Further research is needed to determine whether the differences observed reflect artifacts or actual differences in functional abilities and other health measures. The need for policies that support rather than penalize grandparents raising grandchildren is stressed. Handle: RePEc:aph:ajpbhl:1999:89:9:1384-1389_5 Template-Type: ReDIF-Article 1.0 Title: Trends in perceived cost as a barrier to medical care, 1991-1996 Journal: American Journal of Public Health Author-Name: Nelson, D.E. Author-Name: Thompson, B.L. Author-Name: Bland, S.D. Author-Name: Rubinson, R. Year: 1999 Volume: 89 Issue: 9 Pages: 1410-1413 Abstract: Objectives. This study examined trends in perceived cost as a barrier to medical care. Methods. The Behavioral Risk Factor Surveillance System was used to analyze monthly telephone survey data from 45 states. Results. Overall, the percentage of persons perceiving cost as a barrier to medical care increased from 1991 until early 1993 and then declined to baseline values in late 1996. Perceived cost was a greater barrier in 1996 than in 1991 for persons with low incomes and for those who were unemployed and uninsured. For self-employed persons, percentages increased until mid-1993 and the remained constant. Conclusions. Further efforts are needed to improve access to medical care for socially disadvantaged populations. Handle: RePEc:aph:ajpbhl:1999:89:9:1410-1413_5 Template-Type: ReDIF-Article 1.0 Title: Awareness and motivation of Japanese donors of blood for research Journal: American Journal of Public Health Author-Name: Nakayama, T. Author-Name: Muto, K. Author-Name: Yoshiike, N. Author-Name: Yokoyama, T. Year: 1999 Volume: 89 Issue: 9 Pages: 1433-1434 Handle: RePEc:aph:ajpbhl:1999:89:9:1433-1434_9 Template-Type: ReDIF-Article 1.0 Title: Prevalence and correlates of survival sex among runaway and homeless youth Journal: American Journal of Public Health Author-Name: Greene, J.M. Author-Name: Ennett, S.T. Author-Name: Ringwalt, C.L. Year: 1999 Volume: 89 Issue: 9 Pages: 1406-1409 Abstract: Objectives. This study examined the prevalence and correlates of survival sex among runaway and homeless youths. Methods. A nationally representative sample of shelter youths and a multicity sample of street youths were interviewed. Results. Approximately 28% of street youths and 10% of shelter youths reported having participated in survival sex, which was associated with age, days away from home, victimization, criminal behaviors, substance use, suicide attempts, sexually transmitted disease, and pregnancy. Conclusions. Intensive and ongoing services are needed to provide resources and residential assistance to enable runaway and homeless youths to avoid survival sex, which is associated with many problem behaviors. Handle: RePEc:aph:ajpbhl:1999:89:9:1406-1409_9 Template-Type: ReDIF-Article 1.0 Title: Labor day and the war on workers Journal: American Journal of Public Health Author-Name: Rosner, D. Author-Name: Markowitz, G. Year: 1999 Volume: 89 Issue: 9 Pages: 1319-1321 Abstract: We celebrate Labor Day every year with barbecues and picnics, rarely remembering that the holiday was born in the midst of tremendous labor struggles to improve working conditions. In the last century, 16-hour workdays and 6- and 7-day workweeks led to terribly high injury rates in the nation's mines and mills. Thousands upon thousands of workers died, caught in the grinding machinery of our growing industries. Today, despite improvements, thousands of workers still die in what has been described as a form of war on the American workforce. This commentary reminds us of the historical toll in lives and limbs that workers have paid to provide us with our modern prosperity. It also reminds us that the continuing toll is far too high and that workers who died and continue to die in order to produce our wealth deserve to be remembered and honored on this national holiday. Handle: RePEc:aph:ajpbhl:1999:89:9:1319-1321_7 Template-Type: ReDIF-Article 1.0 Title: Prenatal effects of maternal smoking on daughters' smoking: Nicotine or testosterone exposure? Journal: American Journal of Public Health Author-Name: Kandel, D.B. Author-Name: Udry, J.R. Year: 1999 Volume: 89 Issue: 9 Pages: 1377-1383 Abstract: Objectives. The purpose of this study was to specify the effect of prenatal fetal exposure to maternal cotinine and testosterone on daughters' smoking in adolescence and adulthood. Methods. Longitudinal causal models were estimated among 240 White mother-daughter pairs from the Child Health and Development Study. Mothers and daughters were reinterviewed when daughters were aged 15 to 17 years, and daughters were interviewed at 27 to 30 years of age. Blood samples were obtained from both parents during pregnancy and from adult daughters. Results. Testosterone and smoking were positively correlated among mothers during their pregnancy and among adult daughters. Maternal prenatal cotinine had no direct effect on daughters' smoking; self-reported smoking in pregnancy did have a direct effect. Smoking among daughters during adolescence was determined by maternal prenatal testosterone and self-reported maternal smoking during pregnancy and postnatally. Smoking among adult daughters reflected chronic smoking since adolescence and the continuing effect of postnatal maternal smoking. Prenatal maternal testosterone affected adult daughters' testosterone. Conclusions. Estimates of the impact of prenatal maternal smoking depend on the measure of smoking. Prenatal testosterone exposure is a previously unrecognized risk factor for smoking among female offspring. Handle: RePEc:aph:ajpbhl:1999:89:9:1377-1383_3 Template-Type: ReDIF-Article 1.0 Title: The Abuela project: Safe cheese workshops to reduce the incidence of Salmonella typhimurium from consumption of raw-milk fresh cheese Journal: American Journal of Public Health Author-Name: Bell, R.A. Author-Name: Hillers, V.N. Author-Name: Thomas, T.A. Year: 1999 Volume: 89 Issue: 9 Pages: 1421-1424 Abstract: Objectives. A multiagency intervention was implemented in Yakima County, Wash, to reduce the incidence of Salmonella serotype Typhimurium infections resulting from eating queso fresco (fresh cheese) made from raw milk, a traditional food in the Hispanic diet. Methods: A pasteurized-milk queso fresco recipe with taste and texture acceptable to the Hispanic community was developed. Trained Hispanic volunteers conducted safe cheese workshops, which were attended by more than 225 persons. Results. Workshop participants' acceptance of the new recipe was excellent and positive behavior changes were maintained over 6 months. Conclusion. Educational interventions in Hispanic communities can reduce the incidence of Salmonella Typhimurium associated with eating queso fresco. Handle: RePEc:aph:ajpbhl:1999:89:9:1421-1424_0 Template-Type: ReDIF-Article 1.0 Title: Exploring the effect of depression on physical disability: Longitudinal evidence from the established populations for epidemiologic studies of the elderly Journal: American Journal of Public Health Author-Name: Penninx, B.W.J.H. Author-Name: Leveille, S. Author-Name: Ferrucci, L. Author-Name: Van Eijk, J.T.M. Author-Name: Guralnik, J.M. Year: 1999 Volume: 89 Issue: 9 Pages: 1346-1352 Abstract: Objectives. This study examined the effect of depression on the incidence of physical disability and the role of confounding and explanatory variables in this relationship. Methods. A cohort of 6247 subjects 65 years and older who were initially free of disability was followed up for 6 years. Baseline depression was assessed by the Center for Epidemiological Studies Depression Scale. Disability in mobility and disability in activities of daily living were measured annually. Results. Compared with the 5751 nondepressed subjects, the 496 depressed subjects had a relative risk (95% confidence interval) of 1.67 (1.44, 1.95) and 1.73 (1.54, 1.94) for incidence disability in activities of daily living and mobility, respectively. Adjustment for sociodemographic characteristics and baseline chronic conditions reduced the risks to 1.39 (1.18, 1.63) and 1.45 (1.29, 1.93), respectively. Less physical activity and fewer social contacts among depressed persons further explained part of their increased disability risk. Conclusions. Depression in older persons may increase the risk for incident disability. This excess risk is partly explained by depressed persons' decreased physical activity and social interaction. The role of other factors (e.g., biological mechanisms) should be examined. Handle: RePEc:aph:ajpbhl:1999:89:9:1346-1352_2 Template-Type: ReDIF-Article 1.0 Title: The public's view of the competence, dangerousness, and need for legal coercion of persons with mental health problems Journal: American Journal of Public Health Author-Name: Pescosolido, B.A. Author-Name: Monahan, J. Author-Name: Link, B.G. Author-Name: Stueve, A. Author-Name: Kikuzawa, S. Year: 1999 Volume: 89 Issue: 9 Pages: 1339-1345 Abstract: Americans' opinions about financial and treatment competence of people with mental health problems, potential for harm to self or others, and the use of legal means to force treatment. Methods. The 1996 General Social Survey provided interview data with a nationally representative sample (n = 1444). Respondents were given a vignette based on diagnostic criteria for schizophrenia, major depression, alcohol dependence, or drug-dependence, or a 'control' case. Results. The specific nature of the problem was the most important factor shaping public reaction. Respondents viewed those with 'troubles,' alcohol dependence, or depression as able to make treatment decisions. Most reported that persons with alcohol or drug problems or schizophrenia cannot manage money and are likely to be violent toward others. Respondents indicated a willingness to coerce individuals into treatment. Respondent and other case characteristics rarely affected opinions. Conclusions. Americans report greater concern with individuals who have drag or alcohol problems than with persons who have other mental health problems. Evaluations of dangerousness and coercion indicate a continuing need for public education. Handle: RePEc:aph:ajpbhl:1999:89:9:1339-1345_0 Template-Type: ReDIF-Article 1.0 Title: Evaluating the public health impact of health promotion interventions: The RE-AIM framework Journal: American Journal of Public Health Author-Name: Glasgow, R.E. Author-Name: Vogt, T.M. Author-Name: Boles, S.M. Year: 1999 Volume: 89 Issue: 9 Pages: 1322-1327 Abstract: Progress in public health and community-based interventions has been hampered by the lack of a comprehensive evaluation framework appropriate to such programs. Multilevel interventions that incorporate policy, environmental, and individual components should be evaluated with measurements suited to their settings, goals, and purpose. In this commentary, the authors propose a model (termed the RE-AIM model) for evaluating public health interventions that assesses 5 dimensions: reach, efficacy, adoption, implementation, and maintenance. These dimensions occur at multiple levels (e.g., individual, clinic or organization, community) and interact to determine the public health or population-based impact of a program or policy. The authors discuss issues in evaluating each of these dimensions and combining them to determine overall public health impact. Failure to adequately evaluate programs on all 5 dimensions can lead to a waste of resources, discontinuities between stages of research, and failure to improve public health to the limits of our capacity. The authors summarize strengths and limitations of the RE-AIM model and recommend areas for future research and application. Handle: RePEc:aph:ajpbhl:1999:89:9:1322-1327_8 Template-Type: ReDIF-Article 1.0 Title: Effects of health care cost-containment programs on patterns of care and readmissions among children and adolescents Journal: American Journal of Public Health Author-Name: Wickizer, T.M. Author-Name: Lessler, D. Author-Name: Boyd-Wickizer, J. Year: 1999 Volume: 89 Issue: 9 Pages: 1353-1358 Abstract: Objectives. This study examined the effects of a utilization management program on patterns of medical care among children and adolescents. Methods. From 1989 through 1993, the program conducted 8568 reviews of pediatric patients, ranging in age from birth to 18 years. The program used preadmission and concurrent review procedures to review and certify patients' need for care. This study used multivariate analyses to assess changes in the number of days of inpatient care approved by the program and to determine whether limitations imposed on length of stay affected the risk of 60-day readmission. Results. Concurrent review reduced the number of requested days of inpatient care by 3.2 days per patient. Low-birthweight infants and adolescent patients with depression or alcohol or drug dependence accounted for a disproportionate share of the reduction. Patients classified as admitted for medical or mental health care and whose stay was restricted by concurrent review were more likely (P < .05) to be readmitted within 60 days after discharge. Conclusions. By limiting care through its review procedures, the utilization management program decreased inpatient resource consumption but also increased the risk of readmission for some patients. Continued investigation should be conducted of the effects of cost-containment programs on the quality of care given to children and adolescents, especially in the area of mental health. Handle: RePEc:aph:ajpbhl:1999:89:9:1353-1358_2 Template-Type: ReDIF-Article 1.0 Title: Prevalence of self-reported nutrition-related health problems in the Lower Mississippi Delta Journal: American Journal of Public Health Author-Name: Smith, J. Author-Name: Lensing, S. Author-Name: Horton, J.A. Author-Name: Lovejoy, J. Author-Name: Zaghloul, S. Author-Name: Forrester, I. Author-Name: McGee, B.B. Author-Name: Bogle, M.L. Year: 1999 Volume: 89 Issue: 9 Pages: 1418-1421 Abstract: Objectives. The purpose of this study was to assess demographic and geographic differences in prevalence of self-reported nutrition-related health problems in Arkansas, Louisiana, and Mississippi. Methods. The authors analyzed 1991 and 1993 Behavioral Risk Factor Surveillance System data for adults 18 years or older. Results. Less educated African American women and of other minority groups who were aged 35 to 64 years reported the highest prevalence of health problems. Geographic differences involved prevalence of hypertension, health status, and insurance status. Conclusions. Specific demographic subgroups and geographic areas with a high risk of health problems are in particular need of targeted interventions. Handle: RePEc:aph:ajpbhl:1999:89:9:1418-1421_8 Template-Type: ReDIF-Article 1.0 Title: Who are 'the homeless'? Reconsidering the stability and composition of the homeless population Journal: American Journal of Public Health Author-Name: Phelan, J.C. Author-Name: Link, B.G. Year: 1999 Volume: 89 Issue: 9 Pages: 1334-1338 Abstract: Objectives. This study assessed the extent to which the use of point- prevalence samples biases conclusions drawn about homeless people. Methods. Three data sets and published research were used to examine the degree to which conditions leading to point-prevalence bias (turnover in the homeless population, variability in the persistence of homelessness, and associations between personal characteristics and persistence) characterize the homeless population. Results were compared from point-prevalence studies concerning persistence of homelessness and characteristics of homeless people with those from a study of formerly homeless people. Results. Conditions leading to point-prevalence bias strongly characterize the homeless population. Moreover profiles of homeless people differed dramatically between point-prevalence studies and the study of formerly homeless people. In the former, average duration of homelessness was longer, and samples included higher proportions of men, minorities, non-high school graduates, and people with histories of psychiatric hospitalization, incarceration, and detoxification. Conclusions. Reliance on point-prevalence samples, when such samples are generalized beyond the currently homeless population, leads to overestimations of the persistence of homelessness, the demographic distinctiveness of the homeless population, and the prevalence of personal disabilities and deviant lifestyles among homeless people. Handle: RePEc:aph:ajpbhl:1999:89:9:1334-1338_4 Template-Type: ReDIF-Article 1.0 Title: The effect of plain packaging on response to health warnings Journal: American Journal of Public Health Author-Name: Goldberg, M.E. Author-Name: Liefeld, J. Author-Name: Madill, J. Author-Name: Vredenburg, H. Year: 1999 Volume: 89 Issue: 9 Pages: 1434-1435 Handle: RePEc:aph:ajpbhl:1999:89:9:1434-1435_1 Template-Type: ReDIF-Article 1.0 Title: The extent of drug therapy for attention deficit-hyperactivity disorder among children in public schools Journal: American Journal of Public Health Author-Name: LeFever, G.B. Author-Name: Dawson, K.V. Author-Name: Morrow, A.L. Year: 1999 Volume: 89 Issue: 9 Pages: 1359-1364 Abstract: Objectives. The purpose of this study was to determine the extent of medication use for attention deficit-hyperactivity disorder (ADHD) in southeastern Virginia. Methods. Students enrolled in grades 2 trough 5 in school districts in city A (n = 5767 students)and city B (n = 23 967 students) were included. Nurses recorded students who received ADHD medication in school. Results. The proportion of students receiving ADHD medication was similar in both cities (8% and 10%) and was 2 to 3 times as high as the expected rate of ADHD. Receipt of drug therapy was associated with social and educational characteristics. Medication was used by 3 times as many boys as girls and by twice as many Whites as Blacks. Medication use increased with years in school, and by fifth grade 18% to 20% of White boys were receiving ADHD medication. Being young for one's grade was positively associated with medication use (P<.01). The prevalence of ADHD was 12% in district A. 63% in district B. Conclusions. These findings suggest that criteria for diagnosis of ADHD vary substantially across US populations, with potential overdiagnosis and overtreatment of ADHD in some groups of children. Handle: RePEc:aph:ajpbhl:1999:89:9:1359-1364_7 Template-Type: ReDIF-Article 1.0 Title: Fruit and vegetable consumption and prevention of cancer: The Black Churches United for Better Health project Journal: American Journal of Public Health Author-Name: Campbell, M.K. Author-Name: Demark-Wahnefried, W. Author-Name: Symons, M. Author-Name: Kalsbeek, W.D. Author-Name: Dodds, J. Author-Name: Cowan, A. Author-Name: Jackson, B. Author-Name: Motsinger, B. Author-Name: Hoben, K. Author-Name: Lashley, J. Author-Name: Demissie, S. Author-Name: McClelland, J.W. Year: 1999 Volume: 89 Issue: 9 Pages: 1390-1396 Abstract: Objectives. This study assessed the effects of the Black Churches United for Better Health project on increasing fruit and vegetable consumption among rural African American church members in North Carolina. Methods. Ten counties comprising 50 churches were pair matched and randomly assigned to either intervention or delayed intervention (no program until after the follow-up survey) conditions. A multicomponent intervention was conducted over approximately 20 months. A total of 2519 adults (77.3% response rate) complete both the baseline and 2-year follow-up interviews. Results. The 2 study groups consumed similar amounts of fruits and vegetables at baseline. At the 2-year follow-up, the intervention group consumed 0.85 (SE = 0.12) servings more than the delayed intervention group (P<.0001). The largest increases were observed among people 66 years or older (1 serving), those with education beyond high school (0.92 servings), those widowed or divorced (0.96 servings), and those attending church frequently (1.3 servings). The least improvement occurred among those aged 18 to 37 years and those who were single. Conclusions. The project was a successful model for achieving dietary change among rural African Americans. Handle: RePEc:aph:ajpbhl:1999:89:9:1390-1396_9 Template-Type: ReDIF-Article 1.0 Title: Questioning epidemiology: Objectivity, advocacy, and socially responsible science Journal: American Journal of Public Health Author-Name: Krieger, N. Year: 1999 Volume: 89 Issue: 8 Pages: 1151-1153 Handle: RePEc:aph:ajpbhl:1999:89:8:1151-1153_0 Template-Type: ReDIF-Article 1.0 Title: Tobacco control legislation [6] Journal: American Journal of Public Health Author-Name: Daynard, R. Author-Name: Bloch, M. Author-Name: Roemer, R. Year: 1999 Volume: 89 Issue: 8 Pages: 1273-1274 Handle: RePEc:aph:ajpbhl:1999:89:8:1273-1274_4 Template-Type: ReDIF-Article 1.0 Title: Should we compromise on tobacco industry immunity to achieve national comprehensive tobacco legislation? [5] Journal: American Journal of Public Health Author-Name: Siegel, M. Year: 1999 Volume: 89 Issue: 8 Pages: 1273 Handle: RePEc:aph:ajpbhl:1999:89:8:1273_4 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: 1999 Volume: 89 Issue: 8 Pages: 1274 Handle: RePEc:aph:ajpbhl:1999:89:8:1274_5 Template-Type: ReDIF-Article 1.0 Title: Erratum: Identifying target groups for a potential vaccination program during a hepatitis A communitywide outbreak (American Journal of Public Health (1999) 89 (918-921)) Journal: American Journal of Public Health Author-Name: Hutin, Y.J.F. Author-Name: Bell, B.P. Author-Name: Marshall, K.L.E. Year: 1999 Volume: 89 Issue: 8 Pages: 1274 Handle: RePEc:aph:ajpbhl:1999:89:8:1274_3 Template-Type: ReDIF-Article 1.0 Title: Epidemiology in the 21st century: Calculation, communication, and intervention Journal: American Journal of Public Health Author-Name: Koplan, J.P. Author-Name: Thacker, S.B. Author-Name: Lezin, N.A. Year: 1999 Volume: 89 Issue: 8 Pages: 1153-1155 Handle: RePEc:aph:ajpbhl:1999:89:8:1153-1155_4 Template-Type: ReDIF-Article 1.0 Title: Alcohol and fatal crashes among American Indians [3] (multiple letters) Journal: American Journal of Public Health Author-Name: Robertson, L.S. Author-Name: Campos-Outcalt, D. Year: 1999 Volume: 89 Issue: 8 Pages: 1270-1271 Handle: RePEc:aph:ajpbhl:1999:89:8:1270-1271_4 Template-Type: ReDIF-Article 1.0 Title: Name-based reporting of HIV infection [4] (multiple letters) Journal: American Journal of Public Health Author-Name: Wortley, P.M. Author-Name: Lehman, J.S. Author-Name: Fleming, P.L. Author-Name: Colfax, G.N. Author-Name: Bindman, A.B. Year: 1999 Volume: 89 Issue: 8 Pages: 1271-1273 Handle: RePEc:aph:ajpbhl:1999:89:8:1271-1273_0 Template-Type: ReDIF-Article 1.0 Title: Drinking patterns of recent Russian immigrants and other Israelis: 1995 national survey results Journal: American Journal of Public Health Author-Name: Rahav, G. Author-Name: Hasin, D. Author-Name: Paykin, A. Year: 1999 Volume: 89 Issue: 8 Pages: 1212-1216 Abstract: Objectives. A large group of Russian Jews has immigrated to Israel since 1989. Russian has one of the highest alcohol consumption levels in the world, while the level in Israel is among the lowest. This study was designed to provide empirical information on the drinking of these Russian immigrants compared with the drinking of other Jewish Israeli residents. Methods. The data came from a 1995 national survey of drinking in Israel. Of 4984 Israelis, 292 were Russian immigrants who had arrived since 1989. Russians were compared with other respondents on several drinking variables. Logistic regression was the principal method of analysis, allowing the relationship to be tested with demographic and cultural variables controlled. A subsidiary analysis was conducted on data about parents' drinking from a survey of secondary school students. Results. There were significant effects for Russian status for several drinking variables, with significant odds ratios ranging from 1.45 to 2.38. These results indicate that recent Russian immigrants to Israel drink more than their Israeli counterparts. Conclusions. Further investigation of the stability of these patients may provide valuable information about cultural effects on drinking. Handle: RePEc:aph:ajpbhl:1999:89:8:1212-1216_4 Template-Type: ReDIF-Article 1.0 Title: The need for mentoring in public health [1] Journal: American Journal of Public Health Author-Name: Mahayosnand, P.P. Author-Name: Stigler, M.H. Year: 1999 Volume: 89 Issue: 8 Pages: 1262-1263 Handle: RePEc:aph:ajpbhl:1999:89:8:1262-1263_6 Template-Type: ReDIF-Article 1.0 Title: Prevalence of self-rated visual impairment among adults with diabetes Journal: American Journal of Public Health Author-Name: Saaddine, J.B. Author-Name: Narayan, K.M.V. Author-Name: Engelgau, M.M. Author-Name: Aubert, R.E. Author-Name: Klein, R. Author-Name: Beckles, G.L.A. Year: 1999 Volume: 89 Issue: 8 Pages: 1200-1205 Abstract: Objectives. This study estimated the prevalence of self-rated visual impairment among US adults with diabetes and identified correlates of such impairment. Methods. Self-reported data from the 1995 Behavioral Risk Factor Surveillance System survey of adults 18 years and older with diabetes were analyzed. Correlates of visual impairment were examined by multiple logistic regression analysis. Results. The prevalence of self-rated visual impairment was 24.8% (95% confidence interval [CI] = 22.3%, 27.3%). Among insulin users, multivariable-adjusted odds ratios were 4.9 (95% CI = 2.6, 9.2) for those who had not completed high school and 1.8 (95% CI = 1.0, 2.8) for those who had completed high school compared with those with higher levels of education. Comparable estimates of odds ratios for non-users of insulin were 2.2 (95% CI = 1.4, 3.4) and 1.3 (95% CI = 0.9, 2.0), respectively. Among nonusers, the adjusted odds for minority adults were 2.4 (95% CI = 1.0, 3.7) times the odds for non-Hispanic Whites. Conclusions. By these data, 1.6 million US adults with diabetes reported having some degree of visual impairment. Future research on the specific causes of visual impairment may help in estimating the avoidable public health burden. Handle: RePEc:aph:ajpbhl:1999:89:8:1200-1205_8 Template-Type: ReDIF-Article 1.0 Title: A population comparison of participants and nonparticipants in a health survey Journal: American Journal of Public Health Author-Name: Klesges, R.C. Author-Name: Williamson, J.E. Author-Name: Somes, G.W. Author-Name: Talcott, G.W. Author-Name: Lando, H.A. Author-Name: Haddock, C.K. Year: 1999 Volume: 89 Issue: 8 Pages: 1228-1231 Abstract: Objectives. This study examined the characteristics of Air Force recruits willing to take part in a health survey vs those unwilling to participate. Methods. US Air Force recruits undergoing basic military training (n = 32144) were surveyed regarding demographic and health variables. Results. Respondents indicating an unwillingness to participate in a health survey reported less healthy lifestyles than those willing the participate. Prediction equations modeling the characteristics of those engaging in 4 risky behaviors were nearly identical regardless of whether those refusing to participate were included. Conclusions. Results suggest that, despite some low estimates of health behaviors due to response bias, relationships between most risk factors are generally unaffected by those not responding to health surveys. Handle: RePEc:aph:ajpbhl:1999:89:8:1228-1231_7 Template-Type: ReDIF-Article 1.0 Title: Paradigms in epidemiology textbooks: In the footsteps on Thomas Kuhn Journal: American Journal of Public Health Author-Name: Bhopal, R. Year: 1999 Volume: 89 Issue: 8 Pages: 1162-1165 Abstract: This article attempts to contribute to the debate on the future of epidemiology by combining Thomas Kuhn's ideas on scientific paradigms with the author's observations on some epidemiology textbooks. The author's interpretations were based on his readings of Kuhn's The Structure of Scientific Revolutions, epidemiology textbooks, and papers on the future of epidemiology. Thomas Kuhn's view is that sciences mostly work with a single paradigm driven by exemplars of successful work, and that proposals for paradigm change are resisted. Sciences that are maturing or changing do not have a dominant paradigm. Epidemiology textbooks showed diversity in their concepts, content, and approach. Most exemplars related to etiologic research rather than public health practice. One key focus of the recent controversy regarding the role of epidemiology has been the increasing inability of epidemiology to solve socially based public health problems. Kuhn's views help explain the polarization of views expressed. Kuhn's philosophy of science offers insights into controversies such as whether a paradigm shift is needed or imminent and the gap between epidemiology and public health practice. Interaction between science philosophers, epidemiologists, and public health practitioners may be valuable. Handle: RePEc:aph:ajpbhl:1999:89:8:1162-1165_2 Template-Type: ReDIF-Article 1.0 Title: Social capital and self-rated health: A contextual analysis Journal: American Journal of Public Health Author-Name: Kawachi, I. Author-Name: Kennedy, B.P. Author-Name: Glass, R. Year: 1999 Volume: 89 Issue: 8 Pages: 1187-1193 Abstract: Objectives. Social capital consists of features of social organization - such as trust between citizens, norms of reciprocity, and group membership - that facilitate collective action. This article reports a contextual analysis of social capital and individual self-rated health, with adjustment for individual household income, health behaviors, and other covariates. Methods. Self-rated health ('Is your overall health excellent, very good, good, fair, or poor?') was assessed among 167259 individuals resing in 39 US states, sampled by the Behavioral Risk Factor Surveillance System. Social capital indicators, aggregated to the state level, were obtained from the General Social Surveys. Results. Individual-level factors (e.g., low income, low education, smoking) were strongly associated with self-rated poor health. However, even after adjustment for these proximal variables, a contextual effect of low social capital on risk of self-rated poor health was found. For example, the odds ratio for fair or poor health associated with living in areas with the lowest levels of social trust was 1.41 (95% confidence interval = 1.33, 1.50) compared with living in high-trust states. Conclusions. These results extend previous findings on the health advantages stemming from social capital. Handle: RePEc:aph:ajpbhl:1999:89:8:1187-1193_6 Template-Type: ReDIF-Article 1.0 Title: Twenty-year trends in the reported incidence of mycosis fungoides and associated mortality Journal: American Journal of Public Health Author-Name: Weinstock, M.A. Author-Name: Gardstein, B. Year: 1999 Volume: 89 Issue: 8 Pages: 1240-1244 Abstract: Objectives. Patterns of mycosis fungoides incidence and associated mortality in the United States were evaluated. Methods. Data were taken from the Surveillance, Epidemiology, and End Results cancer registry program and the National Center for Health Statistics. Results. The incidence rate from 1973 through 1992 was 0.36/10 person years. The age-adjusted incidence rate ratio of Blacks to Whites was 1.7; that of Asians to Whites was 0.6. There was no evidence of increasing incidence rates during the period 1983 through 1992. Mortality rates declined steadily from 1979 to 1991 and were less heterogeneous geographically than incidence rates. Mortality rate patterns with age, sex, and race were similar to the corresponding incidence patterns. Conclusion. The incidence rate of mycosis fungoides has stabilized and the mortality rate has declined. For unknown reasons, the disorder varies greatly among demographic and geographic subgroups. Handle: RePEc:aph:ajpbhl:1999:89:8:1240-1244_8 Template-Type: ReDIF-Article 1.0 Title: Adolescent reproductive events and subsequent breast cancer risk Journal: American Journal of Public Health Author-Name: Marcus, P.M. Author-Name: Baird, D.D. Author-Name: Millikan, R.C. Author-Name: Moorman, P.G. Author-Name: Qaqish, B. Author-Name: Newman, B. Year: 1999 Volume: 89 Issue: 8 Pages: 1244-1247 Abstract: Objectives. This study investigated the relationship between reproductive events during adolescence and subsequent breast cancer risk. Methods. Logistic regression models used self-reported data from 862 case patients and 790 controls in the Carolina Breast Cancer Study. Results. Miscarriage, induced abortion, and full-term pregnancy before 20 years of age were not associated with breast cancer. Among premenopausal women, breast- feeding before 20 years of age was inversely associated with disease. Oral contraceptive use before 18 years of age was positively associated with disease risk among African American women only. Conclusions. Pregnancy during adolescence does not appear to influence breast cancer risk, but breast- feeding may. A possible increased breast cancer risk among African American women who used oral contraceptives as adolescents warrants further study. Handle: RePEc:aph:ajpbhl:1999:89:8:1244-1247_9 Template-Type: ReDIF-Article 1.0 Title: The effectiveness of an abuse assessment protocol in public health prenatal clinics Journal: American Journal of Public Health Author-Name: Wiist, W.H. Author-Name: McFarlane, J. Year: 1999 Volume: 89 Issue: 8 Pages: 1217-1221 Abstract: Objectives. This study evaluated whether incorporation of an abuse assessment protocol into the routine procedures of the prenatal clinics of a large urban public health department led to increased referral for and assessment, identification, and documentation of abuse. Methods. Evaluation was conducted at 3 matched prenatal clinics serving a total of 12 000 maternity patients per year. Two clinics used the abuse protocol and 1 did not. An adult was performed at the clinics on a randomly selected sample of 540 maternity patients charts for the 15 months before the protocol was initiated and of 540 records for the 15 months after the protocol was introduced. Ninety-six percent of the patients represented in the sample were Latina. Results. At the clinics using the protocol, abuse assessment increased from 0 to 88%. Detection of abuse increased from 0.8% to 7%. There were no changes at the comparison clinic. Conclusions. Incorporation of an abuse assessment protocol into the routine procedures of public health department prenatal clinics increases the assessment, identification, and documentation of and referral for abuse among pregnant women. An abuse protocol should be a routine part of maternity care. Handle: RePEc:aph:ajpbhl:1999:89:8:1217-1221_2 Template-Type: ReDIF-Article 1.0 Title: The effectiveness of a short form of the household food security scale Journal: American Journal of Public Health Author-Name: Blumberg, S.J. Author-Name: Bialostosky, K. Author-Name: Hamilton, W.L. Author-Name: Briefel, R.R. Year: 1999 Volume: 89 Issue: 8 Pages: 1231-1234 Abstract: Objectives. On the basis of an 18-item Household Food Security Scale, a short form was developed to assess financially based food insecurity and hunger in surveys of households with and without children. Methods. To maximize the probability that households would be correctly classified with respect to food insecurity and hunger, 6 items from the full scale were selected on the basis of April 1995 Current Population Survey data. Results. The short form classified 97.7% of households correctly and underestimated the prevalence of overall food insecurity and of hunger by 0.3 percentage points. Conclusions. The short form of the Household Food Security Scale is a brief but potentially useful tool for national surveys and some state/local applications. Handle: RePEc:aph:ajpbhl:1999:89:8:1231-1234_8 Template-Type: ReDIF-Article 1.0 Title: The right answer for the wrong question: Consequences of type III error for public health research Journal: American Journal of Public Health Author-Name: Schwartz, S. Author-Name: Carpenter, K.M. Year: 1999 Volume: 89 Issue: 8 Pages: 1175-1180 Abstract: Objectives. This study examined the impact of assessing the causes of interindividual variation within a population when the research question of interest is about causes of differences between populations or time periods. This discrepancy between the research focus and the research question is referred to as a type III error, one that provides the right answer for the wrong question. Methods. Homelessness, obesity, and infant mortality were used to illustrate different consequences of type III errors. These different consequences depend on the relationships between the causes of within- and between-group variation. Conclusions. The cause of interindividual variation and the causes of variation between populations and time periods may be distinct. The problem of examining invariant causes deserves attention. Handle: RePEc:aph:ajpbhl:1999:89:8:1175-1180_9 Template-Type: ReDIF-Article 1.0 Title: Birth defects surveillance: Assessing the 'gold standard' Journal: American Journal of Public Health Author-Name: Honein, M.A. Author-Name: Paulozzi, L.J. Year: 1999 Volume: 89 Issue: 8 Pages: 1238-1240 Abstract: Objectives. This study assessed the sensitivity of the Metropolitan Atlanta Congenital Defects Program (MACDP) by capitalizing on the delayed receipt of a data source. Methods. In 1997, we reviewed the medical records of potential cases from the 1995 birth certificates that had not previously been identified by the MACDP. Capture-recapture methods produced an estimate of total cases. Results. We identified 1149 infants with defects, including 20 exclusively from birth certificates. The estimated sensitivity of the MACDP when data from birth certificates were included was 86.9% (95% confidence interval [CI] = 80.6%, 91.9%) at 1 year after birth, increasing to 94.8% (95% CI = 90.3%, 97.8%) at 2 years after birth. Conclusions. The MACDP under estimates defects by 13% at 1 year after birth and by 5% at 2 years after birth. Handle: RePEc:aph:ajpbhl:1999:89:8:1238-1240_1 Template-Type: ReDIF-Article 1.0 Title: Ethnicity and birthplace in relation to tumor size and stage in Asian American women with breast cancer Journal: American Journal of Public Health Author-Name: Hedeen, A.N. Author-Name: White, E. Author-Name: Taylor, V. Year: 1999 Volume: 89 Issue: 8 Pages: 1248-1252 Abstract: Objectives. This study examined whether Asian American women with breast cancer have tumor characteristics associated with delayed detection of their disease. Methods. Breast cancer size and stage were examined in relation to subjects' ethnic group and birthplace, on the basis of Surveillance, Epidemiology, and End Results program data. Results. Asian-born Asian American women with breast cancer had a greater proportion of tumors larger than 1 cm at diagnosis (79%) than did US White women (70%) (P < .001). In contrast, the proportion of tumors larger than 1 cm among Asian American women born in the United States (67%) did not differ significantly from that among US White women. Conclusions. Lower utilization of breast cancer screening by Asian-born Asian American women is probably responsible for their greater proportion of tumors larger than 1 cm relative to US White women in the study population. Interventional measures should be taken to increase the use of mammographic screening by first-generation Asian American women. Handle: RePEc:aph:ajpbhl:1999:89:8:1248-1252_2 Template-Type: ReDIF-Article 1.0 Title: Jamaica's measles elimination experience Journal: American Journal of Public Health Author-Name: Hirshon, J.M. Author-Name: Irons, B. Author-Name: Figueroa, P. Author-Name: Lewis-Bell, K. Author-Name: Goodman, M. Author-Name: Kirk, G.D. Author-Name: Hersh, B.S. Year: 1999 Volume: 89 Issue: 8 Pages: 1254-1255 Abstract: Objectives. This article describes the effort to eliminate measles from Jamaica and its impact on measles incidence. Methods. In addition to routine measles vaccination, the Jamaican Ministry of Health implemented a strategy of a 1-time-only catch-up vaccination campaign, conducted in 1991, and periodic follow-up campaigns, the first of which occurred in 1995. Results. Since 1991, despite careful surveillance, no serologically confirmed indigenous cases of measles have occurred in Jamaica. Conclusions. Measles virus circulation has been interrupted in Jamaica. The Jamaican experience provides further evidence that global measles eradication is achievable. Handle: RePEc:aph:ajpbhl:1999:89:8:1254-1255_7 Template-Type: ReDIF-Article 1.0 Title: Rates of lower-extremity amputation and arterial reconstruction in the United States, 1979 to 1996 Journal: American Journal of Public Health Author-Name: Feinglass, J. Author-Name: Brown, J.L. Author-Name: LoSasso, A. Author-Name: Sohn, M.-W. Author-Name: Manheim, L.M. Author-Name: Shah, S.J. Author-Name: Pearce, W.H. Year: 1999 Volume: 89 Issue: 8 Pages: 1222-1227 Abstract: Objectives. This report describes trends in the rates of lower-extremity amputation and revascularization procedures and vascular disease risk factors. Methods. We analyzed trends in National Hospital Discharge Survey data for 1979 through 1996 and in National Health Interview Study data for 1983 through 1994. Results. Despite a decline between 1983/84 and 1991/92, by 1995/96 the rate of major amputation had increased 10.6% since 1979/80. The earlier 12 year decline was positively correlated with reductions in the prevalence of smoking (r = 0.88, P < .0001), hypertension (r = 0.65, P = .02), and heart disease (r = 0.73, P = .007), but not diabetes (r = -0.33, P = .29). During the 1980s, amputation and angioplasty rates were inversely correlated (r = -0.75, P = .001), but the decline in amputation rates occurred before the increase in angioplasty. The major amputation rate, which has increased since 1993, was 24.95 per 100 000 people in 1996. Conclusions. Major amputation rates fell in the years following the diffusion of distal bypass surgery but before the widespread use of peripheral angioplasty. Because disease prevalence and primary amputation rates are unknown, it is difficult to estimate the contribution of recent improvements in vascular surgery to limb preservation. Handle: RePEc:aph:ajpbhl:1999:89:8:1222-1227_8 Template-Type: ReDIF-Article 1.0 Title: Reassessing the role of epidemiology in public health Journal: American Journal of Public Health Author-Name: Savitz, D.A. Author-Name: Poole, C. Author-Name: Miller, W.C. Year: 1999 Volume: 89 Issue: 8 Pages: 1158-1161 Abstract: This commentary examines the scope of epidemiology and delineates the role of epidemiology in relation to public health. Epidemiology is a science; public health is a mission that is implemented through societal action. The implications of this differences are considered, and the sufficiency of epidemiology for guiding public health is evaluated in relation to other scientific disciplines and nonscientific considerations. The authors conclude that epidemiology is not the basic science of public health but one of many contributors to guiding action. The need for public health decisions despite scientific uncertainty and the potential for epidemiologic certainty's failing to provide clear guidance to public health action emphasize the distinctiveness of these endeavors. Criticisms that epidemiology fails to solve major public health problems, such as tobacco use; that it overemphasizes methods; that it fails to meet the needs of public health practitioners; and that it isolates itself from public health ethics are unwarranted. However, epidemiology should focus on addressing issues that directly affect public health decisions and should clearly communicate information about such issues to public health workers. Public health is far more complex than merely applying epidemiology. Handle: RePEc:aph:ajpbhl:1999:89:8:1158-1161_9 Template-Type: ReDIF-Article 1.0 Title: Neighborhood environment and self-reported health status: A multilevel analysis Journal: American Journal of Public Health Author-Name: Malmström, M. Author-Name: Sundquist, J. Author-Name: Johansson, S.-E. Year: 1999 Volume: 89 Issue: 8 Pages: 1181-1186 Abstract: Objectives. This study examined whether neighborhood socioeconomic environment helps to explain the proportion of community members with self- reported poor health status. Methods. A random sample of 9240 persons aged 25 to 74 years were interviewed during 1988 and 1989. The socioeconomic environment of each respondent's neighborhood was measured with the Care Need Index (CNI) and the Townsend score. The data were analyzed with a multilevel model adjusted for the independent variables. The second-level variables were the 2 neighborhood scores. Results. There was a clear gradient for poor health and education within every CNI interval so that with an increasing CNI (indicating more deprivation), the prevalence of poor health increased in all 3 education groups (P = .001). In the full model, decreasing educational level, obesity, length and frequency of smoking, physical inactivity, and increasing CNI were associated with poor health. Persons living in the most deprived neighborhoods had a prevalence ratio of 1.69 (95% confidence interval = 1.44, 1.98) for poor health compared with those living in the most affluent areas. Conclusions. Both neighborhood socioeconomic environment and individual educational status are associated with self-reported poor health. Handle: RePEc:aph:ajpbhl:1999:89:8:1181-1186_5 Template-Type: ReDIF-Article 1.0 Title: Frequency of policy recommendations in epidemiologic publications Journal: American Journal of Public Health Author-Name: Jackson, L.W. Author-Name: Lee, N.L. Author-Name: Samet, J.M. Year: 1999 Volume: 89 Issue: 8 Pages: 1206-1211 Abstract: Objectives. The purpose of this study was to determine the frequency and character of policy statements in epidemiologic reports. Methods. The first author followed a standardized protocol and reviewed a random sample of articles selected from the American Journal of Epidemiology, Annals of Epidemiology and Epidemiology. The second author reviewed all articles with policy statements and a 10% sample without such statements. Results. Overall, 23.8% of the articles contained policy statements. Annals of Epidemiology and the American Journal of Epidemiology had similar frequencies of articles with policy statements (30% and 26.7%, respectively), while Epidemiology evidenced the lowest frequency (8.3%). The majority of policy statements (55%) pertained to public health practice; 27.5% involved clinical practice, and the remainder (17.5%) focused on corporate policies, regulatory actions, or undefined arenas. The frequency of policy statements differed according to first author's affiliation, type of publication, area of research, research design, and study population. Conclusions. Although a minority of publications included policy statements, the inclusion of a statement seemed to be influenced by specific study characteristics. Handle: RePEc:aph:ajpbhl:1999:89:8:1206-1211_1 Template-Type: ReDIF-Article 1.0 Title: Individual causal models and population system models in epidemiology Journal: American Journal of Public Health Author-Name: Koopman, J.S. Author-Name: Lynch, J.W. Year: 1999 Volume: 89 Issue: 8 Pages: 1170-1174 Abstract: A group of individuals behaves as a population system when patterns of connections among individuals influence population health outcomes. Epidemiology usually treats populations as collections of independent individuals rather than as systems of interacting individuals. An appropriate theoretical structure, which includes the determinants of connections among individuals, is needed to develop a 'population system epidemiology'. Infection transmission models and sufficient-component cause models provide contrasting templates for the needed theoretical structure. Sufficient- component cause models focus on joint effects of multiple exposures in individuals. They handle time and interactions between individuals in the definition of variables and assume that populations are the sum of their individuals. Transmission models, in contrast, model interactions among individuals over time. Their nonlinear structure means that population risks are not simply the sum of individual risks. The theoretical base for 'population system epidemiology' should integrate both approaches. It should model joint effects of multiple exposures in individuals as time related processes while incorporating the determinants and effects of interactions among individuals. Recent advances in G-estimation and discrete individual transmission model formulation provide opportunities for such integration. Handle: RePEc:aph:ajpbhl:1999:89:8:1170-1174_2 Template-Type: ReDIF-Article 1.0 Title: The direct health care costs of obesity in the United States Journal: American Journal of Public Health Author-Name: Allison, D.B. Author-Name: Zannolli, R. Author-Name: Narayan, K.M.V. Year: 1999 Volume: 89 Issue: 8 Pages: 1194-1199 Abstract: Objectives. Recent estimates suggest that obesity accounts for 5.7% of US total direct health care costs, but these estimates have not accounted for the increased death rate among obese people. This article examines whether the estimated direct health care costs attributable to obesity are offset by the increased mortality rate among obese individuals. Methods. Data on death rates, relative risks of death with obesity, and health care costs at different ages were used to estimate direct health care costs of obesity from 20 to 85 years of age with and without accounting for increased death rates associated with obesity. Sensitivity analyses used different values of relative risk of death, given obesity, and allowed the relative costs due to obesity per unit of time to vary with age. Results. Direct health care costs from 20 to 85 years of age were estimated to be approximately 25% lower when differential mortality was taken into account. Sensitivity analyses suggested that direct health care costs of obesity are unlikely to exceed 4.32% or to be lower than 0.89%. Conclusions. Increased mortality among obese people should be accounted for in order not to overestimate health care costs. Handle: RePEc:aph:ajpbhl:1999:89:8:1194-1199_4 Template-Type: ReDIF-Article 1.0 Title: All-terrain vehicle-related deaths among the West Virginia elderly, 1985 to 1998 [2] Journal: American Journal of Public Health Author-Name: Helmkamp, J.C. Year: 1999 Volume: 89 Issue: 8 Pages: 1263-1264 Handle: RePEc:aph:ajpbhl:1999:89:8:1263-1264_2 Template-Type: ReDIF-Article 1.0 Title: The role of syringe filters in harm reduction among injection drug users Journal: American Journal of Public Health Author-Name: Caflisch, C. Author-Name: Wang, J. Author-Name: Zbinden, R. Year: 1999 Volume: 89 Issue: 8 Pages: 1252-1254 Abstract: Objectives. Three filters were tested for in situ efficacy in reducing bacterial contamination associated with injection drug use. Methods. In a self-matched control design with blinded laboratory testing, injection drug users were asked to use 3 filters in random succession when loading their syringes with drug solution. Results. The 0.22-μm filter proved significantly better than both the cigarette filter (relative risk IRRI = 18.0) and the 20-μm filter (RR = 4.5) in rendering syringes bacteria-free. Conclusions. The 15- to 20-μm syringe filter currently provided infection drug users in Switzerland does not significantly reduce contamination associated with common bacterial infections among users. Filters with pore width 1/100th as large are recommended. Handle: RePEc:aph:ajpbhl:1999:89:8:1252-1254_4 Template-Type: ReDIF-Article 1.0 Title: Public health in managed care: A randomized controlled trial of the effectiveness of postcard reminders Journal: American Journal of Public Health Author-Name: Clayton, A.E. Author-Name: McNutt, L.-A. Author-Name: Homestead, H.L. Author-Name: Hartman, T.W. Author-Name: Senecal, S. Year: 1999 Volume: 89 Issue: 8 Pages: 1235-1237 Abstract: Objectives. This study evaluated the effectiveness of an annual public health intervention in a managed care setting. Methods. Managed care organization members 65 years and older who received influenza immunization in 1996 were randomized to an intervention group (mailed a postcard reminder to receive an influenza vaccination in 1997) or a control group (no postcard). Vaccination rates for both groups were assessed monthly. Results. Members receiving the intervention were no more likely to be immunized (78.6%) than members of the control group (77.2%, P = .222). Members were vaccinated at the same pace regardless of vaccination history and postcard intervention status. Conclusions. Postcard reminders were not an effective intervention among seniors who had been vaccinated the previous year. Handle: RePEc:aph:ajpbhl:1999:89:8:1235-1237_3 Template-Type: ReDIF-Article 1.0 Title: Defending diversity: Affirmative action and medical education Journal: American Journal of Public Health Author-Name: DeVille, K. Year: 1999 Volume: 89 Issue: 8 Pages: 1256-1261 Abstract: Affirmative action programs of all types are under attack legally and politically. Although medical schools have not been specifically targeted, their affirmative action programs, like others in higher education, are potentially in danger. This article examines the current legal status of affirmative action in medical education and concludes that a refurbished defense of such programs is essential if they are to survive impending judicial and political scrutiny. An analysis of existing case law and available evidence suggests that a carefully reinvigorated diversity arguments is the tactic most likely to pass constitutional muster, as well as the justification most likely to blunt growing public and political opposition to admissions policies that take care and ethnicity into consideration. Handle: RePEc:aph:ajpbhl:1999:89:8:1256-1261_9 Template-Type: ReDIF-Article 1.0 Title: Relation of probability of causation to relative risk and doubling dose: A methodologic error that has become a social problem Journal: American Journal of Public Health Author-Name: Greenland, S. Year: 1999 Volume: 89 Issue: 8 Pages: 1166-1169 Abstract: Epidemiologists, biostatisticians, and health physicians frequently serve as expert consultants to lawyers, courts, and administrators. One of the most common errors committed by experts is to equate, without qualification, the attributable fraction estimated from epidemiologic data to the probability of causation requested by courts and administrators. This error has become so pervasive that it has been incorporated into judicial precedents and legislation. This commentary provides a brief overview of the error and the context in which it arises. Handle: RePEc:aph:ajpbhl:1999:89:8:1166-1169_2 Template-Type: ReDIF-Article 1.0 Title: Association between iron deficiency and low-level lead poisoning in an urban primary care clinic Journal: American Journal of Public Health Author-Name: Wright, R.O. Author-Name: Shannon, M.W. Author-Name: Wright, R.J. Author-Name: Hu, H. Year: 1999 Volume: 89 Issue: 7 Pages: 1049-1053 Abstract: Objectives. The purpose of this study was to examine the association between iron deficiency and low-level lead poisoning. Methods. Data were collected in an urban primary care clinic from 3650 children aged 9 to 48 months. Iron deficiency was defined as a red cell mean corpuscular volume (MCV) of less than 70 fL and a red cell distribution width (RDW) of more than 14.5 in children younger than 2 years, and an MCV of less than 73 fL and RDW of more than 14.5 in those 2 years or older. Results. After adjustment for age, hemoglobin concentration, and insurance status, the odds ratios for iron deficiency predicting blood lead levels greater than or equal to 5 μg/dL and greater than or equal to 10 μg/dL were 1.63 (95% confidence interval [CI] = 1.29, 2.04) and 1.44 (95% CI = 1.004, 2.05). Conclusions. Iron deficiency is significantly associated with low-level lead poisoning in children aged 9 to 48 months. Handle: RePEc:aph:ajpbhl:1999:89:7:1049-1053_6 Template-Type: ReDIF-Article 1.0 Title: Back pain prevalence in US industry and estimates of lost workdays Journal: American Journal of Public Health Author-Name: Gou, H.-R. Author-Name: Tanaka, S. Author-Name: Halperin, W.E. Author-Name: Cameron, L.L. Year: 1999 Volume: 89 Issue: 7 Pages: 1029-1035 Abstract: Objectives. Back pain is the most common reason for filing workers' compensation claims and often causes lost workdays. Data from the 1988 National Health Interview Survey were analyzed to identify high-risk industries and to estimate the prevalence of work-related back pain and number of workdays lost. Methods. Analyses included 30074 respondents who worked during the 12 months before the interview. A case patient was defined as a respondent who had back pain every day for a week or more during that period. Results. The prevalence of lost-workday back pain was 4.6%, and individuals with work-related cases lost 101.8 million workdays owing to back pain. Male and female case patients lost about the same number of workdays. Industries in high-risk categories were also identified for future research and intervention, including those seldom studied. Conclusions: This study provides statistically reliable national estimates of the prevalence of back pain among workers and the enormous effect of this condition on American industry in terms of lost workdays. Handle: RePEc:aph:ajpbhl:1999:89:7:1029-1035_7 Template-Type: ReDIF-Article 1.0 Title: Health policy and ethics forum: Managed care plan performance since 1980: Another look at 2 literature reviews Journal: American Journal of Public Health Author-Name: Sullivan, K. Year: 1999 Volume: 89 Issue: 7 Pages: 1003-1008 Abstract: Objectives. This article compares the quality of care provided by managed care plans (MCPs) and indemnity (or fee-for-service [FFS]) plans since 1980. Methods. The 44 studies examined are the studies that Miller and Luft cited in their 1994 and 1997 reviews of the literature comparing MCPs with FFS plans. These studies are examined to determine how well they met Miller and Luft's selection criteria and, in addition, whether they controlled for differences in the breadth of insurance coverage. Results. The 44 studies generated 57 observations. MCPs scored better than FFS plans on 10 of these, equally well on 25, and worse on 22. However, only 44 of these observations met the Miller-Luft criteria plus the coverage criterion. Four of these indicated that MCP care was better, 19 that MCP and FFS care were equivalent, and 21 that MCP care was worse. Conclusions. The small body of reliable studies comparing the quality of MCP care with that FFS care indicates that the quality of care provided by MCPs tends to be equal or inferior to that provided by FFS plans. Handle: RePEc:aph:ajpbhl:1999:89:7:1003-1008_8 Template-Type: ReDIF-Article 1.0 Title: The relation of gestation length to short-term heat stress Journal: American Journal of Public Health Author-Name: Porter, K.R. Author-Name: Thomas, S.D. Author-Name: Whitman, S. Year: 1999 Volume: 89 Issue: 7 Pages: 1090-1092 Abstract: Objectives. This study examined the association between gestation length and heat exposure during the summer months of the Chicago heat wave of 1995. Methods. Birth data from Illinois vital records containing 11792 singleton vaginal births were analyzed to calculate mean gestational ages. Results. No evidence was found to suggest an association between shortened gestation and increased maximum apparent temperature. Conclusions. The data propose no special precautions for pregnant women exposed to short-term heat stress of the intensity evaluated in this study. However, the possible effects of chronic heat exposure on gestation cannot be ruled out. Handle: RePEc:aph:ajpbhl:1999:89:7:1090-1092_4 Template-Type: ReDIF-Article 1.0 Title: Trends in AIDS among hispanics in the United States, 1991-1996 Journal: American Journal of Public Health Author-Name: Klevens, R.M. Author-Name: Diaz, T. Author-Name: Fleming, P.L. Author-Name: Mays, M.A. Author-Name: Frey, R. Year: 1999 Volume: 89 Issue: 7 Pages: 1104-1106 Abstract: Objectives. This article describes recent trends in AIDS among US Hispanics. Methods. Incidence rates were calculated from AIDS surveillance data for persons diagnosed from 1991 through 1996. Increases in the number of cases among Hispanics were calculated by linear regression. Results. Of the 415 864 persons diagnosed with AIDS from 1991 through 1996, 19% were Hispanic. Among Hispanics with AIDS, 67% were born in the United States or Puerto Rico. The relative risk (RR) of AIDS for Hispanics compared with Whites was highest for women (RR = 7.0), followed by children (RR = 6.2) and men (RR = 2.8). Increases in the number of cases were higher among foreign- born Hispanics. Conclusions. An understanding of which Hispanic subgroups are at greatest risk for HIV infection is important for prevention efforts. Handle: RePEc:aph:ajpbhl:1999:89:7:1104-1106_6 Template-Type: ReDIF-Article 1.0 Title: Clinician follow-up of children screened for lead poisoning Journal: American Journal of Public Health Author-Name: Markowitz, M. Author-Name: Rosen, J.F. Author-Name: Clemente, I. Year: 1999 Volume: 89 Issue: 7 Pages: 1088-1090 Abstract: Objectives. This study assessed clinicians' compliance with Centers for Disease Control and Prevention recommendations for follow-up of children with blood lead (BPb) levels of 0.48 μmol/L (10 μg/dL) or higher. Methods. Clinicians success at follow-up was determined for 3 BPb ranges: ≥0.97 μmol/L, 0.73 through 0.92 μmol/L, and 0.48 through 0.68 μmol/L (≥20 μg/dL, 15-19 μg/dL, and 10-14 μg/dL, respectively). Results. A total of 410 children with elevated BPb levels were followed over a 12-month period; within 4 months, 71% of those with initial levels of 0.97 μmo/L or greater were retested and 57% and 34% of children with initial BPb levels of 0.73 through 0.92 μmol/L and 0.48 through 0.68 μmol/L, respectively, were retested. Conclusions. Follow-up of children with elevated BPb levels in inadequate within an urban ambulatory care network. Handle: RePEc:aph:ajpbhl:1999:89:7:1088-1090_6 Template-Type: ReDIF-Article 1.0 Title: The association between occupational lead exposure and serum cholesterol and lipoprotein levels Journal: American Journal of Public Health Author-Name: Kristal-Boneh, E. Author-Name: Coller, D. Author-Name: Froom, P. Author-Name: Harari, G. Author-Name: Ribak, J. Year: 1999 Volume: 89 Issue: 7 Pages: 1083-1087 Abstract: Objectives. This study sought to clarify the possible associations between blood lead level and serum cholesterol and lipoprotein levels in subjects occupationally exposed to lead. Methods. Levels of blood lead, serum total cholesterol, low-density lipoprotein cholesterol high-density lipoprotein (HDL) cholesterol, and triglycerides in 56 male industrial employees who were exposed to lead were compared with those in 87 unexposed employees. Results. Mean blood lead levels were 42.3 (±14.9) μg/dL in the exposed group and 2.7 (±3.6) μg/dL in the nonexposed group. The exposed subjects had higher mean levels of total cholesterol and HDL cholesterol. Conclusions. Blood lead levels are positively associated with total and HDL cholesterol. Handle: RePEc:aph:ajpbhl:1999:89:7:1083-1087_6 Template-Type: ReDIF-Article 1.0 Title: Trends in medical employment: Persistent imbalances in urban Mexico Journal: American Journal of Public Health Author-Name: Frenk, J. Author-Name: Knaul, F.M. Author-Name: Vázquez-Segovia, L.A. Author-Name: Nigenda, G. Year: 1999 Volume: 89 Issue: 7 Pages: 1054-1058 Abstract: Objectives. This study examined the extreme medical unemployment and underemployment in the urban areas of Mexico. The conceptual and methodological approach may be relevant to many countries that have experienced substantial increases in the supply of physicians during the last decades. Methods. On the basis of 2 surveys carried out in 1986 and 1993, the study analyzed the performance of physicians in the labor market as a function of ascription variables (social origin and gender), achievement variables (quality of medical education and specialty studies), and contextual variables (educational generation). Results. The study reveals, despite some improvement, persistently high levels of open unemployment, qualitative underemployment (i.e., work in activities completely outside of medicine), and quantitative underemployment (i.e., work in medical activities but with very low levels of productivity and remuneration). The growing proportion of female doctors presents new challenges, because they are more likely than men to be unemployed and underemployed. Conclusions. While corrective policies can have a positive impact, it is clear that decisions regarding physician supply must be carefully considered, because they have long-lasting effects. An area deserving special attention is the improvement of professional opportunities for female doctors. Handle: RePEc:aph:ajpbhl:1999:89:7:1054-1058_9 Template-Type: ReDIF-Article 1.0 Title: Protecting public health in the face of uncertain risks: The example of diesel exhaust Journal: American Journal of Public Health Author-Name: Stayner, L. Year: 1999 Volume: 89 Issue: 7 Pages: 991-993 Handle: RePEc:aph:ajpbhl:1999:89:7:991-993_8 Template-Type: ReDIF-Article 1.0 Title: The duration and timing of exposure: Effects of socioeconomic environment on adult health Journal: American Journal of Public Health Author-Name: Power, C. Author-Name: Manor, O. Author-Name: Matthews, S. Year: 1999 Volume: 89 Issue: 7 Pages: 1059-1065 Abstract: Objectives. This study investigated timing and duration effects of socio-economic status (SES) on self-rated health at 33 years of age and established whether health risks are modified by changing SES and whether cumulative SES operates through education. Methods. Data were from the 1958 British birth cohort. Occupational class at birth and at 16, 23, and 33 years of age was used to generate a lifetime SES score. Results. At 33 years of age, 12% of men and women reported poor health. SES at birth and at 16, 23, and 33 years of age was significantly associated with poor health: all ages except 16 years in men made an additional contribution to the prediction of poor health. No large differences in effect sizes emerged, suggesting that timing was not a major factor. Odds of poor health increased by 15% (men) and 18% (women) with a 1-unit increase in the lifetime SES score. Strong effects of lifetime SES persisted after adjustment for education level. Conclusions. SES from birth to 33 years of age had a cumulative effect on poor health in early adulthood. This highlights the importance of duration of exposure to socioeconomic conditions for adult health. Handle: RePEc:aph:ajpbhl:1999:89:7:1059-1065_7 Template-Type: ReDIF-Article 1.0 Title: Driver distance from the steering wheel: Perception and objective measurement Journal: American Journal of Public Health Author-Name: Segui-Gomez, M. Author-Name: Levy, J. Author-Name: Roman, H. Author-Name: Thompson, K.M. Author-Name: McCabe, K. Author-Name: Graham, J.D. Year: 1999 Volume: 89 Issue: 7 Pages: 1109-1111 Abstract: Objectives. This study assessed the accuracy of driver perceptions of the distance between the driver's nose and the steering wheel of the vehicle as a factor in considering driver disconnection of an airbag contained in the steering wheel for preventing injury to the driver in an accident. Methods. A cross-sectional survey of 1000 drivers was done to obtain perceived and objective measurements of the distance between the driver's nose and the steering wheel of the vehicle. Results. Of 234 drivers who believed that they sat within 12 inches of the steering wheel, only 8 (3%) actually did so, whereas of 658 drivers who did not believe that they sat within 12 inches of the wheel, 14 (2%) did so. Shorter drivers were more likely than taller ones to both underestimate and overestimate their seating distance. Conclusions. Considerable mis-perception of drivers' distance from the wheel indicates that drivers should objectively measure this distance. Handle: RePEc:aph:ajpbhl:1999:89:7:1109-1111_1 Template-Type: ReDIF-Article 1.0 Title: Diesel exhaust exposure among adolescents in Harlem: A community-driven study Journal: American Journal of Public Health Author-Name: Northridge, M.E. Author-Name: Yankura, J. Author-Name: Kinney, P.L. Author-Name: Santella, R.M. Author-Name: Shepard, P. Author-Name: Riojas, Y. Author-Name: Aggarwal, M. Author-Name: Strickland, P. Year: 1999 Volume: 89 Issue: 7 Pages: 998-1002 Abstract: Objectives. This study sought individual-level data on diesel exhaust exposure and lung function among adolescents in Harlem as part of a community-driven research agenda. Methods. High school students administered in-person surveys to seventh grade students to ascertain information on demographics, asthma history, and self-reported and maternal smoking. Urine samples were assayed for 1-hydroxypyrene (1-HP), a marker of diesel exhaust exposure, and cotinine, a marker of tobacco smoke exposure. Computer-assisted spirometry was used to measure lung function. Results. Three quarters (76%) of the participating students had detectable levels of 1-HP. Three students (13%) had an FEF25-75 of less than or equal to 80% of their predicted measurements, and 4 students (17%) had results between 80% and 90% of the predicted value, all of which are suggestive of possible lung impairment. Conclusions. These data suggest that most adolescents in Harlem are exposed to detectable levels of diesel exhaust, a known exacerbator and possible cause of chronic lung disorders such as asthma. Community-driven research initiatives are important for empowering communities to make needed changes to improve their environments and health. Handle: RePEc:aph:ajpbhl:1999:89:7:998-1002_2 Template-Type: ReDIF-Article 1.0 Title: Estimating the proportion of homes with functioning smoke alarms: A comparison of telephone survey and household survey results Journal: American Journal of Public Health Author-Name: Douglas, M.R. Author-Name: Mallonee, S. Author-Name: Istre, G.R. Year: 1999 Volume: 89 Issue: 7 Pages: 1112-1114 Abstract: Objectives. This study determined the proportion of homes with functioning smoke alarms in a low-income area experiencing a high rate of residential fire-related injuries. Methods. An on-site survey of households was conducted to confirm the results of a telephone survey. Results. In the telephone survey, 71% of households reported having functioning smoke alarms. In the household survey, 66% of households reported having functioning alarms; however, when the alarms were tested, the percentage dropped to 49%. Conclusions. Telephone surveys may overestimate the presence of functioning smoke alarms in some populations. Thus, the use of telephone surveys to establish baseline measures could significantly affect the evaluation of smoke alarm giveaway programs. Handle: RePEc:aph:ajpbhl:1999:89:7:1112-1114_2 Template-Type: ReDIF-Article 1.0 Title: Name-based reporting of HIV-positive test results as a deterrent to testing Journal: American Journal of Public Health Author-Name: Woods, W.J. Author-Name: Dilley, J.W. Author-Name: Lihatsh, T. Author-Name: Sabatino, J. Author-Name: Adler, B. Author-Name: Rinaldi, J. Year: 1999 Volume: 89 Issue: 7 Pages: 1097-1100 Abstract: Objectives. This study evaluated attitudes toward name-based reporting of HIV. Methods. One hundred thirty high-risk, male repeat testers received information on the public health benefits of name-based reporting and reported their intentions to test. Results. Of the 67 men who were randomly selected and asked their intentions before hearing the benefits, 63% said they would not test if reporting were required. After hearing the benefits, 19% changed their minds (P <.014). Of the 63 men who were asked only after hearing the benefits, 44% would not test. Conclusions. Implementing name- based reporting without working before-hand to change attitudes could undermine the benefits of both testing and HIV surveillance. Handle: RePEc:aph:ajpbhl:1999:89:7:1097-1100_6 Template-Type: ReDIF-Article 1.0 Title: Residential radon exposure and risk of lung cancer in Missouri Journal: American Journal of Public Health Author-Name: Alavanja, M.C.R. Author-Name: Lubin, J.H. Author-Name: Mahaffey, J.A. Author-Name: Brownson, R.C. Year: 1999 Volume: 89 Issue: 7 Pages: 1042-1048 Abstract: Objectives. This study investigated residential radon exposure and lung cancer risk, using both standard radon dosimetry and a new radon monitoring technology that evidence suggests, is a better measure of cumulative radon exposure. Methods. Missouri women (aged 30 to 84 years) newly diagnosed with primary lung cancer during the period January 1, 1993, to January 31, 1994 were invited to participate in this population-based case-control study. Both indoor air radon detectors and CR-39 alpha-particle detectors (surface monitors) were used. Results. When surface monitors were used, a significant trend in lung cancer odds ratios was observed for 20-year time-weighted- average radon concentrations. Conclusions. When surface monitors were used, but not when standard radon dosimetry was used, a significant lung cancer risk was found for radon concentrations at and above the action level for mitigation of houses currently used in the United States (148 Bqm-3). The risk was below the action level used in Canada (750 Bqm-3) and many European countries (200-400 Bqm-3). Handle: RePEc:aph:ajpbhl:1999:89:7:1042-1048_5 Template-Type: ReDIF-Article 1.0 Title: Tuberculosis and the HIV epidemic: Increasing annual risk of tuberculous infection in Kenya, 1986-1996 Journal: American Journal of Public Health Author-Name: Odhiambo, J.A. Author-Name: Borgdorff, M.W. Author-Name: Kiambih, F.M. Author-Name: Kibuga, D.K. Author-Name: Kwamanga, D.O. Author-Name: Ng'ang'a, L. Author-Name: Agwanda, R. Author-Name: Kalisvaart, N.A. Author-Name: Misljenovic, O. Author-Name: Nagelkerke, N.J.D. Author-Name: Bosman, M. Year: 1999 Volume: 89 Issue: 7 Pages: 1078-1082 Abstract: Objectives. The purpose of this study was to assess the impact of the increased incidence of tuberculosis (TB) due to HIV infection on the risk of TB infection in schoolchildren. Methods. Tuberculin surveys were carried out in randomly selected primary schools in 12 districts in Kenya during 1986 through 1990 and 1994 through 1996. Districts were grouped according to the year in which TB notification rates started to increase. HIV prevalence in TB patients and changes in TB infection prevalence were compared between districts. Results. Tuberculous infection prevalence rates increased strongly in districts where TB notification rates had increased before 1994 (odds ratio = 3.1, 95% confidence interval = 2.3, 4.1) but did not increase in districts where notification rates had increased more recently or not at all. HIV prevalence rates in TB patients were 50% in districts with an early increase in notification rates and 28% in the other study districts. Conclusions. Countries with an increasing prevalence of HIV infection will need additional resources for TB control, not only for current patients but also for the patients in additional cases arising from the increased risk of TB infection. Handle: RePEc:aph:ajpbhl:1999:89:7:1078-1082_1 Template-Type: ReDIF-Article 1.0 Title: State and federal revenues from tobacco consumed by minors Journal: American Journal of Public Health Author-Name: DiFranza, J.R. Author-Name: Librett, J.J. Year: 1999 Volume: 89 Issue: 7 Pages: 1106-1108 Abstract: Objectives. The purpose of this study was to estimate the value of cigarettes consumed in 1997 by youths younger than 18 years. Methods. Price, population, and consumption data were used to compute conservative and comprehensive estimates, which were then averaged. Results. An estimated 3.76 million daily smokers aged 12 through 17 years consume an estimated 924 million packs of cigarettes per year, generating $222 million in federal tax revenues, $293 million in state tax revenues, and $480 million in tobacco company profits, and producing a retail value of $1.86 billion. Conclusions. The revenues from cigarettes smoked by youths could be used to enforce laws prohibiting the sale of tobacco to minors. Handle: RePEc:aph:ajpbhl:1999:89:7:1106-1108_6 Template-Type: ReDIF-Article 1.0 Title: Occupational exposure to diesel exhaust and lung cancer: A meta-analysis Journal: American Journal of Public Health Author-Name: Lipsett, M. Author-Name: Campleman, S. Year: 1999 Volume: 89 Issue: 7 Pages: 1009-1017 Abstract: Objectives. We undertook a meta-analysis of epidemiological studies investigating the relationship between occupational diesel exhaust exposure and lung cancer. Methods. Thirty of 47 studies initially identified as potentially relevant met specified inclusion criteria. We extracted or calculated 39 independent estimates of relative risk and derived pooled estimates of risk for all studies and for numerous study subsets by using a random-effects model. We also examined interstudy heterogeneity by using linear metaregressions. Results. There was substantial heterogeneity in the pooled risk estimates for all studies combined and for most subsets. Several factors consistent with higher study quality, however, contributed to increased pooled estimates of risk and lower heterogeneity, including (1) adjustment for confounding by cigarette smoking and other covariates, (2) having a lower likelihood of selection bias, and (3) having increased study power. Conclusion. This analysis provides quantitative support for prior qualitative reviews that have ascribed an etiologic role to occupational diesel exhaust exposure in lung cancer induction. Among study populations most likely to have had substantial exposure to diesel exhaust, the pooled smoking-adjusted relative risk was 1.47 (95% confidence interval = 1.29, 1.67). Handle: RePEc:aph:ajpbhl:1999:89:7:1009-1017_4 Template-Type: ReDIF-Article 1.0 Title: Health care worker disability due to latex allergy and asthma: A cost analysis Journal: American Journal of Public Health Author-Name: Phillips, V.L. Author-Name: Goodrich, M.A. Author-Name: Sullivan, T.J. Year: 1999 Volume: 89 Issue: 7 Pages: 1024-1028 Abstract: Objectives. The reported prevalence of occupational allergy to natural rubber latex is 8% to 17%, and that of latex-induced occupational asthma is 2.5% to 6%. Conversion of medical facilities to 'latex-safe' can reduce employee sensitization, impairment, and disability. The purpose of this study was to determine the cost of a latex-safe approach, compared with that of continued latex glove use, and to identify the level of worker disability required to make the latex-safe approach financially preferable to a health care institution. Methods. The costs of 2 strategies-latex-safe vs the status quo were calculated from the perspective of 3 health care institutions. A break-even point was calculated for each facility. Results. In all facilities, the cost of using nonlatex gloves exceeded the cost of using latex gloves. In all 3 facilities, however, 1% or fewer of those at risk would have to become fully disabled or fewer than 2% would have to become partially disabled for the continued use of latex gloves to exceed the cost of the latex-safe approach. Conclusion. Health care facilities, regardless of size, are likely to benefit financially from becoming latex-safe even if latex-related disability levels are extremely low. Handle: RePEc:aph:ajpbhl:1999:89:7:1024-1028_1 Template-Type: ReDIF-Article 1.0 Title: Herbicide and insecticide exposures among dairy farm pesticide applicators Journal: American Journal of Public Health Author-Name: Perry, M.J. Author-Name: Christiani, D.C. Year: 1999 Volume: 89 Issue: 7 Pages: 1118-1119 Handle: RePEc:aph:ajpbhl:1999:89:7:1118-1119_6 Template-Type: ReDIF-Article 1.0 Title: The Ebb and flow of radon Journal: American Journal of Public Health Author-Name: Nicholls, G. Year: 1999 Volume: 89 Issue: 7 Pages: 993-995 Handle: RePEc:aph:ajpbhl:1999:89:7:993-995_1 Template-Type: ReDIF-Article 1.0 Title: The impact of smoke-free workplaces on declining cigarette consumption in Australia and the United States Journal: American Journal of Public Health Author-Name: Chapman, S. Author-Name: Borland, R. Author-Name: Scollo, M. Author-Name: Brownson, R.C. Author-Name: Dominello, A. Author-Name: Woodward, S. Year: 1999 Volume: 89 Issue: 7 Pages: 1018-1023 Abstract: Objectives. This study estimates the contribution of smoke-free workplaces to the recent national declines in cigarette consumption in Australia and the United States. Methods. Nineteen studies of the impact of smoke-free workplaces on workday cigarette consumption were reviewed. The number and cost of cigarettes forgone were calculated and extrapolated to a scenario in which all indoor work areas were smoke-free. Results. Of the 19 studies, 18 reported declines in daily smoking rates, and 17 reported declines in smoking prevalence. Smoke-free workplaces are currently responsible for an annual reduction of some 602 million cigarettes, or 1.8% of all cigarettes that might otherwise be consumed, in Australia, and an annual reduction of 9.7 billion cigarettes (2%) in the United States. Approximately 22.3% of the 2.7 billion decrease in cigarette consumption in Australia between 1988 and 1995 can be attributed to smoke-free workplaces, as can 12.7% of the 76.5 billion decrease in the United States between 1988 and 1994. Conclusions. If workplaces were universally smoke-free, the number of cigarettes forgone annually would increase to 1.14 billion (3.4%) in Australia and 20.9 billion (4.1%) in the United States. Handle: RePEc:aph:ajpbhl:1999:89:7:1018-1023_8 Template-Type: ReDIF-Article 1.0 Title: Elimination and reintroduction of primary and secondary syphilis Journal: American Journal of Public Health Author-Name: Williams, L.A. Author-Name: Klausner, J.D. Author-Name: Whittington, W.L.H. Author-Name: Handsfield, H.H. Author-Name: Celum, C. Author-Name: Holmes, K.K. Year: 1999 Volume: 89 Issue: 7 Pages: 1093-1097 Abstract: Objectives. This study was conducted to define factors associated with the epidemic spread, elimination, and reintroduction of primary and secondary syphilis in King County, Washington, from 1987 through 1998. Methods. Reports of primary and secondary syphilis in King County from 1987 through 1998 were reviewed retrospectively. Results. During the epidemic spread of syphilis, only 15.8% of cases were imported. A total of 24.0% of patients reported cocaine use, and 18.3% of female patients reported having commercial sex. During the elimination of syphilis, significantly higher percentages of cases were imported and lower percentages of patients reported cocaine use or female commercial sex. During the reintroduction of syphilis in 1997-1998, 68% of patients were men who reported sex with men; of this 68%, 66% were sero-positive for HIV. Most men reporting sex with men were 30 years or older and recruited many anonymous partners. Conclusions. As syphilis wanes, local control must focus on outbreaks following its reintroduction. Resurgence of syphilis among men reporting sex with men recapitulates the epidemiology of syphilis before the historical advent of AIDS, warranting immediate attention to this problem. Handle: RePEc:aph:ajpbhl:1999:89:7:1093-1097_9 Template-Type: ReDIF-Article 1.0 Title: Schizophrenia and major affective disorder among Medicaid recipients with HIV/AIDS in New Jersey Journal: American Journal of Public Health Author-Name: Walkup, J. Author-Name: Crystal, S. Author-Name: Sambamoorthi, U. Year: 1999 Volume: 89 Issue: 7 Pages: 1101-1103 Abstract: Objectives. This study sought to identify and characterize seriously mentally ill patients with HIV infection. Methods. Medicaid beneficiaries with HIV/AIDS were identified through the merging of New Jersey HIV/AIDS Registry and Medicaid eligibility files. Claims histories were used to classify individuals as having schizophrenia, major affective disorder, or no serious mental illness. Results. Of 8294 individuals, 476 (5.7%) were classified as having schizophrenia, and 564 (6.8%) were classified as having major affective disorder. Those with serious mental illness were more likely than other groups to be injection drug users and to have claims indicative of substance abuse. Conclusions. Individuals with serious mental illness are a significant but little-recognized subgroup of those with HIV infection. Handle: RePEc:aph:ajpbhl:1999:89:7:1101-1103_8 Template-Type: ReDIF-Article 1.0 Title: Back injury in municipal workers: A case-control study Journal: American Journal of Public Health Author-Name: Myers, A.H. Author-Name: Baker, S.P. Author-Name: Li, G. Author-Name: Smith, G.S. Author-Name: Wiker, S. Author-Name: Liang, K.-Y. Author-Name: Johnson, J.V. Year: 1999 Volume: 89 Issue: 7 Pages: 1036-1041 Abstract: Objectives. The purpose of this study was to identify factors associated with acute low back injury among municipal employees of a large city. Methods. For each of 200 injured case patients, 2 coworker controls were randomly selected, the first matched on gender, job, and department and the second matched on gender and job classification. In-person interviews were conducted to collect data on demographics, work history, work characteristics, work injuries, back pain, psychosocial and work organization, health behaviors, and anthropometric and ergonomic factors related to the job. Psychosocial work organization variables were examined with factor analysis techniques; an aggregate value for job strain was entered into the final model. Risk factors were examined via multivariate logistic regression techniques. Results. High job strain was the most important factor affecting back injury (odds ratio [OR] = 2.12, 95% confidence interval [CI] = 1.28, 3.52), and it showed a significant dose- response effect. Body mass index (OR = 1.54, 95% CI = 1.08, 2.18) and a work movement index (twisting, extended reaching, and stooping) (OR and equals; 1.42, 95% CI = 2.08) were also significant factors. Conclusions. Results suggest that increasing workers' control over their jobs reduces levels of job strain Ergonomic strategies and worksite health promotion may help reduce other risk factors. Handle: RePEc:aph:ajpbhl:1999:89:7:1036-1041_5 Template-Type: ReDIF-Article 1.0 Title: The impact of ethnicity, family income, and parental education on children's health and use of health services Journal: American Journal of Public Health Author-Name: Flores, G. Author-Name: Bauchner, H. Author-Name: Feinstein, A.R. Author-Name: Nguyen, U.-S.D.T. Year: 1999 Volume: 89 Issue: 7 Pages: 1066-1071 Abstract: Objectives. This study characterized ethnic disparities for children in demographics, health status, and use of services; explored whether ethnic sub-groups (Puerto Rican, Cuban, and Mexican) have additional distinctive differences; and determined whether disparities are explained by differences in family income and parental education. Methods. Bivariate and multivariate analyses of data on 99 268 children from the 1989-91 National Health Interview. Surveys were conducted. Results. Native American, Black, and Hispanic children are poorest (35%-41% below poverty level vs 10% of Whites), least healthy (66%-74% in excellent or very good health vs 85% of Whites), and have the least well educated parents. Compared with Whites, non-White children average fewer doctor visits and are more likely to have excessive intervals between visits. Hispanic subgroup differences in demographics, health, and use of services equal or surpass differences among major ethnic groups. In multivariate analyses, almost all ethnic group disparities persisted after adjustment for family income, parental education, and other relevant covariates. Conclusions. Major ethnic groups and subgroups of children differ strikingly in demographics, health, and use of services; subgroup differences are easily overlooked; and most disparities persist even after adjustment for family income and parental education. Handle: RePEc:aph:ajpbhl:1999:89:7:1066-1071_1 Template-Type: ReDIF-Article 1.0 Title: Community-level interventions are needed to prevent new HIV infections Journal: American Journal of Public Health Author-Name: Kelly, J.A. Year: 1999 Volume: 89 Issue: 3 Pages: 299-301 Handle: RePEc:aph:ajpbhl:1999:89:3:299-301_7 Template-Type: ReDIF-Article 1.0 Title: Abandoning race as a variable in public health research [4] (multiple letters) Journal: American Journal of Public Health Author-Name: Buehler, J.W. Author-Name: Bhopal, R.S. Year: 1999 Volume: 89 Issue: 5 Pages: 783 Handle: RePEc:aph:ajpbhl:1999:89:5:783_0 Template-Type: ReDIF-Article 1.0 Title: Socioeconomic status and cardiovascular response [1] (multiple letters) Journal: American Journal of Public Health Author-Name: Carroll, D. Author-Name: Smith, G.D. Author-Name: Lynch, J. Author-Name: Everson, S. Author-Name: Kaplan, G. Year: 1999 Volume: 89 Issue: 3 Pages: 415-416 Handle: RePEc:aph:ajpbhl:1999:89:3:415-416_1 Template-Type: ReDIF-Article 1.0 Title: Cost-effectiveness and Down syndrome [3] (multiple letters) Journal: American Journal of Public Health Author-Name: Ganiats, T.G. Author-Name: Cantor, S.B. Author-Name: Serra-Prat, M. Author-Name: Gallo, P. Author-Name: Jovell, A.J. Author-Name: Aymerich, M. Author-Name: Estrada, D. Year: 1999 Volume: 89 Issue: 1 Pages: 110-112 Handle: RePEc:aph:ajpbhl:1999:89:1:110-112_8 Template-Type: ReDIF-Article 1.0 Title: Vaccinating high school students against hepatitis B: A school/STD clinic collaboration Journal: American Journal of Public Health Author-Name: Peavey, L. Author-Name: Roy, J. Author-Name: Baron-Cyr, M. Author-Name: Dumas, W. Author-Name: Etkind, P. Year: 1999 Volume: 89 Issue: 3 Pages: 412-413 Handle: RePEc:aph:ajpbhl:1999:89:3:412-413_6 Template-Type: ReDIF-Article 1.0 Title: Private health insurance in Ireland [3] Journal: American Journal of Public Health Author-Name: Houghton, F. Year: 1999 Volume: 89 Issue: 3 Pages: 418 Handle: RePEc:aph:ajpbhl:1999:89:3:418_9 Template-Type: ReDIF-Article 1.0 Title: Mammography screening [1] (multiple letters) Journal: American Journal of Public Health Author-Name: Litaker, J.R. Author-Name: Rimer, B.K. Author-Name: Ernster, V.L. Year: 1999 Volume: 89 Issue: 2 Pages: 254-255 Handle: RePEc:aph:ajpbhl:1999:89:2:254-255_0 Template-Type: ReDIF-Article 1.0 Title: Erratum: A community-initiated study of blood lead levels of Nicaraguan children living near a battery factory (American Journal of Public Health (1998) 88 (1843-1845)) Journal: American Journal of Public Health Author-Name: Morales Bonilla, C. Author-Name: Mauss, E.A. Year: 1999 Volume: 89 Issue: 2 Pages: 256 Handle: RePEc:aph:ajpbhl:1999:89:2:256_1 Template-Type: ReDIF-Article 1.0 Title: The protective effect of condoms and nonoxynol-9 against HIV infection: A response to Wittkowski and colleagues [2] (multiple letters) Journal: American Journal of Public Health Author-Name: Feldblum, P.J. Author-Name: Weir, S.S. Author-Name: Cates W., Jr. Author-Name: Wittkowski, K. Author-Name: Susser, E. Author-Name: Dietz, K. Year: 1999 Volume: 89 Issue: 1 Pages: 108-110 Handle: RePEc:aph:ajpbhl:1999:89:1:108-110_2 Template-Type: ReDIF-Article 1.0 Title: Erratum: Going bare: Trends in health insurance coverage, 1989 through 1996 (American Journal of Public Health (1998) 88 (36-42)) 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: 1999 Volume: 89 Issue: 2 Pages: 256 Handle: RePEc:aph:ajpbhl:1999:89:2:256_0 Template-Type: ReDIF-Article 1.0 Title: Erratum: Potential explanations for the educational gradient in coronary heart disease: A population-based case-control study of Swedish women (American Journal of Public Health (1999) 89 (315-321)) Journal: American Journal of Public Health Author-Name: Wamala, S.P. Author-Name: Mittleman, M.A. Author-Name: Schenck-Gustafsson, K. Author-Name: Orth-Gomer, K. Year: 1999 Volume: 89 Issue: 5 Pages: 785 Handle: RePEc:aph:ajpbhl:1999:89:5:785_6 Template-Type: ReDIF-Article 1.0 Title: Disease mapping and public health decision-making: Report of a WHO meeting [1] Journal: American Journal of Public Health Author-Name: Bertollini, R. Author-Name: Martuzzi, M. Year: 1999 Volume: 89 Issue: 5 Pages: 780 Handle: RePEc:aph:ajpbhl:1999:89:5:780_3 Template-Type: ReDIF-Article 1.0 Title: Air pollution: Prevention and long-term perspectives [4] (multiple letters) Journal: American Journal of Public Health Author-Name: Robinson, D.L. Author-Name: Morgan, G. Author-Name: Corbett, S. Author-Name: Wlodarczyk, J. Author-Name: Lewis, P. Year: 1999 Volume: 89 Issue: 3 Pages: 418-419 Handle: RePEc:aph:ajpbhl:1999:89:3:418-419_0 Template-Type: ReDIF-Article 1.0 Title: Protecting children from lead poisoning and building healthy communities Journal: American Journal of Public Health Author-Name: Ryan, D. Author-Name: Levy, B. Author-Name: Pollack, S. Author-Name: Walker B., Jr. Year: 1999 Volume: 89 Issue: 6 Pages: 822-824 Handle: RePEc:aph:ajpbhl:1999:89:6:822-824_8 Template-Type: ReDIF-Article 1.0 Title: Teaching kids about rabies Journal: American Journal of Public Health Author-Name: Dandoy, S. Author-Name: Scanlon, F. Year: 1999 Volume: 89 Issue: 3 Pages: 413-414 Handle: RePEc:aph:ajpbhl:1999:89:3:413-414_5 Template-Type: ReDIF-Article 1.0 Title: Surveillance and prevention of hepatitis B virus transmission Journal: American Journal of Public Health Author-Name: Smith, N. Author-Name: Yusuf, H. Author-Name: Averhoff, F. Year: 1999 Volume: 89 Issue: 1 Pages: 11-13 Handle: RePEc:aph:ajpbhl:1999:89:1:11-13_4 Template-Type: ReDIF-Article 1.0 Title: Editorial: Promoting the health and well-being of future generations Journal: American Journal of Public Health Author-Name: Schneider, D. Author-Name: Northridge, M.E. Year: 1999 Volume: 89 Issue: 2 Pages: 155-157 Handle: RePEc:aph:ajpbhl:1999:89:2:155-157_7 Template-Type: ReDIF-Article 1.0 Title: Erratum: The impact of condom distribution in Seattle schools on sexual behavior and condom use (American Journal of Public Health (1999) 89 (182- 187)) Journal: American Journal of Public Health Author-Name: Kirby, D. Author-Name: Brener, N.D. Author-Name: Brown, N.L. Author-Name: Peterfreund, N. Author-Name: Hillard, P. Author-Name: Harrist, R. Year: 1999 Volume: 89 Issue: 3 Pages: 422 Handle: RePEc:aph:ajpbhl:1999:89:3:422_5 Template-Type: ReDIF-Article 1.0 Title: The 'sausage factory' tour of the legislative process: An interactive orientation Journal: American Journal of Public Health Author-Name: Novotny, T.E. Author-Name: Seward, J. Author-Name: Sun, R.K. Author-Name: Acree, K. Year: 1999 Volume: 89 Issue: 5 Pages: 771-773 Handle: RePEc:aph:ajpbhl:1999:89:5:771-773_4 Template-Type: ReDIF-Article 1.0 Title: A tale of 3 tails Journal: American Journal of Public Health Author-Name: McKinlay, J.B. Author-Name: Marceau, L.D. Year: 1999 Volume: 89 Issue: 3 Pages: 295-298 Handle: RePEc:aph:ajpbhl:1999:89:3:295-298_3 Template-Type: ReDIF-Article 1.0 Title: Cardiovascular disease and risk factor epidemiology: A look back at the epidemic of the 20th century Journal: American Journal of Public Health Author-Name: Javier Nieto, F. Year: 1999 Volume: 89 Issue: 3 Pages: 292-294 Handle: RePEc:aph:ajpbhl:1999:89:3:292-294_0 Template-Type: ReDIF-Article 1.0 Title: Prevention of sexually transmitted diseases: The need for social and behavioral science expertise in public health departments Journal: American Journal of Public Health Author-Name: Van Devanter, N. Year: 1999 Volume: 89 Issue: 6 Pages: 815-818 Handle: RePEc:aph:ajpbhl:1999:89:6:815-818_6 Template-Type: ReDIF-Article 1.0 Title: Condom use in female sex workers in Italy [1] Journal: American Journal of Public Health Author-Name: Spina, M. Author-Name: Tirelli, U. Year: 1999 Volume: 89 Issue: 1 Pages: 108 Handle: RePEc:aph:ajpbhl:1999:89:1:108_2 Template-Type: ReDIF-Article 1.0 Title: Carbon monoxide poisoning in the aftermath of hurricane fran [4] Journal: American Journal of Public Health Author-Name: Cohen, B.A. Author-Name: Stolp, B.W. Author-Name: Dear, G.D. Author-Name: Moon, R.E. Author-Name: Frazier, L.M. Year: 1999 Volume: 89 Issue: 1 Pages: 112 Handle: RePEc:aph:ajpbhl:1999:89:1:112_4 Template-Type: ReDIF-Article 1.0 Title: Antioxidant vitamins and cardiovascular disease: Dr Jekyll or Mr Hyde? Journal: American Journal of Public Health Author-Name: Hercberg, S. Author-Name: Galan, P. Author-Name: Preziosi, P. Year: 1999 Volume: 89 Issue: 3 Pages: 289-291 Handle: RePEc:aph:ajpbhl:1999:89:3:289-291_5 Template-Type: ReDIF-Article 1.0 Title: The public health workforce: Key to public health infrastructure Journal: American Journal of Public Health Author-Name: Gebbie, K.M. Year: 1999 Volume: 89 Issue: 5 Pages: 660-661 Handle: RePEc:aph:ajpbhl:1999:89:5:660-661_1 Template-Type: ReDIF-Article 1.0 Title: The use of race as a variable in public health research [5] (multiple letters) Journal: American Journal of Public Health Author-Name: Rabin, R. Author-Name: Fullilove, M.T. Author-Name: Bhopal, R.S. Year: 1999 Volume: 89 Issue: 5 Pages: 783-784 Handle: RePEc:aph:ajpbhl:1999:89:5:783-784_3 Template-Type: ReDIF-Article 1.0 Title: Ethics and HIV trials [2] Journal: American Journal of Public Health Author-Name: Simonds, R.J. Author-Name: Dondero, T.J. Author-Name: DeCock, K.M. Author-Name: Gayle, H.D. Year: 1999 Volume: 89 Issue: 2 Pages: 255-256 Handle: RePEc:aph:ajpbhl:1999:89:2:255-256_7 Template-Type: ReDIF-Article 1.0 Title: Erratum: Morbidity and mortality attributable to alcohol, tobacco, and illicit drug use in Canada (American Journal of Public Health (1999) 89 (385- 390)) Journal: American Journal of Public Health Author-Name: Single, E. Author-Name: Robson, L. Author-Name: Rehm, J. Author-Name: Xie, X. Year: 1999 Volume: 89 Issue: 5 Pages: 785 Handle: RePEc:aph:ajpbhl:1999:89:5:785_7 Template-Type: ReDIF-Article 1.0 Title: 'Whiting out' white privilege will not advance the study of how racism harms health Journal: American Journal of Public Health Author-Name: Krieger, N. Author-Name: William, D. Author-Name: Zierler, S. Author-Name: Bhopal, R.S. Author-Name: Donaldson, L.J. Year: 1999 Volume: 89 Issue: 5 Pages: 782-785 Handle: RePEc:aph:ajpbhl:1999:89:5:782-785_1 Template-Type: ReDIF-Article 1.0 Title: Household firearms [7] Journal: American Journal of Public Health Author-Name: Cummings, P. Author-Name: LeMier, M. Author-Name: Simmons, K.W. Year: 1999 Volume: 89 Issue: 3 Pages: 421-422 Handle: RePEc:aph:ajpbhl:1999:89:3:421-422_5 Template-Type: ReDIF-Article 1.0 Title: Meeting primary oral health care needs of HIV-infected women Journal: American Journal of Public Health Author-Name: Zabos, G.P. Year: 1999 Volume: 89 Issue: 6 Pages: 818-819 Handle: RePEc:aph:ajpbhl:1999:89:6:818-819_0 Template-Type: ReDIF-Article 1.0 Title: Robinson's rejoinder [5] Journal: American Journal of Public Health Author-Name: Robinson, D.L. Year: 1999 Volume: 89 Issue: 3 Pages: 419-420 Handle: RePEc:aph:ajpbhl:1999:89:3:419-420_4 Template-Type: ReDIF-Article 1.0 Title: On contraception and abortion in armenia [2] (multiple letters) Journal: American Journal of Public Health Author-Name: Cohen-Bearak, A.R. Author-Name: Dolyan, G. Author-Name: Morabia, A. Year: 1999 Volume: 89 Issue: 3 Pages: 416-418 Handle: RePEc:aph:ajpbhl:1999:89:3:416-418_5 Template-Type: ReDIF-Article 1.0 Title: Occasional smoking in a study of premenopausal women [6] (multiple letters) Journal: American Journal of Public Health Author-Name: Elkin, E.P. Author-Name: Windham, G.C. Author-Name: Benowitz, N.L. Author-Name: Swan, S.H. Author-Name: Husten, C.G. Author-Name: Giovino, G. Year: 1999 Volume: 89 Issue: 3 Pages: 420-421 Handle: RePEc:aph:ajpbhl:1999:89:3:420-421_5 Template-Type: ReDIF-Article 1.0 Title: Annotation: Children's disengagement from medical homes - A neglected public health imperative Journal: American Journal of Public Health Author-Name: Irigoyen, M. Author-Name: See, D. Author-Name: Findley, S.E. Year: 1999 Volume: 89 Issue: 2 Pages: 157-159 Handle: RePEc:aph:ajpbhl:1999:89:2:157-159_9 Template-Type: ReDIF-Article 1.0 Title: Relationship of lipoprotein(a) levels to physical activity and family history of coronary heart disease Journal: American Journal of Public Health Author-Name: Martin, S. Author-Name: Elosua, R. Author-Name: Covas, M.-I. Author-Name: Pavesi, M. Author-Name: Vila, J. Author-Name: Marrugat, J. Year: 1999 Volume: 89 Issue: 3 Pages: 383-385 Abstract: Objectives. This study evaluated the association of physical activity with serum lipoprotein(a) [Lp(a)] levels in individuals according to whether they had a family history of coronary heart disease (CHD). Methods. Lp(a) levels in 332 healthy Spanish men aged 20 to 60 years were measured. Physical activity and family history of CHD were assessed. Results. For men with a family history of CHD, the odds ratio for Lp(a) levels above the median value was 0.13 (95% confidence interval | = | 0.03, 0.50) in very active men (energy expended in physical activity > 300 kcal/day) compared with active men (energy expended in physical activity < 300 kcal/day). Conclusions. Regular daily physical activity in individuals with a family history of CHD could be useful for controlling Lp(a) levels. Handle: RePEc:aph:ajpbhl:1999:89:3:383-385_3 Template-Type: ReDIF-Article 1.0 Title: Breathing freely: The need for asthma research on gene-environment interactions Journal: American Journal of Public Health Author-Name: Miller, R.L. Year: 1999 Volume: 89 Issue: 6 Pages: 819-822 Handle: RePEc:aph:ajpbhl:1999:89:6:819-822_1 Template-Type: ReDIF-Article 1.0 Title: Directly observed therapy for tuberculosis [2] Journal: American Journal of Public Health Author-Name: Marks, S. Author-Name: Nguyen, C. Author-Name: Qualls, N. Author-Name: Taylor, Z. Year: 1999 Volume: 89 Issue: 4 Pages: 600 Handle: RePEc:aph:ajpbhl:1999:89:4:600_0 Template-Type: ReDIF-Article 1.0 Title: Directly observed therapy and tuberculosis treatment completion [4] (multiple letters) Journal: American Journal of Public Health Author-Name: Bloch, A.B. Author-Name: Jereb, J.A. Author-Name: Simone, P.M. Author-Name: Onorato, I.M. Author-Name: Novick, L.F. Author-Name: Lipsman, J. Author-Name: Frieden, T.R. Author-Name: Bayer, R. Author-Name: Desvarieux, M. Year: 1999 Volume: 89 Issue: 4 Pages: 602-603 Handle: RePEc:aph:ajpbhl:1999:89:4:602-603_3 Template-Type: ReDIF-Article 1.0 Title: Is epidemiology an applied science or a technology? [1] Journal: American Journal of Public Health Author-Name: Granados, J.A.T. Year: 1999 Volume: 89 Issue: 4 Pages: 599-600 Handle: RePEc:aph:ajpbhl:1999:89:4:599-600_0 Template-Type: ReDIF-Article 1.0 Title: What's a mother to do? Welfare, work, and family Journal: American Journal of Public Health Author-Name: Chavkin, W. Year: 1999 Volume: 89 Issue: 4 Pages: 477-479 Handle: RePEc:aph:ajpbhl:1999:89:4:477-479_2 Template-Type: ReDIF-Article 1.0 Title: Does directly observed therapy work? [3] (multiple letters) Journal: American Journal of Public Health Author-Name: Burman, W.J. Author-Name: El-Sadr, W. Author-Name: Heymann, S.J. Author-Name: Brewer, T.F. Author-Name: Sell, R. Year: 1999 Volume: 89 Issue: 4 Pages: 600-602 Handle: RePEc:aph:ajpbhl:1999:89:4:600-602_2 Template-Type: ReDIF-Article 1.0 Title: Comment: Epidemiology and the new political economy of medicine Journal: American Journal of Public Health Author-Name: Fox, D.M. Year: 1999 Volume: 89 Issue: 4 Pages: 493-496 Handle: RePEc:aph:ajpbhl:1999:89:4:493-496_2 Template-Type: ReDIF-Article 1.0 Title: The safe motherhood initiative: Why has it stalled? Journal: American Journal of Public Health Author-Name: Maine, D. Author-Name: Rosenfield, A. Year: 1999 Volume: 89 Issue: 4 Pages: 480-482 Abstract: Complications of pregnancy and childbirth are still the leading cause of death and disability among women of reproductive age in developing countries. After decades of neglect, the founding of the Safe Motherhood Initiative in 1987 promised action on this problem. A dozen years later, there is no evidence that maternal mortality has declined and there are still few sizeable programs. A major reason for this disappointing record is that the initiative lacks a clear, concise, feasible strategy. This article reviews the available options and proposes a strategy based on improving the availability and quality of medical treatment of obstetric complications. Once district hospitals and health centers provide such needed care, community mobilization to improve utilization may be beneficial. Substantial reductions in maternal deaths would be possible in a relatively short period of time if this strategy were embraced. Handle: RePEc:aph:ajpbhl:1999:89:4:480-482_8 Template-Type: ReDIF-Article 1.0 Title: Editor's note: Science, justice, and breast implants Journal: American Journal of Public Health Author-Name: Bayer, R. Year: 1999 Volume: 89 Issue: 4 Pages: 483 Handle: RePEc:aph:ajpbhl:1999:89:4:483_0 Template-Type: ReDIF-Article 1.0 Title: Changes in Canadian women's mammography rates since the implementation of mass screening programs Journal: American Journal of Public Health Author-Name: De Grasse, C.E. Author-Name: O'Connor, A.M. Author-Name: Boulet, J. Author-Name: Edwards, N. Author-Name: Bryant, H. Author-Name: Breithaupt, K. Year: 1999 Volume: 89 Issue: 6 Pages: 927-929 Abstract: Objectives. This study reports on Canadian mammography rates between 1990, when mass screening programs were launched, and 1994/95. Methods. Mammography rates from 2 national surveys were compared according to the presence of a provincial screening program. Results. Mammography rates among women aged 50 to 69 years (the targeted group) increased significantly, by 16%; increases were twice as high in provinces with screening programs. Among women in their 40s (nontargeted group), the changes were insignificant and independent of screening program status. Conclusions. Screening programs appear to have influenced the mammography rates of targeted women aged 50 to 69 years. Handle: RePEc:aph:ajpbhl:1999:89:6:927-929_7 Template-Type: ReDIF-Article 1.0 Title: Health care coverage and use of preventive services among the near elderly in the United States Journal: American Journal of Public Health Author-Name: Powell-Griner, E. Author-Name: Bolen, J. Author-Name: Bland, S. Year: 1999 Volume: 89 Issue: 6 Pages: 882-886 Abstract: Objectives. It has been proposed that individuals aged 55 to 64 years be allowed to buy into Medicare. This group is more likely than younger adults to have marginal health status, to be separating from the workforce, to face high premiums, and to risk financial hardship from major medical illness. The present study examined prevalence of health insurance coverage by demographic characteristics and examined how lack of insurance may affect use of preventive health services. Methods. Data were obtained from the Behavioral Risk Factor Surveillance System, an ongoing telephone survey of adults conducted by the 50 states and the District of Columbia. Results. Many near- elderly adults least likely to have health care coverage were Black or Hispanic, had less than a high school education and incomes less than $15000 per year, and were unemployed or self-employed. Health insurance coverage was associated with increased use of clinical preventive services even when sex, race/ethnicity, marital status, and educational level were controlled. Conclusions. Many near-elderly individuals without insurance will probably not be able to participate in a Medicare buy-in unless it is subsidized in some way. Handle: RePEc:aph:ajpbhl:1999:89:6:882-886_0 Template-Type: ReDIF-Article 1.0 Title: Maternal minimum-stay legislation: Cost and policy implications Journal: American Journal of Public Health Author-Name: Raube, K. Author-Name: Merrell, K. Year: 1999 Volume: 89 Issue: 6 Pages: 922-923 Abstract: Objectives. Recently, most state legislatures and Congress have passed laws mandating insurance coverage for a minimum period of inpatient care following delivery. This study analyzed the likely cost implications of one state's law. Methods. Hospital discharge records for Illinois women who gave birth (n = 167 769) and infants born (n = 164 905) during a 12-month period predating the law were analyzed. Results. As a percentage of total spending on birth-related admissions and readmissions, the net effect of the law ranges from a savings of 0.1% to a cost of 20.2%. Conclusions. There may be large cost implications to this legislation, even with savings from avoided readmissions. Handle: RePEc:aph:ajpbhl:1999:89:6:922-923_6 Template-Type: ReDIF-Article 1.0 Title: Unemployment and foster home placements: Estimating the net effect of provocation and inhibition Journal: American Journal of Public Health Author-Name: Catalano, R.A. Author-Name: Lind, S.L. Author-Name: Rosenblatt, A.B. Author-Name: Attkisson, C.C. Year: 1999 Volume: 89 Issue: 6 Pages: 851-855 Abstract: Objectives. This study sought, first, to explain and reconcile the provocation and inhibition theories of the effect of rising unemployment on the incidence of antisocial behavior. Second, it tested the hypothesis, implied by the provocation and inhibition theories, that the relationship between unemployment and foster home placements forms an inverted 'U.' Methods. The hypothesis was tested with data from California for 137 months beginning in February 1984. Results. Findings showed that the hypothesis was supported. Conclusions. Rising joblessness increases the incidence of foster home placements among families that lose jobs or income. Levels of joblessness that threaten workers who remain employed, however, inhibit antisocial behavior and reduce the incidence of foster home placements. This means that accounting for the social costs of unemployment is more complicated than assumed under the provocation theory. Handle: RePEc:aph:ajpbhl:1999:89:6:851-855_9 Template-Type: ReDIF-Article 1.0 Title: Involving men in reproductive health: The young men's clinic Journal: American Journal of Public Health Author-Name: Armstrong, B. Author-Name: Cohall, A.T. Author-Name: Vaughan, R.D. Author-Name: Scott, M. Author-Name: Tiezzi, L. Author-Name: McCarthy, J.F. Year: 1999 Volume: 89 Issue: 6 Pages: 902-905 Abstract: Objectives. This report describes the population of young men who use the Young Men's Clinic in New York City, presents a profile of their reproductive behaviors, and describes the clinic's model of service delivery. Methods. Data were gathered through a routine clinic visit form administered by clinic staff. Results. The clinic sees approximately 1200 predominately dominican young men each year for a wide range of clinical and mental health services. Two thirds of clients had ever been sexually active, three quarters had ever used birth control, and 69% had used birth control at their last sexual encounter. Conclusions. The Young Men's Clinic may serve as a model for health care delivery to adolescent and young adult males. Handle: RePEc:aph:ajpbhl:1999:89:6:902-905_5 Template-Type: ReDIF-Article 1.0 Title: The effect of congenital anomalies on mortality risk in White and Black infants Journal: American Journal of Public Health Author-Name: Malcoe, L.H. Author-Name: Shaw, G.M. Author-Name: Lammer, E.J. Author-Name: Herman, A.A. Year: 1999 Volume: 89 Issue: 6 Pages: 887-892 Abstract: Objectives. This population-based study examined the effect of all major congenital anomalies on the mortality of White and Black infants by infant sex, birthweight, gestational age, and lethality of the anomaly. The study also determined the total contribution of anomalies to infant mortality. Methods. California Birth Defects Monitoring Program data were merged with linked birth-death files for 278 646 singleton non-Hispanic White and Black infants born in 1983 through 1986. Malformed infants were compared with nonmalformed infants to determine the effect of anomalies on mortality. Results. The presence of any congenital anomaly increased mortality 9.0-fold (95% CI = 7.3; 11.1) for Black infants and 17.8-fold (95% CI = 16.2, 19.6) for White infants. Even 'nonlethal' anomalies increased mortality up to 8.9- fold. Overall, anomalies contributed to 33% of White infant deaths, to 19% of Black infant deaths, and to over 60% of deaths among Black and White neonates weighing over 1499 g. Conclusions. The contribution of congenital anomalies to mortality of both low- (<2500 g) and normal-birthweight infants is substantially higher than previously estimated, representing a large public health problem for both Black and White infants. Handle: RePEc:aph:ajpbhl:1999:89:6:887-892_6 Template-Type: ReDIF-Article 1.0 Title: Sexual health risk assessment and counseling in primary care: How involved are general practitioners and obstetrician-gynecologists? Journal: American Journal of Public Health Author-Name: Haley, N. Author-Name: Maheux, B. Author-Name: Rivard, M. Author-Name: Gervais, A. Year: 1999 Volume: 89 Issue: 6 Pages: 899-902 Abstract: Objectives. This study examined physicians' evaluation of sexual health risks during a general medical examination and sexually transmitted disease (STD) counseling during consultations for adolescent contraception and treatment of an STD. Methods. An anonymous mail survey was conducted in 1995 with a stratified random sample of 1086 general practitioners and all 241 obstetrician-gynecologists practicing in Quebec, Canada. Results. Fewer than half of the respondents reported routinely inquiring about condom use and number of sexual partners during a general medical examination. Female general practitioners engaged in more sexual health risk assessment and counseling than male general practitioners. Conclusions. This study suggests a low level of involvement in STD prevention by generalists and obstetrician- gynecologists. Handle: RePEc:aph:ajpbhl:1999:89:6:899-902_7 Template-Type: ReDIF-Article 1.0 Title: Premature mortality in the United States: The roles of geographic area, socioeconomic status, household type, and availability of medical care Journal: American Journal of Public Health Author-Name: Mansfield, C.J. Author-Name: Wilson, J.L. Author-Name: Kobrinski, E.J. Author-Name: Mitchell, J. Year: 1999 Volume: 89 Issue: 6 Pages: 893-898 Abstract: Objectives. This study examined premature mortality by county in the United States and assessed its association with metro/urban/rural geographic location, socioeconomic status, house-hold type, and availability of medical care. Methods. Age-adjusted years of potential life lost before 75 years of age were calculated and mapped by county. Predictors of premature mortality were determined by multiple regression analysis. Results. Premature mortality was greatest in rural counties in the Southeast and Southwest. In a model predicting 55% of variation across counties, community structure factors explained more than availability of medical care. The proportions of female- headed households and Black populations were the strongest predictors, followed by variables measuring low education, American Indian population, and chronic unemployment. Greater availability of generalist physicians predicted fewer years of life lost in metropolitan counties but more in rural counties. Conclusions. Community structure factors statistically explain much of the variation in premature mortality. The degree to which premature mortality is predicted by percentage of female-headed households is important for policy-making and delivery of medical care. The relationships described argue strongly for broadening the biomedical model. Handle: RePEc:aph:ajpbhl:1999:89:6:893-898_3 Template-Type: ReDIF-Article 1.0 Title: Income inequality and homicide rates in Rio de Janeiro, Brazil Journal: American Journal of Public Health Author-Name: Szwarcwald, C.L. Author-Name: Bastos, F.I. Author-Name: Viacava, F. Author-Name: Tavares De Andrade, C.L. Year: 1999 Volume: 89 Issue: 6 Pages: 845-850 Abstract: Objectives. This study determined the effect of income inequality on homicide rates in the state of Rio de Janeiro, Brazil. Methods. We conducted an ecological study at 2 geographical levels, municipalities in the state of Rio de Janeiro and administrative regions in the municipality of Rio de Janeiro. The association between homicide and income inequality was tested by multiple regression procedures, with adjustment for other socioeconomic indicators. Results. For the municipalities of Rio de Janeiro State, no association between homicide and income concentration was found, an outcome that can be explained by the municipalities' different degrees of urbanization. However, for the administrative regions in the city of Rio de Janeiro, the 2 income inequality indicators were strongly correlated with the outcome variable (P<.01). Higher homicide rates were found precisely in the sector of the city that has the greatest concentration of slum residents and the highest degree of income inequality. Conclusions. The findings suggest that social policies specifically aimed at low-income urban youth, particularly programs to reduce the harmful effects of relative deprivation, may have an important impact on the homicide rate. Handle: RePEc:aph:ajpbhl:1999:89:6:845-850_0 Template-Type: ReDIF-Article 1.0 Title: Costs and outcomes of hip fracture and stroke, 1984 to 1994 Journal: American Journal of Public Health Author-Name: Sloan, F.A. Author-Name: Taylor Jr., D.H. Author-Name: Picone, G. Year: 1999 Volume: 89 Issue: 6 Pages: 935-937 Abstract: Objectives. This study quantified changes in Medicare payments and outcomes for hip fracture and stroke from 1984 to 1994. Methods. We studied National Long Term Care Survey respondents who were hospitalized for hip fracture (n = 887) or stroke (n = 878) occurring between 1984 and 1994. Changes in Medicare payment and survival were primary outcomes. We also assessed changes in functional and cognitive status. Results. Medicare payments within 6 months increased following hip fracture (103%) or stroke (51%). Survival improved for stroke (P < .001) and to a lesser extent for hip fracture (P = .16). Condition-specific improvements were found in functional and cognitive status. Conclusions. During the period 1984 to 1994, Medicare payments for hip fracture and stroke rose and there were some improvements in survival and other outcomes. Handle: RePEc:aph:ajpbhl:1999:89:6:935-937_5 Template-Type: ReDIF-Article 1.0 Title: Lower body osteoarticular pain and dose of analgesic medications in older disabled women: The Women's Health and Aging Study Journal: American Journal of Public Health Author-Name: Pahor, M. Author-Name: Guralnik, J.M. Author-Name: Wan, J.Y. Author-Name: Ferrucci, L. Author-Name: Penninx, B.W.J.H. Author-Name: Lyles, A. Author-Name: Ling, S. Author-Name: Fried, L.P. Year: 1999 Volume: 89 Issue: 6 Pages: 930-934 Abstract: Objectives. This study assessed use and dosage of analgesic medications in relation to severity of osteorticular pain. Methods. The type and dose of analgesic medication and the severity of pain in the lower back, hips, knees, or feet of 1002 older disabled women were assessed. Results. Severe pain and the use of analgesic medications were reported by 48.5% and 78.8% of women, respectively. Among those who had severe pain, 41.2% were using less than 20% of the maximum analgesic dose. Overall, 6.6% of women were using more than 100% of the maximum dose. Conclusions. Severe pain in common. Additional, more effective, and safe analgesic treatments are needed for controlling pain in older persons. Handle: RePEc:aph:ajpbhl:1999:89:6:930-934_7 Template-Type: ReDIF-Article 1.0 Title: High-risk occupations for breast cancer in the Swedish female working population Journal: American Journal of Public Health Author-Name: Pollán, M. Author-Name: Gustavsson, P. Year: 1999 Volume: 89 Issue: 6 Pages: 875-881 Abstract: Objectives: The purpose of this study was to estimate, for the period 1971 through 1989, occupation-specific risks of breast cancer among Swedish women employed in 1970. Methods. Age-period standardized incidence ratios were computed. Log-linear Poisson models were fitted, with geographical area and town size taken into account. Risks were further adjusted for major occupational group, used as a proxy for socioeconomic status. Risk estimators were also calculated for women reporting the same occupation in 1960 and 1970. Results. Most elevated risks among professionals, managers, and clerks were reduced when intragroup comparisons were carried out, indicating the confounding effect of socioeconomic status. Excess risks were found for pharmacists, teachers of theoretical subjects, schoolmasters, systems analysts and programmers, telephone operators, telegraph and radio operators, metal platers and coaters, and hairdressers and beauticians, as well as for women working in 1960 and 1970 as physicians, religious workers, social workers, bank tellers, cost accountants, and telephonists. Conclusions. While the high risks observed among professional, administrative, and clerical excess risks found for telephone workers and for hairdressers and beauticians deserve further attention. Handle: RePEc:aph:ajpbhl:1999:89:6:875-881_4 Template-Type: ReDIF-Article 1.0 Title: Identifying target groups for a potential vaccination program during a hepatitis A communitywide outbreak Journal: American Journal of Public Health Author-Name: Hutin, Y.J.F. Author-Name: Bell, B.P. Author-Name: Marshall, K.L.E. Author-Name: Schaben, C.P. Author-Name: Dart, M. Author-Name: Quinlisk, M.P. Author-Name: Shapiro, C.N. Year: 1999 Volume: 89 Issue: 6 Pages: 918-921 Abstract: Objectives. This study sought to identify groups for targeted vaccination during a communitywide hepatitis A outbreak in 1996. Methods. Residents of the Sioux city, Iowa, metropolitan area reported with hepatitis A between September 1995 and August 1996 were sampled and compared with population-based controls. Results. In comparison with 51 controls, the 40 case patients were more likely to inject methamphetamine, to attend emergency rooms more often than other health care facilities, and to have a family member who used the Special Supplemental Nutrition Program for Women, Infants, and Children. Conclusions. Groups at increased risk of hepatitis A can be identified and accessed for vaccination during communitywide outbreaks. Handle: RePEc:aph:ajpbhl:1999:89:6:918-921_4 Template-Type: ReDIF-Article 1.0 Title: Sexual mixing patterns in the spread of gonococcal and chlamydial infections Journal: American Journal of Public Health Author-Name: Aral, S.O. Author-Name: Hughes, J.P. Author-Name: Stoner, B. Author-Name: Whittington, W. Author-Name: Handsfield, H.H. Author-Name: Anderson, R.M. Author-Name: Holmes, K.K. Year: 1999 Volume: 89 Issue: 6 Pages: 825-833 Abstract: Objectives. This study sought to define, among sexually transmitted disease (STD) clinic attendees, (1) patterns of sex partner selection, (2) relative risks for gonococcal or chlamydial infection associated with each mixing patterns, and (3) selected links and potential and actual bridge populations. Methods. Mixing matrices were computed based on characteristics of the study participants and their partners. Risk of infection was determined in study participants with various types of partners, and odds ratios were used to estimate relative risk of infection for discordant vs concordant partnerships. Results. Partnerships discordant in terms of race/ethnicity, age, education, and number of partners were associated with significant risk for gonorrhea and chlamydial infection. In low-prevalence subpopulations, within-subpopulation mixing was associated with chlamydial infection, and direct links with high-prevalence subpopulations were associated with gonorrhea. Conclusions. Mixing patterns influence the risk of specific infections, and they should be included in risk assessments for individuals and in the design of screening, health education, and partner notification strategies for populations. Handle: RePEc:aph:ajpbhl:1999:89:6:825-833_7 Template-Type: ReDIF-Article 1.0 Title: Access to care for the uninsured: Is access to a physician enough? Journal: American Journal of Public Health Author-Name: Mainous III, A.G. Author-Name: Hueston, W.J. Author-Name: Love, M.M. Author-Name: Griffith III, C.H. Year: 1999 Volume: 89 Issue: 6 Pages: 910-912 Abstract: Objectives. This study examined a private-sector, statewide program (Kentucky Physicians Care) of care for uninsured indigent persons regarding provision of preventive services. Methods. A survey was conducted of a stratified random sample of 2509 Kentucky adults (811 with private insurance, 849 Medicaid recipients, 849 Kentucky Physicians Care recipients). Results. The Kentucky Physicians Care group had significantly lower rates of receipt of preventive services. Of the individuals in this group, 52% cited cost as the primary reason for not receiving mammography, and 38% had not filled prescribed medicines in the previous year. Conclusions. Providing free access to physicians fills important needs but is not sufficient for many uninsured patients to receive necessary preventive services. Handle: RePEc:aph:ajpbhl:1999:89:6:910-912_4 Template-Type: ReDIF-Article 1.0 Title: Definition and prevalence of sedentarism in an urban population Journal: American Journal of Public Health Author-Name: Bernstein, M.S. Author-Name: Morabia, A. Author-Name: Sloutskis, D. Year: 1999 Volume: 89 Issue: 6 Pages: 862-867 Abstract: Objectives. The present study sought to formulate a precise definition of sedentarism and to identify activities performed by active people that could serve as effective preventive goals. Methods. A population-based sample of 919 residents of Geneva Switzerland, aged 35 to 74 years, completed a 24- hour recall. Sedentary people were defined as those expending less than 10% of their daily energy in the performance of moderate- and high-intensity activities (at least 4 times the basal metabolism rate). Results. The rates of sedentarism were 79.5% in men and 87.2% in women. Among sedentary and active men, average daily energy expenditures were 2600 kcal (95% confidence interval [CI] = 2552, 2648) and 3226 kcal (95% CI = 3110, 3346), respectively; the corresponding averages for women were 2092 kcal (95% CI = 2064, 2120) and 2356 kcal (95% CI = 2274, 2440). The main moderate- and high- intensity activities among active people were sports (tennis, gymnastics, skiing), walking, climbing stairs, gardening, and (for men only) occupational activities. Conclusions. The definition of sedentarism outlined in this article can be reproduced in other populations, allows comparisons across studies, and provides preventive guidelines in that the activities most frequently performed by active people are the ones most likely to be adopted by their sedentary peers. Handle: RePEc:aph:ajpbhl:1999:89:6:862-867_9 Template-Type: ReDIF-Article 1.0 Title: A randomized trial of breast cancer risk counseling: The impact on self- reported mammography use Journal: American Journal of Public Health Author-Name: Schwartz, M.D. Author-Name: Rimer, B.K. Author-Name: Daly, M. Author-Name: Sands, C. Author-Name: Lerman, C. Year: 1999 Volume: 89 Issue: 6 Pages: 924-926 Abstract: Objectives. We evaluated the impact of individualized breast cancer risk counseling on mammography use among women at risk for breast cancer. Methods. Participants (n = 508) were randomized to the breast cancer risk counseling intervention or a general health education control intervention, and 85% completed follow-up. Results. In multivariate modeling, a significant group- by-education interaction demonstrated that among less-educated participants, breast cancer risk counseling led to reduced mammography use. There was intervention effect among the more-educated participants. Conclusions. These results suggest that standard breast cancer risk counseling could have an adverse impact on the health behaviors of less-educated women. Handle: RePEc:aph:ajpbhl:1999:89:6:924-926_9 Template-Type: ReDIF-Article 1.0 Title: Zidovudine and reduction of vertical transmission of HIV in Africa [2] Journal: American Journal of Public Health Author-Name: Msellati, P. Author-Name: Meda, N. Author-Name: Welffens-Ekra, C. Author-Name: Leroy, V. Author-Name: Van De Perre, P. Author-Name: Mandelbrot, L. Author-Name: Dabis, F. Year: 1999 Volume: 89 Issue: 6 Pages: 947-948 Handle: RePEc:aph:ajpbhl:1999:89:6:947-948_5 Template-Type: ReDIF-Article 1.0 Title: Linking community-based blood pressure measurement to clinical care: A randomized controlled trial of outreach and tracking by community health workers Journal: American Journal of Public Health Author-Name: Krieger, J. Author-Name: Collier, C. Author-Name: Song, L. Author-Name: Martin, D. Year: 1999 Volume: 89 Issue: 6 Pages: 856-861 Abstract: Objectives. This study assessed the effectiveness of enhanced tracking and follow-up services provided by community health workers in promoting medical follow-up of persons whose elevated blood pressures were detected during blood pressure measurement at urban community sites. Methods. In a randomized controlled trial, 421 participants received either enhanced or usual referrals to care. Participants were 18 years or older, were either Black or White, and had blood pressure greater than or equal to 140/90 mm Hg and income equal to or less than 200% of poverty. The primary outcome measure was completion of a medical follow-up visit within 90 days of referral. Results. The enhanced intervention increased follow-up by 39.4% (95% confidence interval [CI] = 14%, 71%; P = .001) relative to usual care. Follow-up visits were completed by 65.1% of participants in the intervention group, compared with 46.7% of those in the usual-care group. The number needed to treat was 5 clients (95% CI = 3, 13) per additional follow-up visit realized. Conclusions. Enhanced tracking and outreach increased the proportion of persons with elevated blood pressure detected during community measurement who followed up with medical care. Handle: RePEc:aph:ajpbhl:1999:89:6:856-861_3 Template-Type: ReDIF-Article 1.0 Title: Building momentum: An ethnographic study of inner-city redevelopment Journal: American Journal of Public Health Author-Name: Fullilove, M.T. Author-Name: Green, L. Author-Name: Fullilove III, R.E. Year: 1999 Volume: 89 Issue: 6 Pages: 840-844 Abstract: Objectives. One factor contributing to the decay of inner-city areas, and to consequent excess mortality, is the massive loss of housing. This report studied the effects of redevelopment project on social functioning in an inner-city community. Methods. This ethnographic study included the following elements; a longitudinal study of 10 families living in renovated housing, repeated observations and photographing of the street scene, focus groups, and informal interviews with area residents. The project was located in the Bradhurst section of Harlem in New York City and was focused on a redevelopment effort sponsored by local congregations. Results. Those who were able to move into newly renovated housing found that their living conditions were greatly improved. Neighborhood revitalization lagged behind the rehabilitation of individual apartment houses. This uneven redevelopment was a visual and sensory reminder of 'what had been.' Residents missed the warmth and social support that existed in Harlem before its decline. Conclusions. Rebuilding damaged housing contributes greatly to the well- being of inner-city residents. The current pace and scope of rebuilding are insufficient to restore lost vitality. Handle: RePEc:aph:ajpbhl:1999:89:6:840-844_3 Template-Type: ReDIF-Article 1.0 Title: Hospital volume and survival of breast cancer patients in Connecticut [1] Journal: American Journal of Public Health Author-Name: Polednak, A.P. Year: 1999 Volume: 89 Issue: 6 Pages: 946-947 Handle: RePEc:aph:ajpbhl:1999:89:6:946-947_6 Template-Type: ReDIF-Article 1.0 Title: Characteristics of nurse-midwife patients and visits, 1991 Journal: American Journal of Public Health Author-Name: Paine, L.L. Author-Name: Lang, J.M. Author-Name: Strobino, D.M. Author-Name: Johnson, T.R.B. Author-Name: DeJoseph, J.F. Author-Name: Declercq, E.R. Author-Name: Gagnon, D.R. Author-Name: Scupholme, A. Author-Name: Ross, A. Year: 1999 Volume: 89 Issue: 6 Pages: 906-909 Abstract: Objectives. This study describes the patient populations served by and visits made to certified nurse-midwives (CNMs) in the United States. Methods. Prospective data on 16729 visits were collected from 369 CNMs randomly selected from a 1991 population survey. Population estimates were derived from a multistage survey design with probability sampling. Results. We estimated that approximately 5.4 million visits were made to nearly 3000 CNMs nationwide in 1991. Most visits involved maternity care, although fully 20% were for care outside the maternity cycle. Patients considered vulnerable to poor access or outcomes made 7 of every 10 visits. Conclusions. Nurse- midwives substantially contribute to the health care of women nationwide, especially for vulnerable populations. Handle: RePEc:aph:ajpbhl:1999:89:6:906-909_8 Template-Type: ReDIF-Article 1.0 Title: Dental care access and use among HIV-infected women Journal: American Journal of Public Health Author-Name: Shiboski, C.H. Author-Name: Palacio, H. Author-Name: Neuhaus, J.M. Author-Name: Greenblatt, R.M. Year: 1999 Volume: 89 Issue: 6 Pages: 834-839 Abstract: Objectives. This study sought to identify predictors of dental care use in HIV-infected women. Methods. In a cross-sectional survey of HIV-infected women enrolled in the northern California site of the Women's Interagency HIV Study, dental care use and unmet need were assessed relation to selected variables. Results. Among 213 respondents, who were predominantly Black and younger than 45 years, 43% had not seen a dentist and 53% (among dentate women) reported no dental cleaning in more than a year (although 67% had dental insurance coverage, mainly state Medicaid). Nine percent were edentulous. Among nonusers of dental care, 78% reported that they wanted care but failed to get it. Barriers included fear of and discomfort with dentists, not getting around to making an appointment, and not knowing which dentist to visit. Multivariate analysis showed that lack of past-year dental care was associated mainly with unemployment, a perception of poor oral health, and edentulism. Conclusions. HIV-positive women appear to be underusing dental care services. Fear and lack of information regarding available resources, in addition to unemployment and perception of poor oral health, may be important barriers. Handle: RePEc:aph:ajpbhl:1999:89:6:834-839_8 Template-Type: ReDIF-Article 1.0 Title: The prevalence of low income among childbearing women in California: Implications for the private and public sectors Journal: American Journal of Public Health Author-Name: Braveman, P. Author-Name: Egerter, S. Author-Name: Marchi, K. Year: 1999 Volume: 89 Issue: 6 Pages: 868-874 Abstract: Objectives. This study examined the income distribution of childbearing women in California and sought to identify income groups at increased risk of untimely prenatal care. Methods. A 1994/95 cross-sectional statewide survey of 10 132 postpartum women was used. Results. Sixty-five percent of all childbearing women had low income (0%-200% of the federal poverty level), and 46% were poor (0%-100% of the federal poverty level). Thirty-five percent of women with private prenatal coverage had low income. Most low-income women with Medi-Cal (California's Medicaid) or private coverage received their prenatal care at private-sector sites. Compared with women with incomes over 400% of the poverty level, both poor and near-poor women were at significantly elevated risk of untimely care after adjustment for insurance, education, age, parity, marital status, and ethnicity (adjusted odds ratios = 5.32 and 3.09, respectively). Conclusions. This study's results indicate that low-income women are the mainstream maternity population, not a 'special needs' subgroup; even among privately insured childbearing women, a substantial proportion have low income. Efforts to increase timely prenatal care initiation cannot focus solely on women with Medicaid, the uninsured, women in absolute poverty, or those who receive care at public-sector sites. Handle: RePEc:aph:ajpbhl:1999:89:6:868-874_1 Template-Type: ReDIF-Article 1.0 Title: Great expectations: Historical perspectives on genetic breast cancer testing Journal: American Journal of Public Health Author-Name: Lerner, B.H. Year: 1999 Volume: 89 Issue: 6 Pages: 938-944 Abstract: Women who test positive for a genetic breast cancer marker may have more than a 50% chance of developing the disease. Although past screening technologies have sought to identify actual breast cancers, as opposed to predisposition, the history of screening may help predict, the societal response to genetic testing. For decades, educational messages have encouraged women to find breast cancers as early as possible. Such messages have fostered the popular assumption that immediately discovered and treated breast cancers are necessarily more curable. Research, however, has shown that screening improves the prognosis of some - but not all - breast cancers, and also that it may lead to unnecessary interventions. The dichotomy between the advertised value of early detection and its actual utility has caused particular controversy in the United States, where the cultural climate emphasizes the importance of obtaining all possible medical information and acting on it. Early detection has probably helped to lower overall breast cancer mortality. But it has proven hard to praise aggressive screening without exaggerating its merits. Women considering genetic breast cancer testing should weigh the benefits and limitations of early knowledge. Handle: RePEc:aph:ajpbhl:1999:89:6:938-944_5 Template-Type: ReDIF-Article 1.0 Title: The impact of Medicaid managed care on community clinics in Sacramento County, California Journal: American Journal of Public Health Author-Name: Korenbrot, C.C. Author-Name: Miller, G. Author-Name: Greene, J. Year: 1999 Volume: 89 Issue: 6 Pages: 913-917 Abstract: Objectives. The purpose of this study was to determine the impact of countywide Medicaid managed care on service use at community clinics. Methods. Clinic use before and after introduction of Medicaid plans in one county was compared with that in a group of comparable counties without such plans. Results. There were significant declines of 40% to 45% in the volumes of Medicaid clients, encounters, and revenues at clinics with the introduction of Medicaid plans. Declines of 23% in uninsured clients and encounters did not differ significantly. Conclusions. The introduction of Medicaid managed care with multiple commercial plans can have significant negative effects on nonprofit community clinics. Handle: RePEc:aph:ajpbhl:1999:89:6:913-917_2 Template-Type: ReDIF-Article 1.0 Title: Prevention of relapse in women who quit smoking during pregnancy Journal: American Journal of Public Health Author-Name: McBride, C.M. Author-Name: Curry, S.J. Author-Name: Lando, H.A. Author-Name: Pirie, P.L. Author-Name: Grothaus, L.C. Author-Name: Nelson, J.C. Year: 1999 Volume: 89 Issue: 5 Pages: 706-711 Abstract: Objectives. This study is an evaluation of relapse prevention interventions for smokers who quit during pregnancy. Methods. Pregnant smokers at 2 managed care organizations were randomized to receive a self- help booklet only, prepartum relapse prevention, or prepartum and postpartum relapse prevention. Follow-up surveys were conducted at 28 weeks of pregnancy and at 8 weeks, 6 months, and 12 months postpartum. Results. The pre/post intervention delayed but did not prevent postpartum relapse to smoking. Prevalent abstinence was significantly greater for the pre/post intervention group than for the other groups at 8 weeks (booklet group, 30%; prepartum group, 35%; pre/post group, 39%; P = .02 [different superscripts denote differences at P < .05]) and at 6 months (booklet group, 26%; prepartum group, 24%; pre/post group, 33%; P = .04) postpartum. A nonsignificant reduction in relapse among the pre/post group contributed to differences in prevalent abstinence. There was no difference between the groups in prevalent abstinence at 12 months postpartum. Conclusions. Relapse prevention interventions may need to be increased in duration and potency to prevent postpartum relapse. Handle: RePEc:aph:ajpbhl:1999:89:5:706-711_4 Template-Type: ReDIF-Article 1.0 Title: Minor tobacco alkaloids as biomarkers for tobacco use: Comparison of users of cigarettes, smokeless tobacco, cigars, and pipes Journal: American Journal of Public Health Author-Name: Jacob III, P. Author-Name: Yu, L. Author-Name: Shulgin, A.T. Author-Name: Benowitz, N.L. Year: 1999 Volume: 89 Issue: 5 Pages: 731-736 Abstract: Objectives. This study (1) determined levels of various tobacco alkaloids in commercial tobacco products; (2) determined urinary concentrations, urinary excretion, and half-lives of the alkaloids in humans; and (3) examined the possibility that urine concentrations of nicotine- related alkaloids can be used as biomarkers of tobacco use. Methods. Nicotine intake from various tobacco products was determined through pharmacokinetic techniques. Correlations of nicotine intake with urinary excretion and concentrations of anabasine, anatabine, nornicotine, nicotine, and cotinine were examined. By using urinary excretion data, elimination half-lives of the alkaloids were calculated. Results. Alkaloid levels in commercial tobacco products, in milligrams per gram, were as follows: nicotine, 6.5 to 17.5; nornicotine, 0.14 to 0.66; anabasine, 0.008 to 0.030; and anatabine, 0.065 to 0.27. Measurable concentrations of all alkaloids were excreted in the urine of most subjects smoking cigarettes, cigars, and pipes and using smokeless tobacco. Correlations between nicotine intake and alkaloid concentrations were good to excellent. Conclusions. Anabasine and anatabine, which are present in tobacco but not in nicotine medications, can be used to assess tobacco use in persons undergoing nicotine replacement therapy. Handle: RePEc:aph:ajpbhl:1999:89:5:731-736_3 Template-Type: ReDIF-Article 1.0 Title: Fertility implications of reduced breast-feeding by HIV/AIDS-infected mothers in developing countries [2] Journal: American Journal of Public Health Author-Name: Stecklov, G. Year: 1999 Volume: 89 Issue: 5 Pages: 780-781 Handle: RePEc:aph:ajpbhl:1999:89:5:780-781_8 Template-Type: ReDIF-Article 1.0 Title: The Resource Mothers Program for Maternal Phenylketonuria Journal: American Journal of Public Health Author-Name: St. James, P.S. Author-Name: Shapiro, E. Author-Name: Waisbren, S.E. Year: 1999 Volume: 89 Issue: 5 Pages: 762-764 Abstract: Objectives. The purpose of this study was to measure the effectiveness of resource mothers in reducing adverse consequences of maternal phenylketonuria. Methods. Nineteen pregnancies in the resource mothers group were compared with 64 pregnancies in phenylketonuric women without resource mothers. Weeks to metabolic control and offspring outcome were measured. Results. Mean number of weeks to metabolic control was 8.5 (SE = 2.2) in the resource mothers group, as compared with 16.1 (SE = 1.7) in the comparison group. Infants of women in the resource mothers group had larger birth head circumferences and higher developmental quotients. Conclusions. The resource mothers program described here improves metabolic control in pregnant women with phenylketonuria. Handle: RePEc:aph:ajpbhl:1999:89:5:762-764_5 Template-Type: ReDIF-Article 1.0 Title: An expensive policy: The impact of inadequate funding for substance abuse treatment Journal: American Journal of Public Health Author-Name: Amaro, H. Year: 1999 Volume: 89 Issue: 5 Pages: 657-659 Handle: RePEc:aph:ajpbhl:1999:89:5:657-659_7 Template-Type: ReDIF-Article 1.0 Title: Preventing weight gain in adults: The pound of prevention study Journal: American Journal of Public Health Author-Name: Jeffery, R.W. Author-Name: French, S.A. Year: 1999 Volume: 89 Issue: 5 Pages: 747-751 Abstract: Objectives. This study examined whether weight gain with age could be prevented through the use of a low-intensity intervention. Methods. Participants, 228 men and 998 women recruited from diverse sources, were randomized to one of the following groups: (1) no-contact control, (2) education through monthly newsletters, or (3) education plus incentives for participation. All participants were weighed and completed questionnaires about behaviors and attitudes related to weight at baseline and annually for 3 years thereafter. Results. Individuals in intervention groups reported favorable changes over time in frequency of weighing and healthy dieting practices relative to those in the control group. These behavior changes were in turn related to a reduced rate of weight gain over time. However, weight gain over 3 years did not differ significantly by treatment group. Conclusions. This low-intensity educational approach to weight gain prevention sustained interest over a lengthy time period and was associated positively with behavior change, but it was not strong enough to significantly reduce weight gain with age. Handle: RePEc:aph:ajpbhl:1999:89:5:747-751_9 Template-Type: ReDIF-Article 1.0 Title: Darryl, a cartoon-based measure of cardinal posttraumatic stress symptoms in school-age children Journal: American Journal of Public Health Author-Name: Neugebauer, R. Author-Name: Kline, J. Author-Name: Wasserman, G.A. Author-Name: Fisher, P.W. Author-Name: Miller, L.S. Author-Name: Geller, P.A. Year: 1999 Volume: 89 Issue: 5 Pages: 758-761 Abstract: Objectives. This report examines the reliability and validity of Darryl, a cartoon-based measure of the cardinal symptoms of posttraumatic stress disorder (PTSD). Methods. We measured exposure to community violence through the reports of children and their parents and then administered Darryl to a sample of 110 children age 7 to 9 residing in urban neighborhoods with high crime rates. Results. Darryl's reliability is excellent overall and is acceptable for the reexperiencing, avoidance, and arousal subscales, considered separately. Child reports of exposure to community violence were significantly associated with child reports of PTSD symptoms. Conclusions. Darryl possesses acceptable psychometric properties in a sample of children with frequent exposure to community violence. Handle: RePEc:aph:ajpbhl:1999:89:5:758-761_0 Template-Type: ReDIF-Article 1.0 Title: Weight loss counseling by health care providers Journal: American Journal of Public Health Author-Name: Nawaz, H. Author-Name: Adams, M.L. Author-Name: Katz, D.L. Year: 1999 Volume: 89 Issue: 5 Pages: 764-767 Abstract: Objectives. This study explores the pattern of weight loss counseling by health care providers in Connecticut and the associated weight loss efforts by patients. Methods. Data from the 1994 Connecticut Behavioral Risk Factor Surveillance System survey were analyzed to determine (1) the frequency of weight management counseling by health care providers of overweight adults with and without additional cardiovascular risk factors and (2) the current weight loss practices of overweight subjects. Results. Only 29% of all overweight respondents, and fewer than half with additional cardiovascular risk factors, reported that they had been counseled to lose weight. Conclusions. The findings suggest a need for more counseling of overweight persons, especially those with cardiovascular disease risk factors. Handle: RePEc:aph:ajpbhl:1999:89:5:764-767_8 Template-Type: ReDIF-Article 1.0 Title: Weekly patterns of drug treatment attendance Journal: American Journal of Public Health Author-Name: Svikis, D.S. Author-Name: Pickens, R.W. Author-Name: Schweitzer, W. Author-Name: Johnson, E. Author-Name: Haug, N. Year: 1999 Volume: 89 Issue: 5 Pages: 752-755 Abstract: Objectives. This study examined weekly patterns of drug treatment attendance in relation to date of welfare payment receipt and reason for treatment absence. Methods. Treatment attendance by Medicaid-eligible pregnant women who were drug dependent was examined by calendar week over a 29-month period. Results. Time series analyses showed that attendance was lower during week 1 than week 4. Drug use was the most frequently reported reason for treatment absence during week 1 (25%) but was not reported as a reason during week 3. Conclusions. Drug-dependent outpatients had increased absences associated with illicit drug use during the first week of the month when welfare payments were received. The generalizability of the findings is unknown. Handle: RePEc:aph:ajpbhl:1999:89:5:752-755_7 Template-Type: ReDIF-Article 1.0 Title: Smoking cessation and body mass index of occupationally active men: The Israeli CORDIS study Journal: American Journal of Public Health Author-Name: Froom, P. Author-Name: Kristal-Boneh, E. Author-Name: Melamed, S. Author-Name: Gofer, D. Author-Name: Benbassat, J. Author-Name: Ribak, J. Year: 1999 Volume: 89 Issue: 5 Pages: 718-722 Abstract: Objectives. This study estimated weight gain after smoking cessation and identified factors attenuating this gain. Methods. We conducted a prospective follow-up of 1209 male factory workers for 2 to 4 years. The independent variables were smoking habits, age, sports activity, education, alcohol consumption, ethnicity, duration of follow-up, and body mass index (BMI, kg/m2) at entry. The dependent variable was increase in BMI during follow- up. Results. The mean age-adjusted BMI at entry into the study was 26.6 kg/m2 among past smokers and 25.4 kg/m2 among current smokers. There were no differences in BMI between those who quit less than 3 years before entry and those who quit more than 6 years before entry. During follow-up, the average increase in BMI was 0.07 kg/m2 among never smokers, 0.19 kg/m2 among smokers who had stopped smoking before entry, 0.24 kg/m2 among current smokers, and 0.99 kg/m2 among those who stopped smoking after entry. Cessation of smoking after entry predicted an increased gain in BMI; older age, a higher BMI at entry, sports activity, and alcohol consumption attenuated this gain. Conclusions. The increased rate of weight gain after smoking cessation is transient. However, the weight gained is retained for at least 6 years. Handle: RePEc:aph:ajpbhl:1999:89:5:718-722_0 Template-Type: ReDIF-Article 1.0 Title: Ethics instruction at schools of public health in the United States Journal: American Journal of Public Health Author-Name: Coughlin, S.S. Author-Name: Katz, W.H. Author-Name: Mattison, D.R. Year: 1999 Volume: 89 Issue: 5 Pages: 768-770 Abstract: Objectives. A survey of US schools of public health was undertaken in 1996 and 1997 to obtain a general picture of public health ethics curricula. Methods. An explanatory letter with a list of questions for discussion was sent to the deans of the accredited US schools of public health. The deans were asked that at least 1 individual at their school who 'is most knowledgeable about ethics curricula' review the list of questions and complete an ethics survey contact form. Results. Ethics instruction was required for all students at only 1 (4%) of the 24 schools surveyed, while 7 schools required ethics instruction for some students. Two of the schools had no ethics courses. Ethics instruction was required for all MPH students at 9 (38%) of the schools and for all doctoral students at 4 (17%) of the schools. Most of the schools (19 of 24, or 79%) offered short courses, seminar series, or invited lectures on ethical topics, and 23 (96%) included lectures on ethics topics in other courses such as health law. Conclusions. Training programs at US schools of public health vary greatly in how much attention is given to ethics instruction. Model curricula in public health ethics should be developed to help fill this gap. Handle: RePEc:aph:ajpbhl:1999:89:5:768-770_3 Template-Type: ReDIF-Article 1.0 Title: Changing patterns of drug use among US military recruits before and after enlistment Journal: American Journal of Public Health Author-Name: Bachman, J.G. Author-Name: Freedman-Doan, P. Author-Name: O'Malley, P.M. Author-Name: Johnston, L.D. Author-Name: Segal, D.R. Year: 1999 Volume: 89 Issue: 5 Pages: 672-677 Abstract: Objectives. The US armed forces adopted 'zero tolerance' policies concerning illicit drug use in 1980 and later developed policies to discourage tobacco and alcohol abuse. This article examines drug use among young active-duty recruits both before and after enlistment, compared with non-military age-mates, and documents historical shifts in such drug use across 2 decades. Methods. Analyses employed longitudinal panel data from 20 nationally representative samples of high school seniors (cohorts of 1976- 1995), each surveyed just before graduation and again within 2 years. Separate analyses for men (n = 12 082) and women (n = 15 345) contrasted those who entered military service, college, and civilian employment. Results. Illicit drug use declined more among young military recruits than among their civilian counterparts. Analyses of male recruits at multiple time periods showed (1) declines in the prevalence of marijuana use and cocaine use after the initiation of routine military drug resting and (2) lower proportions of smokers of half a pack or more of cigarettes per day who entered service after the initiation of tobacco bans during basic training. Conclusions. Recent military drug policies appear to deter illicit drug use among enlistees and discourage some smokers from enlisting. Handle: RePEc:aph:ajpbhl:1999:89:5:672-677_0 Template-Type: ReDIF-Article 1.0 Title: Underage drivers are separating drinking from driving Journal: American Journal of Public Health Author-Name: Roeper, P.J. Author-Name: Voas, R.B. Year: 1999 Volume: 89 Issue: 5 Pages: 755-757 Abstract: Objectives. From 1985 to 1995, drivers younger than 21 years experienced a 50% drop in fatal crashes involving alcohol. This study addresses whether the decrease is explained by young drivers' drinking less or by their separating drinking from driving. Methods. Nighttime roadside surveys were conducted in 3 communities to test drivers' breath and administer questionnaires on drinking practices. From 1992 to 1996, 34898 drivers (21% of whom were younger than 21 years were interviewed.) Results. Although drivers younger than 21 years were more likely to have consumed 6 or more drinks on at least 1 occasion during the previous month, a smaller percentage of younger drivers than of older drivers had blood alcohol concentrations of 0.01 or higher. Conclusions. Younger drivers are more likely than drivers older than 21 years to separate drinking from driving. Handle: RePEc:aph:ajpbhl:1999:89:5:755-757_8 Template-Type: ReDIF-Article 1.0 Title: Cardiovascular risk factors in Mexican American adults: A transcultural analysis of NHANES III, 1988-1994 Journal: American Journal of Public Health Author-Name: Sundquist, J. Author-Name: Winkleby, M.A. Year: 1999 Volume: 89 Issue: 5 Pages: 723-730 Abstract: Objectives. This study examined the extent to which cardiovascular disease risk factors differ among subgroups of Mexican Americans living in the United States. Methods. Using data from a national sample (1988-1994) of 1387 Mexican American women and 1404 Mexican American men, aged 25 to 64 years, we examined an estimate of coronary heart disease mortality risk and 5 primary cardiovascular disease risk factors: systolic blood pressure, body mass index, cigarette smoking, non-high-density lipoprotein cholesterol, and type 2 diabetes mellitus. Differences in risk were evaluated by country of birth and primary language spoken. Results. Estimated 10-year coronary heart disease mortality risk per 1000 persons, adjusted for age and education, was highest for US-born Spanish-speaking men and women (27.5 and 11.4, respectively), intermediate for US-born English-speaking men and women (22.5 and 7.0), and lowest for Mexican-born men and women (20.0 and 6.6). A similar pattern of higher risk among US-born Spanish-speaking men and women was demonstrated for each of the 5 cardiovascular disease risk factors. Conclusions. These findings illustrate the heterogeneity of the Mexican American population and identify a new group at substantial risk for cardiovascular disease and in need of effective heart disease prevention programs. Handle: RePEc:aph:ajpbhl:1999:89:5:723-730_4 Template-Type: ReDIF-Article 1.0 Title: Interventions to improve the delivery of preventive services in primary care Journal: American Journal of Public Health Author-Name: Hulscher, M.E.J.L. Author-Name: Wensing, M. Author-Name: Grol, R.P.T.M. Author-Name: Van Der Weijden, T. Author-Name: Van Weel, C. Year: 1999 Volume: 89 Issue: 5 Pages: 737-746 Abstract: Objectives. This review was conducted to determine the effectiveness of different interventions to improve the delivery of preventive services in primary care. Methods. MEDLINE searches and manual searches of 21 scientific journals and the Cochrane Effective Professional and Organization of Care of trials were used to identify relevant studies. Randomized controlled trials and controlled before-and-after studies were included if they focused on interventions designed to improve preventive activities by primary care clinicians. Two researchers independently assessed the quality of the studies and extracted data for use in constructing descriptive overviews. Results. The 58 studies included comprised 86 comparisons between intervention and control groups. Postintervention differences between intervention and control groups varied widely within and across categories of interventions. Most interventions were found to be effective in some studies, but not effective in other studies. Conclusions. Effective interventions to increase preventive activities in primary care are available. Detailed studies are needed to identify factors that influence the effectiveness of different interventions. Handle: RePEc:aph:ajpbhl:1999:89:5:737-746_8 Template-Type: ReDIF-Article 1.0 Title: Methadone dosing, heroin affordability, and the severity of addiction Journal: American Journal of Public Health Author-Name: Bach, P.B. Author-Name: Lantos, J. Year: 1999 Volume: 89 Issue: 5 Pages: 662-665 Abstract: Objectives. This study sought to track changes in US heroin prices from 1988 to 1995 and to determine whether changes in the affordability of heroin were associated with changes in the use of heroin by users seeking methadone treatment, as indexed by methadone dose levels. Methods. Data on the price of heroin were from the Drug Enforcement Administration; data on methadone doses were from surveys conducted in 1988, 1990, and 1995 of 100 methadone maintenance centers. Multivariable models that controlled for time and city effects were used to ascertain whether clinics in cities where heroin was less expensive had patients receiving higher doses of methadone, which would suggest that these patients had relatively higher physiological levels of opiate addiction owing to increased heroin. Results. The amount of pure heroin contained in a $100 (US) purchase has increased on average 3-fold between 1988 and 1995. The average dose of methadone in clinics was positively associated with the affordability of local heroin (P < .01). Conclusions. When heroin prices fall, heroin prices fall, heroin addicts require more methadone (a heroin substitute) to stabilize their addiction - evidence that they are consuming more heroin. Handle: RePEc:aph:ajpbhl:1999:89:5:662-665_5 Template-Type: ReDIF-Article 1.0 Title: Changes at the high end of risk in cigarette smoking among US high school seniors, 1976-1995 Journal: American Journal of Public Health Author-Name: An, L.C. Author-Name: O'Malley, P.M. Author-Name: Schulenberg, J.E. Author-Name: Bachman, J.G. Author-Name: Johnston, L.D. Year: 1999 Volume: 89 Issue: 5 Pages: 699-705 Abstract: Objectives. This study identified high school seniors at low, moderate, and high risk for cigarette use to examine changes in the prevalence of daily smoking within risk groups from 1976 to 1995. Methods. Data were taken from the Monitoring the Future Project's national surveys of high school seniors. Risk classification was based on grade-point average, truancy, nights out per week, and religious commitment. Logistic regression models were used to estimate trends for all seniors and separately for White (n = 244 221), African American (n = 41 005), and Hispanic (n = 18 457) male and female subgroups. Results. Risk group distribution (low = 45%, moderate = 30%, high = 25%) changed little over time. Between 1976 and 1990, greater absolute declines in smoking occurred among high-risk students (17 percentage points) than among low-risk students (6 percentage points). Particularly large declines occurred among high-risk African Americans and Hispanics. Smoking increased in all risk groups in the 1990s. Conclusions. Among high school seniors, a large part of the overall change in smoking occurred among high- risk youth. Policies and programs to reduce smoking among youth must have broad appeal, especially to those at the higher end of the risk spectrum. Handle: RePEc:aph:ajpbhl:1999:89:5:699-705_1 Template-Type: ReDIF-Article 1.0 Title: The impact of smoking, alcohol consumption, and physical activity on use of hospital services Journal: American Journal of Public Health Author-Name: Haapanen-Niemi, N. Author-Name: Miilunpalo, S. Author-Name: Vuori, I. Author-Name: Pasanen, M. Author-Name: Oja, P. Year: 1999 Volume: 89 Issue: 5 Pages: 691-698 Abstract: Objectives. This study investigated the associations of smoking, excess alcohol consumption, and physical inactivity with the use of hospital care. Methods. A cohort of 19- to 63- year-old Finnish men (n = 2534) and women (n = 2668) were followed prospectively for 16 years. Number of hospital days was extracted from the national hospital discharge registry, while data concerning exposure variables were derived from the baseline questionnaire. Results. After adjustment for confounders, male smokers had 70% (95% confidence interval [CI] = 49%, 95%) and female smokers had 49% (95% CI = 29%, 71%) more hospital days due to any cause than did those who had never smoked. Men consuming a moderate amount of alcohol had 21% (95% CI = 10%, 31%) fewer hospital days due to any cause than did nondrinkers. Men who had the lowest energy expenditure during leisure-time physical activity had 36% (95% CI = 15%, 63%) more hospital days than the most active men. The figure for women was 23% (95% CI = 4%, 44%). Conclusions. Smoking was strongly associated with an increased use of hospital services. The associations of alcohol consumption and leisure-time physical activity with use of hospital care depended on the diagnosis under study. Handle: RePEc:aph:ajpbhl:1999:89:5:691-698_4 Template-Type: ReDIF-Article 1.0 Title: Maternal cigarette smoking and invasive meningococcal disease: A cohort study among young children in Metropolitan Atlanta, 1989-1996 Journal: American Journal of Public Health Author-Name: Yusuf, H.R. Author-Name: Rochat, R.W. Author-Name: Baughman, W.S. Author-Name: Gargiullo, P.M. Author-Name: Perkins, B.A. Author-Name: Brantley, M.D. Author-Name: Stephens, D.S. Year: 1999 Volume: 89 Issue: 5 Pages: 712-717 Abstract: Objectives. This study assessed the association between maternal cigarette smoking during pregnancy and the risk of invasive meningococcal disease during early childhood. Methods. Using a retrospective cohort study design, cases from an active surveillance project monitoring all invasive meningococcal disease in the metropolitan Atlanta area from 1989 to 1995 were merged with linked birth and death certificate data files. Children who had not died or acquired meningococcal disease were assumed to be alive and free of the illness. The Cox proportional hazards analysis was used to assess the independent association between maternal smoking and meningococcal disease. Results. The crude rate of meningococcal disease was 5 times higher for children whose mothers smoked during pregnancy than for children whose mothers did not smoke (0.05% vs 0.01%). Multivariate analysis revealed that maternal smoking (risk ratio [RR] = 2.9; 95% confidence interval [CI] = 1.5, 5.7) and a mother's having fewer than 12 years of education (RR=2.1; 95% CI = 1.0, 4.2) were independently associated with invasive meningococcal disease. Conclusions. Maternal smoking, a likely surrogate for tobacco smoke exposure following delivery, appears to be a modifiable risk factor for sporadic meningococcal disease in young children. Handle: RePEc:aph:ajpbhl:1999:89:5:712-717_7 Template-Type: ReDIF-Article 1.0 Title: Predicting posttreatment cocaine abstinence for first-time admissions and treatment repeaters Journal: American Journal of Public Health Author-Name: Hser, Y.-I. Author-Name: Joshi, V. Author-Name: Anglin, M.D. Author-Name: Fletcher, B. Year: 1999 Volume: 89 Issue: 5 Pages: 666-671 Abstract: Objectives. This study examined client and program characteristics that predict posttreatment cocaine abstinence among cocaine abusers with different treatment histories. Methods. Cocaine abusers (n = 507) treated in 18 residential programs were interviewed at intake and 1-year follow-up as part of the nationwide Drug Abuse Treatment Outcome Study (DATOS). Program directors provided the program-level data in a mail survey. We applied the hierarchical linear modeling approach for the analysis. Results. No prior treatment and longer retention in DATOS programs were positive predictors of posttreatment abstinence. The interactive effect of these 2 variables was also significantly positive. Programs that offered legal services and included recovering staff increased their clients' likelihood of cocaine abstinence. Crack use at both the client and program level predicted negative impact. None of the program variables assessed differentially affected the outcomes of first-timers and repeaters. Conclusions: Although treatment repeaters were relatively difficult to treat, their likelihood of achieving abstinence was similar to that of first-timers if they were retained in treatment for a sufficient time. First-timers and repeaters responded similarly to the treatment program characteristics examined. The treatment and policy implications of these findings are discussed. Handle: RePEc:aph:ajpbhl:1999:89:5:666-671_7 Template-Type: ReDIF-Article 1.0 Title: Type of alcoholic drink and risk of major coronary heart disease events and all-cause mortality Journal: American Journal of Public Health Author-Name: Wannamethee, S.G. Author-Name: Shaper, A.G. Year: 1999 Volume: 89 Issue: 5 Pages: 685-690 Abstract: Objectives. This study examined the effects of beer, spirits, and wine drinking on coronary heart disease (CHD) events (fatal and nonfatal) and all- cause mortality. Methods. Men aged 40 to 59 years (n = 7735) were drawn at random from one general practice in each of 24 British towns and followed up for an average of 16.8 years. Results. Regular drinkers showed a significantly lower relative risk of CHD, but not all-cause mortality, than occasional drinkers, even after adjustment for potential confounders. The benefit for CHD of regular drinking was seen within both beer drinkers and spirit drinkers but not among men who reported wine drinking. However, all men who reported wine drinking (both occasional and regular) showed significantly lower age-adjusted risks of CHD and all-cause mortality than men drinking beer or spirits; beer and spirit drinkers showed similar risks. Conclusions. The findings suggest that regular intake of all alcoholic drinks is associated with a lower risk of CHD, but not all-cause mortality, than occasional drinking. A large part, but not all, of the greater benefit seen in wine drinkers relative to other drinkers can be attributed to advantageous lifestyle characteristics (e.g., low rates of smoking and obesity). Handle: RePEc:aph:ajpbhl:1999:89:5:685-690_2 Template-Type: ReDIF-Article 1.0 Title: Drinking and driving among US high school seniors, 1984-1997 Journal: American Journal of Public Health Author-Name: O'Malley, P.M. Author-Name: Johnston, L.D. Year: 1999 Volume: 89 Issue: 5 Pages: 678-684 Abstract: Objectives. This article reports the prevalence of, and trends in, driving after drinking and riding in a car with a driver who has been drinking among American high school seniors, based on data from more than a decade (1984-1997) of annual national surveys. Methods. Logistic regressions were used to assess the effects of demographic factors (gender, region of country, population density, parental education, and race/ethnicity) and selected 'lifestyle' factors (religious commitment, high school grades, truancy, illicit drug use, evenings out per week, and miles driven per week). Results. Rates of adolescent driving after drinking and riding with a driver who had been drinking declined significantly from the mid-1980s to the early or mid-1990s, but the declines have not continued in recent years. Rates of driving or riding after drinking were higher among high school seniors who are male, White, living in the western and northeastern regions of the United States, and living in rural areas. Truancy, number of evenings out, and illicit drug use all related significantly positively with the dependent variables, whereas grade point average and religious commitment had a negative relationship. Miles driven per week related positively to driving after drinking. Handle: RePEc:aph:ajpbhl:1999:89:5:678-684_0 Template-Type: ReDIF-Article 1.0 Title: Larimer County Tobacco and Youth Project. Journal: American Journal of Public Health Author-Name: Watson, A. Author-Name: Grove, N. Year: 1999 Volume: 89 Issue: 4 Pages: 597-598 Handle: RePEc:aph:ajpbhl:1999:89:4:597-598_6 Template-Type: ReDIF-Article 1.0 Title: Ethics, epidemiology, and law: The case of silicone breast implants Journal: American Journal of Public Health Author-Name: Macklin, R. Year: 1999 Volume: 89 Issue: 4 Pages: 487-489 Handle: RePEc:aph:ajpbhl:1999:89:4:487-489_3 Template-Type: ReDIF-Article 1.0 Title: Silicone breast implants: Epidemiological evidence of sequelae Journal: American Journal of Public Health Author-Name: Stein, Z.A. Year: 1999 Volume: 89 Issue: 4 Pages: 484-487 Abstract: Skeptics may certainly find fault with the third study (the only one to report a significant finding) or with all or any of the statistics described. But few could argue, after examining these studies, that the relative risk for a known and well-defined connective tissue disease is likely greater that 2. Another possibility has been raised, one that calls to mind other difficult-to-study syndromes linked to exposures. In a study addressing Gulf War syndrome, signs and symptoms were often mentioned that proved difficult to describe systematically and there fore difficult to study. What if a suspected silicone exposure syndrome were so mild and transient that it did not warrant a physician visit (as in the Mayo Clinic study), receive a diagnosis (as in the Nurses' Health Study), or require admission to a hospital (as in the Danish and Swedish studies)? And if such a disorder were, in fact, mild and transient, should it merit the concern that has been shown and the compensation that has been awarded in the silicone implant litigation cases to date? We suggest that neither a well-described disorder with a relative risk of less than 2 nor a transient and mild disorder seems compatible with the number of litigants over silicone implants and the apparent seriousness of their complaints. Some 400 000 women joined in one class action suit for damages, and 170 000 joined in another. Even if there had been 2 million implants undertaken in the United States over the 3 decades in which implant surgery has been practiced (and some estimates put the number closer to 1 million), there is no conceivable way in which a relative risk of 2 or 3 (or even 4) for each of the rare syndromes reported could explain so many exposed women being affected. At most, 2200 out of 2 million unexposed women would be expected to have had any one of the listed forms of connective tissue disorders, most of which are very rare. Doubling the risk among the exposed population yields 4400, and increasing the risk 20-fold produces 44 000. At this rate, there is no way in which 400 000 litigants could all be affected. Extensions of the already-completed studies are ongoing, at least 1 of which is government funded; apparently it is thought in the United States (though not in the United Kingdom or elsewhere) that there is still room for reasonable doubt as to the supposed causal relationships. But if epidemiology is invoked in the interest of public health to prevent the many uses of silicone, the weight of the evidence abstracted here supports the inference that silicone breast implants have not been proved guilty of causing connective tissue disorders. Handle: RePEc:aph:ajpbhl:1999:89:4:484-487_6 Template-Type: ReDIF-Article 1.0 Title: The impact of welfare reform on parents' ability to care for their children's health Journal: American Journal of Public Health Author-Name: Heymann, S.J. Author-Name: Earle, A. Year: 1999 Volume: 89 Issue: 4 Pages: 502-505 Abstract: Objectives. Most of the national policy debate regarding welfare assumed that if middle-income mothers could balance work while caring for their children's health and development, mothers leaving welfare for work should be able to do so as well. Yet, previous research has not examined the conditions faced by mothers leaving welfare for work. Methods. Using data from the National Longitudinal Survey of Youth, this study examined the availability of benefits that working parents commonly use to meet the health and developmental needs of their children: paid sick leave, vacation leave, and flexible hours. Results. In comparison with mothers who had never received welfare, mothers who had been on Aid to Families with Dependent Children were more likely to be caring for at least 1 child with a chronic condition (37% vs 21%, respectively). Yet, they were more likely to lack sick leave for the entire time they worked (36% vs 20%) and less likely to receive other paid leave or flexibility. Conclusions. If current welfare recipients face similar conditions when they return to work, many will face working conditions that make it difficult or impossible to succeed in the labor force at the same time as meeting their children's health and developmental needs. Handle: RePEc:aph:ajpbhl:1999:89:4:502-505_1 Template-Type: ReDIF-Article 1.0 Title: Mortality among homeless shelter residents in New York City Journal: American Journal of Public Health Author-Name: Barrow, S.M. Author-Name: Herman, D.B. Author-Name: Córdova, P. Author-Name: Struening, E.L. Year: 1999 Volume: 89 Issue: 4 Pages: 529-534 Abstract: Objectives. This study examined the rates and predictors of mortality among sheltered homeless men and women in New York City. Methods. Identifying data on a representative sample of shelter residents surveyed in 1987 were matched against national mortality records for 1987 through 1994. Standardized mortality ratios were computed to compare death rates among homeless people with those of the general US and New York City populations. Logistic regression analysis was used to examine predictors of mortality within the homeless sample. Results. Age-adjusted death rates of homeless men and women were 4 times those of the general US population and 2 to 3 times those of the general population of New York City. Among homeless men, prior use of injectable drugs, incarceration, and chronic homelessness increased the likelihood of death. Conclusions. For homeless shelter users, chronic homelessness itself compounds the high risk of death associated with disease/disability and intravenous drug use. Interventions must address not only the health conditions of the homeless but also the societal conditions that perpetuate homelessness. Handle: RePEc:aph:ajpbhl:1999:89:4:529-534_3 Template-Type: ReDIF-Article 1.0 Title: Directly observed therapy and tuberculosis treatment completion. Novick and Lipsman re: Bayer et al. Journal: American Journal of Public Health Author-Name: Novick, L.F. Author-Name: Lipsman, J. Year: 1999 Volume: 89 Issue: 4 Pages: 604 Handle: RePEc:aph:ajpbhl:1999:89:4:604_3 Template-Type: ReDIF-Article 1.0 Title: Method of linking Medicaid records to birth certificates may affect infant outcome statistics Journal: American Journal of Public Health Author-Name: Buescher, P.A. Year: 1999 Volume: 89 Issue: 4 Pages: 564-566 Abstract: Objectives. This study assessed how different methods of matching Medicaid records to birth certificates affect Medicaid infant outcome statistics. Methods. Claims paid by Medicaid for hospitalization of the newborn and for the mother's delivery were matched separately to 1995 North Carolina live birth certificates. Results. Infant mortality and low- birthweight rates were consistently lower when Medicaid was defined by a matching newborn hospitalization record than when results were based on a matching Medicaid delivery record. Conclusions. Studies of birth outcomes in the Medicaid population may have variable results depending on the method of matching that is used to identify Medicaid births. Handle: RePEc:aph:ajpbhl:1999:89:4:564-566_0 Template-Type: ReDIF-Article 1.0 Title: Consanguinity and recurrence risk of stillbirth and infant death Journal: American Journal of Public Health Author-Name: Stoltenberg, C. Author-Name: Magnus, P. Author-Name: Skrondal, A. Author-Name: Lie, R.T. Year: 1999 Volume: 89 Issue: 4 Pages: 517-523 Abstract: Objectives. The aim of this study was to estimate the recurrence risk for stillbirth and infant death and compare results for offspring of first- cousin parents with results for offspring of unrelated parents. Methods. The study population consisted of all single births with a previous sibling born in Norway between 1967 and 1994. Altogether, 629 888 births were to unrelated parents, and 3466 births were to parents who were first cousins. The risk of stillbirth and infant death was estimated for subsequent siblings contingent on parental consanguinity and survival of the previous sibling. Results. For unrelated parents, the risk of early death (stillbirth plus infant death) for the subsequent sibling was 17 of 1000 if the previous child survived and 67 of 1000 if the previous child died before 1 year of age. For parents who were first cousins, the risk of early death for the subsequent sibling was 29 of 1000 if the previous child survived and 116 of 1000 if the previous child died. Conclusions. The risk recurrence of stillbirth and infant death is higher for offspring of first-cousin parents compared with offspring of unrelated parents. Handle: RePEc:aph:ajpbhl:1999:89:4:517-523_8 Template-Type: ReDIF-Article 1.0 Title: Socioeconomic status and morbidity in the last years of life Journal: American Journal of Public Health Author-Name: Liao, Y. Author-Name: McGee, D.L. Author-Name: Kaufman, J.S. Author-Name: Cao, G. Author-Name: Cooper, R.S. Year: 1999 Volume: 89 Issue: 4 Pages: 569-572 Abstract: Objectives. This study evaluated the effect of socioeconomic status, as characterized by level of education, on morbidity and disability in the last years of life. Methods. The analysis used data from the National Health Interview Survey (1986-1990), with mortality follow-up through December 1991. Results. Among 10 932 decedents 50 years or older at baseline interview, educational attainment was inversely associated with long-term limitation of activity, number of chronic conditions, number of bed days, and days of short hospital stay during the year preceding the interview. Conclusions. Decedents with higher socioeconomic status experienced lower morbidity and disability and better quality of life even in their last years of life. Handle: RePEc:aph:ajpbhl:1999:89:4:569-572_0 Template-Type: ReDIF-Article 1.0 Title: The effect of a Medicaid managed care program on the adequacy of prenatal care utilization in Rhode Island Journal: American Journal of Public Health Author-Name: Griffin, J.F. Author-Name: Hogan, J.W. Author-Name: Buechner, J.S. Author-Name: Leddy, T.M. Year: 1999 Volume: 89 Issue: 4 Pages: 497-501 Abstract: Objectives. The purpose of this study was to determine whether adequacy of prenatal care utilization improved after the implementation of a Medicaid managed care program in Rhode Island. Methods. Rhode Island birth certificate data (1993-1995; n = 37021) were used to analyze pre- and post-program implementation changes in adequacy of prenatal care utilization. Logistic regression models were used to characterize the variation in prenatal care adequacy as a function of both time and the various covariates. Results. Adequacy of prenatal care utilization for Medicaid patients improved significantly after implementation of the program, from 57.1% to 62.1% (odds ratio [OR] = 1.2, 95% confidence interval ([CI] = 1.1, 1.3). After the program was implemented, Medicaid patients who went to private physicians' offices for prenatal care were 1.4 times as likely as before to receive adequate prenatal care (OR = 1.4, 95% CI = 1.2, 1.7). Conclusions. Unlike many other Medicaid expansions for pregnant women, the RIte Care program in Rhode Island has resulted in significant improvement in adequacy of prenatal care utilization for its enrollees. This improvement was due to specific program interventions that addressed and changed organizational and delivery system barriers to care. Handle: RePEc:aph:ajpbhl:1999:89:4:497-501_3 Template-Type: ReDIF-Article 1.0 Title: Cost as a barrier to condom use: The evidence for condom subsidies in the United States Journal: American Journal of Public Health Author-Name: Cohen, D. Author-Name: Scribner, R. Author-Name: Bedimo, R. Author-Name: Farley, T.A. Year: 1999 Volume: 89 Issue: 4 Pages: 567-568 Abstract: Objectives. This study sought to determine the impact of price on condom use. Methods. A program based on distribution of condoms at no charge was replaced with one providing low-cost condoms (25 cents). Pretest and posttest surveys asked about condom use among persons reporting 2 or more sex partners. Results. At pretest, 57% of respondents had obtained free condoms, and 77% had used a condom during their most recent sexual encounter. When the price was raised to 25 cents, the respective percentages decreased to 30% and 64%. Conclusions. Cost is a barrier to condom use. Free condoms should be distributed to encourage their use by persons at risk for HIV and other sexually transmitted diseases. Handle: RePEc:aph:ajpbhl:1999:89:4:567-568_9 Template-Type: ReDIF-Article 1.0 Title: An epidemic of congenital syphilis in Jefferson County, Texas, 1994- 1995: Inadequate prenatal syphilis testing after an outbreak in adults Journal: American Journal of Public Health Author-Name: Southwick, K.L. Author-Name: Guidry, H.M. Author-Name: Weldon, M.M. Author-Name: Mertz, K.J. Author-Name: Berman, S.M. Author-Name: Levine, W.C. Year: 1999 Volume: 89 Issue: 4 Pages: 557-560 Abstract: Objectives: After a syphilis epidemic in Jefferson County, Texas, in 1993 and 1994, congenital syphilis prevalence and risk factors were determined and local prenatal syphilis screening practices were assessed. Methods. Medical records were reviewed, pregnant women with syphilis were interviewed, and prenatal care providers were surveyed. Results. Of 91 women, 59 (65%) had infants with congenital syphilis. Among African Americans, the prevalence per 1000 live births was 24.1 in 1994 and 17.9 in 1995. Of the 50 women with at least 2 prenatal care visits who had infants with congenital syphilis, 15 (30%) had received inadequate testing. Only 16% of 31 providers obtained an early third, trimester syphilis test on all patients. Conclusions. Inadequate prenatal testing contributed to this outbreak of congenital syphilis. Handle: RePEc:aph:ajpbhl:1999:89:4:557-560_0 Template-Type: ReDIF-Article 1.0 Title: Directly observed therapy and tuberculosis treatment completion. Jereb et al. re: Bayer et al. Journal: American Journal of Public Health Author-Name: Jereb, J.A. Author-Name: Simone, P.M. Author-Name: Onorato, I.M. Year: 1999 Volume: 89 Issue: 4 Pages: 603-604 DOI: 10.2105/AJPH.89.4.603 File-URL: http://hdl.handle.net/10.2105/AJPH.89.4.603 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.89.4.603_4 Template-Type: ReDIF-Article 1.0 Title: Driving through: Postpartum care during World War II Journal: American Journal of Public Health Author-Name: Temkin, E. Year: 1999 Volume: 89 Issue: 4 Pages: 587-595 Abstract: In 1996, public outcry over shortened hospital stays for new mothers and their infants led to the passage of a federal law banning 'drive-through deliveries.' This recent round of brief postpartum stays is not unprecedented. During World War II, a baby boom overwhelmed maternity facilities in American hospitals. Hospital births became more popular and accessible as the Emergency Maternal and Infant Care program subsidized obstetric care for servicemen's wives. Although protocols before the war had called for prolonged bed rest in the puerperium, medical theory was quickly revised as crowded hospitals were forced to discharge mothers after 24 hours. To compensate for short inpatient stays, community-based services such as visiting nursing care, postnatal homes, and prenatal classes evolved to support new mothers. Fueled by rhetoric that identified maternal-child health as a critical factor in military morale, postpartum care during the war years remained comprehensive despite short hospital stays. The wartime experience offers a model of alternatives to legislation for ensuring adequate care of postpartum women. Handle: RePEc:aph:ajpbhl:1999:89:4:587-595_7 Template-Type: ReDIF-Article 1.0 Title: The prevalence and health burden of self-reported diabetes in older Mexican Americans: Findings from the Hispanic Established Populations for Epidemiologic Studies of the Elderly Journal: American Journal of Public Health Author-Name: Black, S.A. Author-Name: Ray, L.A. Author-Name: Markides, K.S. Year: 1999 Volume: 89 Issue: 4 Pages: 546-552 Abstract: Objectives. The prevalence and health burden of self-reported adult- onset diabetes mellitus were examined in older Mexican Americans. Methods. Data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly were used to assess the prevalence of self-reported diabetes and its association with other chronic conditions, disability, sensory impairments, health behaviors, and health service use in 3050 community- dwelling Mexican Americans 65 years and older. Results. The prevalence of self-reported diabetes in this sample was 22%, and there were high rates of obesity, diabetes-related complications, and diabetic medication use. Myocardial infarction, stroke, hypertension, angina, and cancer were significantly more common in diabetics than in nondiabetics, as were high levels of depressive symptoms, low perceived health status, disability, incontinence, vision impairment, and health service use. Many of the rate differences found in this sample of older Mexican Americans were higher than those reported among other groups of older adults. Conclusions. Our findings indicate that the prevalence and health burden of diabetes are greater in older Mexican Americans than in older non-Hispanic Whites and African Americans, particularly among elderly men. Handle: RePEc:aph:ajpbhl:1999:89:4:546-552_4 Template-Type: ReDIF-Article 1.0 Title: The effects on fetal development of high α-fetoprotein and maternal smoking Journal: American Journal of Public Health Author-Name: Heinonen, S. Author-Name: Ryynänen, M. Author-Name: Kirkinen, P. Year: 1999 Volume: 89 Issue: 4 Pages: 561-563 Abstract: Objectives. This study determined the risk of impaired fetal growth resulting from the interaction between maternal smoking during pregnancy and unexplained elevated concentrations of maternal serum α-fetoprotein (MSAFP). Methods. This observational study involved 123 pregnant smokers with unexplained second-trimester elevated concentrations of MSAFP, 827 smokers with normal levels, and 471 nonsmokers with raised levels. Results. By logistic regression, coincident smoking and elevated MSAFP levels were found to be associated with increases in the low basic risks of prematurity, small- for-gestational-age births, low birthweight, and need for neonatal care. Conclusions. Maternal smoking has an adverse effect on fetal development in pregnancies with unexplained elevated MSAFP concentrations. Such pregnancies merit close surveillance. Handle: RePEc:aph:ajpbhl:1999:89:4:561-563_6 Template-Type: ReDIF-Article 1.0 Title: Factors associated with refusal to treat HIV-infected patients: The results of a national survey of dentists in Canada Journal: American Journal of Public Health Author-Name: McCarthy, G.M. Author-Name: Koval, J.J. Author-Name: MacDonald, J.K. Year: 1999 Volume: 89 Issue: 4 Pages: 541-545 Abstract: Objectives. This study investigated dentists' refusal to treat patients who have HIV. Methods. A survey was mailed to a random sample of all licensed dentists in Canada, with 3 follow-up attempts (n = 6444). Data were weighted to allow for probability of selection and nonresponse and analyzed with Pearson's χ2 and multiple logistic regression. Results. The response rate was 66%. Of the respondents, 32% had knowingly treated HIV-infected patients in the last year; 16% would refuse to treat HIV-infected patients. Respondents reported willingness to treat HIV-infected patients (81%), injection drug users (86%), hepatitis B virus-infected patients (87%), homosexual and bisexual persons (94%), individuals with sexually transmitted disease(s) (94%), and recipients of blood and blood products (97%). The best predictors of refusal to treat patients with HIV were lack of ethical responsibility (odds ratio = 9.0) and items related to fear of cross- infection or lack of knowledge of HIV. Conclusions. One in 6 dentists reported refusal to treat HIV-infected patients, which was associated primarily with respondents' lack of belief in an ethical responsibility to treat patients with HIV and fears related to cross-infection. These results have implications for undergraduate, postgraduate, and continuing education. Handle: RePEc:aph:ajpbhl:1999:89:4:541-545_4 Template-Type: ReDIF-Article 1.0 Title: A population-based study of environmental hazards in the homes of older persons Journal: American Journal of Public Health Author-Name: Gill, T.M. Author-Name: Williams, C.S. Author-Name: Robison, J.T. Author-Name: Tinetti, M.E. Year: 1999 Volume: 89 Issue: 4 Pages: 553-556 Abstract: Objectives. This study sought to estimate the population-based prevalence of environmental hazards in the homes of older persons and to determine whether the prevalence of these hazards differs by housing type or by level of disability in terms of activities of daily living (ADLs). Methods. An environmental assessment was completed in the homes of 1000 persons 72 years and older. Weighted prevalence rates were calculated for each of the potential hazards and subsequently compared among subgroups of participants characterized by housing type and level of ADL disability. Results. Overall, the prevalence of most environmental hazards was high. Two or more hazards were found in 59% of bathrooms and in 23% to 42% of the other rooms. Nearly all homes had at least 2 potential hazards. Although age- restricted housing was less hazardous than community housing, older persons who were disabled were no less likely to be exposed to environmental hazards than older persons who were nondisabled. Conclusions. Environmental hazards are common in the homes of community-living older persons. Handle: RePEc:aph:ajpbhl:1999:89:4:553-556_4 Template-Type: ReDIF-Article 1.0 Title: Maternal intrapartum temperature elevation as a risk factor for cesarean delivery and assisted vaginal delivery Journal: American Journal of Public Health Author-Name: Lieberman, E. Author-Name: Cohen, A. Author-Name: Lang, J. Author-Name: Frigoletto, F. Author-Name: Goetzl, L. Year: 1999 Volume: 89 Issue: 4 Pages: 506-510 Abstract: Objectives. This study investigated the association of intrapartum temperature elevation with cesarean delivery and assisted vaginal delivery. Methods. Participants were 1233 nulliparous women with singleton, term pregnancies in vertex presentations who had spontaneous labors and were afebrile (temperature: 99.5°F [37.5°C]) at admission for delivery. Rates of cesarean and assisted vaginal deliveries according to highest intrapartum temperature were examined by epidural status. Results. Women with maximum intrapartum temperatures higher than 99.5°F were 3 times as likely to experience cesarean (25.2% vs 7.2%) or assisted vaginal delivery (25.2% vs 8.5%). The association was present in epidural users and nonusers and persisted after birthweight, epidural use, and labor length had been controlled. In adjusted analyses, temperature elevation was associated with a doubling in the risk of cesarean delivery (odds ratio [OR] = 2.3, 95% confidence interval [CI] = 1.5, 3.4) and assisted vaginal delivery (OR = 2.1, 95% CI = 1.4, 3.1). Conclusions. Modest temperature elevation developing during labor was associated with higher rates of cesarean and assisted vaginal deliveries. More frequent temperature elevation among women with epidural analgesia may explain in part the higher rates of cesarean and assisted vaginal deliveries observed with epidural use. Handle: RePEc:aph:ajpbhl:1999:89:4:506-510_7 Template-Type: ReDIF-Article 1.0 Title: International developments in abortion law from 1988 to 1998 Journal: American Journal of Public Health Author-Name: Cook, R.J. Author-Name: Dickens, B.M. Author-Name: Bliss, L.E. Year: 1999 Volume: 89 Issue: 4 Pages: 579-586 Abstract: Objectives. In 2 successive decades since 1967, legal accommodation of abortion has grown in many countries. The objective of this study was to assess whether liberalizing trends have been maintained in the last decade and whether increased protection of women's human rights has influenced legal reform. Methods. A worldwide review was conducted of legislation and judicial rulings affecting abortion, and legal reforms were measured against governmental commitments made under international human rights treaties and at United Nations conferences. Results. Since 1987, 26 jurisdictions have extended grounds for lawful abortion, and 4 countries have restricted grounds. Additional limits on access to legal abortion services include restrictions on funding of services, mandatory counseling and reflection, delay requirements, third-party authorizations, and blockades of abortion clinics. Conclusions. Progressive liberalization has moved abortion laws from a focus on punishment toward concern with women's health and welfare and with their human rights. However, widespread maternal mortality and morbidity show that reform must be accompanied by accessible abortion services and improved contraceptive care and information. Handle: RePEc:aph:ajpbhl:1999:89:4:579-586_6 Template-Type: ReDIF-Article 1.0 Title: Explaining educational differences in mortality: The role of behavioral and material factors Journal: American Journal of Public Health Author-Name: Schrijvers, C.T.M. Author-Name: Stronks, K. Author-Name: Van De Mheen, H.D. Author-Name: Mackenbach, J.P. Year: 1999 Volume: 89 Issue: 4 Pages: 535-540 Abstract: Objectives. This study examined the role of behavioral and material factors in explaining educational differences in all-cause mortality, taking into account the overlap between both types of factors. Methods. Prospective data were used on 15 451 participants in a Dutch longitudinal study. Relative hazards of all-cause mortality by educational level were calculated before and after adjustment for behavioral factors (alcohol intake, smoking, body mass index, physical activity, dietary habits) and material factors (financial problems, neighborhood conditions, housing conditions, crowding, employment status, a proxy of income). Results. Mortality was higher in lower educational groups. Four behavioral factors (alcohol, smoking, body mass index, physical activity) and 3 material factors (financial problems, employment status, income proxy) explained part of the educational differences in mortality. With the overlap between both types of factors accounted for, material factors were more important than behavioral factors in explaining mortality differences by educational level. Conclusions. The association between educational level and mortality can be largely explained by material factors. Thus, improving the material situation of people might substantially reduce educational differences in mortality. Handle: RePEc:aph:ajpbhl:1999:89:4:535-540_1 Template-Type: ReDIF-Article 1.0 Title: Directly observed therapy and tuberculosis treatment completion. Frieden re: Bayer et al. Journal: American Journal of Public Health Author-Name: Frieden, T.R. Year: 1999 Volume: 89 Issue: 4 Pages: 604-605 DOI: 10.2105/AJPH.89.4.604-a File-URL: http://hdl.handle.net/10.2105/AJPH.89.4.604-a Handle: RePEc:aph:ajpbhl:10.2105/AJPH.89.4.604-a_4 Template-Type: ReDIF-Article 1.0 Title: Ischemic stroke risk and passive exposure to spouses' cigarette smoking Journal: American Journal of Public Health Author-Name: You, R.X. Author-Name: Thrift, A.G. Author-Name: McNeil, J.J. Author-Name: Davis, S.M. Author-Name: Donnan, G.A. Year: 1999 Volume: 89 Issue: 4 Pages: 572-575 Abstract: Objectives. This study investigated the association between ischemic stroke risk and passive exposure to cigarette smoking. Methods. Risk factors among 452 hospitalized cases of first-episode ischemic stroke were compared with 452 age- and sex-matched 'neighborhood' controls. Results. The risk of stroke was twice as high for subjects whose spouses smoked as for those whose spouses did not smoke (95% confidence interval = 1.3, 3.1), after adjustment for the subject's own smoking, heart disease, hypertension, diabetes, and education level. These results were confirmed when analysis was limited to those who never smoked. Conclusions. These findings provide evidence that spousal smoking may be a significant risk factor for ischemic stroke. Handle: RePEc:aph:ajpbhl:1999:89:4:572-575_3 Template-Type: ReDIF-Article 1.0 Title: Reinventing the field training experience: building a practical and effective graduate program at the UCLA School of Public Health. Journal: American Journal of Public Health Author-Name: Chickering, K.L. Author-Name: Malik, T. Author-Name: Halbert, R.J. Author-Name: Kar, S.B. Year: 1999 Volume: 89 Issue: 4 Pages: 596-597 Handle: RePEc:aph:ajpbhl:1999:89:4:596-597_6 Template-Type: ReDIF-Article 1.0 Title: Mandatory reporting of intimate partner violence to police: Views of physicians in California Journal: American Journal of Public Health Author-Name: Rodriguez, M.A. Author-Name: McLoughlin, E. Author-Name: Bauer, H.M. Author-Name: Paredes, V. Author-Name: Grumbach, K. Year: 1999 Volume: 89 Issue: 4 Pages: 575-578 Abstract: Objectives. This study examined physicians' perspectives on mandatory reporting of intimate partner violence to police. Methods. We surveyed a stratified random sample of California physicians practicing emergency, family, and internal medicine and obstetrics/gynecology. Results. An estimated 59% of California primary care and emergency physicians (n = 508, 71% response rate) reported that they might not comply with the reporting law if a patient objects. Primary care physicians reported lower compliance. Most physicians agreed that the legislation has potential risks, raises ethical concerns, and may provide benefits. Conclusions. Physicians' stated noncompliance and perceived negative consequences raise the possibility that California's mandatory reporting law is problematic and ineffective. Handle: RePEc:aph:ajpbhl:1999:89:4:575-578_4 Template-Type: ReDIF-Article 1.0 Title: Perinatal risk and severity of illness in newborns at 6 neonatal intensive care units Journal: American Journal of Public Health Author-Name: Richardson, D.K. Author-Name: Shah, B.L. Author-Name: Frantz III, I.D. Author-Name: Bednarek, F. Author-Name: Rubin, L.P. Author-Name: McCormick, M.C. Year: 1999 Volume: 89 Issue: 4 Pages: 511-516 Abstract: Objectives. This multisite study sought to identify (1) any differences in admission risk (defined by gestational age and illness severity) among neonatal intensive care units (NICUs) and (2) obstetric antecedents of newborn illness severity. Methods. Data on 1476 babies born at a gestational age of less than 32 weeks in 6 perinatal centers were abstracted prospectively. Newborn illness severity was measured with the Score for Neonatal Acute Physiology. Regression models were constructed to predict scores as a function of perinatal risk factors. Results. The sites differed by several obstetric case-mix characteristics. Of these, only gestational age, small for gestational age. White race, and severe congenital anomalies were associated with higher scores. Antenatal corticosteroids, low Apgar scores, and neonatal hypothermia also affected illness severity. At 2 sites, higher mean severity could not be explained by case mix. Conclusions. Obstetric events and perinatal practices affect newborn illness severity. These risk factors differ among perinatal centers and are associated with elevated illness severity at some sites. Outcomes of NICU care may be affected by antecedent events and perinatal practices. Handle: RePEc:aph:ajpbhl:1999:89:4:511-516_5 Template-Type: ReDIF-Article 1.0 Title: Burden of proof: Judging science and protecting public health in (and out of) the courtroom Journal: American Journal of Public Health Author-Name: Annas, G.J. Year: 1999 Volume: 89 Issue: 4 Pages: 490-493 Handle: RePEc:aph:ajpbhl:1999:89:4:490-493_1 Template-Type: ReDIF-Article 1.0 Title: Improving access to disability benefits among homeless persons with mental illness: An agency-specific approach to services integration Journal: American Journal of Public Health Author-Name: Rosenheck, R. Author-Name: Frisman, L. Author-Name: Kasprow, W. Year: 1999 Volume: 89 Issue: 4 Pages: 524-528 Abstract: Objectives. This study evaluated a joint initiative of the Social Security Administration (SSA) and the Department of Veterans Affairs (VA) to improve access to Social Security disability benefits among homeless veterans with mental illness. Methods. Social Security personnel were colocated with VA clinical staff at 4 of the VA's Health Care for Homeless Veterans (HCHV) programs. Intake assessment data were merged with SSA administrative data to determine the proportion of veterans who filed applications and who received disability awards at the 4 SSA-VA Joint Outreach Initiative sites (n = 6709) and at 34 comparison HCHV sites (n = 27 722) during the 2 years before and after implementation of the program. Results. During the 2 years after the initiative began, higher proportions of veterans applied for disability (18.9% vs 11.1%; P<.001) and were awarded benefits (11.4% vs 7.2%, P<.001) at SSA-VA Joint Initiative sites. Conclusion. A colocation approach to service system integration can improve access to disability entitlements among homeless persons with mental illness. Almost twice as many veterans were eligible for this entitlement as received at through a standard outreach program. Handle: RePEc:aph:ajpbhl:1999:89:4:524-528_2 Template-Type: ReDIF-Article 1.0 Title: Skirting the issue: Women and international health in historical perspective Journal: American Journal of Public Health Author-Name: Birn, A.-E. Year: 1999 Volume: 89 Issue: 3 Pages: 399-407 Abstract: Over the last decades women have become central to international health efforts, but most international health efforts, but most international health agencies continue to focus narrowly on the maternal and reproductive aspects of women's health. This article explores the origins of this paradigm as demonstrated in the emergence of women's health in the Rockefeller Foundation's public health programs in Mexico in the 1920s and 1930s. These efforts bore a significant reproductive imprint; women dispensed and received services oriented to maternal and childbearing roles. Women's health and social advocacy movements in Mexico and the United States partially shaped this interest. Even more important, the emphasis on women in the Rockefeller programs proved an expedient approach to the Foundation's underlying goals: promoting bacteriologically based public health to the government, medical personnel, business interests, and peasants; helping legitimize the Mexican state; and transforming Mexico into a good political and commercial neighbor. The article concludes by showing the limits to the maternal and reproductive health model currently advocated by most donor agencies, which continue to skirt - or sidestep - major concerns that are integral to the health of women. Handle: RePEc:aph:ajpbhl:1999:89:3:399-407_9 Template-Type: ReDIF-Article 1.0 Title: Potential explanations for the educational gradient in coronary heart disease: A population-based case-control study of Swedish women Journal: American Journal of Public Health Author-Name: Wamala, S.P. Author-Name: Mittleman, M.A. Author-Name: Schenck-Gustafsson, K. Author-Name: Orth-Gomér, K. Year: 1999 Volume: 89 Issue: 3 Pages: 315-321 Abstract: Objectives. This study examined the association between educational attainment and coronary heart disease (CHD) and the factors that may explain this association. Methods. This population-based case-control study included 292 women with CHD who were 65 years, or younger and 292 age-matched controls. Results. Compared with the adjusted odds ratio for CHD associated with college education, the age-adjusted odds ratio associated with mandatory education (≤9 years) was 1.87 (95% confidence interval [CI]=1.23, 2.84) and the odds ratio for high school education was 1.35 (95% CI=0.81, 2.25) (P for trend <.01). The odds ratio for mandatory education was reduced by 82%, to 1.16 (95% CI=0.69, 2.09), after adjustment for psychosocial stress, unhealthy lifestyle patterns, hemostatic factors, hypertension, and lipids. Conclusions. Much of the increased risk of CHD in women with low education appears to be linked to psychosocial stress and lifestyle factors. Hemostatic factors, lipids, and hypertension also contribute to a lesser extent. These factors may be considered in strategies geared to reducing socioeconomic inequalities in cardiovascular health. Handle: RePEc:aph:ajpbhl:1999:89:3:315-321_8 Template-Type: ReDIF-Article 1.0 Title: Prevalence and social correlates of cardiovascular disease risk factors in Harlem Journal: American Journal of Public Health Author-Name: Diez-Roux, A.V. Author-Name: Northridge, M.E. Author-Name: Morabia, A. Author-Name: Bassett, M.T. Author-Name: Shea, S. Year: 1999 Volume: 89 Issue: 3 Pages: 302-307 Abstract: Objectives. This study examined the prevalence, social correlates, and clustering of cardiovascular disease risk factors in a predominantly Black, poor, urban community. Methods. Associations of risk factor prevalences with sociodemographic variables were examined in a population-based sample of 695 men and women aged 18 to 65 years living in Central Harlem. Results. One third of the men and women were hypertensive, 48% of the men and 41% of the women were smokers, 25% of the men and 49% of the women were overweight, and 23% of the men and 35% of the women reported no leisure-time physical activity over the past month. More than 80% of the men and women had at least 1 of these risk factors, and 9% of the men and 19% of the women had 3 or more risk factors. Income and education were inversely related to hypertension, smoking, and physical inactivity. Having 3 or more risk factors was associated with low income and low education (extreme odds ratio [OR]=10.2, 95% confidence interval [CI]=3.0, 34.5 for education; OR=3.7, CI=1.6, 8.9 for income) and with a history of unstable work or of homelessness. Conclusions. Disadvantaged, urban communities are at high risk for cardiovascular disease. These results highlight the importance of socioenvironmental factors in shaping cardiovascular risk. Handle: RePEc:aph:ajpbhl:1999:89:3:302-307_5 Template-Type: ReDIF-Article 1.0 Title: The new old epidemic of coronary heart disease Journal: American Journal of Public Health Author-Name: Bonneux, L. Author-Name: Barendregt, J.J. Author-Name: Van Der Maas, P.J. Year: 1999 Volume: 89 Issue: 3 Pages: 379-382 Abstract: Objectives. This study quantified the consequences for prevalence of increased survival of coronary heart disease (CHD) in the Netherlands from 1980 to 1993. Methods. A multistage life table fitted observed mortality and registration rates from the nationwide hospital register. The outcome was prevalence by age, sex, period, and disease state. Results. The prevalence of CHD from 1980 to 1993 was 4.4% (men, aged 25 to 84 years) and 1.4% (women, aged 25 to 84 years). Between 1980-1983 and 1990-1993, the incidence changed little, but age-adjusted prevalence increased by 19% (men) and 59% (women). Conclusions. Sharply decreasing mortality but near-constant attack rates of CHD caused distinct increases in prevalence, particularly among the elderly. Handle: RePEc:aph:ajpbhl:1999:89:3:379-382_7 Template-Type: ReDIF-Article 1.0 Title: Trends in body weight among American Indians: Findings from a telephone survey, 1985 through 1996 Journal: American Journal of Public Health Author-Name: Will, J.C. Author-Name: Denny, C. Author-Name: Serdula, M. Author-Name: Muneta, B. Year: 1999 Volume: 89 Issue: 3 Pages: 395-398 Abstract: Objectives. This study compared trends in body mass index for American Indian men and women across selected regions of the United States. Methods. Self-reported data were collected from the Behavioral Risk Factor Surveillance System. Results. Among women in the Dakotas, New Mexico and Arizona, and Washington and Oregon, average adjusted body mass index increased significantly by 0.1 to 0.2 units per year. Among men in Alaska and the Dakotas, average adjusted body mass index also increased significantly by 0.1 to 0.2 units each year. Conclusions. Because of rapid increases in average body mass index, some American Indian populations could be burdened by an increased incidence of chronic disease. Handle: RePEc:aph:ajpbhl:1999:89:3:395-398_2 Template-Type: ReDIF-Article 1.0 Title: Evidence for a Black-White crossover in all-cause and coronary heart disease mortality in an older population: The North Carolina EPESE Journal: American Journal of Public Health Author-Name: Corti, M.-C. Author-Name: Guralnik, J.M. Author-Name: Ferrucci, L. Author-Name: Izmirlian, G. Author-Name: Leveille, S.G. Author-Name: Pahor, M. Author-Name: Cohen, H.J. Author-Name: Pieper, C. Author-Name: Havlik, R.J. Year: 1999 Volume: 89 Issue: 3 Pages: 308-314 Abstract: Objectives. This cohort study evaluated racial differences in mortality among Blacks and Whites 65 years and older. Methods. A total of 4136 men and women (1875 Whites and 2261 Blacks) living in North Carolina were interviewed in 1986 and followed up for mortality until 1994. Hazard ratios (HRs) for all-cause and cause-specific mortality were calculated, with adjustment for sociodemographic and coronary heart disease (CHD) risk factors. Results. Black persons had higher mortality rates than Whites at young-old age (65-80 years) but had significantly lower mortality rates after age 80. Black persons age 80 or older had a significantly lower risk of all-cause mortality (HR of Blacks vs Whites, 0.75; 95% confidence interval [CI]=0.62, 0.90) and of CHD mortality (HR 0.44; 95% CI=0.30, 0.66). These differences were not observed for other causes of death. Conclusions. Racial differences in mortality are modified by age. This mortality crossover could be attributed to selective survival of the healthiest oldest Blacks or to other biomedical factors affecting longevity after age 80. Because the crossover was observed for CHD deaths only, age overreporting by Black older persons seems an unlikely explanation of the mortality differences. Handle: RePEc:aph:ajpbhl:1999:89:3:308-314_9 Template-Type: ReDIF-Article 1.0 Title: Morbidity and mortality attributable to alcohol, tobacco, and illicit drug use in Canada Journal: American Journal of Public Health Author-Name: Single, E. Author-Name: Robson, L. Author-Name: Rehm, J. Author-Name: Xi, X. Year: 1999 Volume: 89 Issue: 3 Pages: 385-390 Abstract: Objectives. This study estimated morbidity and mortality attributable to substance abuse in Canada. Methods. Pooled estimates of relative risk were used to calculate etiologic fractions by age, gender, and province for 91 causes of disease or death attributable to alcohol, tobacco, or illicit drugs. Results. There were 33 498 deaths and 208 095 hospitalizations attributed to tobacco, 6701 deaths and 86 076 hospitalizations due to alcohol, and 732 deaths and 7095 hospitalizations due to illicit drugs in 1992. Conclusions. Substance abuse exacts a considerable toll on Canadian society in terms of morbidity and mortality, accounting for 21% of deaths, 23% of years of potential life lost, and 8% of hospitalizations. Handle: RePEc:aph:ajpbhl:1999:89:3:385-390_5 Template-Type: ReDIF-Article 1.0 Title: Sexual harassment and generalized workplace abuse among university employees: Prevalence and mental health correlates Journal: American Journal of Public Health Author-Name: Richman, J.A. Author-Name: Rospenda, K.M. Author-Name: Nawyn, S.J. Author-Name: Flaherty, J.A. Author-Name: Fendrich, M. Author-Name: Drum, M.L. Author-Name: Johnson, T.P. Year: 1999 Volume: 89 Issue: 3 Pages: 358-363 Abstract: Objectives. This study hypothesized that interpersonal workplace stressors involving sexual harassment and generalized workplace abuse are highly prevalent and significantly linked with mental health outcomes including symptomatic distress, the use and abuse of alcohol, and other drug use. Methods. Employees in 4 university occupational groups (faculty, student, clerical, and service workers; n=2492) were surveyed by means of a mailed self-report instrument. Cross-tabular and ordinary least squares and logistic regression analyses examined the prevalence of harassment and abuse and their association with mental health status. Results. The data show high rates of harassment and abuse. Among faculty, females were subjected to higher rates; among clerical and service workers, males were subjected to higher rates. Male and female clerical and service workers experienced higher levels of particularly severe mistreatment. Generalized abuse was more prevalent than harassment for all groups. Both harassment and abuse were significantly linked to most mental health outcomes for men and women. Conclusions. Interpersonally abusive workplace dynamics constitute a significant public health problem that merits increased intervention and prevention strategies. Handle: RePEc:aph:ajpbhl:1999:89:3:358-363_3 Template-Type: ReDIF-Article 1.0 Title: A deviation bar chart for detecting dengue outbreaks in Puerto Rico Journal: American Journal of Public Health Author-Name: Rigau-Pérez, J.G. Author-Name: Millard, P.S. Author-Name: Walker, D.R. Author-Name: Deseda, C.C. Author-Name: Casta-Vélez, A. Year: 1999 Volume: 89 Issue: 3 Pages: 374-378 Abstract: Objectives. A Centers for Disease Control and Prevention deviation bar chart (Statistical Software for Public Health Surveillance) and laboratory- based surveillance data were evaluated for their utility in detecting dengue outbreaks in Puerto Rico. Methods. A significant increase in dengue incidence was defined as an excess of suspected cases of more than 2 SDs beyond the mean for all 4-week periods from April through June (the period of lowest seasonal incidence) 1989 through 1993. An outbreak was defined as a cumulative annual rate of reported dengue greater than 3 per 1000 population. Results. Retrospective application of the system to 1994 data showed agreement with previous analyses. In 1995 and 1996, 36.4% and 27.3% respectively, of municipalities with a significant increase in reports for 2 or more consecutive weeks before the first week of September had an outbreak, compared with 9.0% (in 1995, P=.042) and 6.0% (in 1996, P=.054) of towns without a significant increase. The system showed sensitivity near 40%, specificity near 89%, and accuracy in classifying municipalities near 84%. Conclusions. This method provides a statistically based, visually striking, specific, and timely signal for dengue control efforts. Handle: RePEc:aph:ajpbhl:1999:89:3:374-378_9 Template-Type: ReDIF-Article 1.0 Title: Efficacy of Haemophilus influenzae type b conjugate vaccines and persistence of disease in disadvantaged populations Journal: American Journal of Public Health Author-Name: Jafari, H.S. Author-Name: Adams, W.G. Author-Name: Robinson, K.A. Author-Name: Plikaytis, B.D. Author-Name: Wenger, J.D. Year: 1999 Volume: 89 Issue: 3 Pages: 364-368 Abstract: Objectives. The purpose of this study was to evaluate the effectiveness of Haemophilus influenzae type b (Hib) conjugate vaccines among children aged 2 to 18 months and to determine risk factors for invasive Hib disease during a period of declining incidence (1991-1994). Methods. A prospective population-based case-control study was conducted in a multisate US population of 15.5 million. A laboratory-based active surveillance system was used for case detection. Results. In a multivariate analysis, having a single-parent mother (odds ratio [OR]=4.3, 95% confidence interval [CI]=1.2, 14.8) and household crowding (OR=3.5, 95% CI=1.03, 11.7) were risk factors for Hib disease independent of vaccination status. After adjustment for these risk factors, the protective efficacy of 2 or more Hib vaccine doses was 86% (95% CI=16%, 98%). Among undervaccinated subjects, living with a smoker (P=.02) and several indicators of lower socioeconomic status were risk factors for Hib disease. Conclusions. Hib disease still occurs at low levels in the United States, predominantly in socioeconomically disadvantaged populations. Low immunization coverage may facilitate continuing transmission of Hib. Special efforts to achieve complete and timely immunization in disadvantaged populations are needed. Handle: RePEc:aph:ajpbhl:1999:89:3:364-368_7 Template-Type: ReDIF-Article 1.0 Title: Lead and hypertension in a sample of middle-aged women Journal: American Journal of Public Health Author-Name: Korrick, S.A. Author-Name: Hunter, D.J. Author-Name: Rotnitzky, A. Author-Name: Hu, H. Author-Name: Speizer, F.E. Year: 1999 Volume: 89 Issue: 3 Pages: 330-335 Abstract: Objectives. The role of lead exposure as a risk factor for hypertension is less well defined among women than among men. This case-control study assessed the relation of blood and bone lead concentrations to hypertension in women. Methods. Cases and controls were a subsample of women from the Nurses' Health Study. Hypertension was defined as a physician diagnosis of hypertension between 1988 and 1994 or measured systolic blood pressure ≥ 140 mm Hg or diastolic blood pressure ≥ 90 mm Hg. Results. Mean (SD) blood lead concentration was 0.15 (0.11) μmol/L; mean tibia and patella lead concentrations by K-x-ray fluorescence were 13.3 (9.0) and 17.3 (11.1) μg/g, respectively. After adjustment for potentially confounding factors, an increase from the 10th to the 90th percentile of patella lead values (25 μg/g) was associated with approximately 2-fold (95% confidence interval = 1.1, 3.2) increased risk of hypertension. There was no association between hypertension and either blood or tibia lead concentrations. Conclusions. These findings support a potentially important role for low-level lead exposure as a risk factor for hypertension among non-occupationally exposed women. Handle: RePEc:aph:ajpbhl:1999:89:3:330-335_2 Template-Type: ReDIF-Article 1.0 Title: What's driving an epidemic? The spread of syphilis along an Interstate Highway in rural North Carolina Journal: American Journal of Public Health Author-Name: Cook, R.L. Author-Name: Royce, R.A. Author-Name: Thomas, J.C. Author-Name: Hanusa, B.H. Year: 1999 Volume: 89 Issue: 3 Pages: 369-373 Abstract: Objectives. The purpose of this study was to determine whether county syphilis rates were increased along Interstate Highway 95 (I-95) in North Carolina during a recent epidemic. Methods. Ecological data on syphilis cases, demographic data, highway data, and drag activity data were used to conduct a cross-sectional and longitudinal study of North Carolina counties from 1985 to 1994. Crude and adjusted incidence rate ratios (IRRs) were determined by means of standard and longitudinal Poisson regression models adjusted for sociodemographic factors and drag use. Results. Ten-year syphilis rates in I-95 counties greatly exceeded rates in non-I-95 counties (38 vs 16 cases per 100 000 persons) and remained higher after adjustment for race, age, sex, poverty, large cities, and drug activity (adjusted IRR = 2.05, 95% confidence interval [CI] = 1.84, 2.28). Syphilis rates were stable until 1989, when rates increased sharply in I-95 counties but remained stable in non-I-95 counties. Increased drag activity in I-95 counties preceded the rise in syphilis cases. Conclusions. A better understanding of the relationship between highways and the spread of sexually transmitted diseases may guide future prevention interventions. Handle: RePEc:aph:ajpbhl:1999:89:3:369-373_2 Template-Type: ReDIF-Article 1.0 Title: The relation of the milk supply to infant mortality. 1906. Journal: American Journal of Public Health Author-Name: Knox Jr., J.H. Year: 1999 Volume: 89 Issue: 3 Pages: 408-411 DOI: 10.2105/AJPH.89.3.408 File-URL: http://hdl.handle.net/10.2105/AJPH.89.3.408 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.89.3.408_0 Template-Type: ReDIF-Article 1.0 Title: Community-level HIV intervention in 5 cities: Final outcome data from the CDC AIDS community demonstration projects Journal: American Journal of Public Health Author-Name: Wolitski, R.J. Year: 1999 Volume: 89 Issue: 3 Pages: 336-345 Abstract: Objectives. This study evaluated a theory-based community-level intervention to promote progress toward consistent condom and bleach use among selected populations at increased risk for HIV infection in 5 US cities. Methods. Role-model stories were distributed, along with condoms and bleach, by community members who encouraged behavior change among injection drug users, their female sex partners, sex workers, non-gay-identified men who have sex with men, high-risk youth, and residents in areas with high sexually transmitted disease rates. Over a 3-year period, cross-sectional interviews (n=15 205) were conducted in 10 intervention and comparison community pairs. Outcomes were measured on a stage-of-change scale. Observed condom carrying and intervention exposure were also measured. Results. At the community level movement toward consistent condom use with main (P<.05) and nonmain (P<.05) partners, as well as increased condom carrying (P<.0001), was greater in intervention than in comparison communities. At the individual level, respondents recently exposed to the intervention were more likely to carry condoms and to have higher stage-of-change scores for condom and bleach use. Conclusions. The intervention led to significant communitywide progress toward consistent HIV risk reduction. Handle: RePEc:aph:ajpbhl:1999:89:3:336-345_8 Template-Type: ReDIF-Article 1.0 Title: The reach and effectiveness of a national mass media-led smoking cessation campaign in the Netherlands Journal: American Journal of Public Health Author-Name: Mudde, A.N. Author-Name: De Vries, H. Year: 1999 Volume: 89 Issue: 3 Pages: 346-350 Abstract: Objectives. This study examined the reach, effectiveness, and cost- effectiveness of a mass media-led smoking cessation campaign including television shows, a television clinic, a quit line, local group programs, and a comprehensive publicity campaign. Methods. A random sample of baseline smokers (n=1338) was interviewed before and after the campaign and at a 10- month follow-up. A non-pretested control group (n=508) of baseline smokers was incorporated to control for test effects. Results. Most smokers were aware of the campaign, although active participation rates were low. Dose- response relations between exposure and quitting were found. The follow-up point prevalence abstinence rate attributable to the campaign was estimated to be 4.5% after control for test effects and secular trends. The cost per long-term quitter was about $12. Conclusions. In spite of a massive rise in tobacco promotion expenditures prior to the campaign and the absence of governmental control over the media, the campaign under study may have increased normal cessation rates substantially. Handle: RePEc:aph:ajpbhl:1999:89:3:346-350_5 Template-Type: ReDIF-Article 1.0 Title: Is whole grain intake associated with reduced total and cause-specific death rates in older women? The Iowa women's health study Journal: American Journal of Public Health Author-Name: Jacobs Jr., D.R. Author-Name: Meyer, K.A. Author-Name: Kushi, L.H. Author-Name: Folsom, A.R. Year: 1999 Volume: 89 Issue: 3 Pages: 322-329 Abstract: Objectives. This study sought to determine whether nutrient-rich whole grains reduce mortality risk. Methods. The study included 38 740 Iowa women, aged 55 to 69 years. A food frequency questionnaire was used to obtain data on grain intake. Results. Median whole grain intake quintiles ranged from a median of 0.2 to more than 3 servings per day. Women with higher intakes had healthier lifestyles and less baseline disease. The total death rate decreased in increasing quintiles, and the pattern repeated for cancer, cardiovascular disease, and and other causes combined. Adjusted for lifestyle and baseline disease, the relative hazard rate ratio for total death was about 0.85 in daily consumers of whole grain. Findings persisted in strata of baseline healthy and diseased and were not explained by dietary fiber. Rates of total mortality, but not cardiovascular disease mortality, were higher among frequent consumers of refined grain. Conclusions. Total mortality risk was inversely associated with whole grain intake and positively associated with refined grain intake. Refined grains contributed more than 20% of energy intake, and whole grains contributed 1%. Substitution of whole for refined grain may reduce chronic disease risk in the United States. Handle: RePEc:aph:ajpbhl:1999:89:3:322-329_9 Template-Type: ReDIF-Article 1.0 Title: Body mass index, weight change, and incidence of self-reported physician-diagnosed arthritis among women Journal: American Journal of Public Health Author-Name: Sahyoun, N.R. Author-Name: Hochberg, M.C. Author-Name: Helmick, C.G. Author-Name: Harris, T. Author-Name: Pamuk, E.R. Year: 1999 Volume: 89 Issue: 3 Pages: 391-394 Abstract: Objectives. This study examined the relationship between body mass index (BMI), weight change, and arthritis in women. Methods. Data were taken from the 1982-1984 National Health and Nutrition Examination Survey Epidemiologic Follow-Up Study of 3617 women, aged 25 to 74 years. Results. Women with a BMI greater than 32 at initial interview were at significantly higher risk of developing arthritis than women with a BMI of 19 to 21.9. Compared with stable-weight women with a BMI of less than 25, women who were obese at initial interview (BMI >29) and who subsequently maintained their weight or gained more than 10% of their body weight were at significantly higher risk of developing arthritis. Conclusions. Attaining and maintaining a healthy weight may reduce the risk of developing arthritis. Handle: RePEc:aph:ajpbhl:1999:89:3:391-394_7 Template-Type: ReDIF-Article 1.0 Title: Radon and lung cancer: A cost-effectiveness analysis Journal: American Journal of Public Health Author-Name: Ford, E.S. Author-Name: Kelly, A.E. Author-Name: Teutsch, S.M. Author-Name: Thacker, S.B. Author-Name: Garbe, P.L. Year: 1999 Volume: 89 Issue: 3 Pages: 351-357 Abstract: Objectives. This study examined the cost-effectiveness of general and targeted strategies for residential radon testing and mitigation in the United States. Methods. A decision-tree model was used to perform a cost- effectiveness analysis of preventing radon-associated deaths from lung cancer. Results. For a radon threshold of 4 pCi/L, the estimated costs to prevent 1 lung cancer death are about $3 million (154 lung cancer deaths prevented), or $480 000 per life-year saved, based on universal radon screening and mitigation, and about $2 million (104 lung cancer deaths prevented), or $330 000 per life-year saved, if testing and mitigation are confined to geographic areas at high risk for radon exposure. For mitigation undertaken after a single screening test and after a second confirmatory test, the estimated costs are about $920 000 and $520 000, respectively, to prevent a lung cancer death with universal screening and $130 000 and $80 000 per life-year for high risk screening. The numbers of preventable lung cancer deaths are 811 and 527 for universal and targeted approaches, respectively. Conclusions. These data suggest possible alternatives to current recommendations. Handle: RePEc:aph:ajpbhl:1999:89:3:351-357_5 Template-Type: ReDIF-Article 1.0 Title: Measurement of the validity of a preschool vision screening program Journal: American Journal of Public Health Author-Name: Robinson, B. Author-Name: Bobier, W.R. Author-Name: Martin, E. Author-Name: Bryant, L. Year: 1999 Volume: 89 Issue: 2 Pages: 193-198 Abstract: Objectives. The validity (sensitivity and specificity) of a preschool vision screening program was measured over a 3-year period to determine how well strabismus and significant refractive errors could be detected. Methods. Public health nurses were trained to administer tests of visual acuity, stereoacuity, and ocular alignment. Failure on any test; Visual acuity of 6/9 or less, stereoacuity of less than 100 seconds of arc, or an apparent misalignment of the eyes resulted in referral to an eye care practitioner. An age-matched control was also referred. Analysis of practitioner reports used predefined study-based criteria for ocular abnormalities. Results. More than 1100 children were screened each year. The annually calculated prevalence of vision problems ranged between 10.5% and 13.8%. The estimated sensitivity varied from 60.4% to 70.9% (specificity, 69.6% to 79.9%). The yield indicated that a very high percentage of children with vision problems were identified for the first time. Conclusions. The validity of this screening is comparable to that of other school screenings. The limitations are predictable. Consideration should be given to replacing visual acuity tests with a rapid, objective measure of refractive error and ocular alignment. Handle: RePEc:aph:ajpbhl:1999:89:2:193-198_3 Template-Type: ReDIF-Article 1.0 Title: Smokeless tobacco cessation intervention for college athletes: Results after 1 year Journal: American Journal of Public Health Author-Name: Walsh, M.M. Author-Name: Hilton, J.F. Author-Name: Masouredis, C.M. Author-Name: Gee, L. Author-Name: Chesney, M.A. Author-Name: Ernster, V.L. Year: 1999 Volume: 89 Issue: 2 Pages: 228-234 Abstract: Objectives. The purpose of this study was to determine the efficacy of a college-based smokeless tobacco cessation intervention targeting college athletes. Methods. Sixteen colleges were matched for prevalence of smokeless tobacco use in their combined baseball and foot ball teams and randomly assigned within college pairs to the intervention or the control group. One year prevalence of cessation among smokeless tobacco users was determined by self-report of abstinence for the previous 30 days. Differences between groups were analyzed in a weighted version of the Fisher 1-sided permutation test for paired samples after adjustment for significant predictors of quitting other than the intervention (i.e., smokeless tobacco uses per week and most frequently used brand). Results. Cessation prevalences were 35% in the intervention colleges and 16% in the control colleges when subjects with unknown quit status were defined as nonquitters. After adjustment for other significant predictors of quitting, the difference of 19% increased to 21%. The intervention effect increased with level of smokeless tobacco use. Conclusions. This intervention was effective in promoting smokeless tobacco cessation, especially among those who were more frequent users. Handle: RePEc:aph:ajpbhl:1999:89:2:228-234_8 Template-Type: ReDIF-Article 1.0 Title: Predictors of injury among adult recreational in-line skaters: A multicity study Journal: American Journal of Public Health Author-Name: Seldes, R.M. Author-Name: Grisso, J.A. Author-Name: Pavell, J.R. Author-Name: Berlin, J.A. Author-Name: Tan, V. Author-Name: Bowman, B. Author-Name: Kinman, J.L. Author-Name: Fitzgerald Jr., R.H. Year: 1999 Volume: 89 Issue: 2 Pages: 238-241 Abstract: Objectives. This study examined risk factors for injury, injury prevalence, safety gear use, and skating habits of adult recreational in- line skaters. Methods. Randomly selected in line skaters in 6 major US cities were interviewed. Results. Only 6% of skaters consistently wore all 4 recommended types of safety gear. Skaters with greater skating experience were more likely to perform tricks, wear less safety gear, and sustain an injury. Conclusions. More experienced adult recreational in-line skaters are at increased risk for injury. Safety gear use is alarmingly low-in adult recreational in-line skaters, especially experienced skaters. Safe skating education programs should consider targeting this newly recognized at-risk skating population. Handle: RePEc:aph:ajpbhl:1999:89:2:238-241_1 Template-Type: ReDIF-Article 1.0 Title: Community measures of low-fat milk consumption: Comparing store shelves with households Journal: American Journal of Public Health Author-Name: Fisher, B.D. Author-Name: Strogatz, D.S. Year: 1999 Volume: 89 Issue: 2 Pages: 235-237 Abstract: Objectives. This study examined the relationship between the proportion of milk in food stores that is low-fat and consumption of low-fat milk in the community. Methods. Data were gathered from 503 stores: across 53 New York State zip codes. In 19 zip codes, a telephone survey measured household low- fat milk use. Census data were obtained to examine sociodemographic predictors of the percentage of low-fat milk in stores. Results. The proportion of low-fat milk in stores was directly related to low-fat milk consumption in households and to the median income and urban level of the zip code. Conclusions. These results support using food store shelf-space observations to estimate low-fat milk consumption. Handle: RePEc:aph:ajpbhl:1999:89:2:235-237_8 Template-Type: ReDIF-Article 1.0 Title: The impact of condom distribution in Seattle schools on sexual behavior and condom use Journal: American Journal of Public Health Author-Name: Kirby, D. Author-Name: Brener, N.D. Author-Name: Brown, N.L. Author-Name: Peterfreund, N. Author-Name: Hillard, P. Author-Name: Harrist, R. Year: 1999 Volume: 89 Issue: 2 Pages: 182-187 Abstract: Objectives. Ten Seattle high schools made condoms available through vending machines, baskets in school clinics, or both. This study measured the number of condoms that students obtained and subsequent changes in sexual behavior and condom use. Methods. Schoolwide surveys were administered in spring 1993 and in spring 1995, before and during the condom availability program. These data were-compared with data from nationally representative surveys administered at the same time. Results. Seattle students obtained an average of 4.6 condoms per year, the vast majority from baskets and very few from vending machines. Relative to the national samples, the percentage of Seattle students who had ever had sex remained stable after the program began; current sexual activity decreased significantly; and the percentage of sexually experienced students who used a condom the last time they had sex decreased significantly, particularly in the 5 schools with baskets of condoms in clinics. Conclusions. Making condoms available in Seattle schools enabled students to obtain relatively large numbers of condoms but did not lead to increases in either sexual activity or condom use. Handle: RePEc:aph:ajpbhl:1999:89:2:182-187_4 Template-Type: ReDIF-Article 1.0 Title: Who should be offered prenatal diagnosis? The 35-year-old question Journal: American Journal of Public Health Author-Name: Kuppermann, M. Author-Name: Goldberg, J.D. Author-Name: Nease Jr., R.F. Author-Name: Washington, A.E. Year: 1999 Volume: 89 Issue: 2 Pages: 160-163 Abstract: Prenatal diagnosis of chromosomal disorders is generally offered to women who will be 35 years or older at the time of delivery or who have been determined via serum screening to be at risk similar to that of a woman older than 35 years. This age threshold was based on 4 major rationales that reflect considerations of resources and effectiveness. In this paper, we explore the current screening recommendations and consider new information that calls the 35-years threshold into question. We conclude that guidelines regarding use of prenatal diagnosis account for the preferences of the individual patient as well as for individual risk. Handle: RePEc:aph:ajpbhl:1999:89:2:160-163_9 Template-Type: ReDIF-Article 1.0 Title: Acculturation and breast cancer screening among hispanic women in New York City Journal: American Journal of Public Health Author-Name: O'Malley, A.S. Author-Name: Kerner, J. Author-Name: Johnson, A.E. Author-Name: Mandelblatt, J. Year: 1999 Volume: 89 Issue: 2 Pages: 219-227 Abstract: Objectives. This study investigated whether acculturation was associated with the receipt of clinical breast examinations and mammograms among Colombian, Ecuadorian, Dominican, and Puerto Rican women aged 18 to 74 years in New York City in 1992. Methods. A bilingual, targeted, random-digit- dialed telephone survey was conducted among 908 Hispanic women from a population-based quota sample. Outcome measures included ever and recent use of clinical breast examinations and mammograms. Multivariate logistic regression infidels were used to assess the effect of acculturation on screening use. Results. When demographic, socioeconomic, and health system characteristics and cancer attitudes and beliefs were controlled for, women who were more acculturated had significantly higher odds of ever and recently receiving a clinical breast examination (P ≤ .01) and of ever (P ≤ .01) and recently (P ≤ .05) receiving a mammogram than did less acculturated women. For all screening measures, there was a linear increase in the adjusted probability of being screened as a function of acculturation. Conclusions. Neighborhood and health system interventions to increase screening among Hispanic women should target the less acculturated. Handle: RePEc:aph:ajpbhl:1999:89:2:219-227_5 Template-Type: ReDIF-Article 1.0 Title: Roe v Wade and American fertility Journal: American Journal of Public Health Author-Name: Levine, P.B. Author-Name: Staiger, D. Author-Name: Kane, T.J. Author-Name: Zimmerman, D.J. Year: 1999 Volume: 89 Issue: 2 Pages: 199-203 Abstract: Objectives. This article examines the effect of abortion legalization on fertility rates in the United States. Methods. Fertility rates were compared over time between states that varied in the timing of abortion legalization. Results. States legalizing abortion experienced a 4% decline in fertility relative to states where the legal status of abortion was unchanged. The relative reductions in births to teens, women more than 35 years of age, non- White women, and unmarried women were considerably larger. If women did not travel between states to obtain an abortion, the estimated impact of abortion legalization on birth rates would be about 11%. Conclusions. A complete recriminalization of abortion nationwide could result in 440 000 additional births per year. A reversal of the Roe v Wade decision leaving abortion legal in some states would substantially limit this impact because of the extent of travel between states. Handle: RePEc:aph:ajpbhl:1999:89:2:199-203_4 Template-Type: ReDIF-Article 1.0 Title: Implementation of condom social marketing in Louisiana, 1993 to 1996 Journal: American Journal of Public Health Author-Name: Cohen, D.A. Author-Name: Farley, T.A. Author-Name: Bedimo-Etame, J.R. Author-Name: Scribner, R. Author-Name: Ward, W. Author-Name: Kendall, C. Author-Name: Rice, J. Year: 1999 Volume: 89 Issue: 2 Pages: 204-208 Abstract: Objectives. This article describes the implementation and impact of the first statewide condom social marketing intervention in the United States. Methods. A statewide social marketing program made condoms freely available in 93 public health clinics, 39 community mental health centers, 29 substance abuse treatment sites, and more than 1000 businesses in neighborhoods with high rates of sexually transmitted diseases (STDs) and HIV. Surveys about condom use were conducted annually. Results. Between 1994 and 1996, more than 33 million condoms were distributed without significant opposition. Over time, self-reported condom use at the last sexual encounter increased among African American women (from 28% in 1994 to 36% in 1996), particularly African American women with 2 or more sex partners (from 30% to 48%). Condom use at the last sexual encounter increased among African American men (from 40% in 1994 to an average of 54% in 1996). The number of reported sex partners did not increase. Conclusions. Condom social marketing can be successfully implemented in the United States. The widespread availability of free condoms is associated with increased condom use, particularly among persons at high risk for STDs and HIV. Handle: RePEc:aph:ajpbhl:1999:89:2:204-208_8 Template-Type: ReDIF-Article 1.0 Title: Errors in gestational age: Evidence of bleeding early in pregnancy Journal: American Journal of Public Health Author-Name: Gjessing, H.K. Author-Name: Skjœrven, R. Author-Name: Wilcox, A.J. Year: 1999 Volume: 89 Issue: 2 Pages: 213-218 Abstract: Objectives. This study explored the extent of errors in gestational age as ascertained by last menstrual period. Methods. More than 1.5 million birth records (covering the years 1967-1994) from fife population-based Medical Birth Registry of Norway were used to study variation in gestational age within strata of birth weight. Results. Within 100-g strata of birthweight, it was found that the observed gestational age distribution could be divided into 3 distinct underlying distributions separated by approximately 4 weeks. This pattern was present through all birthweight strata, from 200 g up to 4700 g. In addition, the apparent misclassification causing a gestational age 4 weeks too short was much more common among low-birthweight births than among heavier births. Conclusions. The separation of the gestational age distributions by intervals of close to 4 weeks suggests that errors in gestational age measurements are caused by factors related to menstrual bleeding. Furthermore, there is evidence for a strong relation between bleeding at the time of the next menstrual period after conception and low birthweight. This conclusion should be approached with caution because of the retrospective nature of the data. Handle: RePEc:aph:ajpbhl:1999:89:2:213-218_0 Template-Type: ReDIF-Article 1.0 Title: Interior surface materials in the home and the development of bronchial obstruction in young children in Oslo, Norway Journal: American Journal of Public Health Author-Name: Jaakkola, J.J.K. Author-Name: Øie, L. Author-Name: Nafstad, P. Author-Name: Botten, G. Author-Name: Samuelsen, S.O. Author-Name: Magnus, P. Year: 1999 Volume: 89 Issue: 2 Pages: 188-192 Abstract: Objectives. This study assessed the role of polyvinyl chloride (PVC) plastics and textile materials in the home in the development of bronchial obstruction during the first 2 years of life. Methods. The study was a matched pair case-control study based on a cohort of 3754 newborns in Oslo in 1992 and 1993 who were followed up for 2 years. The case group consisted of 251 children with bronchial obstruction; the control group was matched one- to-one for date of birth. Results. In conditional logistic regression analysis, the risk of bronchial obstruction was related to the presence of PVC flooring (adjusted odds ratio [OR] = 1.89; 95% confidence interval [CI] = 1.14, 3.14) and textile wall materials (adjusted OR = 1.58; 95% CI = 0.98, 2.54). The reference category was wood or parquet flooring and painted walls and ceiling. Further analysis revealed an exposure-response relationship between the assessed amount of PVC and other plasticizer-containing surface materials and the risk of bronchial obstruction. Conclusions. This study provides new evidence of the role of PVC and textile wall materials in the development of bronchial obstruction in young children. Handle: RePEc:aph:ajpbhl:1999:89:2:188-192_3 Template-Type: ReDIF-Article 1.0 Title: The impact of physician bonuses, enhanced fees, and feedback on childhood immunization coverage rates Journal: American Journal of Public Health Author-Name: Fairbrother, G. Author-Name: Hanson, K.L. Author-Name: Friedman, S. Author-Name: Butts, G.C. Year: 1999 Volume: 89 Issue: 2 Pages: 171-175 Abstract: Objectives. The purpose of this study was to examine the effects on immunization coverage of 3 incentives for physicians - a cash bonus for practice-wide increases, enhanced fee for service, and feedback. Methods. Incentives were applied at 4-month intervals over 1 year among 60 inner-city office-based pediatricians. At each interval, charts of 50 randomly selected children between 3 and 35 months of age were reviewed per physician. Results. The percentage of children who were up to date for diphtheria, tetanus, and pertussis and Haemophilus influenzae type b; polio; and measles-mumps- rubella immunization in the study's bonus group improved by 25.3 percentage points (P < .01). No significant changes occurred in the other groups. However, percentage of immunizations received outside the participating practice also increased significantly in the bonus group (P < .0.1). Levels of missed opportunities to immunize were high in all groups and did hot change over time. Physicians' knowledge of contraindications was low. Conclusions: Bonuses sharply and rapidly increased immunization coverage in medical records. However, much of the increase was the result of better documentation. A bonus is a powerful incentive, but more structure or education may be necessary to achieve the desired results. Handle: RePEc:aph:ajpbhl:1999:89:2:171-175_6 Template-Type: ReDIF-Article 1.0 Title: Prevalent urinary incontinence as a correlate of pregnancy, vaginal childbirth, and obstetric techniques Journal: American Journal of Public Health Author-Name: Foldspang, A. Author-Name: Mommsen, S. Author-Name: Djurhuus, J.C. Year: 1999 Volume: 89 Issue: 2 Pages: 209-212 Abstract: Objectives. This study examined the association between pregnancy, vaginal childbirth and obstetric techniques, and the prevalence of urinary incontinence among adult women aged 20 to 59 years. Methods. A cross- sectional survey enrolled a random sample of 6240 women aged 20 to 59 years who were mailed a self-administered questionnaire focusing on urinary incontinence and other health variables. More than 75% of the women responded. The present analysis includes 4345 women who were not pregnant and did not experience a vaginal childbirth during 1994. Results. Multivariate prevalence odds ratios showed increases in relation to urinary incontinence during pregnancy, urinary incontinence immediately after a vaginal childbirth, and age of 30 years or more at the second vaginal childbirth. No multivariate associations were found for forceps delivery or vacuum extraction delivery, episiotomy, or perineal suturing. Conclusions. Not only the process of childbirth itself but also processes during pregnancy seem to be strongly associated with prevalent urinary incontinence. Perincal suturing may be associated with prevalent urinary incontinence, whereas other obstetric techniques inspected do not seem to be so. Handle: RePEc:aph:ajpbhl:1999:89:2:209-212_3 Template-Type: ReDIF-Article 1.0 Title: From socialist principles to motorcycle maintenance: The origin and development of the salaried physician model in the Israeli Public Health Services, 1918 to 1998 Journal: American Journal of Public Health Author-Name: Shvarts, S. Author-Name: De Leeuw, D.L.A. Author-Name: Granit, S. Author-Name: Benbassat, J. Year: 1999 Volume: 89 Issue: 2 Pages: 248-253 Abstract: For more than 70 years, physicians in the Israeli health care system have been employed on a fixed salary rather than on a fee-for-service basis. The present report is a brief review of the origin and development of this unique salaried physician model and its effect on the terms of physicians' employment. Archival documents were reviewed. The salaried physician model was introduced to ensure egalitarian health care for patients rather than equal payment for physicians. It was accepted by physicians because it guaranteed their employment and income. However, over the years, the salaried physician model has evolved into a complex wage scale, with multiple fringe benefits that bypass formal agreements in order to reward individual physicians. In addition, the salaried physician model has encouraged illegal private practice, which is viewed today as one of the major problems of the Israeli Public Health Services. Handle: RePEc:aph:ajpbhl:1999:89:2:248-253_8 Template-Type: ReDIF-Article 1.0 Title: Wife abuse among women of childbearing age in Nicaragua Journal: American Journal of Public Health Author-Name: Ellsberg, M.C. Author-Name: Peña, R. Author-Name: Herrera, A. Author-Name: Liljestrand, J. Author-Name: Winkvist, A. Year: 1999 Volume: 89 Issue: 2 Pages: 241-244 Abstract: Objectives. This study measured the prevalence, frequency, and severity of physical wife abuse and its risk factors in Leon, Nicaragua. Methods. A cross-sectional survey was conducted with a representative sample of 488 women 15 to 49 years of age. Results. The lifetime prevalence of spousal violence was 52% among ever-married women (n=360). Spousal violence was significantly positively associated with poverty, parity, urban residence, and history of violence in the husband's family. No significant associations were found between spousal violence and women's age, education, marital dependency, or occupation. Conclusions. Wife abuse constitutes a major public health problem in Nicaragua, requiring urgent measures for prevention and treatment for victims. Handle: RePEc:aph:ajpbhl:1999:89:2:241-244_9 Template-Type: ReDIF-Article 1.0 Title: The influence of race on approaching families for organ donation and their decision to donate Journal: American Journal of Public Health Author-Name: Guadagnoli, E. Author-Name: McNamara, P. Author-Name: Evanisko, M.J. Author-Name: Beasley, C. Author-Name: Callender, C.O. Author-Name: Poretsky, A. Year: 1999 Volume: 89 Issue: 2 Pages: 244-247 Abstract: Objectives. This study examined whether patients' race was associated with their families' being approached for organ donation and agreeing to donation. Methods. Logistic regression models were applied to data collected from records at 112 hospital. Results. The odds that a family of a White patient was approached for donation were nearly twice those for a family of an African American. The odds of donation also differed by race, but the magnitude varied by patient and hospital characteristics. Conclusions. Much attention directed toward racial disparity in donation has focused on attitudes of the public. The behaviour of hospital staff also may be related to differences in rates. Handle: RePEc:aph:ajpbhl:1999:89:2:244-247_7 Template-Type: ReDIF-Article 1.0 Title: The effectiveness of the reach for health community youth service learning program in reducing early and unprotected sex among urban middle school students Journal: American Journal of Public Health Author-Name: O'Donnell, L. Author-Name: Stueve, A. Author-Name: San Doval, A. Author-Name: Duran, R. Author-Name: Haber, D. Author-Name: Atnafou, R. Author-Name: Johnson, N. Author-Name: Grant, U. Author-Name: Murray, H. Author-Name: Juhn, G. Author-Name: Tang, J. Author-Name: Piessens, P. Year: 1999 Volume: 89 Issue: 2 Pages: 176-181 Abstract: Objectives. This study evaluated the effectiveness of a community youth service (CYS) program in reducing sexual risk behaviors among African American and Latino urban young adolescents. Methods. A total of 1061 students at 2 urban middle schools were surveyed at baseline and 6-month follow-up. Students at one school were randomly assigned by classroom to receive either the Reach for Health CYS program or the Reach for Health classroom curriculum only. Students at the other school served as controls. Results. At follow-up, CYS participants reported significantly less recent sexual activity (P < .05) and scored lower on a sexual activity index than those in the control condition (P < .03). The greatest effect was among eighth graders, who received the most intensive service program (P < .03). The benefit of the curriculam-only intervention appeared greatest among students in special education classes. Conclusions. Well-organized CYS that couples community involvement with classroom health instruction can have a positive impact on the sexual behaviors of young adolescents at risk for HIV, sexually transmitted diseases, and unintended pregnancy. This study also suggests the importance of including students in special education classes in health education programs. Handle: RePEc:aph:ajpbhl:1999:89:2:176-181_9 Template-Type: ReDIF-Article 1.0 Title: The role of state policies and programs in buffering the effects of poverty on children's immunization receipt Journal: American Journal of Public Health Author-Name: Mayer, M.L. Author-Name: Clark, S.J. Author-Name: Konrad, T.R. Author-Name: Freeman, V.A. Author-Name: Slifkin, R.T. Year: 1999 Volume: 89 Issue: 2 Pages: 164-170 Abstract: Objectives. This study assessed the influence of public policies on the immunization status of 2-year-old children in the United States. Methods. Up- to-dateness for the primary immunization series was assessed in a national sample of 8100 children from the 1988 National Maternal and Infant Health Survey and its 1991 Longitudinal Follow-Up. Results. Documented immunization rates of this sample were 33% for poor children and 44% for others. More widespread Medicaid coverage was associated with greater likelihood of up- to-dateness among poor children. Up-to-dateness was more likely for poor children with public rather than private sources of routine pediatric care, but all children living in states where most immunizations were delivered in the public sector were less likely to be up to date. Poor children in states with partial vaccine replacement programs were less likely to be up to date than those in free-market purchase states. Conclusions. While state policies can enhance immunization delivery for poor children, heavy reliance on public sector immunization does not ensure timely receipt of vaccines. Public- and private-sector collaboration is necessary to protect children from vaccine- preventable diseases. Handle: RePEc:aph:ajpbhl:1999:89:2:164-170_9 Template-Type: ReDIF-Article 1.0 Title: Reading ability, education, and cognitive status assessment among older adults in Harlem, New York City Journal: American Journal of Public Health Author-Name: Albert, S.M. Author-Name: Teresi, J.A. Year: 1999 Volume: 89 Issue: 1 Pages: 95-97 Abstract: Objectives. This study examined reported level of education and current reading ability as predictors of cognitive status among older African Americans in central Harlem, New York City. Methods. A probability sample of 164 noninstitutionalized older African Americans was assessed. Mini-Mental State Examination (MMSE) scores were regressed on education and reading ability measures. Results. Reading ability and educational attainment were significant, independent predictors of MMSE performance. Within any level of education, subjects whose grade-equivalent reading ability exceeded reported level of education scored significantly higher on the MMSE. Conclusions. Reading ability may be useful in interpreting the results of cognitive screening among low-educated and minority groups. Handle: RePEc:aph:ajpbhl:1999:89:1:95-97_6 Template-Type: ReDIF-Article 1.0 Title: Going bare: Trends in health insurance coverage, 1989 through 1996 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: 1999 Volume: 89 Issue: 1 Pages: 36-42 Abstract: Objectives. This study analyzed trends in health insurance coverage in the United States from 1989 through 1996. Methods. Data from annual cross- sectional surveys by the US Census Bureau were analyzed. Results. Between 1989 and 1996, the number of uninsured persons increased by 8.3 million (90% confidence interval [CI] = 7.7, 8.9 million). In 1996, 41.7 million (90% CI = 40.9, 42.5 million) lacked insurance. Front 1989 to 1993, the proportion with Medicaid increased by 3.6 percentage points (90% CI = 3.1, 4.0), while the proportion with private insurance declined by 4.2 percentage points (90% CI = 3.7, 4.7). From 1993 to 1996 private coverage rates stabilized but did not reverse earlier declines. Consequently, the number uninsured continued to increase. The greatest increase in the population of insured was among young adults aged 18 to 39 years; rates among children also rose steeply after 1992. While Blacks had the largest percentage increase, Hispanics accounted for 36.4% (90% CI = 32.3%, 40.5%) of the increase in the number uninsured. From 1989 to 1993, the majority of the increase was among poor families. Since then, middle-income families have incurred the largest increase. Northcentral and northeastern states had the largest increases in percent uninsured. Conclusions. Despite economic prosperity, the numbers and rates of the uninsured continued to rise. Principally affected were children and young adults, poor and middle income families, blacks, and Hispanics. Handle: RePEc:aph:ajpbhl:1999:89:1:36-42_0 Template-Type: ReDIF-Article 1.0 Title: Deaths attributable to Alzheimer's disease in the United States Journal: American Journal of Public Health Author-Name: Ewbank, D.C. Year: 1999 Volume: 89 Issue: 1 Pages: 90-92 Abstract: Objectives. This study provided 2 estimates of the number of deaths attributable to Alzheimer's disease in the United States. Methods. One estimate was based on data from the East Boston, Mass, study. The second was based on a simulation using population-based estimates of prevalence and separate estimates of excess death by duration of disease. Results. Despite different methods and very different estimates of prevalence, these 2 methods led to very similar estimates of 173 000 and 163 000 excess deaths. Conclusions. These estimates suggest that 7.1% of all deaths in the United States in 1995 are attributable to Alzheimer's disease, placing it on a par with cerebrovascular diseases as the third leading cause of death. Handle: RePEc:aph:ajpbhl:1999:89:1:90-92_1 Template-Type: ReDIF-Article 1.0 Title: Persistence of susceptibility of measles in France despite routine immunization: A cohort analysis Journal: American Journal of Public Health Author-Name: Chauvin, P. Author-Name: Valleron, A.-J. Year: 1999 Volume: 89 Issue: 1 Pages: 79-81 Abstract: Objectives. This study examined the impact of French routine programs urging the combined measles-mumps-rubella immunization of 15-month-old children. Methods. We applied a cohort analysis to surveillance data collected by general practitioners to estimate the cumulative incidence rate per 1000 unvaccinated children and the proportion of susceptible children, by age and for each birth cohort between 1985 and 1995. Results. More than 70% of unvaccinated children born in 1985 and 1986 had measles by the age of 10. This incidence rate dramatically decreased after implementation of the routine measles-mumps-rubella immunization program in 1989, but the proportion of 5-year-olds susceptible to measles has not decreased appreciably. In 1996, more than 15% of the children born between 1990 and 1995 were susceptible. Conclusions. The measles vaccine coverage achieved by the French routine immunization program remains insufficient as regards reducing the number of susceptible children. Handle: RePEc:aph:ajpbhl:1999:89:1:79-81_9 Template-Type: ReDIF-Article 1.0 Title: Consequences in Georgia of a nationwide outbreak of Salmonella infections: What you don't know might hurt you Journal: American Journal of Public Health Author-Name: Mahon, B.E. Author-Name: Slutsker, L. Author-Name: Hutwagner, L. Author-Name: Drenzek, C. Author-Name: Maloney, K. Author-Name: Toomey, K. Author-Name: Griffin, P.M. Year: 1999 Volume: 89 Issue: 1 Pages: 31-35 Abstract: Objectives. This study assessed the impact in Georgia of a nationwide salmonellosis outbreak caused by ice cream products and the effectiveness of the subsequent warning against eating the implicated products. Methods. A telephone survey of 250 randomly selected Georgia customers of the ice cream producer was conducted 13 to 17 days after the warning. Results. Respondents from 179 households representing 628 persons were interviewed. The median date of first hearing the warning was 5 days after it was issued, and 16 respondents (9%) had not heard it. Among those who had heard the warning, 42 (26%) did not initially believe the products were unsafe. In 22 (31%) of the 72 households that had the implicated ice cream when the respondent heard the warning, someone subsequently ate the ice cream. Diarrhea was reported in 26% (121/463) of persons who had eaten the products but in only 5% (8/152) who had not (odds ratio [controlling for household clustering] = 3.8; 95% confidence interval = 2.0, 7.5). We estimate this outbreak caused 11 000 cases of diarrhea in Georgia, 1760 (16%) with exposure after the warning. Conclusions. A large outbreak occurred in Georgia, much of which might have been prevented by a more timely and convincing warning. Handle: RePEc:aph:ajpbhl:1999:89:1:31-35_3 Template-Type: ReDIF-Article 1.0 Title: Prevalence of hepatitis B virus infection in the United States: The National Health and Nutrition Examination Surveys, 1976 through 1994 Journal: American Journal of Public Health Author-Name: McQuillan, G.M. Author-Name: Coleman, P.J. Author-Name: Kruszon-Moran, D. Author-Name: Moyer, L.A. Author-Name: Lambert, S.B. Author-Name: Margolis, H.S. Year: 1999 Volume: 89 Issue: 1 Pages: 14-18 Abstract: Objectives. Data from 2 National Health and Nutrition Examination Surveys (NHANES), NHANES II (1976-1980 and NHANES III (1988-1994), were analyzed to examine trends in the prevalence of hepatitis B infection in the United States. Methods. Serum specimens were tested for markers of hepatitis B virus infection, and risk factors were determined from questionnaires. Results. The overall age-adjusted prevalence of hepatitis B virus infection was 5.5% (95% confidence interval [CI] = 4.8, 6.2) in NHANES II, as compared with 4.9% (95% CI = 4.3, 5.6) in NHANES III. In both surveys, Black participants had the highest prevalence of infection (NHANES II, 15.8%; NHANES III, 11.9%). No differences in infection were found in the major racial groups between surveys, except for a decrease among those older than 50 years. Black race, increasing number of lifetime sexual partners, and foreign birth had the strongest independent associations with hepatitis B virus infection. Conclusions. Testing of participants in 2 national surveys demonstrates no significant decrease in hepatitis B virus infection, despite the availability of hepatitis B vaccine. Handle: RePEc:aph:ajpbhl:1999:89:1:14-18_6 Template-Type: ReDIF-Article 1.0 Title: Universal HIV screening at a major metropolitan TB clinic: HIV prevalence and high-risk behaviors among TB patients Journal: American Journal of Public Health Author-Name: Weis, S.E. Author-Name: Foresman, B. Author-Name: Cook, P.E. Author-Name: Matty, K.J. Year: 1999 Volume: 89 Issue: 1 Pages: 73-75 Abstract: Objectives. This study assessed the outcome of implementing a policy of universal screening of patients with tuberculosis (TB) for HIV infection at a major metropolitan public health TB clinic. Methods. HIV serologic testing was completed on 768 (93%) of 825 eligible patients. Ninety-eight HIV- positive cases (13%) were compared with 670 HIV-negative cases. The presence of adult HIV risk factors was determined by structured interview and review of medical records. Results. One or more HIV risk factors were present in 93% of HIV-positive cases and 42% of HIV-negative cases. Conclusions. The metropolitan TB clinic is well suited for HIV screening, and HIV-antibody testing and counseling should be provided to all TB patients. Handle: RePEc:aph:ajpbhl:1999:89:1:73-75_0 Template-Type: ReDIF-Article 1.0 Title: Can data-driven benchmarks be used to set the goals of Healthy People 2010? Journal: American Journal of Public Health Author-Name: Allison, J. Author-Name: Kiefe, C.I. Author-Name: Weissman, N.W. Year: 1999 Volume: 89 Issue: 1 Pages: 61-65 Abstract: Objectives. Expert panels determined the public health goals of Healthy People 2000 subjectively. The present study examined whether data-driven benchmarks provide a better alternative. Methods. We developed the 'pared- mean' method to define from data the best achievable health care practices. We calculated the pared-mean benchmark for screening mammography from the 1994 National Health Interview Survey, using the metropolitan statistical area as the 'provider' unit. Beginning with the best-performing provider and adding providers in descending sequence, we established the minimum provider subset that included at least 10% of all women surveyed on this question. The pared-mean benchmark is then the proportion of women in this subset who received mammography. Results. The pared-mean benchmark for screening mammography was 71%, compared with the Healthy People 2000 goal of 60%. Conclusions. For Healthy People 2010, benchmarks derived from data reflecting the best available care provide viable alternatives to consensus-derived targets. We are currently pursuing additional refinements to the data-driven pared-mean benchmark approach. Handle: RePEc:aph:ajpbhl:1999:89:1:61-65_7 Template-Type: ReDIF-Article 1.0 Title: Increasing fruit and vegetable consumption through worksites and families in the Treatwell 5-a-Day study Journal: American Journal of Public Health Author-Name: Sorensen, G. Author-Name: Stoddard, A. Author-Name: Peterson, K. Author-Name: Cohen, N. Author-Name: Hunt, M.K. Author-Name: Stein, E. Author-Name: Palombo, R. Author-Name: Lederman, R. Year: 1999 Volume: 89 Issue: 1 Pages: 54-60 Abstract: Objectives. We report on the results of the Treatwell 5-a-Day study, a worksite intervention aimed at increasing consumption of fruits and vegetables. Methods. Twenty-two worksites were randomly assigned to 3 groups: (1) a minimal intervention control group, (2) a worksite intervention, and (3) a worksite-plus-family intervention. The interventions used community- organizing strategies and were structured to target multiple levels of influence, following a socioecological model. Data were collected by self- administered employee surveys before and after the intervention; the response rate was 87% (n = 1359) at baseline and 76% (n = 1306) at follow-up. A process tracking system was used to document intervention delivery. Results. After control for worksite, gender, education, occupation, race/ethnicity, and living situation, total fruit and vegetable intake increased by 19% in the worksite-plus-family group, 7% in the worksite intervention group, and 0% in the control group (P = .05). These changes reflect a one half serving increase among workers in the worksite-plus-family group compared with the control group (P = .018). Conclusions. The worksite-plus-family intervention was more successful in increasing fruit and vegetable consumption than was the worksite intervention. Worksite interventions involving family members appear to be a promising strategy for influencing workers' dietary habits. Handle: RePEc:aph:ajpbhl:1999:89:1:54-60_0 Template-Type: ReDIF-Article 1.0 Title: Effectiveness of denial of handgun purchase to persons believed to be at high risk for firearm violence Journal: American Journal of Public Health Author-Name: Wright, M.A. Author-Name: Wintemute, G.J. Author-Name: Rivara, F.P. Year: 1999 Volume: 89 Issue: 1 Pages: 88-90 Abstract: Objectives: The purpose of this study was to determine whether denial of handgun purchase is an effective violence prevention strategy. Methods. Individuals denied handgun purchase because of a prior felony conviction and handgun purchasers with a felony arrest at time of purchase were examined. Results. Relative to those denied purchase, handgun purchasers were found to be at greater risk for subsequent offenses involving a gun (relative risk [RR] = 1.21, 95% confidence interval [CI] = 1.08, 1.36) or violence (RR= 1.24, 95% CI= 1.11, 1.39), after adjustment for number of prepurchase weapon/violence charges. Conclusions. Denial of handgun purchase to persons with a prior felony conviction may lower their rate of subsequent criminal activity. Handle: RePEc:aph:ajpbhl:1999:89:1:88-90_9 Template-Type: ReDIF-Article 1.0 Title: Public health developments in colonial Malaya: Colonialism and the politics of prevention Journal: American Journal of Public Health Author-Name: Manderson, L. Year: 1999 Volume: 89 Issue: 1 Pages: 102-107 Abstract: In both African and Asian colonies until the late 19th century, colonial medicine operated pragmatically to meet the medical needs first of colonial officers and troops, immigrant settlers, and laborers responsible for economic development, then of indigenous populations when their ill health threatened the well-being of the expatriate population. Since the turn of the century, however, the consequences of colonial expansion and development for indigenous people's health and become increasingly apparent, and disease control and public health programs were expanded in this light. These programs increased government surveillance of populations at both community and household levels. As a consequence, colonial states extended institutional oversight and induced dependency through public health measures. Drawing on my own work on colonial Malaya, I illustrate developments in public health and their links to the moral logic of colonialism and its complementarity to the political economy. Handle: RePEc:aph:ajpbhl:1999:89:1:102-107_7 Template-Type: ReDIF-Article 1.0 Title: Vasectomy in the United States, 1991 and 1995 Journal: American Journal of Public Health Author-Name: Magnani, R.J. Author-Name: Haws, J.M. Author-Name: Morgan, G.T. Author-Name: Gargiullo, P.M. Author-Name: Pollack, A.E. Author-Name: Koonin, L.M. Year: 1999 Volume: 89 Issue: 1 Pages: 92-94 Abstract: Objectives. This study sought to assess whether the controversy surrounding publications linking vasectomy and prostate cancer has had an effect on vasectomy acceptance and practice in the United States. Methods. National probability surveys of urology, general surgery and family practices were undertaken in 1992 and 1996. Results. Estimates of the total number of vasectomies performed, population rate, and proportion of practices performing vasectomy were not significantly different in 1991 and 1995. Conclusions. This study provides no solid evidence that the recent controversy over prostate cancer has influenced vasectomy acceptance or practice in the United States. However, the use of vasectomy appears to have leveled off in the 1990s. Handle: RePEc:aph:ajpbhl:1999:89:1:92-94_2 Template-Type: ReDIF-Article 1.0 Title: Exercise - It's never too late: The strong-for-life program Journal: American Journal of Public Health Author-Name: Jette, A.M. Author-Name: Lachman, M. Author-Name: Giorgetti, M.M. Author-Name: Assmann, S.F. Author-Name: Harris, B.A. Author-Name: Levenson, C. Author-Name: Wernick, M. Author-Name: Krebs, D. Year: 1999 Volume: 89 Issue: 1 Pages: 66-72 Abstract: Objectives. This investigation determined whether an in-home resistance training program achieved health benefits in older adults with disabilities. Methods. A randomized controlled trial compared the effects of assigning 215 older persons to either a home-based resistance exercise training group or a waiting list control group. Assessments were conducted at baseline and at 3 and 6 months following randomization. The program consisted of videotaped exercise routines performed with elastic bands of varying thickness. Results. High rates of exercise adherence were achieved, with 89% of the recommended exercise sessions performed over 6 months. Relative to controls, subjects who participated in the program achieved statistically significant lower extremity strength improvements of 6% to 12%, a 20% improvement in tandem gait, and a 15% to 18% reduction in physical and overall disability at the 6- month follow-up. No adverse health effects were encountered. Conclusions. These findings provide important evidence that home based resistance exercise programs designed for older persons with disabilities hold promise as an effective public health strategy. Handle: RePEc:aph:ajpbhl:1999:89:1:66-72_2 Template-Type: ReDIF-Article 1.0 Title: Occupational class and ischemic heart disease mortality in the United States and 11 European countries Journal: American Journal of Public Health Author-Name: Kunst, A.E. Author-Name: Groenhof, F. Author-Name: Andersen, O. Author-Name: Borgan, J.-K. Author-Name: Costa, G. Author-Name: Desplanques, G. Author-Name: Filakti, H. Author-Name: Giraldes, M.D.R. Author-Name: Faggiano, F. Author-Name: Harding, S. Author-Name: Junker, C. Author-Name: Martikainen, P. Author-Name: Minder, C. Author-Name: Nolan, B. Author-Name: Pagnanelli, F. Author-Name: Regidor, E. Author-Name: Vågerö, D. Author-Name: Valkonen, T. Author-Name: Mackenbach, J.P. Year: 1999 Volume: 89 Issue: 1 Pages: 47-53 Abstract: Objectives. Twelve countries were compared with respect to occupational class differences in ischemic heart disease mortality in order to identify factors that are associated with smaller or larger mortality differences. Methods. Data on mortality by occupational class among men aged 30 to 64 years were obtained from national longitudinal or cross-sectional studies for the 1980s. A common occupational class scheme was applied to most countries. Potential effects of the main data problems were evaluated quantitatively. Results. A north-south contrast existed within Europe. In England and Wales, Ireland, and Nordic countries, manual classes had higher mortality rates than nonmanual classes. In France, Switzerland, and Mediterranean countries, manual classes had mortality rates as low as, or lower than, those among nonmanual classes. Compared with Northern Europe, mortality differences in the United States were smaller (among men aged 30-44 years) or about as large (among men aged 45-64 years). Conclusions. The results underline the highly variable nature of socioeconomic inequalities in ischemic heart disease mortality. These inequalities appear to be highly sensitive to social gradients in behavioral risk factors. These risk factor gradients are determined by cultural as well as socioeconomic developments. Handle: RePEc:aph:ajpbhl:1999:89:1:47-53_1 Template-Type: ReDIF-Article 1.0 Title: Sensory impairment and driving: The Blue Mountains Eye Study Journal: American Journal of Public Health Author-Name: Ivers, R.Q. Author-Name: Mitchell, P. Author-Name: Cumming, R.G. Year: 1999 Volume: 89 Issue: 1 Pages: 85-87 Abstract: Objectives. This study examined the associations between vision, hearing loss, and car accidents. Methods. A cross-sectional survey of 3654 people aged 49 years and older in the Blue Mountains, Australia, was used. Each subject had a detailed eye examination and interview. Results. Self-reported car accident rates in the past year among 2379 current drivers were 5.6% for those aged 49 to 79 years and 9.1% for those 80 years and older. A 2-line difference in visual acuity was associated with increased risk of accidents (adjusted prevalence ratio [PR] = 1.6), as was visual acuity worse than 6/18 in the right eye (PR = 2.0), overall moderate hearing loss (PR = 1.9), and hearing loss in the right ear (PR = 1.8). Conclusions. Sensory loss in drivers may be an important risk factor for car accidents. Handle: RePEc:aph:ajpbhl:1999:89:1:85-87_3 Template-Type: ReDIF-Article 1.0 Title: Syringe exchange in the United States, 1996: A national profile Journal: American Journal of Public Health Author-Name: Paone, D. Author-Name: Clark, J. Author-Name: Shi, Q. Author-Name: Purchase, D. Author-Name: Des Jarlais, D.C. Year: 1999 Volume: 89 Issue: 1 Pages: 43-46 Abstract: Objectives. This paper provides 1996 information on the status of US syringe exchange programs and compares these findings with data from our 1994 survey. Methods. In November 1996, questionnaires were mailed to 101 syringe exchange programs. Program directors were contacted to conduct telephone interviews based on the mailed questionnaires. Data collected included number of syringes exchanged, syringe exchange program operations, legal status, and services offered. Results. Eighty-seven programs participated in the survey. A total of 46 (53%) were legal, 20 (23%) were illegal but tolerated, and 21 (24%) were illegal-underground. Since 1994, there has been a 54% increase in the number of cities and a 38% increase in the number of states with syringe exchange programs. Eighty-four programs reported exchanging approximately 14 million syringes, a 75% increase from 1994. Syringe exchange programs also provided a variety of other services and supplies, and legal programs were more likely than illegal ones to provide these services. Conclusion. Despite continued lack of federal funding, syringe exchange programs expanded in terms of the number of syringes exchanged, the geographic distribution of programs, and the range of services offered. Handle: RePEc:aph:ajpbhl:1999:89:1:43-46_6 Template-Type: ReDIF-Article 1.0 Title: Assessing prenatal hepatitis B screening in illinois with an inexpensive study design adaptable to other jurisdictions Journal: American Journal of Public Health Author-Name: Barr, D. Author-Name: Hershow, R. Author-Name: Furner, S. Author-Name: Handler, A. Author-Name: Levy, P. Year: 1999 Volume: 89 Issue: 1 Pages: 19-24 Abstract: Objectives. This study estimated, using an economical survey design adaptable to other jurisdictions, the proportion of birth admissions in Illinois hospitals in which mothers were not screened for hepatitis B surface antigen prior to delivery. It also identified factors associated with lack of screening. Methods. Based on a cluster sampling design, 1372 birth records were sampled, and data were abstracted by local personnel at 56 hospitals. Selected data elements were reabstracted on a subsample to evaluate recording errors. Results. Reabstracted data demonstrated 95% agreement among reviewers. Hepatitis B surface antigen screening was documented for 90.7% of mothers; 11% of responding hospitals accounted for 45% of nonscreened mothers. Risk factors for not being screened included no prenatal care, Medicaid or no insurance, and delivery at a hospital lacking a written hepatitis B surface antigen policy. Conclusions. In Illinois, prenatal hepatitis B surface antigen screening rates were high and similar to those in other states. Births without screening or transferred information clustered in a few hospitals. The methods used here can economically identify underscreened populations by sampling a large number of hospitals within designated areas. Handle: RePEc:aph:ajpbhl:1999:89:1:19-24_9 Template-Type: ReDIF-Article 1.0 Title: Reducing AIDS risk among port workers in Santos, Brazil Journal: American Journal of Public Health Author-Name: Hearst, N. Author-Name: Lacerda, R. Author-Name: Gravato, N. Author-Name: Hudes, E.S. Author-Name: Stall, R. Year: 1999 Volume: 89 Issue: 1 Pages: 76-78 Abstract: Objectives. This study examined the impact of a worksite-based AIDS prevention program among port workers in Santos, Brazil, on sexual risk behavior for HIV infection. Methods. Male port workers (n = 226) were followed in a 3-wave prospective cohort study. A multifaceted intervention costing US $90 000 for 20 000 workers was conducted between waves 2 and 3. Results. Heterosexual risk behavior showed no decline between waves 1 and 2 (before the intervention) but decreased substantially between waves 2 and 3 (after the intervention). This decrease resulted from both a decrease in nonprimary partners and an increase in condom use. Conclusions. This worksite-based AIDS program produced marked behavior change at modest cost. Handle: RePEc:aph:ajpbhl:1999:89:1:76-78_9 Template-Type: ReDIF-Article 1.0 Title: Thalidomide and the Titanic: Reconstructing the technology tragedies of the twentieth century Journal: American Journal of Public Health Author-Name: Annas, G.J. Author-Name: Elias, S. Year: 1999 Volume: 89 Issue: 1 Pages: 98-101 Abstract: The Titanic has become a metaphor for the disastrous consequences of an unqualified belief in the safety and invincibility of new technology. Similarly, the thalidomide tragedy stands for all of the 'monsters' that can be inadvertently or negligently created by modem medicine. Thalidomide, once banned, has returned to the center of controversy with the Food and Drug Administration's (FDA's) announcement that thalidomide will be placed on the market for the treatment of erythema nodosum leprosum, a severe dermatological complication of Hansen's disease. Although this indication is very restricted, thalidomide will be available for off-label uses once it is on the market. New laws regarding abortion and a new technology, ultrasound, make reasonable the approval of thalidomide for patients who suffer from serious conditions it can alleviate. In addition, the FDA and the manufacturer have proposed the most stringent postmarketing monitoring ever used for a prescription drug, including counseling, contraception, and ultrasonography in the event of pregnancy. The Titanic/thalidomide lesson for the FDA and public health is that rules and guidelines alone are not sufficient to guarantee safety. Continuous vigilance will be required to ensure that all reasonable postmarketing monitoring steps are actually taken to avoid predictable and preventable teratogenic disasters. Handle: RePEc:aph:ajpbhl:1999:89:1:98-101_5 Template-Type: ReDIF-Article 1.0 Title: Peptic ulcer disease and exposure to domestic pets Journal: American Journal of Public Health Author-Name: McIsaac, W.J. Author-Name: Leung, G.M. Year: 1999 Volume: 89 Issue: 1 Pages: 81-84 Abstract: Objectives. This study assessed whether an association exists between household pets and peptic ulcer disease. Methods. Canadian adults (n = 15779) were asked about cats or dogs in their household and about history of peptic ulcer disease. Logistic regression was used to assess the association between pet ownership and a history of peptic ulcer disease, after adjustment for sociodemographic differences. Results. No relationship was observed between report of household pets and a history of peptic ulcer disease (adjusted odds ratio = 1.14, 95% confidence interval = 0.95, 1.36). Conclusions. In a large sample of Canadian adults, no association was observed between pet ownership and a history of peptic ulcer disease. Handle: RePEc:aph:ajpbhl:1999:89:1:81-84_2 Template-Type: ReDIF-Article 1.0 Title: Breast-feeding and infant illness: A dose-response relationship? Journal: American Journal of Public Health Author-Name: Raisler, J. Author-Name: Alexander, C. Author-Name: O'Campo, P. Year: 1999 Volume: 89 Issue: 1 Pages: 25-30 Abstract: Objectives. The purpose of this study was to determine whether breast- feeding has a dose-related protective effect against illness and whether it confers special health benefits to poor infants. Methods. The association between breast-feeding dose and illnesses in the first 6 months of life was analyzed with generalized estimating equations regression for 7092 infants from the National Maternal and Infant Health Survey. Breast-feeding dose (ratio of breast-feedings to other feedings) was categorized as full, most, equal, less, or no breast-feeding. Results. Compared with no breast-feeding, full breast-feeding infants had lower odds ratios of diarrhea, cough or wheeze, and vomiting and lower mean ratios of illness months and sick baby medical visits. Most breast-feeding infants had lower odds ratios of diarrhea and cough or wheeze, and equal breast-feeding infants had lower odds ratios of cough or wheeze. Full, most, and equal breast-feeding infants without siblings had lower odds ratios of ear infections and certain other illnesses, but those with siblings did not. Less breast-feeding infants had no reduced odds ratios of illness. Findings did not vary by income. Conclusions. Full breast-feeding was associated with the lowest illness rates. Minimal (less) breast-feeding was not protective. Breast-feeding conferred similar health benefits in all economic groups. Handle: RePEc:aph:ajpbhl:1999:89:1:25-30_5