Template-Type: ReDIF-Article 1.0 Title: The slavery hypothesis for hypertension among African Americans: the historical evidence. Journal: American Journal of Public Health Author-Name: Curtin, P.D. Year: 1992 Volume: 82 Issue: 12 Pages: 1681-1686 Abstract: The slavery hypothesis for hypertension has stated that the high blood pressures sometimes measured in African Americans are caused by one or more of these conditions: first, salt deficiency in the parts of Africa that supplied slaves for the Americas; second, the trauma of the slave trade itself; third, conditions of slavery in the United States. A review of the historical evidence shows that there was no salt deficiency in those parts of Africa, nor do present-day West Africans have a high incidence of hypertension. Historical evidence does not support the hypothesis that deaths aboard slave ships were caused mainly by conditions that might be conductive to hypertension, such as salt-depleting diseases. Finally, the hypothesis has depended heavily on evidence from the West Indies, which is not relevant for the United States. There is no evidence that diet or the resulting patterns of disease and demography among slaves in the American South were significantly different from those of other poor southerners. Handle: RePEc:aph:ajpbhl:1992:82:12:1681-1686_8 Template-Type: ReDIF-Article 1.0 Title: The progression of untreated HIV-1 infection prior to AIDS Journal: American Journal of Public Health Author-Name: Hoover, D.R. Author-Name: Saah, A. Author-Name: Bacellar, H. Author-Name: Murphy, R. Author-Name: Visscher, B. Author-Name: Metz, S. Author-Name: Anderson, R. Author-Name: Kaslow, R.A. Year: 1992 Volume: 82 Issue: 11 Pages: 1538-1541 Abstract: Using a case-control study of untreated men, we investigated the physical, mental, and economic effects of human immunodeficiency virus (HIV-1) infection prior to the diagnosis of acquired immunodeficiency syndrome (AIDS). Beginning 2 to 2.5 years prior to AIDS, case subjects reported more of 12 HIV-1 related symptoms and during the year prior to AIDS, at least 30.6 extra days of these symptoms than did control subjects. Within the 6 months preceding AIDS, case subjects' unemployment rose to 9% (P ≤ .05) and depression to 34.2% (P ≤ .001). At 6 to 12 months and within 6 months before AIDS, 17.1% and 31.5%, respectively, were anemic, while 37.7% and 64.7% had CD4+ counts less than 200 x 106/L. Diagnosing AIDS at CD4+ counts less than 200 x 106/L could significantly reduce pre-AIDS morbidity. Other implications of these findings are discussed. Handle: RePEc:aph:ajpbhl:1992:82:11:1538-1541_6 Template-Type: ReDIF-Article 1.0 Title: Commentary: The public health consequences of restricted induced abortion - Lessons from Romania Journal: American Journal of Public Health Author-Name: Stephenson, P. Author-Name: Wagner, M. Author-Name: Badea, M. Author-Name: Serbanescu, F. Year: 1992 Volume: 82 Issue: 10 Pages: 1328-1331 Abstract: The question of whether abortion should be legal is currently being decided in many countries. Although much of the discussion has focused on ethical issues, the public health consequences should not be overlooked and should be addressed realistically and responsibly. Nowhere are the public health manifestations of restricted abortion more apparent than in Romania. The pronatalist policies of the Ceaucescu regime resulted in the highest maternal mortality rate in Europe (approximately 150 maternal deaths per 100 000 live births) and in thousands of unwanted children in institutions. Handle: RePEc:aph:ajpbhl:1992:82:10:1328-1331_9 Template-Type: ReDIF-Article 1.0 Title: The search for meaning: RU 486 and the law of abortion Journal: American Journal of Public Health Author-Name: Banwell, S.S. Author-Name: Paxman, J.M. Year: 1992 Volume: 82 Issue: 10 Pages: 1399-1406 Abstract: The advent of RU 486 (mifepristone), a steroid analogue capable of inducing menses within 8 to 10 weeks of a missed menstrual period, has provoked a firestorm of concern and controversy. When used in conjunction with prostaglandin (RU 486/PG), it is at least 95% effective. Used in France principally to terminate confirmed pregnancies very early in the process of gestation, RU 486 raises many interesting legal questions. This article focuses on whether and how RU 486/PG can be accommodated within the framework of the world's current abortion laws. Four avenues are explored and conclusions drawn. First, it is clear that RU 486/PG can be used readily, if approved, within the regimens established by liberal abortion laws, as has been the experience in France, the United Kingdom, and even China. Second, although unlikely, the introduction of this new technology may inspire a reexamination of restrictive abortion statutes themselves. Third, some of the presently restrictive laws may be interpreted to permit RU 486/PG use as a legal procedure, for a very narrow range of reasons. Finally, in some settings the early use of RU 486/PG (before pregnancy can be confirmed) may fall outside the reach of abortion legislation and hence be acceptable from a legal point of view. Handle: RePEc:aph:ajpbhl:1992:82:10:1399-1406_9 Template-Type: ReDIF-Article 1.0 Title: Lead exposure and child behavior Journal: American Journal of Public Health Author-Name: Sciarillo, W.G. Author-Name: Alexander, G. Author-Name: Farrell, K.P. Year: 1992 Volume: 82 Issue: 10 Pages: 1356-1360 Abstract: Objectives. Unlike cognitive impairments associated with lead exposure, lead-associated child behavior problems have been difficult to specify, particularly in young children. Methods. The Child Behavior Checklist (CBCL) and the Center for Epidemiologic Studies Depression Scale were used as the outcome and confounding variables, respectively, of major interest. These measures were examined with respect to blood lead levels of 201 African- American children aged 2 through 5 years. Results. In comparison with the low exposed group, the high exposed group (two consecutive blood lead levels ≥15 μg/dL) had a significantly higher mean CBCL Total Behavior Problem Score (TBPS) and Internalizing and Externalizing scores; when other factors, including maternal depressive symptomatology, were controlled for, regression procedures indicated a .18-point TBPS increase for each unit increase in lead and a 5.1-point higher TBPS in the high exposed group; children in this group were 2.7 times more likely to have a TBPS in the clinical range. Conclusions. Through its use of a standardized parent-report measure of behavior and its consideration of maternal morale in multiple linear and logistic regression procedures, this study provides further evidence of lead's detrimental effect on child behavior at levels typical of present-day exposure. Handle: RePEc:aph:ajpbhl:1992:82:10:1356-1360_6 Template-Type: ReDIF-Article 1.0 Title: The Tobacco Institute's 'It's the Law' campaign: Has it halted illegal sales of tobacco to children? Journal: American Journal of Public Health Author-Name: DiFranza, J.R. Author-Name: Brown, L.J. Year: 1992 Volume: 82 Issue: 9 Pages: 1271-1273 Abstract: A survey of tobacco retailers was conducted to evaluate the efficacy of the Tobacco Institute's 'It's the Law' program, which has the goal of eliminating the illegal sale of tobacco to minors. Only 4.5% (7) of the 156 retailers surveyed were participating in the 'It's the Law' program. Eighty- six percent of the retailers who were participating in the program were willing to illegally sell cigarettes to children, compared with 88% (131/149) of the retailers who were not participating. Handle: RePEc:aph:ajpbhl:1992:82:9:1271-1273_5 Template-Type: ReDIF-Article 1.0 Title: The vital diversity of tobacco control research Journal: American Journal of Public Health Author-Name: Giovino, G.A. Author-Name: Eriksen, M.P. Author-Name: McKenna, J.W. Year: 1992 Volume: 82 Issue: 9 Pages: 1203-1205 Handle: RePEc:aph:ajpbhl:1992:82:9:1203-1205_7 Template-Type: ReDIF-Article 1.0 Title: Intimidation of CTR-funded scientists claimed [2] Journal: American Journal of Public Health Author-Name: Sterling, T.D. Author-Name: Cummings, K.M. Author-Name: Sciandra, R. Author-Name: Davis, R.M. Author-Name: Warner, K.E. Year: 1992 Volume: 82 Issue: 9 Pages: 1292-1294 Handle: RePEc:aph:ajpbhl:1992:82:9:1292-1294_8 Template-Type: ReDIF-Article 1.0 Title: The development of registries for surveillance of adult lead exposure, 1981 to 1992 Journal: American Journal of Public Health Author-Name: Baser, M.E. Year: 1992 Volume: 82 Issue: 8 Pages: 1113-1118 Abstract: Objectives. Since 1981, 15 states have established registries for surveillance of adult lead absorption, primarily based on reports of elevated blood lead levels from clinical laboratories. I review the status of the registries and recommend steps for further development. Methods. Companies reported to the New York registry are compared with those cited by the Occupational Safety and Health Administration (OSHA). I present data on US workers and plants with potential lead exposures and blood tests, as well as review registries' reporting requirements. Results. Registries identify many companies not cited by the Occupational Safety and Health Administration, but underreporting occurs because (1) reporting is usually not required from laboratories outside the state, (2) most registries use a blood lead reporting level of 1.21 μmol/L, which excludes many exposed workers, and (3) many companies with potential exposures do not have routine monitoring programs. Conclusions. Registries' reporting requirements and procedures should be standardized, including a blood lead reporting level of 0.72 μmol/L. Elevated blood lead levels should be a reportable condition nationwide, and a comprehensive national surveillance system should be established: clinical laboratories should be required to report cases to those states with lead registries or directly to the national adult lead registry. Handle: RePEc:aph:ajpbhl:1992:82:8:1113-1118_2 Template-Type: ReDIF-Article 1.0 Title: Food sources, dietary behavior, and the saturated fat intake of latino children Journal: American Journal of Public Health Author-Name: Basch, C.E. Author-Name: Shea, S. Author-Name: Zybert, P. Year: 1992 Volume: 82 Issue: 6 Pages: 810-815 Abstract: Background. Recent recommendations for Americans aged 2 and older call for a reduction in the average saturated fat intake to less than 10% of calories. Methods. Using 24-hour dietary recalls collected from mothers of 4- to 7- year-old urban Latino children, we identified foods and dietary behavior patterns that distinguish children with higher and lower mean daily percentages of calories from saturated fat. Results. Compared with children in the lowest quintile of intake, children in the highest quintile consumed more than twice as much saturated fat per day from high-fat milk products (18.5 g vs 7.8 g), mostly from whole milk. They did not consume different kinds of milk or different amounts of milk per eating occasion, but on average they consumed milk more frequently (2.8 vs 1.6 eating occasions per day). Even children in the lowest quintile, on average, exceeded the 10% of calories from saturated fat currently recommended. If low-fat (1% fat) milk had been substituted without other dietary changes, all but the highest two quintiles would have been within the recommended level. Conclusions. The substitution of low-fat for whole milk appears to be a key strategy for preschool children for achieving recommended levels of saturated fat intake. Handle: RePEc:aph:ajpbhl:1992:82:6:810-815_3 Template-Type: ReDIF-Article 1.0 Title: Use of hair coloring products and the risk of lymphoma, multiple myeloma, and chronic lymphocytic leukemia Journal: American Journal of Public Health Author-Name: Zahm, S.H. Author-Name: Weisenburger, D.D. Author-Name: Babbitt, P.A. Author-Name: Saal, R.C. Author-Name: Vaught, J.B. Author-Name: Blair, A. Year: 1992 Volume: 82 Issue: 7 Pages: 990-997 Abstract: Objectives. Hair coloring products are widely used and contain components that are mutagenic and carcinogenic. An association between occupational exposure to hair coloring products and hematopoietic cancers has been reported, but the risk for these cancers among users has not been carefully evaluated. Methods. We conducted a population-based, case-control study with telephone interviews from 385 non-Hodgkin's lymphoma cases, 70 Hodgkin's disease cases, 72 multiple myeloma cases, 56 chronic lymphocytic leukemia cases, and 1432 controls. Results. Among women, use was associated with odds ratios of 1.5 for non-Hodgkin's lymphoma, 1.7 for Hodgkin's disease, 1.8 for multiple myeloma, and 1.0 for chronic lymphocytic leukemia. Risk was higher for permanent hair coloring products than for semi- or nonpermanent products, particularly for dark colors. Long duration and early age of first use tended to increase risk, but the patterns were inconsistent. Use was much less common in men and did not significantly increase risk. Conclusions. The use of hair coloring products appears to increase the risk of non-Hodgkin's lymphoma. Multiple myeloma and Hodgkin's disease were also associated, although based on far fewer subjects. If these results represent a causal association, use of hair coloring products would account for 35% of non- Hodgkin's lymphoma cases in exposed women and 20% in all women. Handle: RePEc:aph:ajpbhl:1992:82:7:990-997_1 Template-Type: ReDIF-Article 1.0 Title: Carcinogens in tobacco smoke: Benzo[a]pyrene from Canadian cigarettes and cigarette tobacco Journal: American Journal of Public Health Author-Name: Kaiserman, M.J. Author-Name: Rickert, W.S. Year: 1992 Volume: 82 Issue: 7 Pages: 1023-1026 Abstract: We evaluated the benzo[a]pyrene (BaP) content in the smoke from 35 brands of Canadian cigarettes and 5 brands of Canadian tobaccos for roll-your-own cigarettes. For the cigarettes, mean values of BaP ranged from 3.36 ng to 28.39 ng per cigarette, roughly in proportion with declared tar values. The relationship between declared tar and yields of BaP, however, does not allow accurate prediction of one from the other. For the tobaccos, mean BaP values ranged from 22.92 ng to 26.27 ng (average, 24.7 ng) per cigarette. The implications of these findings are discussed with respect to overall exposure. Handle: RePEc:aph:ajpbhl:1992:82:7:1023-1026_8 Template-Type: ReDIF-Article 1.0 Title: Chlorination, chlorination by-products, and cancer: A meta-analysis Journal: American Journal of Public Health Author-Name: Morris, R.D. Author-Name: Audet, A.-M. Author-Name: Angelillo, I.F. Author-Name: Chalmers, T.C. Author-Name: Mosteller, F. Year: 1992 Volume: 82 Issue: 7 Pages: 955-963 Abstract: Objectives. Individual epidemiological investigations into the association between chlorination by-products in drinking water and cancer have been suggestive but inconclusive. Enough studies exist to provide the basis for a meaningful meta-analysis. Methods. An extensive literature search was performed to identify pertinent case-control studies and cohort studies. Consumption of chlorinated water, surface water, or water with high levels of chloroform was used as a surrogate for exposure to chlorination by-products. Relative risk estimates were abstracted from the individual studies and pooled. Results. A simple meta-analysis of all cancer sites yielded a relative risk estimate for exposure to chlorination by-products of 1.15 (95% CI: 1.09, 1.20). Pooled relative risk estimates for organ-specific neoplasms were 1.21 (95% CI: 1.09, 1.34) for bladder cancer and 1.38 (95% CI: 1.01, 1.87) for rectal cancer. When studies that adjusted for potential confounders were pooled separately, estimates of relative risks did not change substantially. Conclusions. The results of this meta-analysis suggest a positive association between consumption of chlorination by-products in drinking water and bladder and rectal cancer in humans. Handle: RePEc:aph:ajpbhl:1992:82:7:955-963_4 Template-Type: ReDIF-Article 1.0 Title: Epidemiological data on US coal miners' pneumoconiosis, 1960 to 1988 Journal: American Journal of Public Health Author-Name: Attfield, M.D. Author-Name: Castellan, R.M. Year: 1992 Volume: 82 Issue: 7 Pages: 964-970 Abstract: Objectives. Statistics on prevalence of pneumoconiosis among working underground coal miners based on epidemiologic data collected between 1960 and 1988 are presented. The main intent was to examine the time-related trend in prevalence, particularly after 1969, when substantially lower dust levels were mandated by federal act. Methods. Data from studies undertaken between 1960 and 1968 were collected and compared. Information for the period 1969 to 1988 was extracted from a large ongoing national epidemiologic study. Tenure- specific prevalence rates and summary statistics derived from the latter data for four consecutive time intervals within the 19-year period were calculated and compared. Results. The results indicate a reduction in pneumoconiosis over time. The trend is similar to that seen in a large radiologic surveillance program of underground miners operated concurrently. Conclusions. Although such factors as x-ray reader variation, changes in x- ray standards, and worker self-selection for examination may have influenced the findings to some extent, adjusted summary rates reveal a reduction in prevalence concurrent with reductions in coal mine dust levels mandated by federal act in 1969. Handle: RePEc:aph:ajpbhl:1992:82:7:964-970_8 Template-Type: ReDIF-Article 1.0 Title: Surveillance data on US coal miners' pneumoconiosis, 1970 to 1986 Journal: American Journal of Public Health Author-Name: Attfield, M.D. Author-Name: Althouse, R.B. Year: 1992 Volume: 82 Issue: 7 Pages: 971-977 Abstract: Objectives. Statistics on prevalence of pneumoconiosis among working underground coal miners from data collected as part of a large national radiographic surveillance program between 1970 and 1986 are presented. The main intent was to examine the time-related trend in prevalence over this period, which coincides with historically low dust levels mandated by federal act. Methods. Tenure-specific prevalence rates and summary statistics derived from them for four consecutive time intervals within the 16-year period were calculated and compared. Results. The results indicate a reduction in pneumoconiosis over the life of the program. This trend is similar to that seen in epidemiologic studies undertaken concurrently. Conclusions. Although low participation in the surveillance program and other problems complicate the findings, it appears that reductions in dust exposure mandated by federal act in 1969 have led to lower prevalence of pneumoconiosis among underground coal miners. Handle: RePEc:aph:ajpbhl:1992:82:7:971-977_5 Template-Type: ReDIF-Article 1.0 Title: The President's Committee on Health Education: a 20-year retrospective on its politics and policy impact. Journal: American Journal of Public Health Author-Name: Guinta, M.A. Author-Name: Allegrante, J.P. Year: 1992 Volume: 82 Issue: 7 Pages: 1033-1041 Abstract: The President's Committee on Health Education was created by Richard M. Nixon in September 1971 and submitted its final report in September 1973. The committee resulted from the convergence of (1) a perceived national domestic policy need in response to escalating medical costs, (2) Nixon's personal and political ambitions, and (3) the dynamic political context of the late 1960s and early 1970s. Its work led to both private and public initiatives designed to influence the public's health through education; its findings and recommendations also laid the foundation for the National Consumer Health Information and Health Promotion Act of 1976 and thus contributed significantly to the development of subsequent national policy in health promotion and disease prevention. This paper places the work and contributions of the committee into historical perspective by analyzing the committee's origins and methods and the underlying politics that shaped its work and final report. The impact of the President's Committee is traced from the emergence of health education in the early 1970s as a potentially cost-effective alternative to medical care to the pivotal role health education now plays in health promotion and disease prevention efforts. Handle: RePEc:aph:ajpbhl:1992:82:7:1033-1041_3 Template-Type: ReDIF-Article 1.0 Title: Moderate physical activity and bone density among perimenopausal women Journal: American Journal of Public Health Author-Name: Zhang, J. Author-Name: Feldblum, P.J. Author-Name: Fortney, J.A. Year: 1992 Volume: 82 Issue: 5 Pages: 736-738 Abstract: We examined the association between physical activity and bone mineral density (BMD) among 352 perimenopausal women. A personal activity computer was used to estimate the daily energy expenditure on physical activity. BMD was measured by photon absorptiometry at the lumbar spine, midradius, and distal radius. Multiple linear regression, controlling for other factors, indicated that physical activity was positively and significantly associated with BMD at all sites. Moderate physical activity has beneficial effects on BMD among perimenopausal women. Handle: RePEc:aph:ajpbhl:1992:82:5:736-738_3 Template-Type: ReDIF-Article 1.0 Title: Barrier contraceptives and sexually transmitted diseases in women: A comparison of female-dependent methods and condoms Journal: American Journal of Public Health Author-Name: Rosenberg, M.J. Author-Name: Davidson, A.J. Author-Name: Chen, J.-H. Author-Name: Judson, F.N. Author-Name: Douglas, J.M. Year: 1992 Volume: 82 Issue: 5 Pages: 669-674 Abstract: Introduction. Most efforts at sexually transmitted disease (STD) protection center on condom use, but little is known about how condoms compare with other barrier methods, particularly those controlled by women. Methods. To evaluate the effect of different barrier contraceptives on the prevalence of STDs and other vaginal infections, we retrospectively studied 5681 visits by women to an urban STD clinic. Results. As compared with women using no contraceptive or with tubal ligations, women using the contraceptive sponge or diaphragm had at least 65% lower rates of infection with Neisseria gonorrhoeae and Trichomonas vaginalis, while condom users had 34% and 30% lower rates, respectively. For Chlamydia trachomatis, the reduction was 13% among sponge users, 72% among diaphragm users, and 3% among condom users, although these differences were not significant. When compared with women using condoms, women using female-dependent methods (sponge or diaphragm) had significantly lower rates of both gonorrhea and trichomoniasis. Vaginal candidiasis was more common among women using diaphragms but not other barrier methods, while rates of bacterial vaginosis were similar among all groups. Conclusions. Women using the contraceptive sponge or diaphragm experience protection from STDs to a greater extent than those relying on condoms. Female-dependent barrier contraceptives should receive more attention in STD risk-reduction programs. Handle: RePEc:aph:ajpbhl:1992:82:5:669-674_3 Template-Type: ReDIF-Article 1.0 Title: Pregnancy-induced hypertension in North Carolina, 1988 and 1989 Journal: American Journal of Public Health Author-Name: Savitz, D.A. Author-Name: Zhang, J. Year: 1992 Volume: 82 Issue: 5 Pages: 675-679 Abstract: Introduction. Pregnancy-induced hypertension (PIH) is a highly prevalent pregnancy complication with adverse effects on maternal and infant health. Epidemiologic research concerning its etiology is limited. Methods. Birth records from North Carolina for the period 1988 through 1989 include an indication of the presence of PIH. The risk of PIH was examined in relation to several maternal characteristics and exposures, including reproductive history, demographic characteristics, and tobacco use during pregnancy. Risk ratio estimates, adjusted for confounders, were calculated contrasting PIH among exposed vs unexposed women. Results. The overall risk of PIH was 43.1 per 1000 births, with multiple pregnancies, nulliparity, and advanced maternal age associated with markedly increased risks. Tobacco use was inversely associated with PIH, and Blacks and Whites were at virtually equal risk. Conclusions. Problems in diagnosis and classification impede research in this area, with birth certificates limited in quality and breadth of information. Nonetheless, several patterns emerged that are worthy of further epidemiologic evaluation using more sophisticated designs. Handle: RePEc:aph:ajpbhl:1992:82:5:675-679_3 Template-Type: ReDIF-Article 1.0 Title: A documented case of perinatal lead poisoning [1] Journal: American Journal of Public Health Author-Name: Rothenberg, S.J. Author-Name: Schnaas-Arrieta, L. Author-Name: Ugartechea, J.C. Author-Name: Perroni-Hernandez, E. Author-Name: Perez-Guerrero, I.A. Author-Name: Cansino-Prtiz, S. Author-Name: Salinas, V. Author-Name: Zea-Prado, F. Author-Name: Chicz-Demet, A. Year: 1992 Volume: 82 Issue: 4 Pages: 613-614 Handle: RePEc:aph:ajpbhl:1992:82:4:613-614_0 Template-Type: ReDIF-Article 1.0 Title: 'A star is born' in Ypsilanti Journal: American Journal of Public Health Author-Name: Share, D. Author-Name: Givens, C. Author-Name: Davies, D. Author-Name: Eley, E. Author-Name: Chesler, J. Year: 1992 Volume: 82 Issue: 4 Pages: 610-611 Handle: RePEc:aph:ajpbhl:1992:82:4:610-611_5 Template-Type: ReDIF-Article 1.0 Title: The South Karelia air pollution study: Acute health effects of malodorous sulfur air pollutants released by a pulp mill Journal: American Journal of Public Health Author-Name: Haahtela, T. Author-Name: Marttila, O. Author-Name: Vikka, V. Author-Name: Jappinen, P. Author-Name: Jaakkola, J.J.K. Year: 1992 Volume: 82 Issue: 4 Pages: 603-605 Abstract: We evaluated the acute health effects of a strong emission of malodorous sulfur compounds released from a pulp mill in South Karelia, Finland. The 24- hour ambient air concentrations of hydrogen sulfide for the two emission days were 35 and 43 μg/m3 (maximum 4-hour 135 μg/m3). A questionnaire was distributed after the high exposure and later after a low exposure period to 29 households with 75 subjects living in the nearby community. During the high exposure, 63% of the respondents reported experience of at least one symptom compared to 26% during the reference period. Every third participant reported difficulties in breathing. In the 45 subjects responding to both questionnaires more eye, respiratory and neuropsychological symptoms occurred during the exposure compared to the reference period. The strong malodorous emission from a pulp mill caused an alarming amount of adverse effects in the exposed population. Handle: RePEc:aph:ajpbhl:1992:82:4:603-605_7 Template-Type: ReDIF-Article 1.0 Title: Article on parental notification law draws criticism. Convoluted thought processes not likely among sexually active teenagers. Journal: American Journal of Public Health Author-Name: Marty, J. Year: 1992 Volume: 82 Issue: 5 Pages: 759-760 Handle: RePEc:aph:ajpbhl:1992:82:5:759-760_9 Template-Type: ReDIF-Article 1.0 Title: Jazz musicians: "live fast, die young" stereotype not refuted. Journal: American Journal of Public Health Author-Name: Haaga, J.G. Year: 1992 Volume: 82 Issue: 5 Pages: 761 Handle: RePEc:aph:ajpbhl:1992:82:5:761_4 Template-Type: ReDIF-Article 1.0 Title: Article on parental notification law draws criticism. More rigorous research design needed. Journal: American Journal of Public Health Author-Name: Joyce, T. Year: 1992 Volume: 82 Issue: 5 Pages: 758-759 Handle: RePEc:aph:ajpbhl:1992:82:5:758-759_2 Template-Type: ReDIF-Article 1.0 Title: Article on parental notification law draws criticism. Family planning behavior of minors doubted. Journal: American Journal of Public Health Author-Name: Paneth, N. Year: 1992 Volume: 82 Issue: 5 Pages: 757-760 Handle: RePEc:aph:ajpbhl:1992:82:5:757-760_8 Template-Type: ReDIF-Article 1.0 Title: Article on parental notification law draws criticism. Definitions and comparisons flawed. Journal: American Journal of Public Health Author-Name: Santee, B. Year: 1992 Volume: 82 Issue: 5 Pages: 757-759 Handle: RePEc:aph:ajpbhl:1992:82:5:757-759_5 Template-Type: ReDIF-Article 1.0 Title: Smokeless tobacco, cardiovascular risk factors, and nicotine and cotinine levels in professional baseball players Journal: American Journal of Public Health Author-Name: Siegel, D. Author-Name: Benowitz, N. Author-Name: Ernster, V.L. Author-Name: Grady, D.G. Author-Name: Hauck, W.W. Year: 1992 Volume: 82 Issue: 3 Pages: 417-421 Abstract: Background. The use of smokeless tobacco (ST), which has increased in popularity over the past 2 decades, results in considerable systemic exposure to nicotine. Nicotine might contribute to atherosclerosis by an effect on cardiovascular risk factors. Methods. The effects of ST use on cardiovascular risk factors and cotinine and nicotine levels were studied in 1061 professional baseball players during spring training in 1988 and 1989. Results. Of the study participants 477 (45%) were users. ST use was more common among Whites (55%) than among Blacks (29%) or Hispanics (21%), and users reported heavier consumption of alcohol (p < .001) and had higher mean serum caffeine levels (p < .001) than nonusers. ST users did not differ from nonusers in adjusted levels of systolic and diastolic blood pressure, pulse, and total or HDL-cholesterol. Among ST users, participants using snuff had higher mean serum cotinine levels than those who used chewing tobacco (p < .001). There was no association between serum cotinine levels and adjusted levels of any cardiovascular risk factor studied. However, higher diastolic blood pressures were associated with higher mean serum nicotine levels (p = .02). Conclusions. Smokeless tobacco use has at most a modest effect on cardiovascular risk factors in young physically fit men. Handle: RePEc:aph:ajpbhl:1992:82:3:417-421_1 Template-Type: ReDIF-Article 1.0 Title: Snuffing tobacco out of sport Journal: American Journal of Public Health Author-Name: Connolly, G.N. Author-Name: Orleans, C.T. Author-Name: Blum, A. Year: 1992 Volume: 82 Issue: 3 Pages: 351-353 Abstract: Use of oral snuff has risen sharply among baseball players following a tobacco industry marketing campaign that linked smokeless tobacco with athletic performance and virility. Millions of adolescents have copied these professional role models and, today, are at risk of developing oral cancer and other mouth disorders. New policies and programs are needed to break the powerful grip that the tobacco industry has on professional sport. Health agencies, including the National Cancer Institute and the National Institute for Dental Research, have teamed up with major league baseball to help players quit and reduce public use of oral tobacco. If these efforts are successful, our national pastime will once again become America's classroom for teaching health and fitness, not nicotine addiction. Handle: RePEc:aph:ajpbhl:1992:82:3:351-353_0 Template-Type: ReDIF-Article 1.0 Title: Air quality during the winter in Quebec day-care centers Journal: American Journal of Public Health Author-Name: Daneault, S. Author-Name: Beausoleil, M. Author-Name: Messing, K. Year: 1992 Volume: 82 Issue: 3 Pages: 432-434 Abstract: Over 90% of 91 day care centers in greater Montreal, Quebec exceeded 1000 ppm of CO2 during January through April 1989. Four variables were independent positive predictors of CO2 levels: the density of children in the center; presence of electric heating; absence of a ventilation system; and building age. High levels of CO2 are associated with respiratory tract and other symptoms. Clear standards and inspection policies should be established for day care center air quality. Handle: RePEc:aph:ajpbhl:1992:82:3:432-434_8 Template-Type: ReDIF-Article 1.0 Title: Infant mortality, per capita income, and adult illiteracy: An ecological approach Journal: American Journal of Public Health Author-Name: Tresserras, R. Author-Name: Canela, J. Author-Name: Alvarez, J. Author-Name: Sentis, J. Author-Name: Salleras, L. Year: 1992 Volume: 82 Issue: 3 Pages: 435-438 Abstract: The ecological association of infant mortality rate (IM) with per capita income (PI) and prevalence of adult illiteracy (AI) has been studied using countries as the unit of analysis. A negative association between IM and PI in 1960 and 1982 has been observed (sample correlation coefficient [r] = - .625 and r = -.729, respectively; P < .05). A correlation between IM and AI has been found for both men and women (r = .827) and r = .855, respectively; P < .05). The ecological relative risks were 7.43 for men and 5.82 for women (95% confidence intervals: 5.16-10.71 and 4.36-7.75, respectively). The association of IM and PI shows a slight but not significant improvement between 1960 and 1982. AI can be considered a good predictor of IM in countries. Handle: RePEc:aph:ajpbhl:1992:82:3:435-438_5 Template-Type: ReDIF-Article 1.0 Title: An epidemiological comparison of Mexican-American and White non-Hispanic 8th- and 12th-grade students' substance use Journal: American Journal of Public Health Author-Name: Chavez, E.L. Author-Name: Swaim, R.C. Year: 1992 Volume: 82 Issue: 3 Pages: 445-447 Abstract: Surveys of drug and alcohol use were conducted with a national probability sample of 8th- and 12th-grade Mexican-American and White non-Hispanic youth. The drug and alcohol epidemiology is representative of US Mexican-American youth residing in communities with populations of 2500 or more, at least 10% of whom are Mexican Americans. Mexican-American 8th graders reported generally higher rates of use than White non-Hispanics based on lifetime prevalence and use in last month. They also reported higher frequency of high-risk drug behaviors. The pattern was reversed among 12th-grade students. The impact of differential school dropout rates is discussed as a probable cause for this reversal. Handle: RePEc:aph:ajpbhl:1992:82:3:445-447_7 Template-Type: ReDIF-Article 1.0 Title: Readability of health warnings on alcohol and tobacco products [3] Journal: American Journal of Public Health Author-Name: Malouff, J. Author-Name: Gabrilowitz, D. Author-Name: Schutte, N. Year: 1992 Volume: 82 Issue: 3 Pages: 464 Handle: RePEc:aph:ajpbhl:1992:82:3:464_0 Template-Type: ReDIF-Article 1.0 Title: Men who have sex with men: Continued challenges for preventing HIV infection and AIDS Journal: American Journal of Public Health Author-Name: Lifson, A.R. Year: 1992 Volume: 82 Issue: 2 Pages: 166-167 Handle: RePEc:aph:ajpbhl:1992:82:2:166-167_2 Template-Type: ReDIF-Article 1.0 Title: Surveillance of occupational lead exposure in New Jersey: 1986 to 1989 Journal: American Journal of Public Health Author-Name: Tepper, A. Year: 1992 Volume: 82 Issue: 2 Pages: 275-277 Abstract: Between January 1986 and June 1989, 1916 New Jersey workers were identified through a surveillance system for occupational lead exposure. The average annual proportion of workers with a blood lead level above 2.42 μmol/L was 12%. Industries with the highest proportion of workers with blood lead levels above 2.42 μmol/L were special trade construction (35%) and industries dealing with scrap and waste materials (27%). Handle: RePEc:aph:ajpbhl:1992:82:2:275-277_2 Template-Type: ReDIF-Article 1.0 Title: Maternal smoking and the risk of polyhydramnios Journal: American Journal of Public Health Author-Name: Myhra, W. Author-Name: Davis, M. Author-Name: Mueller, B.A. Author-Name: Hickok, D. Year: 1992 Volume: 82 Issue: 2 Pages: 176-179 Abstract: Background. Washington State birth certificates were used to conduct a population-based case-control study to assess the possible association of maternal smoking with polyhydramnios. Methods. All singleton births complicated by polyhydramnios (n = 557) were identified from the vital records for the years 1984 to 1987. For comparison, 1671 records were randomly selected for the same years from singleton births uncomplicated by polyhydramnios. Results. Women who reportedly smoked prenatally were found to be at increased risk for polyhydramnios (relative risk [RR] = 1.7, 95% confidence interval [CI] = 1.5-2.1, adjusted for marital status, maternal age, and parity). When women with conditions known to be associated with polyhydramnios were excluded, the risk for those who smoked prenatally remained elevated (RR = 1.8, 95% CI = 1.1-2.3). Conclusion. Overdistention of the uterus from polyhydramnios may cause a variety of pregnancy complications. The observed association of smoking with polyhydramnios may be a further indication for public health interventions aimed at preventing smoking during pregnancy. Handle: RePEc:aph:ajpbhl:1992:82:2:176-179_0 Template-Type: ReDIF-Article 1.0 Title: On the future of applied smoking research: Is it up in smoke? Journal: American Journal of Public Health Author-Name: Bauman, K.E. Year: 1992 Volume: 82 Issue: 1 Pages: 14-16 Handle: RePEc:aph:ajpbhl:1992:82:1:14-16_4 Template-Type: ReDIF-Article 1.0 Title: Low tar, high toll Journal: American Journal of Public Health Author-Name: Warner, K.E. Author-Name: Slade, J. Year: 1992 Volume: 82 Issue: 1 Pages: 17-18 Handle: RePEc:aph:ajpbhl:1992:82:1:17-18_8 Template-Type: ReDIF-Article 1.0 Title: A prospective study of the attributable risk of cancer due to cigarette smoking Journal: American Journal of Public Health Author-Name: Chyou, P.-H. Author-Name: Nomura, A.M.Y. Author-Name: Stemmermann, G.N. Year: 1992 Volume: 82 Issue: 1 Pages: 37-40 Abstract: Background. The goals of this study were to measure the impact of cigarette smoking on cancer incidence and to determine the attributable risk of cancer due to smoking. Methods. A cigarette smoking history was obtained from 8006 Japanese-American men examined from 1965 through 1968. After 22 years, 1389 incident cases of cancer were identified. There were 212 men with lung cancer; 202 with oral, esophageal, laryngeal, pancreatic, renal, ureteral, or bladder (oral-bladder) cancer; and 975 with cancer at other sites. Results. Current smokers at time of examination had a higher incidence than nonsmokers for each of the three cancer site categories. Eighty-five percent of lung cancer cases diagnosed among current and never smokers can be attributed to cigarette smoking. The attributable risks were 46%, 16%, and 29%, respectively, for oral-bladder cancers, other cancers, and all cancers combined. In turn, the corresponding attributable risks were 60%, 26%, 13%, and 21% in comparing current smokers with past smokers. Conclusions. Current smokers can greatly reduce their risk of cancer, especially lung cancer, if they quit smoking. Handle: RePEc:aph:ajpbhl:1992:82:1:37-40_7 Template-Type: ReDIF-Article 1.0 Title: Demographic and socioeconomic differences in beliefs about the health effects of smoking Journal: American Journal of Public Health Author-Name: Brownson, R.C. Author-Name: Jackson-Thompson, J. Author-Name: Wilkerson, J.C. Author-Name: Davis, J.R. Author-Name: Owens, N.W. Author-Name: Fisher Jr., E.B. Year: 1992 Volume: 82 Issue: 1 Pages: 99-103 Abstract: To assess sociodemographic differences in beliefs about the health effects of cigarette smoking and passive smoke exposure, we recently surveyed 2092 adults in St. Louis and Kansas City, Mo. The percentages of respondents who knew that smoking causes lung cancer, emphysema, and heart disease were 76.7, 74.1, and 67.2, respectively. After multivariate adjustment, knowledge about smoking's health effects was generally lower among women, older respondents, those of lower education level, and current smokers. Blacks were generally less likely to appreciate the health effects of active smoking, but were more likely to acknowledge the health effects of passive smoking. Handle: RePEc:aph:ajpbhl:1992:82:1:99-103_7 Template-Type: ReDIF-Article 1.0 Title: Diversity of tick species biting humans in an emerging area for Lyme disease Journal: American Journal of Public Health Author-Name: Smith Jr., R.P. Author-Name: Lacombe, E.H. Author-Name: Rand, P.W. Author-Name: Dearborn, R. Year: 1992 Volume: 82 Issue: 1 Pages: 66-69 Abstract: Background. Although most tick bites in humans in areas of the northeastern United States in which Lyme disease is highly endemic are due to Ixodes dammini, no study documents the frequency of I. dammini bites in low-prevalence or emerging areas for Lyme disease. Data on the proportion of tick bites in humans that are due to I. dammini in a region may have implications for public health policy and clinical management. Methods. A statewide survey of the tick species that parasitized humans in Maine was conducted during 1989 and 1990. Tick submissions from throughout the state were elicited through media announcements. All ticks that had been removed from humans were identified, and data were collected that included bite seasonality and geography and demographics of tick bite victims. Results. Of 709 ticks submitted, only 17% were I. dammini. Ixodes cookei, a vector for Powassan encephalitis, accounted for 34% of bites, and Dermacentor variabilis accounted for 45%. Other tick species were occasionally implicated. Conclusions. The likelihood that a tick bite was due to I. dammini was lower in Maine than in areas in the northeastern United States in which Lyme disease is highly endemic. Other tick vectors, associated with diseases other than Lyme disease, were more frequently implicated. Regional tick bite surveys may prove useful in assessing the risk of Lyme disease following a tick bite. Handle: RePEc:aph:ajpbhl:1992:82:1:66-69_3 Template-Type: ReDIF-Article 1.0 Title: Occupational risks associated with cigarette smoking: A prospective study Journal: American Journal of Public Health Author-Name: Ryan, J. Author-Name: Zwerling, C. Author-Name: Orav, E.J. Year: 1992 Volume: 82 Issue: 1 Pages: 29-32 Abstract: Background. Studies have indicated that cigarette smokers have more occupational accidents and injuries and use more sick time and health benefits than nonsmokers, therapy producing sizeable costs for employers. However, they usually have not controlled for other possible sources of these costs. We analyzed occupational costs associated with smoking while adjusting for a number of potential confounders. Methods. We conducted a prospective, controlled study of the association between smoking and employment outcomes in 2537 postal employees, adjusting for age, gender, race, drug use, job category, and exercise habits. Results. For smokers, the relative risk for turnover was 1.01 (95% confidence interval [CI], 0.83-1.21); for accidents 1.29 (CI, 1.07-1.55); for injuries 1.40 (CI, 1.11-1.77); for discipline 1.55 (CI, 1.19-2.02). Their mean absence rate was 5.43% compared with 4.06% for nonsmokers. Conclusions. Our study shows that cigarette smoking is associated with adverse employment outcomes after controlling for a number of possible confounders. This finding has implications for companies formulating smoking policies and considering the establishment of smoking cessation programs. Handle: RePEc:aph:ajpbhl:1992:82:1:29-32_4 Template-Type: ReDIF-Article 1.0 Title: Handmade cigarettes: It's the tube that counts Journal: American Journal of Public Health Author-Name: Kaiserman, M.J. Author-Name: Rickert, W.S. Year: 1992 Volume: 82 Issue: 1 Pages: 107-109 Abstract: Thirty-one Canadian brands of fine-cut tobaccos for roll-your-own cigarettes (RYOs) were evaluated under standard conditions using mandated tube and filter combinations. Results indicate no evidence of a significant difference in the amounts of tar, nicotine, and carbon monoxide produced by the 31 brands. In addition, the data emphasize that it is primarily the tube and filter combination that determines delivery of toxic constituents. Handle: RePEc:aph:ajpbhl:1992:82:1:107-109_6 Template-Type: ReDIF-Article 1.0 Title: Geographic and gender variations in total tobacco use Journal: American Journal of Public Health Author-Name: Shopland, D.R. Author-Name: Niemcryk, S.J. Author-Name: Marconi, K.M. Year: 1992 Volume: 82 Issue: 1 Pages: 103-106 Abstract: This study is the first to provide complete information on prevalence rates by gender and geographic variation for each type of tobacco product used in the United States. Results indicate that, in nearly half of all states, total tobacco use in men exceeded 40% and, in four states, exceeded 50%. In women, only Nevada, Kentucky, and Michigan reported prevalence exceeding 33%. Results also indicate, however, that concurrent use of multiple tobacco forms is relatively rare. Substantial regional variation in male total tobacco use was evident, with southern males exhibiting the highest prevalence rate (44.6%). As a result, this region represents a target group in special need of comprehensive and effective tobacco use interventions. Handle: RePEc:aph:ajpbhl:1992:82:1:103-106_0 Template-Type: ReDIF-Article 1.0 Title: Exposure to environmental tobacco smoke in naturalistic settings Journal: American Journal of Public Health Author-Name: Emmons, K.M. Author-Name: Abrams, D.B. Author-Name: Marshall, R.J. Author-Name: Etzel, R.A. Author-Name: Novotny, T.E. Author-Name: Marcus, B.H. Author-Name: Kane, M.E. Year: 1992 Volume: 82 Issue: 1 Pages: 24-28 Abstract: Background. Exposure to environmental tobacco smoke (ETS) has been identified as a risk factor for chronic disease among nonsmokers. Results of epidemiological surveys suggest that the majority of nonsmokers have regular ETS exposure. However, little is known about the topography of exposure. Methods. An exposure diary was used by 186 nonsmokers to self-monitor ETS exposure over a 7-day period. Subjects also completed a questionnaire that assessed their patterns of ETS exposure. Results. The primary source of ETS exposure was the workplace, except when there was a smoker in the household, in which case the household was the primary source. The presence of a smoker in the household resulted in higher levels of exposure both at work and in other locations when compared with subjects without household exposure. Subjects' assessments of exposure on the questionnaire were consistently lower than their self-monitored levels. This finding suggests that general exposure ratings underestimate exposure. Conclusions. This study provides a new understanding of the patterns of ETS exposure and may help guide the development of policies and interventions designed to reduce ETS exposure. Handle: RePEc:aph:ajpbhl:1992:82:1:24-28_1 Template-Type: ReDIF-Article 1.0 Title: Misclassification of smoking status in the CARDIA study: A comparison of self-report with serum cotinine levels Journal: American Journal of Public Health Author-Name: Wagenknecht, L.E. Author-Name: Burke, G.L. Author-Name: Perkins, L.L. Author-Name: Haley, N.J. Author-Name: Friedman, G.D. Year: 1992 Volume: 82 Issue: 1 Pages: 33-36 Abstract: Background. Although widely used in epidemiological studies, self-report has been shown to underestimate the prevalence of cigarette smoking in some populations. Methods. In the CARDIA study, self-report of cigarette smoking was validated against a biochemical marker of nicotine uptake, serum cotinine. Results. The prevalence of smoking was slightly lower when defined by self-report (30.9%) than when defined by cotinine levels equal to or greater than 14 ng/mL (32.2%, P < .05). The misclassification rate (proportion of reported nonsmokers with cotinine levels of at least 14 ng/mL) was 4.2% and was significantly higher among subjects who were Black, had a high school education or less, or were reported former smokers. Possible reasons for misclassification include reporting error, environmental tobacco smoke, and an inappropriate cutoff point for delineation of smoking status. Using self-report as the gold standard, the continine cutoff points that maximized sensitivity and specificity were 14, 9, and 15 ng/mL for all, White, and Black subjects, respectively. The misclassification rate remained significantly higher in Black than in White subjects using these race-specific criteria. Conclusions. Misclassification of cigarette smoking by self-report was low in these young adults; however, within certain race/education groups, self-report may underestimate smoking prevalence by up to 4%. Handle: RePEc:aph:ajpbhl:1992:82:1:33-36_3 Template-Type: ReDIF-Article 1.0 Title: Medical expenditures for disability and disabling comorbidity Journal: American Journal of Public Health Author-Name: Rice, D.P. Author-Name: LaPlante, M.P. Year: 1992 Volume: 82 Issue: 5 Pages: 739-741 Abstract: Disability and disabling comorbidity place a disproportionately large burden on the health care system. National Medical Care Utilization and Expenditure Survey data show that medical care expenditures for noninstitutionalized persons amounted to $154 billion ($691 per capita) in 1980. The medical expenditure per capita for people reporting two or more disabling chronic conditions ($2456) was 5 times the amount incurred by those with no limiting conditions ($486) and more than 1.5 times the amount incurred by those with one limiting condition ($1620). Handle: RePEc:aph:ajpbhl:1992:82:5:739-741_8 Template-Type: ReDIF-Article 1.0 Title: Induced abortion and health as a value Journal: American Journal of Public Health Author-Name: Susser, M. Year: 1992 Volume: 82 Issue: 10 Pages: 1323-1324 Handle: RePEc:aph:ajpbhl:1992:82:10:1323-1324_6 Template-Type: ReDIF-Article 1.0 Title: Commentary: The quest for women's prophylactic methods - Hopes vs science Journal: American Journal of Public Health Author-Name: Cates Jr., W. Author-Name: Stewart, F.H. Author-Name: Trussell, J. Year: 1992 Volume: 82 Issue: 11 Pages: 1479-1482 Abstract: The companion article by Rosenberg and Gollub in this issue summarizes data from 10 observational studies and concludes that female-controlled contraceptive methods, under typical conditions, are comparable to condoms in preventing sexually transmitted diseases and should be merchandized as such. While we agree that chemical and mechanical contraceptives provide protection against some sexually transmitted diseases, we think the authors have overstated the scientific case for these methods, especially in comparison with the condom. We think the current data remain inconclusive regarding the absolute protection of spermicides against the human immunodeficiency virus and their level of protection-relative to that of the condom-against other sexually transmitted diseases. Three reasons account for our differences: the limitations in the comparative data; the reported adverse effects of spermicides on vaginal conditions, including genital ulcers; and the relative value of condoms, even under typical conditions, in preventing sexually transmitted diseases. For these reasons, we would currently counsel both women and men who practice high-risk sexual behaviors to use condoms as their first line of defense. If this is unacceptable, the female barriers become a fallback position to protect against bacterial sexually transmitted diseases. Handle: RePEc:aph:ajpbhl:1992:82:11:1479-1482_2 Template-Type: ReDIF-Article 1.0 Title: Imported leprosy in the United States, 1978 through 1988: An epidemic without secondary transmission Journal: American Journal of Public Health Author-Name: Mastro, T.D. Author-Name: Redd, S.C. Author-Name: Breiman, R.F. Year: 1992 Volume: 82 Issue: 8 Pages: 1127-1130 Abstract: Objectives. Leprosy remains a major health problem in many regions of the world. In the United States, although leprosy continues to be reported, approximately 90% of cases are imported (i.e., occur among immigrants and refugees). An increase in imported cases began in 1978. This study was conducted to analyze this trend and to characterize the contributing cases. Methods. Centers for Disease Control leprosy surveillance data from 1971 through 1988 were analyzed. Results. The number of imported cases reported annually was relatively constant from 1971 through 1977 (mean = 119 per year), increased to 307 in 1985, and then decreased to 102 in 1988. Of the 957 excess cases reported from 1978 through 1988, 73.4% were among persons from Southeast Asia, including 51.3% from Vietnam, Cambodia, and Laos (Indochina). There was no coincident increase in indigenous cases of leprosy; the mean annual number of such cases was 17.7 (range = 10 to 29). Leprosy remains endemic in Texas, Hawaii, Louisiana, and possibly California. Conclusions. An epidemic of imported leprosy began in the United States in 1978, peaked in 1985, and ended by 1988. This increase was primarily due to cases among refugees from Indochina and was limited by a decrease in the influx of Indochinese refugees in the mid-1980s. There is no evidence that these cases resulted in transmission in the United States. Handle: RePEc:aph:ajpbhl:1992:82:8:1127-1130_9 Template-Type: ReDIF-Article 1.0 Title: Race and sex differences in mortality following fracture of the hip Journal: American Journal of Public Health Author-Name: Jacobsen, S.J. Author-Name: Goldberg, J. Author-Name: Miles, T.P. Author-Name: Brody, J.A. Author-Name: Stiers, W. Author-Name: Rimm, A.A. Year: 1992 Volume: 82 Issue: 8 Pages: 1147-1150 Abstract: This paper describes the all-cause mortality experience, following a fracture of the hip, of 712 027 persons covered by the Medicare program from 1984 through 1987. White women experienced the lowest mortality rate (17.2 per 1000 person-months), followed by Black women (22.9 per 1000 person- months), Black men (33.5 per 1000 person-months), and White men (33.7 per 1000 person-months). The observed race-sex differences in survival were found at all ages and regardless of the number of comorbid conditions listed with the discharge diagnosis. While these data demonstrate marked race-sex differences in survival following hip fracture, the cause of these differences is not immediately apparent and demands further investigation. Handle: RePEc:aph:ajpbhl:1992:82:8:1147-1150_1 Template-Type: ReDIF-Article 1.0 Title: Postmarketing surveillance study of permethrin creme rinse Journal: American Journal of Public Health Author-Name: Andrews, E.B. Author-Name: Joseph, M.C. Author-Name: Magenheim, M.J. Author-Name: Tilson, H.H. Author-Name: Doi, P.A. Author-Name: Schultz, M.W. Year: 1992 Volume: 82 Issue: 6 Pages: 857-861 Abstract: Background. An observational, epidemiological study was undertaken to evaluate the safety of permethrin 1% creme rinse (Nix(TM)) for treatment of head lice infestations. Methods. Thirty-seven local public health departments enrolled a total of 38 160 patients for 47 578 treatments with permethrin or other pediculicides from September 1, 1986, through January 31, 1988. Follow- up safety information was collected between 7 and 14 days following treatment via return visit or telephone contact. Results. One hundred three adverse events were reported among 41 955 evaluable treatments. The rates of reported adverse events were 2.2 per 1000 treatments among permethrin treatments, 3.4 per 1000 treatments among lindane treatments, and 1.5 per 1000 treatments among other over-the-counter treatments. No serious, unexpected adverse events were detected in the 18 950 patients treated with permethrin. Conclusions. This study confirmed the safety profile of permethrin in conditions of general use, as seen in clinical trials. Postmarketing safety monitoring in public health departments of drugs used to treat public health conditions was shown to be feasible. Handle: RePEc:aph:ajpbhl:1992:82:6:857-861_8 Template-Type: ReDIF-Article 1.0 Title: Commentary: Environmental disease - A preventable epidemic Journal: American Journal of Public Health Author-Name: Landrigan, P.J. Year: 1992 Volume: 82 Issue: 7 Pages: 941-943 Abstract: Toxic environmental diseases are highly preventable causes of morbidity and mortality. Toxic diseases in the work environment cause an estimated 50 000 to 70 000 deaths and 350 000 new cases of illness each year in the United States; the asbestos pandemic will ultimately claim at least 300 000 lives; pediatric lead poisoning is epidemic, and an estimated 3 to 4 million US preschool children have blood lead levels above 10 μg/dl and could suffer long-term neuropsychological impairment. Prevention of environmental diseases can be achieved through legislation and regulation that control common-source exposures to chemical toxins. Modification of personal behaviors, such as tobacco and alcohol consumption, complements but does not replace control of toxic environmental exposures. Handle: RePEc:aph:ajpbhl:1992:82:7:941-943_7 Template-Type: ReDIF-Article 1.0 Title: Medicaid prenatal care: A comparison of use and outcomes in fee-for- service and managed care Journal: American Journal of Public Health Author-Name: Krieger, J.W. Author-Name: Connell, F.A. Author-Name: LoGerfo, J.P. Year: 1992 Volume: 82 Issue: 2 Pages: 185-190 Abstract: Background. To control rising costs, state Medicaid agencies are enrolling recipients in managed care health plans (MCPs). We performed this study to assess this policy's impact on accessibility and outcomes of Medicaid-funded prenatal care. Methods. We performed a retrospective, controlled study with three cohorts: a study group of 1106 Medicaid recipients enrolled in three MCPs, a matched comparison group of 4830 recipients receiving care in the fee-for-service (FFS) system, and a second matched comparison group of 4434 non-Medicaid enrollees of the same MCPs. Data on prenatal care use and birth outcomes were obtained through linkage of claims and discharge files with birth certificate files. Results. Medicaid recipients enrolled in MCPs used prenatal care similarly to those in the FFS system and showed equal or modestly improved birth-weight distributions. However, Medicaid MCP enrollees showed poorer use of prenatal care and birth outcomes compared with non- Medicaid enrollees of the same plans. Conclusions. Enrollment in MCPs has a neutral or small beneficial effect on the prenatal care received by the Medicaid population. However, providing financial access and modifying the system of care for this population did not result in parity with the general population. Handle: RePEc:aph:ajpbhl:1992:82:2:185-190_5 Template-Type: ReDIF-Article 1.0 Title: Risk factors associated with the classification of unspecified and/or unexplained causes of death in an occupational cohort Journal: American Journal of Public Health Author-Name: Cragle, D.L. Author-Name: Fetcher, A. Year: 1992 Volume: 82 Issue: 3 Pages: 455-457 Abstract: In a matched case-control study of an occupational cohort in East Tennessee, data from the death certificates of 608 cases and controls were abstracted and analyzed in order to investigate possible risk factors associated with the certification on the death certificate of an ill-defined cause of death. There was a very strong association between the ill-defined classification and the certifier, especially if the certifier was a medical examiner (OR = 10.4, 95% CI: 6.0, 18.0). Handle: RePEc:aph:ajpbhl:1992:82:3:455-457_8 Template-Type: ReDIF-Article 1.0 Title: Employment status and heart disease risk factors in middle-aged women: The Rancho Bernardo Study Journal: American Journal of Public Health Author-Name: Kritz-Silverstein, D. Author-Name: Wingard, D.L. Author-Name: Barrett-Connor, E. Year: 1992 Volume: 82 Issue: 2 Pages: 215-219 Abstract: Background. In recent years, an increasing number of women have been entering the labor force. It is known that in men, employment is related to heart disease risk, but there are few studies examining this association among women. Methods. The relation between employment status and heart disease risk factors including lipid and lipoprotein levels, systolic and diastolic blood pressure, fasting and postchallenge plasma glucose and insulin levels, was examined in 242 women aged 40 to 59 years, who were participants in the Rancho Bernardo Heart and Chronic Disease Survey. At the time of a follow-up clinic visit between 1984 and 1987, 46.7% were employed, primarily in managerial positions. Results. Employed women smoked fewer cigarettes, drank less alcohol, and exercised more than unemployed women, but these differences were not statistically significant. After adjustment for covariates, employed women had significantly lower total cholesterol and fasting plasma glucose levels than unemployed women. Differences on other biological variables, although not statistically significant, also favored the employed women. Conclusions. Results of this study suggest that middle- aged women employed in managerial positions are healthier than unemployed women. Handle: RePEc:aph:ajpbhl:1992:82:2:215-219_0 Template-Type: ReDIF-Article 1.0 Title: GHB use in South Carolina [10] Journal: American Journal of Public Health Author-Name: Luby, S. Author-Name: Jones, J. Author-Name: Zalewski, A. Year: 1992 Volume: 82 Issue: 1 Pages: 128 Handle: RePEc:aph:ajpbhl:1992:82:1:128_4 Template-Type: ReDIF-Article 1.0 Title: Vaginal douching among women of reproductive age in the United States: 1988 Journal: American Journal of Public Health Author-Name: Aral, S.O. Author-Name: Mosher, W.D. Author-Name: Cates Jr., W. Year: 1992 Volume: 82 Issue: 2 Pages: 210-214 Abstract: Background. Vaginal douching has been associated with pelvic inflammatory disease (PID) in several epidemiologic studies. Methods. To determine the extent to which douching is practiced and to describe the population subgroups in which it is most prevalent, we analyzed data from the 1988 National Survey of Family Growth, which is based on a nationally representative sample of 8450 United States women between the ages of 15 and 44 years. Results. Thirty-seven percent of the sample reported douching; 18% douched at least once a week. The variable most strongly and consistently associated with douching was race: two thirds of Black women, but only one third of White women, reported douching. The practice was least frequent among 15- to 19-year-olds (31%) and most frequent among 20- to 24-year-olds (41%). Douching was more common among women who lived in poverty (50%) than among those who did not (28%). Seventy percent of Black women living in poverty reported douching. Women with less than a high school education were almost four times more likely to report douching as those with 16 or more years of schooling (56% vs 16%). Women with only 1 partner and those with 10 or more partners were less likely to douche than others. Sixteen percent of women who reported douching, compared with 10% of those who did not, also reported a history of PID. Conclusions. Douching may be a modifiable risk factor for PID, it should be a high priority for future etiologic research. Handle: RePEc:aph:ajpbhl:1992:82:2:210-214_3 Template-Type: ReDIF-Article 1.0 Title: Eligibility for Indian Health Service Programs revisited [1] Journal: American Journal of Public Health Author-Name: Rose, R.A. Year: 1992 Volume: 82 Issue: 7 Pages: 1042-1043 Handle: RePEc:aph:ajpbhl:1992:82:7:1042-1043_8 Template-Type: ReDIF-Article 1.0 Title: Birth weight and perinatal mortality: The effect of gestational age Journal: American Journal of Public Health Author-Name: Wilcox, A.J. Author-Name: Skjoerven, R. Year: 1992 Volume: 82 Issue: 3 Pages: 378-382 Abstract: Background. The strong association between birth weight and perinatal mortality is due both to gestational age and to factors unrelated to gestational age. Conventional analysis obscures these separate contributions to perinatal mortality, and over-emphasizes the role of birth weight. An alternative approach is used here to separate gestational age from other factors. Methods. Data are from 400 000 singleton births in the Norwegian Medical Birth Registry. The method of Wilcox and Russell is used to distinguish the contributions to perinatal mortality made by gestational age and by relative birth weight at each gestational age. Results. Gestational age is a powerful predictor of birth weight and perinatal survival. After these effects of gestational age are controlled for, relative birth weight retains a strong association with survival. Conclusions. Current public health policies in the United States emphasize the prevention of low birth weight. The present analysis suggests that the prevention of early delivery would benefit babies of all birth weights. Handle: RePEc:aph:ajpbhl:1992:82:3:378-382_0 Template-Type: ReDIF-Article 1.0 Title: Maternal recall error of child vaccination status in a developing nation Journal: American Journal of Public Health Author-Name: Valadez, J.J. Author-Name: Weld, L.H. Year: 1992 Volume: 82 Issue: 1 Pages: 120-123 Abstract: In the absence of vaccination card data, Expanded Program on Immunization (EPI) managers sometimes ask mothers for their children's vaccination histories. The magnitude of maternal recall error and its potential impact on public health policy has not been investigated. In this study of 1171 Costa Rican mothers, we compare mothers' recall with vaccination card data for their children younger than 3 years. Analyses of vaccination coverage distributions constructed with recall and vaccination-card data show that recall can be used to estimate population coverage. Although the two data sources are correlated (r = .71), the magnitude of their difference can affect the identification of the vaccination status of an individual child. Maternal recall error was greater than two doses 14% of the time. This error is negatively correlated with the number of doses recorded on the vaccination card (r = -.61) and is weakly correlated with the child's age (r = -.35). Mothers tended to remember accurately the vaccination status of children younger than 6 months, but with older children, the larger the number of doses actually received, the more the mother underestimated the number of doses. No other variables explained recall error. Therefore, reliance on maternal recall could lead to revaccinating children who are already protected, leaving at risk those most vulnerable to vaccine-preventable diseases. Handle: RePEc:aph:ajpbhl:1992:82:1:120-123_6 Template-Type: ReDIF-Article 1.0 Title: Risk of exposure to outdoor advertising of cigarettes and alcohol [1] Journal: American Journal of Public Health Author-Name: Ewert, D. Author-Name: Alleyne, D. Year: 1992 Volume: 82 Issue: 6 Pages: 895-896 Handle: RePEc:aph:ajpbhl:1992:82:6:895-896_0 Template-Type: ReDIF-Article 1.0 Title: Plague surveillance in Los Angeles County [3] Journal: American Journal of Public Health Author-Name: Ryan, C.P. Author-Name: Hughes, P.E. Author-Name: Matsumoto, G. Year: 1992 Volume: 82 Issue: 6 Pages: 897 Handle: RePEc:aph:ajpbhl:1992:82:6:897_2 Template-Type: ReDIF-Article 1.0 Title: Legal blindness among 10-year-old children in metropolitan Atlanta: Prevalence, 1985 to 1987 Journal: American Journal of Public Health Author-Name: Drews, C.D. Author-Name: Yeargin-Allsopp, M. Author-Name: Murphy, C.C. Author-Name: Decoufle, P. Year: 1992 Volume: 82 Issue: 10 Pages: 1377-1379 Abstract: The prevalence of legal blindness in 10-year-olds in metropolitan Atlanta was 6.8 per 10 000 during 1985 to 1987. The prevalence was 8.8 per 10 000 in Black boys, 8.6 per 10 000 in White boys, 6.7 per 10 000 in White girls, and 1.8 per 10 000 in Black girls. Retinopathy of prematurity was the most common known cause (1.0 per 10 000). Of the 61 cases, 40 had other disabilities, including 14 with mental retardation, cerebral palsy, and epilepsy. The low prevalence among Black girls and the frequent occurrence of blindness with other disabilities are noteworthy. Handle: RePEc:aph:ajpbhl:1992:82:10:1377-1379_0 Template-Type: ReDIF-Article 1.0 Title: AIDS in bisexual men in the United States: Epidemiology and transmission to women Journal: American Journal of Public Health Author-Name: Chu, S.Y. Author-Name: Peterman, T.A. Author-Name: Doll, L.S. Author-Name: Buehler, J.W. Author-Name: Curran, J.W. Year: 1992 Volume: 82 Issue: 2 Pages: 220-224 Abstract: Background. Homosexual and bisexual men with acquired immunodeficiency syndrome (AIDS) differ, and bisexual men play an important role in the sexual transmission of human immunodeficiency virus (HIV) to women. Methods. To describe AIDS in these groups, we examined AIDS cases reported nationally through June 1990. Results. Among 65 389 men who reported having had sex with men since 1977, 26% were bisexual. More Black (41%) and Hispanic men (31%) than White men (21%) reported bisexual behavior. Bisexual men were twice as likely to report intravenous drug use (20%) as were homosexual men (9%), regardless of race or ethnicity. Among 3555 women with heterosexually acquired AIDS, 11% reported sexual contact with a bisexual man and no other risk factor, although in some states approximately half reported such contact. In 1989, the AIDS rate due to sex with a bisexual man was three and five times higher among Hispanic and Black women, respectively, than among White women. Conclusions. Differences between bisexual and homosexual men with AIDS and the relative importance of AIDS in women due to sexual contact with bisexual men should be considered in the development of HIV prevention programs. Handle: RePEc:aph:ajpbhl:1992:82:2:220-224_8 Template-Type: ReDIF-Article 1.0 Title: Swimming-associated cryptosporidiosis Journal: American Journal of Public Health Author-Name: Sorvillo, F.J. Author-Name: Fujioka, K. Author-Name: Nahlen, B. Author-Name: Tormey, M.P. Author-Name: Kebabjian, R. Author-Name: Mascola, L. Year: 1992 Volume: 82 Issue: 5 Pages: 742-744 Abstract: In July and August 1988, an outbreak of gastroenteritis affected 44 of 60 (73%) persons from 5 separate swimming groups who had used the same swimming pool in Los Angeles. Cryptosporidium was identified in 5 of 8 (63%) stool specimens, and the clinical picture was consistent with Cryptosporidium infection. Resistance of Cryptosporidium to chlorine, an inadequately maintained pool filtration system, repeated exposure to pool water, and possible continuing pool contamination may have contributed to ongoing transmission. Cryptosporidium should be considered a potential etiologic agent of gastroenteritis associated with recreational water use. Handle: RePEc:aph:ajpbhl:1992:82:5:742-744_4 Template-Type: ReDIF-Article 1.0 Title: Predictors of condom accessibility among Hispanics in San Francisco Journal: American Journal of Public Health Author-Name: Marin, B.V. Author-Name: Marin, G. Year: 1992 Volume: 82 Issue: 4 Pages: 592-595 Abstract: Ready access to condoms can be an important means of slowing the spread of sexually transmitted diseases and human immunodeficiency virus. We identified the factors associated with keeping or carrying condoms in a random-digit dialing survey of 522 Hispanic adults aged 18 to 65 years in San Francisco. Overall, more Hispanic men reported having condoms than Hispanic women (55.2% vs 23.8%). Hispanic men also reported much higher levels of risky sexual behavior than Hispanic women. Condom promotion efforts with Hispanics will require different approaches for each gender. Handle: RePEc:aph:ajpbhl:1992:82:4:592-595_4 Template-Type: ReDIF-Article 1.0 Title: HMO vs fee-for-service care of older persons with acute myocardial infarction Journal: American Journal of Public Health Author-Name: Carlisle, D.M. Author-Name: Siu, A.L. Author-Name: Keeler, E.B. Author-Name: McGlynn, E.A. Author-Name: Kahn, K.L. Author-Name: Rubenstein, L.V. Author-Name: Brook, R.H. Year: 1992 Volume: 82 Issue: 12 Pages: 1626-1630 Abstract: Objectives. Health maintenance organizations (HMOs) continue to grow in number and in their enrollment of Medicare recipients. They are also increasingly viewed as organizational structures that might contribute to control of health care costs. Yet little is known about the quality of care that elderly HMO enrollees receive. Methods. We compared patients from three HMOs to a fee-for-service (FFS) sample that was national in scope. Sickness at admission, the quality of process of care, and mortality were assessed for patients aged 65 years and older who had been hospitalized with a diagnosis of acute myocardial infarction. Results. After adjustment for sickness at admission, there were no significant mortality differences between the HMO and FFS groups at either 30 (23.2% vs 23.5%) or 180 days (34.4% vs 34.5%) after admission. Compliance with process criteria was higher for the HMO group as a whole (P < .05). The HMOs had greater compliance with three of five scales measuring different aspects of care for patients with acute myocardial infarction. Conclusions. We conclude that older patients from our participating HMOs who were hospitalized for acute myocardial infarction received hospital care that was generally better in terms of process than that received by patients in a national FFS sample. Handle: RePEc:aph:ajpbhl:1992:82:12:1626-1630_7 Template-Type: ReDIF-Article 1.0 Title: Drug use and suicide ideation and behavior among North Carolina public school students Journal: American Journal of Public Health Author-Name: Felts, W.M. Author-Name: Chenier, T. Author-Name: Barnes, R. Year: 1992 Volume: 82 Issue: 6 Pages: 870-872 Abstract: We used data from 3064 respondents to the 1990 North Carolina Youth Risk Behavior Survey to examine the relationship between adolescent drug use and suicide ideation and behavior. Principal components analysis followed by varimax rotation was performed separately on the drug use and suicide items. Correlation coefficients computed between the two sets of factor scores and comparison of mean drug use factor scores revealed that drug use, particularly of crack/cocaine, was related to increased suicide ideation and behavior. Handle: RePEc:aph:ajpbhl:1992:82:6:870-872_7 Template-Type: ReDIF-Article 1.0 Title: Planning professional education at schools of public health Journal: American Journal of Public Health Author-Name: Kahn, K. Author-Name: Tollman, S.M. Year: 1992 Volume: 82 Issue: 12 Pages: 1653-1657 Abstract: Objectives. Professional education in public health should equip graduates with adequate knowledge and skills to manage diverse and complex problems. How best to address this challenge is widely debated. We describe the Harvard School of Public Health's self-evaluation and development of a practice- oriented program. Methods. As part of Harvard's schoolwide review of the master of public health (MPH), self-administered questionnaires were distributed to all MPH students, 1987 to 1989, and international and US alumni, 1979 to 1986. Extensive discussions were conducted with relevant student and faculty groups. Results. Survey results provided a basis for educational policy and curricular changes that culminated in a revised MPH that targets key areas of public health practice. Examples from the Harvard experience are provided. Conclusions. Information derived from student and alumni surveys can be highly effective in the process of guiding curricular change at schools of public health. This should be coupled with a strategic approach to gain faculty support for proposed innovations. Ongoing monitoring and modification of the new curriculum is essential. Handle: RePEc:aph:ajpbhl:1992:82:12:1653-1657_9 Template-Type: ReDIF-Article 1.0 Title: Evaluation of an intervention to reduce playground hazards in Atlanta child-care centers Journal: American Journal of Public Health Author-Name: Sacks, J.J. Author-Name: Brantley, M.D. Author-Name: Holmgreen, P. Author-Name: Rochat, R.W. Year: 1992 Volume: 82 Issue: 3 Pages: 429-431 Abstract: In 1988, we identified playground hazards at 58 child-care centers (CCCs) and intervened by showing the director the hazards and distributing safety information. In 1990, we evaluated the 58 intervention CCCs as well as 71 randomly selected control CCCs. Intervention centers had 9.4 hazards per playground; control centers had 8.0. We conclude that the intervention was ineffective. Handle: RePEc:aph:ajpbhl:1992:82:3:429-431_3 Template-Type: ReDIF-Article 1.0 Title: Provider compliance with recommended dietary fluoride supplement protocol Journal: American Journal of Public Health Author-Name: Levy, S.M. Author-Name: Muchow, G. Year: 1992 Volume: 82 Issue: 2 Pages: 281-283 Abstract: Proper dosage of dietary fluoride supplements is important for children without access to optimally fluoridated water to balance dental caries prevention and risks of dental fluorosis. Subsequent to water fluoride assay, compliance by physicians and dentists with the recommended dietary fluoride supplement dosage schedule was determined for 446 children. Approximately one third of child patients and 42% of siblings did not receive the recommended supplement dosage. Handle: RePEc:aph:ajpbhl:1992:82:2:281-283_2 Template-Type: ReDIF-Article 1.0 Title: The accuracy of pharmacists' HIV and condom counseling [3] Journal: American Journal of Public Health Author-Name: Denetclaw, T.H. Year: 1992 Volume: 82 Issue: 10 Pages: 1420-1421 Handle: RePEc:aph:ajpbhl:1992:82:10:1420-1421_3 Template-Type: ReDIF-Article 1.0 Title: Erratum: Workplace compliance with a no-smoking law: A randomized community intervention trial (Am J Public Health (1992) 82 (229-235)) Journal: American Journal of Public Health Author-Name: Rigotti, N.A. Author-Name: Bourne, D. Author-Name: Rosen, A. Author-Name: Locke, J.A. Author-Name: Schelling, T.C. Year: 1992 Volume: 82 Issue: 5 Pages: 718 Handle: RePEc:aph:ajpbhl:1992:82:5:718_4 Template-Type: ReDIF-Article 1.0 Title: Women healers of the middle ages: Selected aspects of their history Journal: American Journal of Public Health Author-Name: Minkowski, W.L. Year: 1992 Volume: 82 Issue: 2 Pages: 288-295 Abstract: The stellar role of women as healers during the Middle Ages has received some attention from medical historians but remains little known or appreciated. In the three centuries preceding the Renaissance, this role was heightened by two roughly parallel developments. The first was the evolution of European universities and their professional schools that, for the most part, systematically excluded women as students, thereby creating a legal male monopoly of the practice of medicine. Ineligible as healers, women waged a lengthy battle to maintain their right to care for the sick and injured. The 1322 case of Jacqueline Felicie, one of many healers charged with illegally practicing medicine, raises serious questions about the motives of male physicians in discrediting these women as incompetent and dangerous. The second development was the campaign-promoted by the church and supported by both clerical and civil authorities-to brand women healers as witches. Perhaps the church perceived these women, with their special, often esoteric, healing skills, as a threat to its supremacy in the lives of its parishioners. The result was the brutal persecution of unknown numbers of mostly peasant women. Handle: RePEc:aph:ajpbhl:1992:82:2:288-295_2 Template-Type: ReDIF-Article 1.0 Title: Global microbial traffic and the interchange of disease Journal: American Journal of Public Health Author-Name: Morse, S.S. Year: 1992 Volume: 82 Issue: 10 Pages: 1326-1327 Handle: RePEc:aph:ajpbhl:1992:82:10:1326-1327_1 Template-Type: ReDIF-Article 1.0 Title: Head and neck injuries from 1990 Illinois tornado [6] Journal: American Journal of Public Health Author-Name: Brenner, S.A. Author-Name: Noji, E.K. Year: 1992 Volume: 82 Issue: 9 Pages: 1296-1297 Handle: RePEc:aph:ajpbhl:1992:82:9:1296-1297_4 Template-Type: ReDIF-Article 1.0 Title: Are we really no. 1? [7] Journal: American Journal of Public Health Author-Name: Ahluwalia, J.S. Year: 1992 Volume: 82 Issue: 6 Pages: 900-901 Handle: RePEc:aph:ajpbhl:1992:82:6:900-901_1 Template-Type: ReDIF-Article 1.0 Title: Dissimilarities between tuskegee study and HIV/AIDS programs emphasized [6] Journal: American Journal of Public Health Author-Name: Grunfeld, G.B. Year: 1992 Volume: 82 Issue: 8 Pages: 1176 Handle: RePEc:aph:ajpbhl:1992:82:8:1176_7 Template-Type: ReDIF-Article 1.0 Title: The reporting of HIV/AIDS deaths in women Journal: American Journal of Public Health Author-Name: Buehler, J.W. Author-Name: Hanson, D.L. Author-Name: Chu, S.Y. Year: 1992 Volume: 82 Issue: 11 Pages: 1500-1505 Abstract: Objective. This study was undertaken to assess the completeness of vital statistics and case reports of acquired immunodeficiency syndrome (AIDS) in measuring human immunodeficiency virus (HIV)-related mortality in women 15 through 44 years of age. Methods. We used vital records to determine the number of deaths attributed to HIV infection and excess deaths due to causes that have increased in tandem with the HIV epidemic. Results. In 1988, among women 15 through 44 years of age, there were 1365 deaths with HIV infection listed as the underlying cause, 202 deaths with HIV infection listed as an associated cause, and 149 excess deaths due to conditions highly associated with HIV infection (subtotal = 1716). In addition, there were 780 excess deaths due to causes that may be related to HIV infection or illicit drug use (maximum estimate of HIV-related deaths = 2496). Of the deaths that occurred in 1988, 1532 were reported through AIDS surveillance (1668 deaths when adjusted for reporting delays). Conclusions. Underlying-cause-of-death vital records and AIDS surveillance identified 55% to 80% and 67% to 97%, respectively, of HIV-related deaths in women 15 through 44 years of age in 1988. The wide ranges of these estimates reflect the potential role of both HIV infection and drug use in contributing to excess mortality. Handle: RePEc:aph:ajpbhl:1992:82:11:1500-1505_0 Template-Type: ReDIF-Article 1.0 Title: Sources of fiber and fat in diets of US women aged 19 to 50: Implications for nutrition education and policy Journal: American Journal of Public Health Author-Name: Thompson, F.E. Author-Name: Sowers, M.F. Author-Name: Frongillo Jr., E.A. Author-Name: Parpia, B.J. Year: 1992 Volume: 82 Issue: 5 Pages: 695-702 Abstract: Introduction. Many women are not meeting dietary recommendations for fiber and fat intakes. Health educators need to know which foods are major sources of these nutrients. Methods. This study analyzed the contributions of 27 food groups to fiber, fat, saturated fat, and cholesterol intakes of 2134 women aged 19 to 50 years in USDA's Continuing Survey of Food Intakes by Individuals, the 1985 and 1986 surveys (CSFII 85-86). Results. Major determinants of fiber intake include frequency of use of certain food groups (vegetables, including potatoes, bread, fruit, soups, ready-to-eat cereal) and choice of particular foods within the larger food groups (e.g., whole grain bread, high fiber cereal). Major determinants of total fat, saturated fat, and cholesterol intakes included frequency of use of certain foods (sweet grains, beef, eggs, cheeses/cream, whole milks) and additions to foods (regular salad dressing and butter/margarine). Demographic characteristics were related to various food group consumption parameters. Conclusions. Information about the relationships between food group and nutrient intake and the effects of household income, race/ethnicity, and region of residence on food group intake indicate opportunities to refine nutritional education programs. Handle: RePEc:aph:ajpbhl:1992:82:5:695-702_2 Template-Type: ReDIF-Article 1.0 Title: Response comparability of family and staff proxies for nursing home residents Journal: American Journal of Public Health Author-Name: Tennstedt, S.L. Author-Name: Skinner, K.M. Author-Name: Sullivan, L.M. Author-Name: McKinlay, J.B. Year: 1992 Volume: 82 Issue: 5 Pages: 747-749 Abstract: Response comparability on a wide variety of factual and judgmental information regarding nursing home residents was assessed for two proxy groups: family and staff. Family proxies had the most information. Family and staff proxies are not interchangeable. A general lack of response comparability suggests that proxies for nursing home residents should be selected in relation to the type of data needed and the time period of interest. Handle: RePEc:aph:ajpbhl:1992:82:5:747-749_2 Template-Type: ReDIF-Article 1.0 Title: Pregnancy among the Hmong: Birthweight, age, and parity Journal: American Journal of Public Health Author-Name: Helsel, D. Author-Name: Petitti, D.B. Author-Name: Kunstadter, P. Year: 1992 Volume: 82 Issue: 10 Pages: 1361-1364 Abstract: Objectives. The influx of Southeast Asians into the United States allows for the study of this special population and contributes to a broader understanding of reproductive health. Methods. We used information on birth certificates to identify 1937 Hmong children born 1985 through 1988 in California, and we compared birthweight and reproductive factors as related to these children with the same factors as related to 3776 White, non- Hispanic children born in the same period. Results. Mean birthweight among Hmong children (3311 g) was significantly lower (P < .05) than among White children (3452 g), but the proportion of births under 1500 g was higher for Whites. Hmong women were of much higher parity and were more likely to deliver at both a young (< 18 years) and an old (> 40 years) maternal age. At every age and every parity, however, Hmong women had cesarean sections at one-half to one-tenth the rate of White women. Conclusions. Despite a high proportion of births at high parity and advanced maternal age, Hmong women gave birth to very low-birthweight babies at essentially the same rates as White women. Their lower cesarean section rates, however, deserve further attention. Handle: RePEc:aph:ajpbhl:1992:82:10:1361-1364_5 Template-Type: ReDIF-Article 1.0 Title: Catania and colleagues respond [2] Journal: American Journal of Public Health Author-Name: Catania, J.A. Author-Name: Dolcini, M.M. Author-Name: Coates, T.J. Year: 1992 Volume: 82 Issue: 11 Pages: 1564-1565 Handle: RePEc:aph:ajpbhl:1992:82:11:1564-1565_7 Template-Type: ReDIF-Article 1.0 Title: Cigarette, alcohol, and coffee consumption and spontaneous abortion Journal: American Journal of Public Health Author-Name: Armstrong, B.G. Author-Name: McDonald, A.D. Author-Name: Sloan, M. Year: 1992 Volume: 82 Issue: 1 Pages: 85-87 Abstract: We analyzed data from a survey of occupational factors and pregnancy outcome to examine the effects of cigarette, alcohol, and coffee consumption on pregnancy outcome. Clear and statistically significant associations were found between cigarette and alcohol consumption and spontaneous abortion. There was a weaker but statistically significant association with coffee consumption: If the associations were casual, 11% of the spontaneous abortions could be attributed to smoking, 5% to alcohol, and 2% to coffee. Handle: RePEc:aph:ajpbhl:1992:82:1:85-87_9 Template-Type: ReDIF-Article 1.0 Title: Prevalence of human T-lymphotropic virus in civilian applicants for the United States Armed Forces Journal: American Journal of Public Health Author-Name: Roberts, C.R. Author-Name: Fipps, D.R. Author-Name: Brundage, J.F. Author-Name: Wright, S.E. Author-Name: Goldenbaum, M. Author-Name: Alexander, S.S. Author-Name: Burke, D.S. Year: 1992 Volume: 82 Issue: 1 Pages: 70-73 Abstract: Background. The wide range in human T-lymphotropic virus (HTLV) seroprevalences reported worldwide has made estimates of seroprevalence difficult in unique populations. In this study, the seropositivity of young adult civilian applicants for the US Armed Forces was determined. Methods. Serum samples from nine geographic regions were screened by an Enzyme-Linked Immunosorbent Assay (ELISA), and repeatedly reactive samples were further tested by Western blot and radioimmunoprecipitation. Specimens were scored as positive when antibody to gag (p24) and env (gp46 or gp68) were detected. Results. Of the 43,750 samples analyzed, 18 were positive for HTLV antibodies. Ten (55%) were from males and eight (45%) were from females. Nine (90%) of the males and seven (87.5%) of the females were Black. Twelve of the positive samples (66.6%) were from the New York City region, which represented only 18.8% of the sample population. Conclusions. The overall HTLV seroprevalence of civilian applicants for the US Armed forces was 0.41 per 1000. This was higher than the seroprevalence reported for volunteer blood donors. Handle: RePEc:aph:ajpbhl:1992:82:1:70-73_0 Template-Type: ReDIF-Article 1.0 Title: Medicaid coverage of screening tests for breast and cervical cancer Journal: American Journal of Public Health Author-Name: Boss, L.P. Author-Name: Guckes, F.H. Year: 1992 Volume: 82 Issue: 2 Pages: 252-253 Abstract: Although most women receive periodic Papanicolaou smear (Pap) for early diagnosis of cervical cancer, those who do not are more likely to be of lower socioeconomic status. Similarly, for the many women who do not receive periodic mammography for early diagnosis of breast cancer, cost has often been cited as a reason. Medicaid provides health benefits to roughly 9.4 million women of the appropriate ages for Pap tests and roughly 3.3 million women of the appropriate ages for mammography. The decision to provide such coverage is made on the state level. Of the 50 states and the District of Columbia, 49 provide some level of coverage for Pap smears, 39 for screening mammography. Knowing the extent of coverage allows public health professionals to take advantage of this funding source to provide services for lower-income women and may help initiate coverage in those states where it is not currently available. Handle: RePEc:aph:ajpbhl:1992:82:2:252-253_5 Template-Type: ReDIF-Article 1.0 Title: Do time trends in food supply levels of macronutrients reflect survey estimates of macronutrient intake? Journal: American Journal of Public Health Author-Name: Crane, N.T. Author-Name: Lewis, C.J. Author-Name: Yetley, E.A. Year: 1992 Volume: 82 Issue: 6 Pages: 862-866 Abstract: Background. Two types of data may be used to estimate trends in food and nutrient intake by the US population: per capita food supply estimates and survey estimates of individual intake. Because these data vary markedly in measurement goals and methods, we examined whether trends in food supply and survey intake estimates for fat, carbohydrate, and protein are reflective of one another. Methods. The data selected for comparison included all available survey estimates of mean intake by the US population (i.e., periodic estimates from 1965 to 1988) and all available per capita food supply estimates from a comparable time period (i.e., annual estimates from 1965 to 1985). Results. The two types of data generally did not reflect the same trends. Furthermore, expressing macronutrient levels as percentage of calories rather than in grams affected the trend relationships. Conclusions. Our findings indicate that caution is needed in the selection and application of available data to estimate trends in macronutrient intake by the US population and in the interpretation of these data with regard to public health research, policies, and programs. Handle: RePEc:aph:ajpbhl:1992:82:6:862-866_4 Template-Type: ReDIF-Article 1.0 Title: Suicide by the elderly [3] Journal: American Journal of Public Health Author-Name: Hochbaum, G.M. Year: 1992 Volume: 82 Issue: 8 Pages: 1175 Handle: RePEc:aph:ajpbhl:1992:82:8:1175_8 Template-Type: ReDIF-Article 1.0 Title: Risk reduction in sexual behavior: A condom giveaway program in a drug abuse treatment clinic Journal: American Journal of Public Health Author-Name: Calsyn, D.A. Author-Name: Meinecke, C. Author-Name: Saxon, A.J. Author-Name: Stanton, V. Year: 1992 Volume: 82 Issue: 11 Pages: 1536-1538 Abstract: Just before and 4 months after initiation of a condom giveaway program, a questionnaire regarding sexual behavior and condom acquisition was administered to 103 men attending an outpatient drug abuse treatment clinic. Jars filled with a variety of condoms were placed in every clinic room. Condom taking varied as a function of room. Sixty percent of the subjects reported taking condoms. At follow-up, clients reported increases in condom possession and in use of condoms for vaginal intercourse. Handle: RePEc:aph:ajpbhl:1992:82:11:1536-1538_9 Template-Type: ReDIF-Article 1.0 Title: Brief supportive telephone outreach as a recruitment and intervention strategy for smoking cessation Journal: American Journal of Public Health Author-Name: Lando, H.A. Author-Name: Hellerstedt, W.L. Author-Name: Pirie, P.L. Author-Name: McGovern, P.G. Year: 1992 Volume: 82 Issue: 1 Pages: 41-46 Abstract: Background. Formal efforts to recruit smokers into cessation programs have failed to reach large segments of the smoking population. Telephone intervention may represent a viable strategy to promote smoking cessation. An even more promising approach may be a combination of brief telephone support and outreach to identified smokers. Methods. Telephone support for smoking cessation was provided to four identified smoker populations in Bloomington, Minn, one of three Minnesota Heart Health Program education communities. Smokers were randomly assigned to an intervention consisting of two 15-minute telephone calls approximately 1 to 3 weeks apart or to a nonintervention control. Results. At the 6-month followup, a significant overall effect was found in favor of the itnervention condition for both self-reported and cotinine-validated quitting. Differences between intervention and control conditions were no longer significant at 18 months. Conclusions. Smokers' receptivity to telephone intervention was at least moderately encouraging. The cost of intervention could be relatively low if trained volunteers initiated telephone calls. However, more intensive telephone intervention and support may be needed to produce lasting changes in smoking prevalence. Handle: RePEc:aph:ajpbhl:1992:82:1:41-46_2 Template-Type: ReDIF-Article 1.0 Title: Predictors of smoking cessation and relapse in older adults Journal: American Journal of Public Health Author-Name: Salive, M.E. Author-Name: Cornoni-Huntley, J. Author-Name: LaCroix, A.Z. Author-Name: Ostfeld, A.M. Author-Name: Wallace, R.B. Author-Name: Hennekens, C.H. Year: 1992 Volume: 82 Issue: 9 Pages: 1268-1271 Abstract: We examined longitudinal changes in smoking behavior among older adults in three community cohorts of the Established Populations for Epidemiologic Studies of the Elderly. Smoking prevalence declined from 15% at baseline to 9% during 6 years of follow-up. Annual smoking cessation and relapse rates were 10% and less than 1%, respectively. Interval diagnosis of myocardial infarction, stroke, or cancer increased subsequent smoking cessation but not relapse. Although smoking cessation around diagnosis is increased, primary prevention could yield greater benefits. Handle: RePEc:aph:ajpbhl:1992:82:9:1268-1271_0 Template-Type: ReDIF-Article 1.0 Title: Body fatness and risk for elevated blood pressure, total cholesterol, and serum lipoprotein ratios in children and adolescents Journal: American Journal of Public Health Author-Name: Williams, D.P. Author-Name: Going, S.B. Author-Name: Lohman, T.G. Author-Name: Harsha, D.W. Author-Name: Srinivasan, S.R. Author-Name: Webber, L.S. Author-Name: Berenson, G.S. Year: 1992 Volume: 82 Issue: 3 Pages: 358-363 Abstract: Background. Recent studies have shown considerable variation in body fatness among children and adolescents defined as obese by a percentile rank for skinfold thickness. Methods. We examined the relationship between percent body fat and risk for elevated blood pressure, serum total cholesterol, and serum lipoprotein ratios in a biracial sample of 3320 children and adolescents aged 5 to 18 years. Equations developed specifically for children using the sum of subscapular (S) and triceps (T) skin-folds were used to estimate percent fat. The S/T ratio provided an index of trunkal fat patterning. Results. Significant overrepresentation (>20%) of the uppermost quintile (UQ) for cardiovascular disease (CVD) risk factors was evident at or above 25% fat in males (32.2% to 37.3% in UQ) and at or above 30% fat in females (26.6% to 45.4% in UQ), even after adjusting for age, race, fasting status, and trunkal fat patterning. Conclusions. These data support the concept of body fatness standards in White and Black children and adolescents as significant predictors of CVD risk factors. Potential applications of these obesity standards include epidemiologic surveys, pediatric health screenings, and youth fitness tests. Handle: RePEc:aph:ajpbhl:1992:82:3:358-363_5 Template-Type: ReDIF-Article 1.0 Title: Health status of older male prisoners: A comprehensive survey Journal: American Journal of Public Health Author-Name: Colsher, P.L. Author-Name: Wallace, R.B. Author-Name: Loeffelholz, P.L. Author-Name: Sales, M. Year: 1992 Volume: 82 Issue: 6 Pages: 881-884 Abstract: Although prison populations remain predominantly young, the number of older inmates in state and federal correctional facilities has been increasing. This report describes the results of a health survey of 119 male inmates 50 years of age and older residing in Iowa state correctional facilities. Subjects' disease history included hypertension (40%), myocardial infarction (19%), and emphysema (18%). Most participants (97%) had missing teeth, 42% had gross physical functional impairments, and 70% smoked cigarettes. These findings have implications for health care provision and release planning. Handle: RePEc:aph:ajpbhl:1992:82:6:881-884_5 Template-Type: ReDIF-Article 1.0 Title: The accuracy of Medicare's hospital claims data: Progress has been made, but problems remain Journal: American Journal of Public Health Author-Name: Fisher, E.S. Author-Name: Whaley, F.S. Author-Name: Krushat, W.M. Author-Name: Malenka, D.J. Author-Name: Fleming, C. Author-Name: Baron, J.A. Author-Name: Hsia, D.C. Year: 1992 Volume: 82 Issue: 2 Pages: 243-248 Abstract: Background. Health care databases provide a widely used source of data for health care research, but their accuracy remains uncertain. We analyzed data from the 1985 National DRG Validation Study, which carefully reabstracted and reassigned ICD-9-CM diagnosis and procedure codes from a national sample of 7050 medical records, to determine whether coding accuracy had improved since the Institute of Medicine studies of the 1970s and to assess the current coding accuracy of specific diagnoses and procedures. Methods. We defined agreement as the proportion of all reabstracted records that had the same principal diagnosis or procedure coded on both the original (hospital) record and on the reabstracted record. We also evaluated coding accuracy in 1985 using the concepts of diagnostic test evaluation. Results. Overall, the percentage of agreement between the principal diagnosis on the reabstracted record and the original hospital record, when analyzed at the third digit, improved from 73.2% in 1977 to 78.2% in 1985. However, analysis of the 1985 data demonstrated that the accuracy of diagnosis and procedure coding varies substantially across conditions. Conclusions. Although some diagnoses and all major surgical procedures that we examined were accurately coded, the variability in the accuracy of diagnosis coding poses a problem that must be overcome if claims-based research is to achieve its full potential. Handle: RePEc:aph:ajpbhl:1992:82:2:243-248_2 Template-Type: ReDIF-Article 1.0 Title: Neonatal tetanus in rural Bangladesh: Risk factors and toxoid efficacy Journal: American Journal of Public Health Author-Name: Hlady, W.G. Author-Name: Bennett, J.V. Author-Name: Samadi, A.R. Author-Name: Begum, J. Author-Name: Hafez, A. Author-Name: Tarafdar, A.I. Author-Name: Boring, J.R. Year: 1992 Volume: 82 Issue: 10 Pages: 1365-1369 Abstract: Objectives. Tetanus continues to be a leading cause of neonatal death in Bangladesh as in other developing countries, yet little is known about risk factors or the efficacy of tetanus toxoid in this setting. Methods. In May 1990, mothers of 6148 infants born alive between March 15, 1989, and March 14, 1990, in 30 rural unions of Rajshahi Division in Bangladesh were interviewed. Three surviving controls for each neonatal tetanus death were matched for sex, residence, and date of birth. Results. Of 330 neonatal deaths, 112 met the case definition for tetanus. Risk was increased with a history of neonatal tetanus in a previous child, application of coconut oil to the vagina, and use of multiple ties on the umbilical cord. Risk was reduced by the birth attendant washing hands and using a cleaned cord-cutting tool. Risk was not reduced by a maternal history of two doses of tetanus toxoid (TT2), although estimated efficacy of TT2 was 45% (95% confidence interval = 16% to 64%). Subsequent to the survey, a reference laboratory reported no potency in three consecutive lots of tetanus vaccine from the production laboratory in Bangladesh. Conclusions. These findings identify high-risk mothers, stress the importance of washing hands and cleaning the cord-cutting tool, and demand improved quality control of tetanus vaccine production. Handle: RePEc:aph:ajpbhl:1992:82:10:1365-1369_5 Template-Type: ReDIF-Article 1.0 Title: The impact of mailing psychoeducational materials to women with abnormal mammograms Journal: American Journal of Public Health Author-Name: Lerman, C. Author-Name: Ross, E. Author-Name: Boyce, A. Author-Name: Gorchov, P.M. Author-Name: McLaughlin, R. Author-Name: Rimer, B. Author-Name: Engstrom, P. Year: 1992 Volume: 82 Issue: 5 Pages: 729-730 Abstract: A randomized trial was conducted to evaluate the impact of mailed psychoeducational materials on adherence to subsequent annual mammography among women with prior abnormal mammograms. The results showed a 13% increment in adherence among women who received this intervention. This effect was independent of all sociodemographic and medical variables examined. We conclude that mailed psychoeducational materials may be an effective mechanism to improve adherence among women with abnormal mammogram results. Handle: RePEc:aph:ajpbhl:1992:82:5:729-730_1 Template-Type: ReDIF-Article 1.0 Title: Socioeconomic status and childhood mortality in North Carolina Journal: American Journal of Public Health Author-Name: Nelson Jr., M.D. Year: 1992 Volume: 82 Issue: 8 Pages: 1131-1133 Abstract: Children in families eligible to receive Aid to Families with Dependent Children (AFDC) were found to have substantially higher mortality rates than non-AFDC children. The disparity seems to be greater for Whites than for non- Whites. These results suggest the presence of social class differentials in access to and use of health care and related services and facilities, in exposure to environmental risks, and in knowledge of injury control measures. Handle: RePEc:aph:ajpbhl:1992:82:8:1131-1133_8 Template-Type: ReDIF-Article 1.0 Title: Mortality among minority populations in the United States Journal: American Journal of Public Health Author-Name: Fingerhut, L.A. Author-Name: Makuc, D.M. Year: 1992 Volume: 82 Issue: 8 Pages: 1168-1170 Handle: RePEc:aph:ajpbhl:1992:82:8:1168-1170_5 Template-Type: ReDIF-Article 1.0 Title: Geographic and socioeconomic variation in the onset of decline of coronary heart disease mortality in white women Journal: American Journal of Public Health Author-Name: Wing, S. Author-Name: Barnett, E. Author-Name: Casper, M. Author-Name: Tyroler, H.A. Year: 1992 Volume: 82 Issue: 2 Pages: 204-209 Abstract: Background. Regional, metropolitan, and socioeconomic factors related to the onset of decline of coronary heart disease (CHD) mortality among White women are reported. Such studies are important for planning population-level interventions. Methods. Mortality data for 1962 to 1978 were used, to estimate the year of onset of decline. Ecological analyses of socioeconomic data from the US census were used to emphasize structural and organizational aspects of changes in disease, rather than as a substitute for an individual- level design. Results. Onset of decline of CHD mortality among White women was estimated to have occurred by 1962 in 53% of 507 state economic areas (SEAs), ranging from 79% in the Northeast to 39% in the South. Metropolitan areas experienced earlier onset of decline than did nonmetropolitan areas. Average income, education, and occupational levels were highest in early onset areas and declined across onset categories. Conclusions. The results provide additional evidence for previously observed geographic and social patterns of CHD decline. Emphasis on structural economic factors determining the shape of the CHD epidemic curve does not detract from the medical importance of risk factors, but underscores the importance of community development to public health improvements. The results are consistent with the idea that the course of the CHD epidemic in the United States has been strongly influenced by socio-economic development. Handle: RePEc:aph:ajpbhl:1992:82:2:204-209_9 Template-Type: ReDIF-Article 1.0 Title: Identification of nonfatal family and intimate assault incidents in police data Journal: American Journal of Public Health Author-Name: Saltzman, L.E. Author-Name: Mercy, J.A. Author-Name: Rhodes, P.H. Year: 1992 Volume: 82 Issue: 7 Pages: 1018-1020 Abstract: We examined different strategies for identifying nonfatal family and intimate assaults (FIAs) in police data. Police most often classify such incidents in the 'assault' category, but they also use other crime categories. We estimated that, during 1984, 3300 FIAs (or 837 per 100 000 population) occurred in Atlanta. Of those, 77% were classified as assaults; 23% were classified in nonassault categories. Research measuring the magnitude of FIAs should take into account incidents classified in nonassault crime categories. Handle: RePEc:aph:ajpbhl:1992:82:7:1018-1020_1 Template-Type: ReDIF-Article 1.0 Title: The accuracy of the national death index when personal identifiers other than Social Security number are used Journal: American Journal of Public Health Author-Name: Williams, B.C. Author-Name: Demitrack, L.B. Author-Name: Fries, B.E. Year: 1992 Volume: 82 Issue: 8 Pages: 1145-1147 Abstract: This study analyzed the accuracy of the National Death Index when personal identifiers were used that included or excluded Social Security number. Computerized records of the Department of Veterans Affairs were used for comparison. Different combinations of identifiers other than Social Security number correctly identified from 83 to 92 percent of dead and 92 to 99 percent of living persons. These results should prove useful in ascertaining the mortality status of patient populations without information on Social Security numbers. Handle: RePEc:aph:ajpbhl:1992:82:8:1145-1147_1 Template-Type: ReDIF-Article 1.0 Title: Prevention: The cost-effectiveness of the California Diabetes and Pregnancy Program Journal: American Journal of Public Health Author-Name: Scheffler, R.M. Author-Name: Feuchtbaum, L.B. Author-Name: Phibbs, C.S. Year: 1992 Volume: 82 Issue: 2 Pages: 168-175 Abstract: Background. The California Diabetes and Pregnancy Program is a new preventive approach to improving pregnancy outcomes through intensive diabetes management preconception and early in pregnancy. Methods. Hospital charges and length of stay data were collected on 102 program enrollees and 218 control cases. Ninety program enrollees and 90 control cases were matched on mother's age. White's classification, and race. Regression models controlled for these variables in addition to MediCal status, birth weight, and enrollment in the program. Results. Hospital charges were about 30% less for program participants and days in the hospital were roughly 25% less. The program effects were larger for women that enrolled before 8 weeks gestation. More serious diabetics were also found to have larger reductions in charges and days. Conclusion. After adjusting for inflation and differences in charges across hospitals, $5.19 is saved for every dollar spent on the program. Handle: RePEc:aph:ajpbhl:1992:82:2:168-175_5 Template-Type: ReDIF-Article 1.0 Title: The quality of computerized hospital discharge data [4] Journal: American Journal of Public Health Author-Name: Muse, A. Author-Name: Smith, P.F. Author-Name: Mikl, J. Year: 1992 Volume: 82 Issue: 7 Pages: 1044 Handle: RePEc:aph:ajpbhl:1992:82:7:1044_4 Template-Type: ReDIF-Article 1.0 Title: The potential role of custody facilities in controlling sexually transmitted diseases Journal: American Journal of Public Health Author-Name: Cohen, D. Author-Name: Scribner, R. Author-Name: Clark, J. Author-Name: Cory, D. Year: 1992 Volume: 82 Issue: 4 Pages: 552-556 Abstract: Background. The National Commission on Correctional Health Care recommends that medical screening, including tests for syphilis and other sexually transmitted diseases, be performed by the 14th day after initial booking procedures. Because the average length of stay in detention is usually less than 14 days, most detainees are not screened or treated for asymptomatic communicable diseases. Methods. In order to determine the incidence and prevalence of syphilis among those booked through a large county jail, a rapid screening procedure to test newly incarcerated inmates and treat those infected was implemented over a 3-week period. Results. Among 6309 detainees eligible for testing during the 3-week period of the study, 129 (2%) were diagnosed with syphilis. During the preceding month when only those reporting symptoms or high-risk behaviors were screened, 20 cases were diagnosed. The sensitivity and predictive value of self-reported risk factors for syphilis infection were low. Among the first 110 diagnosed cases, 17 (15.5%) were released within 3 days and 86 (78%) were released within 6 days. Conclusion. If screening and treatment for syphilis are delayed until the 14th day after booking, the majority of infected inmates will be released prior to evaluation and treatment. Rapid screening and treatment for selected sexually transmitted diseases are likely to be an effective public health measure when implemented in custody settings. Handle: RePEc:aph:ajpbhl:1992:82:4:552-556_9 Template-Type: ReDIF-Article 1.0 Title: A new definition of maternal depletion syndrome Journal: American Journal of Public Health Author-Name: Winkvist, A. Author-Name: Rasmussen, K.M. Author-Name: Habicht, J.-P. Year: 1992 Volume: 82 Issue: 5 Pages: 691-694 Abstract: Background. Although the term 'maternal depletion syndrome' has been commonly used to explain poor maternal and infant health, whether such a syndrome actually exists remains unclear. This uncertainty may be due to the lack of a clear definition of the syndrome and the absence of theoretical frameworks that account for the many factors related to reproductive nutrition. Methods. We propose a new definition of maternal depletion syndrome within a framework that accounts for potential confounding factors. Results. Our conceptual framework distinguishes between childbearing pattern and inadequate diet as causes of poor maternal health; hence, our definition of maternal depletion syndrome has both biological and practical meaning. The new definition is based on overall change in maternal nutritional status over one reproductive cycle in relation to possible depletion and repletion phases and in relation to initial nutritional status. Conclusions. The empirical application of this approach should permit the testing of the existence of maternal depletion syndrome in the developing world, and the distinction between populations where family planning will alleviate maternal depletion and those in which an improved diet is also necessary. Handle: RePEc:aph:ajpbhl:1992:82:5:691-694_6 Template-Type: ReDIF-Article 1.0 Title: Discrepancies between self-reported smoking and carboxyhemoglobin: An analysis of the second national health and nutrition survey Journal: American Journal of Public Health Author-Name: Klesges, L.M. Author-Name: Klesges, R.C. Author-Name: Cigrang, J.A. Year: 1992 Volume: 82 Issue: 7 Pages: 1026-1029 Abstract: Environmental, self-report, and demographic factors mediated the relationship between self-reported cigarette smoking and carboxyhemoglobin among 2114 smokers and 3918 nonsmokers. Self-reported nonsmokers with carboxyhemoglobin levels between 2% and 3% were more likely to be self- reported ex-smokers, to live in a larger community, and to be younger, less educated, and male than were self-reported nonsmokers with carboxyhemoglobin levels of less than 2%. Self-reported nonsmokers with strong evidence of cigarette consumption (carboxyhemoglobin level > 3%) were more likely to be self-reported ex-smokers, younger, less educated, and non-White than were nonsmokers with carboxyhemoglobin levels of less than 2%. Handle: RePEc:aph:ajpbhl:1992:82:7:1026-1029_7 Template-Type: ReDIF-Article 1.0 Title: Trends in obstetric operative procedures, 1980 to 1987 Journal: American Journal of Public Health Author-Name: Zahniser, S.C. Author-Name: Kendrick, J.S. Author-Name: Franks, A.L. Author-Name: Saftlas, A.F. Year: 1992 Volume: 82 Issue: 10 Pages: 1340-1344 Abstract: Objectives. Increasing rates of cesarean deliveries have received widespread attention in recent years, as concern in the United States about unnecessary surgical procedures has increased. However, little information has been published on the national trends of other operative obstetric procedures occurring during deliveries. Methods. We analyzed data from the National Hospital Discharge Survey to examine trends in the use of forceps, vacuum extraction, and cesarean section from 1980 through 1987. Results. The rate of cesarean sections increased by 48%, while the rate of forceps procedures declined by 43%. Although the risk of cesarean section was significantly increased for older women, the risk of forceps and vacuum extraction procedures did not vary by age. Women with private insurance were significantly more likely to receive a cesarean section (rate ratio [RR] = 1.2), forceps procedure (RR = 1.7), and vacuum extraction procedure (RR = 1.8) than were women without private insurance. Conclusions. As pressure mounts to decrease the national cesarean section rate from 24% to 15% by the year 2000, attention should also be given to surveillance of other operative delivery procedures. Handle: RePEc:aph:ajpbhl:1992:82:10:1340-1344_8 Template-Type: ReDIF-Article 1.0 Title: Knowledge and attitudes about AIDS among corporate and public service employees Journal: American Journal of Public Health Author-Name: Barr, J.K. Author-Name: Waring, J.M. Author-Name: Warshaw, L.J. Year: 1992 Volume: 82 Issue: 2 Pages: 225-228 Abstract: Background. We examined the relationship between workplace AIDS education efforts and workers' knowledge about HIV transmission and their attitudes toward coworkers with AIDS. Methods. s. Questionnaires were mailed to corporate and public service workers at 12 work sites to ascertain the extent of their knowledge about AIDS and their attitudes toward coworkers with AIDS. Each work site had offered an AIDS education program. The average response rate was 40%; 3460 workers returned questionnaires. Results. Respondents' knowledge was largely consistent with available scientific evidence. However, a substantial minority still believe HIV infection can be transmitted through casual contact. Over 30% endorse the screening of new employees for AIDS, and 23% would fear contagion from an infected coworker. Thirty percent of the respondents expressed skepticism about the veracity of information from government sources and the scientific community. Work site comparisons show that where educational programs are minimal, employees know less about HIV transmission and hold more negative attitudes. Conclusion. Comprehensive workplace AIDS education programs can reinforce workers' knowledge about HIV transmission, thereby fostering more favorable views toward coworkers with AIDS. Handle: RePEc:aph:ajpbhl:1992:82:2:225-228_8 Template-Type: ReDIF-Article 1.0 Title: Using pamphlets with mail surveys to improve response [1] Journal: American Journal of Public Health Author-Name: Shaker, L.A. Author-Name: Derycke-Chapman, K. Author-Name: Brass, L.M. Year: 1992 Volume: 82 Issue: 3 Pages: 463-464 Handle: RePEc:aph:ajpbhl:1992:82:3:463-464_2 Template-Type: ReDIF-Article 1.0 Title: Adolescents' multisubstance use patterns: The role of heavy alcohol and cigarette use Journal: American Journal of Public Health Author-Name: Bailey, S.L. Year: 1992 Volume: 82 Issue: 9 Pages: 1220-1224 Abstract: Objectives. Knowledge about the roles that heavy alcohol and cigarette use play in patterns of concurrent substance use among adolescents is lacking despite studies showing that adolescent substance users are typically multisubstance users and that alcohol and cigarettes are commonly used heavily by those who use illicit substances. Methods. The roles of increasing use and heavy first-time use of alcohol and cigarettes in multisubstance use patterns were examined in a cohort of 4192 secondary students who were surveyed three times over a 4-year period. Results. When subsequent use patterns were compared for students who increased their levels of alcohol or cigarette use and those who initiated use for the first time but at heavy frequencies, analyses indicated that the former group was more likely to initiate the subsequent use of other substances and to maintain and increase use already initiated. Conclusions. These results suggest that adolescents are likely to have been involved in a history of licit substance use characterized by increasing levels of use before progressing to and maintaining the use of other substances. Increasing frequencies of alcohol and cigarette use, therefore, may be markers for more serious patterns of substance use. Handle: RePEc:aph:ajpbhl:1992:82:9:1220-1224_9 Template-Type: ReDIF-Article 1.0 Title: Creating a healthy public Journal: American Journal of Public Health Author-Name: Keck, C.W. Year: 1992 Volume: 82 Issue: 9 Pages: 1206-1209 Abstract: Significant change in thought and action will be required for our health system to become capable of serving all citizens effectively. Reliance on market forces and political expediency to shape health policy has focused attention inappropriately on finding ways to pay for illness care rather than maximizing health status. This misdirection of thought and effort has led many of us to search for ways to assure that health policy decisions are consistently based on both science and an ethic of humane concern. Courageous and disciplined local leadership will be needed to motivate policymakers to focus on the task of creating a healthy public. Linkage of academicians and practitioners with the public in a manner than empowers communities to assess and prioritize their own health problems could foster a strong community- based demand for ethical and humane decision making. Constituent demand for improved health status could provide the support politicians need if they are to legislate a national health program that emphasizes health promotion and disease prevention as well as illness care. Handle: RePEc:aph:ajpbhl:1992:82:9:1206-1209_1 Template-Type: ReDIF-Article 1.0 Title: Smoking-related behavior, beliefs, and social environment of young black women in subsidized public housing in Chicago Journal: American Journal of Public Health Author-Name: Manfredi, C. Author-Name: Lacey, L. Author-Name: Warnecke, R. Author-Name: Buis, M. Year: 1992 Volume: 82 Issue: 2 Pages: 267-272 Abstract: Survey data indicate that young Black female smokers living in public housing are heavier smokers and have weaker motivation to quit, health beliefs and social environment less conducive to cessation, and less knowledge of where to get help to quit than other young Black female smokers in metropolitan Chicago. Compared with White women, the latter, other Black women smoke fewer cigarettes daily and have a stronger desire to quit and more concern about health reasons for quitting, but have a weaker belief in the risk of lung cancer from smoking, greater concern about quitting difficulties, and less knowledge of where to get help to quit. Low education, not race, is associated with higher smoking prevalence and less social pressure to quit or support for quitting. Handle: RePEc:aph:ajpbhl:1992:82:2:267-272_7 Template-Type: ReDIF-Article 1.0 Title: Erratum: The potential role of custody facilities in controlling sexually transmitted diseases (Am J Public Health (1992) 82 (552-556)) Journal: American Journal of Public Health Author-Name: Cohen, D. Author-Name: Scribner, R. Author-Name: Clark, J. Author-Name: Cory, D. Year: 1992 Volume: 82 Issue: 5 Pages: 718 Handle: RePEc:aph:ajpbhl:1992:82:5:718_0 Template-Type: ReDIF-Article 1.0 Title: Lead exposure in sandblasting [4] Journal: American Journal of Public Health Author-Name: Silbergeld, E.K. Year: 1992 Volume: 82 Issue: 3 Pages: 464-465 Handle: RePEc:aph:ajpbhl:1992:82:3:464-465_2 Template-Type: ReDIF-Article 1.0 Title: Defining carpal tunnel syndrome [6] Journal: American Journal of Public Health Author-Name: Hales, T.R. Author-Name: Katz, J.N. Year: 1992 Volume: 82 Issue: 3 Pages: 466-467 Handle: RePEc:aph:ajpbhl:1992:82:3:466-467_2 Template-Type: ReDIF-Article 1.0 Title: Seagram defends ad [5] Journal: American Journal of Public Health Author-Name: Herbits, S.E. Year: 1992 Volume: 82 Issue: 8 Pages: 1176 Handle: RePEc:aph:ajpbhl:1992:82:8:1176_6 Template-Type: ReDIF-Article 1.0 Title: Nonclinical factors associated with surgery received for treatment of early-stage breast cancer Journal: American Journal of Public Health Author-Name: Satariano, E.R. Author-Name: Swanson, G.M. Author-Name: Moll, P.P. Year: 1992 Volume: 82 Issue: 2 Pages: 195-198 Abstract: Background. Women diagnosed with early breast cancer have had the opportunity to receive breast-conserving surgical treatment, which reduces the physical and psychological morbidity heretofore associated with breast removal. Methods. Nonclinical factors associated with women receiving partial mastectomies with radiation (P+R) compared with modified radical mastectomies without radiation (MOR) were examined in 2238 Black and White women diagnosed, in 1985 through 1987, with early-stage breast cancer in the metropolitan Detroit area. Results. Age at diagnosis and size of hospital were the strongest predictors of type of surgery received, with younger women (less than 55 years of age) and women treated in larger hospitals (more than 500 beds) more than twice as likely to receive P+R. Stratifying on race, age at diagnosis remained the strongest predictor for White women, followed by hospital size. Among Black women, hospital size was more strongly associated with surgery received than was age. Conclusions. Younger women and women undergoing treatment at large hospitals are more likely to receive the breast-conserving P+R. Black women treated in small hospitals appear to be particularly unlikely to receive P+R. Handle: RePEc:aph:ajpbhl:1992:82:2:195-198_0 Template-Type: ReDIF-Article 1.0 Title: Commentary: Methods women can use that may prevent sexually transmitted disease, including HIV Journal: American Journal of Public Health Author-Name: Rosenberg, M.J. Author-Name: Gollub, E.L. Year: 1992 Volume: 82 Issue: 11 Pages: 1473-1478 Abstract: Although sexually transmitted diseases, including human immunodeficiency virus (HIV), are a major concern for women, few prevention messages are targeted specifically to women. Those that are generally stress abstaining, altering the number or selection of partners, and urging partners to use condoms. But these behaviors may be unrealistic for many women, particularly women who are at highest risk for sexually transmitted diseases, because they require significant changes in lifestyle or depend on male-controlled condom use. Recommendation of contraceptives for prevention of sexually transmitted diseases depends largely on how well specific methods perform under controlled conditions, either in the laboratory or in clinical trials. Observational studies, which better reflect day-to-day use, indicate that condoms, barriers, and spermicides, used property and consistently, can provide substantial protection against various sexually transmitted diseases. Condoms can similarly help protect against HIV, but studies of barriers and spermicides are scant and currently inconclusive. Finally, those methods that are controlled by women are consistently more effective in preventing sexually transmitted diseases. Thus, although condoms used well are still the best choice, the imperative for female-controlled methods indicates that diaphragms and spermicides should receive greater emphasis in prevention messages. Handle: RePEc:aph:ajpbhl:1992:82:11:1473-1478_4 Template-Type: ReDIF-Article 1.0 Title: Duration of Medicaid AIDS hospitalizations - Variation by season, stage, and year Journal: American Journal of Public Health Author-Name: Markson, L.E. Author-Name: Turner, B.J. Author-Name: Fanning, T.R. Year: 1992 Volume: 82 Issue: 4 Pages: 578-580 Abstract: Using New York State Medicaid data from 1984 to 1987, we analyzed hospital length-of-stay patterns for acquired immunodeficiency syndrome (AIDS) patients. We found an overall decline in monthly average length of stay, with seasonal fluctuations producing longer stays in the fall and winter months. These findings suggest that hospital utilization for AIDS patients is changing over time and may vary by season. Handle: RePEc:aph:ajpbhl:1992:82:4:578-580_6 Template-Type: ReDIF-Article 1.0 Title: Professional relationships between midwives and physicians: Collaboration or conflict? Journal: American Journal of Public Health Author-Name: Baldwin, L.-M. Author-Name: Hutchinson, H.L. Author-Name: Rosenblatt, R.A. Year: 1992 Volume: 82 Issue: 2 Pages: 262-264 Abstract: This study examines the professional relationships between midwives and physicians providing obstetrical care in Washington State. Four hundred ninety-six randomly sampled family physicians and obstetrician-gynecologists and 211 certified nurse, licensed, and lay midwives were surveyed to learn more about midwife/physician consulting relationships. Only certified nurse midwives have forged mutually satisfactory relationships with the physician community. Increased hospital-based training and practice opportunities are needed before licensed midwives can improve their professional relationships with physicians. Handle: RePEc:aph:ajpbhl:1992:82:2:262-264_1 Template-Type: ReDIF-Article 1.0 Title: National mortality rates: The impact of inequality? Journal: American Journal of Public Health Author-Name: Wilkinson, R.G. Year: 1992 Volume: 82 Issue: 8 Pages: 1082-1084 Abstract: Although health is closely associated with income differences within each country there is, at best, only a weak link between national mortality rates and average income among the developed countries. On the other hand, there is evidence of a strong relationship between national mortality rates and the scale of income differences within each society. These three elements are coherent if health is affected less by changes in absolute material standards across affluent populations than it is by relative income or the scale of income differences and the resulting sense of disadvantage within each society. Rather than socioeconomic mortality differentials representing a distribution around given national average mortality rates, it is likely that the degree of income inequality indicates the burden of relative deprivation on national mortality rates. Handle: RePEc:aph:ajpbhl:1992:82:8:1082-1084_4 Template-Type: ReDIF-Article 1.0 Title: Workplace compliance with a no-smoking law: A randomized community intervention trial Journal: American Journal of Public Health Author-Name: Rigotti, N.A. Author-Name: Bourne, D. Author-Name: Rosen, A. Author-Name: Locke, J.A. Author-Name: Schelling, T.C. Year: 1992 Volume: 82 Issue: 2 Pages: 229-235 Abstract: Background. Compliance with state and local laws restricting smoking in public places and workplaces has not been systematically evaluated. Methods. We assessed workplace compliance with a comprehensive no-smoking law adopted in Brookline, Mass, and tested whether mailing information to businesses increased awareness of and compliance with the law. We conducted a random sample telephone survey of 299 businesses (87% response rate). Self-reported compliance was validated by direct observations. Results. One year after its adoption, the law was popular with businesses. The prevalence of smoking restrictions, smoking policies, and no-smoking signs was 80%, 59%, and 40%, respectively. One third of businesses banned smoking. Full compliance with the law was low, however, because few businesses posted a copy of their smoking policy as required. The mailing increased employers' awareness of the law. Employers sent the mailing also reported better compliance, but this was not confirmed by direct observations. Conclusions. The law was popular and contributed to a high prevalence of workplace smoking restrictions. Different interpretations of the law by policymakers and businesses seemed to explain why formal compliance was low. The mailing increased awareness of, but not compliance with, the law. Handle: RePEc:aph:ajpbhl:1992:82:2:229-235_9 Template-Type: ReDIF-Article 1.0 Title: Inaccuracies in certification of nonmelanoma skin cancer deaths Journal: American Journal of Public Health Author-Name: Weinstock, M.A. Author-Name: Bogaars, H.A. Author-Name: Ashley, M. Author-Name: Litle, V. Author-Name: Bilodeau, E. Author-Name: Kimmel, S. Year: 1992 Volume: 82 Issue: 2 Pages: 278-281 Abstract: Nonmelanoma skin cancer is the most common cancer site in the United States, yet mortality from this cause is poorly understood. We sought medical records of the 116 reported deaths during 1979 through 1987 from this cause (International Classification of Diseases, 9th version [ICD-9], code 173) among Rhode Island residents to evaluate the accuracy of the reported cause of death. Of the 110 cases for which the cause of death could be classified as correct or incorrect, 59 (54%) were misclassified, 49 (83%) of which were mucous-membrane, squamous-cell carcinomas of the head and neck. For most of these, the written death certificate diagnosis was squamous-cell carcinoma of the head and neck, which was coded 173.4. Other problematic diagnoses were cancer of the head and neck and malignant fibrous histiocytoma. In response to a mailed survey, most health departments replied that squamous-cell carcinoma of the head and neck was coded under rubric 173 and malignant fibrous histiocytoma was coded under rubric 171, but there was no unanimity. The misclassification of other causes of death to ICD-9 rubric 173 is substantial. The vast majority were coded to rubric 173.4 and were due to a small number of diagnoses that are recognizable on examination of the death certificate. Handle: RePEc:aph:ajpbhl:1992:82:2:278-281_4 Template-Type: ReDIF-Article 1.0 Title: Making human junk: Child labor as a health issue in the progressive era Journal: American Journal of Public Health Author-Name: Derickson, A. Year: 1992 Volume: 82 Issue: 9 Pages: 1280-1290 Abstract: The adverse health effects of work on approximately 2 million employed children troubled many in the United States during the early 20th century. Advocates of reform initially built a rationale for protective legislation primarily from informal, lay observations of the broad developmental outcomes of premature employment. In this endeavor, they projected a dismal scenario of impending national deterioration. This argument received strong criticism for the inadequacy of its corroborating evidence. In response, Progressive reformers emphasized the specific, measurable consequences of particular occupations. Increasingly, liberal advocates of the exclusion of boys and girls from the work force drew upon statistical compilations of occupational injuries and illnesses diagnosed by physicians. Despite their turn toward scientism, Progressives remained somewhat ambivalent about the sufficiency of quantitative data alone to achieve their aims. Handle: RePEc:aph:ajpbhl:1992:82:9:1280-1290_9 Template-Type: ReDIF-Article 1.0 Title: US national health data on Asian Americans and Pacific Islanders: A research agenda for the 1990s Journal: American Journal of Public Health Author-Name: Yu, E.S.H. Author-Name: Liu, W.T. Year: 1992 Volume: 82 Issue: 12 Pages: 1645-1652 Abstract: Objectives. In spite of over 30 years of periodic nationwide surveys, we have thus far only the most rudimentary estimates of the determinants of the health of Asian Americans and Pacific Islanders. This paper explores ways to improve the capability of the National Center for Health Statistics (NCHS) to collect national health data on these populations. Methods. The NCHS 'race' coding practices are reviewed, their limitations stated, ways to improve the numerator and denominator data discussed, and a research agenda presented. Results. Resources can be intensified to produce better denominator data, and to improve the collection of detailed ethnicity information for the numerators, in at least the three states (California, New York, and Hawaii) where the majority of Asian/Pacific Islanders lived in 1990. Subsequently, these efforts should be extended to the 10 states where 79% of these individuals reside or to the top 15 metropolitan areas where they are concentrated. Conclusions. If the recommendations are implemented, several coordinated multisite, multiwave epidemiologic surveys can be conducted using standardized interview instruments and data collection procedures that will capitalize on the geographic distribution of Asian/Pacific Islanders. Handle: RePEc:aph:ajpbhl:1992:82:12:1645-1652_9 Template-Type: ReDIF-Article 1.0 Title: Magic Johnson's credibility among African-American men [6] Journal: American Journal of Public Health Author-Name: Mays, V.M. Author-Name: Flora, J.A. Author-Name: Schooler, C. Author-Name: Cochran, S.D. Year: 1992 Volume: 82 Issue: 12 Pages: 1692-1693 Handle: RePEc:aph:ajpbhl:1992:82:12:1692-1693_3 Template-Type: ReDIF-Article 1.0 Title: How women's adopted low-fat diets affect their husbands Journal: American Journal of Public Health Author-Name: Shattuck, A.L. Author-Name: White, E. Author-Name: Kristal, A.R. Year: 1992 Volume: 82 Issue: 9 Pages: 1244-1250 Abstract: Objectives. One way of promoting a reduction in dietary fat intake is by changing the diet of family members. This study investigated the long-term effects of a low-fat dietary intervention on husbands of women who participated in the Women's Health Trial (WHT). Methods. An average of 12 months after the end of the WHT, a randomly selected sample of participants' husbands was sent dietary and health questionnaires as part of a follow-up study of the maintenance of the low-fat diet among WHT participants. Results. We found an absolute difference in fat intake between groups of 4 percentage points (32.9% energy from fat among intervention husbands [n = 188] vs 36.9% among control husbands [n = 180]). The wife's attitude and fat intake were among the most important predictors of her husband's fat intake, indicating that the effect of the WHT intervention on the husbands of participants was more likely due to their acceptance of lower-fat foods being served at home than to overt actions by the men. Conclusions. Our results suggest that a dietary intervention aimed at women can have an effect on their husbands and may be a cost-effective approach to healthy dietary change for both women and men. Handle: RePEc:aph:ajpbhl:1992:82:9:1244-1250_4 Template-Type: ReDIF-Article 1.0 Title: Restricted activity days among older adults Journal: American Journal of Public Health Author-Name: Kosorok, M.R. Author-Name: Omenn, G.S. Author-Name: Diehr, P. Author-Name: Koepsell, T.D. Author-Name: Patrick, D.L. Year: 1992 Volume: 82 Issue: 9 Pages: 1263-1267 Abstract: Objectives. The number of restricted activity days experienced by an individual in the course of a year is an important measure of functional well-being, particularly for older adults. We sought to determine multivariate associations between restricted activity days and various health conditions. Methods. We used data from the 1984 Supplement on Aging of the National Health Interview Survey to estimate the relationship between restricted activity days and age, gender, and the presence or absence of selected chronic conditions and falls for all noninstitutionalized people aged 65 years and over. Chronic conditions and falls accounted for most of the variance in the model. Results. Of an annual average of 31 restricted activity days, 6 days were associated with falls; 4 days with heart disease; 4 days with arthritis and rheumatism; 2 days each with high blood pressure, cerebrovascular disease, and visual impairment; and 1 day each with atherosclerosis, diabetes, major malignancies, and osteoporosis. Conclusions. These results can be used in estimating the potential impact of health promotion programs on the health status of noninstitutionalized older adults. Handle: RePEc:aph:ajpbhl:1992:82:9:1263-1267_7 Template-Type: ReDIF-Article 1.0 Title: Effects of workplace health promotion not demonstrated [7] Journal: American Journal of Public Health Author-Name: Warner, K.E. Author-Name: Bertera, R.L. Year: 1992 Volume: 82 Issue: 1 Pages: 126-127 Handle: RePEc:aph:ajpbhl:1992:82:1:126-127_4 Template-Type: ReDIF-Article 1.0 Title: Which newborns in New York City are at risk for special education placement? Journal: American Journal of Public Health Author-Name: Goldberg, D. Author-Name: McLaughlin, M. Author-Name: Grossi, M. Author-Name: Tytun, A. Author-Name: Blum, S. Year: 1992 Volume: 82 Issue: 3 Pages: 438-440 Abstract: In this study of 162 third graders in New York City public schools, we found that slightly over half of the children in special education were males who had Medicaid coverage at birth and mothers with medical conditions or adverse health habits noted on the birth certificate; two thirds of the children with this combination of characteristics actually were placed in special education. These findings suggest that newborns at risk for later learning disabilities can be targeted to receive preventive interventions. Handle: RePEc:aph:ajpbhl:1992:82:3:438-440_9 Template-Type: ReDIF-Article 1.0 Title: Disability in occupations in a national sample Journal: American Journal of Public Health Author-Name: Leigh, J.P. Author-Name: Fries, J.F. Year: 1992 Volume: 82 Issue: 11 Pages: 1517-1524 Abstract: Objectives. We sought to develop lists of jobs whose members reported high and low levels of functional disability. Methods. Samples of women (n = 6096) and men (n = 3653) were drawn from the National Health and Nutrition Examination Survey I Epidemiological Follow-up. Disability was measured with a modified Stanford Health Assessment Questionnaire. We analyzed women and men separately, and we calculated average disability indices within longest- held occupations while adjusting for age, age-squared, married spouse present, and education. We minimized attrition bias with an econometric technique. Results. From highest to lowest association with disability, the female broad occupations ranking was as follows: farming, no occupation, laborers, service, technicians, operatives, crafts workers, transportation operators, professionals, sales workers, administrative support, and managers. The male broad occupations ranking was as follows: no occupation, farming, operatives, crafts workers, service, technicians, manager, administrative support, sales, and professionals. The highest levels of disability for women and men occurred among nonconstruction laborers, farm workers, twisting machine operators, servants, machinery maintenance workers, mining machine operators, and bus drivers. Conclusions. Our results suggest that, in understanding levels of functional disability, occupational safety and health play a larger role than is generally assumed. Handle: RePEc:aph:ajpbhl:1992:82:11:1517-1524_0 Template-Type: ReDIF-Article 1.0 Title: Conclusions on cancer and low socioeconomic status questioned [1] Journal: American Journal of Public Health Author-Name: Gunn, R.A. Author-Name: Sosin, D.M. Author-Name: Farley, T.A. Author-Name: Mandelblatt, J. Year: 1992 Volume: 82 Issue: 10 Pages: 1418-1420 Handle: RePEc:aph:ajpbhl:1992:82:10:1418-1420_2 Template-Type: ReDIF-Article 1.0 Title: Adolescent smoking, weight changes, and binge-purge behavior: Associations with secondary amenorrhea Journal: American Journal of Public Health Author-Name: Johnson, J. Author-Name: Whitaker, A.H. Year: 1992 Volume: 82 Issue: 1 Pages: 47-54 Abstract: Background. The association of secondary amenorrhea with extreme forms of substance use, weight control, and exercise in nonrepresentative samples raises questions as to whether adolescents in the general population who engage in these behaviors are at increased risk for secondary amenorrhea. We examined the prevalence and behavioral correlates of secondary amenorrhea in a county-wide high school population of 2544 girls aged 13 to 18. Methods. A survey questionnaire, which elicited menstrual history as well as weight history, weight control practices, level of exercise, and use of cigarettes, wine, and beer, was administered during school hours; absentees were also surveyed. The completion rate was 91%. Results. The 1-year prevalence of secondary amenorrhea was 8.5%. Secondary amenorrhea was associated with smoking one or more packs of cigarettes per day (adjusted relative risk [RRa] = 1.96, 1.21-3.10), with multiple binge-eating behavors in combination with laxative use or self-induced vomiting (RRa = 4.17, 2.54-6.32), and with weight fluctuation due to weight control (RRa = 2.59, 1.33-4.79). There was no association between amenorrhea and alcohol consumption or exercise level. Conclusions. Estimates of attributable risk are provided and indicate that bulimic behaviors and cigarette smoking may result in a considerable excess of cases of secondary amenorrhea in an adolescent population. Handle: RePEc:aph:ajpbhl:1992:82:1:47-54_0 Template-Type: ReDIF-Article 1.0 Title: Serving all Journal: American Journal of Public Health Author-Name: Susser, M. Year: 1992 Volume: 82 Issue: 4 Pages: 521-522 Handle: RePEc:aph:ajpbhl:1992:82:4:521-522_3 Template-Type: ReDIF-Article 1.0 Title: Socioeconomic status and health: How education, income, and occupation contribute to risk factors for cardiovascular disease Journal: American Journal of Public Health Author-Name: Winkleby, M.A. Author-Name: Jatulis, D.E. Author-Name: Frank, E. Author-Name: Fortmann, S.P. Year: 1992 Volume: 82 Issue: 6 Pages: 816-820 Abstract: Background. Socioeconomic status (SES) is usually measured by determining education, income, occupation, or a composite of these dimensions. Although education is the most commonly used measure of SES in epidemiological studies, no investigators in the United States have conducted an empirical analysis quantifying the relative impact of each separate dimension of SES on risk factors for disease. Methods. Using data on 2380 participants from the Stanford Five-City Project (85% White, non-Hispanic), we examined the independent contribution of education, income, and occupation to a set of cardiovascular disease risk factors (cigarette smoking, systolic and diastolic blood pressure, and total and high-density lipoprotein cholesterol). Results. The relationship between these SES measures and risk factors was strongest and most consistent for education, showing higher risk associated with lower levels of education. Using a forward selection model that allowed for inclusion of all three SES measures after adjustment for age and time of survey, education was the only measure that was significantly associated with the risk factors (P < .05). Conclusion. If economics or time dictate that a single parameter of SES be chosen and if the research hypothesis does not dictate otherwise, higher education may be the best SES predictor of good health. Handle: RePEc:aph:ajpbhl:1992:82:6:816-820_3 Template-Type: ReDIF-Article 1.0 Title: Rotating shift work, sleep, and accidents related to sleepiness in hospital nurses Journal: American Journal of Public Health Author-Name: Gold, D.R. Author-Name: Rogacz, S. Author-Name: Bock, N. Author-Name: Tosteson, T.D. Author-Name: Baum, T.M. Author-Name: Speizer, F.E. Author-Name: Czeisler, C.A. Year: 1992 Volume: 82 Issue: 7 Pages: 1011-1014 Abstract: A hospital-based survey on shift work, sleep, and accidents was carried out among 635 Massachusetts nurses. In comparison to nurses who worked only day/evening shifts, rotators had more sleep/wake cycle disruption and nodded off more at work. Rotators had twice the odds of nodding off while driving to or from work and twice the odds of a reported accident or error related to sleepiness. Application of circadian principles to the design of hospital work schedules may result in improved health and safety for nurses and patients. Handle: RePEc:aph:ajpbhl:1992:82:7:1011-1014_5 Template-Type: ReDIF-Article 1.0 Title: Prevalence of HIV antibodies in transsexual and female prostitutes Journal: American Journal of Public Health Author-Name: Modan, B. Author-Name: Goldschmidt, R. Author-Name: Rubinstein, E. Author-Name: Vonsover, A. Author-Name: Zinn, M. Author-Name: Golan, R. Author-Name: Chetrit, A. Author-Name: Gottlieb-Stematzky, T. Year: 1992 Volume: 82 Issue: 4 Pages: 590-592 Abstract: Human immunodeficiency virus (HIV) prevalence was studied in an unselected group of 216 female and transsexual prostitutes. Subjects were asked about age, biological sex, marital status, children, length of occupation, sexual practices, and drug abuse history. Blood was drawn on site. All 128 females who did not admit to drug abuse were seronegative; 2 of the 52 females (3.8%) who admitted to intravenous drug abuse were seropositive. In contrast, 11.1% of the 36 male transsexuals (including 3 out of 32 non-drug abusers) were seropositive. The results support the notion that vaginal transmission of HIV is less effective than anal transmission. Handle: RePEc:aph:ajpbhl:1992:82:4:590-592_5 Template-Type: ReDIF-Article 1.0 Title: A quality-of-life method for estimating the value of avoided morbidity Journal: American Journal of Public Health Author-Name: French, M.T. Author-Name: Mauskopf, J.A. Year: 1992 Volume: 82 Issue: 11 Pages: 1553-1555 Abstract: We developed a quality-of-life method for valuing changes in health status. Our model determines changes in health attributes for different illnesses and then estimates the dollar value of the corresponding welfare losses. We used our quality-of-life approach to estimate willingness to pay to avoid asthma, a headache, a cough, bronchitis, and arthritis. Estimates derived using our method are similar to those obtained from more expensive and restrictive traditional methods. Handle: RePEc:aph:ajpbhl:1992:82:11:1553-1555_1 Template-Type: ReDIF-Article 1.0 Title: A statewide early intervention program for HIV-infected people Journal: American Journal of Public Health Author-Name: Coye, M.J. Author-Name: Grant, C. Author-Name: Hummel, R.P. Author-Name: Conviser, R. Year: 1992 Volume: 82 Issue: 2 Pages: 303-304 Handle: RePEc:aph:ajpbhl:1992:82:2:303-304_2 Template-Type: ReDIF-Article 1.0 Title: Ownership and performance of outpatient substance abuse treatment centers Journal: American Journal of Public Health Author-Name: Wheeler, J.R.C. Author-Name: Fadel, H. Author-Name: D'Aunno, T.A. Year: 1992 Volume: 82 Issue: 5 Pages: 711-718 Abstract: Background. Little is known about the organization and performance of outpatient substance abuse treatment (OSAT) centers. We examine several performance measures of OSAT units, including clients treated, services provided, revenue sources, financial performance, and access to care, in relation to ownership of the center. Methods. Data were drawn from a national random sample of 575 OSAT centers (85.8% response rate) participating in a telephone survey conducted in 1988. Analysis of variance by ownership was conducted on each performance measure, with differences subjected to tests of statistical significance. Results. Descriptive results show that major funding sources differ by ownership. Private for-profit centers generate higher profits, charge higher prices, and achieve higher levels of financial performance than public and not-for-profit centers. Public centers provide better access to care for persons who are unable to pay. Conclusions. There appear to be substantial and interrelated differences by ownership type in the financing and operation of OSAT units. Handle: RePEc:aph:ajpbhl:1992:82:5:711-718_1 Template-Type: ReDIF-Article 1.0 Title: Carrier screening for cystic fibrosis: A pilot study of the attitudes of pregnant women Journal: American Journal of Public Health Author-Name: Botkin, J.R. Author-Name: Alemagno, S. Year: 1992 Volume: 82 Issue: 5 Pages: 723-725 Abstract: We surveyed the attitudes of a consecutive sample of 306 pregnant Caucasian women toward carrier screening for cystic fibrosis. Of the 214 respondents, 98% said that screening should be offered before pregnancy, and 69% said they would accept carrier screening during pregnancy. Twenty-nine percent of the respondents indicated a willingness to terminate a pregnancy if the fetus were found to have cystic fibrosis. We conclude that carrier screening is of interest to pregnant women, although interest in terminating a pregnancy because of screening results may be limited. Handle: RePEc:aph:ajpbhl:1992:82:5:723-725_0 Template-Type: ReDIF-Article 1.0 Title: Predictors of smoking relapse after noncardiac surgery Journal: American Journal of Public Health Author-Name: Simon, J.A. Author-Name: Browner, W.S. Author-Name: Mangano, D.T. Year: 1992 Volume: 82 Issue: 9 Pages: 1235-1237 Abstract: Objectives. We studied 235 smokers who were admitted for major noncardiac surgery and who survived hospitalization to determine the frequency and predictors of smoking relapse 1 year after hospitalization. Methods. We analyzed data collected prospectively from the Study of Perioperative Ischemia. We determined smoking status by self-report. Results. At 12 months posthospitalization, 142 (76%) of the 186 surviving patients had resumed smoking. Significant independent predictors of relapse at 12 months were a history of alcohol abuse and a history of heavy cigarette smoking (P < 0.01 and P < 0.05, respectively). Conclusions. Since smokers commonly undergo surgery, the perioperative period provides a valuable window of opportunity for smoking cessation interventions designed to decrease the high rate of smoking relapse after surgery. Handle: RePEc:aph:ajpbhl:1992:82:9:1235-1237_0 Template-Type: ReDIF-Article 1.0 Title: Correlates of obesity in young Black and White women: The CARDIA study Journal: American Journal of Public Health Author-Name: Burke, G.L. Author-Name: Savage, P.J. Author-Name: Manolio, T.A. Author-Name: Sprafka, J.M. Author-Name: Wagenknecht, L.E. Author-Name: Sidney, S. Author-Name: Perkins, L.L. Author-Name: Liu, K. Author-Name: Jacobs Jr., D.R. Year: 1992 Volume: 82 Issue: 12 Pages: 1621-1625 Abstract: Objectives. Although differences in obesity between Blacks and Whites are well documented in adult women, less information is available on potential correlates of these differences, especially in young adults. Methods. The association between behavioral and demographic factors and body size was assessed in 2801 Black and White women aged 18 to 30 years. Results. Black women had significantly higher age-adjusted mean body mass index and subscapular skinfold thickness than did White women. Obesity had different associations with age and education across racial groups. A positive relationship between age and obesity was seen in Black women but not in White women, whereas a negative association between education and body size was noted only in White women. Potential contributing factors to the increased prevalence of obesity in Black women include a more sedentary lifestyle, higher energy intake, earlier menarche, and earlier age at first childbirth. Conclusions. The difference in obesity across race could not be explained completely by these factors, since within virtually all strata, Black women had higher body mass indexes. Further investigation is needed to develop interventional strategies to prevent or reduce excess levels of obesity in Black women. Handle: RePEc:aph:ajpbhl:1992:82:12:1621-1625_2 Template-Type: ReDIF-Article 1.0 Title: The cost and frequency of hospitalization for fall-related injuries in older adults Journal: American Journal of Public Health Author-Name: Alexander, B.H. Author-Name: Rivara, F.P. Author-Name: Wolf, M.E. Year: 1992 Volume: 82 Issue: 7 Pages: 1020-1023 Abstract: Using a population-based hospital discharge registry with E codes, we examine the 1989 hospitalizations of older adults in Washington State for fall-related injuries. Fall-related trauma accounted for 5.3% of all hospitalizations of older adults, with hospital charges totaling $53 346 191, and resulted in discharge to nursing care more often than other such hospitalizations. An annual hospitalization rate of 13.5 per 1000 persons and an annual cost of $92 per person is reported. The importance of preventing fall-related injuries in older adults is discussed. Handle: RePEc:aph:ajpbhl:1992:82:7:1020-1023_8 Template-Type: ReDIF-Article 1.0 Title: Physician and infection control practitioner HIV/AIDS reporting characteristics Journal: American Journal of Public Health Author-Name: Jones, J.L. Author-Name: Meyer, P. Author-Name: Garrison, C. Author-Name: Kettinger, L. Author-Name: Hermann, P. Year: 1992 Volume: 82 Issue: 6 Pages: 889-891 Abstract: We surveyed a random sample of South Carolina physicians and infection control practitioners about the reporting of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) cases. Of physicians surveyed, 79% indicated that HIV infection as well as AIDS should be reported by name. The following characteristics were associated with those physicians who do not report AIDS cases: not feeling responsible for reporting, not reporting a case perceived to have been reported in another state, believing that information required for reporting is not on the chart, and residing in an urban setting. Targeted education can address these underreporting factors. Handle: RePEc:aph:ajpbhl:1992:82:6:889-891_0 Template-Type: ReDIF-Article 1.0 Title: Factors associated with AIDS risk behaviors among high school students in an AIDS epicenter Journal: American Journal of Public Health Author-Name: Walter, H.J. Author-Name: Vaughan, R.D. Author-Name: Gladis, M.M. Author-Name: Ragin, D.F. Author-Name: Kasen, S. Author-Name: Cohall, A.T. Year: 1992 Volume: 82 Issue: 4 Pages: 528-532 Abstract: Background. A greater understanding of the determinants of risky behaviors is an essential precursor to the development of successful AIDS prevention programs for adolescents. Methods. A survey measuring AIDS-related behaviors, beliefs, and knowledge was administered to a sample of 531 10th-grade students residing in an AIDS epicenter. Results. Of the 56.8% of students reporting past-year involvement in sexual intercourse, 67.3% reported unprotected intercourse with low-risk partners, 1.3% reported unprotected intercourse with high-risk partners, and 6.6% reported a past-year history of a sexually transmitted disease. Students whose friends had intercourse and never or inconsistently used condoms, who personally sanctioned intercourse involvement, who believed that the majority of their peers had intercourse, and who perceived low preventive action self-efficacy, were 5.1, 3.0, 2.1, 3.7, and 2.8 times more likely, respectively, to score in the riskier categories of an AIDS behavior index. Conclusions. These findings suggest that addressing socioenvironmental influences on risky and preventive behaviors may prove to be the most effective AIDS prevention strategy among adolescents. Handle: RePEc:aph:ajpbhl:1992:82:4:528-532_3 Template-Type: ReDIF-Article 1.0 Title: Cocaine use in obstetric patients underreported [2] Journal: American Journal of Public Health Author-Name: Sackoff, J. Author-Name: Kline, J. Author-Name: Kinney, A. Author-Name: Grunebaum, A. Year: 1992 Volume: 82 Issue: 7 Pages: 1043 Handle: RePEc:aph:ajpbhl:1992:82:7:1043_7 Template-Type: ReDIF-Article 1.0 Title: The Supreme Court, abortion, and the jurisprudence of class Journal: American Journal of Public Health Author-Name: Mariner, W.K. Year: 1992 Volume: 82 Issue: 11 Pages: 1556-1562 Abstract: The US Supreme Court's decision in Planned Parenthood of Southeastern Pennsylvania v Casey both protects a women's liberty to choose to terminate her pregnancy and permits the state to make it more difficult for her to exercise her choice. In their opinion on the case, Justices O'Connor, Kennedy, and Souter eloquently defend constitutional protection of the right to make intimate decisions like continuing or ending a pregnancy. At the same time, they permit the state to try to persuade pregnant women not to have abortions and to make abortion harder to obtain and more costly, as long as the state's methods do not create an 'undue burden' on the decision. Any restriction on abortion is a burden; whether it is 'undue' (and therefore unconstitutional) depends on one's circumstances. The Court appears to view the difference between an undue burden and mere inconvenience from the perspective of privilege. The restrictions that were upheld may not significantly affect middle-class access to abortion, but they could prove insurmountable for many less privileged women. Handle: RePEc:aph:ajpbhl:1992:82:11:1556-1562_6 Template-Type: ReDIF-Article 1.0 Title: Measuring up: Quality assurance for cholesterol screening programs in Ohio Journal: American Journal of Public Health Author-Name: Boyle, K. Author-Name: Lenhert, E. Author-Name: Porter, L. Author-Name: Pryor, B. Year: 1992 Volume: 82 Issue: 12 Pages: 1687-1688 Handle: RePEc:aph:ajpbhl:1992:82:12:1687-1688_4 Template-Type: ReDIF-Article 1.0 Title: Pediatric gonococcal infection, Florida, 1984 to 1988 Journal: American Journal of Public Health Author-Name: Desenclos, J.-C.A. Author-Name: Garrity, D. Author-Name: Wroten, J. Year: 1992 Volume: 82 Issue: 3 Pages: 426-428 Abstract: We reviewed Florida pediatric gonococcal (GC) infection surveillance data collected between 1984 and 1988. The incidence rate was 11 per 100 000 per year for the age group 1 month through 9 years. Incidence rates were higher for females, other-than-Whites, and residents of rural counties than for males, Whites, and residents of urban counties. The ratio of pediatric GC cases in children younger than 10 years per 1000 adult male GC cases, a substitute measure for the proportion of males that may have perpetrated child sexual abuse, was 3.3 for Whites and 4.9 for other-than-Whites, and was higher for residents of nonmetropolitan counties (9.7) than for residents of metropolitan counties (4.2). These data highlight the importance of GC infection in children and suggest that routine surveillance of pediatric GC infection may be a useful tool for monitoring the occurrence of child sexual abuse. Handle: RePEc:aph:ajpbhl:1992:82:3:426-428_3 Template-Type: ReDIF-Article 1.0 Title: Music preference as a diagnostic indicator of adolescent drug use [3] Journal: American Journal of Public Health Author-Name: Dent, C.W. Author-Name: Galaif, J. Author-Name: Sussman, S. Author-Name: Stacy, A.W. Author-Name: Burton, D. Author-Name: Flay, B.R. Year: 1992 Volume: 82 Issue: 1 Pages: 124 Handle: RePEc:aph:ajpbhl:1992:82:1:124_2 Template-Type: ReDIF-Article 1.0 Title: Job strain and prevalence of hypertension in a biracial population of urban bus drivers Journal: American Journal of Public Health Author-Name: Albright, C.L. Author-Name: Winkleby, M.A. Author-Name: Ragland, D.R. Author-Name: Fisher, J. Author-Name: Syme, S.L. Year: 1992 Volume: 82 Issue: 7 Pages: 984-989 Abstract: Objectives. In this study we tested the association between occupational stress-as measured by job demands, decision latitude, and job strain-and hypertension in a population of 1396 Black and White bus drivers. Methods. Height, weight, blood pressure, and medical history were assessed by physical exam. Drivers completed a questionnaire assessing their work schedules, personal habits, and self-perceptions about job demands and decision latitude. Results. Univariate analyses revealed significant inverse associations; lower levels of job demands and job strain were associated with a higher prevalence of hypertension for Blacks and Whites. After 12 confounding variables were controlled for, the association between these two measures of occupational stress and hypertension became nonsignificant. Decision latitude was also not significantly associated with hypertension. Conclusions. Our findings are inconsistent with previous studies' findings of a positive association between job strain and chronic diseases. The difference in results may be explained by our incorporation of individuals' perceptions in the measurement of occupational stressors and our use of individuals from a single occupation with comparable job responsibilities and income, thus controlling for potential confounding by social class. Handle: RePEc:aph:ajpbhl:1992:82:7:984-989_5 Template-Type: ReDIF-Article 1.0 Title: Variations in asthma hospitalizations and deaths in New York City Journal: American Journal of Public Health Author-Name: Carr, W. Author-Name: Zeitel, L. Author-Name: Weiss, K. Year: 1992 Volume: 82 Issue: 1 Pages: 59-65 Abstract: Background. Recent reports have identified New York City as having asthma mortality rates that are substantially higher than expected based on US rates. This study investigates the problems of asthma morbidity and mortality in New York City. Methods. Data on asthma hospitalizations (1982 to 1986) and deaths (1982 to 1987) among persons aged 0 to 34 years were studied. Descriptive and multivariate techniques were used to examine differences in rates among subgroups and across geographic areas. Results. The average annual hospitalization rate was 39.2 per 10,000; the mortality rate was 1.2 per 100,000. Hospitalization and death rates among Blacks and Hispanics were 3 to 5.5 times those of Whites. Large geographic variations in hospitalizations and mortality occurred. Asthma hospitalization and mortality rates were highly correlated (r = .67), with the highest rates concentrated in the city's poorest neighborhoods. Household income, percentage of population Black, and percentage of population Hispanic were significant predictors of area hospitalization rates (adjusted R2 = .75). Conclusion. These findings provide a basis for focusing investigations of the causes of variations in asthma outcomes and targeting interventions to reduce the disproportionate morbidity and mortality borne by poor and minority populations. Handle: RePEc:aph:ajpbhl:1992:82:1:59-65_2 Template-Type: ReDIF-Article 1.0 Title: Denver's increase in HIV counseling after Magic Johnson's HIV disclosure [5] Journal: American Journal of Public Health Author-Name: Cohn, D.L. Author-Name: Miller, L.A. Author-Name: Yamaguchi, K.J. Author-Name: Douglas, J.M. Year: 1992 Volume: 82 Issue: 12 Pages: 1692 Handle: RePEc:aph:ajpbhl:1992:82:12:1692_4 Template-Type: ReDIF-Article 1.0 Title: Ethnic differences in nicotine exposure [1] Journal: American Journal of Public Health Author-Name: McCarthy, W.J. Author-Name: Caskey, N.H. Author-Name: Jarvik, M.E. Author-Name: Perez-Stable, E.J. Author-Name: Marin, B. Author-Name: Marin, G. Author-Name: Benowitz, N. Author-Name: Wagenknecht, L.E. Author-Name: Haley, N.J. Author-Name: Jacobs Jr., D.R. Year: 1992 Volume: 82 Issue: 8 Pages: 1171-1173 Handle: RePEc:aph:ajpbhl:1992:82:8:1171-1173_8 Template-Type: ReDIF-Article 1.0 Title: Distribution of HIV type 1 infection in childbearing women in California Journal: American Journal of Public Health Author-Name: Capell, F.J. Author-Name: Vugia, D.J. Author-Name: Mordaunt, V.L. Author-Name: Marelich, W.D. Author-Name: Ascher, M.S. Author-Name: Trachtenberg, A.I. Author-Name: Cunningham, G.C. Author-Name: Arnon, S.S. Author-Name: Kizer, K.W. Year: 1992 Volume: 82 Issue: 2 Pages: 254-256 Abstract: The incidence of acquired immunodeficiency syndrome (AIDS) is increasing among California heterosexuals and children. To assess human immunodeficiency virus (HIV)-1 infection in childbearing women, we conducted a blinded serosurvey of newborns. Dried blood specimens taken from 99% of California births during the third quarter of 1988 (n = 135 808) and linked only to maternal demographic categories were tested for HIV-1 antibody by enzyme immunoassay and confirmed by Western blot. Period prevalence of HIV-1 infection was 7.4 per 10 000 childbearing women. Prevalence was highest for Black women and was also elevated for Hispanic and San Francisco Bay Area women. Findings suggest that California Hispanic women will make up an increasing proportion of new AIDS cases. Handle: RePEc:aph:ajpbhl:1992:82:2:254-256_7 Template-Type: ReDIF-Article 1.0 Title: Cancer anxiety and attitudes toward mammography among screening attenders, nonattenders, and women never invited Journal: American Journal of Public Health Author-Name: Gram, I.T. Author-Name: Slenker, S.E. Year: 1992 Volume: 82 Issue: 2 Pages: 249-251 Abstract: A mailed questionnaire survey was conducted among the following groups: 179 women who screened false positive at a free mammography screening; a random sample of 250 women who screened negative; 670 nonattenders of the screening; and a random population sample of 250 women who lived in another city and were not invited, but were otherwise comparable. The most frequently reported reason for nonattendance was not having the opportunity. Furthermore, only 18% of the nonattenders reported anxiety about breast cancer compared with 33% of the population sample (P < .05). Ninety-nine percent of the women who attended indicated a positive attitude toward mammography that had not been adversely affected by screening experiences. Handle: RePEc:aph:ajpbhl:1992:82:2:249-251_9 Template-Type: ReDIF-Article 1.0 Title: Surveillance of sentinel occupational mortality in the District of Columbia: 1980 to 1987 Journal: American Journal of Public Health Author-Name: Cottrell, A. Author-Name: Schwartz, E. Author-Name: Sokas, R. Author-Name: Kofie, V. Author-Name: Welch, L. Year: 1992 Volume: 82 Issue: 1 Pages: 117-119 Abstract: Epidemiological surveillance of sentinel occupationally related deaths commonly relies on computerized analyses of mortality data obtained from vital statistics records. A computer search of death records in the District of Columbia for the period 1980 to 1987 identified 15 cases that noted asbestosis, silicosis, coal worker's pneumoconiosis, or primary cancer of the pleura/mesothelioma as the underlying cause of death. A manual review of the death certificates for the same period identified three times as many cases (n = 48) with any mention of these conditions. Problems with performing surveillance of these events using death certificates include the lack of sufficient information to identify mesotheliomas and the failure to code and computerize all contributing causes of death. Handle: RePEc:aph:ajpbhl:1992:82:1:117-119_5 Template-Type: ReDIF-Article 1.0 Title: Reducing response time in potential MI cases [3] Journal: American Journal of Public Health Author-Name: Sobel, J. Author-Name: Rodgers, W. Author-Name: DeMots, H. Author-Name: Swenson, R. Year: 1992 Volume: 82 Issue: 4 Pages: 616 Handle: RePEc:aph:ajpbhl:1992:82:4:616_3 Template-Type: ReDIF-Article 1.0 Title: Health corners: Reducing chronic disease risks among Black public housing residents in the nation's capital Journal: American Journal of Public Health Author-Name: Rivo, M.L. Author-Name: Gray, K. Year: 1992 Volume: 82 Issue: 4 Pages: 611-612 Handle: RePEc:aph:ajpbhl:1992:82:4:611-612_7 Template-Type: ReDIF-Article 1.0 Title: Obesity and cardiovascular disease risk factors in Black and White girls: The NHLBI Growth and Health Study Journal: American Journal of Public Health Author-Name: Morrison, J.A. Year: 1992 Volume: 82 Issue: 12 Pages: 1613-1620 Abstract: Objectives. Obesity may be a possible explanation for the higher cardiovascular disease mortality in Black women compared with White women. The National Heart, Lung, and Blood Institute Growth and Health Study (NGHS) is designed to assess factors associated with the development of obesity in Black and White preadolescent girls and its effects on major cardiovascular- disease risk factors. Methods. NGHS is a 5-year cohort study of 2379 girls, aged 9 through 10 years at entry. Anthropometry, blood pressure, and maturation staging are measured annually, and blood lipids biannually. Information on education, income, and family composition is also obtained from parents. Results. At baseline, compared with White girls, Black girls were slightly older, biologically more mature, taller, heavier, and had higher Quetelet Indices, skinfolds, and blood pressures. Black girls had lower triglycerides and higher HDL cholesterol than White girls. Total cholesterol and LDL cholesterol were similar in the two groups. Conclusions. Baseline descriptive characteristics of the NGHS cohort showed that, in subjects aged 9 and 10 years, racial differences in obesity and blood pressure were already present. Handle: RePEc:aph:ajpbhl:1992:82:12:1613-1620_1 Template-Type: ReDIF-Article 1.0 Title: Erratum: Predictors of smoking cessation and relapse in older adults (Am J Public Health (1992) 82 (1268-1271)) Journal: American Journal of Public Health Author-Name: Salive, M.E. Author-Name: Cornoni-Huntley, J. Author-Name: LaCroix, A.Z. Author-Name: Ostfeld, A.M. Author-Name: Wallace, R.B. Author-Name: Hennekens, C.H. Year: 1992 Volume: 82 Issue: 11 Pages: 1489 Handle: RePEc:aph:ajpbhl:1992:82:11:1489_0 Template-Type: ReDIF-Article 1.0 Title: Mass media as drug users' key information source on overdoses [3] Journal: American Journal of Public Health Author-Name: Sorensen, J.L. Author-Name: London, J. Author-Name: Tusel, D. Author-Name: Wolfe, R. Author-Name: Washburn, A. Year: 1992 Volume: 82 Issue: 9 Pages: 1294-1295 Handle: RePEc:aph:ajpbhl:1992:82:9:1294-1295_0 Template-Type: ReDIF-Article 1.0 Title: HMO membership, treatment, and mortality risk among prostatic cancer patients Journal: American Journal of Public Health Author-Name: Greenwald, H.P. Author-Name: Henke, C.J. Year: 1992 Volume: 82 Issue: 8 Pages: 1099-1104 Abstract: Objectives. Treatment and mortality risk were compared between prostate cancer patients receiving care in fee-for-service settings and those receiving care in a health maintenance organization (HMO). Methods. Two samples were obtained from a population-based tumor registry. Patients in the first sample (n = 201) were interviewed shortly after diagnosis to obtain data on income, education, overall health status, and expenditures for health status, and expenditures for health care. These data were combined with information from the tumor registry on cancer stage, age, treatment, place of residence, and source of care. Only tumor registry data were obtained for most patients in the second sample (n = 962). For both samples, survival time was monitored for up to 80 months. Results. Multivariate analysis of data from the interviewed sample indicated that HMO patients were less likely to receive surgery but more likely to receive radiation therapy than were those in fee-for-service settings. Mortality risk was lower for the HMO patients than for those in fee-for-service plans. Findings based on the second sample were nearly identical. Conclusions. This study suggests that HMOs may offer important advantages to lower-income patients at risk for specific life- threatening diseases. Handle: RePEc:aph:ajpbhl:1992:82:8:1099-1104_2 Template-Type: ReDIF-Article 1.0 Title: Health and the environment in the 1990s Journal: American Journal of Public Health Author-Name: Doll, R. Year: 1992 Volume: 82 Issue: 7 Pages: 933-941 Abstract: Expectation of life at birth provides a simple measure of the state of health of a country. Differences in the expectation are examined in the United States over time and between males and females and Whites and non- Whites, and worldwide between market and nonmarket developed countries, and between developed and developing countries. The principal factors responsible for the trends and the current differences are changes in the social and physical environment, in personal behavior, and in medical care, and their relative importance is assessed. It is concluded that, at present, the principal environmental hazards worldwide are those associated with poverty of individuals within the market economies and of communities in the developing countries and that in the future, they will be the effects of overpopulation and the production of greenhouse gases. Handle: RePEc:aph:ajpbhl:1992:82:7:933-941_7 Template-Type: ReDIF-Article 1.0 Title: Daniel and Yeo respond [4] Journal: American Journal of Public Health Author-Name: Daniel, W.F. Author-Name: Yeo, R.A. Year: 1992 Volume: 82 Issue: 12 Pages: 1691-1692 Handle: RePEc:aph:ajpbhl:1992:82:12:1691-1692_9 Template-Type: ReDIF-Article 1.0 Title: Pregnancy-related mortality in New Jersey, 1975 to 1989 Journal: American Journal of Public Health Author-Name: Mertz, K.J. Author-Name: Parker, A.L. Author-Name: Halpin, G.J. Year: 1992 Volume: 82 Issue: 8 Pages: 1085-1088 Abstract: Objectives. National data are thought to underestimate pregnancy-related mortality in the United States. A multisource surveillance system for pregnancy-associated deaths in New Jersey offers an opportunity to identify the magnitude of and the trends in pregnancy-related mortality at the state level. Methods. Data from all reported pregnancy-related deaths in the state from 1975 to 1989 were studied, and pregnancy mortality ratios were calculated. Results. The New Jersey pregnancy mortality ratio decreased from the late 1970s to the early 1980s but began to rise in the late 1980s. The pregnancy mortality ratio for non-Whites was 3.6 times that for Whites for the 15-year period. The causes of pregnancy-related deaths changed over the 15-year period, with direct obstetrical causes playing a decreasing role. AIDS has become the major cause of pregnancy-related mortality in New Jersey. Finally, approximately 44% of the pregnancy-related deaths were considered to be preventable by the physician or patient or both. Conclusions. New efforts must be made to combat the recent rise in pregnancy-related deaths, with special attention to preventing deaths among non-White women. Handle: RePEc:aph:ajpbhl:1992:82:8:1085-1088_8 Template-Type: ReDIF-Article 1.0 Title: Wanting children Journal: American Journal of Public Health Author-Name: Miller, C.A. Year: 1992 Volume: 82 Issue: 3 Pages: 341-343 Handle: RePEc:aph:ajpbhl:1992:82:3:341-343_4 Template-Type: ReDIF-Article 1.0 Title: Handedness, accidents, and mental state [3] Journal: American Journal of Public Health Author-Name: James, W.H. Year: 1992 Volume: 82 Issue: 12 Pages: 1691 Handle: RePEc:aph:ajpbhl:1992:82:12:1691_7 Template-Type: ReDIF-Article 1.0 Title: Ineffectiveness of AIDS education and HIV antibody testing in reducing high-risk behaviors among injection drug users Journal: American Journal of Public Health Author-Name: Calsyn, D.A. Author-Name: Saxon, A.J. Author-Name: Freeman Jr., G. Author-Name: Whittaker, S. Year: 1992 Volume: 82 Issue: 4 Pages: 573-575 Abstract: The effectiveness of education in reducing high-risk human immunodeficiency virus (HIV) transmission behaviors was examined in 313 injection drug users. Involvement in high-risk behaviors was assessed via structured interview at study entry and 4 months following the intervention. Subjects were randomly assigned to (1) AIDS education, (2) AIDS education with optional HIV antibody testing, or (3) a wait list. The sample as a whole decreased its involvement in high-risk behaviors, but there were no significant differences as a function of experimental group assignment. Handle: RePEc:aph:ajpbhl:1992:82:4:573-575_9 Template-Type: ReDIF-Article 1.0 Title: Young women's antisocial behavior and the later emotional and behavioral health of their children Journal: American Journal of Public Health Author-Name: Martin, S.L. Author-Name: Burchinal, M.R. Year: 1992 Volume: 82 Issue: 7 Pages: 1007-1010 Abstract: Objectives. Antisocial and criminal behavior are increasing among US youth, especially among females. Thus, questions arise concerning whether youthful female deviant behavior eventually will have negative behavioral and emotional consequences for the later children of these women. Methods. Associations between the severity of early female antisocial behavior (including both drug-related and non-drug-related offenses) and the later behavioral and emotional health of the children of these women were examined among 1425 mother-child pairs of the National Longitudinal Survey of Youth. Results. Multiple linear regression procedures indicated a significant positive relationship between the severity of the mothers' early non-drug- related offenses and the later severity of the children's scores on the Antisocial, Hyperactive, Anxious/Depressed, Headstrong, Peer Conflict/Social Withdrawal, Immature Dependency, and Total Problem subscales of the Behavior Problem Index. Conclusions. This study demonstrated an association between the antisocial behavior of female youth and the later behavioral and emotional problems of the children of these women. Future research needs to determine the mechanisms underlying the intergenerational transmission of these types of problems so that effective preventive and therapeutic public health practices may be designed and implemented. Handle: RePEc:aph:ajpbhl:1992:82:7:1007-1010_1 Template-Type: ReDIF-Article 1.0 Title: Breast cancer screening practices among users of county-funded health centers vs women in the entire community Journal: American Journal of Public Health Author-Name: Lane, D.S. Author-Name: Polednak, A.P. Author-Name: Burg, M.A. Year: 1992 Volume: 82 Issue: 2 Pages: 199-203 Abstract: Background. Breast cancer screening rates tend to be lower among women with lower income and/or education. Methods. Telephone surveys of random samples of women aged 50 to 75 who had visited five health centers (n = 795) and women in the same age group residing in the entire community (n = 404) were conducted in 1988. Results. Despite the significantly lower socioeconomic level, a higher proportion of minority women, and a poorer knowledge of mammography, screening rates in the health center group were not lower than in the community sample. About half or more of the health center respondents had ever had a mammogram regardless of income, education, age, and ethnic group. Of the community respondents, 49% had ever had a mammogram, but the proportion varied significantly by income and education. Within the subgroup of women having annual incomes below $15 000, mammography use was actually higher among health center women; that is, 50% of health center vs 35% of community women reported ever having a mammogram and 31% vs 14%, respectively, reported having a mammogram in the past year. Conclusion. The findings demonstrate the importance of publicly funded health centers in achieving screening rates among the socioeconomically disadvantaged that are comparable to (or even higher than) those in the general population. Handle: RePEc:aph:ajpbhl:1992:82:2:199-203_3 Template-Type: ReDIF-Article 1.0 Title: Living arrangements and survival among middle-aged and older adults in the NHANES I epidemiologic follow-up study Journal: American Journal of Public Health Author-Name: Davis, M.A. Author-Name: Neuhaus, J.M. Author-Name: Moritz, D.J. Author-Name: Segal, M.R. Year: 1992 Volume: 82 Issue: 3 Pages: 401-406 Abstract: Background. There is concern about but little information on how living alone affects the health and survival of older adults. Methods. We examined the association between living arrangements (living alone, with a spouse, or with someone other than a spouse) and survival among 7651 adults, aged 45 to 74 years in the National Health and Nutrition Examination Survey (NHANES I) (1971-1975) and traced at the NHANES I Follow-up Study (1982-1984), to see whether certain sociodemographic factors (race, education, income, and employment), health behaviors (alcohol, smoking, physical activity, and obesity), or chronic medical conditions were influential in the association. Results. We found a stronger association of living arrangements with survival for men than for women, and for middle-aged men than for older men. For men, those living alone and those living with someone other than a spouse were equally disadvantaged in terms of survival. Income, race, employment, and physical activity influenced the association of living arrangements and survival, but their impact varied by age, gender, and living arrangement. Conclusion. Living arrangements had a weak impact on survival among men, but had no effect among women. Handle: RePEc:aph:ajpbhl:1992:82:3:401-406_2 Template-Type: ReDIF-Article 1.0 Title: Attitudes toward genetic testing of Amish, Mennonite, and Hutterite families with cystic fibrosis Journal: American Journal of Public Health Author-Name: Miller, S.R. Author-Name: Schwartz, R.H. Year: 1992 Volume: 82 Issue: 2 Pages: 236-242 Abstract: Background. We had the unique opportunity to study families with cystic fibrosis (CF) from an interrelated Amish-Mennonite kindred and from an isolated Hutterite kindred. Methods. While obtaining blood for DNA linkage analysis to help find the CF gene, we asked family members to answer a questionnaire about attitudes and feelings toward genetic testing. The questionnaire was also administered to families receiving care at the University of Rochester. After DNA-based CF carrier testing was developed, we asked the families whether they wanted to know the results. Results. Each cultural group felt differently about many issues. Between 31% and 78% approved of CF-carrier testing and 14% to 78% approved of prenatal diagnosis. The majority (59%) of Hutterite parents and siblings were opposed to carriers marrying carriers and most (82%) of the CF families wanted to know the results of carrier testing. Conclusions. Cultural differences need to be understood before genetic services are offered. Also, most CF mutations and their clinical correlates (phenotypes) will need to be defined. There are as few as three CF mutations in the Hutterite population. It will be possible to offer them the option to choose accurate genetic counseling. It will be difficult to offer genetic services to other populations with more heterogeneous attitudes and many more identified and yet-to-be-identified CF mutations. Handle: RePEc:aph:ajpbhl:1992:82:2:236-242_8 Template-Type: ReDIF-Article 1.0 Title: Correlates of using mental health services: Implications of using alternative definitions Journal: American Journal of Public Health Author-Name: Mechanic, D. Author-Name: Angel, R.J. Author-Name: Davies, L. Year: 1992 Volume: 82 Issue: 1 Pages: 74-78 Abstract: Background. Studies using varying definitions of mental health visits result in widely divergent estimates. This analysis examines the stability of a predictive model using three varying definitions based on provider type, diagnosis, psychotherapy, and psychotropic medication use. Methods. Interview and questionnaire data and claims records from the RAND Health Insurance Experiment are used to test these models among 3138 enrollees. Results. Estimates of visits, and factors associated with them, are highly sensitive to definitions. Depression was the only symptom/life situation variable, and education the only sociodemographic measure, predictive across all three models. Risk indicators such as suicide thoughts and drinking problems were only significant for the traditional (mental health specialty) model. While patients within the traditional model definition were significantly younger than other enrollees, those within the model using the most expansive definition were significantly older. Varying the definition also led to different results in respect to experimental manipulations, geographic sites, and some specific types of comorbidity. Conclusions. A reasonable definition, consistent with medical standards, requires, at least, a mental health diagnostic judgment and some form of psychotherapeutic or drug treatment. Studies of the content of mental health care are needed. Handle: RePEc:aph:ajpbhl:1992:82:1:74-78_4 Template-Type: ReDIF-Article 1.0 Title: The Behavioral Risk Factor Survey and the Stanford Five-City Project Survey: A comparison of cardiovascular risk behavior estimates Journal: American Journal of Public Health Author-Name: Jackson, C. Author-Name: Jatulis, D.E. Author-Name: Fortmann, S.P. Year: 1992 Volume: 82 Issue: 3 Pages: 412-416 Abstract: Background. Nearly all state health departments collect Behavioral Risk Factor Survey (BRFS) data, and many report using these data in public health planning. Although the BRFS is widely used, little is known about its measurement properties. This study compares the cardiovascular risk behavior estimates of the BRFS with estimates derived from the physiological and interview data of the Stanford Five-City Project Survey (FCPS). Method. The BRFS is a random telephone sample of 1588 adults aged 25 to 64; the FCPS is a random household sample of 1512 adults aged 25 to 64. Both samples were drawn from the same four California communities. Results. The surveys produced comparable estimates for measures of current smoking, number of cigarettes smoked per day, rate of ever being told one has high blood pressure, rate of prescription of blood pressure medications, compliance in taking medications, and mean total cholesterol. Significant differences were found for mean body mass index, rates of obesity, and, in particular, rate of controlled hypertension. Conclusions. These differences indicate that, for some risk variables, the BRFS has limited utility in assessing public health needs and setting public health objectives. A formal validation study is needed to test all the risk behavior estimates measured by this widely used instrument. Handle: RePEc:aph:ajpbhl:1992:82:3:412-416_8 Template-Type: ReDIF-Article 1.0 Title: Passive smoking and lung cancer in nonsmoking women Journal: American Journal of Public Health Author-Name: Brownson, R.C. Author-Name: Alavanja, M.C.R. Author-Name: Hock, E.T. Author-Name: Loy, T.S. Year: 1992 Volume: 82 Issue: 11 Pages: 1525-1530 Abstract: Objectives. The causes of lung cancer among nonsmokers are not clearly understood. To further evaluate the relation between passive smoke exposure and lung cancer in nonsmoking women, we conducted a population-based, case- control study. Methods. Case patients (n = 618), identified through the Missouri Cancer Registry for the period 1986 through 1991, included 432 lifetime nonsmokers and 186 ex-smokers who had stopped at least 15 years before diagnosis or who had smoked for less than 1 pack-year. Control subjects (n = 1402) were selected from driver's license and Medicare files. Results. No increased risk of lung cancer was associated with childhood passive smoke exposure. Adulthood analyses showed an increased lung cancer risk for lifetime nonsmokers with exposure of more than 40 pack-years from all household members (odds ratio [OR] = 1.3; 95% confidence interval [CI] = 1.0, 1.8) or from spouses only (OR = 1.3; 95% CI = 1.0, 1.7). When the time- weighted product of pack-years and average hours exposed per day was considered, a 30% excess risk was shown at the highest quartile of exposure among lifetime nonsmokers. Conclusions. Ours and other recent studies suggest a small but consistent increased risk of lung cancer from passive smoking. Comprehensive actions to limit smoking in public places and worksites are well-advised. Handle: RePEc:aph:ajpbhl:1992:82:11:1525-1530_4 Template-Type: ReDIF-Article 1.0 Title: Mum's the word: The supreme court and family planning Journal: American Journal of Public Health Author-Name: Mariner, W.K. Year: 1992 Volume: 82 Issue: 2 Pages: 296-301 Abstract: On May 23, 1991, the US Supreme Court upheld federal regulations that prohibit federally funded family planning programs from counseling about or referring for abortion. As a result, government benefits may now entail substantial costs. The regulations changed the nature of government-assisted family planning from comprehensive care and counseling to limited services and government-prescribed information. The reasoning in Rust v Sullivan allows government to limit freedom of speech in federally funded programs. The decision may have been influenced by antiabortion sentiment, but it does not affect the legality of abortion. Instead, it sets a precedent for government control of whether and how health care can be discussed wherever government pays some of the bills. Handle: RePEc:aph:ajpbhl:1992:82:2:296-301_4 Template-Type: ReDIF-Article 1.0 Title: Measuring the use of mammography: Two methods compared Journal: American Journal of Public Health Author-Name: Degnan, D. Author-Name: Harris, R. Author-Name: Ranney, J. Author-Name: Quade, D. Author-Name: Earp, J.A. Author-Name: Gonzalez, J. Year: 1992 Volume: 82 Issue: 10 Pages: 1386-1388 Abstract: Population studies often estimate mammography use using women's self- reports. In one North Carolina county, we compared self-report surveys with a second method-counting mammograms per population-for 1987 and 1989. Estimates from self-reports (35% in 1987, 55% in 1989) were considerably higher than those from mammogram counts (20% in 1987, 36% in 1989). We then confirmed 66% of self-reports in the past year. Self-reported use is more accurate regarding whether a woman has had a mammogram than when she had it, but self- reports accurately measure change over time. Handle: RePEc:aph:ajpbhl:1992:82:10:1386-1388_3 Template-Type: ReDIF-Article 1.0 Title: Firefighters and heart disease [4] Journal: American Journal of Public Health Author-Name: Friel, J.K. Author-Name: Stones, M. Year: 1992 Volume: 82 Issue: 8 Pages: 1175-1176 Handle: RePEc:aph:ajpbhl:1992:82:8:1175-1176_8 Template-Type: ReDIF-Article 1.0 Title: High-risk sexual behavior and condom use among gay and bisexual African- American men Journal: American Journal of Public Health Author-Name: Peterson, J.L. Author-Name: Coates, T.J. Author-Name: Catania, J.A. Author-Name: Middleton, L. Author-Name: Hilliard, B. Author-Name: Hearst, N. Year: 1992 Volume: 82 Issue: 11 Pages: 1490-1494 Abstract: Objectives. Little is known about the human immunodeficiency virus (HIV) high-risk sexual practices of gay and bisexual African-American men. These data are needed so that better interventions can be developed and implemented in this population. Methods. The frequency and correlates of unprotected anal intercourse were examined among 250 gay and bisexual African-American men in the San Francisco Bay Area. The cohort was recruited in 1990 from bars, bathhouses, and erotic bookstores, and through African-American gay organizations, street outreach, advertisements in gay mainstream and African- American newspapers, health clinics, and personal referral from other participants. Results. More than 50% of the men in our sample reported having unprotected anal intercourse in the past 6 months, a considerably higher percentage than that among gay White men in San Francisco through 1988 and 1989. Men who practiced unprotected anal intercourse were more likely to be poor, to have been paid for sex, or to have used injection drugs; to have a higher perceived risk of HIV infection; and to report less social support for concerns about risky sexual behavior. Condom norms, condom efficacy, and negative expectations about using condoms predicted these men's failure to use them. Conclusion. In the second decade of the acquired immunodeficiency syndrome epidemic, risk reduction programs are still needed for gay and bisexual African-American men. Handle: RePEc:aph:ajpbhl:1992:82:11:1490-1494_6 Template-Type: ReDIF-Article 1.0 Title: Women health workers: Past and present Journal: American Journal of Public Health Author-Name: Fee, E. Author-Name: Korstad, R.R. Year: 1992 Volume: 82 Issue: 2 Pages: 165-166 Handle: RePEc:aph:ajpbhl:1992:82:2:165-166_4 Template-Type: ReDIF-Article 1.0 Title: Decline in human immunodeficiency virus seropositivity and seroconversion in US Navy enlisted personnel: 1986 to 1989 Journal: American Journal of Public Health Author-Name: Garland, F.C. Author-Name: Gorham, E.D. Author-Name: Cunnion, S.O. Author-Name: Miller, M.R. Author-Name: Balazs, L.L. Year: 1992 Volume: 82 Issue: 4 Pages: 581-584 Abstract: The US Navy administered 1 795 578 enzyme-linked immunosorbent assay (ELISA) tests to 848 632 active-duty Navy enlisted personnel during 1986 to 1989. This study identified 2438 human immunodeficiency virus (HIV)- seropositive active-duty enlisted Navy personnel, including 778 seroconverters. Three types of quarterly rates of HIV seropositivity and seroconversion were determined. All three rates declined. This decline could not be explained by changes in the population tested according to age, race, sex, occupation, or geographic location of home port. Handle: RePEc:aph:ajpbhl:1992:82:4:581-584_9 Template-Type: ReDIF-Article 1.0 Title: British data on coal miners' pneumoconiosis and relevance to US conditions Journal: American Journal of Public Health Author-Name: Attfield, M.D. Year: 1992 Volume: 82 Issue: 7 Pages: 978-983 Abstract: Objectives. The current primary federal dust standard for US underground coal miners of 2 mg/m3 respirable dust is based on British epidemiological information on exposure-response derived in 1969. Since then, much new information has become available. This paper reviews and compares the available information as it relates to the US mining situation. Methods. Recent exposure-response information on pneumoconiosis and dust exposure derived by British researchers was employed to estimate working-life risks of pneumoconiosis for miners exposed to 2 mg/m3. Results. It is estimated that close to 9% of underground coal miners who work for 40 years in a 2 mg/m3 environment would develop pneumoconiosis (category 1 or greater). Progressive massive fibrosis would develop in 0.7%. Conclusions. There are unresolved questions relating to the validity of extrapolating findings on British mines and miners to the US and also in predicting disease levels at the low end of the dust exposure spectrum. Given the data available, current information suggests miners who are employed for a working lifetime at the current federal dust limit of 2 mg/m3 are still at risk of developing pneumoconiosis. Handle: RePEc:aph:ajpbhl:1992:82:7:978-983_5 Template-Type: ReDIF-Article 1.0 Title: Determinants of passive smoking in children in Edinburgh, Scotland Journal: American Journal of Public Health Author-Name: Jarvis, M.J. Author-Name: Strachan, D.P. Author-Name: Feyerabend, C. Year: 1992 Volume: 82 Issue: 9 Pages: 1225-1229 Abstract: Objectives. Using saliva cotinine as a quantitative marker, we examined the contribution of factors other than parental smoking to children's passive exposure to tobacco smoke. Methods. Saliva specimens from a random sample of 734 7-year-old schoolchildren in Edinburgh, Scotland, were analyzed for cotinine. Their parents completed a questionnaire covering smoking habits and conditions in the home. Results. A number of independent predictors of cotinine were identified in addition to the main one of smoking by household members. These predictors included home ownership, social class, day of the week, season of the year, number of parents present, crowding in the home, the number of children in the household, and sex. Cotinine was higher in children from less advantaged backgrounds, during winter, on Mondays, in girls, and when fewer other children were present. The effects were similar between children from nonsmoking and smoking homes. Conclusions. Questionnaire measures of parental smoking are insufficient to fully characterize young children's exposure to passive smoking. Because socioeconomic variables contribute to measured exposure, passive-smoking studies that treat class as a confounder and control for it may be overcontrolling. Handle: RePEc:aph:ajpbhl:1992:82:9:1225-1229_3 Template-Type: ReDIF-Article 1.0 Title: Implementing the Veterans Administration's no-smoking policy Journal: American Journal of Public Health Author-Name: Bevvino, C. Author-Name: Jacob, M.C. Year: 1992 Volume: 82 Issue: 10 Pages: 1416-1417 Handle: RePEc:aph:ajpbhl:1992:82:10:1416-1417_6 Template-Type: ReDIF-Article 1.0 Title: Access to cancer screening services for women Journal: American Journal of Public Health Author-Name: Kirkman-Liff, B. Author-Name: Kronenfeld, J.J. Year: 1992 Volume: 82 Issue: 5 Pages: 733-735 Abstract: A major effort in preventive care for women has emphasized the obtaining of Pap smears and mammograms. This paper uses survey data from one state to examine issues of access to Pap smears and mammograms. Poor women receiving health care through a managed-care Medicaid program received these services at the same rate as women with other types of health insurance, while the uninsured were less likely to have had either type of service. Handle: RePEc:aph:ajpbhl:1992:82:5:733-735_9 Template-Type: ReDIF-Article 1.0 Title: Erratum: Cigarette smoking as a risk factor for sudden infant death syndrome: A population-based study (Am J Public Health (1990) 80 (29-32)) Journal: American Journal of Public Health Author-Name: Haglund, B. Author-Name: Cnattingius, S. Year: 1992 Volume: 82 Issue: 11 Pages: 1489 Handle: RePEc:aph:ajpbhl:1992:82:11:1489_2 Template-Type: ReDIF-Article 1.0 Title: Site assessment of youth access to cigarette vending machines [4] Journal: American Journal of Public Health Author-Name: Gambescia, S.F. Year: 1992 Volume: 82 Issue: 10 Pages: 1421 Handle: RePEc:aph:ajpbhl:1992:82:10:1421_2 Template-Type: ReDIF-Article 1.0 Title: Native American vs all-races infant mortality [5] Journal: American Journal of Public Health Author-Name: Fleshman, C. Author-Name: Williams, S.D. Year: 1992 Volume: 82 Issue: 9 Pages: 1295-1296 Handle: RePEc:aph:ajpbhl:1992:82:9:1295-1296_6 Template-Type: ReDIF-Article 1.0 Title: Pneumococcal bacteremia in Monroe County, New York Journal: American Journal of Public Health Author-Name: Bennett, N.M. Author-Name: Buffington, J. Author-Name: LaForce, F.M. Year: 1992 Volume: 82 Issue: 11 Pages: 1513-1516 Abstract: Objectives. Knowledge of the epidemiology of pneumococcal disease is critical for public health planning, evaluation of preventive strategies, and development of immunization recommendations. Methods. We studied the incidence and case-fatality rates of pneumococcal bacteremia as a proxy for pneumococcal disease in Monroe County, New York, from 1985 through 1989 by reviewing the laboratory and clinical care records of all cases occurring among residents. Results. There were 671 cases identified, for an overall yearly rate of 18.8 per 100 000. The rates were highest in the very young, in the very old, and in non-White populations. Age-specific rates were consistently higher in Blacks than in Whites. Predisposing medical conditions were present in 61% of cases. Case-fatality rates were 15% overall, 27% in those with predisposing medical conditions, and approximately 30% in Blacks older than 55 years and Whites older than 65 years. Conclusions. This study documents the incidence of and mortality from pneumococcal bacteremia. It supports previous observations that Black populations have an increased risk of invasive pneumococcal infection and suggests that immunization should be considered for Blacks older than 55 years. Handle: RePEc:aph:ajpbhl:1992:82:11:1513-1516_9 Template-Type: ReDIF-Article 1.0 Title: Current cigarette smoking and risk of acute pelvic inflammatory disease Journal: American Journal of Public Health Author-Name: Scholes, D. Author-Name: Daling, J.R. Author-Name: Stergachis, A.S. Year: 1992 Volume: 82 Issue: 10 Pages: 1352-1355 Abstract: Objectives. Further information is needed on modifiable factors associated with the occurrence of acute pelvic inflammatory disease (PID). Cigarette smoking has been implicated as a risk factor for PID sequelae, but the association between smoking and PID has yet to be fully examined. Methods. We conducted a population-based case-control study to evaluate smoking as a risk factor for acute PID. The case patients (n = 131) were women health maintenance organization (HMO) enrollees between the ages of 18 and 40 years who were treated for a first episode of PID. The control patients (n = 294) were randomly selected from the HMO enrollment files. Results. Relative to never smokers, current smokers were at increased risk of PID. Women who smoked 10 or more cigarettes per day had a higher risk than did those who smoked less. Available data indicate that smoking status is not serving as a marker for uncontrolled confounding by lifestyle factors. Conclusions. Our study results suggest that smoking represents a modifiable risk factor for acute PID. Handle: RePEc:aph:ajpbhl:1992:82:10:1352-1355_8 Template-Type: ReDIF-Article 1.0 Title: The influence of social and political violence on the risk of pregnancy complications Journal: American Journal of Public Health Author-Name: Zapata, B.C. Author-Name: Rebolledo, A. Author-Name: Atalah, E. Author-Name: Newman, B. Author-Name: King, M.-C. Year: 1992 Volume: 82 Issue: 5 Pages: 685-690 Abstract: Background. Events in Chile provided an opportunity to evaluate health effects associated with exposure to high levels of social and political violence. Methods. neighborhoods in Santiago, Chile, were mapped for occurrences of sociopolitical violence during 1985-86, such as bomb threats, military presence, undercover surveillance, and political demonstrations. Six health centers providing prenatal care were then chosen at random: three from 'high-violence' and three from 'low-violence' neighborhoods. The 161 healthy, pregnant women due to deliver between August 1 and September 7, 1986, who attended these health centers were interviewed twice about their living conditions. Pregnancy complications and labor/delivery information were subsequently obtained from clinic and hospital records. Results. Women living in the high-violence neighborhoods were significantly more likely to experience pregnancy complications than women living in lower violence neighborhoods (OR=5.0; 95% CI=1.9-12.6; p<0.01). Residence in a high-violence neighborhood was the strongest risk factor observed; results persisted after controlling for several sets of potential confounders. Conclusion. Living in areas of high social and political violence increased the risk of pregnancy complications among otherwise healthy women. Handle: RePEc:aph:ajpbhl:1992:82:5:685-690_1 Template-Type: ReDIF-Article 1.0 Title: Performance of the Reflotron in Massachusetts' Model System for Blood Cholesterol Screening Program Journal: American Journal of Public Health Author-Name: Havas, S. Author-Name: Bishop, R. Author-Name: Koumjian, L. Author-Name: Reisman, J. Author-Name: Wozenski, S. Year: 1992 Volume: 82 Issue: 3 Pages: 458-461 Abstract: The precision, accuracy, and durability of the Reflotron were evaluated by the Massachusetts Model Systems for Blood Cholesterol Screening Program. Screenings were conducted in diverse community settings over 16 months. Fingerstick samples from 10 428 individuals were tested. None of the four analyzers met the 1992 standards for precision, although two met the 1992 standards for accuracy. More than 40% of Reflotron values differed from the reference laboratory values by upwards of 5%. More than 16% of individuals were misclassified in terms of their risk category. All four instruments malfunctioned during the project. Handle: RePEc:aph:ajpbhl:1992:82:3:458-461_4 Template-Type: ReDIF-Article 1.0 Title: Evaluation of a self-help dietary intervention in a primary care setting Journal: American Journal of Public Health Author-Name: Beresford, S.A.A. Author-Name: Farmer, E.M.Z. Author-Name: Feingold, L. Author-Name: Graves, K.L. Author-Name: Sumner, S.K. Author-Name: Baker, R.M. Year: 1992 Volume: 82 Issue: 1 Pages: 79-84 Abstract: Background. Dietary intervention to reduce fat consumption and increase fiber consumption has been recommended by the National Cancer Institute, but there is little evidence concerning the effectiveness of self-help materials. The purpose of this study was to evaluate such self-help materials, introduced by a nurse in a primary care setting. Methods. A randomized controlled trial involving 242 subjects was conducted in two primary care clinics in Chapel Hill, NC, in 1987. Changes in fat and fiber consumption in the intervention and control groups during the 3-month interval between interviews were compared using analysis of covariance. Results. The estimated reduction in fat was 3.8g larger for the intervention group than for the control group, but the confidence interval included zero. For those individuals who had some responsibility for meal preparation there was a larger difference (-6.9g) in favor of the intervention group, although the difference using calorie-adjusted values was -3.8g with a 95% confidence interval (-7.1, -0.4). The differences for fiber change were smaller. Conclusions. We found significant small but consistent differential changes associated with a minimal self-help intervention, but we cannot rule out the possibility of some response bias. Nonetheless, this study demonstrates that the use of self-help materials for dietary change is feasible, and may be effective. Handle: RePEc:aph:ajpbhl:1992:82:1:79-84_7 Template-Type: ReDIF-Article 1.0 Title: Use of cardiovascular disease medications and mortality in people with older onset diabetes Journal: American Journal of Public Health Author-Name: Klein, B.E.K. Author-Name: Moss, S.E. Author-Name: Klein, R. Year: 1992 Volume: 82 Issue: 8 Pages: 1142-1144 Abstract: Mortality follow-up for a cohort defined in 1980 with diabetes diagnosed at 30 years of age or older has been completed through 1988. History of medication use was obtained during the initial evaluation. There were 605 (44.2%) confirmed deaths; heart disease was the underlying cause in 49.9% of the deaths. Use of loop diuretics was associated with an odds ratio of death of 1.8 (95% CI = 1.4, 2.2). Although a causal relationship cannot be inferred, it is reasonable to suggest that blood chemistries be monitored regularly in persons on these drugs since electrolyte imbalance may be related to death. Handle: RePEc:aph:ajpbhl:1992:82:8:1142-1144_6 Template-Type: ReDIF-Article 1.0 Title: Folic acid and neural tube defect: Can't we come to closure? Journal: American Journal of Public Health Author-Name: Willett, W.C. Year: 1992 Volume: 82 Issue: 5 Pages: 666-668 Abstract: In a series of nonrandomized and randomized intervention trials and case- control and cohort studies, women using multivitamins or folic acid supplements during the first 6 weeks of pregnancy experienced a three- to fourfold reduction in neural tube defects among their offspring. Viewed collectively, these data provide strong evidence that an important subset of US women do not receive sufficient folic acid to minimize their risk of a defective pregnancy. Further, the amounts of folic acid contained in multivitamins (usually 200-400 μg per day) appear adequate to greatly reduce, and probably eliminate, the excess risk. Handle: RePEc:aph:ajpbhl:1992:82:5:666-668_7 Template-Type: ReDIF-Article 1.0 Title: Improving referral compliance after public cholesterol screening Journal: American Journal of Public Health Author-Name: Maiman, L.A. Author-Name: Hildreth, N.G. Author-Name: Cox, C. Author-Name: Greenland, P. Year: 1992 Volume: 82 Issue: 6 Pages: 804-809 Abstract: Background. Noncompliance with referral to a physician for retesting and diagnosis is a concern in public cholesterol screening. Methods. Participants (n = 2109) were referred by a health professional or lay communicator and randomly assigned to a coupon offer, referral reminder letter, or control group. A questionnaire was completed at screening, and a telephone interview was conducted 5 months later. Results. Physician visit rates showed no professional or lay differences. For 'no history' subjects, the behavioral interventions were effective compared with controls (coupon = 60.7% and reminder = 57.7% vs control = 46.1%). With professional counseling, only the coupon was effective; for lay counseling, both coupon and reminder yielded higher visit rates. Adjusted for sociodemographics, heart disease risk factors, and health perceptions, the intervention effects remained (professional-coupon offer: odds ratio [OR] = 1.94, 95% confidence interval [CI] = 1.21, 3.09; professional-reminder letter: OR = 1.04, 95% CI = 0.67, 1.63; lay-coupon offer: OR = 2.52, 95% CI = 1.52, 4.18; and lay-reminder letter: OR = 3.10, 95% CI = 1.83, 5.22). Conclusions. For unaware participants, lay counselors and referral follow-up efforts tailored to specific cholesterol risk groups are indicated. Handle: RePEc:aph:ajpbhl:1992:82:6:804-809_4 Template-Type: ReDIF-Article 1.0 Title: Neuroleptic medication and prescription practices with sheltered-care residents: A 12-year perspective Journal: American Journal of Public Health Author-Name: Segal, S.P. Author-Name: Cohen, D. Author-Name: Marder, S.R. Year: 1992 Volume: 82 Issue: 6 Pages: 846-852 Abstract: Objectives. Most adult residents of sheltered-care facilities (board and care, family care, psychosocial rehabilitation, and other supported housing arrangements) for the chronically mentally ill receive neuroleptics. These facilities house over 300 000 mentally ill residents, but neuroleptic prescription practices with this population have not been studied. Methods. A probability sample (n = 393) of all adult former psychiatric patients in sheltered care in California was surveyed in 1973; 94% of the located survivors (n = 243) were reinterviewed 12 years later. Results. In 1973, 79% received neuroleptics; in 1985, 76%. Polypharmacy decreased, and the elderly remained less medicated than adults. Yet, mean daily neuroleptic doses doubled, more persons received higher doses, and 62% reported adverse effects. Furthermore, high dosing was attributed to psychiatrists rather than other physicians, even when controlling for residents' clinical and sociodemographic characteristics. Conclusions. Neuroleptic drugs became the staple pharmacological treatment for mentally ill sheltered-care residents. While physicians more cautiously medicated the elderly, they had not reduced doses by 1985, even after a decade of treatment. The specialty of the prescriber was an important factor in preference for high-dose treatment. Handle: RePEc:aph:ajpbhl:1992:82:6:846-852_7 Template-Type: ReDIF-Article 1.0 Title: Inferences from secular trend analysis of hypertension control Journal: American Journal of Public Health Author-Name: Kannel, W.B. Author-Name: Wolf, P.A. Year: 1992 Volume: 82 Issue: 12 Pages: 1593-1595 Handle: RePEc:aph:ajpbhl:1992:82:12:1593-1595_4 Template-Type: ReDIF-Article 1.0 Title: Analyzing the effect of prenatal care on pregnancy outcome: A conditional approach Journal: American Journal of Public Health Author-Name: Malloy, M.H. Author-Name: Kao, T.-C. Author-Name: Lee, Y.J. Year: 1992 Volume: 82 Issue: 3 Pages: 448-450 Abstract: We used vital statistics data to examine the effect of the time of entry into prenatal care relative to the gestational age of delivery on pregnancy outcome. Early entry into prenatal care was associated with better outcomes only in women who delivered at 37 through 42 weeks of gestation. We are concerned that the evaluation of the effect of prenatal care using vital statistics data may be questionable because of the problems inherent in the data. Handle: RePEc:aph:ajpbhl:1992:82:3:448-450_8 Template-Type: ReDIF-Article 1.0 Title: Potential lead exposures from lead crystal decanters Journal: American Journal of Public Health Author-Name: Appel, B.R. Author-Name: Kahlon, J.K. Author-Name: Ferguson, J. Author-Name: Quattrone, A.J. Author-Name: Book, S.A. Year: 1992 Volume: 82 Issue: 12 Pages: 1671-1673 Abstract: We measured the concentrations of lead leached into 4% acetic acid, white port, and a synthetic alcoholic beverage that were stored in lead crystal decanters for 1-, 2-, and 10-day periods at room temperature. In decanters from 14 different manufacturers, measured lead concentrations ranged from 100 to 1800 μg/L. The pH of the leaching medium is probably the dominant factor determining the extent of lead leached, with greater leaching occurring at lower pH values. The consumption of alcoholic beverages stored in lead crystal decanters is judged to pose a hazard. Handle: RePEc:aph:ajpbhl:1992:82:12:1671-1673_3 Template-Type: ReDIF-Article 1.0 Title: The US decline in stroke mortality: What does ecological analysis tell us? Journal: American Journal of Public Health Author-Name: Jacobs Jr., D.R. Author-Name: McGovern, P.G. Author-Name: Blackburn, H. Year: 1992 Volume: 82 Issue: 12 Pages: 1596-1599 Abstract: We review a study in this issue that concludes, from analyses of ecological associations, that the use of medication to lower high blood pressure has caused at most a small decline in US stroke mortality rates. Our analysis suggests that other possible sources of the decline may be population-wide falls in levels of blood pressure, cigarette smoking, and coronary heart disease mortality, as well as improved treatment of cardiac and respiratory sequelae of stroke. Although the ecological method is powerful for answering questions about medical interventions' population- wide effects on disease, it must be used with care. Of particular concern are variables with meanings that differ between the ecological and the individual levels, the number of ecological units available for analysis, the sample size within the ecological units, and the range of independent variables used in ecological regression. Handle: RePEc:aph:ajpbhl:1992:82:12:1596-1599_3 Template-Type: ReDIF-Article 1.0 Title: The epidemiology of low back pain in an adolescent population Journal: American Journal of Public Health Author-Name: Olsen, T.L. Author-Name: Anderson, R.L. Author-Name: Dearwater, S.R. Author-Name: Kriska, A.M. Author-Name: Cauley, J.A. Author-Name: Aaron, D.J. Author-Name: LaPorte, R.E. Year: 1992 Volume: 82 Issue: 4 Pages: 606-608 Abstract: We assessed the prevalence of low back pain (LBP) in a cohort of 1242 adolescents (aged 11 through 17) currently participating in a 4-year prospective study of medically treated injuries. Overall, 30.4% of the adolescents reported LBP. The impact of LBP in adolescents was considerable, with one third resulting in restricted activity and 7.3% seeking medical attention. Life-table analysis demonstrated that by age 15, the prevalence of LBP increased to 36%. There were few differences by gender or race. These results suggest that LBP in adolescents is a serious public health problem. Handle: RePEc:aph:ajpbhl:1992:82:4:606-608_2 Template-Type: ReDIF-Article 1.0 Title: The surveillance definition for AIDS Journal: American Journal of Public Health Author-Name: Buehler, J.W. Year: 1992 Volume: 82 Issue: 11 Pages: 1462-1464 Handle: RePEc:aph:ajpbhl:1992:82:11:1462-1464_0 Template-Type: ReDIF-Article 1.0 Title: Assessing providers of coronary revascularization: A method for peer review organizations Journal: American Journal of Public Health Author-Name: Hartz, A.J. Author-Name: Kuhn, E.M. Author-Name: Kayser, K.L. Author-Name: Pryor, D.P. Author-Name: Green, R. Author-Name: Rimm, A.A. Year: 1992 Volume: 82 Issue: 12 Pages: 1631-1640 Abstract: Objectives. Current methods to evaluate quality of care are usually limited to reviews of individual cases or comparisons of hospital mortality rates. We present an alternative method that compares complication rates adjusted for patient characteristics. Methods. Detailed clinical data that were specifically designed for quality comparisons of providers of revascularization procedures were abstracted from the medical records of 1998 Medicare patients, in 16 hospitals, who had coronary artery bypass surgery and 2091 patients, in 16 hospitals, who had angioplasty. Providers were ranked on the basis of an unadjusted risk, a risk adjusted for detailed clinical information, and a risk adjusted only for patient comorbidities. Results. Complication rates differed significantly and substantially among the hospitals. Clinical adjustment changed the hospital rankings for the bypass surgery hospitals, but not for the angioplasty hospitals. Adjustment for comorbidities did not affect hospital rankings for either procedure. Conclusions. When sample sizes are limited, adverse outcome rates may be a more sensitive measure of quality of care than mortality rates. Rates that are unadjusted or adjusted only for comorbidities may be inadequate for evaluating some providers of bypass surgery. Handle: RePEc:aph:ajpbhl:1992:82:12:1631-1640_3 Template-Type: ReDIF-Article 1.0 Title: The second Chicago Televised Smoking Cessation Program: A 24-month follow- up Journal: American Journal of Public Health Author-Name: Warnecke, R.B. Author-Name: Langenberg, P. Author-Name: Siu Chi Wong Author-Name: Flay, B.R. Author-Name: Cook, T.D. Year: 1992 Volume: 82 Issue: 6 Pages: 835-840 Abstract: Objectives. As smoking decreases in the population, the remaining smoking population will change, and cessation initiatives will have to incorporate strategies designed for these smokers. Methods. To study patterns of response to a cessation intervention composed of 20 televised segments and the American Lung Association Freedom from Smoking in 20 Days manual, this study compared cessation rates over 24 months in a cohort of smokers who registered for a cessation program with those in a cohort selected from the smoking population at large. Results. At post intervention, multiple point prevalence of cessation among participants, adjusted for baseline smoking, was 14% among registrants and 6% in the population; at 24 months the adjusted rates were 6% and 2%, respectively. Heavy smokers benefited more than light smokers, and there was a consistent dose-response relationship between extent of exposure to the intervention and cessation. Conclusion. The effects of the intervention were strongest for those who read the manual and watched the programs daily. Manual use was important, and those who did not read it did not appear to benefit. Compared to the population and given full participation, heavy smokers benefited more than lighter smokers. Handle: RePEc:aph:ajpbhl:1992:82:6:835-840_3 Template-Type: ReDIF-Article 1.0 Title: Mortality and the attribution of health problems to aging among older adults Journal: American Journal of Public Health Author-Name: Rakowski, W. Author-Name: Hickey, T. Year: 1992 Volume: 82 Issue: 8 Pages: 1139-1141 Abstract: This study examined the association between mortality and attributing health problems to aging among 1391 respondents from the Longitudinal Study of Aging who indicated difficulty with activities of daily living. Of this number, 72 persons attributed impairment primarily to 'old age.' Logistic regression controlling for demographics, physical health problems, self-rated health, and social involvements showed an association with mortality (adjusted odds ratio = 1.78, CI = 1.05, 3.00). Attributing health problems to aging may carry a risk of adverse health events. Handle: RePEc:aph:ajpbhl:1992:82:8:1139-1141_5 Template-Type: ReDIF-Article 1.0 Title: The interchange of disease and health between the Old and New Worlds Journal: American Journal of Public Health Author-Name: Berlinguer, G. Year: 1992 Volume: 82 Issue: 10 Pages: 1407-1413 Abstract: A review of the five centuries since Columbus discovered America helps us understand the mutual contributions of the Old and the New Worlds to the history of diseases and their treatment. It also shows the consequences of this 'mutual discovery' as they are currently emerging in the fields of health, culture, and the environment. To evaluate the multiple aspects of the interchange between the Old and New Worlds, this paper discusses the following: the causes of the rapid decline of the original American populations; the diffusion of communicable diseases between the two civilizations; the health consequences of nutritional changes on both sides of the Atlantic; drug addictions, as they developed through the centuries and as they exist today; the ways diseases were and are evaluated, prevented, diagnosed, and treated; and the mutual impact of different models of health services. Arguing that a major global change following the discovery of America was the transition from isolation of the two worlds to communication, and, more recently, to global interdependence, the paper also discusses some problems of bioethical relevance and the possible impact of new epidemics. Finally, it suggests that a critical analysis of the past may help stimulate future cooperation and solidarity. Handle: RePEc:aph:ajpbhl:1992:82:10:1407-1413_7 Template-Type: ReDIF-Article 1.0 Title: Improving the American diet [5] Journal: American Journal of Public Health Author-Name: Blackburn, G.L. Author-Name: Patterson, B.H. Author-Name: Block, G. Year: 1992 Volume: 82 Issue: 3 Pages: 465-466 Handle: RePEc:aph:ajpbhl:1992:82:3:465-466_4 Template-Type: ReDIF-Article 1.0 Title: Epidemiologic studies on electromagnetic fields and cancer [4] Journal: American Journal of Public Health Author-Name: Jauchem, J.R. Year: 1992 Volume: 82 Issue: 6 Pages: 897-898 Handle: RePEc:aph:ajpbhl:1992:82:6:897-898_2 Template-Type: ReDIF-Article 1.0 Title: Legal needle buying in St. Louis Journal: American Journal of Public Health Author-Name: Compton III, W.M. Author-Name: Cottler, L.B. Author-Name: Decker, S.H. Author-Name: Mager, D. Author-Name: Stringfellow, R. Year: 1992 Volume: 82 Issue: 4 Pages: 595-596 Abstract: This study sought to determine if and why barriers to the over-the-counter purchase of syringes in the St. Louis metropolitan area might exist, given that no ordinance prohibits such a sale there. Two male research assistants (one African American, one White) approached 33 of the area's pharmacies to buy syringes. In 14 of those pharmacies, either the purchase was refused or the minimum number of syringes that could be bought was so large (at least 100) that the sale was not practical. Racial bias in rates of refusal and implications for prohibiting or restricting legal availability of syringes are discussed. Handle: RePEc:aph:ajpbhl:1992:82:4:595-596_1 Template-Type: ReDIF-Article 1.0 Title: Work-site nutrition intervention and employees' dietary habits: The treatwell program Journal: American Journal of Public Health Author-Name: Sorensen, G. Author-Name: Morris, D.M. Author-Name: Hunt, M.K. Author-Name: Hebert, J.R. Author-Name: Harris, D.R. Author-Name: Stoddard, A. Author-Name: Ockene, J.K. Year: 1992 Volume: 82 Issue: 6 Pages: 877-880 Abstract: In a randomized, controlled study of the Treatwell work-site nutrition intervention program, which focused on promoting eating patterns low in fat and high in fiber, 16 work sites from Massachusetts and Rhode Island were recruited to participate and randomly assigned to either an intervention or a control condition. The intervention included direct education and environmental programming tailored to each work site; control work sites received no intervention. A cohort of workers randomly sampled from each site was surveyed both prior to and following the intervention. Dietary patterns were assessed using a semiquantitative food frequency questionnaire. Adjusting for work site, the decrease in mean dietary fat intake was 1.1% of total calories more in intervention sites than in control sites (P <.005). Mean changes in dietary fiber intake between intervention and control sites did not differ. This study provides evidence that a work-site nutrition intervention program can effectively influence the dietary habits of workers. Handle: RePEc:aph:ajpbhl:1992:82:6:877-880_6 Template-Type: ReDIF-Article 1.0 Title: Erratum: Reduction in HIV risk-associated sexual behaviors among black male adolescents: Effects of an AIDS prevention intervention (Am J Public Health (1992) 82 (372-377)) Journal: American Journal of Public Health Author-Name: Jemmott III, J.B. Author-Name: Jemmott, L.S. Author-Name: Fong, G.T. Year: 1992 Volume: 82 Issue: 5 Pages: 718 Handle: RePEc:aph:ajpbhl:1992:82:5:718_5 Template-Type: ReDIF-Article 1.0 Title: Habits and attitudes of public health students Journal: American Journal of Public Health Author-Name: Hemenway, D. Author-Name: Solnick, S.J. Author-Name: Weil, D.S. Author-Name: Koeck, C.M. Year: 1992 Volume: 82 Issue: 3 Pages: 464 Handle: RePEc:aph:ajpbhl:1992:82:3:464_8 Template-Type: ReDIF-Article 1.0 Title: Race, belief in destiny, and seat belt usage: A pilot study Journal: American Journal of Public Health Author-Name: Colon, I. Year: 1992 Volume: 82 Issue: 6 Pages: 875-877 Abstract: A survey of 1063 individuals found that when belief in destiny was statistically controlled, differences in seat belt use by race disappeared. Thus, racial differences in seat belt use are statistically accounted for and might be explained by belief in destiny. Efforts to increase seat belt use should target minority groups rather than include them in broadbrush programs. Further, these efforts should take into account this important difference in motivation. Handle: RePEc:aph:ajpbhl:1992:82:6:875-877_7 Template-Type: ReDIF-Article 1.0 Title: The completeness of AIDS case reporting, 1988: A multisite collaborative surveillance project Journal: American Journal of Public Health Author-Name: Rosenblum, L. Author-Name: Buehler, J.W. Author-Name: Morgan, M.W. Author-Name: Costa, S. Author-Name: Hidalgo, J. Author-Name: Holmes, R. Author-Name: Lieb, L. Author-Name: Shields, A. Author-Name: Whyte, B.M. Year: 1992 Volume: 82 Issue: 11 Pages: 1495-1499 Abstract: Objectives. The purpose of this study was to evaluate the completeness of acquired immunodeficiency syndrome (AIDS) case reporting. Methods. Statewide or hospital-specific 1988 medical records were linked with AIDS surveillance in six sites. Medical records were reviewed for persons who had diagnoses suggesting human immunodeficiency virus (HIV) infection or AIDS but were not reported to AIDS surveillance by September 1989. Results. Among 4500 hospitalized persons diagnosed with AIDS through 1988 in the six sites, completeness of reporting was 92% (95% CI = 89%, 96%; range across sites = 89% to 97%). Completeness of reporting was high in males (92%), females (95%), Whites (95%), Blacks (90%), Hispanics (92%), men reporting sexual contact with men (92%), persons reporting injecting-drug use (91%), and persons exposed to HIV through heterosexual contact (99%). In Medicaid enrollees (two states), completeness of reporting was 99% (95% CI = 95%, 99%) in inpatients and 90% (95% CI = 79%, 90%) in outpatients. Of previously reported persons with AIDS, 82% were reported within 5 months of diagnosis. Conclusions. Completeness of AIDS reporting was high, overall and in each major demographic and HIV exposure group. These results demonstrate that current surveillance data in these six sites provide timely and accurate information regarding persons with AIDS. Handle: RePEc:aph:ajpbhl:1992:82:11:1495-1499_3 Template-Type: ReDIF-Article 1.0 Title: The public health implications of humans' natural levels of lead [3] Journal: American Journal of Public Health Author-Name: Smith, D.R. Author-Name: Flegal, A.R. Year: 1992 Volume: 82 Issue: 11 Pages: 1565-1566 Handle: RePEc:aph:ajpbhl:1992:82:11:1565-1566_9 Template-Type: ReDIF-Article 1.0 Title: Project together: Serving substance-abusing mothers and their children in Des Moines Journal: American Journal of Public Health Author-Name: Saunders, E. Year: 1992 Volume: 82 Issue: 8 Pages: 1166-1167 Handle: RePEc:aph:ajpbhl:1992:82:8:1166-1167_2 Template-Type: ReDIF-Article 1.0 Title: Community health and odor pollution regulation [4] Journal: American Journal of Public Health Author-Name: Shusterman, D. Year: 1992 Volume: 82 Issue: 11 Pages: 1566-1567 Handle: RePEc:aph:ajpbhl:1992:82:11:1566-1567_3 Template-Type: ReDIF-Article 1.0 Title: Survey strategies discussed: Using more than one questionnaire [9] Journal: American Journal of Public Health Author-Name: Cherkin, D. Author-Name: Barlow, B. Author-Name: Lambert, J. Author-Name: Beland, F. Year: 1992 Volume: 82 Issue: 1 Pages: 127-128 Handle: RePEc:aph:ajpbhl:1992:82:1:127-128_9 Template-Type: ReDIF-Article 1.0 Title: Cigarette, alcohol, and coffee consumption and prematurity Journal: American Journal of Public Health Author-Name: McDonald, A.D. Author-Name: Armstrong, B.G. Author-Name: Sloan, M. Year: 1992 Volume: 82 Issue: 1 Pages: 87-90 Abstract: We analyzed data from a survey of occupational and other factors in pregnancy to assess the effects of cigarette, alcohol, and coffee consumption on pregnancy outcome. The risk of low birth weight for gestational age was found to increase substantially with smoking. Occasional consumers of alcohol had a slightly reduced risk relative to total abstainers. In more frequent drinkers, there was a small increase in risk. Risk increased slightly with coffee consumption. Handle: RePEc:aph:ajpbhl:1992:82:1:87-90_4 Template-Type: ReDIF-Article 1.0 Title: Functional limitations and disability among elders in the Framingham study Journal: American Journal of Public Health Author-Name: Kelly-Hayes, M. Author-Name: Jette, A.M. Author-Name: Wolf, P.A. Author-Name: D'Agostino, R.B. Author-Name: Odell, P.M. Year: 1992 Volume: 82 Issue: 6 Pages: 841-845 Abstract: Background. The measurement of physical disability as an indication of the impact of disease is commonly seen in research. However, these measures often do not clearly differentiate between functional limitations and daily performance of an activity. Methods. We measured the differences between self-reported disability and observed functional limitations in six activities of daily living tasks among community-dwelling elders. The value of functional limitations vs disability measures in determining risk factors for disablement was ascertained. Results. Systematic differences were found among the 1453 participants. At least 89% of the time when a difference was identified, the subjects ranked disability greater than the functional limitations observed. For those who were cognitively impaired, discrepancies occurred up to 11% of the time. In determining risk factors for disablement, we found that neurological impairments were associated with both functional limitations and disability, while sociocultural factors were associated with disability only. Conclusions. Our findings suggest that physical functional limitations and disability in the elderly are two distinct concepts and that the measure of choice should be determined by research objectives and the type of population being studied. Handle: RePEc:aph:ajpbhl:1992:82:6:841-845_0 Template-Type: ReDIF-Article 1.0 Title: Attitudes about infertility interventions among fertile and infertile couples Journal: American Journal of Public Health Author-Name: Halman, L.J. Author-Name: Abbey, A. Author-Name: Andrews, F.M. Year: 1992 Volume: 82 Issue: 2 Pages: 191-194 Abstract: Background. There has been marked progress in the development of infertility interventions. This paper reports attitudes about 11 interventions for infertility. Methods. Face-to-face interviews were conducted with each member of 185 infertile and 90 presumed fertile couples in southeastern Michigan. Results. Seven of these interventions were generally viewed favorably and four were generally viewed negatively, regardless of the couple's fertility status. Infertile couples viewed all interventions, except for adoption, more favorably than did fertile couples. Multidimensional scaling was used to cluster the interventions according to similarity in endorsement. These clusters form a continuum from interventions that allow only one member of the couple to be a biological parent to the most noninvasive techniques. All clusters remain roughly equidistant from adoption, in which neither member of the couple is a biological parent. Conclusions. Interventions that produce a child who is biologically related to only one member of the couple were viewed most negatively. Members of couples who were receiving fertility treatment made finer discriminations among infertility interventions than did individuals who had not received treatment. Handle: RePEc:aph:ajpbhl:1992:82:2:191-194_4 Template-Type: ReDIF-Article 1.0 Title: Breast-feeding patterns in a rural village in Giza, Egypt Journal: American Journal of Public Health Author-Name: Hakim, I.A. Author-Name: El-Ashmawy, I.A. Year: 1992 Volume: 82 Issue: 5 Pages: 731-732 Abstract: In a longitudinal study of infant feeding in rural Giza, Egypt, we found that 68.8% of the recruited mothers initiated early suckling of colostrum, but only 51.2% of the infants were exclusively breast-fed in the first week. Solid foods were introduced much earlier than at the recommended age of 4 to 6 months. Sixty percent of the mothers who participated in the study considered breast-feeding plus regular or irregular complementary feeding to be exclusive breast-feeding. Handle: RePEc:aph:ajpbhl:1992:82:5:731-732_5 Template-Type: ReDIF-Article 1.0 Title: Epidemiology training over the telephone in California Journal: American Journal of Public Health Author-Name: Bohnstedt, M. Author-Name: Kohatsu, N.D. Author-Name: Wetta, J. Year: 1992 Volume: 82 Issue: 12 Pages: 1688-1689 Handle: RePEc:aph:ajpbhl:1992:82:12:1688-1689_5 Template-Type: ReDIF-Article 1.0 Title: Commentary: Caring for the indigent mentally ill - New strategies and old problems Journal: American Journal of Public Health Author-Name: Ferran Jr., E. Year: 1992 Volume: 82 Issue: 6 Pages: 796-798 Abstract: Christianson and his colleagues examine how Medicaid beneficiaries receive mental health services in HMOs by analyzing two important aspects of service delivery: the use of community-based treatment programs by Medicaid beneficiaries enrolled in health maintenance organizations (HMOs) and the reimbursement levels paid to these programs by HMOs. The hypotheses studied are complex issues that concern mental-health advocates and providers. Traditional community-based mental health services have always struggled to maintain their presence in the health care field, having to contend with changing funding priorities and more serious and multiple problems presented by their patients. For prepaid plans to work effectively for the indigent mentally ill, the complex issues have to be made clear and acknowledged as meaningful variables. Handle: RePEc:aph:ajpbhl:1992:82:6:796-798_9 Template-Type: ReDIF-Article 1.0 Title: Locking devices on cigarette vending machines: Evaluation of a city ordinance Journal: American Journal of Public Health Author-Name: Forster, J.L. Author-Name: Hourigan, M.E. Author-Name: Kelder, S. Year: 1992 Volume: 82 Issue: 9 Pages: 1217-1219 Abstract: Objectives. Policymakers, researchers, and citizens are beginning to recognize the need to limit minors' access to tobacco by restricting the sale of cigarettes through vending machines. One policy alternative that has been proposed by the tobacco industry is a requirement that vending machines be fitted with electronic locking devices. This study evaluates such a policy as enacted in St. Paul, Minn. Methods. A random sample of vending machine locations was selected for cigarette purchase attempts conducted before implementation and at 3 and 12 months postimplementation. Results. The rate of noncompliance by merchants was 34% after 3 months and 30% after 1 year. The effect of the law was to reduce the ability of a minor to purchase cigarettes from locations originally selling cigarettes through vending machines from 86% at baseline to 36% at 3 months. The purchase rate at these locations rose to 48% at 1 year. Conclusions. Our results suggest that cigarette vending machine locking devices may not be as effective as vending machine bans and require additional enforcement to ensure compliance with the law. Handle: RePEc:aph:ajpbhl:1992:82:9:1217-1219_4 Template-Type: ReDIF-Article 1.0 Title: Weight loss attempts in adults: Goals, duration, and rate of weight loss Journal: American Journal of Public Health Author-Name: Williamson, D.F. Author-Name: Serdula, M.K. Author-Name: Anda, R.F. Author-Name: Levy, A. Author-Name: Byers, T. Year: 1992 Volume: 82 Issue: 9 Pages: 1251-1257 Abstract: Objectives. Although attempted weight loss is common, little is known about the goals and durations of weight loss attempts and the rates of achieved weight loss in the general population. Methods. Data were collected by telephone in 1989 from adults aged 18 years and older in 39 states and the District of Columbia. Analyses were carried out separately for the 6758 men and 14 915 women who reported currently trying to lose weight. Results. Approximately 25% of the men respondents and 40% of the women respondents reported that they were currently trying to lose weight. Among men, a higher percentage of Hispanics (31%) than of Whites (25%) or Blacks (23%) reported trying to lose weight. Among women, however, there were no ethnic differences in prevalence. The average man wanted to lose 30 pounds and to weigh 178 pounds; the average woman wanted to lose 31 pounds and to weigh 133 pounds. Black women wanted to lose an average of 8 pounds more than did White women, but Black women's goal weight was 10 pounds heavier. The average rate of achieved weight loss was 1.4 pounds per week for men and 1.1 pounds per week for women; these averages, however, may reflect only the experience of those most successful at losing weight. Conclusions. Attempted weight loss is a common behavior, regardless of age, gender, or ethnicity, and weight loss goals are substantial; however, obesity remains a major public health problem in the United States. Handle: RePEc:aph:ajpbhl:1992:82:9:1251-1257_9 Template-Type: ReDIF-Article 1.0 Title: Sudden infant death syndrome and maternal smoking Journal: American Journal of Public Health Author-Name: Malloy, M.H. Author-Name: Hoffman, H.J. Author-Name: Peterson, D.R. Year: 1992 Volume: 82 Issue: 10 Pages: 1380-1382 Abstract: Data from Missouri for the period 1980 to 1985 suggest a dose-response relationship between smoking during pregnancy and the incidence of sudden infant death syndrome (SIDS). However, data from the National Institute of Child Health and Human Development SIDS Cooperative Epidemiological Study did not support a dose-response relationship. Neither the Missouri data nor the Cooperative Study data support a relationship between the age of occurrence of SIDS and smoking during pregnancy. Handle: RePEc:aph:ajpbhl:1992:82:10:1380-1382_2 Template-Type: ReDIF-Article 1.0 Title: RU 486 Journal: American Journal of Public Health Author-Name: Rosenfield, A. Year: 1992 Volume: 82 Issue: 10 Pages: 1325-1326 Handle: RePEc:aph:ajpbhl:1992:82:10:1325-1326_9 Template-Type: ReDIF-Article 1.0 Title: Condom use in multi-ethnic neighborhoods of San Francisco: The population- based AMEN (AIDS in Multi-Ethnic Neighborhoods) Study Journal: American Journal of Public Health Author-Name: Catania, J.A. Author-Name: Coates, T.J. Author-Name: Kegeles, S. Author-Name: Fullilove, M.T. Author-Name: Peterson, J. Author-Name: Marin, B. Author-Name: Siegel, D. Author-Name: Hulley, S. Year: 1992 Volume: 82 Issue: 2 Pages: 284-287 Abstract: We examined the prevalence and correlates of condom use in a community- based sample of unmarried heterosexual and gay/bisexual Whites, Blacks, and Hispanics (aged 20 to 44 years) in San Francisco (n = 1229). Only 9% of heterosexual males reported always using condoms, and fewer of those with multiple sexual partners (6%) reported always using condoms compared with those in monogamous relationships (12%). Much higher proportions of gay/bisexual men reported always using condoms (48%). Racial differences in condom use were observed only among women. Sexual communication and the sexual enjoyment value of condoms were consistent correlates of condom use across gender and sexual orientation, while other condom-related beliefs were significant predictors of condom use only for men. In general, condom promotion programs should build sexual communication skills, teach people how to enhance enjoyment with condoms, and reduce psychological barriers to condom acquisition and use. Handle: RePEc:aph:ajpbhl:1992:82:2:284-287_4 Template-Type: ReDIF-Article 1.0 Title: Readmission after surgery in Washington State rural hospitals Journal: American Journal of Public Health Author-Name: Welch, H.G. Author-Name: Larson, E.H. Author-Name: Hart, L.G. Author-Name: Rosenblatt, R.A. Year: 1992 Volume: 82 Issue: 3 Pages: 407-411 Abstract: Background. Because of concern about the quality of care in rural hospitals, we examined readmission following four surgical procedures commonly performed in Washington State rural hospitals: appendectomy, cesarean section, cholecystectomy, and transurethral prostatectomy. Methods. In a retrospective cohort study, we identified all patients discharged after receiving one of the foregoing procedures using the statewide hospital discharge database. Readmissions to any hospital in the state within 7 or 30 days of discharge were also identified. Results. During the 2-year period examined, there were no significant differences in readmission rates for surgeries performed in rural and urban hospitals, although the readmission rates for all four procedures were nominally lower in rural hospitals. Logistic regression analyses that controlled for factors that influence readmission did not change these results. Conclusions. Investigating readmission rates following common surgeries, we found no evidence of low- quality surgical care in Washington State rural hospitals. Early readmission is an imperfect marker for poor surgical outcome, however, and other proxies for quality remain to be examined. Handle: RePEc:aph:ajpbhl:1992:82:3:407-411_1 Template-Type: ReDIF-Article 1.0 Title: Risk factors associated with antibodies to leptospires in inner-city residents of Baltimore: A protective role for cats Journal: American Journal of Public Health Author-Name: Childs, J.E. Author-Name: Schwartz, B.S. Author-Name: Ksiazek, T.G. Author-Name: Graham, R.R. Author-Name: LeDuc, J.W. Author-Name: Glass, G.E. Year: 1992 Volume: 82 Issue: 4 Pages: 597-599 Abstract: Leptospiral antibody prevalence was 16% in residents of Baltimore. Seropositivity was associated with age, gender, race, and bird ownership, and negatively associated with contact with rat excrement and cat ownership. Current cat ownership reduced the antibody risk associated with age and race from odds ratios (95% confidence interval) of 3.3 (2.0, 5.5) and 3.3 (1.1, 9.3), respectively, to the baseline level. These data establish the high prevalence of leptospiral antibody in Baltimore and suggest a protective role for cats in reducing the risk of human infection. Handle: RePEc:aph:ajpbhl:1992:82:4:597-599_6 Template-Type: ReDIF-Article 1.0 Title: Cigarette, alcohol, and coffee consumption and congenital defects Journal: American Journal of Public Health Author-Name: McDonald, A.D. Author-Name: Armstrong, B.G. Author-Name: Sloan, M. Year: 1992 Volume: 82 Issue: 1 Pages: 91-93 Abstract: We analyzed data from a survey of occupational and other factors and preganncy outcome to assess the effects of cigarette, alcohol, and coffee consumption. There was no evidence of an association between any congenital defect and smoking. Results for alcohol and coffee consumption were largely negative, but there was a weak association with musculoskeletal defects in babies born to women who drank one or more alcoholic drinks a day. Handle: RePEc:aph:ajpbhl:1992:82:1:91-93_5 Template-Type: ReDIF-Article 1.0 Title: Trends in prevalences of behavioral risk factors: Recent Hawaiian experience Journal: American Journal of Public Health Author-Name: Chung, C.S. Author-Name: Villafuerte, A. Author-Name: Wood, D.W. Author-Name: Lew, R. Year: 1992 Volume: 82 Issue: 11 Pages: 1544-1546 Abstract: Recent time trends were studied for the prevalences of behavioral risk factors in Hawaii during the 5-year period from 1986 through 1990. The presence of linear time trend was analyzed by the multiple logistic regression method on weighted data, adjusting for confounding factors. The risk factors studied were seatbelt nonuse, lack of exercise, obesity, hypertension, smoking, acute drinking, chronic drinking, and driving while intoxicated. Seatbelt nonuse showed a significant decline, from 8.6% to 4.8%, with a mean annual decrease of 0.9 percentage point. Lack of exercise and obesity increased steadily, from 48.0% to 62.4% and from 16.7% to 21.6%, respectively, with respective annual mean increases of 3.3 and 1.4 percentage points. Handle: RePEc:aph:ajpbhl:1992:82:11:1544-1546_4 Template-Type: ReDIF-Article 1.0 Title: The potential impact of epidemiology on the prevention of occupational disease Journal: American Journal of Public Health Author-Name: Wegman, D.H. Year: 1992 Volume: 82 Issue: 7 Pages: 944-954 Abstract: This presentation reviews occupational epidemiology as a foundation for workplace disease prevention activities. By examining descriptive, etiologic and intervention occupational epidemiology studies, a range of opportunities are illustrated where epidemiology has played, or could play a principal role in guiding preventive efforts. Descriptive studies presented include ones based on vital records, on epidemic investigations, cross-sectional surveys, and surveillance. Etiologic studies review the largely successful development of knowledge for lung cancer and asbestos exposure for pulmonary effects of isocyanate exposures. However, attention is also directed to the need for etiologic studies of work environment risks for both cardiovascular and musculoskeletal disease. Finally importance is placed on the too infrequent epidemiologic studies of intervention. Historical examples of control of large risks from nickel cancers and silicosis are balanced with more recent examples of successes at reducing smaller risks of cardiovascular disease and oil acne. Throughout, emphasis is placed on the importance of reintegrating the academic discipline of epidemiology into the application of study findings to prevention of workplace risks. Handle: RePEc:aph:ajpbhl:1992:82:7:944-954_5 Template-Type: ReDIF-Article 1.0 Title: What is the dentist's occupational risk of becoming infected with hepatitis B or the human immunodeficiency virus? Journal: American Journal of Public Health Author-Name: Capilouto, E.I. Author-Name: Weinstein, M.C. Author-Name: Hemenway, D. Author-Name: Cotton, D. Year: 1992 Volume: 82 Issue: 4 Pages: 587-589 Abstract: Surveys have shown that dentists are reluctant to treat persons infected with the human immunodeficiency virus (HIV). However, dentists are much more willing to treat patients with infectious hepatitis B virus (HBV). This study shows that the annual cumulative risk of infection from routine treatment of patients whose seropositivity is undisclosed is 57 times greater from HBV than from HIV, and that the risk of dying from HBV infection is 1.7 times greater than the risk of HIV infection, for which mortality is almost certain. Handle: RePEc:aph:ajpbhl:1992:82:4:587-589_5 Template-Type: ReDIF-Article 1.0 Title: Controlling cardiovascular disease: The role of the local health department Journal: American Journal of Public Health Author-Name: Brownson, R. Author-Name: Smith, C. Author-Name: Jorge, N. Author-Name: Dean, C. Author-Name: DePrima, L. Year: 1992 Volume: 82 Issue: 10 Pages: 1414-1416 Handle: RePEc:aph:ajpbhl:1992:82:10:1414-1416_6 Template-Type: ReDIF-Article 1.0 Title: Seroprevalence of HIV-type 1 in a Northern California health plan population: An unlinked survey Journal: American Journal of Public Health Author-Name: Hiatt, R.A. Author-Name: Capell, F.J. Author-Name: Ascher, M.S. Year: 1992 Volume: 82 Issue: 4 Pages: 564-567 Abstract: We conducted an unlinked seroprevalence survey for human immunodeficiency virus-type 1 (HIV-1) of 9821 persons who had a routine personal health appraisal examination in 1989 while members of the Kaiser Permanente Medical Care Program in northern California. An outside laboratory performed enzyme immunoassay (EIA) analyses, and the California Viral and Rickettsial Diseases Laboratory confirmed EIA-reactive samples by immunofluorescent assay and Western blot assay. Only 20 specimens (0.2%) were confirmed as positive, and 18 were from men. These data suggest that, at the time of this survey, HIV-1 infection was not widespread in the northern California population represented by this health plan membership. Handle: RePEc:aph:ajpbhl:1992:82:4:564-567_3 Template-Type: ReDIF-Article 1.0 Title: Perspectives on HIV/AIDS epidemiology and prevention from the Eighth International Conference on AIDS Journal: American Journal of Public Health Author-Name: Castro, K.G. Author-Name: Valdiserri, R.O. Author-Name: Curran, J.W. Year: 1992 Volume: 82 Issue: 11 Pages: 1465-1470 Abstract: The Eighth International AIDS Symposium in Amsterdam, the Netherlands, provided updated scientific and programmatic information on the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) to thousands of interested participants. As in the other scientific areas, the amount of information presented in epidemiology and prevention was overwhelming; however, the scientific progress described was steady but incremental. This commentary summarizes progress made in three selected areas that were highlighted during the meeting's scientific session and a fourth that received widespread media attention: (1) the epidemiology of HIV/AIDS in heterosexual women; (2) tuberculosis as an increasing opportunistic pathogen in HIV-infected persons; (3) prevention research, practice, and policy; and (4) preliminary reports of severe immunodeficiency in persons without evident HIV infection. In order to stem HIV transmission worldwide, a safe and effective vaccine is urgently needed. Currently, in the absence of such a vaccine, it is crucial for all of the world's communities to apply the best science-based prevention methods available. Handle: RePEc:aph:ajpbhl:1992:82:11:1465-1470_8 Template-Type: ReDIF-Article 1.0 Title: Effectiveness of an order to evacuate [2] Journal: American Journal of Public Health Author-Name: Goldbaum, G.M. Author-Name: Frinell, D. Year: 1992 Volume: 82 Issue: 1 Pages: 123-124 Handle: RePEc:aph:ajpbhl:1992:82:1:123-124_2 Template-Type: ReDIF-Article 1.0 Title: Erratum: Cohort study of the impact of perinatal drug use on prematurity in an inner-city population. (Am J Public Health, (1992) 82 (726-728)) Journal: American Journal of Public Health Author-Name: Feldman, J.G. Author-Name: Minkoff, H.L. Author-Name: McCalla, S. Author-Name: Salwen, M.A. Year: 1992 Volume: 82 Issue: 8 Pages: 1088 Handle: RePEc:aph:ajpbhl:1992:82:8:1088_2 Template-Type: ReDIF-Article 1.0 Title: Determinants of worldwide health Journal: American Journal of Public Health Author-Name: Winkelstein Jr., W. Year: 1992 Volume: 82 Issue: 7 Pages: 931-932 Handle: RePEc:aph:ajpbhl:1992:82:7:931-932_6 Template-Type: ReDIF-Article 1.0 Title: Improvement in intergenerational health Journal: American Journal of Public Health Author-Name: Fries, J.F. Author-Name: Williams, C.A. Author-Name: Morfeld, D. Year: 1992 Volume: 82 Issue: 1 Pages: 109-112 Abstract: Differences in health status between subjects, their parents, and their children were analyzed in 2206 subjects who had attended the University of Pennsylvania during the 1939 to 1940 school year. Subjects compared their overall health status at the average age of 70 with that of their same-sex parent at the same age and with that of their same-sex child at the approximate average age of 45, providing reasons for reported differences. Thus, health status in family members of the same sex at the same age in 1988 was compared with that in approximately 1963. Subject health was strikingly improved compared with that of their parents a generation earlier, with 58% reporting their health to be better or much better, and only 9% reporting it to be worse or much worse (P < .001). The major reasons for the difference were decreased prevalence of chronic conditions and healthier life-styles. The same results were observed in a community-based population of 317 subjects and, even more strikingly, in a group of 422 aging long-distance runners. These observations suggest substantial improvement in senior health status over the past quarter century in selected populations, and they contrast with equivocal changes that have been noted with traditional serial survey techniques. Handle: RePEc:aph:ajpbhl:1992:82:1:109-112_7 Template-Type: ReDIF-Article 1.0 Title: Cigarette smoking and occupational status: 1977 to 1990 Journal: American Journal of Public Health Author-Name: Covey, L.S. Author-Name: Zang, E.A. Author-Name: Wynder, E.L. Year: 1992 Volume: 82 Issue: 9 Pages: 1230-1234 Abstract: Objectives. In this study we examined the relationship between occupational status and smoking habits in men and women during the period from 1977 to 1990. Methods. Cigarette smoking and occupational history were obtained from 8045 men and women who served as controls for a hospital-based study of tobacco-related diseases. Results. There was an association between increasing occupational status and tobacco exposure in men, but not in women. The quit rate increased over time in all sex-occupational groups except for male laborers, whose quit rate remained constant. Nicotine-dependent smokers are likely to find it difficult to quit. Male nicotine-dependent smokers were consistently found in greater numbers among blue collar workers throughout the study period. Initially, female nicotine-dependent smokers were more often found among blue collar workers, but in recent years became more frequent among white collar workers. Conclusion. These trends provide clues to the future epidemiological distribution of lung cancer and other tobacco- related diseases. An understanding of gender differences in the occupational profile of cigarette smokers can provide guidelines for effective antismoking interventions. Handle: RePEc:aph:ajpbhl:1992:82:9:1230-1234_0 Template-Type: ReDIF-Article 1.0 Title: Delay in ambulance dispatch to road accidents Journal: American Journal of Public Health Author-Name: Brodsky, H. Year: 1992 Volume: 82 Issue: 6 Pages: 873-875 Abstract: When a road accident occurs, the police communications officer, or 911 operator, generally receives the first call. If the caller reports injuries, the emergency medical services dispatcher is notified immediately; but if the caller is uncertain of injuries, the operator may wait. Most often an ambulance is not needed. However, in nearly 20% of fatal road accidents in Missouri, waiting for confirmation of need resulted in a delay of 5 minutes or more in the dispatch of an ambulance. Handle: RePEc:aph:ajpbhl:1992:82:6:873-875_9 Template-Type: ReDIF-Article 1.0 Title: Improving estimates of HIV-1 seroprevalence among childbearing women: Use of smaller blood spots Journal: American Journal of Public Health Author-Name: Hoxie, N.J. Author-Name: Vergeront, J.M. Author-Name: Pfister, J.R. Author-Name: Hoffman, G.L. Author-Name: Markwardt-Elmer, P.A. Author-Name: Davis, J.P. Year: 1992 Volume: 82 Issue: 10 Pages: 1370-1373 Abstract: Objectives. Nationwide, human immunodeficiency virus type 1 (HIV-1) seroprevalence surveys using dried neonatal blood specimens are critical to estimating HIV-1 seroprevalence among childbearing women. However, the noninclusion of blood specimens deemed 'quantity not sufficient' (QNS) for HIV-1 antibody testing potentially introduces bias. In Wisconsin beginning in 1990, we modified the survey protocol to reduce QNS rates and assess bias introduced by QNS specimens. Methods. The HIV-1 antibody assay was modified to use four 1/8-in blood spots when a single 1/4 -in blood spot could not be obtained. Both methods obtain identical blood volumes for testing. Results. During a 27-month period, 7396 (4.8%) of 154 683 specimens were deemed QNS using 1/4 -in blood spots. Of these, 6590 (89%) were of sufficient quantity to be tested using four 1/8-in blood spots; 6 (0.09%) specimens tested with 1/8- in blood spots were HIV-1 Western blot assay positive compared with 44 (0.03%) of 147 287 1/4 -in specimens (odds ratio = 3.0; 95% confidence interval = 1.2, 7.4). Conclusions. Because noninclusion of QNS specimens potentially introduces bias, incorporating the results of HIV-1 antibody testing of QNS specimens using four 1/8-in blood spots can improve the accuracy of HIV-1 seroprevalence estimates in these serologic surveys. Handle: RePEc:aph:ajpbhl:1992:82:10:1370-1373_1 Template-Type: ReDIF-Article 1.0 Title: Occupational injuries among minors doing farm work in Washington State: 1986 to 1989 Journal: American Journal of Public Health Author-Name: Heyer, N.J. Author-Name: Franklin, G. Author-Name: Rivara, F.P. Author-Name: Parker, P. Author-Name: Haug, J.A. Year: 1992 Volume: 82 Issue: 4 Pages: 557-560 Abstract: Background. There is growing evidence that many children are injured while engaged in agricultural work. However, little specific information on farm work-related injuries among minors is available, probably because employment or workers' compensation data for children are hard to obtain. Methods. Workers' compensation data were used to evaluate occupational injuries among children in Washington State from 1986 through 1989. The frequency and severity of injuries among minors doing farm work were compared with the distributions of injuries among minors working in food service and all other occupations by year of injury, age of injury, and month and hour of injury. Results. A total of 16 481 claims filed by children under age 18 were evaluated. Although farm workers accounted for only 7% of all claims, they made up 36% of claims filed by children under age 14, and 17% of claims filed by children aged 14 or 15. Injuries classified as serious accounted for 26% of farm worker claims compared with only 16% of all claims filed by children. Conclusions. Although injury rates could not be developed owing to the lack of denominator data, this study demonstrates that farm work is dangerous for young children. Handle: RePEc:aph:ajpbhl:1992:82:4:557-560_1 Template-Type: ReDIF-Article 1.0 Title: Sudden unexplained infant deaths in Central Africa [7] Journal: American Journal of Public Health Author-Name: Bulterys, M. Author-Name: Chao, A. Author-Name: Mukafaranswa, B. Author-Name: Kraus, J.F. Author-Name: Saah, A. Year: 1992 Volume: 82 Issue: 3 Pages: 467 Handle: RePEc:aph:ajpbhl:1992:82:3:467_5 Template-Type: ReDIF-Article 1.0 Title: Use of odds ratio questioned [2] Journal: American Journal of Public Health Author-Name: Mendell, M.J. Author-Name: Jaakkola, J.J.K. Author-Name: Heinonen, O.P. Year: 1992 Volume: 82 Issue: 6 Pages: 896-897 Handle: RePEc:aph:ajpbhl:1992:82:6:896-897_4 Template-Type: ReDIF-Article 1.0 Title: Safe sexual practices not reliably maintained by homosexual men Journal: American Journal of Public Health Author-Name: De Wit, J.B.F. Author-Name: De Vroome, E.M.M. Author-Name: Sandfort, T.G.M. Author-Name: Van Griensven, G.J.P. Author-Name: Coutinho, R.A. Author-Name: Tielman, R.A.P. Year: 1992 Volume: 82 Issue: 4 Pages: 615-616 Handle: RePEc:aph:ajpbhl:1992:82:4:615-616_0 Template-Type: ReDIF-Article 1.0 Title: AIDS education for drug abusers: Evaluation of short-term effectiveness Journal: American Journal of Public Health Author-Name: McCusker, J. Author-Name: Stoddard, A.M. Author-Name: Zapka, J.G. Author-Name: Morrison, C.S. Author-Name: Zorn, M. Author-Name: Lewis, B.F. Year: 1992 Volume: 82 Issue: 4 Pages: 533-540 Abstract: Background. Interventions are needed to assist drug abusers in reducing risky drug and sexual behavior. Methods. A randomized controlled trial compared three small-group AIDS educational interventions among 567 clients of a 21-day inpatient drug detoxification program: a two-session informational intervention, given either during the first (early) or second (late) week of treatment; and a six-session enhanced intervention. Changes in knowledge, attitudes, and psychomotor skills were assessed before and after each intervention, and behavioral outcomes were assessed at follow-up 10 to 18 weeks after admission. Results. Immediately after the interventions, enhanced group members reported significantly greater self-efficacy to talk themselves out of AIDS-risky behavior; other knowledge and attitude scales did not differ by intervention. At follow-up, significant reductions in risky drug use were reported by all groups. Enhanced group members reported significantly greater reduction in injection frequency than did late informational subjects. Conclusions. No beneficial effect was detected of delaying AIDS education for clients entering detoxification. At this early stage of follow-up, there is only weak evidence that an enhanced intervention improved outcomes. Handle: RePEc:aph:ajpbhl:1992:82:4:533-540_5 Template-Type: ReDIF-Article 1.0 Title: Hispanic subgroups and intraracial comparisons [2] Journal: American Journal of Public Health Author-Name: Wong, F.Y. Author-Name: McKay, D.R. Year: 1992 Volume: 82 Issue: 12 Pages: 1691 Handle: RePEc:aph:ajpbhl:1992:82:12:1691_4 Template-Type: ReDIF-Article 1.0 Title: Skilled nursing facility care for persons with AIDS: Comparison with other patients Journal: American Journal of Public Health Author-Name: Swan, J.H. Author-Name: Benjamin, A.E. Author-Name: Brown, A. Year: 1992 Volume: 82 Issue: 3 Pages: 453-455 Abstract: We compared average daily hours of care for patients with and without acquired immunodeficiency syndrome (AIDS) in a hospital-based skilled nursing facility. Patients with AIDS averaged over an hour more direct nursing care per patient day (6.5 vs 5.4 hours). These findings support other reports of greater nursing time and higher costs of caring for nursing home patients with AIDS. Handle: RePEc:aph:ajpbhl:1992:82:3:453-455_4 Template-Type: ReDIF-Article 1.0 Title: Correlates of nonadherence to hypertension treatment in an inner-city minority population Journal: American Journal of Public Health Author-Name: Shea, S. Author-Name: Misra, D. Author-Name: Ehrlich, M.H. Author-Name: Field, L. Author-Name: Francis, C.K. Year: 1992 Volume: 82 Issue: 12 Pages: 1607-1612 Abstract: Objectives. Adherence to treatment is a key factor in achieving blood pressure control among hypertensives. We examined correlates of nonadherence to hypertension treatment in an inner-city minority population. Methods. Subjects (n = 202) were interviewed as part of a case-control study of severe, uncontrolled hypertension conducted in two New York City hospitals in 1989-91. All subjects were African American or Hispanic. Self-reported nonadherence to drug treatment for hypertension was measured using a five- item scale, and the sample was dichotomized as more (n = 87) or less (n = 115) adherent. Multiple logistic regression analysis was used to adjust for demographic and other covariates. Results. Nonadherence was associated with having blood pressure checked in an emergency room (adjusted odds ratio [OR] = 7.9; 95% confidence interval [CI] = 1.75, 35.77; P < .01), lack of a primary care physician (adjusted OR = 2.9; 95% CI = 1.37, 6.02; P < .01), current smoking (adjusted OR = 2.4; 95% CI = 1.10, 5.22; P = .03), and younger age (adjusted OR = 1.03, 95% CI = 1.00, 1.06; P = .03). Conclusions. Changing the locus of care for hypertension from emergency rooms to primary care physicians may improve adherence to hypertension treatment in minority populations. Handle: RePEc:aph:ajpbhl:1992:82:12:1607-1612_7 Template-Type: ReDIF-Article 1.0 Title: Community AIDS/HIV risk reduction: The effects of endorsements by popular people in three cities Journal: American Journal of Public Health Author-Name: Kelly, J.A. Author-Name: St. Lawrence, J.S. Author-Name: Stevenson, L.Y. Author-Name: Hauth, A.C. Author-Name: Kalichman, S.C. Author-Name: Diaz, Y.E. Author-Name: Brasfield, T.L. Author-Name: Koob, J.J. Author-Name: Morgan, M.G. Year: 1992 Volume: 82 Issue: 11 Pages: 1483-1489 Abstract: Objectives. It is critical to extend community-level acquired immunodeficiency syndrome (AIDS) prevention efforts beyond education alone and to develop models that better encourage behavioral changes. Gay men in small cities are vulnerable to human immunodeficiency virus (HIV) infection due to continued high rates of risk behavior. This research introduced an intervention that trained popular people to serve as behavioral change endorsers to peers sequentially across three different cities. Methods. Populationwide surveys were conducted of all men patronizing gay clubs in each city to establish risk behavior base rates. After a small cadre of popular 'trendsetters' were identified, they received training in approaches for peer education and then contracted to communicate risk reduction recommendations and endorsements to friends. Surveys were repeated at regular intervals in all cities, with the same intervention introduced in lagged fashion across each community. Results. Intervention consistently produced systematic reductions in the population's high-risk behavior (unprotected anal intercourse) of 15% to 29% from baseline levels, with the same pattern of effects sequentially replicated in all three cities. Conclusions. This constitutes the first controlled, multiple-city test of an HIV prevention model targeting communities. The results support the utility of norm-changing approaches to reduce HIV risk behavior. Handle: RePEc:aph:ajpbhl:1992:82:11:1483-1489_5 Template-Type: ReDIF-Article 1.0 Title: Community-based case management of HIV disease Journal: American Journal of Public Health Author-Name: Payne, F.J. Author-Name: Sharrett, C.S. Author-Name: Poretz, D.N. Author-Name: Eron, L.J. Author-Name: Stage, T. Author-Name: Foroobar, R. Author-Name: Bowman, C. Author-Name: Miller, R.K. Year: 1992 Volume: 82 Issue: 6 Pages: 893-894 Handle: RePEc:aph:ajpbhl:1992:82:6:893-894_3 Template-Type: ReDIF-Article 1.0 Title: Eligibility for publicly financed home care Journal: American Journal of Public Health Author-Name: Jackson, M.E. Author-Name: Burwell, B. Author-Name: Clark, R.F. Author-Name: Harahan, M. Year: 1992 Volume: 82 Issue: 6 Pages: 853-856 Abstract: Objectives. Proposals for publicly financed home care for the elderly now tend to include cognitive impairment criteria as well as activities of daily living (ADL) criteria. The numbers of elderly deemed eligible for services will depend on the definitions of ADL and cognitive impairment used. Methods. Data from the 1984 National Long-Term Care Survey were used to generate a series of estimates of the community-dwelling elderly with ADL disabilities and cognitive impairment. Results. When only ADL criteria are used, estimates of disability range from 472 000 to over 3 million (1.6% to 12.5% of the community-dwelling elderly). These estimates increase to approximately 1 million to 4.2 million (3.5% to 14.0% of the community-dwelling elderly) when cognitive impairment criteria are added. Conclusions. The use of more stringent or more liberal eligibility criteria will have dramatic effects on the number of elders who qualify for services. The nature of the eligibility criteria employed in any expansion of federally financed home care benefits will be a major factor in determining the costs of such a program. Handle: RePEc:aph:ajpbhl:1992:82:6:853-856_2 Template-Type: ReDIF-Article 1.0 Title: Education, race, and high-density lipoprotein cholesterol among US adults Journal: American Journal of Public Health Author-Name: Freedman, D.S. Author-Name: Strogatz, D.S. Author-Name: Williamson, D.F. Author-Name: Aubert, R.E. Year: 1992 Volume: 82 Issue: 7 Pages: 999-1006 Abstract: Objectives. Although educational achievement is positively related to levels of high-density lipoprotein cholesterol (HDL-C) among White adults, there is an inverse association among Blacks. We assessed whether this interaction could be attributed to differences in the relation of education to correlates of HDL-C. Methods. Cross-sectional analyses were based on data from 8391 White and 995 Black adults who participated in the Second National Health and Nutrition Examination Survey. Results. Associations between education and HDL-C levels varied from negative (Black men), to nearly nonexistent (White men and Black women), to positive (White women). Mean HDL- C levels were higher among Blacks than among Whites, but differences varied according to educational achievement. Among adults with less than 9 years of education, mean levels were 6 to 10 mg/dL higher among Blacks, but the racial difference was less than 1 mg/dL among adults with at least 16 years of education. About 20% to 40% of these differences could be accounted for by obesity, alcohol consumption, and other characteristics. Conclusions. Because of the implications for coronary heart disease risk, consideration should be given to behavioral characteristics associated with the interaction between race and educational achievement. Handle: RePEc:aph:ajpbhl:1992:82:7:999-1006_8 Template-Type: ReDIF-Article 1.0 Title: The mortality of lead smelter workers: An update Journal: American Journal of Public Health Author-Name: Steenland, K. Author-Name: Selevan, S. Author-Name: Landrigan, P. Year: 1992 Volume: 82 Issue: 12 Pages: 1641-1644 Abstract: Objectives. Mortality studies of lead workers have shown excesses of nonmalignant renal disease and cerebrovascular disease. Animal studies and one human study have shown excess kidney cancer. We have updated a mortality study of male lead smelter workers (n = 1990). Methods. An analysis was conducted using standard life table techniques. The updated analysis added 11 years of follow-up and 363 new deaths. Results. The original study had found elevated but nonsignificant risks for kidney cancer, stroke, and nonmalignant renal disease, probably attributable to lead exposure. Deaths from accidents and nonmalignant respiratory disease were significantly elevated, but probably not as a result of lead exposure. In the updated study, no new deaths from nonmalignant renal disease occurred (9 observed, standardized mortality ratio = 1.21). Three more deaths from kidney cancer were observed, yielding a standardized mortality ratio of 1.93 (9 observed, 95% CI = 0.88, 3.67), which increased for those who had worked in areas with the highest lead exposure (8 observed, standardized mortality ratio = 2.39, 95% CI = 1.03, 4.71). Cerebrovascular disease remained elevated for those with more than 20 years of exposure (26 observed, standardized mortality ratio = 1.41, 95% CI = 0.92, 2.07). Conclusions. This cohort with high lead exposure showed a diminishing excess of death from nonmalignant renal disease, a continued excess from kidney cancer, and an excess of cerebrovascular disease only in those with longest exposure to lead. Handle: RePEc:aph:ajpbhl:1992:82:12:1641-1644_9 Template-Type: ReDIF-Article 1.0 Title: Car size or car mass: Which has greater influence on fatality risk? Journal: American Journal of Public Health Author-Name: Evans, L. Author-Name: Frick, M.C. Year: 1992 Volume: 82 Issue: 8 Pages: 1105-1112 Abstract: Objectives. Proposed increases in corporate average fuel economy standards would probably lead to lighter cars. Well-established relationships between occupant risk and car mass predict consequent additional casualties. However, if size, not mass, is the causative factor in these relationships, then decreasing car mass need not increase risk. This study examines whether mass or size is the causative factor. Methods. Data from the Fatal Accident Reporting System are used to explore relationships between car mass, car size (as represented by wheelbase), and driver fatality risk in two-car crashes. Results. When cars of identical (or similar) wheelbase but different mass crash into each other, driver fatality risk depends strongly on mass; the relationship is quantitatively similar to that found in studies that ignore wheelbase. On the other hand, when cars of similar mass but different wheelbase crash into each other, the data reveal no dependence of driver fatality risk on wheelbase. Conclusions. Mass is the dominant causative factor in relationships between driver risk and car size in two-car crashes, with size, as such, playing at most a secondary role. Reducing car mass increases occupant risk. Handle: RePEc:aph:ajpbhl:1992:82:8:1105-1112_2 Template-Type: ReDIF-Article 1.0 Title: A neonatal hepatitis B surveillance and vaccination program: New York City, 1987 to 1988 Journal: American Journal of Public Health Author-Name: Henning, K.J. Author-Name: Pollack, D.M. Author-Name: Friedman, S.M. Year: 1992 Volume: 82 Issue: 6 Pages: 885-888 Abstract: From July 1987 to June 1988, 1030 pregnant women with hepatitis B were reported to a New York City surveillance program. Among 832 infants under follow-up, the coverage rates for combined hepatitis B immune globulin and vaccine doses 1, 2, and 3 were 84%, 77%, and 59%, respectively. Infants covered by Medicaid and uninsured Black and Hispanic infants were significantly less likely to be completely vaccinated. An estimated 160 cases of chronic hepatitis B infection were prevented among infants enrolled in the program. Strategies are needed to improve vaccine coverage among hard-to- reach groups. Handle: RePEc:aph:ajpbhl:1992:82:6:885-888_2 Template-Type: ReDIF-Article 1.0 Title: Cumulative trauma disorders of the hand and wrist in the auto industry Journal: American Journal of Public Health Author-Name: Nelson, N.A. Author-Name: Park, R.M. Author-Name: Silverstein, M.A. Author-Name: Mirer, F.E. Year: 1992 Volume: 82 Issue: 11 Pages: 1550-1552 Abstract: Surveillance for cumulative trauma disorders (CTDs) of the hand and wrist was carried out in five US automotive plants from 1985 to 1986, using Occupational Safety and Health Administration (OSHA) Form 200 injury and illness logs and medical insurance claims. Results using both record sources indicated that hand and wrist disorders may be more common in foundries than in other types of automotive plants. Similarly, in assembly plants, employees in certain departments appeared to be at higher risk for CTDs. Although our results are based on small numbers of cases, they suggest plants and departments that might be targeted for more detailed investigation. Handle: RePEc:aph:ajpbhl:1992:82:11:1550-1552_9 Template-Type: ReDIF-Article 1.0 Title: The correct use of growth charts [5] Journal: American Journal of Public Health Author-Name: Geefhuysen, C.J. Author-Name: Ruel, M.T. Author-Name: Habicht, J.-P. Year: 1992 Volume: 82 Issue: 6 Pages: 898-899 Handle: RePEc:aph:ajpbhl:1992:82:6:898-899_8 Template-Type: ReDIF-Article 1.0 Title: Smoking initiation and cessation in relation to body fat distribution based on data from a study of Swedish women Journal: American Journal of Public Health Author-Name: Lissner, L. Author-Name: Bengtsson, C. Author-Name: Lapidus, L. Author-Name: Bjorkelund, C. Year: 1992 Volume: 82 Issue: 2 Pages: 273-275 Abstract: In a representative sample of Swedish women, smokers were significantly less obese than nonsmokers. However, a smoker was likely to have significantly more upper-body fat than a nonsmoker of similar body mass index. Women who quit smoking experienced less upper-body fat deposition than would be expected by their accompanying weight gain, suggesting that weight gained as a consequence of smoking cessation is not preferentially deposited in the region associated with increased cardiovascular risk. Handle: RePEc:aph:ajpbhl:1992:82:2:273-275_4 Template-Type: ReDIF-Article 1.0 Title: The transformation of American midwifery: 1975 to 1988 Journal: American Journal of Public Health Author-Name: Declercq, E.R. Year: 1992 Volume: 82 Issue: 5 Pages: 680-684 Abstract: Background. The use of midwives is a natural solution to the problem of improving access to skilled perinatal services while lowering costs. The number of midwife-attended births has grown from 0.9% of all births in 1975 to 3.4% of all births in 1988. The purpose of the study was to determine how mothers served by midwives and the settings in which they are served have changed in that period. Methods. The analysis is based on birth certificate data from 1975 to 1988 from the Natality, Marriage and Divorce Statistics Branch of the National Center for Health Statistics, Centers for Disease Control. Results. Almost all of the growth (93.2%) in midwife-attended births from 1975 to 1988 was in hospitals; 87.3% of all births attended by midwives occurred in hospitals. Pronounced differences exist between mothers served by midwives in and outside of hospitals, and there are strong regional patterns in midwife attendance at birth. Conclusions. Given the positive outcomes associated with midwifery practice, further research into the content of midwifery care is recommended. Handle: RePEc:aph:ajpbhl:1992:82:5:680-684_9 Template-Type: ReDIF-Article 1.0 Title: Estimation of the break-even point for smoking cessation programs in pregnancy Journal: American Journal of Public Health Author-Name: Shipp, M. Author-Name: Croughan-Minihane, M.S. Author-Name: Petitti, D.B. Author-Name: Washington, A.E. Year: 1992 Volume: 82 Issue: 3 Pages: 383-390 Abstract: Background. Successful programs to help pregnant women quit smoking have been developed and evaluated, but formal smoking cessation programs are not a part of care at most prenatal sites. The cost of such programs may be an issue. Considering the costs of adverse maternal and infant outcomes resulting from smoking, we estimated there would be an amount of money a prenatal program could invest in smoking cessation and still 'break even' economically. Methods. A model was developed and published data, along with 1989 hospital charge data, were used to arrive at a break-even point for smoking cessation programs in pregnancy. Results. Using overall United States data, we arrived at a break-even cost of $32 per pregnant woman. When these data were varied to fit specific US populations, the break-even costs varied from $10 to $237, with the incidence of preterm low birth weight having the most impact on the cost. Conclusions. It may be advisable to invest greater amounts of money in a prenatal smoking cessation program for some populations. However, for every population there is an amount that can be invested while still breaking even. Handle: RePEc:aph:ajpbhl:1992:82:3:383-390_3 Template-Type: ReDIF-Article 1.0 Title: Lead exposure in the construction industry: Results from the California Occupational Lead Registry, 1987 through 1989 Journal: American Journal of Public Health Author-Name: Waller, K. Author-Name: Osorio, A.M. Author-Name: Maizlish, N. Author-Name: Royce, S. Year: 1992 Volume: 82 Issue: 12 Pages: 1669-1671 Abstract: The construction industry is exempt from the medical monitoring portions of the US Federal Occupational Safety and Health Administration General Industry Lead Standard. Of 28 construction workers reported to the California Occupational Lead Registry through March 1989, 11 (39%) had blood lead levels of 2.90 μmol/L (60 μg/dL) or greater, the level at which immediate removal from lead exposure is mandated in nonconstruction industries. Many workers had not been warned of possible lead exposure. The exemption of the construction industry from the General Industry Lead Standard should be reconsidered. Handle: RePEc:aph:ajpbhl:1992:82:12:1669-1671_6 Template-Type: ReDIF-Article 1.0 Title: Nutrition: The need to define 'optimal' intake as a basis for public policy decisions Journal: American Journal of Public Health Author-Name: Wynder, E.L. Author-Name: Weisburger, J.H. Author-Name: Ng, S.K. Year: 1992 Volume: 82 Issue: 3 Pages: 346-350 Abstract: Much of the current chronic disease incidence, notably coronary artery disease and certain types of cancer, relates to nutritionally induced metabolic overload. The evidence for this conclusion is based on extensive analytical, descriptive, and metabolic epidemiological investigations as well as critical experimental studies in animals. Dietary assessments within homogenous populations, because of inherent measurement errors and similarities in eating habits, make only limited contributions to this issue. This communication makes recommendations as to an 'optimal' diet, especially for fats and fibers, as a goal for effective disease prevention that is within our reach with the appropriate support of an informed public and a cooperative food industry. To facilitate effective public health action, the 'optimal' diet is called the 25/25 diet, that is, 25% of calories as fat and 25 g per day of fiber. Handle: RePEc:aph:ajpbhl:1992:82:3:346-350_4 Template-Type: ReDIF-Article 1.0 Title: The costs of searching for deaths: National Death Index vs Social Security Administration [3] Journal: American Journal of Public Health Author-Name: Kraut, A. Author-Name: Chan, E. Author-Name: Landrigan, P.J. Year: 1992 Volume: 82 Issue: 5 Pages: 760-761 Handle: RePEc:aph:ajpbhl:1992:82:5:760-761_4 Template-Type: ReDIF-Article 1.0 Title: The future of public health Journal: American Journal of Public Health Author-Name: Walker Jr., B. Year: 1992 Volume: 82 Issue: 1 Pages: 21-23 Abstract: Significant progress has been made in developing the biological, social, and behavioral science base for public health services. But this knowledge will have limited value unless it is transformed into programs and services for the people who need them. The systems and mechanics for this transmutation may not have reached their full potential. Assuring that they do so offers, in the 1990s, a challenge and an opportunity for the public health community. Handle: RePEc:aph:ajpbhl:1992:82:1:21-23_5 Template-Type: ReDIF-Article 1.0 Title: The Roseto effect: A 50-year comparison of mortality rates Journal: American Journal of Public Health Author-Name: Egolf, B. Author-Name: Lasker, J. Author-Name: Wolf, S. Author-Name: Potvin, L. Year: 1992 Volume: 82 Issue: 8 Pages: 1089-1092 Abstract: Objectives. Earlier studies found striking differences in mortality from myocardial infarction between Roseto, a homogeneous Italian-American community in Pennsylvania, and other nearby towns between 1955 and 1965. These differences disappeared as Roseto became more 'Americanized' in the 1960s. The present study extended the comparison over a longer period of time to test the hypothesis that the findings from this period were not due to random fluctuations in small communities. Methods. We examined death certificates for Roseto and Bangor from 1935 to 1985. Age-standardized death rates and mortality ratios were computed for each decade. Results. Rosetans had a lower mortality rate from myocardial infarction over the course of the first 30 years, but it rose to the level of Bangor's following a period of erosion of traditionally cohesive family and community relationships. This mortality-rate increase involved mainly younger Rosetan men and elderly women. Conclusions. The data confirmed the existence of consistent mortality differences between Roseto and Bangor during a time when there were many indicators of greater social solidarity and homogeneity in Roseto. Handle: RePEc:aph:ajpbhl:1992:82:8:1089-1092_6 Template-Type: ReDIF-Article 1.0 Title: Reductions in HIV risk-associated sexual behaviors among Black male adolescents: Effects of an AIDS prevention intervention Journal: American Journal of Public Health Author-Name: Jemmott III, J.B. Author-Name: Jemmott, L.S. Author-Name: Fong, G.T. Year: 1992 Volume: 82 Issue: 3 Pages: 372-377 Abstract: Background. The number of reported cases of acquired immune deficiency syndrome (AIDS) is increasing disproportionately among Blacks in the United States. The relatively high incidence of sexually transmitted diseases among Black adolescents suggests the need for AIDS prevention programs to reduce their risk of sexually transmitted human immunodeficiency virus (HIV) infection. Methods. Black male adolescents (n = 157) were randomly assigned to receive an AIDS risk reduction intervention aimed at increasing AIDS- related knowledge and weakening problematic attitudes toward risky sexual behavior, or to receive a control intervention on career opportunities. Results. The adolescents who received the AIDS intervention subsequently had greater AIDS knowledge, less favorable attitudes toward risky sexual behavior, and lower intentions to engage in such behavior than did those in the control condition. Follow-up data collected 3 months later revealed that the adolescents who had received the AIDS intervention reported fewer occasions of coitus, fewer coital partners, greater use of condoms, and a lower incidence of heterosexual anal intercourse than did the other adolescents. Conclusions. These results suggest that interventions that increase knowledge about AIDS and change attitudes toward risky sexual behavior may have salutary effects on Black adolescents' risk of HIV infection. Handle: RePEc:aph:ajpbhl:1992:82:3:372-377_4 Template-Type: ReDIF-Article 1.0 Title: Job strain and mortality in elderly men: Social network, support, and influence as buffers Journal: American Journal of Public Health Author-Name: Falk, A. Author-Name: Hanson, B.S. Author-Name: Isacsson, S.-O. Author-Name: Ostergren, P.-O. Year: 1992 Volume: 82 Issue: 8 Pages: 1136-1139 Abstract: The aim was to investigate whether job strain affects mortality in a representative population of elderly men, and whether social network and social support outside the workplace can buffer the negative health effects of job strain. A higher relative mortality risk (RR) was found among men exposed to job strain (RR = 1.7). The combination of exposure to job strain and seven different measures of weak social network and social support was associated with a further increased RR ranging from 2.1 to 4.6. Handle: RePEc:aph:ajpbhl:1992:82:8:1136-1139_5 Template-Type: ReDIF-Article 1.0 Title: The effect of legal drinking age on fatal injuries of adolescents and young adults Journal: American Journal of Public Health Author-Name: Jones, N.E. Author-Name: Pieper, C.F. Author-Name: Robertson, L.S. Year: 1992 Volume: 82 Issue: 1 Pages: 112-115 Abstract: This study examined the effect of legal drinking age (LDA) on fatal injuries in persons aged 15 to 24 years in the United States between 1979 and 1984. Effects on pre-LDA teens, adolescents targeted by LDA, initiation at LDA, and post-LDA drinking experience were assessed. A higher LDA was also associated with reduced death rates for motor vehicle drivers, pedestrians, unintentional injuries excluding motor vehicle injuries, and suicide. An initiation effect on homicides was identified. Reductions in injury deaths related to drinking experience were not found. In general, a higher LDA reduced deaths among adolescents and young adults for various categories of violent death. Handle: RePEc:aph:ajpbhl:1992:82:1:112-115_4 Template-Type: ReDIF-Article 1.0 Title: Men's disclosure of HIV test results to male primary sex partners Journal: American Journal of Public Health Author-Name: Schnell, D.J. Author-Name: Higgins, D.L. Author-Name: Wilson, R.M. Author-Name: Goldbaum, G. Author-Name: Cohn, D.L. Author-Name: Wolitski, R.J. Year: 1992 Volume: 82 Issue: 12 Pages: 1675-1676 Abstract: We evaluated disclosure of human immunodeficiency virus (HIV) antibody status to a main sex partner and the impact on the relationship in men who have sex with men and who are enrolled in the Acquired Immunodeficiency Syndrome (AIDS) Community Demonstration Projects cohorts. Eighty-nine percent of both seronegative and seropositive men disclosed the results to their main sex partner. Seventy percent of the seronegative men and 82% of the seropositive men who did so reported that the relationship remained 'as strong as ever' after 6 months. Most men who did not disclose their test results to their main partner reported being 'single' after 6 months. Handle: RePEc:aph:ajpbhl:1992:82:12:1675-1676_9 Template-Type: ReDIF-Article 1.0 Title: Erratum: Body fatness and risk for elevated blood pressure, total cholesterol, and serum lipoprotein ratios in children and adolescents (Am J Public Health (1992) 82 (358-363)) Journal: American Journal of Public Health Author-Name: Williams, D.P. Author-Name: Going, S.B. Author-Name: Lohman, T.G. Year: 1992 Volume: 82 Issue: 4 Pages: 527 Handle: RePEc:aph:ajpbhl:1992:82:4:527_4 Template-Type: ReDIF-Article 1.0 Title: Home apnea monitoring and disruptions in family life: A multidimensional controlled study Journal: American Journal of Public Health Author-Name: Ahmann, E. Author-Name: Wulff, L. Author-Name: Meny, R.G. Year: 1992 Volume: 82 Issue: 5 Pages: 719-722 Abstract: We used data from telephone interviews and mailed questionnaires to examine 12 aspects of family life among 93 families with infants considered at high risk for sudden infant death syndrome and on home apnea monitors and a matched comparison group with infants not requiring monitoring. Using logistic regression to control confounding variables, we found that case mothers were at an increased risk of poor health, but we found no other significant differences in family life between the two groups. Handle: RePEc:aph:ajpbhl:1992:82:5:719-722_0 Template-Type: ReDIF-Article 1.0 Title: The validity of self-reported HIV antibody test results Journal: American Journal of Public Health Author-Name: McCusker, J. Author-Name: Stoddard, A.M. Author-Name: McCarthy, E. Year: 1992 Volume: 82 Issue: 4 Pages: 567-569 Abstract: Three hundred twenty-six participants in a multisite study were initially tested for human immunodeficiency virus (HIV) antibody and later interviewed; 228 were recent drug injectors and 38 were HIV positive. Later, 264 (81%) correctly reported their test results, 9 (3%) gave incorrect results, and 53 (16%) said either that they had not been tested or that they did not know the results. The predictive values of positive and negative self-reports were 90% and 98%, respectively (P < .01). Handle: RePEc:aph:ajpbhl:1992:82:4:567-569_3 Template-Type: ReDIF-Article 1.0 Title: Decreased access to medical care for girls in Punjab, India: The roles of age, religion, and distance Journal: American Journal of Public Health Author-Name: Booth, B.E. Author-Name: Verma, M. Year: 1992 Volume: 82 Issue: 8 Pages: 1155-1157 Abstract: Risk factors that increase the likelihood of discrimination against girls in India have not been well studied. In this study of hospitalized children in Punjab, India, girls were less likely to be in the newborn or infant age groups, to be of the Sikh religion, or to come from far away than were boys. These differences suggest that these factors are significant risk factors for denied access to medical care for girls living in Punjab, India. Handle: RePEc:aph:ajpbhl:1992:82:8:1155-1157_3 Template-Type: ReDIF-Article 1.0 Title: Agent orange: Exposure and policy [8] Journal: American Journal of Public Health Author-Name: Waterbor, J.W. Author-Name: Gough, M. Year: 1992 Volume: 82 Issue: 1 Pages: 127 Handle: RePEc:aph:ajpbhl:1992:82:1:127_2 Template-Type: ReDIF-Article 1.0 Title: Informed consent and hysterectomy: Enhancing the right to know Journal: American Journal of Public Health Author-Name: Rose, B.K. Year: 1992 Volume: 82 Issue: 4 Pages: 609-610 Handle: RePEc:aph:ajpbhl:1992:82:4:609-610_7 Template-Type: ReDIF-Article 1.0 Title: Trends in sexual behavior and the HIV pandemic Journal: American Journal of Public Health Author-Name: Ehrhardt, A.A. Year: 1992 Volume: 82 Issue: 11 Pages: 1459-1461 Handle: RePEc:aph:ajpbhl:1992:82:11:1459-1461_5 Template-Type: ReDIF-Article 1.0 Title: Cesarean section rates in Italy by hospital payment mode: An analysis based on birth certificates Journal: American Journal of Public Health Author-Name: Bertollini, R. Author-Name: DiLallo, D. Author-Name: Spadea, T. Author-Name: Perucci, C. Year: 1992 Volume: 82 Issue: 2 Pages: 257-261 Abstract: This study, based on birth certificate data from 1985 through 1987, investigated cesarean section (CS) rates in the Lazio region of Italy and their relationship with mode of hospital care payment. Use of abdominal delivery increased from 22.3% in 1985 to 24.3% in 1987. CS rates were highest (34.7%) in private hospitals. A marked variation in the use of CS was associated with mode of hospital care payment independently from other predictors of abdominal delivery. Handle: RePEc:aph:ajpbhl:1992:82:2:257-261_0 Template-Type: ReDIF-Article 1.0 Title: Editorial: The double bind in science policy and the protection of women from HIV infection Journal: American Journal of Public Health Author-Name: Stein, Z.A. Year: 1992 Volume: 82 Issue: 11 Pages: 1471-1472 Handle: RePEc:aph:ajpbhl:1992:82:11:1471-1472_8 Template-Type: ReDIF-Article 1.0 Title: Preterm birth, intrauterine growth retardation, and perinatal mortality Journal: American Journal of Public Health Author-Name: Kiely, J.L. Author-Name: Susser, M. Year: 1992 Volume: 82 Issue: 3 Pages: 343-345 Handle: RePEc:aph:ajpbhl:1992:82:3:343-345_4 Template-Type: ReDIF-Article 1.0 Title: Does equal socioeconomic status in Black and White men mean equal risk of mortality? Journal: American Journal of Public Health Author-Name: Keil, J.E. Author-Name: Sutherland, S.E. Author-Name: Knapp, R.G. Author-Name: Tyroler, H.A. Year: 1992 Volume: 82 Issue: 8 Pages: 1133-1136 Abstract: Although concerns have been expressed that mortality from coronary disease and all other causes is greater among Blacks than Whites, we hypothesized that, when socioeconomic status is adequately considered, mortality inequalities between Blacks and Whites are insignificant. The study population was a random sampling of Black and White men who were 35 years of age or older when recruited into the Charleston Heart Study in 1960. Education level and occupational status at baseline were used to compare mortality over the ensuing 28 years between Black and White men, who were classified as low or high socioeconomic status. In no instance were Black- White differences in all-cause or coronary disease mortality rates significantly different when socioeconomic status was controlled. We conclude that socioeconomic status is an important predictor of mortality and that, when socioeconomic status is considered, differences in Black-White mortality rates may be small. Handle: RePEc:aph:ajpbhl:1992:82:8:1133-1136_3 Template-Type: ReDIF-Article 1.0 Title: Screening behaviors among relatives of breast cancer patients [2] Journal: American Journal of Public Health Author-Name: Vogel, V.G. Year: 1992 Volume: 82 Issue: 10 Pages: 1420 Handle: RePEc:aph:ajpbhl:1992:82:10:1420_1 Template-Type: ReDIF-Article 1.0 Title: Overcoming the absence of socioeconomic data in medical records: Validation and application of a census-based methodology Journal: American Journal of Public Health Author-Name: Krieger, N. Year: 1992 Volume: 82 Issue: 5 Pages: 703-710 Abstract: Background. Most US medical records lack socioeconomic data, hindering studies of social gradients in health and ascertainment of whether study samples are representative of the general population. This study assessed the validity of a census-based approach in addressing these problems. Methods. Socioeconomic data from 1980 census tracts and block groups were matched to the 1985 membership records of a large prepaid health plan (n = 1.9 million), with the link provided by each individual's residential address. Among a subset of 14 420 Black and White members, comparisons were made of the association of individual, census tract, and census block-group socioeconomic measures with hypertension, height, smoking, and reproductive history. Results. Census-level and individual-level socioeconomic measures were similarly associated with the selected health outcomes. Census data permitted assessing response bias due to missing individual-level socioeconomic data and also contextual effects involving the interaction of individual- and neighborhood-level socioeconomic traits. On the basis of block-group characteristics, health plan members generally were representative of the total population; persons in impoverished neighborhoods, however, were underrepresented. Conclusions. This census-based methodology offers a valid and useful approach to overcoming the absence of socioeconomic data in most US medical records. Handle: RePEc:aph:ajpbhl:1992:82:5:703-710_9 Template-Type: ReDIF-Article 1.0 Title: Ultraviolet light exposure and lens opacities: The Beaver Dam Eye Study Journal: American Journal of Public Health Author-Name: Cruickshanks, K.J. Author-Name: Klein, B.E.K. Author-Name: Klein, R. Year: 1992 Volume: 82 Issue: 12 Pages: 1658-1662 Abstract: Objectives. Exposure to sunlight may be a risk factor for the development of cataract. The relationships between exposure to sunlight and to the ultraviolet-B (UVB) component of light and the prevalence of lens opacities were examined in the Beaver Dam Eye Study. Methods. Persons 43 to 84 years of age residing in Beaver Dam, Wisconsin, were examined using standardized photographic assessments of lens opacities. A questionnaire about medical history and exposure to light was administered. Results. After adjusting for other risk factors, men who had higher levels of average annual ambient UVB light were 1.36 times more likely to have more severe cortical opacities than men with lower levels. However, UVB exposure was not found to be associated with nuclear sclerosis or posterior subcapsular opacities in men. Moreover, no associations with UVB exposure were found for women, who were less likely to be exposed to UVB. Conclusions. Exposure to UVB light may be associated with the severity of cortical opacities in men. However, the lack of an association in women, the group more likely to have cortical opacities, suggests that other factors may be more important in the pathogenesis of lens opacities. Handle: RePEc:aph:ajpbhl:1992:82:12:1658-1662_1 Template-Type: ReDIF-Article 1.0 Title: Women and children first: Towards a US family policy Journal: American Journal of Public Health Author-Name: Sidel, R. Year: 1992 Volume: 82 Issue: 5 Pages: 664-665 Handle: RePEc:aph:ajpbhl:1992:82:5:664-665_1 Template-Type: ReDIF-Article 1.0 Title: Communitywide smoking prevention: Long-term outcomes of the Minnesota Heart Health Program and the Class of 1989 Study Journal: American Journal of Public Health Author-Name: Perry, C.L. Author-Name: Kelder, S.H. Author-Name: Murray, D.M. Author-Name: Klepp, K.-I. Year: 1992 Volume: 82 Issue: 9 Pages: 1210-1216 Abstract: Objectives. The Class of 1989 Study is part of the Minnesota Heart Health Program (MHHP), a populationwide research and demonstration project designed to reduce cardiovascular disease in three educated communities from 1980 to 1993. This paper describes an intensive, school-based behavioral intervention on cigarette smoking, comparing long-term outcomes in one of the intervention communities with those in a matched reference community. Methods. Beginning in sixth grade (1983), seven annual waves of cohort and cross-sectional behavioral measurements were taken from one MHHP intervention community and its matched pair. All students in each community were eligible to participate (baseline n = 2401). Self-reported data collected at each period described prevalence and intensity of cigarette smoking. Results. There were no differences at baseline for either weekly smoking prevalence or intensity of smoking. Throughout the follow-up period, however, smoking rates as determined by these measures were significantly lower in the intervention community: 14.6% of students were weekly smokers at the end of high school compared with 24.1% in the reference community. Conclusions. These results suggest that multiple intervention components such as behavioral education in schools, booster programs to sustain training, and complementary communitywide strategies may all be needed for lasting reductions in adolescent tobacco use. Handle: RePEc:aph:ajpbhl:1992:82:9:1210-1216_8 Template-Type: ReDIF-Article 1.0 Title: Mammography outreach program Journal: American Journal of Public Health Author-Name: Destouet, J.M. Author-Name: Evens, R.G. Year: 1992 Volume: 82 Issue: 2 Pages: 302-303 Handle: RePEc:aph:ajpbhl:1992:82:2:302-303_2 Template-Type: ReDIF-Article 1.0 Title: Editorial: Managed care for the seriously mentally ill Journal: American Journal of Public Health Author-Name: Mechanic, D. Year: 1992 Volume: 82 Issue: 6 Pages: 788-789 Handle: RePEc:aph:ajpbhl:1992:82:6:788-789_4 Template-Type: ReDIF-Article 1.0 Title: Prevention of cigarette smoking through mass media intervention and school programs Journal: American Journal of Public Health Author-Name: Flynn, B.S. Author-Name: Worden, J.K. Author-Name: Secker-Walker, R.H. Author-Name: Badger, G.J. Author-Name: Geller, B.M. Author-Name: Costanza, M.C. Year: 1992 Volume: 82 Issue: 6 Pages: 827-834 Abstract: Objectives. In this study we tested the ability of mass media interventions to enhance the efficacy of school cigarette smoking prevention programs. Methods. For 4 years, students in one pair of communities received media interventions and school programs that had common educational objectives. Students in a matched pair of communities received only the school programs. The combined cohort of 5458 students was surveyed at baseline in grades 4, 5, and 6 and was followed up annually for 4 years. Results. Significant reductions in reported smoking, along with consistent effects on targeted mediating variables, were observed for the media-and- school group. For cigarettes per week the reduction was 41% (2.6 vs 4.4); for smoking cigarettes yesterday the reduction was 34% (8.6% vs 13.1%); and for smoking in the past week the reduction was 35% (12.8% vs 19.8%). No effects were observed for substance use behaviors not targeted by the interventions. Conclusions. These results provide evidence that mass media interventions are effective in preventing cigarette smoking when they are carefully targeted at high-risk youths and share educational objectives with school programs. Handle: RePEc:aph:ajpbhl:1992:82:6:827-834_7 Template-Type: ReDIF-Article 1.0 Title: Impact of HIV infection on mortality and accuracy of AIDS reporting on death certificates Journal: American Journal of Public Health Author-Name: Hessol, N.A. Author-Name: Buchbinder, S.P. Author-Name: Colbert, D. Author-Name: Scheer, S. Author-Name: Underwood, R. Author-Name: Barnhart, J.L. Author-Name: O'Malley, P.M. Author-Name: Doll, L.S. Author-Name: Lifson, A.R. Year: 1992 Volume: 82 Issue: 4 Pages: 561-564 Abstract: To assess the impact of HIV infection on mortality and the accuracy of AIDS reporting on death certificates, we analyzed data from 6704 homosexual and bisexual men in the San Francisco City Clinic cohort. Identification of AIDS cases and deaths in the cohort was determined through multiple sources, including the national AIDS surveillance registry and the National Death Index. Through 1990, 1518 deaths had been reported in the cohort and 1292 death certificates obtained. Of the 1292 death certificates, 1162 were for known AIDS cases, but 9% of the AIDS cases did not have HIV infection or AIDS noted on the death certificate. Only 0.7% of the decedents had AIDS listed as a cause of death and had not been reported to AIDS surveillance. AIDS and HIV infection was the leading cause of death in the cohort, with the highest proportionate mortality ratio (85%) and standardized mortality ratio (153 in 1987), and the largest number of years of potential life lost (32 008 years). The devastating impact of HIV infection on mortality is increasing and will require continued efforts to prevent and treat HIV infection. Handle: RePEc:aph:ajpbhl:1992:82:4:561-564_9 Template-Type: ReDIF-Article 1.0 Title: Fear of dying and HIV infection vs hepatitis B infection Journal: American Journal of Public Health Author-Name: Schneiderman, L.J. Author-Name: Kaplan, R.M. Year: 1992 Volume: 82 Issue: 4 Pages: 584-586 Abstract: Accidental exposure to the blood of hepatitis B patients produced less fear than does accidental exposure today to the human immunodeficiency virus (HIV), even though both have an approximately equal overall risk of death (- 1%). Subjects responding to hypothetical insect-exposure and disease-exposure scenarios chose to avoid the HIV-type risk of 1% chance of exposure/100% chance of death. Fear of certain death seems to account for the greater concern about exposure to HIV than to Hepatitis B. Handle: RePEc:aph:ajpbhl:1992:82:4:584-586_4 Template-Type: ReDIF-Article 1.0 Title: The inpatient AIDS unit: A preliminary empirical investigation of access, economic, and outcome issues Journal: American Journal of Public Health Author-Name: Fahs, M.C. Author-Name: Fulop, G. Author-Name: Strain, J. Author-Name: Sacks, H.S. Author-Name: Muller, C. Author-Name: Cleary, P.D. Author-Name: Schmeidler, J. Author-Name: Turner, B. Year: 1992 Volume: 82 Issue: 4 Pages: 576-578 Abstract: An AIDS unit model ('cluster beds') and a general inpatient placement model ('scatter beds') in a major teaching hospital were compared to determine whether they differed on several dimensions of care. After controlling for severity of illness, (the major predictor of admission to the AIDS unit), length of stay, charges, and inpatient mortality rates did not differ between the two settings. Equal proportions of White, Hispanic, male, and privately insured patients were found in both settings. Nursing staff turnover rates were comparable to those of other sites. However, the data raise new issues regarding access to AIDS units for older, Black, and female patients. Handle: RePEc:aph:ajpbhl:1992:82:4:576-578_6 Template-Type: ReDIF-Article 1.0 Title: Longevity of jazz musicians: Spencer replies to Haaga and Rothman [8] Journal: American Journal of Public Health Author-Name: Spencer, F.J. Year: 1992 Volume: 82 Issue: 6 Pages: 901 Handle: RePEc:aph:ajpbhl:1992:82:6:901_1 Template-Type: ReDIF-Article 1.0 Title: How effective are excise tax increases in reducing cigarette smoking? Journal: American Journal of Public Health Author-Name: Wasserman, J. Year: 1992 Volume: 82 Issue: 1 Pages: 19-20 Handle: RePEc:aph:ajpbhl:1992:82:1:19-20_8 Template-Type: ReDIF-Article 1.0 Title: Community health, community risks, community action Journal: American Journal of Public Health Author-Name: Shea, S. Year: 1992 Volume: 82 Issue: 6 Pages: 785-787 Handle: RePEc:aph:ajpbhl:1992:82:6:785-787_6 Template-Type: ReDIF-Article 1.0 Title: The disclosure of celebrity HIV infection: Its effects on public attitudes Journal: American Journal of Public Health Author-Name: Kalichman, S.C. Author-Name: Hunter, T.L. Year: 1992 Volume: 82 Issue: 10 Pages: 1374-1376 Abstract: Objectives. Despite the magnitude of the acquired immunodeficiency syndrome (AIDS) epidemic, studies have shown low levels of public concern about human immunodeficiency virus (HIV)/AIDS. We investigated the effects of celebrity disclosure of HIV infection on the AIDS-related perceptions of urban men. Methods. Measures of AIDS-related perceptions were collected from 361 men waiting for mass transportation in downtown Chicago; 252 were assessed at three time points prior to and 109 were assessed at two time points after professional basketball star Earvin 'Magic' Johnson's disclosure of his HIV infection. Results. Significant increases in concern about AIDS, interest in AIDS information, and talking with friends about AIDS occurred after celebrity disclosure of HIV infection. Conclusions. Celebrity disclosure of HIV seropositivity demonstrated a marked change in AIDS-related perceptions among the men surveyed. Changes in awareness due to celebrity disclosure may lead to increased readiness to reduce risk and could be viewed as a window of opportunity for HIV prevention efforts. Handle: RePEc:aph:ajpbhl:1992:82:10:1374-1376_5 Template-Type: ReDIF-Article 1.0 Title: The quality of life in the year before death Journal: American Journal of Public Health Author-Name: Lentzner, H.R. Author-Name: Pamuk, E.R. Author-Name: Rhodenhiser, E.P. Author-Name: Rothenberg, R. Author-Name: Powell-Griner, E. Year: 1992 Volume: 82 Issue: 8 Pages: 1093-1098 Abstract: Objectives. Most Americans wish to live a long healthy life, but fear disease and dependency in their last years. Until recently, little has been known about the prevalence of opposite extremes of health in old age, particularly in the period leading up to death. Methods. We used results from the 1986 National Mortality Followback Survey to estimate proportions of elderly decedents who were 'fully functional' or 'severely restricted' in the last year of life. Estimates were based on responses from proxies to questions regarding the decedent's functional status, mental awareness, and time spent in institutions. Results. Approximately 14% of all decedents aged 65 years and older were defined as fully functional in the last year of life; 10% were defined as severely restricted. Proportions varied with the decedent's age and sex, the underlying cause of death, and the presence of other preexisting conditions. Conclusions. Results from this survey and future surveys can be used to learn more about 'successful agers'-their medical histories, their life-styles, and whether their relative number is increasing or decreasing over time. Handle: RePEc:aph:ajpbhl:1992:82:8:1093-1098_9 Template-Type: ReDIF-Article 1.0 Title: Television news, hegemony, and health [6] Journal: American Journal of Public Health Author-Name: Wallack, L. Author-Name: Dorfman, L. Year: 1992 Volume: 82 Issue: 1 Pages: 125-126 Handle: RePEc:aph:ajpbhl:1992:82:1:125-126_3 Template-Type: ReDIF-Article 1.0 Title: The social impact of dental problems and visits Journal: American Journal of Public Health Author-Name: Gift, H.C. Author-Name: Reisine, S.T. Author-Name: Larach, D.C. Year: 1992 Volume: 82 Issue: 12 Pages: 1663-1668 Abstract: Objectives. The purpose of this analysis was to assess selected social consequences of maintaining oral health and treating oral diseases. The associations among socioeconomic and demographic factors with time lost from work or school and reductions in normal activities are explored. Methods. Data were gathered as part of the 1989 National Health Interview Survey from 50 000 US households (117 000 individuals), representing 240 million persons. The oral health care supplement was analyzed using the software SUDAAN to produce standard errors for estimates based on complex multistage sample designs. Results. Because of dental visits or problems, 148 000 hours of work were lost per 100 000 workers, 117 000 hours of school were lost per 100 000 school-age children, and 17 000 activity days beyond work and school time were restricted per 100 000 individuals in 1989. Exploratory analyses suggest that sociodemographic groups have different patterns of such time loss and of reduced normal activities. Conclusions. Overall, there is low social impact individually from dental visits and oral conditions. At the societal level, however, such problems and treatments among disadvantaged groups appear to have a greater impact. Handle: RePEc:aph:ajpbhl:1992:82:12:1663-1668_6 Template-Type: ReDIF-Article 1.0 Title: The safety of home birth: The Farm Study Journal: American Journal of Public Health Author-Name: Durand, A.M. Year: 1992 Volume: 82 Issue: 3 Pages: 450-452 Abstract: Pregnancy outcomes of 1707 women, who enrolled for care between 1971 and 1989 with a home birth service run by lay midwives in rural Tennessee, were compared with outcomes from 14 033 physician-attended hospital deliveries derived from the 1980 US National Natality/National Fetal Mortality Survey. Based on rates of perinatal death, of low 5-minute Apgar scores, of a composite index of labor complications, and of use of assisted delivery, the results suggest that, under certain circumstances, home births attended by lay midwives can be accomplished as safely as, and with less intervention than, physician-attended hospital deliveries. Handle: RePEc:aph:ajpbhl:1992:82:3:450-452_0 Template-Type: ReDIF-Article 1.0 Title: Birthweight distributions in Mexico City and among US Southwest Mexican Americans: The effect of altitude Journal: American Journal of Public Health Author-Name: Notzon, F.C. Author-Name: Bobadilla, J.L. Author-Name: Coria, I. Year: 1992 Volume: 82 Issue: 7 Pages: 1014-1017 Abstract: In this study birthweight distributions for Mexican Americans and Mexico City were compared. Sharp differences in the two distributions were nearly eliminated by controlling for altitude. The small remaining excess in low birthweight in Mexico City appears to be due to a slight overrepresentation of tertiary hospital deliveries, and possibly to a greater prevalence of pathological conditions. The results are consistent with the favorable low birthweight rate reported for Mexican Americans and illustrate the need to adjust for altitude in studies of low birthweight. Handle: RePEc:aph:ajpbhl:1992:82:7:1014-1017_4 Template-Type: ReDIF-Article 1.0 Title: Implications of the revised surveillance definition: AIDS among New York City drug users Journal: American Journal of Public Health Author-Name: Des Jarlais, D.C. Author-Name: Wenston, J. Author-Name: Friedman, S.R. Author-Name: Sotheran, J.L. Author-Name: Maslansky, R. Author-Name: Marmor, M. Author-Name: Yancovitz, S. Author-Name: Beatrice, S. Year: 1992 Volume: 82 Issue: 11 Pages: 1531-1533 Abstract: The Centers for Disease Control (CDC) has proposed revising the AIDS surveillance definition to include any HIV-seropositive person with a CD4 cell count of less than 200 cells per microliter. Based on a study of persons receiving treatment for HIV infection, this new definition would lead to an estimated 50% increase in the number of persons recognized as living with AIDS. Among 440 HIV-seropositive research subjects recruited from drug treatment programs and through street outreach in New York City, 59 met this definition, yet only 25% of those had been reported to the New York City AIDS registry. The new definition, if combined with HIV and T-cell testing at drug treatment and street outreach programs, could thus yield very large increases in the number of injecting drug users meeting the new surveillance definition of AIDS. Handle: RePEc:aph:ajpbhl:1992:82:11:1531-1533_9 Template-Type: ReDIF-Article 1.0 Title: Intestinal parasites among North Carolina migrant farmworkers Journal: American Journal of Public Health Author-Name: Ciesielski, S.D. Author-Name: Seed, J.R. Author-Name: Ortiz, J.C. Author-Name: Metts, J. Year: 1992 Volume: 82 Issue: 9 Pages: 1258-1262 Abstract: Objectives. The public health significance of intestinal parasitism among migrant farmworkers has been poorly defined. We report a three-part study in which we attempted to provide population-based estimates and identify risk factors for infection. Methods. Parasite prevalence and incidence were estimated from two cross-sectional studies and a longitudinal study. We used questionnaires and clinical measurements such as hematocrits to examine risk factors and health effects. Results. In the 1987 convenience sample (n = 265), parasite prevalence ranged from 28% among the US born to 86% among the Central American born, with no significant difference between the prevalence of pathogens among US-born (14%) and Mexican-born (24%) subjects (P = .12, χ2 test). High prevalences were also found in the 1988 random sample. An annual incidence of 9.5% (n = 74) was demonstrated in 1988. Symptoms such as abdominal pain were associated with infection, and lower hematocrits were associated with hookworm infection (P = .02, t test). Conclusions. Infection with intestinal parasites appears to be an occupational hazard of farmwork, necessitating improved working and living conditions and greater clinical awareness. Handle: RePEc:aph:ajpbhl:1992:82:9:1258-1262_3 Template-Type: ReDIF-Article 1.0 Title: Recall of AIDS public service announcements and their impact on the ranking of AIDS as a national problem Journal: American Journal of Public Health Author-Name: Siska, M. Author-Name: Jason, J. Author-Name: Murdoch, P. Author-Name: Wen Shan Yang Author-Name: Donovan, R.J. Year: 1992 Volume: 82 Issue: 7 Pages: 1029-1032 Abstract: The efficacy of two public service announcements from Phase V of the 'America Responds to AIDS' (ARTA) campaign was assessed at two sites. Participants were randomly assigned to view a local news program, one with an ARTA public service announcement appearing six times and the other with no AIDS public service announcements. During telephone interviews with 907 participants 1 to 3 nights after viewing, 21% at Site A and 59% at Site B could correctly recall the ARTA public service announcements. Absolute mentions of AIDS as an important national issue increased. Handle: RePEc:aph:ajpbhl:1992:82:7:1029-1032_2 Template-Type: ReDIF-Article 1.0 Title: Report card on our national response to the AIDS epidemic - Some A's, too many D's Journal: American Journal of Public Health Author-Name: Rogers, D.E. Year: 1992 Volume: 82 Issue: 4 Pages: 522-524 Handle: RePEc:aph:ajpbhl:1992:82:4:522-524_9 Template-Type: ReDIF-Article 1.0 Title: Women with multiple sexual partners: United States, 1988 Journal: American Journal of Public Health Author-Name: Seidman, S.N. Author-Name: Mosher, W.D. Author-Name: Aral, S.O. Year: 1992 Volume: 82 Issue: 10 Pages: 1388-1394 Abstract: Women who have multiple sexual partners in a short time period are appropriate targets for sexually transmitted disease (STD) prevention. We analyzed survey data collected in 1988 from a nationally representative sample of 8450 American women aged 15 to 44 to identify markers of such behavior. Among sexually active persons, 0.4% of married women and 8.4% of unmarried women had two or more sexual partners in the 3 months preceding the interview; unmarried marital status, early age at first sexual intercourse, lack of religious affiliation, and young age were associated with this behavior. All except young age were predictive after multivariate analysis. Such factors may help define women at elevated STD risk and allow better targeting of STD prevention. Handle: RePEc:aph:ajpbhl:1992:82:10:1388-1394_1 Template-Type: ReDIF-Article 1.0 Title: Hair dye use and multiple myeloma in White men Journal: American Journal of Public Health Author-Name: Brown, L.M. Author-Name: Everett, G.D. Author-Name: Burmeister, L.F. Author-Name: Blair, A. Year: 1992 Volume: 82 Issue: 12 Pages: 1673-1674 Abstract: In recent reports, multiple myeloma has been linked to use of hair coloring products containing mutagenic and carcinogenic chemicals. A population-based case-control study in Iowa of 173 White men with multiple myeloma and 650 controls obtained information on hair dye use. Risk of multiple myeloma was significantly elevated (OR = 1.9) among hair dye users and was greatest among those using hair dyes at least once a month for a year or more (OR = 4.3). These data, along with results from other studies, suggest that use of hair dyes contributes to the development of multiple myeloma. Handle: RePEc:aph:ajpbhl:1992:82:12:1673-1674_1 Template-Type: ReDIF-Article 1.0 Title: HIV prevalence and risk behavior among injecting drug users who participate in 'low-threshold' methadone programs in Amsterdam Journal: American Journal of Public Health Author-Name: Hartgers, C. Author-Name: Van den Hoek, A.J.A.R. Author-Name: Krijnen, P. Author-Name: Coutinho, R.A. Year: 1992 Volume: 82 Issue: 4 Pages: 547-551 Abstract: Introduction. After the onset of the HIV epidemic, the hope arose that the 'harm reduction' approach of the Amsterdam 'low-threshold' methadone programs would have a function in controlling the spread of HIV among injecting drug users (IDUs). Methods. To find evidence for this assumption, 386 IDUs participating in an HIV study between 1985 and 1989 were studied. Long-term regular participants in low-threshold methadone programs were compared with short-term and/or irregular participants. Results. Controlling for possible confounders, long-term regular participants had a slightly increased but not statistically significant risk of being HIV infected. With regard to current drug use, they injected daily and shared needles as often as did short-term and/or irregular participants. Conclusions. The results suggest that the Amsterdam low-threshold methadone programs fail to diminish HIV risk behavior. If these programs want to have a positive effect on the spread of HIV, expansion of existing HIV prevention efforts, an increase in the daily methadone dose level, and measures to enforce regular attendance may be required. Handle: RePEc:aph:ajpbhl:1992:82:4:547-551_0 Template-Type: ReDIF-Article 1.0 Title: Longevity of jazz musicians: Flawed analysis [4] Journal: American Journal of Public Health Author-Name: Rothman, K.J. Author-Name: Haaga, J.G. Year: 1992 Volume: 82 Issue: 5 Pages: 761 Handle: RePEc:aph:ajpbhl:1992:82:5:761_8 Template-Type: ReDIF-Article 1.0 Title: Decontamination of an HIV-contaminated CPR manikin Journal: American Journal of Public Health Author-Name: Corless, I.B. Author-Name: Lisker, A. Author-Name: Buckheit, R.W. Year: 1992 Volume: 82 Issue: 11 Pages: 1542-1543 Abstract: There has been a concern that the number of persons engaging in cardiopulmonary resuscitation (CPR) training could decline because of questions about human immunodeficiency virus (HIV-1) transmission. We investigated the theoretical possibility that a CPR manikin might serve as a fornite for HIV-1 transmission. Decontamination protocols were tested by using elevated levels of virus and decreasing decontamination times. Even under these compromising conditions, however, decontamination was effective. Handle: RePEc:aph:ajpbhl:1992:82:11:1542-1543_7 Template-Type: ReDIF-Article 1.0 Title: Antihypertensive treatment and US trends in stroke mortality, 1962 to 1980 Journal: American Journal of Public Health Author-Name: Casper, M. Author-Name: Wing, S. Author-Name: Strogatz, D. Author-Name: Davis, C.E. Author-Name: Tyroler, H.A. Year: 1992 Volume: 82 Issue: 12 Pages: 1600-1606 Abstract: Objectives. This study examines the association between increases in antihypertensive pharmacotherapy and declines in stroke mortality among 96 US groups stratified by race, sex, age, metropolitan status, and region from 1962 to 1980. Methods. Data on the prevalence of controlled hypertension and socioeconomic profiles were obtained from three successive national health surveys. Stroke mortality rates were calculated using data from the National Center for Health Statistics and the Bureau of the Census. The association between controlled hypertension trends and stroke mortality declines was assessed with weighted regression. Results. Prior to 1972, there was no association between trends in controlled hypertension and stroke mortality declines (β = 0.04, P = .69). After 1972, groups with larger increases in controlled hypertension experienced slower rates of decline in stroke mortality (β = 0.16, P = .003). Faster rates of decline were modestly but consistently related to improvements in socioeconomic indicators only for the post-1972 period. Conclusions. These results do not support the hypothesis that increased antihypertensive pharmacotherapy has been the primary determinant of recent declines in stroke mortality. Additional studies should address the association between declining stroke mortality and trends in socioeconomic resources, dietary patterns, and cigarette smoking. Handle: RePEc:aph:ajpbhl:1992:82:12:1600-1606_2 Template-Type: ReDIF-Article 1.0 Title: HIV infection in intravenous drug users entering drug treatment, United States, 1988 to 1989 Journal: American Journal of Public Health Author-Name: Allen, D.M. Author-Name: Onorato, I.M. Author-Name: Green, T.A. Year: 1992 Volume: 82 Issue: 4 Pages: 541-546 Abstract: Background. Intravenous drug use has played a key role in the human immunodeficiency virus (HIV) epidemic. Standardized surveillance of HIV infection among intravenous drug users (IVDUs) is needed to determine HIV prevalence rates, to monitor changes in prevalence over time, and to describe behaviors associated with HIV infection. Methods. In 1987, the Centers for Disease Control began collaborating with state and local health departments to conduct a national program of HIV seroprevalence surveys in a variety of populations and settings. This program includes unlinked HIV seroprevalence surveys in IVDUs entering sentinel drug treatment programs. Results. From April 1988 through December 1989, annual studies were completed in 59 drug treatment centers in 33 US cities. Center-specific seroprevalence rates ranged from 0% to 48.2%, with a median of 4.6%. HIV seroprevalence rates varied widely by geographic area, with rates highest in the Northeast, intermediate in the Middle Atlantic cities of Baltimore and Washington, DC, and lower in other parts of the country. Median rates were 15.6% among African Americans, 3.2% among Hispanics, and 3.3% among Whites. Conclusions. Intravenous drug use is likely to remain an important factor in HIV transmission. This study supports the need to develop or expand programs to prevent the further introduction and spread of HIV among IVDUs and to prevent HIV transmission to their sexual partners. Handle: RePEc:aph:ajpbhl:1992:82:4:541-546_4 Template-Type: ReDIF-Article 1.0 Title: Hazards of low-level lead exposure recognized [3] Journal: American Journal of Public Health Author-Name: Binder, S. Year: 1992 Volume: 82 Issue: 7 Pages: 1043-1044 Handle: RePEc:aph:ajpbhl:1992:82:7:1043-1044_7 Template-Type: ReDIF-Article 1.0 Title: History, biography, and HIV infection [5] Journal: American Journal of Public Health Author-Name: Friedman, S.R. Author-Name: Kleinman, P.H. Author-Name: Des Jarlais, D.C. Year: 1992 Volume: 82 Issue: 1 Pages: 125 Handle: RePEc:aph:ajpbhl:1992:82:1:125_2 Template-Type: ReDIF-Article 1.0 Title: Safe sex and low-risk groups [1] Journal: American Journal of Public Health Author-Name: Baird, B.N. Year: 1992 Volume: 82 Issue: 1 Pages: 123 Handle: RePEc:aph:ajpbhl:1992:82:1:123_2 Template-Type: ReDIF-Article 1.0 Title: Morbidity among pediatric motor vehicle crash victims: The effectiveness of seat belts Journal: American Journal of Public Health Author-Name: Osberg, J.S. Author-Name: Di Scala, C. Year: 1992 Volume: 82 Issue: 3 Pages: 422-425 Abstract: It is well established that seat belts reduce mortality and morbidity among children. Data are presented for 413 children injured severely enough in motor vehicle crashes to require hospitalization. Of the unrestrained children, 4.5% died, compared with 2.4% of the belted children. Unrestrained children had a higher proportion of injuries in four of five anatomical regions, were more severely injured, stayed longer in the hospital, and were 15% more likely than belted children to be discharged with impairments. Handle: RePEc:aph:ajpbhl:1992:82:3:422-425_1 Template-Type: ReDIF-Article 1.0 Title: VA mortality reporting for World War II Army Veterans [4] Journal: American Journal of Public Health Author-Name: Page, W.F. Year: 1992 Volume: 82 Issue: 1 Pages: 124-125 Handle: RePEc:aph:ajpbhl:1992:82:1:124-125_6 Template-Type: ReDIF-Article 1.0 Title: Changes in mammography use: Economic, need, and service factors Journal: American Journal of Public Health Author-Name: Zapka, J.G. Author-Name: Hosmer, D. Author-Name: Costanza, M.E. Author-Name: Harris, D.R. Author-Name: Stoddard, A. Year: 1992 Volume: 82 Issue: 10 Pages: 1345-1351 Abstract: Objectives. The purpose of this study was to document changes in mammography use between 1987 and 1990 and assess the relationship of use to selected economic, need, and health system factors. Methods. Independent random-digit-dialed telephone surveys of women between 52 and 75 years of age were conducted. Results. Between 1987 and 1990, the proportion of women who had had a mammogram in the past year increased from 31% to 51%. Though income was significantly related to overall patterns of use, it was not associated with recent mammogram use in 1990. Women with a family history of breast cancer reported greater use at both times, as did women who reported having a regular physician (particularly a gynecologist or internist). When all other variables were controlled for, women were over nine times more likely to have had multiple and recent mammograms in 1990 than in 1987. Conclusions. Mammography use dramatically increased between 1987 and 1990. There were strong relationships between the type of regular physician and mammography screening and between economic and personal history and repeated and recent mammography use. Handle: RePEc:aph:ajpbhl:1992:82:10:1345-1351_9 Template-Type: ReDIF-Article 1.0 Title: The medical origins of homelessness Journal: American Journal of Public Health Author-Name: Winkleby, M.A. Author-Name: Rockhill, B. Author-Name: Jatulis, D. Author-Name: Fortmann, S.P. Year: 1992 Volume: 82 Issue: 10 Pages: 1394-1398 Abstract: In 1989 through 1990, we conducted a cross-sectional survey of 1437 homeless adults in northern California (98% response rate). Prevalences of alcohol abuse, illegal drug use, and psychiatric hospitalization when adults first became homeless were 15% to 33% lower than prevalences following homelessness. The largest differences between the homeless and a comparison group of 3122 nonhomeless adults were for psychiatric hospitalization (odds ratios [ORs] of 4.6 for men and 5.9 for women) and alcohol abuse (ORs of 2.3 for men and 4.0 for women). However, when prehomeless prevalences of addictive and psychiatric disorders were compared with prevalences among the nonhomeless, absolute differences were no greater than 12%. Handle: RePEc:aph:ajpbhl:1992:82:10:1394-1398_5 Template-Type: ReDIF-Article 1.0 Title: Newspapers: A source for injury surveillance? Journal: American Journal of Public Health Author-Name: Rainey, D.Y. Author-Name: Runyan, C.W. Year: 1992 Volume: 82 Issue: 5 Pages: 745-746 Abstract: Newspapers have not been extensively evaluated as an injury surveillance source. We compared clippings with medical examiner records for 45 residential fire deaths and 58 drownings of children to assess extent, completeness, and accuracy of newspaper coverage. Newspapers covered 96% of the fire fatalities and 78% of the drownings and contained more information than medical examiner records on several factors, including fire cause and smoke detector presence, pool fences, warning signs, and supervision of children. Handle: RePEc:aph:ajpbhl:1992:82:5:745-746_7 Template-Type: ReDIF-Article 1.0 Title: Prevalence of obesity among children of military dependents at two major medical centers Journal: American Journal of Public Health Author-Name: Tiwary, C.M. Author-Name: Holguin, A.H. Year: 1992 Volume: 82 Issue: 3 Pages: 354-357 Abstract: Background. Prevalence of childhood obesity is unknown among military dependents. We ascertained the prevalence among all children aged 1 year or older attending the pediatric and adolescent clinics at the Walter Reed Army Medical Center (WRAMC) during 1978 and the Brooke Army Medical Center (BAMC) during 1986 and 1990. Methods. Obesity was defined according to the child's relative weight computed from growth charts of the National Center for Health Statistics. Results. The study sample included 1715 children (1078 at BAMC, 637 at WRAMC). Among them, 14.8% were overweight, 10.8% were obese, and 7.7% (3.0% males, 4.7% females) were grossly obese. The prevalence of grossly obese children was 5.5% at WRAMC and 9.0% at BAMC; 11.5% among children of retirees and 7.3% among children of active duty personnel (P < .008); 5.5% among children of officers and 12.2% among children of sergeants (P < .0005). The prevalence of very obese children was 10.1% for those older than 12 years of age and 3.3% for those aged 6 years or younger (P < .0001). Conclusions. Retiree status of the sponsor was more important than sponsor's rank or child's age in determining the prevalence of childhood obesity. Prevalence of obesity approximately doubled over the 8 to 12 years of the study. Handle: RePEc:aph:ajpbhl:1992:82:3:354-357_1 Template-Type: ReDIF-Article 1.0 Title: A cohort study of the impact of perinatal drug use on prematurity in an inner-city population Journal: American Journal of Public Health Author-Name: Feldman, J.G. Author-Name: Minkoff, H.L. Author-Name: McCalla, S. Author-Name: Salwen, M. Year: 1992 Volume: 82 Issue: 5 Pages: 726-728 Abstract: Perinatal illicit drug use was determined by anonymously testing the urine of 1111 inner-city parturients. Fourteen percent tested positive, 11.5% for cocaine. As determined by self-report or by positive test results, 17% used drugs. Twenty-eight percent of low birthweights and 20% of premature births in this group were attributable to drug use. Risk of prematurity was reduced by a factor of 2 to 3 with adequate prenatal care. These data suggest an enormous potential for improving perinatal health. Handle: RePEc:aph:ajpbhl:1992:82:5:726-728_5 Template-Type: ReDIF-Article 1.0 Title: The lowest birth-weight infants and the US infant mortality rate: NCHS 1983 linked birth/infant death data Journal: American Journal of Public Health Author-Name: Overpeck, M.D. Author-Name: Hoffman, H.J. Author-Name: Prager, K. Year: 1992 Volume: 82 Issue: 3 Pages: 441-444 Abstract: The National Center for Health Statistics Linked Birth and Infant Death Data Set, 1983 birth cohort, shows that infants weighing less than 750 g, comprising only 0.3% of all births, account for 25% of deaths in the first year of life and for 41% of deaths in the first week. If interventions had prevented the death of these very small babies, the infant mortality rate would have been 8.3 per 1000 live births instead of 10.9, and the Black/White mortality differential would have been reduced by 25%. Handle: RePEc:aph:ajpbhl:1992:82:3:441-444_0 Template-Type: ReDIF-Article 1.0 Title: Women's health, women's lives, women's rights Journal: American Journal of Public Health Author-Name: Rodriguez-Trias, H. Year: 1992 Volume: 82 Issue: 5 Pages: 663-664 Handle: RePEc:aph:ajpbhl:1992:82:5:663-664_9 Template-Type: ReDIF-Article 1.0 Title: Homosexual and bisexual men's perceptions of discrimination in health services Journal: American Journal of Public Health Author-Name: Kass, N.E. Author-Name: Faden, R.R. Author-Name: Fox, R. Author-Name: Dudley, J. Year: 1992 Volume: 82 Issue: 9 Pages: 1277-1279 Abstract: Questionnaires were distributed to homosexual and bisexual male participants in the Multicenter AIDS Cohort Study and to homosexual and bisexual male patients with acquired immunodeficiency syndrome (AIDS) to determine whether the men believed they had been refused medical or dental treatment because of their sexual orientation or a condition related to the human immunodeficiency virus (HIV). Men with AIDS were significantly more likely (18%) to report being refused treatment by a doctor or dentist on the basis of a known or suspected HIV-related condition than were men who were seropositive (5%) or seronegative (1%). Significantly more respondents reported refusal of dental care than of medical care. Handle: RePEc:aph:ajpbhl:1992:82:9:1277-1279_6 Template-Type: ReDIF-Article 1.0 Title: Falls among the elderly: A community prevention program Journal: American Journal of Public Health Author-Name: Tideiksaar, R. Year: 1992 Volume: 82 Issue: 6 Pages: 892-893 Handle: RePEc:aph:ajpbhl:1992:82:6:892-893_9 Template-Type: ReDIF-Article 1.0 Title: Subpopulation differentials in STD transmission [7] Journal: American Journal of Public Health Author-Name: Seidman, S.N. Author-Name: Aral, S. Year: 1992 Volume: 82 Issue: 9 Pages: 1297 Handle: RePEc:aph:ajpbhl:1992:82:9:1297_4 Template-Type: ReDIF-Article 1.0 Title: Biotechnology products in the field: Bringing regulation closer to home Journal: American Journal of Public Health Author-Name: Grossmann, R.S. Year: 1992 Volume: 82 Issue: 8 Pages: 1165-1166 Handle: RePEc:aph:ajpbhl:1992:82:8:1165-1166_0 Template-Type: ReDIF-Article 1.0 Title: Fairness in physician reimbursement [2] Journal: American Journal of Public Health Author-Name: Mejia, P. Year: 1992 Volume: 82 Issue: 4 Pages: 616 Handle: RePEc:aph:ajpbhl:1992:82:4:616_6 Template-Type: ReDIF-Article 1.0 Title: Responses to anonymous questionnaires concerning sexual behavior: A method to examine potential biases Journal: American Journal of Public Health Author-Name: Biggar, R.J. Author-Name: Melbye, M. Year: 1992 Volume: 82 Issue: 11 Pages: 1506-1512 Abstract: Objectives. Low response rates to voluntary surveys raise questions about how representative the responses are. We compared the behavior and attitudes of responders, willing and reluctant, and nonresponders to anonymous questionnaires about behaviors that might expose participants to the human immunodeficiency virus (HIV). Methods. Questionnaires were sent to 1080 Danish adults 18 through 59 years including explicit questions about sexual acts and illegal drug use. Identical questionnaires were sent to 3600 other Danes, similarly chosen; packets sent to these persons included cards to be returned separately informing us that they had responded. Questionnaires were sent twice more to nonresponders, who, if they then responded, were considered reluctant responders. One hundred nonresponders were telephoned and asked why they had refused to respond. Results. Enclosing return cards did not affect initial response rate, but prompting boosted replies from 52% to 73%. However, behaviors were generally similar among initial and reluctant responders. One third of nonresponders agreed to respond if we wished (total potential response: 82%). In general, the reasons for nonresponse did not suggest that the lifestyles of nonresponders placed them at risk for HIV infection. Conclusions. This method provides a simple, inexpensive approach to improving response rates and learning about the biases of reluctant responders and nonresponders. Handle: RePEc:aph:ajpbhl:1992:82:11:1506-1512_5 Template-Type: ReDIF-Article 1.0 Title: PHLIS: An electronic system for reporting public health data from remote sites Journal: American Journal of Public Health Author-Name: Bean, N.H. Author-Name: Martin, S.M. Author-Name: Bradford Jr., H. Year: 1992 Volume: 82 Issue: 9 Pages: 1273-1276 Abstract: Disease surveillance conducted by the Centers for Disease Control (CDC) in conjunction with state health departments provides databases of information to public health workers. These databases' utility is limited by the lag time from occurrence of disease events until records are available for analysis. We developed the Public Health Laboratory Information System (PHLIS), a PC- based electronic reporting system for entering, editing, and analyzing data locally and for transmitting data electronically to other state or federal offices. Advantages of PHLIS include reduction in paper handling, decrease in lag time between disease incident and availability of information for analysis, ability to rapidly examine data for clusters of disease, down- loadable summary tables, data editing at site of input, data analysis capability, increased interaction among participants, and current data for responses to inquiries. PHLIS is available without cost and is transportable to other agencies, states, or countries. Handle: RePEc:aph:ajpbhl:1992:82:9:1273-1276_5 Template-Type: ReDIF-Article 1.0 Title: Trends in tans and skin protection in Australian fashion magazines, 1982 through 1991 Journal: American Journal of Public Health Author-Name: Chapman, S. Author-Name: Marks, R. Author-Name: King, M. Year: 1992 Volume: 82 Issue: 12 Pages: 1677-1680 Abstract: We rated 3971 photographs of models from midsummer editions of six Australian fashion magazines from 1982-1983 to 1990-1991 for tan on a 9- point scale, for the presence of hats, for sun-protective clothing, and for shade setting. With the exception of the 1990-1991 sample, there was an increasing proportion of light tans over the years. Men were more likely to be deeply tanned than were women. The proportion of models wearing hats followed an increasing linear trend across the five periods. Three quarters of the outdoor photographs were taken in unshaded settings. In unshaded settings, 17% of the women and 5% of the men wore hats. Handle: RePEc:aph:ajpbhl:1992:82:12:1677-1680_3 Template-Type: ReDIF-Article 1.0 Title: Trend in suicide rates since fluoxetine introduction [4] Journal: American Journal of Public Health Author-Name: Masica, D.N. Author-Name: Kotsanos, J.G. Author-Name: Beasley Jr., C.M. Author-Name: Potvin, J.H. Year: 1992 Volume: 82 Issue: 9 Pages: 1295 Handle: RePEc:aph:ajpbhl:1992:82:9:1295_7 Template-Type: ReDIF-Article 1.0 Title: Childhood chronic illness: Prevalence, severity, and impact Journal: American Journal of Public Health Author-Name: Newacheck, P.W. Author-Name: Taylor, W.R. Year: 1992 Volume: 82 Issue: 3 Pages: 364-371 Abstract: Background. Using data from the 1988 National Health Interview Survey, this article presents national estimates of the prevalence and impact of childhood chronic conditions. Methods. Proxy responses to a checklist of child health conditions administered for 17 110 children under 18 years of age were used. Conditions were classified as chronic if they were first noticed more than 3 months prior to the interview or if they were the type that would ordinarily be of extended duration, such as arthritis. Results. An estimated 31% of children were affected by chronic conditions. Among these children, highly prevalent conditions included respiratory allergies 9.7 per 100, repeated ear infections 8.3 per 100 and asthma 4.3 per 100. These children can be divided into three groups: 66% with mild conditions that result in little or no bother or activity limitation; 29% with conditions of moderate severity that result in some bother or limitation of activity, but not both; and 5% with severe conditions that cause frequent bother and limitation of activity. The 5% with severe conditions accounted for 19% of physician contacts and 33% of hospital days related to chronic illness. Conclusions. Childhood chronic conditions have highly variable impacts on children's activities and use of health care. Handle: RePEc:aph:ajpbhl:1992:82:3:364-371_0 Template-Type: ReDIF-Article 1.0 Title: Factors associated with artificial feeding in Shanghai Journal: American Journal of Public Health Author-Name: Chen, Y. Year: 1992 Volume: 82 Issue: 2 Pages: 264-266 Abstract: Factors associated with artificial feeding were analyzed for 3285 infants in Shanghai. Boys, those from more highly educated families, and those born by assisted delivery or by cesarean section were more likely to be artificially fed than were girls, those from less educated families, and those born by spontaneous delivery. Infants whose birth weight was around 3750 g had the lowest probability of artificial feeding; higher and lower birth weights were positively associated with artificial feeding. Handle: RePEc:aph:ajpbhl:1992:82:2:264-266_7 Template-Type: ReDIF-Article 1.0 Title: The effect of state cigarette tax increases on cigarette sales, 1955 to 1988 Journal: American Journal of Public Health Author-Name: Peterson, D.E. Author-Name: Zeger, S.L. Author-Name: Remington, P.L. Author-Name: Anderson, H.A. Year: 1992 Volume: 82 Issue: 1 Pages: 94-96 Abstract: We evaluated the effect of state cigarette tax increases on cigarette sales in the 50 states for the years 1955 to 1988. State cigarette tax increases were associated with an average decline in cigarette consumption of three cigarette packs per capita (about 2.4%). Larger tax increases were associated with larger declines in consumption. Raising state cigarette taxes appears to be an effective public health intervention that can reduce cigarette consumption and its associated health consequences. Handle: RePEc:aph:ajpbhl:1992:82:1:94-96_5 Template-Type: ReDIF-Article 1.0 Title: Low birth weight in relation to multiple induced abortions Journal: American Journal of Public Health Author-Name: Mandelson, M.T. Author-Name: Maden, C.B. Author-Name: Daling, J.R. Year: 1992 Volume: 82 Issue: 3 Pages: 391-394 Abstract: Background. Most studies report that a single induced abortion does not increase risk for delivering a low birth weight infant in a subsequent pregnancy. However, the effect of multiple abortions has not been adequately evaluated. Methods. This relationship was studied in 6541 White women who delivered their first child between 1984 and 1987. We compared the frequencies of low birth weight (less than 2500 g) among infants born to 1999 women without prior induced abortion and 1999 women with one abortion with the frequencies of low birth weight among infants born to women with two (n = 1850), three (n = 520), and four or more (n = 173) prior induced abortions. Results. After adjustment for confounding variables, we found no linear relationship in risk of low birth weight among women with one (relative risk [RR] = 1.2, 95% confidence interval [CI] = 0.9-1.5), two (RR = 1.5, 95% CI = 1.1-2.0), three (RR = 1.3, 95% CI = 0.8-1.9), or four or more (RR = 1.6, 95% CI = 0.9-2.9) prior induced abortions. Conclusions. These findings confirm earlier reports of little or no evidence of harmful effects on birth weight by one or by two or more induced abortions. We further report that risk is not significantly elevated even in women with three, four, or more prior terminations of pregnancy when compared with women with one or two abortions. Handle: RePEc:aph:ajpbhl:1992:82:3:391-394_0 Template-Type: ReDIF-Article 1.0 Title: Standards for peer evaluation: The hospital quality assurance committee Journal: American Journal of Public Health Author-Name: Feldman, S.E. Author-Name: Roblin, D.W. Year: 1992 Volume: 82 Issue: 4 Pages: 525-527 Abstract: Required recertification of physicians has been proposed as a way to improve quality of care. Hospital medical staff quality assurance committees may be more meaningful targets for reform than individual physicians. Review standards are needed to make these committees effective monitors. Increasing regulatory attention to medical staff peer review can be expected. Handle: RePEc:aph:ajpbhl:1992:82:4:525-527_8 Template-Type: ReDIF-Article 1.0 Title: Could sunscreens increase melanoma risk? Journal: American Journal of Public Health Author-Name: Garland, C.F. Author-Name: Garland, F.C. Author-Name: Gorham, E.D. Year: 1992 Volume: 82 Issue: 4 Pages: 614-615 Handle: RePEc:aph:ajpbhl:1992:82:4:614-615_8 Template-Type: ReDIF-Article 1.0 Title: First-year impact of the 1989 California cigarette tax increase on cigarette consumption Journal: American Journal of Public Health Author-Name: Flewelling, R.L. Author-Name: Kenney, E. Author-Name: Elder, J.P. Author-Name: Pierce, J. Author-Name: Johnson, M. Author-Name: Bal, D.G. Year: 1992 Volume: 82 Issue: 6 Pages: 867-869 Abstract: We employed a time series design to evaluate the impact of the 1989 California cigarette tax increase on cigarette consumption in California. Adult per capita consumption data from 1980 to 1990 were analyzed for California and the United States. Trend data indicated a sharp drop in California cigarette consumption coincident with the tax increase. Time- series regression analyses support this observation, and suggest that a 5% to 7% decline in consumption is attributable to the tax increase. Handle: RePEc:aph:ajpbhl:1992:82:6:867-869_9 Template-Type: ReDIF-Article 1.0 Title: Weight gain prevention and smoking cessation: Cautionary findings Journal: American Journal of Public Health Author-Name: Hall, S.M. Author-Name: Tunstall, C.D. Author-Name: Vila, K.L. Author-Name: Duffy, J. Year: 1992 Volume: 82 Issue: 6 Pages: 799-803 Abstract: Objectives. Weight gain is a consistent sequela of smoking cessation. A successful intervention might attract smokers who fear weight gain. If the gain causes smoking relapse, such an intervention might reduce smoking relapse risk. Methods. Using a sample of 158 smokers who completed a 2-week smoking treatment program, we compared an innovative weight gain prevention intervention with both a nonspecific treatment and standard treatment. Subjects were assessed on weight and smoking behavior and followed for 1 year. Results. A disturbing, unexpected finding was that subjects in both the innovative and nonspecific conditions had a higher risk of smoking relapse than did standard treatment subjects. Some differences were observed between abstinent and smoking subjects in weight gain by treatment condition. Conclusions. Both active interventions may have been so complicated that they detracted from non-smoking. Also, caloric restriction may increase the reinforcing value of nicotine, a psychoactive drug, thereby increasing smoking relapse risk. The magnitude of weight gain after smoking cessation may not merit interventions that increase smoking risk. Perhaps attitudinal modifications are the most appropriate. Handle: RePEc:aph:ajpbhl:1992:82:6:799-803_5 Template-Type: ReDIF-Article 1.0 Title: HIV prevention and the two faces of partner notification Journal: American Journal of Public Health Author-Name: Bayer, R. Author-Name: Toomey, K.E. Year: 1992 Volume: 82 Issue: 8 Pages: 1158-1164 Abstract: In the cases of medical patients with sexually transmitted diseases (particularly those with the human immunodeficiency virus), two distinct approaches exist to notifying sexual and/or needle-sharing partners of possible risk. Each approach has its own history (including unique practical problems of implementation) and provokes its own ethical dilemmas. The first approach-the moral 'duty to warn'-arose out of clinical situations in which a physician knew the identity of a person deemed to be at risk. The second approach-that of contact tracing-emerged from sexually transmitted disease control programs in which the clinician typically did not know the identity of those who might have been exposed. Confusion between the two approaches has led many to mistake processes that are fundamentally voluntary as mandatory and those that respect confidentiality as invasive of privacy. In the context of the AIDS epidemic and the vicissitudes of the two approaches, we describe the complex problems of partner notification and underscore the ethical and political contexts within which policy decisions have been made. Handle: RePEc:aph:ajpbhl:1992:82:8:1158-1164_6 Template-Type: ReDIF-Article 1.0 Title: Use of community-based mental health programs by HMOs: Evidence from a Medicaid demonstration Journal: American Journal of Public Health Author-Name: Christianson, J.B. Author-Name: Lurie, N. Author-Name: Finch, M. Author-Name: Moscovice, I.S. Author-Name: Hartley, D. Year: 1992 Volume: 82 Issue: 6 Pages: 790-796 Abstract: Background. Proposals to enroll Medicaid beneficiaries in health maintenance organizations (HMOs) have raised concerns that community-based mental health treatment programs would be adversely affected. Methods. In Hennepin County (Minnesota) 35% of Medicaid beneficiaries were randomly assigned to prepaid plans. Random samples of individuals with severe mental illness were selected from the prepaid enrollees and from beneficiaries remaining with traditional Medicaid. The two groups were compared with respect to their use of community treatment programs and the write-off (the proportion of patient charges for which payment was not received) experienced by those programs for members of the study sample. Results. There was no strong evidence that Medicaid beneficiaries with severe mental illness who were randomly assigned to prepaid plans used community-based mental health treatment programs differently than did other Medicaid beneficiaries. However, write-offs were consistently higher for enrollees in prepaid plans. Conclusions. In the short run, the use of community-based mental health treatment programs need not be affected by enrollment of Medicaid beneficiaries in prepaid plans, providing that Medicaid program administrators take steps to minimize the disruption of ongoing treatment, offer beneficiaries a choice among prepaid plans, and encourage community treatment programs to contract with plans to serve beneficiaries. Handle: RePEc:aph:ajpbhl:1992:82:6:790-796_7 Template-Type: ReDIF-Article 1.0 Title: Characteristics related to elderly persons' not eating for 1 or more days: Implications for meal programs Journal: American Journal of Public Health Author-Name: Frongillo Jr., E.A. Author-Name: Rauschenbach, B.S. Author-Name: Roe, D.A. Author-Name: Williamson, D.F. Year: 1992 Volume: 82 Issue: 4 Pages: 600-602 Abstract: We examined how social, economic, location, health, and food need characteristics are related to elderly persons' not eating for 1 or more days. The following variables were positively related to not eating: ethnicity, location, receipt of Medicaid, living alone, health problems, mobility, age less than 80 years, cancer, nausea, difficulty swallowing, diarrhea, loss of appetite, and receipt of food from a food pantry. These results have implications for allocating meal program funds, screening clients, and monitoring whether clients eat regularly. Handle: RePEc:aph:ajpbhl:1992:82:4:600-602_7 Template-Type: ReDIF-Article 1.0 Title: Evaluating the treatment of sexually transmitted diseases at an urban public hospital outpatient clinic Journal: American Journal of Public Health Author-Name: Shekelle, P.G. Author-Name: Kosecoff, J. Year: 1992 Volume: 82 Issue: 1 Pages: 115-117 Abstract: Sexually transmitted diseases occur disproportionately among the poor, are often treated in public hospitals and clinics, and have not been subjected to quality-of-care evaluation. We designed a medical record abstraction system using well-established, specific process-of-care criteria drawn from the medical literature and experts and grouped into three levels of quality: excellent, adequate, and minimal. One hundred seventy-six consecutive patients were identified from the clinic logbook and their medical records abstracted. Deficiencies in history taking, physical examination, laboratory testing, treatment, and public health reporting were identified. Handle: RePEc:aph:ajpbhl:1992:82:1:115-117_1 Template-Type: ReDIF-Article 1.0 Title: The Red Cross and CDC's natural-disaster surveillance system [1] Journal: American Journal of Public Health Author-Name: Patrick, P. Author-Name: Brenner, S.A. Author-Name: Noji, E. Author-Name: Lee, J. Year: 1992 Volume: 82 Issue: 12 Pages: 1690 Handle: RePEc:aph:ajpbhl:1992:82:12:1690_5 Template-Type: ReDIF-Article 1.0 Title: Age and mammography in older women [1] Journal: American Journal of Public Health Author-Name: Mayer, J.A. Author-Name: Slymen, D.J. Author-Name: Drew, J.A. Author-Name: Wright, B.L. Author-Name: Elder, J.P. Author-Name: Williams, S.J. Year: 1992 Volume: 82 Issue: 5 Pages: 755 Handle: RePEc:aph:ajpbhl:1992:82:5:755_5 Template-Type: ReDIF-Article 1.0 Title: Predictors of shelter use among low-income families: Psychiatric history, substance abuse, and victimization Journal: American Journal of Public Health Author-Name: Weitzman, B.C. Author-Name: Knickman, J.R. Author-Name: Shinn, M. Year: 1992 Volume: 82 Issue: 11 Pages: 1547-1550 Abstract: For poor housed and homeless families in New York City, NY, we examined the degree to which psychiatric and substance-abuse problems and victimization placed the families at elevated risk of requiring emergency housing, and we documented the prevalence of such problems. These problems were infrequently reported by both groups. However, past mental hospitalization, treatment in a detoxification center, childhood sexual abuse, and adult physical abuse were associated with increased risk of homelessness. Handle: RePEc:aph:ajpbhl:1992:82:11:1547-1550_7 Template-Type: ReDIF-Article 1.0 Title: Smoking cessation in women concerned about weight Journal: American Journal of Public Health Author-Name: Pirie, P.L. Author-Name: McBride, C.M. Author-Name: Hellerstedt, W. Author-Name: Jeffery, R.W. Author-Name: Hatsukami, D. Author-Name: Allen, S. Author-Name: Lando, H. Year: 1992 Volume: 82 Issue: 9 Pages: 1238-1243 Abstract: Background. Weight gain after smoking cessation is often cited by women smokers as a primary reason for not attempting to quit smoking or for relapsing after a cessation attempt. Methods. A randomized trial of 417 women smokers was conducted to test the addition of two weight control strategies to a smoking cessation program. Participants received the standard smoking cessation program, the program plus nicotine gum, the program plus behavioral weight control, or the program plus both nicotine gum and behavioral weight control. Weight and smoking status were measured at the end of treatment and at 6 and 12 months posttreatment. Results. Smoking cessation rates were highest in the group receiving the smoking cessation program plus nicotine gum. Weight gain did not vary by treatment condition, so its effect on relapse could not be examined by group. There was no significant relationship between weight gained and relapse in individuals. Conclusions. The added behavioral weight control program was attractive to the participants and did not reduce smoking cessation rates. However, it did not produce the expected effect on weight, thereby restricting our ability to examine the effect of weight control on smoking cessation and relapse. Handle: RePEc:aph:ajpbhl:1992:82:9:1238-1243_8 Template-Type: ReDIF-Article 1.0 Title: Mortality, disability, and falls in older persons: The role of underlying disease and disability Journal: American Journal of Public Health Author-Name: Dunn, J.E. Author-Name: Rudberg, M.A. Author-Name: Furner, S.E. Author-Name: Cassel, C.K. Year: 1992 Volume: 82 Issue: 3 Pages: 395-400 Abstract: Background. Falls are prevalent in older persons and can have serious consequences. Methods. Data from the Longitudinal Study on Aging were analyzed to study the relationship between falls and both mortality and functional status in 4270 respondents age 70 and over. The effects of demographic traits, chronic conditions, and disability present at baseline were controlled for by means of multivariable analyses. Results. Risk of death within 2 years was greater for both single fallers (crude odds ratio [OR], 1.5; 95% confidence interval [CI], 1.1-2.0) and multiple fallers (crude OR, 2.2; 95% CI, 1.7-2.8). This excess risk was dissipated when selected covariates were added to the model. No crude or adjusted association was evident between single falls and functional impairment; however, multiple falls were an independent risk factor (adjusted OR, 1.6; 95% CI, 1.2-2.0). Conclusions. Multiple falls in older persons increase risk of functional impairment and may indicate underlying conditions that increase risk of death. Handle: RePEc:aph:ajpbhl:1992:82:3:395-400_9 Template-Type: ReDIF-Article 1.0 Title: Socioeconomic differences in mortality in Britain and the United States Journal: American Journal of Public Health Author-Name: Smith, G.D. Author-Name: Egger, M. Year: 1992 Volume: 82 Issue: 8 Pages: 1079-1081 Handle: RePEc:aph:ajpbhl:1992:82:8:1079-1081_9 Template-Type: ReDIF-Article 1.0 Title: Declining child mortality rates in Nicaragua [1] Journal: American Journal of Public Health Author-Name: Garfield, R.M. Author-Name: Sandiford, P. Author-Name: Smith, G.D. Author-Name: Coyle, E. Year: 1992 Volume: 82 Issue: 9 Pages: 1291-1292 Handle: RePEc:aph:ajpbhl:1992:82:9:1291-1292_5 Template-Type: ReDIF-Article 1.0 Title: Lower respiratory illness in infants and low socioeconomic status Journal: American Journal of Public Health Author-Name: Margolis, P.A. Author-Name: Greenberg, R.A. Author-Name: Keyes, L.L. Author-Name: LaVange, L.M. Author-Name: Chapman, R.S. Author-Name: Denny, F.W. Author-Name: Bauman, K.E. Author-Name: Boat, B.W. Year: 1992 Volume: 82 Issue: 8 Pages: 1119-1126 Abstract: Objectives. Infants from families of low socioeconomic status are said to suffer higher rates of lower respiratory illness, but this assertion has not been carefully examined. Methods. We studied the frequency and determinants of lower respiratory illness in infants of different socioeconomic status (n = 393) by analyzing data from a community-based cohort study of respiratory illness during the first year of life in central North Carolina. Results. The incidence of lower respiratory illness was 1.41 in the low socioeconomic group, 1.26 in the middle group, and 0.67 in the high group. The prevalence of persistent respiratory symptoms was 39% in infants in the low socioeconomic group, 24% in infants in the middle group, and 14% in infants in the high group. The odds of persistent respiratory symptoms in infants of low and middle socioeconomic status were reduced after controlling for environmental risk factors for lower respiratory illness. Enrollment in day care was associated with an increased risk of persistent symptoms among infants of high but not low socioeconomic status. Conclusions. Infants of low socioeconomic status are at increased risk of persistent respiratory symptoms. This risk can be partly attributed to environmental exposures, most of which could be changed. Handle: RePEc:aph:ajpbhl:1992:82:8:1119-1126_4 Template-Type: ReDIF-Article 1.0 Title: Handedness, traffic crashes, and defensive reflexes [7] Journal: American Journal of Public Health Author-Name: Coren, S. Year: 1992 Volume: 82 Issue: 8 Pages: 1176-1177 Handle: RePEc:aph:ajpbhl:1992:82:8:1176-1177_2 Template-Type: ReDIF-Article 1.0 Title: Erratum: Association news: Deceased members (Am J Public Health (1992) 82 (753)) Journal: American Journal of Public Health Author-Name: Rao, K.N. Author-Name: Rausher, H. Author-Name: Richards, S. Author-Name: Robins, H.B. Author-Name: Rohleder, F.O. Author-Name: Ross, M.A. Author-Name: Salber, E.J. Author-Name: Saltysiak, B.A. Author-Name: Schooler, K.K. Author-Name: Shackelford, J.W. Author-Name: Shea, A.E. Author-Name: Simon, C.B. Author-Name: Steed Jr., H.C. Author-Name: Stern, O. Author-Name: Stewart, J.E. Author-Name: Sullivan, M.M. Author-Name: Tenenbaum, S.G. Author-Name: Thompson, G.B. Author-Name: Tucker, C.R. Year: 1992 Volume: 82 Issue: 6 Pages: 798 Handle: RePEc:aph:ajpbhl:1992:82:6:798_9 Template-Type: ReDIF-Article 1.0 Title: Article on HIV in Cuba criticized [6] Journal: American Journal of Public Health Author-Name: Santana, S. Author-Name: Perez-Stable, E.J. Year: 1992 Volume: 82 Issue: 6 Pages: 899-900 Handle: RePEc:aph:ajpbhl:1992:82:6:899-900_2 Template-Type: ReDIF-Article 1.0 Title: Predictors of smoking prevalence among New York Latino youth Journal: American Journal of Public Health Author-Name: Dusenbury, L. Author-Name: Kerner, J.F. Author-Name: Baker, E. Author-Name: Botvin, G. Author-Name: James-Ortiz, S. Author-Name: Zauber, A. Year: 1992 Volume: 82 Issue: 1 Pages: 55-58 Abstract: Background. We examined prevalence rates and risk factors for smoking among Latino adolescents, using a multiethnic sample of sixth- and seventh-grade students (n = 3129) in 47 New York City public and parochial schools. Methods. The students completed questionnaires; self-reported smoking data were collected by means of the ''bogus pipeline'' technique. The largest group of Latino students (43%) was Puerto Rican; 20% were of Dominican background, 7% were Colombian, and 7% were Ecuadorian. ''Current smoking'' was defined as smoking at least once per month. Results. A series of logistic regression analyses indicated that peer influence was the strongest predictor of smoking. Family influence was important as well. Conclusions. The results are discussed in terms of their implications for prevention. Handle: RePEc:aph:ajpbhl:1992:82:1:55-58_8 Template-Type: ReDIF-Article 1.0 Title: Socioeconomic and behavioral correlates of body mass index in black adults: The Pitt County Study Journal: American Journal of Public Health Author-Name: Croft, J.B. Author-Name: Strogatz, D.S. Author-Name: James, S.A. Author-Name: Keenan, N.L. Author-Name: Ammerman, A.S. Author-Name: Malarcher, A.M. Author-Name: Haines, P.S. Year: 1992 Volume: 82 Issue: 6 Pages: 821-826 Abstract: Background. Obesity is more prevalent among Black women than Black men, but there is little information on the correlates of obesity in Blacks. This study describes the relations of sociodemographic factors and health behaviors to body mass index in a southern, Black population. Methods. In 1988, a community probability sample of 1784 Black adults, aged 25 to 50, was examined in Pitt County, NC. Results. More women than men were at least 20% overweight (57% vs 36%). The relation of socioeconomic status (a composite of education and occupation) to age-adjusted body mass index level was inverse in women but not in men. Body mass index did not differ with either current energy intake or energy expenditure. Smokers and drinkers had lower age- adjusted levels than non-smokers and abstainers. Conclusions. Since the excess body mass index levels associated with low socioeconomic status in women could not be explained after controlling for adverse health behaviors, further epidemiologic study of risk factors for obesity in Black women is recommended. Handle: RePEc:aph:ajpbhl:1992:82:6:821-826_8 Template-Type: ReDIF-Article 1.0 Title: Cognitive and attitudinal impacts of a university AIDS course: Interdisciplinary education as a public health intervention Journal: American Journal of Public Health Author-Name: Strauss, R.P. Author-Name: Corless, I.B. Author-Name: Luckey, J.W. Author-Name: Van der Horst, C.M. Author-Name: Dennis, B.H. Year: 1992 Volume: 82 Issue: 4 Pages: 569-572 Abstract: This paper describes an interdisciplinary, variable credit-bearing university course on acquired immunodeficiency syndrome (AIDS) that enrolled 429 students. Pre- and post-course questionnaires were used to assess knowledge and attitudes relative to AIDS and these were compared to National Health Interview Survey findings. Considerable cognitive and attitudinal changes occurred over the course period. University courses, taught annually, were found to be an efficient mechanism for educating large numbers of future community leaders and professionals about AIDS. Handle: RePEc:aph:ajpbhl:1992:82:4:569-572_3 Template-Type: ReDIF-Article 1.0 Title: Stage at diagnosis in breast cancer: Race and socioeconomic factors Journal: American Journal of Public Health Author-Name: Wells, B.L. Author-Name: Horm, J.W. Year: 1992 Volume: 82 Issue: 10 Pages: 1383-1385 Abstract: Cancer incidence data from three US metropolitan areas were coupled with census tract indicators of education and income. The data suggest that both Black and White cancer patients living in census tracts with lower median education/income values are diagnosed in later disease stages than are patients in tracts with higher median education/income values. Within education and income strata, Black women had a less favorable stage of disease at diagnosis than Whites. The exception was in upper education/income levels, where the disadvantage for Blacks disappeared. These data provide additional evidence that women of low socioeconomic status could benefit from targeted screening. Handle: RePEc:aph:ajpbhl:1992:82:10:1383-1385_1 Template-Type: ReDIF-Article 1.0 Title: A cost-effectiveness analysis of three staffing models for the delivery of low-risk prenatal care Journal: American Journal of Public Health Author-Name: Graveley, E.A. Author-Name: Littlefield, J.H. Year: 1992 Volume: 82 Issue: 2 Pages: 180-184 Abstract: Background. Health care costs are increasing at more than twice the rate of inflation, thus, public officials are seeking safe and economic methods to deliver quality prenatal care to poor pregnant women. This study was undertaken to determine the relationship between the cost and effectiveness of three prenatal clinic staffing models: physician based, mixed staffing, and clinical nurse specialist with physicians available for consultation. Methods. Maternal and neonatal physiological outcome data were obtained from the hospital clinical records of 156 women attending these clinics. The women were then interviewed concerning their satisfaction with their prenatal care clinic. The financial officer from each clinic provided data on the clinic staffing costs and hours of service. Results. There were no differences in outcomes for the maternal-neonatal physiological variables, although newborn admission to the Neonatal Intensive Care Unit (NICU) approached significance among the clinics. The clinic staffed by clinical nurse specialists had the greatest client satisfaction and the lowest cost per visit. Conclusions. The use of clinical nurse specialists might substantially reduce the cost of providing prenatal care while maintaining quality, and might thereby save valuable resources. Handle: RePEc:aph:ajpbhl:1992:82:2:180-184_5 Template-Type: ReDIF-Article 1.0 Title: HIV antibody testing and posttest counseling in the United States: Data from the 1989 National Health Interview Survey Journal: American Journal of Public Health Author-Name: Anderson, J.E. Author-Name: Hardy, A.M. Author-Name: Cahill, K. Author-Name: Aral, S. Year: 1992 Volume: 82 Issue: 11 Pages: 1533-1535 Abstract: To see how successful human immunodeficiency virus (HIV) counseling and testing efforts have been in testing the United States population, particularly among those at increased risk for HIV infection, we analyzed data from the 1989 National Health Interview Survey. Twenty percent of the NHIS sample (or, in terms of the general US population, an estimated 36 million persons) reported having been tested for HIV antibodies, mostly through blood donations. Although persons with increased risk of HIV infection had been tested and counseled at a much higher rate than the general population, the majority of this group had not yet been tested. Handle: RePEc:aph:ajpbhl:1992:82:11:1533-1535_0 Template-Type: ReDIF-Article 1.0 Title: Estimation of small area population denominators [2] Journal: American Journal of Public Health Author-Name: Stoto, M.A. Author-Name: Aickin, M. Year: 1992 Volume: 82 Issue: 8 Pages: 1174 Handle: RePEc:aph:ajpbhl:1992:82:8:1174_6 Template-Type: ReDIF-Article 1.0 Title: Seroprevalence of HIV-1 and hepatitis B and C in prostitutes in Albuquerque, New Mexico Journal: American Journal of Public Health Author-Name: Tabet, S.R. Author-Name: Palmer, D.L. Author-Name: Wiese, W.H. Author-Name: Voorhees, R.E. Author-Name: Pathak, D.R. Year: 1992 Volume: 82 Issue: 8 Pages: 1151-1154 Abstract: A survey of persons soliciting sex in an area known to be frequented by prostitutes in Albuquerque, NM, included 43 females and 66 males. Seroprevalence rates found in this population-based study were as follows: human immunodeficiency virus type 1 (HIV-1) 3%; hepatitis B, 39%; hepatitis C, 45%. Increased age, intravenous drug use, and condom use were independent risk factors for hepatitis B. Female gender and intravenous drug use were independent risk factors for hepatitis C. Neither sharing injection equipment nor engaging in receptive anal intercourse was independently associated with hepatitis B or C. Handle: RePEc:aph:ajpbhl:1992:82:8:1151-1154_4 Template-Type: ReDIF-Article 1.0 Title: Mass media-led antismoking campaign can remove the education gap in quitting behavior Journal: American Journal of Public Health Author-Name: Macaskill, P. Author-Name: Pierce, J.P. Author-Name: Simpson, J.M. Author-Name: Lyle, D.M. Year: 1992 Volume: 82 Issue: 1 Pages: 96-98 Abstract: This study investigated whether the effective mass media-led antismoking campaigns in Australia had the traditional differential effect across educational levels. Our population surveys included random samples of 12,851 people before the campaign and 11,609 several years after the campaign had started. No statistically significant differences were found in quitting across education levels in three of the four subgroups. Mass media-led antismoking campaigns may play an important role in getting the antismoking message to the less educated. Handle: RePEc:aph:ajpbhl:1992:82:1:96-98_9 Template-Type: ReDIF-Article 1.0 Title: Determinants of depressive symptoms in the early weeks after miscarriage Journal: American Journal of Public Health Author-Name: Neugebauer, R. Author-Name: Kline, J. Author-Name: O'Connor, P. Author-Name: Shrout, P. Author-Name: Johnson, J. Author-Name: Skodol, A. Author-Name: Wicks, J. Author-Name: Susser, M. Year: 1992 Volume: 82 Issue: 10 Pages: 1332-1339 Abstract: Objectives. We tested whether and under what conditions miscarriage increases depressive symptoms in the early weeks following loss. Methods. We interviewed 232 women within 4 weeks of miscarriage and 283 pregnant women and 318 community women who had not recently been pregnant. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression (CES-D) Scale. Results. Among women who had miscarried, the proportion who were highly symptomatic on the CES-D was 3.4 times that of pregnant women and 4.3 times that of community women. Among childless women, the proportion of women who had miscarried who were highly symptomatic was 5.7 times that of pregnant women and 11.0 times that of community women. Women who had miscarried were equally depressed regardless of length of gestation; among pregnant women, depressive symptoms declined with length of gestation. Among women who had miscarried, symptom levels did not vary with attitude toward the pregnancy; among pregnant women, depressive symptoms were elevated in those with unwanted pregnancies. Prior reproductive loss and advanced maternal age (35+ years) were not associated with symptom levels in any cohort. Conclusions. Depressive symptoms are markedly increased in the early weeks following miscarriage. This effect is substantially modified by number of living children, length of gestation at loss, and attitude toward pregnancy. Handle: RePEc:aph:ajpbhl:1992:82:10:1332-1339_5 Template-Type: ReDIF-Article 1.0 Title: Article on parental notification law draws criticism [2] Journal: American Journal of Public Health Author-Name: Ferguson, B. Author-Name: Paneth, N. Author-Name: Santee, B. Author-Name: Joyce, T. Author-Name: Marty, J. Author-Name: Rogers, J.L. Year: 1992 Volume: 82 Issue: 5 Pages: 755-760 Handle: RePEc:aph:ajpbhl:1992:82:5:755-760_5 Template-Type: ReDIF-Article 1.0 Title: The validity of self-reported condom use [1] Journal: American Journal of Public Health Author-Name: Cohen, D.A. Author-Name: Dent, C. Year: 1992 Volume: 82 Issue: 11 Pages: 1563-1564 Handle: RePEc:aph:ajpbhl:1992:82:11:1563-1564_8 Template-Type: ReDIF-Article 1.0 Title: Sociodemographic factors and the quality of prenatal care Journal: American Journal of Public Health Author-Name: Hansell, M.J. Year: 1991 Volume: 81 Issue: 8 Pages: 1023-1028 Abstract: Background: In this study, maternal sociodemographic factors are examined in relationship to the quality of prenatal health services US women receive. Methods: Data from the 1980 National Natality Survey and 1980 Fetal Mortality Survey were used for the analysis. Indicator variables for prenatal care quality are the percentages of prenatal visits at which blood pressure and urine were tested, the performance of hemoglobin or hematocrit tests, and the presence or absence of advice regarding salt restriction and diuretics usage during pregnancy. Results: Distribution of the basic examinations in prenatal care vary according to marital status, parity, education, and residence in a metropolitan or nonmetropolitan county. The advice received concerning salt and diuretics usage was also influenced by sociodemographic variables. Conclusions: The analyses reveal that prenatal care is not of even minimally acceptable quality for many women. Handle: RePEc:aph:ajpbhl:1991:81:8:1023-1028_9 Template-Type: ReDIF-Article 1.0 Title: Crack cocaine, fellatio, and the transmission of HIV [4] Journal: American Journal of Public Health Author-Name: Haverkos, H.W. Author-Name: Steel, E. Year: 1991 Volume: 81 Issue: 8 Pages: 1078-1079 Handle: RePEc:aph:ajpbhl:1991:81:8:1078-1079_5 Template-Type: ReDIF-Article 1.0 Title: Human exposure to rabies from pet wild raccoons in South Carolina and West Virginia, 1987 through 1988 Journal: American Journal of Public Health Author-Name: Woodruff, B.A. Author-Name: Jones, J.L. Author-Name: Eng, T.R. Year: 1991 Volume: 81 Issue: 10 Pages: 1328-1330 Abstract: During 1987 and 1988, exposures to eight pet wild raccoons in South Carolina and West Virginia resulted in administration of rabies post-exposure prophylaxis to 19 children and 26 adults. All eight raccoons appeared normal at the time of capture, and three had no signs of illness when sacrificed. The direct medical cost resulting from these exposures was $23 714 ($527 per person). Regulations and public education may help decrease this type of rabies exposure. Handle: RePEc:aph:ajpbhl:1991:81:10:1328-1330_0 Template-Type: ReDIF-Article 1.0 Title: Breast cancer screening among relatives of women with breast cancer Journal: American Journal of Public Health Author-Name: Kaplan, K.M. Author-Name: Weinberg, G.B. Author-Name: Small, A. Author-Name: Herndon, J.L. Year: 1991 Volume: 81 Issue: 9 Pages: 1174-1179 Abstract: Background. National surveys indicate that only 15% to 30% of all women in the general population 50 years of age or older have an annual mammogram. Methods. We studied first-degree female relatives of women with breast cancer, who are at elevated risk of disease, to describe the breast cancer screening practices of these relatives and to improve their practices through a program of intensive education. We report here the screening behaviors of 2471 relatives of women with breast cancer. Results. Self-reported behaviors were as follows: 49% performed monthly breast self-examination and 70% had annual breast examinations by a medical professional. Of 983 women 50 years of age or older, 49% had had a mammogram, but only 14% have a mammogram annually. Of women 50 years of age or older who had never had a mammogram, 92% reported never having had one recommended by a medical professional. Conclusions. Our findings indicate that screening behaviors in relatives of breast cancer patients are not substantially different from those of women in the general population. Enhanced efforts both to educate medical professionals and to encourage women to demand screening mammography are necessary to reduce breast cancer mortality. Handle: RePEc:aph:ajpbhl:1991:81:9:1174-1179_5 Template-Type: ReDIF-Article 1.0 Title: Behavior changes after notification of HIV infection Journal: American Journal of Public Health Author-Name: Cleary, P.D. Author-Name: Van Devanter, N. Author-Name: Rogers, T.F. Author-Name: Singer, E. Author-Name: Shipton-Levy, R. Author-Name: Steilen, M. Author-Name: Stuart, A. Author-Name: Avorn, J. Author-Name: Pindyck, J. Year: 1991 Volume: 81 Issue: 12 Pages: 1586-1590 Abstract: Background. To learn more about how people who did not volunteer for testing react to information about HIV infection, we assessed short-term behavior changes in HIV-positive blood donors. Methods. Blood donors who were notified at the New York Blood Center that they were HIV positive were asked to participate in a study. A nurse elicited a medical history, performed a limited medical examination, and asked participants to complete a questionnaire that included questions about drug use, sexual behavior, and psychological characteristics. Participants were asked to return in 2 weeks to complete another questionnaire. Results. Many fewer men and women reported engaging in unsafe sexual behaviors in the 2 weeks preceding the follow-up visit than had reported such behaviors prior to notification. These changes were greater than those other investigators have reported, but about 40% of the participants still reported unsafe sexual activity at the follow-up interview. Conclusions. To make nonvolunteer screening programs for HIV infection more effective in reducing the spread of HIV infection, we need to learn more about how to help people change their high-risk behaviors. Handle: RePEc:aph:ajpbhl:1991:81:12:1586-1590_5 Template-Type: ReDIF-Article 1.0 Title: Erratum: Older Americans present a double challenge: Preventing disability and providing care (Am J Public Health. 1981;81:287-288. Editorial) Journal: American Journal of Public Health Author-Name: Kovar, M.G. Year: 1991 Volume: 81 Issue: 7 Pages: 838 Handle: RePEc:aph:ajpbhl:1991:81:7:838_8 Template-Type: ReDIF-Article 1.0 Title: Impairments due to injuries Journal: American Journal of Public Health Author-Name: Kovar, M.G. Year: 1991 Volume: 81 Issue: 12 Pages: 1670-1672 Handle: RePEc:aph:ajpbhl:1991:81:12:1670-1672_7 Template-Type: ReDIF-Article 1.0 Title: The ban on cigarette vending machines in Bloomington, Minnesota Journal: American Journal of Public Health Author-Name: Lando, H.A. Author-Name: Bluhm, J. Author-Name: Forster, J. Year: 1991 Volume: 81 Issue: 10 Pages: 1339-1340 Handle: RePEc:aph:ajpbhl:1991:81:10:1339-1340_3 Template-Type: ReDIF-Article 1.0 Title: Bleach programs for preventing AIDS among IV drug users: Modeling the impact of HIV prevalence Journal: American Journal of Public Health Author-Name: Siegel, J.E. Author-Name: Weinstein, M.C. Author-Name: Fineberg, H.V. Year: 1991 Volume: 81 Issue: 10 Pages: 1273-1279 Abstract: Background. The growing importance of drug use as a mode of HIV transmission has led to increased attention to AIDS prevention among intravenous drug users (IVDUs). This analysis examines the effectiveness of bleach distribution, a program to prevent HIV transmission via shared needles. Methods. We used a Markov model to assess the role of the initial HIV prevalence among drug users in determining the effectiveness of bleach programs. The model incorporates survey data on risk behaviors and published information describing HIV incubation and mortality. It predicts life expectancy for cohorts of IVDUs with and without a bleach program to estimate program effectiveness. Results. We found that bleach programs can produce the greatest life-year savings in areas of low HIV prevalence. In the lowest prevalence scenario (0.02 initial prevalence), initiation of the program resulted in a projected savings of 2.3 life years per HIV-negative drug user, compared with 1.7 and 1.3 years under medium (0.25) and high (0.60) prevalence, respectively. Conclusions. While bleach programs are beneficial in all groups of IVDUs, these results highlight the advantages of introducing bleach programs early, when prevalence is still comparatively low in a drug-user population. Handle: RePEc:aph:ajpbhl:1991:81:10:1273-1279_4 Template-Type: ReDIF-Article 1.0 Title: Patterns of mental health utilization among island Puerto Rican poor Journal: American Journal of Public Health Author-Name: Alegria, M. Author-Name: Robles, R. Author-Name: Freeman, D.H. Author-Name: Vera, M. Author-Name: Jimenez, A.L. Author-Name: Rios, C. Author-Name: Rios, R. Year: 1991 Volume: 81 Issue: 7 Pages: 875-879 Abstract: Background: This paper describes utilization of mental health services by poor Puerto Ricans living on the island. It examines the utilization rates, within health sectors, and settings for the provision of mental health services. Methods: Data are based on an islandwide probability sample of 18- to 64-year-old respondents living in low socioeconomic areas. We assessed need with the Psychiatric Symptom and Dysfunction Scales. Results: Approximately one-third of our study population (31.5%) met criteria for need. Of these, only 32% had received any mental health care in the past year. Need was significantly associated with use of physical or mental health services for mental health problems. We found those who needed services to be five times more likely than those who did not need services to have used one or both sectors of care at least once in the past year. Among the first group 21.8% used the physical health sector to deal with mental health problems in contrast with 17.9% who sought care in the mental health sector. In the physical health sector, subjects used the public and private settings equally. In the mental health sector, 70% of subjects used the public setting. Conclusions: This suggests the nonpsychiatric physician as a main provider for mental health treatment. Handle: RePEc:aph:ajpbhl:1991:81:7:875-879_4 Template-Type: ReDIF-Article 1.0 Title: Liquid scintillation versus gamma ray counting in radon measurements with charcoal [3] Journal: American Journal of Public Health Author-Name: Cohen, B.L. Year: 1991 Volume: 81 Issue: 12 Pages: 1676-1677 Handle: RePEc:aph:ajpbhl:1991:81:12:1676-1677_9 Template-Type: ReDIF-Article 1.0 Title: A multistate outbreak of hepatitis A caused by the consumption of raw oysters Journal: American Journal of Public Health Author-Name: Desenclos, J.-C.A. Author-Name: Klontz, K.C. Author-Name: Wilder, M.H. Author-Name: Nainan, O.V. Author-Name: Margolis, H.S. Author-Name: Gunn, R.A. Year: 1991 Volume: 81 Issue: 10 Pages: 1268-1272 Abstract: Background. In August 1988 we investigated a multistate outbreak of hepatitis A caused by Panama City, Florida, raw oysters. Methods. Cases of hepatitis A (HA) with onset in July-August 1988 were identified among persons who ate seafoods harvested in the coastal waters of Panama City, Florida. We conducted a case-control study, using eating companions of case-patients, and calculated attack rate (AR) per 1000 dozen raw oysters served. Enzyme immunoassay (EIA) and a polymerase chain reaction (PCR) technique were performed on samples of raw shellfish obtained from Panama City coastal waters. Results. Sixty-one case-patients were identified in five states: Alabama (23), Georgia (18), Florida (18), Tennessee (1), and Hawaii (1). We found an increased risk of HA for raw oyster eaters (odds ratio = 24.0; 95% confidence interval = 5.4-215.0; P < .001). The AR of HA in seafood establishments was 1.9/1000 dozen raw oysters served. The EIA and PCR revealed HA virus antigen and nucleic acid in oysters from both unapproved and approved oyster beds, in confiscated illegally harvested oysters, and in scallops from an approved area. Conclusions. The monitoring of coastal waters and the enforcement of shellfish harvesting regulations were not adequate to protect raw oyster consumers. More emphasis should be placed on increasing public awareness of health hazards associated with eating raw shellfish. Handle: RePEc:aph:ajpbhl:1991:81:10:1268-1272_3 Template-Type: ReDIF-Article 1.0 Title: Editorial on nutrition draws praise and criticism [1] Journal: American Journal of Public Health Author-Name: Egan, M.J.B. Author-Name: Thomas, J. Author-Name: Mosher, J.F. Author-Name: Willett, W. Year: 1991 Volume: 81 Issue: 11 Pages: 1524-1525 Handle: RePEc:aph:ajpbhl:1991:81:11:1524-1525_1 Template-Type: ReDIF-Article 1.0 Title: Beyond brochures: A systematic approach to prevention Journal: American Journal of Public Health Author-Name: Cohen, L. Author-Name: Taylor, L. Year: 1991 Volume: 81 Issue: 7 Pages: 929-930 Handle: RePEc:aph:ajpbhl:1991:81:7:929-930_1 Template-Type: ReDIF-Article 1.0 Title: Screening recommendations for the elderly Journal: American Journal of Public Health Author-Name: Beers, M.H. Author-Name: Fink, A. Author-Name: Beck, J.C. Year: 1991 Volume: 81 Issue: 9 Pages: 1131-1140 Abstract: Background. Studies have documented the potential contributions of preventive health care programs. Yet little is known about which screening tests should be included in public health programs for older persons. This study offers recommendations regarding these tests. Methods. The recommendations come from synthesizing the findings of the US Preventive Services Task Force, the literature, and the consensus of experts in geriatrics, gerontology, and health policy research. The literature was evaluated to identify methodologically sound studies of the prevalence of selected disorders and benefits and availability of screening procedures for those disorders. Experts from various fields specializing in the care of the elderly formed panels to assist in evaluating the literature and providing further information from gerontological and public health perspectives. Results. We recommend vision testing for refractive error; inspection of the skin surface for fungal infection and skin cancer, drug eruptions, and xerosis; a history for symptoms of xerosis; audiometric testing for presbycusis; surveys for hearing loss; otoscopic inspection for cerumen impaction; dental examination for caries; measurement of blood pressure for hypertension; and breast examination and mammography for cancer. Conclusions. Our study suggests that these screening procedures are useful for public health screening programs. More information is needed on the effects of screening services on the health and functioning of older persons. Handle: RePEc:aph:ajpbhl:1991:81:9:1131-1140_0 Template-Type: ReDIF-Article 1.0 Title: Erratum: Regular Source of Ambulatory Care and Access to Health Service (Am J Public Health. 1991:81:434-438) Journal: American Journal of Public Health Author-Name: Hayward, R.A. Author-Name: Bernard, A.M. Author-Name: Freeman, H.E. Author-Name: Corey, C.R. Year: 1991 Volume: 81 Issue: 7 Pages: 838 Handle: RePEc:aph:ajpbhl:1991:81:7:838_7 Template-Type: ReDIF-Article 1.0 Title: Adult foster care for the elderly in Oregon: A mainstream alternative to nursing homes? Journal: American Journal of Public Health Author-Name: Kane, R.A. Author-Name: Kane, R.L. Author-Name: Illston, L.H. Author-Name: Nyman, J.A. Author-Name: Finch, M.D. Year: 1991 Volume: 81 Issue: 9 Pages: 1113-1120 Abstract: Background. In Oregon, adult foster care (AFC) homes, which are private residences where a live-in manager cares for one to five disabled residents, have been covered by Medicaid since 1981 and seem to offer a mainstream alternative to nursing homes. They house almost 6000 older people, two thirds of which pay privately. Methods. In a cross-sectional study, we interviewed 400 AFC and 400 nursing home residents. Data analyses included descriptive cross-tabulations; hierarchical loglinear models for judging the effects of care setting and payment status on resident characteristics; and logit analyses for predicting care setting and payment status within care settings. Results. On average, nursing home residents were more physically and cognitively impaired than AFC residents, but there was considerable overlap in patterns of frailty in the two settings. Medicaid AFC residents were less disabled than privately paying AFC residents. AFC residents reported more social activity, even when we controlled for disability status. AFC residents and their families were more likely to value privacy and homelike settings when choosing a care setting, whereas nursing home residents were more likely to value rehabilitation and organized activity programs. Conclusions. Both AFC and nursing homes are viable components of a long-term care repertoire. The greater disability levels of private-pay AFC residents refutes the criticisms that disabled Medicaid residents were being inappropriately channeled to AFC. Handle: RePEc:aph:ajpbhl:1991:81:9:1113-1120_0 Template-Type: ReDIF-Article 1.0 Title: Serum total cholesterol: HDL cholesterol ratios in US white and black adults by selected demographic and socioeconomic variables (HANES II) Journal: American Journal of Public Health Author-Name: Linn, S. Author-Name: Fulwood, R. Author-Name: Carroll, M. Author-Name: Brook, J.G. Author-Name: Johnson, C. Author-Name: Kalsbeek, W.D. Author-Name: Rifkind, B.M. Year: 1991 Volume: 81 Issue: 8 Pages: 1038-1043 Abstract: Background: Framingham Study findings suggest that total cholesterol (TC):High density lipoprotein cholesterol (HDL-C) ratio is a useful summary of the joint contribution of TC and HDL-C to coronary heart disease (CHD) risk. Information on the distribution of TC:HDL-C in the US population is limited to selected populations and the relationship of the ratio distribution and its correlates has received little attention. Method: TC/HDL-C ratios were examined in a representative sample of the United States adult population ages 20 to 74 years, between February 1976 and February 1980 during NHANES II, using stratification and multivariate regression analyses. Results: Age-adjusted mean ratios were higher in men compared with women and were higher in Whites compared with Blacks. White men had the highest TC/HDL-C mean ratios. These relationships remained after stratification by age, education, body mass index, alcohol use, cigarette smoking, and physical activity. Using multivariate analyses, the ratios were positively related to BMI, age, and smoking; and negatively related to female sex, alcohol use, being Black, and physical activity. Conclusions: Using a ratio reference point of greater than or equal to 4.5 from the Framingham study, at least an estimated 44 million persons ages 25 to 74 years in the US were found to be at higher risk of developing coronary heart disease. Handle: RePEc:aph:ajpbhl:1991:81:8:1038-1043_3 Template-Type: ReDIF-Article 1.0 Title: Smoking, social support, and hassles in an urban African-American community Journal: American Journal of Public Health Author-Name: Romano, P.S. Author-Name: Bloom, J. Author-Name: Syme, S.L. Year: 1991 Volume: 81 Issue: 11 Pages: 1415-1422 Abstract: Background. Despite public health efforts, the prevalence of smoking among African Americans remains high. The determinants of smoking behavior in this population must be elucidated so that interventions can be better targeted and more effective. Methods. As part of a prospective community intervention trial to reduce cancer mortality, we conducted a random household survey of 1137 African-American adults in San Francisco and Oakland between November 1985 and July 1986. The survey instrument included questions about social network characteristics, instrumental and emotional aspects of social support, smoking behavior, and stressors. Results. The overall prevalence of smoking (41.9%) was higher than that reported in national surveys. Logistic models revealed that persons reporting high levels of stress, represented by an abbreviated hassles index, were more likely to smoke than those reporting less stress. Women with poor social networks were more likely to smoke (odds ratio = 3.1) than women with optimal networks; however, this relationship did not hold among men. Indeed, men lacking emotional support from friends or family were less likely to smoke (odds ratio = 0.5) than men receiving such support. No interaction between social support and hassels was observed. Conclusions. Stressful environments may contribute to high-risk smoking behavior among urban African Americans. Handle: RePEc:aph:ajpbhl:1991:81:11:1415-1422_2 Template-Type: ReDIF-Article 1.0 Title: Self-disclosure of HIV infection to sexual partners Journal: American Journal of Public Health Author-Name: Marks, G. Author-Name: Richardson, J.L. Author-Name: Maldonado, N. Year: 1991 Volume: 81 Issue: 10 Pages: 1321-1323 Abstract: Self-disclosure of HIV infection to current sexual partners was examined in 138 seropositive men, mostly lower income Hispanics, from Los Angeles. Forty-five percent had been sexually active since learning their serostatus. Of these, 52% had kept their infection secret from one or more partners. The likelihood of disclosure decreased in direct proportion to the number of partners. Nondisclosure occurred in conjunction with unprotective receptive and insertive anal intercourse. Potential factors promoting nondisclosure are discussed. Handle: RePEc:aph:ajpbhl:1991:81:10:1321-1323_6 Template-Type: ReDIF-Article 1.0 Title: Let's not ''blame the victim'' - Exercise does protect against heart disease [7] Journal: American Journal of Public Health Author-Name: Lee, J.M. Author-Name: Marantz, P.R. Year: 1991 Volume: 81 Issue: 12 Pages: 1678-1679 Handle: RePEc:aph:ajpbhl:1991:81:12:1678-1679_2 Template-Type: ReDIF-Article 1.0 Title: Erratum: VIII. Hospitalization of HIV-seropositive newborns with AIDS-related disease within the first year of life (Am J Public Health. May 1991;81 (suppl):46-49) Journal: American Journal of Public Health Author-Name: Glebatis, D.M. Author-Name: Novick, L.F. Author-Name: Stacy, A. Year: 1991 Volume: 81 Issue: 9 Pages: 1112 Handle: RePEc:aph:ajpbhl:1991:81:9:1112_2 Template-Type: ReDIF-Article 1.0 Title: Environmental health and African Americans Journal: American Journal of Public Health Author-Name: Walker Jr., B. Year: 1991 Volume: 81 Issue: 11 Pages: 1395-1398 Abstract: As environmental health has taken on immensely increased significance in the prevention of disease, dysfunction, and premature death, its boundaries have been anything but stable. This instability, along with a multitude of demographic, social, and economic currents, have brought into stark relief the increasing demand for scientists who have the skills and knowledge to perform environmental risk assessment and implement effective risk management policies and services. Despite this demand far too few African Americans want, or are prepared, to pursue careers in sciences. This paper describes efforts to address this problem and suggests why such initiatives may not yield the desired results. Handle: RePEc:aph:ajpbhl:1991:81:11:1395-1398_4 Template-Type: ReDIF-Article 1.0 Title: The association between congenital syphilis and cocaine/crack use in New York City: A case-control study Journal: American Journal of Public Health Author-Name: Greenberg, M.S.Z. Author-Name: Singh, T. Author-Name: Htoo, M. Author-Name: Schultz, S. Year: 1991 Volume: 81 Issue: 10 Pages: 1316-1318 Abstract: From 1987 to 1989, an epidemic of congenital syphilis was observed in New York City. A case-control study was done to assess the association between various maternal risk factors and congenital syphilis. Independent of the effect of other factors, the odds of being exposed to cocaine were 3.9 times greater among cases than controls (95% confidence interval, 2.8-5.3). This study suggests that the epidemic of congenital syphilis may be related to the increase in cocaine/crack use among delivering mothers. Handle: RePEc:aph:ajpbhl:1991:81:10:1316-1318_2 Template-Type: ReDIF-Article 1.0 Title: Interpersonal violence-related injuries in an African-American community in Philadelphia Journal: American Journal of Public Health Author-Name: Wishner, A.R. Author-Name: Schwarz, D.F. Author-Name: Grisso, J.A. Author-Name: Holmes, J.H. Author-Name: Sutton, R.L. Year: 1991 Volume: 81 Issue: 11 Pages: 1474-1476 Abstract: Violence has been recognized as a significant health problem. This study describes fatal and nonfatal interpersonal violence-related injury events over 1 year in an indigent African-American community in Philadelphia. Information on inquiries was collected from emergency rooms, the Office of the Medical Examiner, and death certificate files. For persons aged 15 through 49 years, violence-related injury rates surpassed any other injury type. The overall violence-related injury rate was 28.7 per thousand population. Interpersonal violence-related injuries were important for the 0- to 4-year age group (9.19 injuries per 1000 population), and continued as a major cause of morbidity through age 59 (12.08 injuries per 1000 population). For more than half of the events, information from the emergency room chart was sufficient only to categorize the incident as a ''fight'' or that it was intentional; no further classification was possible. Handle: RePEc:aph:ajpbhl:1991:81:11:1474-1476_5 Template-Type: ReDIF-Article 1.0 Title: Homicide trends in New York State, 1980 to 1988 [4] Journal: American Journal of Public Health Author-Name: Relethford, J.H. Year: 1991 Volume: 81 Issue: 12 Pages: 1677 Handle: RePEc:aph:ajpbhl:1991:81:12:1677_3 Template-Type: ReDIF-Article 1.0 Title: The New York needle trial: The politics of public health in the age of AIDS Journal: American Journal of Public Health Author-Name: Anderson, W. Year: 1991 Volume: 81 Issue: 11 Pages: 1506-1517 Abstract: During the past 5 years, the exchange of sterile needles and syringes for dirty injecting equipment has gained increasing acceptance outside the United States as a potential means of reducing the transmission of the human immunodeficiency virus (HIV) among intravenous drug users. This article describes the controversy over attempts to establish a needle and syringe exchange scheme in New York City between 1985 and 1991. The response to a health crisis is used as an indicator of patterns of social and institutional practice. Advocates of needle exchanges had reached a stalemate with the promoters of law enforcement, and the strategic reformulation of the policy problem in terms of the research process seemed to offer a solution. The article discusses the practical limitations on designing and carrying out a controversial health promotion policy; the use (under constraint) of a restrictive research process to constitute - rather than simply to guide or monitor - public policy; and the potential ethical hazards of health professionals' seeking a polemical recourse to the clinical trial. The efforts to establish a needle exchange in New York thus illustrate more general problems for AIDS prevention. Handle: RePEc:aph:ajpbhl:1991:81:11:1506-1517_0 Template-Type: ReDIF-Article 1.0 Title: Injection drug use, mortality, and the AIDS epidemic Journal: American Journal of Public Health Author-Name: Selwyn, P.A. Year: 1991 Volume: 81 Issue: 10 Pages: 1247-1249 Handle: RePEc:aph:ajpbhl:1991:81:10:1247-1249_2 Template-Type: ReDIF-Article 1.0 Title: Uncompensated hospital care for pregnancy and childbirth cases Journal: American Journal of Public Health Author-Name: Zollinger, T.W. Author-Name: Saywell Jr., R.M. Author-Name: Chu, D.K.W. Year: 1991 Volume: 81 Issue: 8 Pages: 1017-1022 Abstract: Background: The large number of medically indigent patients in the United States is a major concern to policymakers and may be due to recent increases in the number of uninsured people. The purpose of this study was to identify the factors that affect the amount of unpaid hospital charges for services provided to pregnant women. Methods: Individual and hospital data were collected on a representative set of 235 pregnancy and childbirth patients with unpaid hospital charges from 28 hospitals in the state of Indiana. Results: Most of these patients did not have insurance coverage (63.8%), yet the majority were employed in the public or private sector (72.3%). Over half (55.5%) of the total uncompensated care amount for this group was from the $1000 to 2499 debt category. The median charge for these patients was $1468, of which the typical hospital was able to collect only 25.5%. Conclusions: The findings support the belief that any national effort to expand the availability of health insurance coverage to women through increased employment will not totally eliminate the uncompensated care problem. The findings also indicate that rural hospitals face the uncompensated care problem mainly because a significant portion of rural patients are without adequate health insurance coverage. Handle: RePEc:aph:ajpbhl:1991:81:8:1017-1022_5 Template-Type: ReDIF-Article 1.0 Title: Lazy eyes and public vision: Health department focus on preschool vision testing Journal: American Journal of Public Health Author-Name: Bacharach, J.A. Year: 1991 Volume: 81 Issue: 12 Pages: 1668-1669 Handle: RePEc:aph:ajpbhl:1991:81:12:1668-1669_0 Template-Type: ReDIF-Article 1.0 Title: A 5-year follow-up study of 117 battered women Journal: American Journal of Public Health Author-Name: Bergman, B. Author-Name: Brismar, B. Year: 1991 Volume: 81 Issue: 11 Pages: 1486-1489 Abstract: This paper reports register data concerning somatic and psychiatric hospital care on 117 battered women who were identified in a surgical emergency department and offered a treatment program. Data were collected during a period of 10 years before to 5 years after the battering in question. It was concluded that the battered woman seeks hospital care much more than the average woman of the same age. It is, however, not only traumatic injuries that bring her to the hospital, but also medical, gynecological, psychiatric, and unspecified disorders and suicide attempts. In this study it was hypothesized that this overuse of hospital care reflects the situation at home characterized by ongoing battering and other psychosocial problems. During the 5 years following the battering, the women did not show any signs of reducing their use of hospital care. It is alarming that this high use of medical care continues over years, and doctors should consider battering as one possible explanation for this phenomenon. Handle: RePEc:aph:ajpbhl:1991:81:11:1486-1489_4 Template-Type: ReDIF-Article 1.0 Title: Is coronary-care-unit admission restricted for elderly patients? A multicenter study Journal: American Journal of Public Health Author-Name: Fleming, C. Author-Name: D'Agostino, R.B. Author-Name: Selker, H.P. Year: 1991 Volume: 81 Issue: 9 Pages: 1121-1126 Abstract: Background. To investigate whether elderly patients are more likely to experience restricted access to high technology medical care, we examined the impact of age on the likelihood of coronary care unit (CCU) admission for patients with acute myocardial infarction. Methods. As part of a prospective investigation of emergency room triage for patients with suspected cardiac ischemia, we studied 4223 patients presenting to six hospitals. Because CCU admission is the accepted standard of care for acute infarction, we defined nonadmission to the CCU as a restriction of access to care. We used a logistic regression model to control for gender, hospital, and CCU occupancy at the time of admission and examined the relationship between age and CCU nonadmission. Results. Patients 75 years or older with acute myocardial infarction were 2.5 times more likely not to be admitted to the CCU than younger patients (RR 2.5, 95% CI 1.64, 3.85). Coronary unit admission was restricted even when the physician's admitting diagnosis was ''myocardial infarction'' (RR 7.1, 95% CI 2.1, 25.0) or ''rule-out myocardial infarction'' (RR 1.5, 95% CI 1.1, 2.1). Observed differences in clinical presentation or severity of illness between older and younger patients did not account for these findings. Conclusion. Our findings suggest that physicians may intentionally restrict access to coronary care for elderly patients with acute myocardial infarction. Handle: RePEc:aph:ajpbhl:1991:81:9:1121-1126_1 Template-Type: ReDIF-Article 1.0 Title: Attitudes toward abortion among parents of children with cystic fibrosis Journal: American Journal of Public Health Author-Name: Wertz, D.C. Author-Name: Rosenfield, J.M. Author-Name: Janes, S.R. Author-Name: Erbe, R.W. Year: 1991 Volume: 81 Issue: 8 Pages: 992-996 Abstract: Background: DNA prenatal diagnosis for cyctic fibrosis (CF) has been available for parents of affected children since late 1985. Methods: Using anonymous questionnaires, we surveyed 395 parents of children with CF at 12 New England CF centers with regard to 12 maternal or family situations and 11 fetal characteristics; 271 (68%) responded. Results: The majority supported legal abortion in the first trimester for all 23 situations; 58% would abort for severe mental retardation (MR), 40% would abort for a genetic disorder leading to death before age five years, 41% for a child bedridden for life, 35% for moderate MR, 20% for CF and 17% for a severe incurable disorder starting at age 40 years. Few would abort for a disorder starting at age 60 years, for genetic susceptibility to alcoholism or for sex selection. Variables most strongly related to abortion for CF were attitudes of spouse, respondent's siblings, and CF doctor toward abortion for CF as well as infrequent attendance at religious services. Conclusions: Prenatal diagnosis may not reduce substantially the number of CF births to parents of CF children because most do not accept abortion for CF. Handle: RePEc:aph:ajpbhl:1991:81:8:992-996_9 Template-Type: ReDIF-Article 1.0 Title: Handedness and accident proneness [3] Journal: American Journal of Public Health Author-Name: Daniel, W.F. Author-Name: Yeo, R.A. Author-Name: Coren, S. Year: 1991 Volume: 81 Issue: 10 Pages: 1346-1347 Handle: RePEc:aph:ajpbhl:1991:81:10:1346-1347_8 Template-Type: ReDIF-Article 1.0 Title: Injury prevention awareness in an urban Native American population Journal: American Journal of Public Health Author-Name: Hsu, J.S.J. Author-Name: Williams, S.D. Year: 1991 Volume: 81 Issue: 11 Pages: 1466-1468 Abstract: The injury-related mortality rate for Native American children between the ages of 1 and 4 years is nearly three times that of the same age group in the general population. To assess injury prevention awareness in urban Native American families, we administered 39 age-appropriate questions from the Framingham Safety Survey to 50 Native American families and 100 other families and developed an answer scoring system to analyze and compare survey responses. Survey responses revealed that Native American families are less likely to keep small objects, household products, and medicines out of the reach of their children and to possess and understand the use of ipecac. Although urban Native-American families appear to be less aware of ingestion prevention practices than other urban families, these and other deficiencies in injury prevention awareness are more likely the result of factors related to their low-income status than to culturally based practices. Handle: RePEc:aph:ajpbhl:1991:81:11:1466-1468_9 Template-Type: ReDIF-Article 1.0 Title: An evaluation of the impact of maternity care coordination on Medicaid birth outcomes in North Carolina Journal: American Journal of Public Health Author-Name: Buescher, P.A. Author-Name: Roth, M.S. Author-Name: Williams, D. Author-Name: Goforth, C.M. Year: 1991 Volume: 81 Issue: 12 Pages: 1625-1629 Abstract: Background. Care coordination is an important component of the enhanced prenatal care services provided under the recent expansions of the Medicaid program. The effect of maternity care coordination services on birth outcomes in North Carolina was assessed by comparing women on Medicaid who did and did not receive these services. Methods. Health program data files, including Medicaid claims paid for maternity care coordination, were linked to 1988 and 1989 live birth certificates. Simple comparisons of percentages and rates were supplemented by a logistic regression analysis. Results. Among women on Medicaid who did not receive maternity care coordination services, the low birth weight rate was 21% higher, the very low birth weight rate was 62% higher, and the infant mortality rate was 23% higher than among women on Medicaid who did receive such services. It was estimated that, for each $1.00 spent on maternity care coordination, Medicaid saved $2.02 in medical costs for newborns up to 60 days of age. Among the women who did receive maternity care coordination, those receiving it for 3 or more months had better outcomes than those receiving it for less than 3 months. Conclusions. These results suggest that maternity care coordination can be effective in reducing low birth weight, infant mortality, and newborn medical care costs among babies born to women in poverty. Handle: RePEc:aph:ajpbhl:1991:81:12:1625-1629_4 Template-Type: ReDIF-Article 1.0 Title: Factors influencing the formation of new human coronary lesions: Age, blood pressure, and blood cholesterol Journal: American Journal of Public Health Author-Name: Mack, W.J. Author-Name: Blankenhorn, D.H. Year: 1991 Volume: 81 Issue: 9 Pages: 1180-1184 Abstract: Background. The Cholesterol Lowering Atherosclerosis Study, a controlled angiographic trial, has reported that new native coronary artery lesions are significantly reduced by aggressive blood lipid lowering therapy with colestipol plus niacin. To study factors relevant to primary atherosclerosis prevention, we have conducted an epidemiologic analysis of new native coronary lesion formation in placebo-treated patients. Methods. Univariate and multivariate logistic regression procedures were used to examine age at entry into the study, number of years since bypass, body weight, diastolic and systolic blood pressure, plasma total cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol, non-HDL-cholesterol, and apolipoproteins A-I,B, and C-III. Results. Significant univariate protective factors were older age (P<.006), reduction of total plasma cholesterol (P<.040), and systolic (P<.024) and diastolic (P<.022) blood pressure. Significant multivariate protective factors were older age (P<.005) and reduction in systolic blood pressure (P<.021). Blood pressure effects were not associated with use of specific antihypertensive agents. Conclusions. These data provide additional support for the control of hypertension and reduction of blood cholesterol level for primary and secondary ischemic heart disease prevention. They also indicate the existence of a population at high risk for early coronary lesion formation and the need for improved means to identify such individuals prior to the onset of clinical manifestations of ischemic heart disease. Handle: RePEc:aph:ajpbhl:1991:81:9:1180-1184_9 Template-Type: ReDIF-Article 1.0 Title: Utilization of health services in a cohort of intravenous drug users with known HIV-1 serostatus Journal: American Journal of Public Health Author-Name: Solomon, L. Author-Name: Frank, R. Author-Name: Vlahov, D. Author-Name: Astemborski, J. Year: 1991 Volume: 81 Issue: 10 Pages: 1285-1290 Abstract: Background. Intravenous drug users (IVDUs) with human immunodeficiency virus (HIV) infection and AIDS often have no health insurance or rely on public programs to finance their health care. We examined the independent contributions of HIV serostatus, clinical symptoms, CD4 cell counts, and health insurance to utilization of health services among 1881 intravenous drug users in Baltimore, Maryland. Methods. Participants in an ongoing natural history study of HIV were informed of HIV serostatus and seropositives were informed of CD4 cell counts; 6 months later, participants were administered a questionnaire concerning self-reported use of health services, insurance coverage, and HIV-related symptoms. Results. Of 1881 participants, 67% had health insurance (including Medicaid), 48% had at least one outpatient visit, and 12% had at least one inpatient visit within the prior 6 months. The proportion of the study population that was HIV-1 seropositive was 32%. In multivariate analysis, the single most important predictor of health care utilization was the presence of two or more HIV-related clinical symptoms. HIV positive serostatus alone or known low CD4 counts were not significantly associated with use of health care services. Conclusions. These data suggest that HIV seropositive IVDUs are not receiving recommended preventive care. Additional efforts will be needed to ensure that HIV-seropositive drug users participate in currently recommended protocols for early treatment of asymptomatic HIV-1 infection. Handle: RePEc:aph:ajpbhl:1991:81:10:1285-1290_6 Template-Type: ReDIF-Article 1.0 Title: Comparing the predictive accuracy of health risk appraisal: The Centers for Disease Control versus Carter Center Program Journal: American Journal of Public Health Author-Name: Gazmararian, J.A. Author-Name: Foxman, B. Author-Name: Yen, L.T.-C. Author-Name: Morgenstern, H. Author-Name: Edington, D.W. Year: 1991 Volume: 81 Issue: 10 Pages: 1296-1301 Abstract: Background. From 1986 to 1987 the Carter Center of Emory University joined with the Centers for Disease Control (CDC) to develop a new, probability-based, adult health risk appraisal (HRA) instrument for the public domain. This new instrument is compared with the CDC HRA version to determine which is a more accurate predictor of mortality. Methods. We compared predicted mortality risks from the CDC HRA and the Carter Center HRA with the observed mortality among 3135 smokers and never-smoking persons, aged 25 to 60, followed from 1959 to 1979 as part of the Tecumseh Community Health Study. Results. When individuals were classified according to the difference between their actual age and risk age, for the CDC HRA, there was a progressively increasing risk of 10-year mortality as the difference increased. The Carter Center HRA did not show this trend. An analysis using relative operating characteristic curves showed that the mortality risk predictions for both programs were very similar for men and women. However, differences between actual age and risk age for the two programs were not similar for men or women, particularly older men. Therefore, actual age minus risk age for the CDC program was a more accurate predictor of 10-year mortality than was this difference for the Carter Center program. Conclusions. The results from both types of analyses suggest that the validity of risk ages obtained from the Carter Center version may not be sufficient to justify updating programs for those currently using the CDC instrument. Handle: RePEc:aph:ajpbhl:1991:81:10:1296-1301_0 Template-Type: ReDIF-Article 1.0 Title: What scientists funded by the tobacco industry believe about the hazards of cigarette smoking Journal: American Journal of Public Health Author-Name: Cummings, K.M. Author-Name: Sciandra, R. Author-Name: Gingrass, A. Author-Name: Davis, R. Year: 1991 Volume: 81 Issue: 7 Pages: 894-896 Abstract: Despite overwhelming evidence documenting the hazards of cigarette smoking, the tobacco industry denies that smoking has been proven to cause disease. The industry professes a desire to clear up the smoking and health ''question'' and often points to its support of the Council for Tobacco Research (CTR) as evidence of its interest in investigating the health dangers of smoking. This paper presents results of a survey of CTR-funded scientists regarding their beliefs about the health dangers posed by smoking cigarettes. The vast majority of scientists funded by the CTR believe that cigarette smoking is an addition that causes a wide range of serious, often fatal, diseases. This result suggests that the tobacco industry is unwilling to accept even the opinions of scientists it has deemed worthy of funding. Scientists should consider the ethical implications of accepting funds from the CTR and other tobacco industry-supported institutions. Handle: RePEc:aph:ajpbhl:1991:81:7:894-896_9 Template-Type: ReDIF-Article 1.0 Title: Costs and benefits of implementing child survival services at a private mining company in Peru Journal: American Journal of Public Health Author-Name: Foreit, K.G. Author-Name: Haustein, D. Author-Name: Winterhalter, M. Author-Name: La Mata, E. Year: 1991 Volume: 81 Issue: 8 Pages: 1055-1057 Abstract: Costs and savings of child health services were studied in a private mining company in Peru. Despite considerable outlays for medical services, few children under age 5 were vaccinated, and half of their illnesses went untreated. Children who were attended at the company clinic usually received unnecessary medication. As a result of the study, the company hired additional staff to provide integrated maternal-child preventive health care and family planning and contracted for intensive training and periodic on-site supervision. In less than 2 years, vaccination coveraged reached 75%, and virtually all children under age 1 were enrolled in growth monitoring. Prescriptions were reduced by 24%, including a 67% drop in antimicrobials. The cost of the new services was $13 200 for the first 2 years. Approximately $6800 has been saved in pharmaceuticals prescribed for respiratory infection and diarrhea. Recently, two more mines adopted maternal and child health and family planning services. It is hoped that cost-benefit arguments will encourage other companies to incorporate aggressive child survival measures into their health plans. Handle: RePEc:aph:ajpbhl:1991:81:8:1055-1057_6 Template-Type: ReDIF-Article 1.0 Title: Substance abuse in military personnel: Better or worse? Journal: American Journal of Public Health Author-Name: Gardner Jr., L.I. Year: 1991 Volume: 81 Issue: 7 Pages: 837-838 Handle: RePEc:aph:ajpbhl:1991:81:7:837-838_8 Template-Type: ReDIF-Article 1.0 Title: Characteristics of maternal employment during pregnancy: Effects on low birthweight Journal: American Journal of Public Health Author-Name: Peoples-Sheps, M.D. Author-Name: Siegel, E. Author-Name: Suchindran, C.M. Author-Name: Origasa, H. Author-Name: Ware, A. Author-Name: Barakat, A. Year: 1991 Volume: 81 Issue: 8 Pages: 1007-1012 Abstract: Background: Although maternal employment is considered a risk factor for low birthweight (LBW), the manner in which employment might affect birthweight is poorly understood. In this analysis, selected characteristics of employment during pregnancy were examined for effects on pregnancy outcomes. Methods: Work characteristics included the number of hours per week, physical activities, and environmental conditions. The outcomes of interest were fetal growth retardation (<2500 grams at term) and preterm delivery (<37 weeks). The study population consisted of 2711 non-Black, married mothers who participated in the 1980 National Natality Survey (NNS). The NNS data were merged with data from the 1977 revision of The Dictionary of Occupational Titles (DOT) from which measures of occupational physical activities and environmental exposures were obtained. Logistic regression was used in the analysis. Results: Those who worked 40 or more hours per week were more likely than women who worked fewer hours to have a low birthweight delivery at ≥37 weeks. No physical or environmental characterics of work were associated with low birthweight or preterm delivery. Conclusions: Non-Black married American women may face a risk of delivering low-birthweight babies at or near term only if they work 40 or more hours each week. However, the lack of risk associated with other characteristics of work may be a function of measurement error in the DOT data source or of low levels of exposure in the analysis population. Handle: RePEc:aph:ajpbhl:1991:81:8:1007-1012_4 Template-Type: ReDIF-Article 1.0 Title: Hooray for health! A health education program for day-care home providers Journal: American Journal of Public Health Author-Name: Rizk, M.A. Year: 1991 Volume: 81 Issue: 12 Pages: 1667-1668 Handle: RePEc:aph:ajpbhl:1991:81:12:1667-1668_5 Template-Type: ReDIF-Article 1.0 Title: The NHSC mandate [3] Journal: American Journal of Public Health Author-Name: Rodos, J.J. Year: 1991 Volume: 81 Issue: 9 Pages: 1213 Handle: RePEc:aph:ajpbhl:1991:81:9:1213_2 Template-Type: ReDIF-Article 1.0 Title: Preventing and postponing death: Trends in Tennessee infant mortality Journal: American Journal of Public Health Author-Name: Piper, J.M. Year: 1991 Volume: 81 Issue: 8 Pages: 1046-1048 Abstract: Infants born in Tennessee between 1984 and 1988 experienced reduced mortality compared with those born in the 5 years previous. For all birthweight singleton infants, the reduction from 10.2 to 8.4 deaths per 1000 live births represents an 18% decline in mortality. The most impressive gain made was for very low birthweight (<1500 g) infants in the neonatal period, where mortality was reduced 24%. However, for these infants there was nearly a sixfold increase in the postneonatal mortality associated with prematurity-related causes. Handle: RePEc:aph:ajpbhl:1991:81:8:1046-1048_3 Template-Type: ReDIF-Article 1.0 Title: The impact of vitamin A supplementation on morbidity: A randomized community intervention trial Journal: American Journal of Public Health Author-Name: Abdeljaber, M.H. Author-Name: Monto, A.S. Author-Name: Tilden, R.L. Author-Name: Schork, M.A. Author-Name: Tarwotjo, I. Year: 1991 Volume: 81 Issue: 12 Pages: 1654-1656 Abstract: A randomized community trial investigated the impact of vitamin A supplementation on symptoms of respiratory and enteric infections among Indonesian children aged 1 to 5 years. A sample of 450 villages had been randomized into 229 villages that received vitamin A distribution and 221 that were observed as controls. The prevalence rates of cough, fever, and diarrhea were reduced in the treatment villages compared with the control villages by 8%, 5%, and 11%, respectively, but the reduction was not statistically significant. These results indicate that vitamin A supplements did not produce a substantial reduction in these symptoms, in spite of a reported reduction in all-cause mortality. Handle: RePEc:aph:ajpbhl:1991:81:12:1654-1656_6 Template-Type: ReDIF-Article 1.0 Title: Passive smoking during the first year of life Journal: American Journal of Public Health Author-Name: Greenberg, R.A. Author-Name: Bauman, K.E. Author-Name: Strecher, V.J. Author-Name: Keyes, L.L. Author-Name: Glover, L.H. Author-Name: Haley, N.J. Author-Name: Stedman, H.C. Author-Name: Loda, F.A. Year: 1991 Volume: 81 Issue: 7 Pages: 850-853 Abstract: Background and Purpose: A description of passive smoking during the first year of life might assist planning preventive efforts. Methods: Changes in the ecology of passive smoking were investigated in a sample of infants in central North Carolina followed from birth to one year of age. Results: The prevalence of tobacco smoke absorption, indicated by excretion of cotinine, increased from 53 percent to 77 percent (95% CI of difference: 14, 35) during the first year of life. Most infants (92 percent) excreting cotinine at three weeks of age were also excreting it at one year. Moreover, 61 percent of infants not excreting cotinine at age three weeks were excreting it at one year. This increase reflected an increased exposure to household and, particularly, nonhousehold sources of smoke; the proportion of infants exposed to nonhousehold smokers increased from 14 percent to 36 percent. Conclusions: These findings suggest that prevention of the onset of passive smoking should begin very early. Handle: RePEc:aph:ajpbhl:1991:81:7:850-853_0 Template-Type: ReDIF-Article 1.0 Title: How blind is blind review? Journal: American Journal of Public Health Author-Name: Yankauer, A. Year: 1991 Volume: 81 Issue: 7 Pages: 843-845 Abstract: Background: No representative surveys of scientific opinion about blind review have been published, and there is very little information on the success of the blinding process. The American Journal of Public Health has practiced blind review since 1977. Methods: In 1989 to 1990 312 of its reviewers were asked to identify author and institution in the manuscript they reviewed, to provide clues to such identification, to express their opinion concerning blind review, and to offer reasons for their opinion. Results: Reviewers claimed to be able to identify author and/or institution in 47% of the 614 chances offered; identification was incorrect 16% of the time, overall identification correct 39% of the time. Self-referencing was the clue to identification in 62%, personal knowledge in 38% of the cases. If only personal knowledge cases are considered, blinding was successful 83% of the time. Blinding was favored by 75% of the reviewers with most asserting it eliminated bias. Reasons given for opposing blind review included the following: blinding not possible, identification will not influence judgment, and its observe, identification assists judgment. Conclusions: For the American Journal of Public Health blinding is usually, but not always, successful; and the majority of its reviewers favor current policy. Until more definitive data are in, reviewer preference, which differs from journal to journal, seems the most legitimate guide to journal policy on blind review. Handle: RePEc:aph:ajpbhl:1991:81:7:843-845_9 Template-Type: ReDIF-Article 1.0 Title: Erratum: OSHA's four inconsistent carcinogen policies (Am J Public Health, 1991, 81: 775-780) Journal: American Journal of Public Health Author-Name: Robinson, J.C. Author-Name: Paxman, D.G. Year: 1991 Volume: 81 Issue: 8 Pages: 980 Handle: RePEc:aph:ajpbhl:1991:81:8:980_2 Template-Type: ReDIF-Article 1.0 Title: Erratum: Comparison of newborn screening records and birth certificates to estimate bias in newborn HIV serosurveys (Am J Public Health. May 1991;81 (suppl):22-24) Journal: American Journal of Public Health Author-Name: Pass, K.A. Author-Name: Schedlbauer, L.M. Author-Name: MacCubbin, P.A. Author-Name: Glebatis III, D.M. Year: 1991 Volume: 81 Issue: 9 Pages: 1112 Handle: RePEc:aph:ajpbhl:1991:81:9:1112_4 Template-Type: ReDIF-Article 1.0 Title: Timeliness of national reporting of communicable diseases: The experience of the National Electronic Telecommunications System for Surveillance Journal: American Journal of Public Health Author-Name: Birkhead, G. Author-Name: Chorba, T.L. Author-Name: Root, S. Author-Name: Klaucke, D.N. Author-Name: Gibbs, N.J. Year: 1991 Volume: 81 Issue: 10 Pages: 1313-1315 Abstract: The timeliness of reporting four nationally notifiable diseases was examined using data reported via the National Electronic Telecommunications System for Surveillance. Timeliness of reporting varied by disease (bacterial meningitis: median 20 days; salmonellosis: median 22 days; shigellosis: median 23 days; and hepatitis A: median 33 days) and by state. These findings indicate a need to standardize surveillance definitions and to account for reporting differences between states in interpreting regional disease trends or detecting multistate disease outbreaks. Handle: RePEc:aph:ajpbhl:1991:81:10:1313-1315_5 Template-Type: ReDIF-Article 1.0 Title: Knowledge of diagnosis and reproductive history among survivors of childhood plumbism Journal: American Journal of Public Health Author-Name: Hu, H. Year: 1991 Volume: 81 Issue: 8 Pages: 1070-1072 Abstract: As part of a study of the long-term consequences of childhood plumbism, 35 survivors of lead poisoning in the period 1930 through 1944 were interviewed along with 22 controls matched for age, sex, and town of residence. Subjects were asked to recall all pregnancies they engendered (men) or carried (women), outcome, and intellectual development of resulting children. Matched female plumbism subjects reported a higher proportion of spontaneous abortion or stillbirths among pregnancies (relative risk = 1.60, 95% confidence interval [CI] = 0.6-4.0) and a higher proportion of learning disabilities among school-age children (relative risk = 3.0, 95% CI = 0.9-10.2) in comparison with their controls. There was no evidence of clustering of learning disabilities within families or confounding by parental educational level. These results suggest that women with a history of childhood lead poisoning may be at risk for having spontaneous abortions or stillbirths and having children who manifest significant learning disabilities. Handle: RePEc:aph:ajpbhl:1991:81:8:1070-1072_4 Template-Type: ReDIF-Article 1.0 Title: Comparison of subjective ratings of function with observed functional ability of frail older persons Journal: American Journal of Public Health Author-Name: Elam, J.T. Author-Name: Graney, M.J. Author-Name: Beaver, T. Author-Name: El Derwi, D. Author-Name: Applegate, W.B. Author-Name: Miller, S.T. Year: 1991 Volume: 81 Issue: 9 Pages: 1127-1130 Abstract: Background. Important clinical decisions often hinge on patients' functional status. Previous studies have shown disagreement among sources of ratings of patients' functional status. This study compared patient self-ratings, family member ratings, and physician ratings of patient function to performance-based functional testing criteria. Methods. Five activities of daily living of 73 older patients were studied at admission to a rehabilitation unit following discharge from an acute care community hospital. Data were collected from patients, family members, and physicians and were compared with performance-based function testing. Results. Patient ratings were significantly more accurate than physician ratings for walking, transferring, and telephoning. Patients were significantly more accurate than family members for rating walking and telephoning, but patients were not significantly more accurate than family members or physicians for rating eating or dressing. Conclusions. We conclude that decisions about patients' functional level should be based on performance testing. If performance testing is unavailable, patients' own ratings are most accurate, followed by family ratings. Physicians' ratings are least accurate. Handle: RePEc:aph:ajpbhl:1991:81:9:1127-1130_0 Template-Type: ReDIF-Article 1.0 Title: Strategies to prevent HIV infection in the United States Journal: American Journal of Public Health Author-Name: Hinman, A.R. Year: 1991 Volume: 81 Issue: 12 Pages: 1557-1559 Handle: RePEc:aph:ajpbhl:1991:81:12:1557-1559_1 Template-Type: ReDIF-Article 1.0 Title: Injury-related medical care utilization in a problem drinking population Journal: American Journal of Public Health Author-Name: Blose, J.O. Author-Name: Holder, H.D. Year: 1991 Volume: 81 Issue: 12 Pages: 1571-1575 Abstract: Background. Population-based data on the overall risk of injury among problem drinkers are extremely limited. Methods. We conducted an eight-year study of injury-related medical care utilization for a group of problem drinkers (n = 3,729) enrolled in the health insurance plan of a large manufacturing firm with plants in a number of midwestern states. A comparison non-problem drinking cohort matched on age, gender, and number of years of enrollment with the same company plan was also utilized. Results. Problem drinkers utilized injury-related medical care at a rate 1.6 times that of the comparison group and experienced injury-related medical care costs which were three times as high. Increased risk were found for both men and women and for all ages studied. Conclusions. This study is one of the few to examine the overall incidence of fatal and non-fatal injuries among a large population of problem drinkers and provides evidence that higher medical care costs are associated with chronic alcohol use. Handle: RePEc:aph:ajpbhl:1991:81:12:1571-1575_0 Template-Type: ReDIF-Article 1.0 Title: Family structure and child health Journal: American Journal of Public Health Author-Name: Bloom, B. Author-Name: Dawson, D. Year: 1991 Volume: 81 Issue: 11 Pages: 1526-1527 Handle: RePEc:aph:ajpbhl:1991:81:11:1526-1527_3 Template-Type: ReDIF-Article 1.0 Title: APHA, the Journal, and alcohol advertising - The ethics involved [4] Journal: American Journal of Public Health Author-Name: Freedman, J.E. Author-Name: Novey, S.R. Author-Name: Cowell, C. Author-Name: Schiffer, W.K. Author-Name: Godshall, W.T. Author-Name: Mosher, J.F. Year: 1991 Volume: 81 Issue: 10 Pages: 1347-1348 Handle: RePEc:aph:ajpbhl:1991:81:10:1347-1348_1 Template-Type: ReDIF-Article 1.0 Title: Oral rehydration program evaluation by quality assurance sampling in rural Haiti Journal: American Journal of Public Health Author-Name: Pierre-Louis, J.N. Year: 1991 Volume: 81 Issue: 9 Pages: 1205-1207 Abstract: An oral rehydration program in rural Haiti was evaluated by quality assurance sampling. The quality assurance sampling method and its application are described. The indicators measured were knowledge of the oral rehydration salts packet, knowledge of preparation of the solution from the packet, oral rehydration therapy use, and knowledge of preparation of the solution from salt and sugar. Coverages of the first two indicators were adequate, coverages of the latter two were inadequate. The method is a useful low-cost approach to evaluation of program coverage. Handle: RePEc:aph:ajpbhl:1991:81:9:1205-1207_3 Template-Type: ReDIF-Article 1.0 Title: Staff involvement and special follow-up time increase physicians' counseling about smoking cessation: A controlled trial Journal: American Journal of Public Health Author-Name: Duncan, C. Author-Name: Stein, M.J. Author-Name: Cummings, S.R. Year: 1991 Volume: 81 Issue: 7 Pages: 899-901 Abstract: We compared the counseling behaviors of two groups of health maintenance organization physicians: one group received training about smoking cessation counseling; the other group received the same training plus staff support and appointment time specially designated for follow-up of smokers. We interviewed patients after their office visits to measure smoking counselling. The group receiving staff support and designated follow-up time counseled more and made more follow-up appointments about smoking. Handle: RePEc:aph:ajpbhl:1991:81:7:899-901_8 Template-Type: ReDIF-Article 1.0 Title: Acceptance of the female condom by Latin- and African-American women [2] Journal: American Journal of Public Health Author-Name: Schilling, R.F. Author-Name: El-Bassel, N. Author-Name: Leeper, M.A. Author-Name: Freeman, L. Year: 1991 Volume: 81 Issue: 10 Pages: 1345-1346 Handle: RePEc:aph:ajpbhl:1991:81:10:1345-1346_4 Template-Type: ReDIF-Article 1.0 Title: Public health intervention in a cocaine-related syphilis outbreak Journal: American Journal of Public Health Author-Name: Hibbs, J.R. Author-Name: Gunn, R.A. Year: 1991 Volume: 81 Issue: 10 Pages: 1259-1262 Abstract: Background. Cocaine users and prostitutes are at high risk for syphilis, but disease control is difficult among these populations. During a cocaine-related syphilis outbreak in Chester, Pennsylvania, in 1989, we conducted a control program at sites where sex and drugs were sold. Methods. During a 2-week period, investigators recruited persons from these sites for interview, serologic testing, and empiric treatment. Results. Among 136 persons screened, 25 (18%) had early syphilis and 26 others (19%) had recent sexual contact with early syphilis patients. All were treated at initial screening at a cost of $402 and 12 investigator hours per case, compared to $470 and 20 hours per case when treated during routine investigator activities. This program may have contributed to a short-term decline in syphilis incidence in Chester by reducing the period of infectivity of these patients. Conclusions. Screening and empiric treatment of persons at sites where sex and drugs are sold can be useful in short-term control of cocaine-related syphilis outbreaks. Handle: RePEc:aph:ajpbhl:1991:81:10:1259-1262_3 Template-Type: ReDIF-Article 1.0 Title: A randomized trial of an interim methadone maintenance clinic Journal: American Journal of Public Health Author-Name: Yancovitz, S.R. Author-Name: Des Jarlais, D.C. Author-Name: Peyser, N.P. Author-Name: Drew, E. Author-Name: Friedmann, P. Author-Name: Trigg, H.L. Author-Name: Robinson, J.W. Year: 1991 Volume: 81 Issue: 9 Pages: 1185-1191 Abstract: Background. Interim methadone maintenance has been proposed as a method of providing clinically effective services to heroin addicts waiting for treatment in standard comprehensive methadone maintenance programs. Methods. A clinic that provided initial medical evaluation, methadone medication, and AIDS education, but did not include formal drug abuse counseling or other social support services was established in New York City. A sample of 301 volunteer subjects recruited from the waiting list for treatment in the Beth Israel methadone program were randomly assigned to immediate entry into the interim clinic or a control group. Results. There were no differences in initial levels of illicit drug use across the experimental and control groups. One-month urinalysis follow-up data showed a significant reduction in heroin use in the experimental group (from 63% positive at intake to 29% positive) with no change in the control group (62% to 60% positive). No significant change was observed in cocaine urinalyses (approximately 70% positive for both groups at intake and follow-up). A higher percentage of the experimental group were in treatment at 16-month follow-up (72% vs 56%). Conclusions. Limited services interim methadone maintenance can reduce heroin use among persons awaiting entry into comprehensive treatment and increase the percentage entering treatment. Handle: RePEc:aph:ajpbhl:1991:81:9:1185-1191_3 Template-Type: ReDIF-Article 1.0 Title: HIV infection, genital ulcer disease, and crack cocaine use among patients attending a clinic for sexually transmitted diseases Journal: American Journal of Public Health Author-Name: Chirgwin, K. Author-Name: DeHovitz, J.A. Author-Name: Dillon, S. Author-Name: McCormack, W.M. Year: 1991 Volume: 81 Issue: 12 Pages: 1576-1579 Abstract: Background. Recently there has been a rise in genital ulcer disease (GUD) in urban minority heterosexuals in the United States. The impact of these increased GUD rates on HIV transmission patterns in this population is unknown. Methods. Sexually transmitted disease (STD) diagnoses were correlated with HIV antibody status and risk factor history in 194 patients who consented to HIV testing at an STD clinic in central Brooklyn. Results. Of 36 HIV-positive patients, 23 (64%) denied HIV risk factors other than heterosexual contact with persons of unknown HIV status. HIV antibody was associated with GUD (odds radio [OR] = 2.72, 95% confidence interval [CI] = 1.20-6.24), multiple concurrent STDs (OR = 2.51, 95% CI = 1.08-5.81), and a history of crack cocaine use (OR = 2.98, 95% CI = inexact-9.61). Crack use was also associated with GUD (OR = 15.15, 95% CI = 3.27-inexact) and multiple simultaneous STDs (OR = 13.87, 95% CI = 4.62-inexact). In a log-linear model analysis, HIV infection was independently associated with GUD and crack use. HIV infection, genital ulcer disease, and crack cocaine use were more common in women than men. Conclusions. The association between HIV infection and GUD seen here may be secondary to high-risk sexual behavior, which in turn may be partially attributable to crack cocaine use and drug-related prostitution. The high rate of coinfection with HIV and GUD raises a concern about the increased efficiency of sexual transmission of HIV in this population. Handle: RePEc:aph:ajpbhl:1991:81:12:1576-1579_4 Template-Type: ReDIF-Article 1.0 Title: Lead paint abatement - Definition and outcomes debated [1] Journal: American Journal of Public Health Author-Name: Binder, S. Author-Name: Wylie, K.M. Author-Name: Mielke, H.W. Author-Name: Matte, T.D. Author-Name: Binder, S. Author-Name: Falk, H. Author-Name: Marino, P.E. Author-Name: Landrigan, P.J. Author-Name: Farfel, M. Author-Name: Chisolm, J.J. Year: 1991 Volume: 81 Issue: 10 Pages: 1342-1345 Handle: RePEc:aph:ajpbhl:1991:81:10:1342-1345_6 Template-Type: ReDIF-Article 1.0 Title: Hearing loss and hearing aid use in Hispanic adults: Results from the Hispanic Health and Nutrition Examination Survey Journal: American Journal of Public Health Author-Name: Lee, D.J. Author-Name: Carlson, D.L. Author-Name: Lee, H.M. Author-Name: Ray, L.A. Author-Name: Markides, K.S. Year: 1991 Volume: 81 Issue: 11 Pages: 1471-1474 Abstract: Data from the Hispanic Health and Nutrition Examination Survey were employed to investigate the prevalence of hearing loss and hearing aid use in Mexican-American, Cuban-American, and Puerto Rican adults. Hearing loss was 6 to 14 times more prevalent in older (ages 54 to 74) vs younger (ages 20 through 34) subjects. Cuban Americans and Mexican Americans tended to have a similar prevalence of hearing loss, whereas Puerto Ricans had markedly lower rates. Mexican-American men had higher rates of hearing loss than Mexican-American women. The prevalence of hearing aid use among hearing-impaired individuals ranged from 2% to 11%. Implications for future research are discussed. Handle: RePEc:aph:ajpbhl:1991:81:11:1471-1474_3 Template-Type: ReDIF-Article 1.0 Title: Malnutrition in elderly ambulatory medical patients Journal: American Journal of Public Health Author-Name: Manson, A. Author-Name: Shea, S. Year: 1991 Volume: 81 Issue: 9 Pages: 1195-1197 Abstract: Elderly ambulatory persons may be especially susceptible to malnutrition, particularly those who are poor and socially isolated or have commorbid chronic medical diseases. We found that 98 of 2,986 persons age 60 years or older attending a hospital-based medical practice between 1979 and 1989 weighed less than 45.4 kg (100 lbs). All but 1 of these subjects met criteria for malnutrition as judged against age-specific norms for weight. Thus the prevalence of malnutrition in this sample was 3.25% (95% CI 2.61, 3.89%). Interviews and physical examinations of a subsample (n = 16) revealed that all 16 subjects either met anthropometric-based criteria for malnutrition or were being treated for malnutrition. Of the 98 subjects who weighted less than 45.4 kg, 62 (63.3%; 95% CI 53.8, 72.8%) had comorbid conditions that could have contributed to malnutrition. Physicians did not record a diagnosis of malnutrition or weight loss in 47.9% of subjects (95% CI 38.0, 57.8%) and did not prescribe a nutrition supplement for 76.5% of subjects (95% CI 68.1, 84.9%). Subjects treated with nutrition supplement were more likely to have cancer. These findings suggest that malnutrition, both with and without concomitant major comorbid disease, is releatively frequent among elderly ambulatory patients and that a specific nutritional diagnosis is not made in many cases. We suggest that weight under 45.4 kg in an elderly person is a useful criterion for identifying elderly patients at nutritional risk. Handle: RePEc:aph:ajpbhl:1991:81:9:1195-1197_4 Template-Type: ReDIF-Article 1.0 Title: Anonymity in testing for HIV antibodies desired option [2] Journal: American Journal of Public Health Author-Name: Weitz, R. Year: 1991 Volume: 81 Issue: 9 Pages: 1213 Handle: RePEc:aph:ajpbhl:1991:81:9:1213_9 Template-Type: ReDIF-Article 1.0 Title: Cognitive impairment and hospital use Journal: American Journal of Public Health Author-Name: Weiler, P.G. Author-Name: Lubben, J.E. Author-Name: Chi, I. Year: 1991 Volume: 81 Issue: 9 Pages: 1153-1157 Abstract: Background. An increasing number of older people are at higher risk of developing Alzheimer's Disease or another dementias. The resultant cognitive impairment has been well identified as one of the risk factors for nursing home placement but it has not been well studied as a risk for hospitalization. Methods. To study the association between cognitive impairment and hospital use, this study examined data from a randomly selected cohort of community dwelling California elderly (California Senior Survey). The cohort was followed for one year (N = 940). Results. Only about 17 percent of the study population was in the mildly or moderately/severe impaired category. Those participants with cognitive impairment were almost twice as likely as those without any impairment to be hospitalized and to be hospitalized for six days or more. Conclusions. Although the cause of the cognitive impairment and hospitalization was not determined in this study, the data support the importance of cognitive impairment as a risk factor for hospital use even after controlling for age, ADL, IADL, and prior hospitalizations. The causes for this need to be further examined so the burden of such care can be reduced. Handle: RePEc:aph:ajpbhl:1991:81:9:1153-1157_2 Template-Type: ReDIF-Article 1.0 Title: Hypertension management in health care for the homeless clinics: Results from a survey Journal: American Journal of Public Health Author-Name: Kinchen, K. Author-Name: Wright, J.D. Year: 1991 Volume: 81 Issue: 9 Pages: 1163-1165 Abstract: Background. With the exception of alcohol abuse, hypertension is the most common chronic physical health problem encountered among homeless persons. The material conditions of homelessness greatly complicate the management of this disorder. Some of the complications and their solutions are discussed here, based on the experiences of health clinics for the homeless in large US cities. Methods. In 1988, the Stewart B. McKinney Homeless Assistance Act established health care clinics for homeless persons in 108 cities. We surveyed medical directors in these clinics, asking about the management of hypertension in this difficult-to-treat population; 65 responded. Results. Comparisons between our survey data and those obtained in two recent surveys of clinicians in ''normal'' clinical practice provide interesting lessons in how medical practice is adapted to respond to the unique needs and problems of the urban homeless. Although therapeutic goals are similar, the means chosen to achieve them often are not. Conclusions. The treatment of homeless hypertensives illustrates the problems inherent in strict biomedical models of disease and its alleviation. Preferred treatments, course of disease, and success of intervention are powerfully affected by social factors. Handle: RePEc:aph:ajpbhl:1991:81:9:1163-1165_5 Template-Type: ReDIF-Article 1.0 Title: Age- and sex-specific cycles in United States suicides, 1973 to 1985 Journal: American Journal of Public Health Author-Name: McCleary, R. Author-Name: Chew, K.S.Y. Author-Name: Hellsten, J.J. Author-Name: Flynn-Bransford, M. Year: 1991 Volume: 81 Issue: 11 Pages: 1494-1497 Abstract: Total US suicides peak on the first day of each week, in the first week of each month, and in the late spring of each year. Although these cycles are assumed to characterize all US suicides, analyses by age and sex show that the cycles occur only in a few subpopulations. Day-of-the-week effects are found almost exclusively in middle-aged suicides; day-of-the-month effects are found almost exclusively in elderly male suicides; and month-of-the-year effects are found almost exclusively in teenaged and elderly suicides. Handle: RePEc:aph:ajpbhl:1991:81:11:1494-1497_2 Template-Type: ReDIF-Article 1.0 Title: Erratum: Yankauer A. How blind is blind review? (Am J Public Health, December 1991, Vol. 81, p 843-845 Journal: American Journal of Public Health Author-Name: McNutt, M.D. Author-Name: Evans, R.T. Author-Name: Fletcher, R.H. Author-Name: Fletcher, S.W. Year: 1991 Volume: 81 Issue: 12 Pages: 1570 Handle: RePEc:aph:ajpbhl:1991:81:12:1570_0 Template-Type: ReDIF-Article 1.0 Title: The health risks of Asian Americans Journal: American Journal of Public Health Author-Name: Yu, E.S.H. Year: 1991 Volume: 81 Issue: 11 Pages: 1391-1393 Handle: RePEc:aph:ajpbhl:1991:81:11:1391-1393_1 Template-Type: ReDIF-Article 1.0 Title: Public health then and now: The Tuskegee Syphilis Study, 1932 to 1972: Implications for HIV education and AIDS risk education programs in the black community Journal: American Journal of Public Health Author-Name: Thomas, S.B. Author-Name: Quinn, S.C. Year: 1991 Volume: 81 Issue: 11 Pages: 1498-1504 Abstract: The Tuskegee study of untreated syphilis in the Negro male is the longest nontherapeutic experiment on human beings in medical history. The strategies used to recruit and retain participants were quite similar to those being advocated for HIV/AIDS prevention programs today. Almost 60 years after the study began, there remains a trail of distrust and suspicion that hampers HIV education efforts in Black communities. The AIDS epidemic has exposed the Tuskegee study as a historical marker for the legitimate discontent of Blacks with the public health system. The belief that AIDS is a form of genocide is rooted in a social context in which Black Americans, faced with persistent inequality, believe in conspiracy theories about Whites against Blacks. These theories range from the belief that the government promotes drug abuse in Black communities to the belief that HIV is a manmade weapon of racial warfare. An open and honest discussion of the Tuskegee Syphilis Study can facilitate the process of rebuilding trust between the Black community and public health authorities. This dialogue can contribute to the development of HIV education programs that are scientifically sound, culturally sensitive, and ethnically acceptable. Handle: RePEc:aph:ajpbhl:1991:81:11:1498-1504_7 Template-Type: ReDIF-Article 1.0 Title: MOM-mobile brings ultrasounds to moms Journal: American Journal of Public Health Author-Name: Martin, J.B. Author-Name: Finnerty, M.J. Year: 1991 Volume: 81 Issue: 8 Pages: 1073-1074 Handle: RePEc:aph:ajpbhl:1991:81:8:1073-1074_5 Template-Type: ReDIF-Article 1.0 Title: Farm tractors and mandatory roll-over protection retrofits: Potential costs of the policy in New York Journal: American Journal of Public Health Author-Name: Kelsey, T.W. Author-Name: Jenkins, P.L. Year: 1991 Volume: 81 Issue: 7 Pages: 921-923 Abstract: Tractor roll-overs are the leading cause of fatal farm accidents, accounting for more than one-fourth of all agriculturally related deaths. Most of these deaths could be prevented if the tractors were equipped with roll-over protective structures (ROPS). This study estimates the number of tractors in New York without ROPS, projects their retirement, and then estimates the number of lives which would be saved if ROPS were retrofitted on old tractors. The basic costs associated with mandating ROPS are calculated from these estimates. The minimum economic cost of mandating ROPS is $511,136 per life saved for the retrofits, and an additional $253,254 per life saved for every $1 million spent annually on enforcement. It is concluded that a policy mandating ROPS on all tractors would be expensive, but should be considered with particular attention to the need for and cost effectiveness of enforcement. Handle: RePEc:aph:ajpbhl:1991:81:7:921-923_4 Template-Type: ReDIF-Article 1.0 Title: AIDS surveillance among American Indians and Alaska Natives Journal: American Journal of Public Health Author-Name: Metler, R. Author-Name: Conway, G.A. Author-Name: Stehr-Green, J. Year: 1991 Volume: 81 Issue: 11 Pages: 1469-1471 Abstract: To assess the human immunodeficiency virus epidemic among American Indians and Alaska Natives (AI/AN), we examined acquired immunodeficiency syndrome (AIDS) case and seroprevalence data through December 1990. While AI/AN had a low 1990 reported AIDS case rate (4.0/100,000), the increase in diagnosed cases adjusted for reporting delays from 1989 to 1990 was higher (23.1%) among AI/AN than any other racial/ethnic group. Seroprevalence data for military applicants have documented higher rates for AI/AN than for either Whites or Asian/Pacific Islanders. Handle: RePEc:aph:ajpbhl:1991:81:11:1469-1471_0 Template-Type: ReDIF-Article 1.0 Title: The use of direct mail to increase clinician knowledge: An intervention study Journal: American Journal of Public Health Author-Name: Sadowsky, D. Author-Name: Kunzel, C. Year: 1991 Volume: 81 Issue: 7 Pages: 923-925 Abstract: A probability sample of American general practitioner dentists, 40 years of age or older, in solo private practice, was the target of two direct mail interventions offered at two different times, to test whether knowledge regarding prophylaxis of patients at risk for infective endocarditis could be improved. Tests of knowledge were responses in a mail questionnaire to clinical vignettes, designed to elicit the content of antibiotic regimens used for patients at risk. The research design enabled detection of (1) the effect of the interventions; (2) the differences in their effect; (3) the attenuation of their effect; and (4) the effect of time. Where baseline knowledge was low, it was improved and did not rapidly disappear. Both mail interventions were equally effective, in most instances, and there was no attenuation of the interventions' effect and no effect of time on the control groups' knowledge over a 4 1/2 month period. The results suggest that it is possible to improve clinicians' knowledge of expert recommendations through direct mail intervention. Handle: RePEc:aph:ajpbhl:1991:81:7:923-925_4 Template-Type: ReDIF-Article 1.0 Title: Perinatal and infant mortality in various geographic areas of Italy [4] Journal: American Journal of Public Health Author-Name: Parazzini, F. Author-Name: La Vecchia, C. Year: 1991 Volume: 81 Issue: 7 Pages: 933 Handle: RePEc:aph:ajpbhl:1991:81:7:933_1 Template-Type: ReDIF-Article 1.0 Title: Workers' compensation data add to fatal injury census [6] Journal: American Journal of Public Health Author-Name: Sorock, G. Author-Name: Stanbury, M. Year: 1991 Volume: 81 Issue: 12 Pages: 1678 Handle: RePEc:aph:ajpbhl:1991:81:12:1678_0 Template-Type: ReDIF-Article 1.0 Title: Marquette County Health Department: Food service sanitation - Doing better with less Journal: American Journal of Public Health Author-Name: Johnson, R.M. Year: 1991 Volume: 81 Issue: 10 Pages: 1340-1341 Handle: RePEc:aph:ajpbhl:1991:81:10:1340-1341_1 Template-Type: ReDIF-Article 1.0 Title: Characteristics of a random sample of emergency food program users in New York: II. Soup kitchens Journal: American Journal of Public Health Author-Name: Bowering, J. Author-Name: Clancy, K.L. Author-Name: Poppendieck, J. Year: 1991 Volume: 81 Issue: 7 Pages: 914-917 Abstract: A random sample of soup kitchen clients in New York City was studied and specific comparisons made on various parameters including homelessness. Compared with the general population of low income persons, soup kitchen users were overwhelmingly male, disproportionately African-American, and more likely to live alone. The homeless (41 percent of the sample) were less likely to receive food stamps or free food, or to use food pantries. Fewer of them received Medicaid or had health insurance. Forty-seven percent had no income in contrast to 29 percent of the total sample. Handle: RePEc:aph:ajpbhl:1991:81:7:914-917_5 Template-Type: ReDIF-Article 1.0 Title: Risk factors for childhood homicides in Ohio: A birth certificate-based case-control study Journal: American Journal of Public Health Author-Name: Winpisinger, K.A. Author-Name: Hopkins, R.S. Author-Name: Indian, R.W. Author-Name: Hostetler, J.R. Year: 1991 Volume: 81 Issue: 8 Pages: 1052-1054 Abstract: Death certificates of children less than 8 years of age who were killed between 1979 and 1986 were linked to their Ohio birth certificates and compared with those of Ohio children born in 1983 (controls). Having an unmarried mother increased risk of homicide almost fivefold (odds ratio 4.87). Having a teenage mother, a mother who had not graduated from high-school, and being of Black race or low birthweight each increased the risk by approximately threefold. Increases in the proportion of children born to unmarried mothers may contribute to increases in childhood homicide rates. Handle: RePEc:aph:ajpbhl:1991:81:8:1052-1054_5 Template-Type: ReDIF-Article 1.0 Title: Number of bicycle injuries unrealistic [5] Journal: American Journal of Public Health Author-Name: Andrews, F.M. Author-Name: Thompson, D.C. Author-Name: Thompson, R.S. Author-Name: Rivara, F.P. Year: 1991 Volume: 81 Issue: 8 Pages: 1079 Handle: RePEc:aph:ajpbhl:1991:81:8:1079_1 Template-Type: ReDIF-Article 1.0 Title: Health behaviors, risk factors, and health indicators associated with cigarette use in Mexican Americans: Results from the Hispanic HANES Journal: American Journal of Public Health Author-Name: Lee, D.J. Author-Name: Markides, K.S. Year: 1991 Volume: 81 Issue: 7 Pages: 859-864 Abstract: Background: Cigarette smokers often engage in other, potentially deleterious, health behaviors. Such behaviors have not been well documented in Mexican American smokers. Methods: Data from the Southwestern sample of the Hispanic Health and Nutrition Examination Survey (HHANES) were employed to investigate differences in health behaviors, risk factors and health indicators between cigarette smokers and nonsmokers among Mexican Americans. Differences between those smoking < 10 and 10 or more cigarettes per day were also examined by age group and gender. Results: Positive associations between smoking status and heavy coffee and alcohol consumption were found across gender and age groups. Less consistent was the finding that smokers weighed less than nonsmokers. Lower systolic and diastolic blood pressures in middle-aged smokers, and higher levels of depressive symptomatology among smoking women were found. Those smoking 10 or more cigarettes per day were more likely to report heavy coffee consumption, with younger men reporting greater activity limitation due to poor health. Middle-aged men and women in the 10+ category were generally in better health than lighter smokers. Conclusions: Modest associations between cigarette smoking, health behaviors and risk factors found in other studies were confirmed in this Mexican American population. Few significant associations between smoking and health status were noted. Handle: RePEc:aph:ajpbhl:1991:81:7:859-864_9 Template-Type: ReDIF-Article 1.0 Title: Sustained effects of an educational program to reduce sales of cigarettes to minors Journal: American Journal of Public Health Author-Name: Altman, D.G. Author-Name: Rasenick-Douss, L. Author-Name: Foster, V. Author-Name: Tye, J.B. Year: 1991 Volume: 81 Issue: 7 Pages: 891-893 Abstract: We report 1-year follow-up data from a sample of stores participating in a 6-month community-wide educational effort to reduce cigarette sales to minors in Santa Clara County, California. The proportion of over-the-counter sales to minors at the 1-year follow-up illustrated that although statistically significant reductions were maintained 6 months after the intervention ended, recidivism occurred. Suggestions for achieving long-term reductions in sales to minors are offered. Handle: RePEc:aph:ajpbhl:1991:81:7:891-893_9 Template-Type: ReDIF-Article 1.0 Title: The increasing supply of physicians in US urban and rural areas, 1975 to 1988 Journal: American Journal of Public Health Author-Name: Frenzen, P.D. Year: 1991 Volume: 81 Issue: 9 Pages: 1141-1147 Abstract: Background. Despite the rapid growth of the US physician supply since the mid-1970s, it remains unclear whether physicians have spread into the most rural areas of the country. This report examines the urban-rural distribution of physicians between 1975 and 1988. Methods. A county-based typology of the urban-rural continuum was employed to examine trends in the supply of nonfederal primary care physicians, specialist physicians, and osteopaths. Results. All urban and rural areas gained physicians during the late 1970s and 1980s. The supply of physicians increased most rapidly in metropolitan counties. Within nonmetropolitan area, urbanized remote counties became more prominent centers of the physician supply. Osteopaths were more likely to locate in the most rural areas than allopaths. The physician supply in all areas also became more specialized over time. Conclusions. The rapid growth of the US physician supply was associated with the spread of more practitioners into all parts of the country. However, the supply of physicians increased most rapidly in urban areas, widening urban-rural differences in the availability of physicians. Handle: RePEc:aph:ajpbhl:1991:81:9:1141-1147_9 Template-Type: ReDIF-Article 1.0 Title: Suicides at Niagara Falls [5] Journal: American Journal of Public Health Author-Name: Ross, T.E. Author-Name: Lester, D. Year: 1991 Volume: 81 Issue: 12 Pages: 1677-1678 Handle: RePEc:aph:ajpbhl:1991:81:12:1677-1678_8 Template-Type: ReDIF-Article 1.0 Title: Patterns of breast and cervical cancer screening at three public health centers in an inner-city urban area Journal: American Journal of Public Health Author-Name: Whitman, S. Author-Name: Ansell, D. Author-Name: Lacey, L. Author-Name: Chen, E.H. Author-Name: Ebie, N. Author-Name: Dell, J. Author-Name: Phillips, C.W. Year: 1991 Volume: 81 Issue: 12 Pages: 1651-1653 Abstract: In an effort to examine breast and cervical cancer screening patterns among poor African-American urban women, medical records were abstracted at three public health centers located in the inner city of Chicago. The proportions of eligible women at these three centers who received Pap smears, breast examinations, and mammograms were computed. These proportions were notably low and differed significantly among the three centers. Because the literature is now suggesting that an appropriate sequence best defines adequate screening, sequences of screenings were also determined and were found to be lacking. All of these screening histories fall far below the screening objectives set by the National Cancer Institute for the year 2000. This information suggests that interventions are needed that will help health centers serving poor women to deliver more frequent cancer screening. Handle: RePEc:aph:ajpbhl:1991:81:12:1651-1653_7 Template-Type: ReDIF-Article 1.0 Title: The importance of assessing the fit of logistic regression models: A case study Journal: American Journal of Public Health Author-Name: Hosmer, D.W. Author-Name: Taber, S. Author-Name: Lemeshow, S. Year: 1991 Volume: 81 Issue: 12 Pages: 1630-1635 Abstract: Background. The logistic regression model is being used with increasing frequency in all areas of public health research. In the calendar year 1989, over 30% of the articles published in the American Journal of Public Health employed some form of logistic regression modeling. In spite of this increase, there has been no commensurate increase in the use of commonly available methods for assessing model adequacy. Methods. We review the current status of the use of logistic regression modeling in the American Journal of Public Health. We present a brief overview of currently available and easily used methods for assessing the adequacy of a fitted logistic regression model. Results. An example is used to demonstrate the methods as well as a few of the adverse consequences of failing to assess the fit of the model. One important adverse consequence illustrated in the example is the inclusion of variables in the model as a result of the influence of one subject. Conclusions. Failure to address model adequacy may lead to misleading or incorrect inferences. Recommendations are made for the use of methods for assessing model adequacy and for future editorial policy in regard to the review of articles using logistic regression. Handle: RePEc:aph:ajpbhl:1991:81:12:1630-1635_3 Template-Type: ReDIF-Article 1.0 Title: Epidemiologic studies utilizing surveys: Accounting for the sampling design Journal: American Journal of Public Health Author-Name: Korn, E.L. Author-Name: Graubard, B.I. Year: 1991 Volume: 81 Issue: 9 Pages: 1166-1173 Abstract: Background. Since large-scale health surveys usually have complicated sampling schemes, there is often a question as to whether the sampling design must be considered in the analysis of the data. A recent disagreement concerning the analysis of a body iron stores-cancer association found in the first National Health and Nutrition Examination Survey and its follow-up is used to highlight the issues. Methods. We explain and illustrate the importance of two aspects of the sampling design: clustering and weighting of observations. The body iron stores-cancer data are reanalyzed by utilizing or ignoring various aspects of the sampling design. Simple formulas are given to describe how using the sampling design of a survey in the analysis will affect the conclusions of that analysis. Results. The different analyses of the body iron stores-cancer data lead to very different conclusions. Application of the simple formulas suggests that utilization of the sample clustering in the analysis is appropriate, but that a standard utilization of the sample weights leads to an uninformative analysis. The recommended analysis incorporates the sampling weights in a nonstandard way and the sample clustering in the standard way. Conclusions. Which particular aspects of the sampling design to use in the analysis of complex survey data and how to use them depend on certain features of the design. We give some guidelines for when to use the sample clustering and sample weights in the analysis. Handle: RePEc:aph:ajpbhl:1991:81:9:1166-1173_4 Template-Type: ReDIF-Article 1.0 Title: Leptospirosis on Kauai: Investigation of a common source waterborne outbreak Journal: American Journal of Public Health Author-Name: Katz, A.R. Author-Name: Manea, S.J. Author-Name: Sasaki, D.M. Year: 1991 Volume: 81 Issue: 10 Pages: 1310-1312 Abstract: During the summer of 1987, a common source waterborne outbreak of leptospirosis occurred on the island of Kauai in the state of Hawaii. Eight leptospirosis cases were identified using the microscopic agglutination test. Methodologic weaknesses in this technique were responsible for the initial missed diagnosis on six of the eight cases. All cases had repeated exposure to the Waimea River. A wide array of animal reservoirs and optimal water conditions may have been factors in this outbreak. Handle: RePEc:aph:ajpbhl:1991:81:10:1310-1312_9 Template-Type: ReDIF-Article 1.0 Title: Situational factors associated with AIDS risk behavior lapses and coping strategies used by gay men who successfully avoid lapses Journal: American Journal of Public Health Author-Name: Kelly, J.A. Author-Name: Kalichman, S.C. Author-Name: Kauth, M.R. Author-Name: Kilgore, H.G. Author-Name: Hood, H.V. Author-Name: Campos, P.E. Author-Name: Rao, S.M. Author-Name: Brasfield, T.L. Author-Name: St. Lawrence, J.S. Year: 1991 Volume: 81 Issue: 10 Pages: 1335-1338 Abstract: While most gay men have reduced behavior practices at high risk for HIV infection, there is growing evidence that many also lapse to unsafe sex. This study examined situational factors related to risk behavior lapses as well as coping strategies used by men who successfully resist lapse urges. A convenience sample of 470 men patronizing gay bars or attending social organization meetings in four cities was surveyed. Forty-five percent of men were classified as ''lapsers'' (those who had had unprotected anal intercourse in the previous 6 months) and 24% were classified as ''resisters'' (those who successfully resisted urges to engage in this behavior). All provided information concerning the importance of factors related to the most recent occurrence of either unsafe sex or resisting unsafe urges. Most episodes of unsafe sex occurred outside monogamous relationships and with partners of unknown HIV serostatus, although simply inquiring about partner serostatus was relatively common. Lapsers rated affectionate feelings and wishing to please a partner as well as spontaneity of unsafe sex as the most important situational factors surrounding high-risk behavior. Resisters of unsafe sex urges reported active cognitive self-guidance, experience in safe sex, and recall of both AIDS fears and safety benefits as their most important coping strategies. Gay men who continue high-risk behavior may be overrelying on partner reports of negative serostatus. Lapse prevention approaches tailored to situations that create increased risk vulnerability must be developed. Teaching skills already used by men who successfully resist unsafe sex urges might be one approach. Handle: RePEc:aph:ajpbhl:1991:81:10:1335-1338_8 Template-Type: ReDIF-Article 1.0 Title: Language of interview: Relevance for research of southwest Hispanics Journal: American Journal of Public Health Author-Name: Kirkman-Liff, B. Author-Name: Mondragon, D. Year: 1991 Volume: 81 Issue: 11 Pages: 1399-1404 Abstract: Background. This paper reports the results of a survey investigating health status, access, satisfaction with care, and barriers to care in Arizona. The major focus is on the association between language of interview and the dependent measures; interviews were conducted in English and Spanish. Methods. The differences between groups were tested using chi-square statistics for each independent categorical variable; the significance of all the independent variables on each of the dependent variables was tested simultaneously using maximum likelihood logistical regression models. Results. Language of interview for Hispanic children was a significant variable, more important than ethnicity itself, in determining health status, access, satisfaction with care, and barriers to care; language of interview for Hispanic adults was not a significant measure, but neither was ethnicity. Instead, income affected access to care for adults. Conclusions. This pattern of results suggests that in the southwestern United States, studies on health status and access to care that use only ethnicity and do not include language of interview may fail to identify populations of Hispanic children who are remarkably more vulnerable. Public health research of Hispanic populations can be more instrumental toward policy improvement if it increases its specificity with this heterogeneous group. Analysis of language of interview has a low cost and a high benefit toward this specification. Handle: RePEc:aph:ajpbhl:1991:81:11:1399-1404_3 Template-Type: ReDIF-Article 1.0 Title: Standardized comparisons of the use of alcohol, drugs, and cigarettes among military personnel and civilians Journal: American Journal of Public Health Author-Name: Bray, R.M. Author-Name: Marsden, M.E. Author-Name: Peterson, M.R. Year: 1991 Volume: 81 Issue: 7 Pages: 865-869 Abstract: Background: Understanding the effectiveness of policies and programs aimed at combating substance abuse in the military requires comparison with the civilian population from which military personnel are drawn. Methods: Standardized comparisons of the use of alcohol, drugs, and cigarettes among military personnel and civilians were conducted with data from the 1985 Worldwide Survey of Alcohol and Nonmedical Drug Use among Military Personnel and the 1985 National Household Survey on Drug Abuse. The two data sets were equated for age and geographic location of respondents, and civilian substance use rates were standardized to reflect the sociodemographic distribution of the military. Results: Military personnel were significantly less likely than civilians to use drugs, but were significantly more likely to use alcohol and cigarettes and to engage in heavy use of alcohol and cigarettes. Heavy drinking was especially likely among young military men. Military women were similar to military men in their smoking and drug use patterns. Conclusions: Findings suggest that military policies and programs have been notably effective in reducing drug use, but that efforts to limit alcohol and cigarette use should be intensified. Military efforts directed against alcohol abuse should be targeted toward younger men, while smoking and drug prevention programs should be directed toward both men and women. Handle: RePEc:aph:ajpbhl:1991:81:7:865-869_7 Template-Type: ReDIF-Article 1.0 Title: Overcoming denial and increasing the intention to use condoms through the induction of hypocrisy Journal: American Journal of Public Health Author-Name: Aronson, E. Author-Name: Fried, C. Author-Name: Stone, J. Year: 1991 Volume: 81 Issue: 12 Pages: 1636-1638 Abstract: Feelings of hypocrisy were induced in college students to increase condom use. Hypocrisy was created by making subjects mindful of their past failure to use condoms and then having them persuade others about the importance of condoms for AIDS prevention. The induction of hypocrisy decreased denial and led to greater intent to improve condom use relative to the control conditions. The implications of these findings for AIDS prevention are discussed. Handle: RePEc:aph:ajpbhl:1991:81:12:1636-1638_3 Template-Type: ReDIF-Article 1.0 Title: Controlled trial of Giardia lamblia: Control strategies in day care centers Journal: American Journal of Public Health Author-Name: Bartlett, A.V. Author-Name: Englender, S.J. Author-Name: Jarvis, B.A. Author-Name: Ludwig, L. Author-Name: Carlson, J.F. Author-Name: Topping, J.P. Year: 1991 Volume: 81 Issue: 8 Pages: 1001-1006 Abstract: Background: Strategies for control of Giardia lamblia in day care differ in numbers of children treated and in costs to parents and day care operators. The effectiveness of these strategies has not been systematically evaluated. Methods: We conducted a prospective randomized controlled trial comparing three strategies for control of Giardia in infant-toddler day care centers: Group 1, exclusion and treatment of symptomatic and asymptomatic infected children; Group 2, exclusion and treatment of symptomatic infection only; Group 3, exclusion and treatment of symptomatic infection, treatment of asymptomatic infection in the center. The study included 31 day care centers with 4180 child-months of observation. Giardia prevalence was determined before intervention and 1, 2, 4, and 6 months later; new infants and toddlers were tested on admission. Results: Initial Giardia prevalences were 18% to 22% in the three groups. Giardia was identified in 10.5% of 676 new infants and toddlers entering study day care centers during the 6-month follow-up. Giardia prevelances by intervention group were 8%, 12%, and 7% at 1 month, and 7%, 8%, and 8% at 6 months. Conclusions: The stricter intervention resulted in greater cost in terms of child day care and parents' work days lost, but did not result in significantly better control of Giardia infections in this day care environment. Handle: RePEc:aph:ajpbhl:1991:81:8:1001-1006_8 Template-Type: ReDIF-Article 1.0 Title: Knowledge about HIV and behavioral risks of foreign-born Boston public school students Journal: American Journal of Public Health Author-Name: Hingson, R.W. Author-Name: Strunin, L. Author-Name: Grady, M. Author-Name: Strunk, N. Author-Name: Carr, R. Author-Name: Berlin, B. Author-Name: Craven, D.E. Year: 1991 Volume: 81 Issue: 12 Pages: 1638-1641 Abstract: In 1990, 3049 Boston public middle and high school students were surveyed anonymously in English, Spanish, Vietnamese, Chinese, French, or Haitian Creole. Significantly fewer immigrant students, 35% of those surveyed, knew the principal modes of human immunodeficiency virus transmission. Fewer immigrants reported having sexual intercourse (31% vs 53% of nonimmigrants), but among the sexually active only 38% always used condoms, and more immigrants reported intercourse with intravenous drug users (4% vs 1% of non-immigrants). AIDS education should be taught to immigrant students in their native languages. Handle: RePEc:aph:ajpbhl:1991:81:12:1638-1641_6 Template-Type: ReDIF-Article 1.0 Title: HIV instruction, HIV knowledge, and drug injection among high school students in the United States Journal: American Journal of Public Health Author-Name: Holtzman, D. Author-Name: Anderson, J.E. Author-Name: Kann, L. Author-Name: Arday, S.L. Author-Name: Truman, B.I. Author-Name: Kolbe, L.J. Year: 1991 Volume: 81 Issue: 12 Pages: 1596-1601 Abstract: Background. The prevalence of HIV-related behaviors and determinants of these behaviors among adolescents in the United States have not been well studied. Methods. To determine the prevalence of HIV-related drug behaviors and to assess the effects of HIV-related school-based instruction and HIV knowledge on these behaviors, data were analyzed from a 39-item, self-administered questionnaire completed by a probability sample of all students in grades 9 through 12 in the United States. Results. Usable responses were obtained from 8098 students. Of these, 2.7% (95% confidence interval [CI] = 2.3-3.2) and 1.7% (95% CI = 1.3-2.1) reported injecting illicit drugs ever and during the past year, respectively. Corresponding prevalences of needle sharing were 0.8% (95% CI = 0.5-1.1) and 0.5% (95% CI = 0.3-0.7). Regression analysis revealed that students with higher knowledge scores were less likely and males more likely to have ever injected drugs. HIV knowledge was similarly associated with other outcome measures of drug-injection behavior. Although HIV instruction did not directly influence drug-injection behavior independently of demographic characteristics, it was positively associated with HIV knowledge. Conclusions. While these results do not establish a causal relationship, they suggest that HIV knowledge and school-based instruction may play a role in maintaining low levels of drug-injection behavior among high school students. Handle: RePEc:aph:ajpbhl:1991:81:12:1596-1601_9 Template-Type: ReDIF-Article 1.0 Title: Surveillance of attempted suicide among adolescents in Oregon, 1988 Journal: American Journal of Public Health Author-Name: Andrus, J.K. Author-Name: Fleming, D.W. Author-Name: Heumann, M.A. Author-Name: Wassell, J.T. Author-Name: Hopkins, D.D. Author-Name: Gordon, J. Year: 1991 Volume: 81 Issue: 8 Pages: 1067-1069 Abstract: In January 1988, Oregon became the first state to require hospital-based reporting of attempted suicide (AS) in all adolescents < 18 years old. From January to December 1988, 644 cases of AS were reported (annual rate of 214 per 100 000 population, ages 10 to 17 years). We compared these 644 cases of AS with all 137 Oregon adolescents < 18 years old who committed suicide in Oregon during the 10-year-period 1979 through 1988, and found that the strongest predictor of outcome was method used. Handle: RePEc:aph:ajpbhl:1991:81:8:1067-1069_0 Template-Type: ReDIF-Article 1.0 Title: Health for all: A public health vision Journal: American Journal of Public Health Author-Name: McBeath, W.H. Year: 1991 Volume: 81 Issue: 12 Pages: 1560-1565 Abstract: The approach of a millennial passage invites public health to a review of past performance and a preview of future prospects toward assuring a healthy public. Since the 1974 Canadian Lalonde report, the best national plans for health progress have emphasized disease prevention and health promotion. WHO's multinational Health for All by the Year 2000 promotes basic health services essential to leading a socially and economically productive life. Healthy People 2000, the latest US guide, establishes three goals: increase healthy life span, reduce health disparities, and achieve universal access to preventive services. Its objectives can be used to excite public understanding, equip program development, evaluate progress, and encourage public accountability for health initiatives. Needed is federal leadership in defining requisite action and securing necessary resources. Elsewhere a ''new public health'' emphasizes community life-style and multisectoral ''healthy public policy.'' In the United States, a national health program is needed to achieve equity in access to personal health care. Even more essential is equitable sharing in basic health determinants in society - nutritious food, basic education, safe water, decent housing, secure employment, adequate income, and peace. Vital to such a future is able and active leadership now from governments and public health professionals. Handle: RePEc:aph:ajpbhl:1991:81:12:1560-1565_1 Template-Type: ReDIF-Article 1.0 Title: Reporting for disease control activities [2] Journal: American Journal of Public Health Author-Name: Teutsch, S. Author-Name: Berkelman, R.L. Author-Name: Toomey, K.E. Author-Name: Vogt, R.L. Year: 1991 Volume: 81 Issue: 7 Pages: 932 Handle: RePEc:aph:ajpbhl:1991:81:7:932_5 Template-Type: ReDIF-Article 1.0 Title: Interim methadone clinics: An undervalued approach Journal: American Journal of Public Health Author-Name: Dole, V.P. Year: 1991 Volume: 81 Issue: 9 Pages: 1111-1112 Handle: RePEc:aph:ajpbhl:1991:81:9:1111-1112_6 Template-Type: ReDIF-Article 1.0 Title: Erratum: Determinants of late stage diagnosis of breast and cervical cancer: The impact of age, race, social class, and hospital type (Am J Public Health, 1991, 81:646-649) Journal: American Journal of Public Health Author-Name: Mandelblatt, J. Author-Name: Andrews, H. Author-Name: Kerner, J. Author-Name: Zauber, A. Author-Name: Burnett, W. Year: 1991 Volume: 81 Issue: 8 Pages: 980 Handle: RePEc:aph:ajpbhl:1991:81:8:980_4 Template-Type: ReDIF-Article 1.0 Title: Television viewing and obesity in adult females Journal: American Journal of Public Health Author-Name: Tucker, L.A. Author-Name: Bagwell, M. Year: 1991 Volume: 81 Issue: 7 Pages: 908-911 Abstract: We measured the relation between time spent watching television per week and obesity in 4,771 adult females. After controlling for age, education, cigarette smoking, length of work week, and weekly duration of exercise, females who reported three to four hours of TV viewing per day showed almost twice the prevalence of obesity (body fat > 30 percent), and those who reported more than four hours of TV watching per day showed more than double the prevalence of obesity, compared to the reference group (<1 hr/day). Part of the TV/obesity association was a function of differences in exercise duration among the four TV viewing categories. Handle: RePEc:aph:ajpbhl:1991:81:7:908-911_2 Template-Type: ReDIF-Article 1.0 Title: Impaired and disabled elderly in the community Journal: American Journal of Public Health Author-Name: Ford, A.B. Author-Name: Roy, A.W. Author-Name: Haug, M.R. Author-Name: Folmar, S.J. Author-Name: Jones, P.K. Year: 1991 Volume: 81 Issue: 9 Pages: 1207-1209 Abstract: A nine-year representative, longitudinal study of 1,598 urban elderly shows that two to eight times as many impaired or disabled are cared for in the community as in institutions. Younger age, male gender, better income, and living with others, especially children, favor continuing care in the home. Handle: RePEc:aph:ajpbhl:1991:81:9:1207-1209_2 Template-Type: ReDIF-Article 1.0 Title: A comparison of breast-feeding data from the National Surveys of Family Growth and the Ross Laboratories Mothers Surveys Journal: American Journal of Public Health Author-Name: Ryan, A.S. Author-Name: Pratt, W.F. Author-Name: Wysong, J.L. Author-Name: Lewandowski, G. Author-Name: McNally, J.W. Author-Name: Krieger, F.W. Year: 1991 Volume: 81 Issue: 8 Pages: 1049-1052 Abstract: This study compares rates of breast feeding reported in the National Surveys of Family Growth with those from the Ross Laboratories Mothers Surveys. Both surveys have documented rates of breast feeding over the last 30 or more years. Despite differences in survey methodology, both surveys document similar long-term trends in breast feeding. The similarities of rates in breast feeding also are evident across several maternal sociodemographic characteristics. We conclude that both surveys produce reliable and useful estimates of breast feeding. Handle: RePEc:aph:ajpbhl:1991:81:8:1049-1052_6 Template-Type: ReDIF-Article 1.0 Title: Knowledge about AIDS and HIV in the US adult population: Influence of the local incidence of AIDS Journal: American Journal of Public Health Author-Name: McCaig, L.F. Author-Name: Hardy, A.M. Author-Name: Winn, D.M. Year: 1991 Volume: 81 Issue: 12 Pages: 1591-1595 Abstract: Background. Accurate information about acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) is important for prevention. This study determined whether AIDS knowledge varied among populations residing in areas with a low, medium, or high incidence of AIDS. Methods. Respondents to the 1988 National Health Interview Survey of AIDS Knowledge and Attitudes, which is based on a nationally representative sample of 29,659 adults, were rated on their knowledge about modes of HIV transmission, general knowledge about AIDS, and misperceptions about HIV transmission through casual contact. Results. Persons 50 years of age or older, Blacks, Hispanics, and persons with less than a high school education had lower knowledge scores and higher misperception scores. Residents of the high-incidence area had more misperceptions than those who lived in the medium- or low-incidence areas. Sociodemographic determinants of scores were important factors overall and within each AIDS incidence area. Conclusions. These data suggest that the ability of educational messages to reach and be absorbed by individuals nationwide is less dependent on whether they live in an area with a high incidence of AIDS and more dependent on other demographic variables. New and continued efforts are needed to improve knowledge in older persons, minorities, and the less educated in all parts of the country. Handle: RePEc:aph:ajpbhl:1991:81:12:1591-1595_5 Template-Type: ReDIF-Article 1.0 Title: Effects of paternal occupational exposure on spontaneous abortions Journal: American Journal of Public Health Author-Name: Lindbohm, M.-L. Author-Name: Hemminki, K. Author-Name: Bonhomme, M.G. Author-Name: Anttila, A. Author-Name: Rantala, K. Author-Name: Heikkila, P. Author-Name: Rosenberg, M.J. Year: 1991 Volume: 81 Issue: 8 Pages: 1029-1033 Abstract: Background: Paternal exposure to mutagenic agents has been suggested to affect pregnancy outcome adversely. Methods: A nationwide data base of medically diagnosed spontaneous abortions and other pregnancies and national census data was used to evaluate the effects of men's occupational exposures on risk of spontaneous abortion in 99,186 pregnancies in Finland. Census data from the years 1975 and 1980 provided information about the occupation, industry, and socioeconomic status. A job-exposure classification was developed to classify women and their husbands according to possible occupational exposures on the basis of their occupational title and industry. Results: In 10% of the pregnancies, the husband was exposed to one or more of the mutagens, and the rate of spontaneous abortion was unaffected (OR = 1.0). Of the 25 specific mutagenic exposures evaluated, paternal exposure to four (ethylene oxide, rubber chemicals, solvents used in refineries, and solvents used in the manufacturing of rubber products) was associated with an increased relative risk of spontaneous abortion. In addition, the risk of spontaneous abortion was higher among wives of rubber products workers than among unexposed men. Conclusions: Although there is some biological rationale for the findings of this study, these findings need to be confirmed by studies in which individual exposures can be measured directly. Handle: RePEc:aph:ajpbhl:1991:81:8:1029-1033_9 Template-Type: ReDIF-Article 1.0 Title: Cervical cancer screening: Who is not screened and why? Journal: American Journal of Public Health Author-Name: Harlan, L.C. Author-Name: Bernstein, A.B. Author-Name: Kessler, L.G. Year: 1991 Volume: 81 Issue: 7 Pages: 885-891 Abstract: Background: The decline in death rates from cervical cancer in the United States has been widely attributed to the use of Papanicolaou (Pap) smears for early detection of cervical cancer. Methods: Pap smear screening rates, beliefs about appropriate screening intervals and factors affecting screening were examined using 1987 National Health Interview Survey data. Results: Results indicate that through age 69, Blacks are screened at similar or higher rates than Whites. Hispanics, particularly those speaking only or mostly Spanish, are least likely to have received a Pap smear within the last three years. Of women who had never heard of or never had a Pap smear, nearly 80 percent reported contact with a medical practitioner in the past two years, while more than 90 percent reported a contact in the past five years. Overall, the most frequently reported reason for not having a recent Pap smear was procrastinating or not believing it was necessary. Conclusions: Thus, in developing screening programs, Hispanics, particularly Spanish speakers, must be targeted. In addition, educational programs should target unscreened women who forego the test due to underestimating its importance, procrastination, or because their medical care provider did not suggest the procedure. Women must be intensively educated that Pap smears should be scheduled routinely to detect asymptomatic cervical cancer. Handle: RePEc:aph:ajpbhl:1991:81:7:885-891_4 Template-Type: ReDIF-Article 1.0 Title: Does cigarette smoking have an independent effect on coronary heart disease incidence in the elderly? Journal: American Journal of Public Health Author-Name: Benfante, R. Author-Name: Reed, D. Author-Name: Frank, J. Year: 1991 Volume: 81 Issue: 7 Pages: 897-899 Abstract: In order to evaluate the effects of cigarette smoking on coronary heart disease (CHD) in elderly persons in the Honolulu Heart Program, 1,394 men between ages 65 and 74 were followed during an average 12-year period for new cases of nonfatal myocardial infarction and fatal CHD. Incidence rates increased progressively in individuals classified at baseline as never, former, and current smokers, respectively. The absolute excess risk associated with cigarette smoking was nearly twice as high in elderly compared with middle-aged men. Handle: RePEc:aph:ajpbhl:1991:81:7:897-899_3 Template-Type: ReDIF-Article 1.0 Title: Canine seroprevalence and the distribution of Ixodes dammini in an area of emerging Lyme disease Journal: American Journal of Public Health Author-Name: Rand, P.W. Author-Name: Smith Jr., R.P. Author-Name: Lacombe, E.H. Year: 1991 Volume: 81 Issue: 10 Pages: 1331-1334 Abstract: This study evaluates the relative usefulness of canine serosurveys to predict risk of exposure in an area of emerging Lyme disease by comparing the distribution of canine seroprevalence with that of vector ticks. From 16 veterinary clinics throughout the State of Maine, 828 canine sera were obtained during the heartworm-testing months of April and May 1989 and measured for anti-Borrelia antibodies by enzyme-linked immunosorbent assay. In the same year, 1605 ticks, including 585 Ixodes dammini, were collected from pets, humans, small mammals, and deer. Thirty-six dogs were seropositive, 28 of which had not traveled to endemic areas. Eighty-nine percent of all seropositive dogs were from towns within 20 miles (32 km) of the coast; the great majority lived within 5 miles (8 km) of tidewater (odds ratio = 4.45, P = .002). Positivity varied from 17% in a southern coastal clinic to 0% in four northern clinics. Of 585 I. dammini identified, all but 5 (99.1%) were also from towns within 20 miles of the coast. Comparison of I. dammini submissions with those of another commonly found tick, Ixodes cookei, corroborated this predominantly coastal distribution. Canine seropositivity generally coincided with this coastal range. These data predicted areas of risk for human Lyme disease, although the prevalence of reported cases remained low. Handle: RePEc:aph:ajpbhl:1991:81:10:1331-1334_9 Template-Type: ReDIF-Article 1.0 Title: Adverse working conditions and premature delivery Journal: American Journal of Public Health Author-Name: Marbury, M.C. Year: 1991 Volume: 81 Issue: 8 Pages: 973-974 Handle: RePEc:aph:ajpbhl:1991:81:8:973-974_5 Template-Type: ReDIF-Article 1.0 Title: Characteristics of a random sample of emergency food program users in New York: I. Food pantries Journal: American Journal of Public Health Author-Name: Clancy, K.L. Author-Name: Bowering, J. Author-Name: Poppendieck, J. Year: 1991 Volume: 81 Issue: 7 Pages: 911-914 Abstract: Food pantry users throughout New York State were studied and many demographic differences found between New York City and Upstate New York respondents. Seven percent of households had no income and median income as percent of the poverty level was 59 percent. Slightly more than 40 percent were spending over 60 percent of their incomes on housing. The data from this survey, the first in New York State to employ a random sampling design, demonstrate a sizable gap between household needs and available resources. Handle: RePEc:aph:ajpbhl:1991:81:7:911-914_1 Template-Type: ReDIF-Article 1.0 Title: HIV infection and risk behaviors among intravenous drug users in low seroprevalence areas in the Midwest Journal: American Journal of Public Health Author-Name: Siegal, H.A. Author-Name: Carlson, R.G. Author-Name: Falck, R. Author-Name: Li, L. Author-Name: Forney, M.A. Author-Name: Rapp, R.C. Author-Name: Baumgartner, K. Author-Name: Myers, W. Author-Name: Nelson, M. Year: 1991 Volume: 81 Issue: 12 Pages: 1642-1644 Abstract: We studied behavioral factors that place intravenous drug users at risk for the acquisition and transmission of the human immunodeficiency virus (HIV) in a sample of 855 individuals not in drug treatment, living in central and southwestern Ohio. The HIV seropositivity rate for the sample was 1.5%. Three factors were significantly related to HIV infection: homeless shelter residence (odds ratio [OR] = 7.7, 95% confidence interval (CI) = 3.0-20.0), travel to northeastern HIV hyperendemic areas (OR = 5.2, 95% CI = 1.8-15.4), and recent male homosexual or bisexual behavior (OR = 11.2, 95% CI = 2.9-43.9). Handle: RePEc:aph:ajpbhl:1991:81:12:1642-1644_4 Template-Type: ReDIF-Article 1.0 Title: Analysis of US child care safety regulations Journal: American Journal of Public Health Author-Name: Runyan, C.W. Author-Name: Gray, D.E. Author-Name: Kotch, J.B. Author-Name: Kreuter, M.W. Year: 1991 Volume: 81 Issue: 8 Pages: 981-985 Abstract: Background: With 1.9 million US children cared for in organized group child care, the safety of these children is a public health concern. In the absence of federal policy, each state has developed its own day care safety regulations. Methods: After creating a set of 36 criteria from three sets of national guidelines, we assessed the safety regulations of 45 states. With a mailed survey of state day care regulatory personnel, we examined the processes of formulating and implementing safety policy in 47 states. Results: For 24 of the 36 items, more than half the states' regulations were below the criteria or failed to mention the topic. Most notable is the inattention to playground safety, choking hazards, and firearms. Conclusion: The uneven quality of regulations may be a reflection of a regulatory process that is fragmented, with many different groups sharing authority and with limited involvement of injury prevention specialists. Handle: RePEc:aph:ajpbhl:1991:81:8:981-985_3 Template-Type: ReDIF-Article 1.0 Title: Human papillomavirus, gonorrhea, syphilis, and cervical dysplasia in jailed women Journal: American Journal of Public Health Author-Name: Bickell, N.A. Author-Name: Vermund, S.H. Author-Name: Holmes, M. Author-Name: Safyer, S. Author-Name: Burk, R.D. Year: 1991 Volume: 81 Issue: 10 Pages: 1318-1320 Abstract: We assessed the prevalence of human papillomavirus (HPV) by cervicovaginal lavage and Southern blot and inquired about behavioral risk factors for cervical disease and sexually transmitted diseases by interview in 114 female detainees at a large New York City jail. Of the women screened, 8% had abnormal Pap smears, 35% had HPV, 7% had gonorrhea, and 22% had serologic syphilis. Given the high rates of HPV infection and cervical cytology, Pap smears should be a routine intake procedure for incarcerated women. Handle: RePEc:aph:ajpbhl:1991:81:10:1318-1320_3 Template-Type: ReDIF-Article 1.0 Title: The impact of HIV on the usefulness of sputum smears for the diagnosis of tuberculosis Journal: American Journal of Public Health Author-Name: Long, R. Author-Name: Scalcini, M. Author-Name: Manfreda, J. Author-Name: Jean-Baptiste, M. Author-Name: Hershfield, E. Year: 1991 Volume: 81 Issue: 10 Pages: 1326-1328 Abstract: In a developing country, 289 patients were examined for active pulmonary mycobacterial disease (sputum smear and culture) and HIV infection (serology) to compare the sensitivity and positive predictive value of sputum smears for diagnosing pulmonary tuberculosis in patients with and without antibodies to HIV. Seventy-nine percent of HIV-seronegative vs 66% of HIV-seropositive patients with positive cultures for Mycobacterium tuberculosis were smear positive (P < .05), and a positive sputum smear predicted the presence of M. tuberculosis in 90% of HIV seronegative vs 80% of HIV seropositive patients (P < .05). In our opinion, HIV did not significantly compromise the diagnostic utility of the sputum smear. Handle: RePEc:aph:ajpbhl:1991:81:10:1326-1328_3 Template-Type: ReDIF-Article 1.0 Title: Risk factors for suicide attempts among Navajo adolescents Journal: American Journal of Public Health Author-Name: Grossman, D.C. Author-Name: Milligan, B.C. Author-Name: Deyo, R.A. Year: 1991 Volume: 81 Issue: 7 Pages: 870-874 Abstract: Background: Rates of adolescent suicide in the United States are highest among Native Americans but little is known about risk factors for suicide attempts in this population. Methods: To identify risk factors for self-reported suicide attempts by Navajo adolescents, we analyzed the 1988 Indian Health Service Adolescent Health Survey that was administered to 7,254 students in grades 6 through 12 on the Navajo reservation. The responses of students reporting a past suicide attempt were compared to others. Results: Nearly 15 percent (N = 971) reported a previous suicide attempt; over half of those admitted to more than one attempt. Controlling for age, a logistic regression model revealed the following associations with suicide attempts: a history of mental health problems (OR = 3.2); alienation from family and community (OR = 3.2); having a friend who attempted suicide (OR = 2.8); weekly consumption of hard liquor (OR = 2.7); a family history of a suicide or attempt (OR = 2.3); poor self-perception of health (OR = 2.2); a history of physical abuse (OR = 1.9); female gender (OR = 1.7); and sexual abuse (OR = 1.5). Conclusions: Efforts to prevent adolescent suicide attempts in this population should target individuals with those risk factors of the highest risk and prevalence of exposure. Handle: RePEc:aph:ajpbhl:1991:81:7:870-874_7 Template-Type: ReDIF-Article 1.0 Title: Dogs as sentinels for Lyme disease in Massachusetts Journal: American Journal of Public Health Author-Name: Lindenmayer, J.M. Author-Name: Marshall, D. Author-Name: Onderdonk, A.B. Year: 1991 Volume: 81 Issue: 11 Pages: 1448-1455 Abstract: Background. An investigation of the relationship between incident human cases of Lyme disease and seroprevalence of antibodies to B. burgdorferi in dogs was undertaken in order to determine whether dogs might serve as sentinels for Lyme disease. Methods. 3011 canine serum samples were analyzed by ELISA for antibody to B. burgdorferi. Records of incident human cases of Lyme disease were obtained from the Massachusetts Department of Public Health. Results. Regression analyses of the relationship between the log 10 (mean incidence in people 1985-1989) and canine seroprevalence from July 1988-August 1989 revealed that canine seroprevalence was highly predictive of incidence (R 2 = 0.86, p < .0001). A logistic regression model that incorporates the altitude of the town where each dog was resident, the date of sampling, and information on each dog's age, sex, and breed adequately explained the risk of canine seropositivity. Dogs resident at altitudes less than 200 feet, of sporting or large mixed breeds, and greater than two years of age were five times, four times, and almost three times more likely, respectively, to exhibit seropositivity than were other dogs. Conclusions. Estimates of the prevalence of antibody to B. burgdorferi in dog populations offers a sensitive, reliable, and convenient measure of the potential risk to people of B. burgdorferi in the environment. Risk factors for canine seropositivity may directly or indirectly illuminate certain aspects of the epidemiology of human Lyme disease. Handle: RePEc:aph:ajpbhl:1991:81:11:1448-1455_9 Template-Type: ReDIF-Article 1.0 Title: Characteristics of infant deaths due to HIV/AIDS [2] Journal: American Journal of Public Health Author-Name: Chu, S.Y. Author-Name: Buehler, J.W. Author-Name: Rogers, M.F. Year: 1991 Volume: 81 Issue: 8 Pages: 1076-1077 Handle: RePEc:aph:ajpbhl:1991:81:8:1076-1077_7 Template-Type: ReDIF-Article 1.0 Title: Reduction of high-risk sexual behavior among heterosexuals undergoing HIV antibody testing: A randomized clinical trial Journal: American Journal of Public Health Author-Name: Wenger, N.S. Author-Name: Linn, L.S. Author-Name: Epstein, M. Author-Name: Shapiro, M.F. Year: 1991 Volume: 81 Issue: 12 Pages: 1580-1585 Abstract: Background. We evaluated the effect of HIV antibody testing on sexual behavior and communication with sexual partners about AIDS risk among heterosexual adults at a clinic for sexually transmitted diseases. Methods. We randomized 186 subjects to receive either AIDS education alone (the control group) or AIDS education, an HIV antibody test, and the test results (the intervention group). These subjects were then followed up 8 weeks later. Results. At follow-up, mean number of sexual partners decreased, but not differently between groups. However, compared with controls, HIV antibody test intervention subjects, all of whom tested negative, questioned their most recent sexual partner more about HIV antibody status (P < 0.01), worried more about getting AIDS (P < 0.03), and tended to use a condom more often with their last sexual partner (P = 0.05): 40% of intervention subjects vs 20% of controls used condoms, avoided genital intercourse, or knew their last partner had a negative HIV antibody test (P < 0.005). Conclusion. HIV antibody testing combined with AIDS education increases concern about HIV and, at least in the short term, may promote safer sexual behaviors. Additional strategies will be necessary if behaviors risky for HIV transmission are to be further reduced. Handle: RePEc:aph:ajpbhl:1991:81:12:1580-1585_9 Template-Type: ReDIF-Article 1.0 Title: Ethnic populations in public mental health: Services choice and level of use Journal: American Journal of Public Health Author-Name: Hu, T.-W. Author-Name: Snowden, L.R. Author-Name: Jerrell, J.M. Author-Name: Nguyen, T.D. Year: 1991 Volume: 81 Issue: 11 Pages: 1429-1434 Abstract: Background. Barriers to access and use of mental health care by Asians, Blacks, and Hispanic Americans have been a source of concern for many years. Limitations in our knowledge base persist regarding patterns of use in public sector programs of certain services. Using a sample of almost 27,000 persons, this study examined access and level of use by ethnic minority groups of emergency services, inpatient care, individual outpatient visit, and case management. Methods. Data from the management information systems of San Francisco and Santa Clara counties were analyzed for fiscal year 1987 1/4 988. Multivariate models were evaluated at two stages, reflecting whether or not a service had been used, and if used, the level of use. Results. Asians and Hispanics used less emergency and inpatient but more outpatient care than did Whites; Blacks used more emergency and less outpatient care. Conclusions. Ethnicity continues to play a role in understanding the utilization of mental health services. Regarding emergency and inpatient care, Asian and Hispanic patterns of use appear relatively favorable, whereas the patterns of Blacks continue to be problematic. Handle: RePEc:aph:ajpbhl:1991:81:11:1429-1434_0 Template-Type: ReDIF-Article 1.0 Title: Cancer incidence in the Puerto Rican-born population of Long Island, New York Journal: American Journal of Public Health Author-Name: Polednak, A.P. Year: 1991 Volume: 81 Issue: 11 Pages: 1405-1407 Abstract: Background. There are apparently no published data on cancer incidence in the Puerto Rican-born populations of the northeastern United States. Methods. Standardized incidence ratios (SIRs) were calculated for 1980 through 1986 for the Puerto Rican-born population in Long Island (New York). Results. Significantly reduced SIRs were found for males (SIR = 0.77) but not for females (SIR = 0.91), using expected numbers derived from incidence rates for all areas in the Surveillance, Epidemiology and End Results (SEER) Program (excluding Puerto Rico). Using incidence rates for Puerto Rico to obtain expected numbers, there was evidence for the retention of elevated SIRs for stomach cancer (both sexes) and for significantly elevated SIRs for lung cancer (both sexes), colon-rectum cancer (females), prostate cancer, and breast and uterine corpus cancer. Using rates for SEER areas, the SIRs for lung cancer approached 1.00, in contrast to other US Puerto Rican-born populations. Conclusion. The data indicate the need for surveys on smoking and other health-related behaviors in the population studied and provide further evidence for heterogeneity in cancer patterns in US Puerto Rican-born populations. Handle: RePEc:aph:ajpbhl:1991:81:11:1405-1407_9 Template-Type: ReDIF-Article 1.0 Title: Occupational injuries among North Carolina migrant farmworkers Journal: American Journal of Public Health Author-Name: Ciesielski, S. Author-Name: Hall, S.P. Author-Name: Sweeney, M. Year: 1991 Volume: 81 Issue: 7 Pages: 926-927 Abstract: A population-based cross-sectional study of occupational injuries among a random sample of 287 migrant farmworkers demonstrated frequent obstacles to health care; 65% (11/17) of the more seriously injured subjects did not receive prompt care or never received care. Subjects not receiving prompt care were twice as likely to have incomplete recovery. Employers covered medical expenses for only 5/13 (38%) of the injured workers, and only 3/15 were compensated for lost work. This study indicates that comprehensive Workers' Compensation coverage is urgently needed in North Carolina. Handle: RePEc:aph:ajpbhl:1991:81:7:926-927_9 Template-Type: ReDIF-Article 1.0 Title: Geographic variation in relative fees under Medicare Journal: American Journal of Public Health Author-Name: Escarce, J.J. Year: 1991 Volume: 81 Issue: 11 Pages: 1491-1493 Abstract: Little is known about geographic variation in Medicare's relative fee structure. Using 1986 Part B Medicare claims data, ratios among physician fees for surgical procedures belonging to small families of closely related procedures, excluding outliers, were found to vary up to twofold. Under Medicare's current system of physician payment, physicians in different areas face different financial incentives for performing one procedure in preference to possible alternatives. Changes in incentives under a resource-based Medicare fee schedule will be more pervasive than previously recognized. Handle: RePEc:aph:ajpbhl:1991:81:11:1491-1493_2 Template-Type: ReDIF-Article 1.0 Title: Service needs of severely disturbed children Journal: American Journal of Public Health Author-Name: Trupin, E.W. Author-Name: Forsyth-Stephens, A. Author-Name: Low, B.P. Year: 1991 Volume: 81 Issue: 8 Pages: 975-980 Abstract: Background: As one piece of a statewide Children's Mental Health System Analysis conducted in Washington State, the specific service needs of severely emotionally disturbed children were investigated. Methods: The primary caseworkers of 3398 children under the care of the state responded to a survey of the child's treatment history, social and clinical condition, and service needs. Service need data on the 2455 children in the sample who were classifiable as severely emotionally disturbed were examined using log linear analysis. Results: School- and home-based services were frequently reported needs of school-aged children. Adolescent children were reported to be in need of services which prepare them for adulthood. Services endorsed for female children tended to focus on assistance to family members, therapy, and protection, whereas services endorsed for male children focused on home removal, substance abuse treatment, and preparation for employment. Conclusions: Severely emotionally disturbed children are in need of a variety of nontraditional mental health services. Significant differences in the needs of male versus female children, and of differently aged children, are present that have serious implications for service system development. Handle: RePEc:aph:ajpbhl:1991:81:8:975-980_7 Template-Type: ReDIF-Article 1.0 Title: Frequency and thoroughness of STD/HIV risk assessment by physicians in a high-risk metropolitan area Journal: American Journal of Public Health Author-Name: Boekeloo, B.O. Author-Name: Marx, E.S. Author-Name: Kral, A.H. Author-Name: Coughlin, S.C. Author-Name: Bowman, M. Author-Name: Rabin, D.L. Year: 1991 Volume: 81 Issue: 12 Pages: 1645-1648 Abstract: The US Preventive Services Task Force recommends that all primary care physicians assess the sexually transmitted disease/human immunodeficiency virus (STD/HIV) risk of all adolescent and adult patients. To determine whether factors amenable to change through continuing medical education are associated with frequent and thorough STD/HIV risk assessment, a telephone survey of primary care physicians in the Washington, DC metropolitan area was conducted (n = 961). Thirty-seven percent of physicians reported regularly asking new adult patients about their sexual practices; 60% asked new adolescent patients. STD/HIV risk questioning was associated with physicians' confidence in their ability to help prevent HIV, comfort with discussing patients' sexual practices, and perception of a large STD/HIV problem in their practice. These findings suggest that continuing medical education should target improvement in physicians' sexual practice questioning skills. Handle: RePEc:aph:ajpbhl:1991:81:12:1645-1648_5 Template-Type: ReDIF-Article 1.0 Title: Maternal transfers and hospital perinatal mortality rates [1] Journal: American Journal of Public Health Author-Name: Fireman, B.H. Author-Name: Goldhaber, M.K. Author-Name: Mayfield, J. Year: 1991 Volume: 81 Issue: 8 Pages: 1075-1076 Handle: RePEc:aph:ajpbhl:1991:81:8:1075-1076_5 Template-Type: ReDIF-Article 1.0 Title: Effects of budgeting on health care services in Dutch hospitals Journal: American Journal of Public Health Author-Name: Casparie, A.F. Author-Name: Hoogendoorn, D. Year: 1991 Volume: 81 Issue: 11 Pages: 1442-1447 Abstract: Background. In 1983 hospital budgeting was introduced in the Netherlands. We studied the effect of the enactment of budgeting on the efficiency and effectiveness of health care. Methods. In four different age groups, the admission rate, length of stay, type and number of surgical inpatient procedures, and hospital mortality were measured in all short-term hospitals from 1977 through 1988. Data were standardized by age and sex. Results. For the total population, the hospital admission rate and the operation rate decreased after 1982. However, for the subgroup of patients beyond the age of 65 both rates are still on the rise, but the increase in the admission rate for elderly patients has slowed significantly since 1983. The tendency toward a shorter length of stay, together with the diminished admission rates, led to a 22% decrease in standardized hospital days between 1982 and 1988. The severity of the operations increased. Most operations performed on elderly patients were aimed at improving the quality of their lives rather than lengthening their life expectancy. The hospital mortality rate decreased in all age groups. Conclusions. The findings suggest that modern medicine in the Netherlands has become more efficient and more effective. Better health care for older patients was achieved within the same budget. The tendency toward more efficiency by hospitals has been reinforced since 1983. Handle: RePEc:aph:ajpbhl:1991:81:11:1442-1447_6 Template-Type: ReDIF-Article 1.0 Title: Inpatient morbidity among HIV-infected male soldiers prior to their diagnosis of HIV infection Journal: American Journal of Public Health Author-Name: Renzullo, P.O. Author-Name: McNeil, J.G. Author-Name: Gardner, L.I. Author-Name: Brundage, J.F. Year: 1991 Volume: 81 Issue: 10 Pages: 1280-1284 Abstract: Background. A natural history study of human immunodeficiency virus (HIV) disease was carried out among 1575 HIV-infected US Army men and 6220 demographically similar uninfected soldiers. Inpatient morbidity occurring up to 8 years prior to the date of HIV infection diagnosis among those men who became HIV infected was evaluated for both groups. Methods. Incidence density rates were calculated for hospital admissions. Poisson regression was used to assess the trend in hospital admissions among those subsequently diagnosed with HIV infection. Prevalence ratios for discharge diagnoses were also calculated. Results. Sixteen diagnoses/diagnosis categories occurred statistically more frequently among subsequently HIV diagnosed individuals than among those who remained uninfected. Among these were hepatitis B and abscess of anal/rectal region (6 to 8 years prior to HIV infection diagnosis); unspecified viral infection, enlarged lymph nodes, syphilis (3 to 5 years prior to HIV infection diagnosis); and diagnoses suggestive of acute retroviral syndrome (1 to 2 years prior to HIV infection diagnosis). Conclusions. Data such as these may provide useful information to HIV surveillance efforts regarding patterns of morbidity experienced prior to HIV infection as well as to health care providers regarding patients at high risk for becoming infected with HIV. Handle: RePEc:aph:ajpbhl:1991:81:10:1280-1284_4 Template-Type: ReDIF-Article 1.0 Title: Cardiovascular risk factors among Asian Americans living in Northern California Journal: American Journal of Public Health Author-Name: Klatsky, A.L. Author-Name: Armstrong, M.A. Year: 1991 Volume: 81 Issue: 11 Pages: 1423-1428 Abstract: Background. Recent substantial immigration has created large population subsets of Asian Americans in the United States. Available data about cardiovascular risk factors in these persons are sparse. Methods. This study examined data among 13,031 persons self-classified as 5951 Chinese, 4211 Filipinos, 1703 Japanese, and 1166 other Asians. Covariates in regression analyses were age, smoking, alcohol, education, and marital status. Results. Chinese men and women had the lowest adjusted mean body mass index. Filipino men and women had the highest prevalence of hypertension. There were no major differences in blood glucose levels. Total cholesterol levels were highest in Japanese men and women. Comparisons of US-born persons and those born in respective countries of origin showed no major cholesterol or glucose differences; more hypertension only in Chinese and other Asian men; higher body mass index in men, but not in women of most ethnicities; and a lower smoking prevalence in men, but a substantially higher one in women. Conclusions. These data show important ethnic differences in risk factors among Asian Americans and indicate groups that should be targeted for public health efforts concerned with obesity (Asian-American men), hypertension (Filipino-American men and women), hypercholesteremia (all Asian Americans), and smoking cessation (Asian-American women). Handle: RePEc:aph:ajpbhl:1991:81:11:1423-1428_4 Template-Type: ReDIF-Article 1.0 Title: Lessons from London: The British are reforming their national health service Journal: American Journal of Public Health Author-Name: Vall-Spinosa, A. Year: 1991 Volume: 81 Issue: 12 Pages: 1566-1570 Abstract: In an effort to keep abreast of the chaning needs of a more affluent society and to ensure better value for money, the British are reforming their National Health Service. They are promoting competition and entrepreneurship, and directing funding to follow a patient rather than flowing directly to institutions. British physicians are resisting these changes. The United States, in the middle of a health care crisis of its own, can learn a great deal from Britain, especially in the area of controlling expenditures. The low cost of the National Health Service can be attributed to four major factors: (1) It is general practitioner driven and no patient accesses a specialist or hospital directly. (2) Hospitals, which employ all the specialists and supply most of the technology, operate on very tight, cash-limited budgets. (3) Administrative costs are very low. (4) The expense of malpractice is not (yet) a major concern. Changes occurring in both countries foretell a future wherein our health care systems may look very much alike. Handle: RePEc:aph:ajpbhl:1991:81:12:1566-1570_9 Template-Type: ReDIF-Article 1.0 Title: History, ethics, and politics in AIDS prevention research Journal: American Journal of Public Health Author-Name: Des Jarlais, D.C. Author-Name: Stepherson, B. Year: 1991 Volume: 81 Issue: 11 Pages: 1393-1394 Handle: RePEc:aph:ajpbhl:1991:81:11:1393-1394_1 Template-Type: ReDIF-Article 1.0 Title: Estimation of population denominators for public health studies at the tract, gender, and age-specific level Journal: American Journal of Public Health Author-Name: Aickin, M. Author-Name: Dunn, C.N. Author-Name: Flood, T.J. Year: 1991 Volume: 81 Issue: 7 Pages: 918-920 Abstract: In epidemiologic and public health studies of disease incidence in geographic subpopulations, attention is properly directed toward the ascertainment of accurate numerators. Population or person-years denominators are generally given less consideration, under the assumption that estimates produced by sources other than the state health department are sufficiently accurate. Here, we report our experience in estimating person-years denominators in the highly urbanized, rapidly expanding population of Maricopa County, Arizona. The usual sources of population estimates were found to be of little use for public health purposes, and so we report on a method for obtaining smoothed person-years figures that can accurately reflect population acceleration which varies from one time period to another. Our method is to regress the logarithm of census enumerations on quadratic or tertic polynomials in time. We describe how differential reliability of census figures can be incorporated into our procedure, and how the problem of missing census data can be handled by an iterated regression method. Our evidence suggests that the logarithmic regression model works well, even in the face of rapid and erratic population growth or decline. Handle: RePEc:aph:ajpbhl:1991:81:7:918-920_7 Template-Type: ReDIF-Article 1.0 Title: Occupational health and safety in Brazil Journal: American Journal of Public Health Author-Name: Frumkin, H. Author-Name: De Camara, M.V. Year: 1991 Volume: 81 Issue: 12 Pages: 1619-1624 Abstract: Background. Brazil is the world's fifth largest and sixth most populous nation. Its economy is varied, with strong manufacturing, agriculture, mining, and service sectors. Therefore, a wide variety of workplace hazards confronts its work force. This paper describes Brazil's occupational safety and health regulatory scheme, workers' compensation system, plant-level practices, training, and data collection. Methods. We reviewed and analyzed Brazilian regulatory legislation and government and non-governmental organization (NGO) activity in occupational safety and health, as well as the structure and function of the workers' compensation system. We also reviewed available data on injuries and diseases from major sources, including the now-defunct Instituto Nacional do Previdencia Social (INPS) and the workers' compensation scheme, Seguro de Acidente de Trabalho (SAT). Results. The incidence of work-place injuries has decreased in recent years and is now reported to be about 5 per 100 workers per year. The case fatality rate has been constant at about 5 fatalities per 1000 injuries. Less than 6% of reported injuries are classified as ''diseases.'' Brazil's rates are comparable to those of Mexico and Zimbabwe, and two to four times higher than in most industrialized countries. Conclusions. Brazil has a high incidence of occupational injuries and diseases; these injuries and diseases are underreported; there is a large informal sector at special risk; and Brazil illustrates the disparity that exists in many countries between legislation on the books and legislation that is actually implemented. Handle: RePEc:aph:ajpbhl:1991:81:12:1619-1624_7 Template-Type: ReDIF-Article 1.0 Title: The impact of time in treatment on the employment and earnings of drug abusers Journal: American Journal of Public Health Author-Name: French, M.T. Author-Name: Zarkin, G.A. Author-Name: Hubbard, R.L. Author-Name: Rachal, J.V. Year: 1991 Volume: 81 Issue: 7 Pages: 904-907 Abstract: We use data from a longitudinal survey to estimate the effects of time in drug abuse treatment on post-treatment weeks worked and earnings for 2,420 clients in three treatment modalities. The regression analysis shows that time in treatment had a positive and statistically significant impact on these labor market outcomes, but the effects were small for all modalities. Although residential clients experienced the largest relative changes in weeks worked and real earnings, a benefit-cost calculation suggests that additional residential treatment cannot be justified from earnings improvements alone. These results may indicate a need for more employment services while in treatment. Handle: RePEc:aph:ajpbhl:1991:81:7:904-907_3 Template-Type: ReDIF-Article 1.0 Title: Suicide among the elderly: Issues facing public health Journal: American Journal of Public Health Author-Name: Sorenson, S.B. Year: 1991 Volume: 81 Issue: 9 Pages: 1109-1110 Handle: RePEc:aph:ajpbhl:1991:81:9:1109-1110_0 Template-Type: ReDIF-Article 1.0 Title: Income, race, and surgery in Maryland Journal: American Journal of Public Health Author-Name: Gittelsohn, A.M. Author-Name: Halpern, J. Author-Name: Sanchez, R.L. Year: 1991 Volume: 81 Issue: 11 Pages: 1435-1441 Abstract: Background. We describe common surgical and medical hospital admission rates for Maryland residents, exploring systematic effects of race and income. Methods. The data comprise Maryland hospital discharges and population estimates for 1985 to 1987. Patient income is the race-specific median family income of residence zip code. Logistic regression is used to measure incidence by race, income, and residence for surgical and medical reasons for admission. Results. Population rates for discretionary orthopedic, vascular, and laryngologic surgery tend to increase with community income levels. Coronary and carotid artery surgery rates are two to three times higher among Whites. The more discretionary the procedure, the lower is the relative incidence among Blacks. By contrast, admission rates for most medical reasons decline with increasing income levels and are elevated among Blacks. The affluent receive coronary artery procedures whereas the poor are hospitalized for coronary artery disease. Conclusions. Blacks and the poor appear to have higher illness burdens requiring hospital care. Discretionary surgeries have a White predominance and increase with income; medical admissions have a Black predominance and decline with income. Race and community income level are important factors in differential hospital utilization rates. Handle: RePEc:aph:ajpbhl:1991:81:11:1435-1441_7 Template-Type: ReDIF-Article 1.0 Title: Suicides among older United States residents: Epidemiologic characteristics and trends Journal: American Journal of Public Health Author-Name: Meehan, P.J. Author-Name: Saltzman, L.E. Author-Name: Sattin, R.W. Year: 1991 Volume: 81 Issue: 9 Pages: 1198-1200 Abstract: Suicide rates for elderly US residents decreased between 1950 and 1980, but have increased recently. We analyzed suicide mortality trends using national mortality data for the period 1980 through 1986. Suicide rates during this period increased for each 5-year age group over age 65. Elderly White males have the highest suicide rates and experienced a rate increase of 23%. The rate for Black males rose by 42%. Divorced males have the highest age-adjusted sex- and marital status-specific rates, and experienced a rate increase of 38% over the 7-year period. Suicide rates among older US residents vary by region of the country and are highest in the West. Rates increased in all regions except the Northeast. Firearms are the most common method of suicide in the elderly, and firearm use increased during this period from 60% to 66% of all suicides. Given the recent increase in suicide rates for the elderly and the magnitude of the problem in this age group, it is again important to direct our attention to the problem of suicide in the elderly and recognize the need for effective prevention strategies. Handle: RePEc:aph:ajpbhl:1991:81:9:1198-1200_6 Template-Type: ReDIF-Article 1.0 Title: The health effects of economic insecurity Journal: American Journal of Public Health Author-Name: Catalano, R. Year: 1991 Volume: 81 Issue: 9 Pages: 1148-1152 Abstract: Background. Interest in the health and behavioral effects of economic insecurity appears to vary with the performance of the economy. The current recession in the United States and Western Europe and growing unemployment in Eastern Europe make it timely to analytically review the recent research concerned with the health effects of economic contraction. Methods. The research concerned with the health and behavioral effects of economic insecurity is organized by dependent variable and method. Rules for determining which effects are supported by strong and which by weak evidence are developed and applied to the literature. Results. Evidence for effects on symptoms of psychological distress, seeking help for psychological distress, and nonspecific physiological illness is strong. Evidence for effects on suicide, child abuse, adverse birth outcomes, and heart disease is characterized as weak or sufficiently controversial to warrant skepticism. Conclusions. The health effects of economic security are undoubtedly mediated by economic policies. Estimating the effect of policy alternatives on the incidence of various outcomes is, however, very difficult given the current state of the research. The effect of rising unemployment on health in Eastern Europe cannot, moreover, be estimated from existing research. Effects estimated from Western economies probably do not generalize to situations in which the meaning of economic insecurity is conditioned by profound social and political reforms. Handle: RePEc:aph:ajpbhl:1991:81:9:1148-1152_7 Template-Type: ReDIF-Article 1.0 Title: Physicians promoting bicycle helmets for children: A randomized trial Journal: American Journal of Public Health Author-Name: Cushman, R. Author-Name: James, W. Author-Name: Waclawik, H. Year: 1991 Volume: 81 Issue: 8 Pages: 1044-1046 Abstract: Head injury is the leading cause of death and serious morbidity in bicycle accidents. There is good evidence to recommend helmets, yet few children wear them. We evaluated helmet promotion in a randomized trial targeting children presenting to primary care settings for routine ambulatory care. The intervention consisted of physician counseling and take-home pamphlets. The study involved 339 families, 167 in the intervention group and 172 in the control group. In a follow-up telephone call, 2 to 3 weeks later, only 7.2% of the intervention group had purchased helmets, compared with 7.0% of the control group (χ2 = 0.0056, P = .94). During the latter half of the study, bicycle safety received considerable media attention in Ottawa, and the provincial medical society sponsored a $5 discount campaign. Therefore both groups were subject to community ''co-intervention.'' Nonetheless, we were surprised that physician counseling made no additional impact. Our results and the success of certain community programs suggest that physicians interested in helmet promotion would do better to participate in the design and implementation of multidisciplinary campaigns. Handle: RePEc:aph:ajpbhl:1991:81:8:1044-1046_9 Template-Type: ReDIF-Article 1.0 Title: Source of bias in prenatal care utilization indices: Implications for evaluating the Medicaid expansion Journal: American Journal of Public Health Author-Name: Alexander, G.R. Author-Name: Tompkins, M.E. Author-Name: Petersen, D.J. Author-Name: Weiss, J. Year: 1991 Volume: 81 Issue: 8 Pages: 1013-1016 Abstract: Background: Recent expansions in eligibility for coverage of prenatal care services by the Medicaid program reflect national initiatives to improve pregnancy outcomes. This study investigates the potential impact that completeness of reporting of prenatal care and gestational age variables and strategies to impute missing data may have on evaluations of the Medicaid expansion. Methods: This study, examining 15 years of vital record data from a single state and comparing 1 year of data from four mid-Atlantic states, selected single live births to resident mothers for analyses. The ''day 15'' and the ''preceding case'' methods were used to impute missing gestational age data. Results: Considerable temporal and geographic variation was detected in completeness of reporting of variables used to construct prenatal care indices. After imputing values for cases with missing data, the proportion of cases for which adequacy of prenatal care utilization could not be determined ranged from 3% to 24% among the states investigated. For those cases where gestational age data could be imputed, the distribution of prenatal care utilization was not markedly disparate from those cases with complete reporting of gestational age. Conclusions: The results indicate that variations in reporting, decisions regarding the treatment of missing data, and the choice of the denominator can alter prenatal care utilization percentages and have implications for evaluations of the impact of the recent Medicaid expansion on prenatal care utilization. Handle: RePEc:aph:ajpbhl:1991:81:8:1013-1016_6 Template-Type: ReDIF-Article 1.0 Title: Socioeconomic status and electrolyte intake in Black adults: The Pitt County Study Journal: American Journal of Public Health Author-Name: Gerber, A.M. Author-Name: James, S.A. Author-Name: Ammerman, A.S. Author-Name: Keenan, N.L. Author-Name: Garrett, J.M. Author-Name: Strogatz, D.S. Author-Name: Haines, P.S. Year: 1991 Volume: 81 Issue: 12 Pages: 1608-1612 Abstract: Background. Although the inverse association between socioeconomic status (SES) and blood pressure has often been observed, little is known about the relationship between SES and dietary risk factors for elevated blood pressure. Therefore, this study described the distribution of dietary intakes of sodium, potassium, and calcium and examined the association between electrolyte intake and SES among 1784 Black men and women aged 25 to 50 residing in eastern North Carolina. Methods. Household interviews were conducted in 1988 to obtain information on psychosocial and dietary correlates of blood pressure. Electrolyte intake (mg/day) was assessed using a food frequency questionnaire adapted to reflect regional and ethnic food preferences. SES was categorized into three levels defined by the participant's educational level and occupation. Results. After adjustment for age and energy intake, potassium and calcium intake increased with increasing SES for both sexes. Sodium intake was high for all groups and did not vary markedly with SES, but sodium to potassium and sodium to calcium ratios decreased with increasing SES. In addition, high SES individuals were more likely to believe that diet affects risk for disease and to report less salt use at the table and less current sodium consumption than in the past. Conclusion. These data indicate that nutritional beliefs as well as the consumption of electrolytes are associated with SES in Black adults. Handle: RePEc:aph:ajpbhl:1991:81:12:1608-1612_2 Template-Type: ReDIF-Article 1.0 Title: The health hazards of saunas and spas and how to minimize them Journal: American Journal of Public Health Author-Name: Press, E. Year: 1991 Volume: 81 Issue: 8 Pages: 1034-1037 Abstract: Background: The rapidly increasing number of spas, hot tubs, and saunas intensifies the potentials for deaths from hyperthermia and drowning. Methods: I analyzed 54 such deaths reported to me by 55 medical examiners and coroners in the United States and 104 deaths reported to the US Consumer Product Safety Commission (CPSC). Results: Only seven of the 158 deaths analyzed occurred in saunas. All of the remaining deaths occurred in spas, jacuzzis, or hot tubs, which were far more numerous. The chief risk factors identified were alcohol ingestion, heart disease, seizure disorders, and cocaine ingestion (alone or in combination with alcohol ingestion). These factors accounted for 71 or 44.7% of the 159 fatalities. Of these risk factors, alcohol represented 38%; heart disease, 31%; seizure disorders, 17%; and cocaine ingestion, alone or in combination with alcohol, 14%. Sixty-one of the 151 spa-associated deaths occurred in children under 12 years of age. Accidental drownings from uncovered or improperly covered spas and, to a lesser extent, entrapment by suction, were the chief causes of childhood drownings. Conclusions: Children and older persons who have heart disease or seizure disorders or who use alcohol or cocaine are especially vulnerable. Recommended preventive measures include shortening the time of exposure, lowering the temperature, establishing safety standards for covers and for baffles for suction outlets, and using warning notices. Handle: RePEc:aph:ajpbhl:1991:81:8:1034-1037_3 Template-Type: ReDIF-Article 1.0 Title: How can physicians get kids to wear bicycle helmets? A prototypic challenge in injury prevention Journal: American Journal of Public Health Author-Name: Runyan, C.W. Author-Name: Runyan, D.K. Year: 1991 Volume: 81 Issue: 8 Pages: 972-973 Handle: RePEc:aph:ajpbhl:1991:81:8:972-973_9 Template-Type: ReDIF-Article 1.0 Title: Low-level air pollution and upper respiratory infections in children Journal: American Journal of Public Health Author-Name: Jaakkola, J.J.K. Author-Name: Paunio, M. Author-Name: Virtanen, M. Author-Name: Heinonen, O.P. Year: 1991 Volume: 81 Issue: 8 Pages: 1060-1063 Abstract: Effects of low-level air pollution were studied in one polluted city and two reference cities in northern Finland by comparing the frequency of upper respiratory infections over a 12-month period in 1982 as reported by parents of children ages 14 through 18 months (n = 679) and 6 years (n = 759). A similar comparison was carried out between children living in the more polluted and less polluted areas of the polluted city. The annual mean and the greatest half-hour concentrations of sulfur dioxide (23 and 807 μg/m3), particulates (31 and 291 μg/m3), nitrogen oxides (15 and 160 μg/m3), and hydrogen sulfide (2 and 177 μg/m3) in the polluted city were mainly due to industrial sources. In the reference cities, air pollution was produced mainly by traffic and heating. Adjusted odds ratios (OR) for one or more upper respiratory infections of residents in the polluted city vs those in the reference cities were 2.0 (95% confidence interval [CI] = 1.3-3.2) in the younger age group and 1.6 (95% CI = 1.1-2.1) in the older age group. Within the polluted city, OR calculated for living in more vs less polluted areas were 2.0 (95% CI = 1.0-4.0) in the younger and 1.6 (95% CI = 1.0-2.7) in the older children. The present results suggests that, for children, air pollution can be hazardous in concentrations lower than those recorded in earlier studies from Britain and central Europe. The synergistic effect of sulfur dioxide, particulates, nitrogen oxides, hydrogen sulfide, and other pollutants may be a contributing factor. Handle: RePEc:aph:ajpbhl:1991:81:8:1060-1063_6 Template-Type: ReDIF-Article 1.0 Title: Study on PMS and caffeine consumption flawed [1] Journal: American Journal of Public Health Author-Name: Leviton, A. Author-Name: Rossignol, A.M. Author-Name: Bonnlander, H. Year: 1991 Volume: 81 Issue: 12 Pages: 1673-1675 Handle: RePEc:aph:ajpbhl:1991:81:12:1673-1675_9 Template-Type: ReDIF-Article 1.0 Title: Needle sharing in The Netherlands: An ethnographic analysis Journal: American Journal of Public Health Author-Name: Grund, J.-P.C. Author-Name: Kaplan, C.D. Author-Name: Adriaans, N.F.P. Year: 1991 Volume: 81 Issue: 12 Pages: 1602-1607 Abstract: Background. Needle sharing has been reported to be the main cause of the rapid spread of the human immunodeficiency virus (HIV) among injecting drug users. Risk behaviors such as needle sharing are, however, the end result of complicated interaction patterns in drug user networks, which have their specific rules and rituals, and larger social structures and official drug policy. Methods. To study these interaction patterns we examined the drug administration rituals of heroin addicts in Rotterdam, The Netherlands. Intensive ethnographic descriptions were collected by participant observation. Results. In less than 10% of the observed self-injections unsafe syringes were used. In 68% of the self-injections new, sterile syringes were used. Needle sharing as a planned sequence was not observed. Sharing was determined primarily by the availability of syringes, experience with the injecting ritual, and drug craving. In all observed needle-sharing events, subjects were aware of the risks involved and undertook efforts to clean the injection equipment. Conclusions. In contrast to psychological approaches aimed at reducing individual ''risk behavior,'' these findings suggest that HIV prevention can be made more effective if active drug injectors are organized to help themselves and their peers prevent high-risk exchange situations. Handle: RePEc:aph:ajpbhl:1991:81:12:1602-1607_7 Template-Type: ReDIF-Article 1.0 Title: Physical activity and hypertension in Black adults: The Pitt County study Journal: American Journal of Public Health Author-Name: Ainsworth, B.E. Author-Name: Keenan, N.L. Author-Name: Strogatz, D.S. Author-Name: Garrett, J.M. Author-Name: James, S.A. Year: 1991 Volume: 81 Issue: 11 Pages: 1477-1479 Abstract: The relation of physical activity to hypertension was examined in 1751 Black adults in Pitt County, NC. More women (65%) than men (44%) were classified as sedentary. Sedentary behavior was not associated with the prevalence of hypertension in men, but was associated with a 31% increase in prevalence for women (sedentary-26.2%; active-20.0%; P < .01). The association in women was independent of other risk factors for hypertension. Handle: RePEc:aph:ajpbhl:1991:81:11:1477-1479_5 Template-Type: ReDIF-Article 1.0 Title: Response from Schwartzbaum, et al. [3] Journal: American Journal of Public Health Author-Name: Schwartzbaum, J.A. Author-Name: Wheat, J.R. Author-Name: Norton, R.W. Year: 1991 Volume: 81 Issue: 7 Pages: 932-933 Handle: RePEc:aph:ajpbhl:1991:81:7:932-933_7 Template-Type: ReDIF-Article 1.0 Title: Risk factors for shooting gallery use and cessation among intravenous drug users Journal: American Journal of Public Health Author-Name: Celentano, D.D. Author-Name: Vlahov, D. Author-Name: Cohn, S. Author-Name: Anthony, J.C. Author-Name: Solomon, L. Author-Name: Nelson, K.E. Year: 1991 Volume: 81 Issue: 10 Pages: 1291-1295 Abstract: Background. Shooting galleries, locations where intravenous drug users (IVDUs) can rent or borrow needles and syringes, are a high-risk environment for HIV-1 transmission. This study investigates risk factors for lifetime attendance at shooting galleries and differentiates characteristics of those who continue to frequent shooting galleries and those who have stopped. Methods. We interviewed 2615 active IVDUs in Baltimore in 1988 and 1989 and determined patterns of IV drug use, sociodemographics, and HIV-1 serostatus as related to persistence vs cessation of shooting gallery use. Results. Over half (52%) of active IVDUs reported ever using a shooting gallery, with 33% reporting use within the prior 3 months. In multivariate analysis, lifetime shooting gallery use was associated with male gender, homosexuality/bisexuality, low socioeconomic status, Black race, and heavier drug involvement. Persistent shooting gallery users were more frequently male, homosexual/bisexual, homeless, less educated, and started IV drug use more recently compared with those who ceased going to shooting galleries. Conclusions. Shooting gallery attendance may be pragmatic from a sociological and economic perspective, but it carries with it a heightened risk of acquiring HIV-1 infection. Handle: RePEc:aph:ajpbhl:1991:81:10:1291-1295_0 Template-Type: ReDIF-Article 1.0 Title: International collaboration in a cluster investigation [3] Journal: American Journal of Public Health Author-Name: Garza, A. Author-Name: Mutchinick, O. Author-Name: Cordero, J.F. Author-Name: Burse, V.W. Year: 1991 Volume: 81 Issue: 8 Pages: 1077-1078 Handle: RePEc:aph:ajpbhl:1991:81:8:1077-1078_3 Template-Type: ReDIF-Article 1.0 Title: Comparison of smoking habits of Blacks and Whites in a case-control study Journal: American Journal of Public Health Author-Name: Kabat, G.C. Author-Name: Morabia, A. Author-Name: Wynder, E.L. Year: 1991 Volume: 81 Issue: 11 Pages: 1483-1486 Abstract: Information from Blacks and Whites interviewed in a case-control study of tobacco-related diseases was analyzed to identify explanatory factors for racial differences in smoking habits. Blacks were three times more likely to be light vs heavy smokers. This association did not differ according to such variables as cigarette preference, degree of inhalation, or quitting. The association of race and light smoking was present in both current and ex-smokers. Sociodemographic or smoking-related characteristics do not appear to explain racial differences in smoking habits. Future studies should focus on cultural factors influencing smoking behavior. Handle: RePEc:aph:ajpbhl:1991:81:11:1483-1486_6 Template-Type: ReDIF-Article 1.0 Title: Occupational injuries and illnesses among Washington State agricultural workers Journal: American Journal of Public Health Author-Name: Demers, P. Author-Name: Rosenstock, L. Year: 1991 Volume: 81 Issue: 12 Pages: 1656-1658 Abstract: In Washington state 29 451 workers' compensation claims were filed by farm workers between 1982 and 1986. Five percent of claimants were under 18 years of age, including 1.3% under the age of 16. Agricultural workers were found to be at higher risk than other workers in the state for fatal injury (relative risk [RR] = 2.5, 95% confidence interval [CI] = 1.7-3.7), sprains and strains (RR = 1.4, CI = 1.3-1.4), fractures (RR = 2.3, CI = 2.2-2.4), dislocations (RR = 1.9, CI = 1.7-2.2), concussions (RR = 1.9, CI = 1.6-2.3), amputations (RR = 2.5, CI = 2.0-3.1), dermatitis (RR = 4.3, CI = 4.0-4.7), systemic poisoning (RR = 3.4, CI = 3.1-3.7), respiratory disease (RR = 1.7, CI = 1.0-2.9), and tendonitis (RR = 1.2, CI = 1.1-1.4). Handle: RePEc:aph:ajpbhl:1991:81:12:1656-1658_8 Template-Type: ReDIF-Article 1.0 Title: Mammography in a health maintenance organization Journal: American Journal of Public Health Author-Name: Hansen, J.P. Author-Name: Knapp, P.A. Author-Name: Newcomb, P.A. Year: 1991 Volume: 81 Issue: 11 Pages: 1489-1490 Abstract: The charts of a random sample of 496 women, aged 51 and older, in a staff model health maintenance organization (HMO) were retrospectively audited for mammography frequency over an 8-year period. Of the 496 women, 306 (61.7%) had at least one mammogram. For the 422 women who had been members of the HMO for at least 2 years, 196 (46.4%) had mammography within the previous 18 months. Handle: RePEc:aph:ajpbhl:1991:81:11:1489-1490_6 Template-Type: ReDIF-Article 1.0 Title: Representativeness of deaths identified through the injury-at-work item on the death certificate: Implications for surveillance Journal: American Journal of Public Health Author-Name: Russell, J. Author-Name: Conroy, C. Year: 1991 Volume: 81 Issue: 12 Pages: 1613-1618 Abstract: Background. This research investigated the accuracy of the injury-at-work item on the death certificate for surveillance of occupational injury deaths in Oklahoma during 1985 and 1986. Methods. Representativeness of occupational injury deaths identified by death certificates was assessed by comparing these deaths with all occupational injury deaths identified through death certificates, workers' compensation reports, medical examiner reports, and OSHA records for categories of occupation, industry, and external causes of death. Results. Certain external causes of death (e.g., motor vehicle traffic deaths) and certain occupations (e.g., farming) and industries (agriculture and services) are more often underidentified through death certificates. Conclusions. The findings of this study support Baker's observation that no single data source contains all deaths or all the data elements necessary to describe occupational injury deaths. Data sources may be combined to improve representativeness through more complete case ascertainment. Handle: RePEc:aph:ajpbhl:1991:81:12:1613-1618_7 Template-Type: ReDIF-Article 1.0 Title: Differences in biological responses to cigarette smoking remain unexplained [8] Journal: American Journal of Public Health Author-Name: Hebert, J.R. Year: 1991 Volume: 81 Issue: 12 Pages: 1679 Handle: RePEc:aph:ajpbhl:1991:81:12:1679_5 Template-Type: ReDIF-Article 1.0 Title: Public health and the law: From health-based to technology-based standards for hazardous air pollutants Journal: American Journal of Public Health Author-Name: Robinson, J.C. Author-Name: Pease, W.S. Year: 1991 Volume: 81 Issue: 11 Pages: 1518-1523 Abstract: The Clean Air Act Amendments of 1990 represent a major shift in regulatory emphasis for toxic air pollutants. Recognizing the immediate public health benefits that can be gained from the application of currently available and affordable control technologies, Congress has abandoned its insistence that health risks should be the only consideration in establishing emissions standards. Previously excluded concerns about economic costs and technological feasibility will now determine the initial level of pollution control required of toxic air pollution sources. In exchange for reducing the stringency of emissions limits, the newly amended act extends the scope of regulation by listing 189 toxic substances that must be controlled over the next decade. This exchange of regulatory depth for breadth occurs against a history of reluctance by the Environmental Protection Agency to implement the original health-protective language of the Clean Air Act. It mirrors earlier compromises under the Clean Water Act and the Occupational Safety and Health Act. Handle: RePEc:aph:ajpbhl:1991:81:11:1518-1523_9 Template-Type: ReDIF-Article 1.0 Title: Tobacco industry scientific advisors: Serving society or selling cigarettes? Journal: American Journal of Public Health Author-Name: Warner, K.E. Year: 1991 Volume: 81 Issue: 7 Pages: 839-842 Abstract: According to industry documents, the tobacco industry has executed a ''brilliantly conceived'' strategy to ''creat[e] doubt'' in the public's mind about whether cigarette smoking is in fact a serious cause of disease. A component of this strategy has been the funding of scientific research ''into the gaps in knowledge in the smoking controversy.'' Grant review and selection are performed by a group of independent scientists. Knowledgeable observers believe that the existence of this research funding program in general, and the Scientific Advisory Board in particular, is intended by the industry to reinforce doubts in the public mind about the severity of the hazards posed by smoking. Because the Advisory Board has never taken a public stance against the industry's position that the causal relationship between smoking and disease remains unproven, I polled these scientists to determine whether they believed that smoking is a cause of lung cancer. Despite repeated opportunities, only four of 13 board members responded, all affirmatively; two others have expressed their judgment that smoking causes lung cancer in their professional publications. Thus, over half of the Board members, and the Board as a whole, have not gone on record as rejecting the industry's ''party line.'' It might be hoped that the American scientists would follow the lead of the members of a similar body of scientists in Australia who have taken a strong and public stand against the industry position that smoking is not an established cause of disease. Handle: RePEc:aph:ajpbhl:1991:81:7:839-842_9 Template-Type: ReDIF-Article 1.0 Title: Outbreak of coxsackievirus A16 hand, foot, and mouth disease in a child day-care center [2] Journal: American Journal of Public Health Author-Name: Ferson, M.J. Author-Name: Bell, S.M. Year: 1991 Volume: 81 Issue: 12 Pages: 1675-1676 Handle: RePEc:aph:ajpbhl:1991:81:12:1675-1676_4 Template-Type: ReDIF-Article 1.0 Title: Confidential reporting by physicians [1] Journal: American Journal of Public Health Author-Name: Vernon, T.M. Year: 1991 Volume: 81 Issue: 7 Pages: 931-932 Handle: RePEc:aph:ajpbhl:1991:81:7:931-932_7 Template-Type: ReDIF-Article 1.0 Title: Development and validation of a simple device to estimate birthweight and screen for low birthweight in developing countries Journal: American Journal of Public Health Author-Name: Dusitsin, N. Author-Name: Chompootaweep, S. Author-Name: Poomsuwan, P. Author-Name: Dusitsin, K. Author-Name: Sentrakul, P. Author-Name: Lumbiganond, P. Year: 1991 Volume: 81 Issue: 9 Pages: 1201-1205 Abstract: Lowbirthweight (<2500 g) is the major factor associated with the death of infants within the first 4 weeks of life. The mean birthweight of newborn babies of a certain geographic area reflects the quality of maternal and child health care service as well as the degree of socioeconomic development of the particular region. Hence, birthweight is being used increasingly as an indicator for health and socioeconomic planning. However, in a developing country such as Thailand, two-fifths of the babies are delivered at home and are not weighted because scales are not available. To solve this problem in rural areas, a circular nomographic chart was developed with which the birthweight can be computed from a newborn baby's chest and mid-arm circumferences. Preliminary trials comparing these charts with standard baby scales showed a high degree of accuracy with sufficient sensitivity and specificity. Handle: RePEc:aph:ajpbhl:1991:81:9:1201-1205_6 Template-Type: ReDIF-Article 1.0 Title: Aging and the fitness of fire fighters: The complex issues involved in abolishing mandatory retirement ages Journal: American Journal of Public Health Author-Name: Saupe, K. Author-Name: Sothmann, M. Author-Name: Jasenof, D. Year: 1991 Volume: 81 Issue: 9 Pages: 1192-1194 Abstract: This study presents an assessment of the cardiorespiratory health and physical fitness of fire fighters of different ages with the aim of addressing several questions currently being debated on a national level. These include how fire fighters differ across age groups in their health and physical fitness, and what would be the impact on the existing work force of implementing minimum fitness standards as an alternative to mandatory retirement ages. Fire fighters aged 20-65 years were found to be similar in their cardiorespiratory health and physical fitness to the sedentary segment of the general population of the same age. particularly worrisome, however, is the low maximal aerobic capacity (31, 28, 26 ml/kg/min), high percent body fat (26, 29, 30), and high resting blood pressure (136/86, 140/90, 143/93 mm Hg) observed in the 40-45-, 50-55-, and 60-65-year-old fire fighters, respectively. In fact, 66%, 83%, and 93% of the fire fighters in these three age groups, respectively, fall below the lowest published recommendations for maximal aerobic capacity in this profession. These data underscore the need to establish minimum health and physical performance standards for fire fighters and demonstrate the profound impact such minimum standards will have on the existing work force. Handle: RePEc:aph:ajpbhl:1991:81:9:1192-1194_0 Template-Type: ReDIF-Article 1.0 Title: Protective effects of condoms: Implications for public health [1] Journal: American Journal of Public Health Author-Name: Job-Spira, N. Author-Name: Coste, J. Author-Name: Spencer, B. Author-Name: Fernandez, H. Year: 1991 Volume: 81 Issue: 9 Pages: 1212 Handle: RePEc:aph:ajpbhl:1991:81:9:1212_9 Template-Type: ReDIF-Article 1.0 Title: Epidemiology and the law: Courts and confidence intervals Journal: American Journal of Public Health Author-Name: Christoffel, T. Author-Name: Teret, S.P. Year: 1991 Volume: 81 Issue: 12 Pages: 1661-1666 Abstract: Beginning with the swine flu litigation of the early 1980s, epidemiological evidence has played an increasingly prominent role in helping the nation's courts deal with alleged causal connections between plaintiffs' diseases or other harm and exposure to specific noxious agents (such as asbestos, toxic waste, radiation, and pharmaceuticals). Judicial reliance on epidemiology has high-lighted the contrast between the nature of scientific proof and of legal proof. Epidemiologists need to recognize and understand the growing involvement of their profession in complex tort litigation. Handle: RePEc:aph:ajpbhl:1991:81:12:1661-1666_4 Template-Type: ReDIF-Article 1.0 Title: Immunoglobulins and growth parameters at birth of infants born to HIV seropositive and seronegative women Journal: American Journal of Public Health Author-Name: Butz, A. Author-Name: Hutton, N. Author-Name: Larson, E. Year: 1991 Volume: 81 Issue: 10 Pages: 1323-1326 Abstract: Health characteristics of neonates born to human immunodeficiency virus (HIV) seropositive (n = 63) and HIV seronegative (n = 57) women were compared. No significant differences were found between the two infant groups for sociodemographic characteristics, mode of delivery, Apgar scores, gestational age, growth parameters, or immunoglobulin levels. Furthermore, no differences were detected in a subgroup of infants later confirmed to have HIV infection (class P-2). Maternal HIV infection does not appear to affect newborn health characteristics. Handle: RePEc:aph:ajpbhl:1991:81:10:1323-1326_1 Template-Type: ReDIF-Article 1.0 Title: Recent trends in the incidence of toxic shock syndrome in northern California Journal: American Journal of Public Health Author-Name: Petitti, D.B. Author-Name: Reingold, A.L. Year: 1991 Volume: 81 Issue: 9 Pages: 1209-1211 Abstract: The incidence of toxic shock syndrome in women members of a large prepaid medical care program in Northern California was 1.5 cases per 100,000 in a period after removal of tampons containing polyacrylate rayon and reductions in tampon absorbency. This rate was lower, but not significantly lower, than the rate of 2.2 per 100,000 in the prior interval. It was higher, but not significantly higher, than the rate of 0.4 per 100,000 in the era before ''superabsorbent'' materials were introduced into tampons. The incidence in men has been stable at about 0.1 cases per 100,000 for the 15-year period from 1972 through 1987. Handle: RePEc:aph:ajpbhl:1991:81:9:1209-1211_1 Template-Type: ReDIF-Article 1.0 Title: Impact of a geriatric assessment unit on subsequent health care charges Journal: American Journal of Public Health Author-Name: Applegate, W.B. Author-Name: Graney, M.J. Author-Name: Miller, S.T. Author-Name: Elam, J.T. Year: 1991 Volume: 81 Issue: 10 Pages: 1302-1306 Abstract: Background. In a recent randomized controlled trial assessing the efficacy of an inpatient geriatric assessment unit (GAU), we demonstrated that patients assigned to the unit were less likely than those in the usual care group to be admitted to a nursing home and more likely to remain living in the community. Despite evidence of benefits of GAU care, questions remain about its cost. We examine the impact of GAU treatment on subsequent health care charges. Methods. Sequential referrals of elderly disabled patients considered at risk for institutionalization or likely to improve with rehabilitation were randomized to the GAU or to usual care. Charge data were collected on utilization of a wide variety of health care services starting at the point of randomization. Results. The group randomized to the GAU experienced significantly higher rehabilitation charges per participant ($10 583 vs $2066, P = .0001), but lower mean nursing home charges ($1798 vs $3426, P = .004). Total health care charges per participant over the 1 year follow-up were greater for the GAU group ($28 406 vs $16 444, P = .004). When charges were adjusted per year of life survived, the GAU group still showed a substantial (but nonsignificant, P = .10) increase in total charges. However, when charges were adjusted per day subsequently spent residing in the community, adjusted total charges were similar between the two groups. Conclusion. Our results indicated that improved outcomes from GAU care require an investment in rehabilitation that is not totally offset by decreasing institutional charges in the following year. Handle: RePEc:aph:ajpbhl:1991:81:10:1302-1306_4 Template-Type: ReDIF-Article 1.0 Title: Black-White differences in infant mortality in 38 standard metropolitan statistical areas Journal: American Journal of Public Health Author-Name: Polednak, A.P. Year: 1991 Volume: 81 Issue: 11 Pages: 1480-1482 Abstract: The Black-White difference in infant mortality rates for 1982 through 1986 in 38 large US standard metropolitan statistical areas (SMSAs) varied by a factor of almost seven. In multiple regression analyses the most important predictor of the Black-White difference in the 38 SMSAs was an index of Black-White residential dissimilarity (or ''segregation index''), independent of Black-White differences in median family income and poverty prevalence. Certain SMSAs in California had relatively low segregation indexes and small Black-White differences in infant mortality, despite considerable Black-White differences in poverty prevalence. The explanations for the apparent effect of residential segregation should be explored. Handle: RePEc:aph:ajpbhl:1991:81:11:1480-1482_8 Template-Type: ReDIF-Article 1.0 Title: Mortality of intravenous drug users in Rome: A cohort study Journal: American Journal of Public Health Author-Name: Perucci, C.A. Author-Name: Davoli, M. Author-Name: Rapiti, E. Author-Name: Abeni, D.D. Author-Name: Forastiere, F. Year: 1991 Volume: 81 Issue: 10 Pages: 1307-1310 Abstract: A historical cohort study was carried out in Rome to examine overall and cause-specific mortality among intravenous drug users (IV-DUs). A total of 4200 IVDUs (3411 men and 789 women) enrolled in methadone treatment centers between 1980 and 1988 were studied. There were 239 deaths during the follow-up period. The overall SMR was 10.10 in the entire cohort (95% confidence interval, 8.86-11.47), 9.30 in males and 18.07 in females. A large excess of mortality in both sexes was found for infectious, circulatory, respiratory, and digestive diseases as well as for violence, overdose, AIDS, and unknown or ill-defined causes. Tumors and suicide were excessive only in males. Deaths due to drug overdose, violence or trauma, and cirrhosis accounted for 63.6%, AIDS for 7.1%, endocarditis and other bacterial infections for 7.1%, and neoplasms for 3.8% of total mortality. These findings document serious health consequences of drug abuse in Italy. Handle: RePEc:aph:ajpbhl:1991:81:10:1307-1310_0 Template-Type: ReDIF-Article 1.0 Title: Tobacco smoking as a risk factor for colon polyps Journal: American Journal of Public Health Author-Name: Zahm, S.H. Author-Name: Cocco, P. Author-Name: Blair, A. Year: 1991 Volume: 81 Issue: 7 Pages: 846-849 Abstract: Background: Data from a cancer screening project among pattern makers were used to evaluate the association between tobacco smoking and prevalence of colon polyps. Methods: From 1981-1983, 549 White men were examined by flexible sigmoidoscopy and completed self-administered questionnaires including smoking histories. Results: One or more colon polyps were detected in 76 men. Standardized prevalence rates (SPR) for polyps increased by smoking category (never smoked = 0.094; ex-smokers = 0.118, current smokers = 0.214) and by cigarettes per day, years of smoking, and pack-years among both current and ex-smokers. Both adenomatous and hyperplastic polyps showed an association with smoking while other types of polyps and polyps with unspecified histology did not. The risk associated with smoking was greater for polyps greater than one centimeter in diameter. An interaction with occupational exposures was suggested by a greater increase in the SPR for polyps among current smokers employed as pattern makers for more than 10 years than among current smokers similarly employed for 10 years or less. Conclusions: Since at least some colon polyps are considered precursor lesions to colon cancer, one of the most common cancers in the United States, this report suggests that the possible link between colon polyps and smoking deserves further evaluation. Handle: RePEc:aph:ajpbhl:1991:81:7:846-849_1 Template-Type: ReDIF-Article 1.0 Title: Cause-specific mortality in a population-based study of diabetes Journal: American Journal of Public Health Author-Name: Moss, S.E. Author-Name: Klein, R. Author-Name: Klein, B.E.K. Year: 1991 Volume: 81 Issue: 9 Pages: 1158-1162 Abstract: Background. Mortality from vascular diseases has been reported to be high in diabetic persons. Methods. To evaluate mortality from these and other specific causes, we examined cause-specific age-sex standardized mortality ratios in a geographically defined population of younger onset (diagnosed before age 30 and taking insulin, n = 1200) and older onset (diagnosed after age 30, n = 1772) diabetic persons followed for 8.5 years. Cause of death was determined from death certificates. Results. In younger onset persons, age-sex standardized mortality ratios were significantly high (P <.05) for all causes of death (7.5) as well as for diabetes (191), all heart disease (9.1), ischemic heart disease (10.1), other heart disease (6.3), nephritis and nephrosis (41.2), accidents (2.9), and all other causes (3.2). In older onset persons, age-sex standardized mortality ratios were significantly high for all causes of death (2.0) as well as for diabetes (16.8), all heart disease (2.3), ischemic heart disease (2.3), other heart disease (2.1), stroke (2.0), and pneumonia and influenza (1.7). Conclusions. Diabetic persons experience very high mortality, especially from vascular diseases, compared to the general population. Handle: RePEc:aph:ajpbhl:1991:81:9:1158-1162_2 Template-Type: ReDIF-Article 1.0 Title: Promoting physical activity and a healthful diet among children: Results of a school-based intervention study Journal: American Journal of Public Health Author-Name: Simons-Morton, B.G. Author-Name: Parcel, G.S. Author-Name: Baranowski, T. Author-Name: Forthofer, R. Author-Name: O'Hara, N.M. Year: 1991 Volume: 81 Issue: 8 Pages: 986-991 Abstract: Background: National health objectives call for improved diet and more regular physical activity among children. We tested the effects of a school-based program to improve students' diet and physical activity behavior at school. Methods: Two of the four elementary schools in one Texas school district were assigned to intervention and two to control conditions. The three intervention components were classroom health education, vigorous physical education, and lower fat, lower sodium school lunches. Nutrients from school lunches and the total day and the amount of physical activity students obtained during physical education were assessed as outcome. Results: Analysis of school lunches showed declines from base line to posttest in the two intervention schools of 15.5% and 10.4% for total fat, 31.7% and 18.8% for saturated fat, and 40.2% and 53.6% for sodium; posttest values were lower in the intervention schools. Observation of physical activity during physical education classes indicated an increase in the intervention schools from baseline to posttest in the percent of time children engaged in moderate-to-vigorous physical activity from less than 10% of class time at baseline to about 40% of class time at posttest; posttest values were higher in the intervention schools than in the control schools. Conclusions: This efficacy study demonstrates the feasibility of substantially modifying school lunches and school physical education to improve children's diet and physical activity behavior at school. Handle: RePEc:aph:ajpbhl:1991:81:8:986-991_9 Template-Type: ReDIF-Article 1.0 Title: Back to the future: The IOM report reconsidered Journal: American Journal of Public Health Author-Name: Annas, G.J. Author-Name: Glantz, L.H. Author-Name: Scotch, N.A. Year: 1991 Volume: 81 Issue: 7 Pages: 835-837 Handle: RePEc:aph:ajpbhl:1991:81:7:835-837_5 Template-Type: ReDIF-Article 1.0 Title: Decline in the use of illicit drugs by high school students in New York State: A comparison with national data Journal: American Journal of Public Health Author-Name: Kandel, D.B. Author-Name: Davies, M. Year: 1991 Volume: 81 Issue: 8 Pages: 1064-1067 Abstract: A school-based epidemiological survey of the use of drugs was carried out in Spring 1988 among 7,611 adolescents representative of students in grades 7 through 12 in New York State public and private schools. This survey provides the most recent data on the use of crack in that population. Comparison with a statewide survey carried out five years earlier reveals a large decline in the use of illicit drugs in that period. This decline appears to be stronger than the decline reported for national samples. Handle: RePEc:aph:ajpbhl:1991:81:8:1064-1067_3 Template-Type: ReDIF-Article 1.0 Title: Infant diet and salmonellosis Journal: American Journal of Public Health Author-Name: Haddock, R.L. Author-Name: Cousens, S.N. Author-Name: Guzman, C.C. Year: 1991 Volume: 81 Issue: 8 Pages: 997-1000 Abstract: Background: The Island of Guam has experienced a high incidence of infant salmonellosis for a number of years (age-specific incidence rate of approximately 3700 cases per 100,000 infants in 1984). Interviews of case parents suggested that the use of high-iron infant formula was associated with this problem. Methods: A case-control study was conducted to test this hypothesis. Information on feeding practices and a variety of medical and socioeconomic factors was collected for 78 laboratory-confirmed Salmonella-case infants and 167 control infants. Results: Case infants were less likely to have been breast-fed (odds ratio [OR] = 9.15; 95% confidence interval [CI] = 2.71-30.9) and more likely to have been fed infant formula with an iron content of 10 mg/L or greater (OR = 2.96; 95% CI = 1.24-7.08) than were control infants. Conclusions: Although the precise means by which infants are most commonly exposed to Salmonella bacteria remain obscure, breast-feeding apparently protects against the development of physician-diagnosed clinical salmonellosis, while the feeding of high-iron infant formula has the opposite effect. Handle: RePEc:aph:ajpbhl:1991:81:8:997-1000_7 Template-Type: ReDIF-Article 1.0 Title: Changes in AIDS case reporting after hospital site visits Journal: American Journal of Public Health Author-Name: Fife, D. Author-Name: McAnaney, J. Author-Name: Rahman, M.A. Year: 1991 Volume: 81 Issue: 12 Pages: 1648-1650 Abstract: In an effort to improve AIDS case reporting, site visits (meetings with hospital staff to encourage reporting) were made to all Philadelphia hospitals. Comparisons of hospitals visited during a 7-week period with hospitals not visited during that period indicated that the site visits were followed by a marked increase in case reports. No similar increase was observed at the comparison hospitals. The increased reporting was accompanied by an increased lag time from diagnosis to report, suggesting that the additional reports at visited hospitals were the result of the identification of previously missed cases rather than a speedup of reporting. Cases reported after the visits were more likely to have white-collar occupations or private medical insurance than were those reported before the visits. Handle: RePEc:aph:ajpbhl:1991:81:12:1648-1650_8 Template-Type: ReDIF-Article 1.0 Title: Are the correlates of cigarette smoking initiation different for black and white adolescents? Journal: American Journal of Public Health Author-Name: Headen, S.W. Author-Name: Bauman, K.E. Author-Name: Deane, G.D. Author-Name: Koch, G.G. Year: 1991 Volume: 81 Issue: 7 Pages: 854-858 Abstract: Background: Studies of adolescent smoking suggest that the causes of smoking initiation may differ for Blacks and Whites. Methods: Correlates of smoking initiation were examined among 1,277 nonsmokers, ages 12-14, who completed questionnaires in their homes. The analyses examined relationships between smoking initiation and 11 explanatory variables using logistic regression with the combined sample and with Black and White samples. Results: Over two years, 24 percent of Whites and 14 percent of Blacks started to smoke. Whites were more likely to start smoking at age 12 and Blacks at age 14. Having a best friend who smoked increased the odds of initiating smoking over twofold for Whites but had no effect on the odds of smoking for Blacks. Conclusions: Whites initiate smoking earlier than Blacks and are more likely to be influenced by friend behavior. Handle: RePEc:aph:ajpbhl:1991:81:7:854-858_5 Template-Type: ReDIF-Article 1.0 Title: The effects of removing a statutory barrier to workers' compensation for farm workers Journal: American Journal of Public Health Author-Name: Demers, P. Author-Name: Rosenstock, L. Year: 1991 Volume: 81 Issue: 12 Pages: 1659-1660 Abstract: In 1983 the Washington State Supreme Court ruled unconstitutional a unique exemption that excluded farm workers from workers' compensation if they had not earned $150 in continuous work with the same employer. In order to examine the effect of removing this restriction, workers' compensation data were analyzed to examine the number of farm workers covered, the number of claims submitted, and claim acceptance rates before and after the ruling. Although the 1983 ruling appears to have had a significant impact on the treatment of claims, no increase in utilization of the workers' compensation system was observed. Further intervention is required if the objective of treating farm workers equitably is to be realized. Handle: RePEc:aph:ajpbhl:1991:81:12:1659-1660_2 Template-Type: ReDIF-Article 1.0 Title: A prospective study of hospitalization with gallstone disease among women: Role of dietary factors, fasting period, and dieting Journal: American Journal of Public Health Author-Name: Sichieri, R. Author-Name: Everhart, J.E. Author-Name: Roth, H. Year: 1991 Volume: 81 Issue: 7 Pages: 880-884 Abstract: Background: Dietary risk factors for the development of gallstones have not been clearly established. We analyzed data from a population-based prospective study to determine dietary risk factors for hospitalization with gallstone disease. Methods: We evaluated the role of dietary constituents, fasting, and dieting on subsequent hospitalization with gallstone disease among 4,730 women, ages 25 to 74 years, who participated in the first follow-up of the first National Health and Nutrition Examination Survey. Baseline dietary variables were established through a 24-hour dietary recall and a medical history. Proportional hazards models were used to calculate the effects of dietary variables while controlling for baseline risk factors. Results: After an average of 10 years follow-up, gallstone disease was confirmed by hospital records among 216 women who denied gallstone disease at the baseline examination. The hazard rate of hospitalization with gallstone disease increased with increasing overnight fasting period and with dieting. Intake of fiber showed a small protective effect. The effect of energy intake was significant only among women younger than age 50 years at baseline. Results were not affected by adjustment for known risk factors for gallstone disease or other dietary factors. Conclusion: A long overnight fasting period, dieting, and low fiber intake may increase the risk of hospitalization with gallstone disease. Handle: RePEc:aph:ajpbhl:1991:81:7:880-884_7 Template-Type: ReDIF-Article 1.0 Title: National health objectives for the year 2000: The demographic impact of health promotion and disease prevention Journal: American Journal of Public Health Author-Name: Stoto, M.A. Author-Name: Durch, J.S. Year: 1991 Volume: 81 Issue: 11 Pages: 1456-1465 Abstract: Background. The national objectives in Healthy People 2000, drafted by health professionals aware of currently available public health interventions, represent a wealth of information about near-term future mortality and morbidity. Methods. Life table methods were used to calculate the impact of projected changes in mortality and activity limitation rates on life expectancy and expected disability years. Results. Meeting the mortality objectives would increase life expectancy at birth by 1.5 to 2.1 years, raising life expectancy to 76.6 to 77.2 years. In addition, meeting the target for disability from chronic conditions would increase the number of years of life without activity limitations from 66.8 years to 69.3-69.7 years. If the targets for coronary heart disease and unintentional injury were changed to reflect recent trends, a greater improvement in life expectancy at birth would be achieved: from 1.8 to 2.7 years to 76.9 to 77.8 years. Conclusion. Meeting the targets would have an important demographic impact. Including changes in the coronary heart disease and injuries targets, life expectancy in the year 2000 would be above the middle of the ranges used in current Census Bureau projections. Handle: RePEc:aph:ajpbhl:1991:81:11:1456-1465_5 Template-Type: ReDIF-Article 1.0 Title: Diverging gonorrhea and syphilis trends in the 1980s: Are they real? Journal: American Journal of Public Health Author-Name: Gershman, K.A. Author-Name: Rolfs, R.T. Year: 1991 Volume: 81 Issue: 10 Pages: 1263-1267 Abstract: Background. The purpose of this study was to evaluate whether the divergence in national trends of gonorrhea and syphilis from 1986 to 1989 in the United States was real and if overall trends masked a contemporaneous increase in both diseases in a core group. Methods. We analyzed the following: (1) reported cases of gonorrhea and primary and secondary syphilis in the United States for the years 1981 to 1989, (2) gonorrhea screening results from six states for the years 1985 to 1989, and (3) reported cases of gonorrhea and primary and secondary syphilis by census tract for the years 1986 to 1989 in one city. Results. The incidence of gonorrhea decreased 22% in the United States from 1986 to 1989 while the incidence of primary and secondary syphilis increased 59%. Among Blacks, syphilis incidence increased 100% and gonorrhea incidence decreased 13%; among Whites and Hispanics, the incidence of both diseases decreased. Results from gonorrhea screening among females in six states agree with gonorrhea incidence trends in those areas. Race-specific and census tract analyses of data from a number of metropolitan areas where overall rates diverged did not demonstrate a group in which the incidence of both diseases increased. Conclusions. We conclude that diverging trends of gonorrhea and syphilis from 1986 to 1989 are real and emphasize differences in the epidemiologic characteristics of these two sexually transmitted diseases. Handle: RePEc:aph:ajpbhl:1991:81:10:1263-1267_9 Template-Type: ReDIF-Article 1.0 Title: Measles vaccination coverage among latino children aged 12 to 59 months in Los Angeles County: A household survey Journal: American Journal of Public Health Author-Name: Ewert, D.P. Author-Name: Thomas, J.C. Author-Name: Chun, L.Y. Author-Name: Enguidanos, R.C. Author-Name: Waterman, S.H. Year: 1991 Volume: 81 Issue: 8 Pages: 1057-1059 Abstract: A high rate of measles transmission has occurred in Los Angeles County since 1987. To determine measles vaccination coverage among Latino preschoolers, the group at highest risk of measles during this period, a cluster survey was conducted among Latino households with children aged 12 to 59 months. Of 279 children enrolled, 240 (86%, 95% confidence interval = 81% to 91%) reportedly had received the measles vaccine. Measles vaccination coverage among Latino preschoolers in Los Angeles County is insufficient to halt measles transmission within this subpopulation. Handle: RePEc:aph:ajpbhl:1991:81:8:1057-1059_2 Template-Type: ReDIF-Article 1.0 Title: Tobacco consumption declining faster in Canada than in the US Journal: American Journal of Public Health Author-Name: Kaiserman, M.J. Author-Name: Rogers, B. Year: 1991 Volume: 81 Issue: 7 Pages: 902-904 Abstract: Consumption and prices of tobacco products in Canada and the United States are compared over the period 1981 to 1989. In Canada, consumption has fallen from a higher level and at a faster rate than in the United States (3.52 kg/adult to 2.48 kg/adult vs 3.21 kg/adult to 2.48 kg/adult). With respect to cost, the real tobacco price index in Canada has grown faster than its US counterpart. These results are attributed to higher taxation practices, vigorous legislation, and the leadership role adopted by the Canadian government during the 1980s. Handle: RePEc:aph:ajpbhl:1991:81:7:902-904_8 Template-Type: ReDIF-Article 1.0 Title: Injuries in working populations: black-white differences. Journal: American Journal of Public Health Author-Name: Wagener, D.K. Author-Name: Winn, D.W. Year: 1991 Volume: 81 Issue: 11 Pages: 1408-1414 Abstract: BACKGROUND. Although "accidents and adverse effects" mortality is higher among Blacks than Whites, annual injury rates reported in the National Health Interview Survey (NHIS) are lower among Blacks. We evaluated the influence of sociodemographic risk factors on injury rates among working adults. METHODS. NHIS data from 1983 through 1987 for currently working adults were used. Methods were developed to estimate standard errors using data from different sample frames and sample sizes. RESULTS. Working Blacks had fewer reported injuries requiring medical attention or restriction of usual activities than working Whites (22.0 vs 27.0 per 100 persons per year). The difference was pronounced among younger adults in both sexes and among both poor and nonpoor. However, age, sex, and income could not completely explain racial differentials. "At-work" injury rates (36% of all injury episodes) were similar for Blacks and Whites (9.2 vs 9.9 per 100 persons per year), except low-income Blacks and Blacks in service or blue-collar occupations had nonsignificantly smaller at-work injury rates. CONCLUSION. Possible reporting biases could not be completely eliminated. However, available evidence does not rule out a true difference in injury rates by race, highlighting the complexity of understanding the etiology of injuries and, hence, developing public health programs to prevent injuries. Handle: RePEc:aph:ajpbhl:1991:81:11:1408-1414_1 Template-Type: ReDIF-Article 1.0 Title: A randomized trial to evaluate the risk of gastrointestinal disease due to consumption of drinking water meeting current microbiological standards Journal: American Journal of Public Health Author-Name: Payment, P. Author-Name: Richardson, L. Author-Name: Siemiatycki, J. Author-Name: Dewar, R. Author-Name: Edwardes, M. Author-Name: Franco, E. Year: 1991 Volume: 81 Issue: 6 Pages: 703-708 Abstract: Background: This project directly and empirically measured the level of gastrointestinal (GI) illness related to the consumption of tapwater prepared from sewage-contaminated surface waters and meeting current water quality criteria. Methods: A randomized intervention trial was carried out; 299 eligible households were supplied with domestic water filters (reverse-osmosis) that eliminate microbial and chemical contaminants from their water, and 307 households were left with their usual tapwater without a filter. The GI symptomatology was evaluated by means of a family health diary maintained prospectively by all study families over a 15-month period. Results: The estimated annual incidence of GI illness was 0.76 among tapwater drinkers compared with 0.50 among filtered water drinkers (p < 0.01). These findings were consistently observed in all population subgroups. Conclusion: It is estimated that 35% of the reported GI illnesses among the tapwater drinkers were water-related and preventable. Our results raise questions about the adequacy of current standards of drinking water quality to prevent water-borne endemic gastrointestinal illness. Handle: RePEc:aph:ajpbhl:1991:81:6:703-708_8 Template-Type: ReDIF-Article 1.0 Title: Asthmatic responses to airborne acid aerosols Journal: American Journal of Public Health Author-Name: Ostro, B.D. Author-Name: Lipsett, M.J. Author-Name: Wiener, M.B. Author-Name: Selner, J.C. Year: 1991 Volume: 81 Issue: 6 Pages: 694-702 Abstract: Background: Controlled exposure studies suggest that asthmatics may be more sensitive to the respiratory effects of acidic aerosols than individuals without asthma. This study investigates whether acidic aerosols and other air pollutants are associated with respiratory symptoms in free-living asthmatics. Methods: Daily concentrations of hydrogen ion (H+), nitric acid, fine particulates, sulfates and nitrates were obtained during an intensive air monitoring effort in Denver, Colorado, in the winter of 1987-88. A panel of 207 asthmatics recorded respiratory symptoms, frequency of medication use, and related information in daily diaries. We used a multiple regression time-series model to analyze which air pollutants, if any, were associated with health outcomes reported by study participants. Results: Airborne H+ was found to be significantly associated with several indicators of asthma status, including moderate or severe cough and shortness of breath. Cough was also associated with fine particulates, and shortness of breath with sulfates. Incorporating the participants' time spent outside and exercise intensity into the daily measure of exposure strengthened the association between these pollutants and asthmatic symptoms. Nitric acid and nitrates were not significantly associated with any respiratory symptom analyzed. Conclusions: In this population of asthmatics, several outdoor air pollutants, particularly airborne acidity, were associated with daily respiratory symptoms. Handle: RePEc:aph:ajpbhl:1991:81:6:694-702_3 Template-Type: ReDIF-Article 1.0 Title: Sociodemographic distribution of gonorrhea incidence: implications for prevention and behavioral research. Journal: American Journal of Public Health Author-Name: Rice, R.J. Author-Name: Roberts, P.L. Author-Name: Handsfield, H.H. Author-Name: Holmes, K.K. Year: 1991 Volume: 81 Issue: 10 Pages: 1252-1258 Abstract: BACKGROUND. Despite a declining incidence during the AIDS era, gonorrhea remains the most frequently reported communicable disease in the United States. METHODS. During 1986 and 1987 we supplemented gonorrhea case reporting with laboratory surveillance in King County, Washington. Incidence rates were correlated with demographic variables. RESULTS. Overall incidence of gonorrhea was similar for men and women, but highest for 16- to 21-year-old females and urban Seattle residents. Incidence rates by ethnicity were Blacks, 3033; Native Americans, 843; Hispanics, 617; Asians, 190; and Whites, 121. Census tracts representing the lowest socioeconomic status (SES) quartile accounted for 58% of reported gonorrhea. Black female teenagers residing in the lowest SES urban areas had highest incidence rates: aged 14 to 15, 3.4%; 16 to 17, 10.4%; 18, 17.0%; and 19, 15.4%. Rates in female teenagers were even higher after adjustment for estimated proportion of those who were sexually experienced. CONCLUSIONS. Gonorrhea incidence is associated with age, gender, ethnicity, SES, and residence. Identification of populations at highest risk for gonorrhea can direct interventions against all sexually transmitted diseases. Clearly, interventions to alter high-risk behaviors must be initiated in early adolescence. Handle: RePEc:aph:ajpbhl:1991:81:10:1252-1258_0 Template-Type: ReDIF-Article 1.0 Title: Self-confidence enhancement: a new anti-tobacco approach in South Africa. Journal: American Journal of Public Health Author-Name: Hunter, S.M. Author-Name: Steyn, K.K. Author-Name: Yach, D. Author-Name: Sipamla, N. Year: 1991 Volume: 81 Issue: 7 Pages: 928-929 Handle: RePEc:aph:ajpbhl:1991:81:7:928-929_5 Template-Type: ReDIF-Article 1.0 Title: Regression-adjusted small area estimates of functional dependency in the noninstitutionalized American population age 65 and over Journal: American Journal of Public Health Author-Name: Elston, J.M. Author-Name: Koch, G.G. Author-Name: Weissert, W.G. Year: 1991 Volume: 81 Issue: 3 Pages: 335-343 Abstract: Health planning efforts for the population age 65 and over have been hampered continually by the lack of reliable estimates of the noninstitutionalized long-term care population. Until recently national estimates were virtually nonexistent, and reliable small area estimates remain unavailable. However, with the recent publication of several national surveys and the 1990 Census, synthetic estimates can be made for states and counties by using multivariate methods to model functional dependency at the national level, and then applying the predicted probabilities to corresponding state and county data. Using the 1984 National Health Interview Survey's Supplement on Aging and the 1986 Area Health Resources File System, we have produced log-linear regression models that include demographic and contextual variables as predictors of functional dependency among the noninstitutionalized population age 65 and over. Age, sex, race, and the percent of the 65 and over population who reside in poverty were found to be significant predictors of functional dependency. Applying these models to 1986 Medicare Enrollment Statistics, regression-adjusted synthetic estimates of two levels of functional dependency were produced for all states and - as examples of how the rates can be used to produce additional synthetic estimates - the largest county in each state. We also produced point estimates and standard errors for the national prevalence of functional dependency among the noninstitutionalized population age 65 and over. Handle: RePEc:aph:ajpbhl:1991:81:3:335-343_5 Template-Type: ReDIF-Article 1.0 Title: The United Mine Workers of American and the recognition of occupational respiratory diseases, 1902-1968. Journal: American Journal of Public Health Author-Name: Derickson, A. Year: 1991 Volume: 81 Issue: 6 Pages: 782-790 Abstract: This study examines the early efforts of the United Mine Workers of America to illuminate the problem of occupational respiratory diseases in the coal fields. The union used the hearings of the US Anthracite Coal Strike Commission of 1902-3 to draw public attention to "miners' asthma." In 1915, it began to agitate for the provision of workers' compensation benefits for victims of this disorder. Throughout the 1950s and 1960s, the union's Welfare and Retirement Fund disseminated information on advances in understanding chronic pulmonary diseases of mining. In particular, the miners' fund promoted the British conceptualization of a distinctive coal workers' pneumoconiosis. At the same time, the staff of the union health plan pressed the US Public Health Service and the Pennsylvania Department of Health to investigate the prevalence of occupational respiratory diseases among bituminous miners. Taken together, these endeavors contributed significantly to growing recognition of the severity and extent of this important public health problem and thus helped lay the foundation for the Federal Coal Mine Health and Safety Act of 1969. Handle: RePEc:aph:ajpbhl:1991:81:6:782-790_2 Template-Type: ReDIF-Article 1.0 Title: Survival trends of people with AIDS in Washington State Journal: American Journal of Public Health Author-Name: Lafferty, W.E. Author-Name: Glidden, D. Author-Name: Hopkins, S.G. Year: 1991 Volume: 81 Issue: 2 Pages: 217-219 Abstract: Survival rates of 609 cases of acquired immunodeficiency syndrome (AIDS) in Washington State diagnosed between 1982 and 1987 according to pre-1987 AIDS surveillance definition were analyzed. People with a primary diagnosis of Kaposi's sarcoma survived longer than those with Pneumocystis carinii pneumonia. Both groups survived longer than those with other diagnoses. Median survival increased from 11.3, to 12.5, to 20.8 months for cases diagnosed in or before 1985, during 1986, and during 1987, respectively. Handle: RePEc:aph:ajpbhl:1991:81:2:217-219_4 Template-Type: ReDIF-Article 1.0 Title: An evaluation of the use of the Statewide Planning and Research Cooperative System of New York State as a resource planning tool for HIV infection Journal: American Journal of Public Health Author-Name: Kaufman, G.I. Author-Name: DiFerdinando Jr., G.T. Author-Name: Gottesman, S.E. Year: 1991 Volume: 81 Issue: 2 Pages: 215-217 Abstract: Hospital discharge records of patients with Pneumocystis carinii pneumonia (PCP) in New York State were studied to determine whether cases of human immunodeficiency virus (HIV) infection were identified. We estimate that as many as 13 percent of hospitalizations of patients with PCP in 1987 and 10 percent of those in 1988 were not appropriately identified as HIV related. Identification of PCP as HIV related was a function of a hospital's volume of PCP admissions. Handle: RePEc:aph:ajpbhl:1991:81:2:215-217_1 Template-Type: ReDIF-Article 1.0 Title: Long-term care for the functionally dependent elderly Journal: American Journal of Public Health Author-Name: Hing, E. Author-Name: Bloom, B. Year: 1991 Volume: 81 Issue: 2 Pages: 223-225 Handle: RePEc:aph:ajpbhl:1991:81:2:223-225_3 Template-Type: ReDIF-Article 1.0 Title: A measles outbreak at a college with a prematriculation immunization requirement Journal: American Journal of Public Health Author-Name: Hersh, B.S. Author-Name: Markowitz, L.E. Author-Name: Hoffman, R.E. Author-Name: Hoff, D.R. Author-Name: Doran, M.J. Author-Name: Fleishman, J.C. Author-Name: Preblud, S.R. Author-Name: Orenstein, W.A. Year: 1991 Volume: 81 Issue: 3 Pages: 360-364 Abstract: Background. In early 1988 an outbreak of 84 measles cases occurred at a college in Colorado in which over 98 percent of students had documentation of adequate measles immunity (physician diagnosed measles, receipt of live measles vaccine on or after the first birthday, or serologic evidence of immunity) due to an immunization requirement in effect since 1986. Methods. To examine potential risk factors for measles vaccine failure, we conducted a retrospective cohort study among students living in campus dormitories using student health service vaccination records. Results. Overall, 70 (83 percent) cases had been vaccinated at ≥12 months of age. Students living in campus dormitories were at increased risk for measles compared to students living off-campus (RR = 3.0, 95% CI = 2.0, 4.7). Students vaccinated at 12-14 months of age were at increased risk compared to those vaccinated at ≥15 months (RR = 3.1, 95% CI = 1.7, 5.7). Time since vaccination was not a risk factor for vaccine failure. Measles vaccine effectiveness was calculated to be 94% (95% CI = 86, 98) for vaccination at ≥15 months. Conclusions. As in secondary schools, measles outbreaks can occur among highly vaccinated college populations. Implementation of recent recommendations to require two doses of measles vaccine for college entrants should help reduce measles outbreaks in college populations. Handle: RePEc:aph:ajpbhl:1991:81:3:360-364_3 Template-Type: ReDIF-Article 1.0 Title: Dioxins and dibenzofurans in adipose tissue of US Vietnam veterans and controls Journal: American Journal of Public Health Author-Name: Kang, H.K. Author-Name: Watanabe, K.K. Author-Name: Breen, J. Author-Name: Remmers, J. Author-Name: Conomos, M.G. Author-Name: Stanley, J. Author-Name: Flicker, M. Year: 1991 Volume: 81 Issue: 3 Pages: 344-349 Abstract: The primary reason for concern about the adverse effects of exposure to Agent Orange is attributable to its toxic contaminant, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) or dioxin. We studied adipose tissues from 36 Vietnam veterans, a similar group of 79 non-Vietnam veterans, and 80 civilians; the tissue specimens were selected from the 8,000 archived tissues collected from the non-institutionalized general population by the US Environmental Protection Agency. The geometric mean (± standard deviation) dioxin levels in adipose tissue for Vietnam veterans, non-Vietnam veterans, and civilian controls were 11.7 (± 1.7), 10.9 (± 1.7), and 12.4 (± 1.9) parts per trillion on a lipid weight basis, respectively. The mean levels for these groups were not significantly different from each other with or without adjustment for age of individuals, body mass index, and specimen collection year. In addition, none of the surrogate measures of Agent Orange exposure such as military branch, service within specific geographic region, military occupation, and troop location in relation to recorded Agent Orange spray was associated with the dioxin levels in adipose tissue of Vietnam veterans. Our results suggest that heavy exposure to Agent Orange or dioxin for most US troops was unlikely. Handle: RePEc:aph:ajpbhl:1991:81:3:344-349_2 Template-Type: ReDIF-Article 1.0 Title: AIDS-related knowledge, sexual behavior, and condom use among men and women in Kinshasa, Zaire Journal: American Journal of Public Health Author-Name: Bertrand, J.T. Author-Name: Makani, B. Author-Name: Hassig, S.E. Author-Name: Niwembo, K.L. Author-Name: Djunghu, B. Author-Name: Muanda, M. Author-Name: Chirhamolekwa, C. Year: 1991 Volume: 81 Issue: 1 Pages: 53-58 Abstract: This study was conducted in 1988 among a random sample of 6,625 men and women of reproductive age in all 24 administrative zones of Kinshasa, the capital city of Zaire, to determine existing levels of knowledge regarding AIDS (acquired immunodeficiency syndrome), sexual behavior, knowledge and use of condoms in marital and extramarital relations; perceived risk of AIDS, and attitudes toward testing for the human immunodeficiency virus (HIV). Awareness of AIDS is almost universal, and the vast majority know the four main modes of transmission. Almost half believed in transmission by mosquitoes and in a vaccine or cure for AIDS. The majority of male respondents knew of condoms, but negative attitudes toward condom use are widespread, and few respondents perceived them to play a central role in combatting AIDS. Handle: RePEc:aph:ajpbhl:1991:81:1:53-58_5 Template-Type: ReDIF-Article 1.0 Title: Cuba's response to the HIV epidemic Journal: American Journal of Public Health Author-Name: Perez-Stable, E.J. Year: 1991 Volume: 81 Issue: 5 Pages: 563-567 Abstract: Background: Cuba's response to the human immunodeficiency virus (HIV) epidemic has been to conduct mass testing of the population to ascertain seroprevalence, to enforce mandatory relative quarantine of persons testing positive, and to implement educational interventions using media and school-based programs. Methods: Interview with the Vice-Minister of Health and review of available data. Results: Reports to date show a very low seroprevalence rate without evidence of a widespread epidemic. Sexual contact with foreign-born persons is the primary risk factor. Possible advantages of Cuba's policy include rapid reduction in the risk of HIV transmission by infected blood products, an opportunity for focused education and secondary prevention, and limitation of new infections. Possible disadvantages include the restriction of individual freedom in those who are not guilty of any illegal act, quarantine of persons with false positive HIV tests, and ongoing transmission because of the incomplete nature of the quarantine. The policy is expensive and may displace other public health priorities. The content of the media-based educational interventions has emphasized rational medical information in unimaginative formats with a limited focus on prevention. Conclusions: The issue of personal responsibility for behavioral change versus government imposed regulations is at the core of Cuba's HIV policy. The quarantine policy may paradoxically permit most Cubans to feel that they are personally invulnerable to the HIV epidemic. Handle: RePEc:aph:ajpbhl:1991:81:5:563-567_9 Template-Type: ReDIF-Article 1.0 Title: Risk assessment and control of waterborne giardiasis Journal: American Journal of Public Health Author-Name: Rose, J.B. Author-Name: Haas, C.N. Author-Name: Regli, S. Year: 1991 Volume: 81 Issue: 6 Pages: 709-713 Abstract: Background: Waterborne giardiasis has been increasing in the United States with 95 outbreaks reported over the last 25 years. The Safe Drinking Water Act has mandated control of this pathogen. Methods: A risk assessment model was developed to estimate risk of infection after exposure to treated waters containing varying levels of Giardia cysts. The model was defined by a dose-response curve developed from human feeding studies for Giardia and assumed 2L of water consumption per day. Data on concentrations and distribution of the organism in source waters were used to assess exposure after varying reductions achieved through treatment. Results: In surveys reporting prevalence and levels of Giardia cyst contamination, average levels of cysts in surface waters ranged from 0.33 to 104/100L; from pristine watersheds (protected from all human activity) 0.6 to 5/100L. Yearly risks were 4.8 x 10-3 for systems using polluted waters and 1.3 x 10-4 for pristine waters with a 10-3 treatment reduction. Conclusion: Public Health officials will need to work with the water industry to ensure a risk of less than 1/10,000 for source waters with 0.7 to 70 cysts per 100 liters through treatment achieving reduction of 10-3 to 10-5, respectively, of Giardia cysts. Handle: RePEc:aph:ajpbhl:1991:81:6:709-713_9 Template-Type: ReDIF-Article 1.0 Title: Does increased detection account for the rising incidence of breast cancer? Journal: American Journal of Public Health Author-Name: Liff, J.M. Author-Name: Sung, J.F.C. Author-Name: Chow, W.-H. Author-Name: Greenberg, R.S. Author-Name: Flanders, W.D. Year: 1991 Volume: 81 Issue: 4 Pages: 462-465 Abstract: Background: The incidence of breast cancer has been increasing over time in the United States. Methods: To determine the role of screening in this increase, trends in the incidence of in situ and invasive carcinoma of the breast were evaluated using records of the metropolitan Atlanta SEER program between 1979 and 1986. From a sample of records, evidence of symptoms and mammographic screening prior to diagnosis was recorded. Results: The average annual age-adjusted incidence of invasive disease rose 29 percent among Whites and 41 percent among Blacks. Incidence increased in all age groups. A trend towards earlier detection of invasive disease was found. Asymptomatic tumors accounted for only 40 percent of the increased incidence among whites and 25 percent of the increased incidence among blacks, with mammography as the principal contributing procedure. Conclusions: These data suggest that increased detection accounts for some but not all of the rising incidence of breast cancer in the United States. Handle: RePEc:aph:ajpbhl:1991:81:4:462-465_8 Template-Type: ReDIF-Article 1.0 Title: V. Projection of AIDS incidence in women in New York State Journal: American Journal of Public Health Author-Name: Lessner, L. Year: 1991 Volume: 81 Issue: SUPPL. Pages: 30-34 Abstract: The results of the Newborn HIV Seroprevalence Study in New York State for 1988 were used to estimate the number of human immunodeficiency virus (HIV)-infected women of childbearing age in 1988. The estimate was accomplished for each of 80 age, racial/ethnic, and geographic strata by dividing the number of seropositive newborns by the 1988 estimated fertility rate. Summing across strata yielded a total of 23,430 infected women age 15 to 44 years in 1988. From this estimate a tree model was used to estimate the number of women infected during 1981-1988. Back calculation was used to distribute these infections over time, and the selected incubation distribution was used to estimate future AIDS cases for this population: 8,295 cases by 1993. Handle: RePEc:aph:ajpbhl:1991:81:SUPPL.:30-34_3 Template-Type: ReDIF-Article 1.0 Title: Lyme borreliosis in an inner-city park in baltimore [1] Journal: American Journal of Public Health Author-Name: Schwartz, B.S. Author-Name: Hofmeister, E. Author-Name: Glass, G.E. Author-Name: Arthur, R.R. Author-Name: Childs, J.E. Author-Name: Cranfield, M.R. Year: 1991 Volume: 81 Issue: 6 Pages: 803-804 Handle: RePEc:aph:ajpbhl:1991:81:6:803-804_5 Template-Type: ReDIF-Article 1.0 Title: Congenital syphilis not an artifact [2] Journal: American Journal of Public Health Author-Name: Cohen, D.A. Author-Name: Mascola, L. Year: 1991 Volume: 81 Issue: 4 Pages: 513-514 Handle: RePEc:aph:ajpbhl:1991:81:4:513-514_9 Template-Type: ReDIF-Article 1.0 Title: The donation and sale of blood by intravenous drug users Journal: American Journal of Public Health Author-Name: Chitwood, D.D. Author-Name: Page, J.B. Author-Name: Comerford, M. Author-Name: Inciardi, J.A. Author-Name: McCoy, C.B. Author-Name: Trapido, E. Author-Name: Lai, S. Year: 1991 Volume: 81 Issue: 5 Pages: 631-633 Abstract: In spite of efforts to dissuade intravenous drug users (IVDUs) from donating or selling blood, some continue to do so. As part of a longitudinal study, 915 IVDUs in South Florida were interviewed concerning their history of donation or sale of blood and tested for antibodies to HIV-1 and HTLV-I/II. Approximately 17 percent had either donated or sold blood during 1985 through 1988; most contributors (80.4 percent) sold to commercial blood services. IVDUs who had donated/sold blood were more likely to be male and not in drug treatment than were those who had not contributed blood. IVDUs not in treatment at the time of interview were more likely than IVDUs in treatment to have sold blood. Of those who had donated/sold blood since 1985, 19.6 percent subsequently tested positive for antibodies to HIV-1 and 5.7 percent were positive for antibodies to HTLV-I/II. Increased effort is required to screen prospective donors and sellers, particularly at commercial blood banks. Handle: RePEc:aph:ajpbhl:1991:81:5:631-633_8 Template-Type: ReDIF-Article 1.0 Title: Why do child mortality rates fall? An analysis of the Nicaraguan experience Journal: American Journal of Public Health Author-Name: Sandiford, P. Author-Name: Morales, P. Author-Name: Gorter, A. Author-Name: Coyle, E. Author-Name: Smith, G.D. Year: 1991 Volume: 81 Issue: 1 Pages: 30-37 Abstract: A comprehensive review of available sources of mortality data was undertaken to document the changes that have occurred in infant mortality in Nicaragua over the last three decades. It was found that a rapid fall in infant mortality commenced in the early 1970s and has continued steadily since. Trends in several different factors which might have led to this breakthrough were examined including: income, nutrition, breastfeeding practices, maternal education, immunizations, access to health services, provision of water supplies and sanitation, and anti-malarial programs. Of these, improved access to health services appears to have been the most important factor. At a time when the number of hospital beds per capita was dropping, increasing numbers of health care professionals, particularly nurses, were becoming available to staff primary health care facilities built in the 1960s. These were provided at least partly in response to the growing political turmoil enveloping the nation at that time. Certain Nicaraguan cultural attributes may be added to the impact of the reforms. Efforts in the field of public health made since the 1979 insurrection appear to have maintained the decline in child mortality. Handle: RePEc:aph:ajpbhl:1991:81:1:30-37_4 Template-Type: ReDIF-Article 1.0 Title: Effectiveness of source documents for identifying fatal occupational injuries: A synthesis of studies Journal: American Journal of Public Health Author-Name: Stout, N. Author-Name: Bell, C. Year: 1991 Volume: 81 Issue: 6 Pages: 725-728 Abstract: Background: The complete and accurate identification of fatal occupational injuries among the US work force is an important first step in developing work injury prevention efforts. Numerous sources of information, such as death certificates, Workers' Compensation files, Occupational Safety and Health Administration (OSHA) files, medical examiner records, state health and labor department reports, and various combinations of these, have been used to identify cases of work-related fatal injuries. Recent studies have questioned the effectiveness of these sources for identifying such cases. Methods: At least 10 studies have used multiple sources to define the universe of fatal work injuries within a state and to determine the capture rates, or proportion of the universe identified, by each source. Results of these studies, which are not all available in published literature, are summarized here in a format that allows researchers to readily compare the ascertainment capabilities of the sources. Results: The overall average capture rates of sources were as follows: death certificates, 81%; medical examiner records, 61%; Workers' Compensation reports, 57%; and OSHA reports 32%. Variations by state and value added through the use of multiple sources are presented and discussed. Conclusions: This meta-analysis of 10 state-based studies summarizes the effectiveness of various source documents for capturing cases of fatal occupational injuries to help researchers make informed decisions when designing occupational injury surveillance systems. Handle: RePEc:aph:ajpbhl:1991:81:6:725-728_4 Template-Type: ReDIF-Article 1.0 Title: X. The AIDS epidemic in New York State Journal: American Journal of Public Health Author-Name: Smith, P.F. Author-Name: Mikl, J. Author-Name: Hyde, S. Author-Name: Morse, D.L. Year: 1991 Volume: 81 Issue: SUPPL. Pages: 54-60 Abstract: New York State has reported more AIDS cases (26,576) through November 1989 than any other state, accounting for 23 percent of all reported cases in the nation at the time. New York City has reported 22,231 (84 percent) of the state-wide cases. The epidemiology of AIDS in New York State has been easily influenced by the large number of cases among IVDUs. Whereas intravenous drug use accounts for 16 percent of adult/adolescent cases in the rest of the nation, it accounts for 39 percent of the cases in New York State. Intravenous drug use is the leading exposure category among racial minorities, with a disproportionately high rate of cases among Blacks and Hispanics. The epidemic among women and children has also been severe, resulting from intravenous drug use by women, heterosexual transmission from drug users to women, and perinatal transmission to their children. Handle: RePEc:aph:ajpbhl:1991:81:SUPPL.:54-60_4 Template-Type: ReDIF-Article 1.0 Title: Decline in hepatitis B cases [3] Journal: American Journal of Public Health Author-Name: Taylor, F. Year: 1991 Volume: 81 Issue: 2 Pages: 221-222 Handle: RePEc:aph:ajpbhl:1991:81:2:221-222_8 Template-Type: ReDIF-Article 1.0 Title: It's only oil, it's only money!!! [3] Journal: American Journal of Public Health Author-Name: Sherman, J.D. Year: 1991 Volume: 81 Issue: 1 Pages: 113 Handle: RePEc:aph:ajpbhl:1991:81:1:113_0 Template-Type: ReDIF-Article 1.0 Title: Benzodiazepine anti-anxiety agents: Prevalence and correlates of use in a southern community Journal: American Journal of Public Health Author-Name: Swartz, M. Author-Name: Landerman, R. Author-Name: George, L.K. Author-Name: Melville, M.L. Author-Name: Blazer, D. Author-Name: Smith, K. Year: 1991 Volume: 81 Issue: 5 Pages: 592-596 Abstract: Background: Benzodiazepine anti-anxiety agents are the most widely prescribed psychotherapeutic drugs in the United States today. Recent evidence, however, suggests that their use may be decreasing. Methods: We examine the population prevalence and correlates of use of benzodiazepine anxiolytics at the Duke site of the NIMH-sponsored Epidemiologic Catchment Area project. Results: Bivariate analysis of use patterns for the drugs revealed demographic predictors similar to those reported in previous studies: increased likelihood of use by the elderly, Whites, women, the less educated, and the separated or divorced. Use is also associated with symptoms of psychic distress, negative life events, use of health care services, and diagnoses of affective disorder, agoraphobia with panic, and panic disorder. Age, sex, race, education, and marital status remain associated with non-hypnotic benzodiazepine use in a logistic regression analysis. Conclusions: Multivariate analyses of these data indicate that when potential confounding factors are controlled, age, sex, race, education, and marital status are significantly related to benzodiazepine anxiolytic use but the effects of sex and education are mediated by intervening variables. Implications of these findings are discussed particularly in relation to high levels of use in the elderly. Handle: RePEc:aph:ajpbhl:1991:81:5:592-596_7 Template-Type: ReDIF-Article 1.0 Title: Using a state cancer registry to increase screening behaviors of sisters and daughters of breast cancer patients Journal: American Journal of Public Health Author-Name: Houts, P.S. Author-Name: Wojtkowiak, S.L. Author-Name: Simmonds, M.A. Author-Name: Weinberg, G.B. Author-Name: Heitjan, D.F. Year: 1991 Volume: 81 Issue: 3 Pages: 386-388 Abstract: The Pennsylvania Cancer Registry was used to contact breast cancer patients and, through them, their adult sisters and daughters. The sisters and daughters were counseled concerning their higher than average risks for breast cancer and their need for mammography and breast self-examination. Results showed a 9 percent increase in mammography and a 10 percent increase in breast self-examination rates for the counseled over control group. Costs were $49 per counseled sister or daughter indicating a need to increase cost effectiveness before implementation is practical. Handle: RePEc:aph:ajpbhl:1991:81:3:386-388_7 Template-Type: ReDIF-Article 1.0 Title: Childhood lead poisoning: A disease for the history texts Journal: American Journal of Public Health Author-Name: Needleman, H.L. Year: 1991 Volume: 81 Issue: 6 Pages: 685-687 Handle: RePEc:aph:ajpbhl:1991:81:6:685-687_0 Template-Type: ReDIF-Article 1.0 Title: Congenital syphilis criteria [1] Journal: American Journal of Public Health Author-Name: Htoo, M. Author-Name: Schultz, S. Author-Name: Zenker, P.N. Author-Name: Berman, S.M. Year: 1991 Volume: 81 Issue: 1 Pages: 111-112 Handle: RePEc:aph:ajpbhl:1991:81:1:111-112_2 Template-Type: ReDIF-Article 1.0 Title: III. Comparison of newborn screening records and birth certificates to estimate bias in newborn HIV serosurveys Journal: American Journal of Public Health Author-Name: Pass, K.A. Author-Name: Schedlbauer, L.M. Author-Name: MacCubbin, P.A. Author-Name: Glebatis, D.M. Year: 1991 Volume: 81 Issue: SUPPL. Pages: 22-24 Abstract: Implicit in the New York State Newborn HIV Seroprevalence Study is the assumption that newborns of all New York State residents are tested for human immunodeficiency virus (HIV) antibodies. We examined this assumption by describing that part of the 1988 New York newborn population not tested in the HIV seroprevalence study and assessing any bias contributed by this group. Of the expected total HIV specimens 1.5 percent were never received by the Newborn Screening Program, 0.5 percent were invalid specimens for which no repeat specimen could be obtained, and 1.7 percent were unsuitable or of insufficient quantity to be tested for HIV antibody. Thus 96.3 percent of all 1988 New York newborns were tested for HIV antibody. Black infants from New York City and low-birthweight infants were represented disproportionately among those not tested. Assignment of all untested newborn to HIV-positive status increased the seroprevalence rate 17 percent (0.64 percent to 0.75 percent). Handle: RePEc:aph:ajpbhl:1991:81:SUPPL.:22-24_3 Template-Type: ReDIF-Article 1.0 Title: Does maternal tobacco smoking modify the effect of alcohol on fetal growth? Journal: American Journal of Public Health Author-Name: Olsen, J. Author-Name: da Costa Pereira, A. Author-Name: Olsen, S.F. Year: 1991 Volume: 81 Issue: 1 Pages: 69-73 Abstract: Smoking and drinking habits were registered by a self-administered questionnaire in 36th week of gestation in 11,698 pregnant women, more than 80 percent of all such women in two Danish cities 1984-87. Alcohol consumption of 120 g/week or more was associated with a greater reduction in the average birthweight in the babies of smokers than of nonsmokers (about 40 grams for the nonsmokers and about 200 grams for the smokers). This is particularly striking considering that the average birthweight for smokers is lower than for non-smokers. A birthweight difference of more than 500 grams was found between babies of mothers who neither smoked nor drank and mothers who smoked and drank heavily. Our data suggest that women's smoking habits should be taken into consideration when giving pregnant women advice about drinking. Handle: RePEc:aph:ajpbhl:1991:81:1:69-73_3 Template-Type: ReDIF-Article 1.0 Title: The yield of cholesterol screening in an urban black community Journal: American Journal of Public Health Author-Name: Russell, N.K. Author-Name: Becker, D.M. Author-Name: Finney, C.P. Author-Name: Moses, H. Year: 1991 Volume: 81 Issue: 4 Pages: 448-451 Abstract: Background: While the distribution of cholesterol levels have been well studied in the general population, little is known about cholesterol and other cardiovascular disease risk factors in screenings held in an urban Black community. This study was designed to determine the yield of cholesterol screening in this community. Methods: Screening took place in eight community sites. Serum total cholesterol was measured using a rapid capillary technique. Blood pressure was taken according to national guidelines and the average of two to three measurements were used. Standard interviews were used to determine the presence of cardiovascular risk factors by history. Results: Of the 562 individuals screened, 44.9 percent had cholesterol levels requiring referral for follow-up care. Of those with total cholesterol ≥ 6.21 mmol/L, 66.4 percent were previously undetected and more than half also had blood pressure levels ≥140/90 mmHg on screening; 45 percent of all participants had blood pressure ≥140/90 on screenings. Of those with a history of elevated total cholesterol levels, none had levels below 5.17 mmol/L at the time of screening. Conclusions: Multiple risk factors are highly prevalent in the urban Black community during cholesterol screening programs. Findings suggest the need for cholesterol programs incorporating blood pressure screening in the urban Black community. Handle: RePEc:aph:ajpbhl:1991:81:4:448-451_6 Template-Type: ReDIF-Article 1.0 Title: Effects of a worksite nonsmoking policy: Evidence for increased cessation Journal: American Journal of Public Health Author-Name: Sorsensen, G. Author-Name: Rigotti, N. Author-Name: Rosen, A. Author-Name: Pinney, J. Author-Name: Prible, R. Year: 1991 Volume: 81 Issue: 2 Pages: 202-204 Abstract: A random sample of employees was surveyed 20 months after a nonsmoking policy was implemented at the New England Telephone Company in 1986. Overall, 21 percent of respondents who were smoking at the time they heard about the policy had quit smoking; 42 percent of quitters said they stopped smoking because of the policy. Cessation was highest among those who reported less smoke in their work area, but was not related to participation in cessation programs. This study suggests that worksite nonsmoking policies may have favorable effects on smoking cessation. Handle: RePEc:aph:ajpbhl:1991:81:2:202-204_8 Template-Type: ReDIF-Article 1.0 Title: Motorcycle licensure, ownership, and injury crash involvement Journal: American Journal of Public Health Author-Name: Kraus, J.F. Author-Name: Anderson, C. Author-Name: Zador, P. Author-Name: Williams, A. Author-Name: Arzemanian, S. Author-Name: Li, W. Author-Name: Salatka, M. Year: 1991 Volume: 81 Issue: 2 Pages: 172-176 Abstract: The interrelationships among motorcycle licensure, ownership, and injury crash involvement were investigated in a sample of 2,723 motorcycle drivers severely or fatally injured in California in 1985-86. Owners of motorcycles in such crashes (''driver-owners'') were less likely to have valid licenses than a random sample of motorcycle owners who had not been in crashes (42 vs. 57 percent). Thirty-three percent of the crash-involved drivers had valid motorcycle driver's licenses; 39 percent were operating motorcycles they did not own (''driver-nonowners''). Driver-nonowners were less likely to be validly licensed than driver-owners (20 percent vs. 44 percent). The licensing rate of crash-involved driver-nonowners was 15 percent if the owner was also unlicensed. Rates of valid licensure were lowest among the youngest drivers. Virtually no crash-involved driver-nonowners under age 21 were licensed in cases in which the owner was also young and unlicensed. Handle: RePEc:aph:ajpbhl:1991:81:2:172-176_9 Template-Type: ReDIF-Article 1.0 Title: Salmonella egg survey in Hawaii: Evidence for routine bacterial surveillance Journal: American Journal of Public Health Author-Name: Ching-Lee, M.R. Author-Name: Katz, A.R. Author-Name: Sasaki, D.M. Author-Name: Minette, H.P. Year: 1991 Volume: 81 Issue: 6 Pages: 764-766 Abstract: One hundred and six dozen eggs, representing 12 brands, were purchased from Oahu supermarkets and cultured for Salmonella using standard FDA (Food and Drug Administration) microbiological techniques. Two enrichment incubation temperatures were used to improve culture sensitivity. Ten cartons (9.4 percent) of the 106 dozen samples had shells positive for Salmonella. Seven of the 10 were traced to a single egg processor. Inspection of the facility led to the discovery of malfunctioning equipment used in the egg washing and sanitation process. Handle: RePEc:aph:ajpbhl:1991:81:6:764-766_0 Template-Type: ReDIF-Article 1.0 Title: Are people more health conscious? A longitudinal study of one community Journal: American Journal of Public Health Author-Name: Niknian, M. Author-Name: Lefebvre, R.C. Author-Name: Carleton, R.A. Year: 1991 Volume: 81 Issue: 2 Pages: 205-207 Abstract: Secular changes in cardiovascular health awareness, knowledge and behavior were observed in four biennial cross-sectional surveys and a cohort survey in a New England community. These changes are not related to more health promotion activities in the social milieu of respondents, but are more likely due to national mass media health campaigns, the effects of which may influence outcomes of community-based cardiovascular disease prevention studies. Handle: RePEc:aph:ajpbhl:1991:81:2:205-207_7 Template-Type: ReDIF-Article 1.0 Title: Pesticide poisoning surveillance through regional poison control centers Journal: American Journal of Public Health Author-Name: Olson, D.K. Author-Name: Sax, L. Author-Name: Gunderson, P. Author-Name: Sioris, L. Year: 1991 Volume: 81 Issue: 6 Pages: 750-753 Abstract: The purpose of this study is to describe pesticide exposure in the population of callers to Minnesota Regional Poison Centers. Case files from 1988 reporting pesticide exposure to humans were identified in cooperation with the Minnesota Center for Health Statistics. Data analysis was conducted by computer using SAS statistical package. Of the 1,428 case files indicating pesticide as the primary substance of exposure to Minnesota residents, a mean age of 5 years (range, one month to 85 years) was identified; 50 percent of all cases were below age 3 years. Males accounted for 1.3 times as many cases as females. Insecticide was identified in the largest percentage of case files (74 percent) followed by herbicide (12 percent), rodenticide (11 percent) and fungicide-nonmedicinal (3 percent). Ingestion was the most common route of exposure; 85 percent of all calls originated from a residence. While insecticides are still the most common types of pesticide call, herbicide has surpassed insecticide in production and sales in the US. In this study, herbicide type exposure calls present a much different picture than other pesticide types. The usefulness of poison control centers for examination of pesticide poisoning is explored. Since reporting occurs coincidental with the exposure and its associated symptoms, each pesticide poisoning report could potentially serve as a true sentinel health event. Handle: RePEc:aph:ajpbhl:1991:81:6:750-753_0 Template-Type: ReDIF-Article 1.0 Title: Physical activity on the job and cancer in Missouri Journal: American Journal of Public Health Author-Name: Brownson, R.C. Author-Name: Chang, J.C. Author-Name: Davis, J.R. Author-Name: Smith, C.A. Year: 1991 Volume: 81 Issue: 5 Pages: 639-642 Abstract: We conducted a series of case-control studies to investigate the risks of 16 cancer types in relation to occupational physical activity. These studies were based on Missouri Cancer Registry data for 17,147 White male cancer patients registered between 1984 and 1989. Colon cancer risk was increased for both the moderate (odds ratio (OR) = 1.1; 95% confidence interval (CI) = 1.0, 1.3) and low (OR = 1.2; 95% CI = 1.0, 1.5) activity levels. Similar elevations were observed for prostate cancer at the moderate (OR = 1.1; 95% CI = 1.0, 1.3) and low (OR = 1.5; 95% CI = 1.2, 1.8) levels of activity, and for cancer of the testis at the low activity level (OR = 2.2; 95% CI = 1.3, 3.7). An opposite trend (p < 0.01) was noted for lung cancer, which showed decreased risk at the moderate (OR = 0.9; 95% CI = 0.8, 1.0) and low (OR = 0.8; 95% CI = 0.6, 0.9) activity levels. These associations suggest that further study of the relationship between physical activity and site-specific cancer risk is warranted. Handle: RePEc:aph:ajpbhl:1991:81:5:639-642_6 Template-Type: ReDIF-Article 1.0 Title: Hyperendemic urban blastomycosis Journal: American Journal of Public Health Author-Name: Manetti, A.C. Year: 1991 Volume: 81 Issue: 5 Pages: 633-636 Abstract: Within the United States, blastomycosis is primarily endemic in the Mississippi and Ohio River valleys, but reliable figures as to its prevalence and incidence are scarce. A review of pathology department files and medical records from three hospitals in Rockford, Illinois, revealed 32 documented cases of blastomycosis in an eight and one-half year period beginning in March 1981. Twenty-three of these cases were urban since they occurred within the Rockford census tract boundaries - an incidence more than 3.5 times greater than expected in an endemic area. Addresses of patients in 18 of the 23 cases were concentrated at the northeast and southwest ends of the city. Implications are discussed. Handle: RePEc:aph:ajpbhl:1991:81:5:633-636_6 Template-Type: ReDIF-Article 1.0 Title: The epidemiology of licit and illicit substance use among high school students in Greece Journal: American Journal of Public Health Author-Name: Kokkevi, A. Author-Name: Stefanis, C. Year: 1991 Volume: 81 Issue: 1 Pages: 48-52 Abstract: Findings on self-reported adolescent licit and illicit substance use are presented based on a nationwide 1984 probability sample of 11,058 Greek adolescent students ages 14-18 years old. Regular smoking and use of alcohol in the 30 days prior to the survey were reported by 22.3 percent and 82.8 percent, respectively. Nearly one-third of the students (30.3 percent) reported lifetime use of psychotropic drugs without prescription, without ever having used any illicit drug. Illicit drug use is less common in Greece than in other European and North American countries with a lifetime prevalence rate of 6 percent. Regular use of tobacco, alcohol, and illicit drugs was more common in males, while unprescribed use of licit psychotropic drugs prevailed in females. Regular smoking, drinking, and illicit drug use were associated with urbanization but not socioeconomic status. Between 1984 and 1988 in an Athenian subsample of schools there was a 20 percent increase in illicit drug use among males. Use of psychotropic drugs without prescription decreased much more than use of tobacco and alcohol. Handle: RePEc:aph:ajpbhl:1991:81:1:48-52_6 Template-Type: ReDIF-Article 1.0 Title: The UCLA population studies of CORD: X. A cohort study of changes in respiratory function associated with chronic exposure to SO(X), NO(X), and hydrocarbons Journal: American Journal of Public Health Author-Name: Detels, R. Author-Name: Tashkin, D.P. Author-Name: Sayre, J.W. Author-Name: Rokaw, S.N. Author-Name: Massey Jr., F.J. Author-Name: Coulson, A.H. Author-Name: Wegman, D.H. Year: 1991 Volume: 81 Issue: 3 Pages: 350-359 Abstract: Two never-smoking cohorts in Southern California, one in Lancaster (N = 2340) exposed only to moderate levels of oxidants and the other in Long Beach (N = 1326) exposed to high levels of SO(X), NO2, hydrocarbons and particulates completed spirometry and the single-breath nitrogen test five to six years apart. Forty-seven percent and 45 percent of the participants were retested. Mean results at baseline for those tested and not retested were similar. Loss to follow-up was primarily due to moving (39 percent and 47 percent). Every difference of consequence indicated greater deterioration in lung function in Long Beach. The level of significance of the difference was greatest, even in the youngest age groups, for ΔN2750-1250, suggesting that the earliest site of impairment may occur in the small airways. Greater deterioration in spirometric parameters was observed in every age group in Long Beach females above seven years of age at baseline and in Long Beach males above 15 years of age, suggesting that chronic exposure to the pollutant mix occurring in Long Beach ultimately adversely affects the large airways as well as small airways. Handle: RePEc:aph:ajpbhl:1991:81:3:350-359_2 Template-Type: ReDIF-Article 1.0 Title: Endemic giardiasis and municipal water supply Journal: American Journal of Public Health Author-Name: Fraser, G.G. Author-Name: Cooke, K.R. Year: 1991 Volume: 81 Issue: 6 Pages: 760-762 Abstract: To test the hypothesis that endemic giardiasis may be transmitted by unfiltered municipal water supplies, the incidence of laboratory-confirmed giardiasis was studied in a natural experiment due to the arrangement of the public water supply of Dunedin, New Zealand. The incidence rate ratio was 3.3 (90% CI = 1.1, 10.1) for the population receiving unfiltered (microstrained) water relative to that using sand filtered water. In a parallel case-control study of incident cases, the odds ratio for giardiasis and unfiltered (microstrained) water supply was 1.8 (90% CI = 0.5, 6.9). Handle: RePEc:aph:ajpbhl:1991:81:6:760-762_9 Template-Type: ReDIF-Article 1.0 Title: Agent Orange: Exposure and policy Journal: American Journal of Public Health Author-Name: Gough, M. Year: 1991 Volume: 81 Issue: 3 Pages: 289-290 Handle: RePEc:aph:ajpbhl:1991:81:3:289-290_2 Template-Type: ReDIF-Article 1.0 Title: Soft plastic bread packaging: Lead content and reuse by families Journal: American Journal of Public Health Author-Name: Weisel, C. Author-Name: Demak, M. Author-Name: Marcus, S. Author-Name: Goldstein, B.D. Year: 1991 Volume: 81 Issue: 6 Pages: 756-758 Abstract: The presence of lead in labels painted on soft plastic bread packaging was evaluated. Lead was detected on the outside of 17 of 18 soft plastic bread bags that were analyzed, with an average of 26 ± 6 mg per bag with lead. Of 106 families questioned, 16 percent of respondents reported turning the bags inside out before reusing for food storage, thus putting food in contact with the lead paint. We estimate that a weak acid, such as vinegar, could readily leach 100 μg of lead from a painted plastic bag within 10 minutes. Further, lead and other metals painted on food packaging of any type becomes part of the municipal waste stream subject to incineration and to landfilling. The use of lead in packaging presents an unnecessary risk to public health. Handle: RePEc:aph:ajpbhl:1991:81:6:756-758_8 Template-Type: ReDIF-Article 1.0 Title: Health policy: If you don't know where you're going, any road will take you Journal: American Journal of Public Health Author-Name: Sultz, H. Year: 1991 Volume: 81 Issue: 4 Pages: 418-420 Abstract: It is not surprising that our health care system seems stalled in a developmental time warp, insulated from pressures to change. Everybody knows what should be changed, but changed to what? There is no national health policy that provides the context to redesign the health care system or even plan its incremental improvement. The self-interest ethos of the 1980s allowed decades of health and social advances to be rescinded with hardly a whisper of outrage. The more sophisticated our medical technology became, the more indifferent was the response to the real health needs of our society. Neither a society nor a health care system can survive without virtue or a cause that supersedes individual interests. Our health care cannot progress without an articulated purpose, a common vision expressed as policy that eliminates ambiguity of purpose, ambivalence towards performance standards, conflicts of principles, and contradictions of goals. The challenge calls for great leadership - to define policies that reverse the decline in both the indices of health and the political will to address the public good. To attempt less would allow this country's health care system to go down any road the vagaries of our political process take it. Handle: RePEc:aph:ajpbhl:1991:81:4:418-420_2 Template-Type: ReDIF-Article 1.0 Title: Use of a medical center's computerized health care database for notifiable disease surveillance Journal: American Journal of Public Health Author-Name: Watkins, M. Author-Name: Lapham, S. Author-Name: Hoy, W. Year: 1991 Volume: 81 Issue: 5 Pages: 637-639 Abstract: The sensitivity of a medical center's inpatient and outpatient database to detect notifiable diseases was examined. Only 53 percent of inpatient and 7 percent of outpatient laboratory-confirmed cases of shigellosis, salmonellosis, giardiasis, and hepatitis were identified by an automated search for matching diagnosis codes. Reasons for lack of sensitivity include nonavailability of laboratory results at the time of diagnosis assignment, use of a standardized encounter form with limited preselected diagnosis codes, and pre-empting of the infectious disease diagnosis by other diagnoses. Handle: RePEc:aph:ajpbhl:1991:81:5:637-639_4 Template-Type: ReDIF-Article 1.0 Title: Neonatal diarrhea at a maternity hospital in Rangoon Journal: American Journal of Public Health Author-Name: Aye, D.T. Author-Name: Bact, D. Author-Name: Sack, D.A. Author-Name: Wachsmuth, I.K. Author-Name: Kyi, D.T. Author-Name: Thwe, S.M. Year: 1991 Volume: 81 Issue: 4 Pages: 480-481 Abstract: Between 1981 and 1986, 1,540 infants born at the Central Women's Hospital in Rangoon were transferred to the Sick Baby Unit because of diarrhea (15.4 per 1,000 live births). Rates among cesarean infants were five times as high as those of infants born vaginally (51.0 and 10.3 per 1000 live births, respectively). One hundred eighty-four of the infants with diarrhea died (case fatality rate = 12 percent). We conclude that neonatal diarrhea is endemic in this large maternity hospital in Burma, and that control efforts should be targeted especially to cesarean and low birthweight infants. Handle: RePEc:aph:ajpbhl:1991:81:4:480-481_8 Template-Type: ReDIF-Article 1.0 Title: Tracking progress toward national health objectives in the elderly: What do restricted activity days signify? Journal: American Journal of Public Health Author-Name: Scholes, D. Author-Name: LaCroix, A.Z. Author-Name: Wagner, E.H. Author-Name: Grothaus, L.C. Author-Name: Hecht, J.A. Year: 1991 Volume: 81 Issue: 4 Pages: 485-488 Abstract: Restricted activity days is the measure by which the 1990 health objectives for prevention of functional disability in older adults will be evaluated. Yet its significance in older populations is poorly understood. We evaluated its use as an outcome measure for a randomized trial designed to impact upon physical function in elderly HMO enrollees. As predicted, restricted activity days was more correlated with physical disability measures than with other health status measures. Distributional properties and rates of missing data were shortcomings. Handle: RePEc:aph:ajpbhl:1991:81:4:485-488_0 Template-Type: ReDIF-Article 1.0 Title: Longevity and left-handedness [1] Journal: American Journal of Public Health Author-Name: Kuhlemeier, K.V. Year: 1991 Volume: 81 Issue: 4 Pages: 513 Handle: RePEc:aph:ajpbhl:1991:81:4:513_8 Template-Type: ReDIF-Article 1.0 Title: Behavioral, health and psychosocial factors and risk for HIV infection among sexually active homosexual men: The Multicenter AIDS Cohort Study Journal: American Journal of Public Health Author-Name: Penkower, L. Author-Name: Dew, M.A. Author-Name: Kingsley, L. Author-Name: Becker, J.T. Author-Name: Satz, P. Author-Name: Schaerf, F.W. Author-Name: Sheridan, K. Year: 1991 Volume: 81 Issue: 2 Pages: 194-196 Abstract: We examined whether 644 homosexual men who engaged in receptive anal intercourse were at particularly elevated risk for seroconversion if they also possessed specific behavioral, health or psychosocial vulnerability characteristics. Of 11 potential factors examined, heavy drinking, moderate to heavy drug use, and younger age were significantly related to seroconversion. These variables were also associated with an increased number of sexual partners, anonymous sex, and failure to use condoms. Handle: RePEc:aph:ajpbhl:1991:81:2:194-196_1 Template-Type: ReDIF-Article 1.0 Title: A community-based study of the use of chiropractic services Journal: American Journal of Public Health Author-Name: Shekelle, P.G. Author-Name: Brook, R.H. Year: 1991 Volume: 81 Issue: 4 Pages: 439-442 Abstract: Background: Little population-based information is available on the use of chiropractice services. Methods: We analyzed data from the RAND Health Insurance Experiment (HIE), a community-based study of the use of health services. Insurance claim forms for all fee-for-service patients who completed the study were examined for all visits coded as being seen by a chiropractor. Services provided and patient-specified symptoms were taken from these forms. Population-based use rates were calculated for each HIE site. Use rates and services were calculated separately for first visits and repeat visits. Results: There were 5,279 persons who contributed 19,021 person-years of exposure during the study; 395 different persons used 7,873 chiropractic services for a visit rate of 41 per 100 person-years and rate of use of 7.5 percent. Forty-two percent of all visits were for pain in the back. Spinal manipulation accounted for 61 percent of all services provided. Compared to non-users, users tended to be White, middle-aged, married, and high school educated. Seven-fold geographic variations in the use of chiropractic services were seen. Conclusions: Chiropractors deliver a substantial amount of health care to the US population, and there are significant geographic variations in the rate and intensity of use of chiropractic services. Handle: RePEc:aph:ajpbhl:1991:81:4:439-442_5 Template-Type: ReDIF-Article 1.0 Title: Impact of work on the quality of life of community-residing young elderly Journal: American Journal of Public Health Author-Name: Ruchlin, H.S. Author-Name: Morris, J.N. Year: 1991 Volume: 81 Issue: 4 Pages: 498-500 Abstract: Using a random sample of 310 Massachusetts community-residing elderly between the ages of 65 and 74, this study investigates the relationship between employment status and quality of life using a modified version of the Spitzer Uniscale QL index. The odds of reporting the highest quality of life rating, after controlling for socioeconomic and health characteristics, was 3.51:1 for those who worked versus those who did not do so. Handle: RePEc:aph:ajpbhl:1991:81:4:498-500_5 Template-Type: ReDIF-Article 1.0 Title: Black-white differences in cancer prevention knowledge and behavior Journal: American Journal of Public Health Author-Name: Jepson, C. Author-Name: Kessler, L.G. Author-Name: Portnoy, B. Author-Name: Gibbs, T. Year: 1991 Volume: 81 Issue: 4 Pages: 501-504 Abstract: Data from the 1987 National Health Interview Survey Cancer Control Supplement were used to estimate multivariate logistic regression models of diet change, mammography utilization, stool blood test utilization, and smoking. Predictor variables included race, sex, age, income, dietary concerns, and four knowledge-related variables: education and three measures of cancer prevention knowledge. When knowledge variables were included in the models, race was not a significant predictor of behavior, with one exception: among women, Blacks were found to smoke less than Whites. Handle: RePEc:aph:ajpbhl:1991:81:4:501-504_9 Template-Type: ReDIF-Article 1.0 Title: Intake of tapwater and total water by pregnant and lactating women Journal: American Journal of Public Health Author-Name: Ershow, A.G. Author-Name: Brown, L.M. Author-Name: Cantor, K.P. Year: 1991 Volume: 81 Issue: 3 Pages: 328-334 Abstract: Background. Despite theoretically higher requirements for water due to physiologic demands of pregnancy and lactation, little is known of actual ranges of intake in pregnant and lactating women. Methods. Population-based estimates of total water and tapwater intake in women of reproductive age were derived using data from the 1977-78 USDA Nationwide Food Consumption Survey. Three-day average intakes were calculated for 188 pregnant women, 77 lactating women, and 6,201 non-pregnant, non-lactating control women. Results. Total water intake (mean ± SD) was 1,940 ± 686 g/day (median 1,835) for control women, 2,076 ± 743 g/day (median 1,928) for pregnant women and 2,242 ± 658 g/day (median 2,164) for lactating women. Tapwater intake was 1,157 ± 635 g/day (median 1,065) for control women, 1,189 ± 699 g/day (median 1,063) for pregnant women, and 1,310 ± 591 g/day (median 1,330) for lactating women. Total water intake was equal to or greater than 3,000 g/day among 7 percent of control women, 11 percent of pregnant women, and 13 percent of lactating women. Tapwater intake was equal to or greater than 2,000 g/day among 10 percent of control women, 15 percent of pregnant women, and 8 percent of lactating women. Conclusions. These results should be useful in estimating amounts of nutrients and toxic substances that women of reproductive age obtain through the water supply. Handle: RePEc:aph:ajpbhl:1991:81:3:328-334_2 Template-Type: ReDIF-Article 1.0 Title: Increased risk of ectopic pregnancy with maternal cigarette smoking Journal: American Journal of Public Health Author-Name: Coste, J. Author-Name: Job-Spira, N. Author-Name: Fernandez, H. Year: 1991 Volume: 81 Issue: 2 Pages: 199-201 Abstract: As part of a case-control study of ectopic pregnancy, we evaluated the potential etiologic role of cigarette smoking. Maternal cigarette smoking at the time of conception was associated with an increased risk of ectopic pregnancy with a dose-response relationship (adjusted odds ratios: 1.30 to 2.49). On the other hand, partner's smoking was not associated with ectopic pregnancy. The study provides a supplementary argument towards a causal effect of smoking in the development of ectopic pregnancy. Handle: RePEc:aph:ajpbhl:1991:81:2:199-201_6 Template-Type: ReDIF-Article 1.0 Title: Community leaders help increase response rates in AIDS survey Journal: American Journal of Public Health Author-Name: Longoria, J.M. Year: 1991 Volume: 81 Issue: 5 Pages: 654-655 Handle: RePEc:aph:ajpbhl:1991:81:5:654-655_1 Template-Type: ReDIF-Article 1.0 Title: Serosurveillance of human immunodeficiency virus infection Journal: American Journal of Public Health Author-Name: Dondero Jr., T.J. Author-Name: Curran, J.W. Year: 1991 Volume: 81 Issue: 5 Pages: 561-562 Handle: RePEc:aph:ajpbhl:1991:81:5:561-562_5 Template-Type: ReDIF-Article 1.0 Title: HIV seroconversion and oral intercourse [1] Journal: American Journal of Public Health Author-Name: Lane, H.C. Author-Name: Holmberg, S.D. Author-Name: Jaffe, H.W. Year: 1991 Volume: 81 Issue: 5 Pages: 658 Handle: RePEc:aph:ajpbhl:1991:81:5:658_7 Template-Type: ReDIF-Article 1.0 Title: Cardiovascular risk factor levels in ethnic Hawaiians Journal: American Journal of Public Health Author-Name: Curb, J.D. Author-Name: Aluli, N.E. Author-Name: Kautz, J.A. Author-Name: Petrovitch, H. Author-Name: Knutsen, S.F. Author-Name: Knutsen, R. Author-Name: O'Conner, H.K. Author-Name: O'Conner, W.E. Year: 1991 Volume: 81 Issue: 2 Pages: 164-167 Abstract: We report a cardiovascular risk factor survey of ''native'' Hawaiians 20-59 years old (70 percent, or 257), living on the Hawaiian Homestead lands on the island of Molokai, Hawaii. More than 60 percent of both sexes were overweight. Among males, 42 percent were smokers. The percent of the population with systolic blood pressure greater than 140 mm Hg or a diastolic pressure greater than 90 mm Hg or taking hypertensive medications was 14 percent of those ages 20-39 and 36 percent of those ages 40-59. The percent with serum cholesterol ≥ 6.2 mmol/L ranged from 8 percent of those 20-29 years old to 46 percent in those 50-59 years old. Two percent of those ages 20-29 had a history of diabetes, or 2+ or greater glycosuria by dipstick, as did 23 percent of those ages 50-59. The majority of the known diabetics exhibited glycosuria and elevated glycohemoglobin levels, indicating poor control. Hypertension, although usually known to the participant, was frequently uncontrolled. From these data, it appears that among this group of Hawaiians major risk factors for cardiovascular disease were frequent, while at the same time the levels of awareness and/or control for most of these factors were low. Handle: RePEc:aph:ajpbhl:1991:81:2:164-167_0 Template-Type: ReDIF-Article 1.0 Title: I. New York State HIV seroprevalence project: Goals, windows, and policy consideration Journal: American Journal of Public Health Author-Name: Novick, L.F. Year: 1991 Volume: 81 Issue: SUPPL. Pages: 11-14 Abstract: In the summer of 1987, the New York State Department of Health embarked on an extensive effort to determine the prevalence of trends of HIV infection in the state. Serosurveillance for antibody to HIV was undertaken by blind testing of available blood samples. Six populations were selected as windows on the epidemic: newborns, homeless adolescents, prisoners, and clients of family planning, STD, and drug treatment clinics. Testing of all newborns in New York State began in December 1987, and all six study windows were operational by June 1988. As of March 1990 blind testing for HIV antibody had been performed on more than 725,000 blood specimens in these six studies. Collectively these seroprevalence activities are providing invaluable information and impetus to preventive actions and public policy. Handle: RePEc:aph:ajpbhl:1991:81:SUPPL.:11-14_2 Template-Type: ReDIF-Article 1.0 Title: Comparison of two growth charts in Lesotho: Health workers' ability to understand and use them for action Journal: American Journal of Public Health Author-Name: Ruel, M.T. Author-Name: Pelletier, D.L. Author-Name: Habicht, J.-P. Author-Name: Mason, J.B. Author-Name: Chobokoane, C.S. Author-Name: Maruping, A.P. Year: 1991 Volume: 81 Issue: 5 Pages: 610-616 Abstract: Background: Two growth monitoring charts widely used for growth monitoring in Africa (the Road-to-Health (RTH) and the Growth Surveillance (GS)) were compared in order to assist the Government of Lesotho to decide on an appropriate national growth chart. Methods: Thirty-four health workers were taught and tested on the RTH during a first week of training and on the GS during a second week (the RTH-GS group), while the order was reversed for another 25 trainees (the GS-RTH group). The health workers were trained and tested on their ability not only to use and interpret the two charts, but also to make the right decisions about specific actions to be taken when growth faltering occurs. Results: There was no difference between scores to the RTH and GS charts after one week of training. After the second week of training, the scores to the RTH chart improved and became better than those to the GS chart. The scores to the GS test did not increase with previous knowledge of the RTH chart. Conclusions: For this reason and others discussed in the paper, the RTH chart was recommended for nationwide use in Lesotho. The adoption of this recommendation was facilitated by the close involvement in this research of public and private agencies responsible for growth monitoring in Lesotho. Handle: RePEc:aph:ajpbhl:1991:81:5:610-616_3 Template-Type: ReDIF-Article 1.0 Title: Occupational carpal tunnel syndrome in Washington state, 1984-1988 Journal: American Journal of Public Health Author-Name: Franklin, G.M. Author-Name: Haug, J. Author-Name: Heyer, N. Author-Name: Checkoway, H. Author-Name: Peck, N. Year: 1991 Volume: 81 Issue: 6 Pages: 741-746 Abstract: Background: There are no published population-based studies of occupational carpal tunnel syndrome (OCTS) using a strict case definition. Most studies are either industry specific or present patient self-report of symptoms. Methods: We conducted a population-based incidence study of OCTS using the Washington State Workers' Compensation database. Incident OCTS claims were identified with paid bills for physician reported ICD codes 354.0 and 354.1. Results: There were 7,926 incident OCTS claims identified for the years 1984-1988, which yields an industry-wide incidence rate of 1.74 claims/1,000 FTEs. The mean age (37.4 years) and female/male ratio (1.2:1) in this population differ from those reported in nonoccupational carpal tunnel studies (mean age, 51 years; female/male ratio, 3:1). The female-specific OCTS incidence rate increased significantly during the study period. The highest industry specific OCTS rates were found in the food processing, carpentry, egg production, wood products, and logging industries. Conclusion: Demographic differences and industry-specific rates consistent with workplace exposures suggest that OCTS is distinct from CTS occurring in nonoccupational settings. Workers' compensation data proved useful in identifying high risk industries. Handle: RePEc:aph:ajpbhl:1991:81:6:741-746_3 Template-Type: ReDIF-Article 1.0 Title: Epidemic diarrhea of the newborn, a nosocomial problem in developing countries Journal: American Journal of Public Health Author-Name: Yankauer, A. Year: 1991 Volume: 81 Issue: 4 Pages: 415-417 Handle: RePEc:aph:ajpbhl:1991:81:4:415-417_5 Template-Type: ReDIF-Article 1.0 Title: Erratum: Race and weight change in US women: The roles of socioeconomic and marital status (Am J Public Health 1991;81:319-323) Journal: American Journal of Public Health Author-Name: Kahn, H.S. Author-Name: Williamson, D.F. Author-Name: Stevens, J.A. Year: 1991 Volume: 81 Issue: 6 Pages: 688 Handle: RePEc:aph:ajpbhl:1991:81:6:688_0 Template-Type: ReDIF-Article 1.0 Title: Race and weight change in US women: The roles of socioeconomic and marital status Journal: American Journal of Public Health Author-Name: Kahn, H.S. Author-Name: Williamson, D.F. Author-Name: Stevens, J.A. Year: 1991 Volume: 81 Issue: 3 Pages: 319-323 Abstract: Background. The prevalence of overweight among Black women in the US is higher than among White women, but the causes are unknown. Methods. We examined the weight change for 514 Black and 2,770 White women who entered the first Health and Nutrition Examination Survey (1971-75) at ages 25-44 years and were weighted again a decade later. We used multivariate analyses to estimate the weight-change effects associated with race, family income, education, and marital change. Results. The mean weight change was greater for the Black women than the White women. Adjustments for height, duration of follow-up, baseline body mass index, and multiple demographic, social, and behavioral variables did not reduce this mean Black-White difference. Conclusions. Among US women, Black race is independently associated with a reduced likelihood of major weight loss, but not with major weight gain. Women at greatest risk of weight gain are those with education below college level, those entering marriage, and those with very low family income. Handle: RePEc:aph:ajpbhl:1991:81:3:319-323_7 Template-Type: ReDIF-Article 1.0 Title: Trends in the content and use of oral contraceptives in the United States, 1964-88 Journal: American Journal of Public Health Author-Name: Gerstman, B.B. Author-Name: Gross, T.P. Author-Name: Kennedy, D.L. Author-Name: Bennett, R.C. Author-Name: Tomita, D.K. Author-Name: Stadel, B.V. Year: 1991 Volume: 81 Issue: 1 Pages: 90-96 Abstract: Drug marketing and physician survey data were used to examine trends in the use and hormonal content of oral contraceptives in the United States between 1964 and 1988. Retail prescriptions for oral contraceptives peaked at approximately 68 million in 1973 and have remained between 50 million and 60 million since 1981. Despite this relative consistency in the number of prescriptions, physician ''mentions'' of oral contraceptives have increased by approximately 75 percent. This increase may reflect closer monitoring of women on oral contraceptives. Use of multiphasic formulations has steadily risen, accounting for 37 percent of the oral contraceptive prescriptions in 1988. Mean estrogen and progestin doses in all types of formulations have steadily declined. A change in the type of estrogen and progestin used in preparations has coincided with this decline in dose. The association between age and use of high-dose formulations seen in the past was no longer evident in 1988. The data demonstrate that oral contraceptive formulations in wide use today differ in hormone content from those of the past, when most of the major studies addressing the risks associated with oral contraceptive use were completed. There is therefore a need to determine the risks and long-term effects associated with these newer formulations. Handle: RePEc:aph:ajpbhl:1991:81:1:90-96_2 Template-Type: ReDIF-Article 1.0 Title: Effect of hospital utilization review on medical expenditures in selected diagnostic areas: An exploratory study Journal: American Journal of Public Health Author-Name: Wickizer, T.M. Year: 1991 Volume: 81 Issue: 4 Pages: 482-484 Abstract: Quarterly claims data on 43 insured groups were analyzed through multivariate techniques to explore whether the effects of hospital inpatient utilization review vary across selected broad diagnostic areas. Findings suggest that utilization review was associated with decreases in expenditures of approximately 15 percent for diagnoses within the surgical area, a lesser decrease within the mental health area, and still lesser decrease within the medical area. However, these measurements are imprecise both because of the small numbers and the aggregated diagnoses in each category. Handle: RePEc:aph:ajpbhl:1991:81:4:482-484_1 Template-Type: ReDIF-Article 1.0 Title: Alcohol use and abuse in random samples of physicians and medical students Journal: American Journal of Public Health Author-Name: McAuliffe, W.E. Author-Name: Rohman, M. Author-Name: Breer, P. Author-Name: Wyshak, G. Author-Name: Santangelo, S. Author-Name: Magnuson, E. Year: 1991 Volume: 81 Issue: 2 Pages: 177-182 Abstract: Background. This study sought to resolve conflicting views about whether physicians are especially prone to alcohol abuse. Methods. Using an anonymous, mailed questionnaire on substance use, we surveyed 500 physicians, 510 pharmacists, and 974 of their students. The physicians and pharmacists were selected randomly from the state society's membership lists, and students selected were from local school lists. Follow-up surveys were sent to nonresponders at two-week intervals. Results. The physicians and medical students did not drink especially heavily and were no more vulnerable to alcoholism than were their counterparts in pharmacy and other professions. Physicians differed from pharmacists in their style of drinking (greater frequency, smaller quantity), but not in total amount of alcohol consumed. Drinking habits among physicians were not associated with medical specialty or type of practice, but were positively related to gender (males drank more than females) and to age (older doctors were more apt to qualify as heavy drinkers than were younger doctors). Conclusions. Physicians were no more likely to abuse substances nonmedically than were other professionals. Any group in which alcohol use is nearly universal incurs a risk of abuse and impairment that cannot be ignored. Handle: RePEc:aph:ajpbhl:1991:81:2:177-182_2 Template-Type: ReDIF-Article 1.0 Title: Impact of the Minnesota parental notification law on abortion and birth Journal: American Journal of Public Health Author-Name: Rogers, J.L. Author-Name: Boruch, R.F. Author-Name: Stoms, G.B. Author-Name: DeMoya, D. Year: 1991 Volume: 81 Issue: 3 Pages: 294-298 Abstract: Background. The impact of the Minnesota Parental Notification Law on abortion and birth was examined. Methods. Using linear models, outcome parameters were compared before and after enactment of the law. Time by age group interactions also were examined. Results. The pre-enactment to post-enactment change in the Minnesota abortion rate reflected a greater decline for minors (≤17 years old) than for 18-19 year-olds (who were not under the law). An increase in abortion rate occurred for women ages 20-44. The law appeared to have had no impact on birth rate in minors. Following the enactment of the law, the rate of early abortions (≤12 weeks) declined among minors more than the rate of late abortions (> 12 weeks). This resulted in a pre-enactment to post-enactment increase in the ratio of late-to-early abortions among minors. Conclusions. These data suggest that parental notification facilitated pregnancy avoidance in 15-17 year-old Minnesota women. Abortion rates declined unexpectedly while birth rates continued to decline in accordance with a long-term trend. Handle: RePEc:aph:ajpbhl:1991:81:3:294-298_0 Template-Type: ReDIF-Article 1.0 Title: A routine tool for detection and assessment of epidemics of influenza-like syndromes in France Journal: American Journal of Public Health Author-Name: Costagliola, D. Author-Name: Flahault, A. Author-Name: Galinec, D. Author-Name: Garnerin, P. Author-Name: Menares, J. Author-Name: Valleron, A.-J. Year: 1991 Volume: 81 Issue: 1 Pages: 97-99 Abstract: A regression model for the non-epidemic level of influenza-like syndrome has been estimated from the 55,200 cases collected between October 1984 and August 1988 using the French Communicable Diseases Computer Network. The start of a major epidemic in 1988-89 was detected early. The size of the epidemic, for the entire country, was estimated at approximately 4.3 million cases. The excess cost of sick-leave, among those of working age, was estimated at $86 million. Handle: RePEc:aph:ajpbhl:1991:81:1:97-99_9 Template-Type: ReDIF-Article 1.0 Title: The influence of three mass media campaigns on variables related to adolescent cigarette smoking: Results of a field experiment Journal: American Journal of Public Health Author-Name: Bauman, K.E. Author-Name: LaPrelle, J. Author-Name: Brown, J.D. Author-Name: Koch, G.G. Author-Name: Padgett, C.A. Year: 1991 Volume: 81 Issue: 5 Pages: 597-604 Abstract: Background: This paper reports findings from a field experiment that evaluated mass media campaigns designed to prevent cigarette smoking by adolescents. Methods: The campaigns featured radio and television messages on expected consequences of smoking and a component to stimulate personal encouragement of peers not to smoke. Six Standard Metropolitan Statistical Areas in the Southeast United States received campaigns and four served as controls. Adolescents and mothers provided pretest and posttest data in their homes. Results and Conclusions: The radio campaign had a modest influence on the expected consequences of smoking and friend approval of smoking, the more expensive campaigns involving television were not more effective than those with radio alone, the peer-involvement component was not effective, and any potential smoking effects could not be detected. Handle: RePEc:aph:ajpbhl:1991:81:5:597-604_4 Template-Type: ReDIF-Article 1.0 Title: An eight-year study of oral carcinoma in an elderly black population [1] Journal: American Journal of Public Health Author-Name: Streckfus, C.F. Year: 1991 Volume: 81 Issue: 3 Pages: 389 Handle: RePEc:aph:ajpbhl:1991:81:3:389_5 Template-Type: ReDIF-Article 1.0 Title: Gender differences in cigarette smoking and quitting in a cohort of young adults Journal: American Journal of Public Health Author-Name: Pirie, P.L. Author-Name: Murray, D.M. Author-Name: Luepker, R.V. Year: 1991 Volume: 81 Issue: 3 Pages: 324-327 Abstract: Background. Smoking among young women is associated with a variety of negative health outcomes. Gender specific influences on smoking, quitting and attempting to quit are hypothesized to occur and may have implications for cessation programs. Methods. Telephone surveys were conducted in a large (n = 6,711) cohort of young men and women (average age 19.2 years) which was first established in 1979 and has been resurveyed several times since then. Questions concerned smoking, successful and unsuccessful attempts to quit, withdrawal symptoms during quit attempts, and concerns about quitting. Results. More women than men reported current smoking (26.5 vs 22.6 percent), but quitting attempts, successful and unsuccessful, were equally common. Withdrawal symptoms were reported equally, except for wanting to eat more than usual and weight gain, both of which were reported more often by women than men. Women smokers reported substantially more concern about weight gain if they quit smoking (57.9 vs 26.3 percent expressing concern). Conclusions. Targeted programs are needed to address issues of concern to young women smokers, particularly fear of gaining weight. Handle: RePEc:aph:ajpbhl:1991:81:3:324-327_8 Template-Type: ReDIF-Article 1.0 Title: Determinants of late stage diagnosis of breast and cervical cancer: The impact of age, race, social class, and hospital type Journal: American Journal of Public Health Author-Name: Mandelblatt, J. Author-Name: Andrews, H. Author-Name: Kerner, J. Author-Name: Zauber, A. Author-Name: Burnett, W. Year: 1991 Volume: 81 Issue: 5 Pages: 646-649 Abstract: Previous studies of the relationship between cancer stage, age, and race have not controlled for social class and health care setting. Logistic regression analyses, using information from the New York State Tumor Registry and area-level social class indicators, demonstrated that, in New York City, older Black, lower class women in public hospitals were 3.75 and 2.54 times more likely to have late stage breast or cervical cancer, respectively, than were younger White, high social class women in non-public hospitals. Handle: RePEc:aph:ajpbhl:1991:81:5:646-649_4 Template-Type: ReDIF-Article 1.0 Title: Comparison of AIDS knowledge, attitudes, and behaviors among incarcerated adolescents and a public school sample in San Francisco Journal: American Journal of Public Health Author-Name: DiClemente, R.J. Author-Name: Lanier, M.M. Author-Name: Horan, P.F. Author-Name: Lodico, M. Year: 1991 Volume: 81 Issue: 5 Pages: 628-630 Abstract: Data collected from incarcerated youth (n = 113) and a public school sample (n = 802) demonstrate that both adolescent groups have a high level of AIDS knowledge. Incarcerated youth are less aware of HIV risk-reduction behaviors and report markedly higher rates of HIV risk behaviors. Incarcerated youth are at substantially increased risk of HIV infection relative to their school-based counterparts and should be a primary target of HIV prevention programs. Handle: RePEc:aph:ajpbhl:1991:81:5:628-630_2 Template-Type: ReDIF-Article 1.0 Title: The validity of health risk appraisals for coronary heart disease: Results from a randomized field trial Journal: American Journal of Public Health Author-Name: Smith, K.W. Author-Name: McKinlay, S.M. Author-Name: McKinlay, J.B. Year: 1991 Volume: 81 Issue: 4 Pages: 466-470 Abstract: Background: While health risk appraisals (HRAs) are becoming increasingly popular as tools for health assessment and health education, comparatively little is known about the accuracy of these risk estimates. Methods: A field trial among 732 randomly selected adults ages 25 to 65 years was conducted to assess the validity of the risk scores produced by four widely used HRAs. Results: Self-reported HRA risk scores for cigarette smoking and relative weight were generally accurate, but correlations between physiological measurements and scores for blood pressure, cholesterol, and physical activity were always lower than .51. Correlations between epidemiologic estimates of the probability of CHD death and HRA total risk scores ranged from .13 to .75; partial correlations adjusting for age, race, and gender ranged from .12 to .47. Conclusions: The HRAs chosen for the field trial exhibited modest correlations with the CHD mortality risk predicted by the epidemiologic model. Mathematical errors made by respondents completing self-scored instruments and lack of knowledge regarding physiologic status decrease the accuracy of HRA risk estimates. Handle: RePEc:aph:ajpbhl:1991:81:4:466-470_0 Template-Type: ReDIF-Article 1.0 Title: Antibiotic use among children in an urban Brazilian slum: A risk factor for diarrhea? Journal: American Journal of Public Health Author-Name: Schorling, J.B. Author-Name: De Souza, M.A. Author-Name: Guerrant, R.L. Year: 1991 Volume: 81 Issue: 1 Pages: 99-100 Abstract: Among a cohort of children in a poor urban setting in Brazil, the relative risk for the occurrence of a new episode of diarrhea in the two weeks following antibiotic use vs all other weeks was 1.44 (95% confidence interval (CI) = 1.33, 2.45). Among children never exposed to antibiotics, the odds ratio was 1.34 (95% CI = 0.84, 2.16) after stratifying by individual child and controlling for previous diarrhea. Further research is needed to confirm whether antibiotics are a risk factor for diarrhea in such settings. Handle: RePEc:aph:ajpbhl:1991:81:1:99-100_9 Template-Type: ReDIF-Article 1.0 Title: Measurement of attitudes and behaviors in public health surveys Journal: American Journal of Public Health Author-Name: Beland, F. Author-Name: Maheux, B. Author-Name: Lambert, J. Year: 1991 Volume: 81 Issue: 1 Pages: 103-105 Abstract: We divided 900 general practitioners into two groups: one group received a questionnaire measuring both attitudes and behaviors toward preventive aspects of medical care, while the other received two separate questionnaires - one measuring behaviors, and one measuring attitudes. Response rates of the two groups were similar. Respondents in the first group retrieved their answer to the attitudinal items when responding to behavioral items, increasing the correlations between attitudes and behaviors by an average of .147 as compared to the second group; hence the second procedure was preferable. Handle: RePEc:aph:ajpbhl:1991:81:1:103-105_7 Template-Type: ReDIF-Article 1.0 Title: Understanding history to shape the future - The new editors' vision Journal: American Journal of Public Health Author-Name: Fee, E. Author-Name: Korstad, R.R. Year: 1991 Volume: 81 Issue: 6 Pages: 781-782 Handle: RePEc:aph:ajpbhl:1991:81:6:781-782_9 Template-Type: ReDIF-Article 1.0 Title: Lead exposure in outdoor firearm instructors Journal: American Journal of Public Health Author-Name: Tripathi, R.K. Author-Name: Sherertz, P.C. Author-Name: Llewellyn, G.C. Author-Name: Armstrong, C.W. Year: 1991 Volume: 81 Issue: 6 Pages: 753-755 Abstract: This study was conducted to determine lead exposure of firearm instructors at an outdoor firing range, while cadets were firing nonjacketed and jacketed lead ammunitions. The breathing zone air for lead exceeded the Occupational Safety and Health Administration standard of 50 μg/m3 for two instructors during firing exercises using nonjacketed bullets. The use of totally copper-jacketed bullets reduced the breathing zone lead levels by 92 percent for instructor #1 and by 96 percent for instructor #2; subsequent blood lead levels showed a significant decline in both instructors. Handle: RePEc:aph:ajpbhl:1991:81:6:753-755_2 Template-Type: ReDIF-Article 1.0 Title: Birthweight and infant mortality in blacks [3] Journal: American Journal of Public Health Author-Name: Polednak, A.P. Year: 1991 Volume: 81 Issue: 3 Pages: 389-390 Handle: RePEc:aph:ajpbhl:1991:81:3:389-390_6 Template-Type: ReDIF-Article 1.0 Title: Oats and cholesterol: The prospects for prevention of heart disease Journal: American Journal of Public Health Author-Name: Humble, C.G. Year: 1991 Volume: 81 Issue: 2 Pages: 159-160 Handle: RePEc:aph:ajpbhl:1991:81:2:159-160_8 Template-Type: ReDIF-Article 1.0 Title: HIV infection in an Ethiopian prison Journal: American Journal of Public Health Author-Name: Kebede, Y. Author-Name: Pickering, J. Author-Name: McDonald, J.C. Author-Name: Wotton, K. Author-Name: Zewde, D. Year: 1991 Volume: 81 Issue: 5 Pages: 625-627 Abstract: HIV-1 antibody was detected in 6.0 percent of prisoners in an Ethiopian prison. HIV-1 seropositivity was strongly associated with positive VDRL status (RR = 3.7) and recent admission to prison (RR = 3.5). Seropositive prisoners were more likely to have prostitute contacts. No correlation was found between seropositivity and number of sexual contacts, long-term sex partners, or dental extractions. HIV-1 infection in this area may be of recent origin and the high prevalence may reflect rates in the surrounding community. Handle: RePEc:aph:ajpbhl:1991:81:5:625-627_7 Template-Type: ReDIF-Article 1.0 Title: Admission and mid-stay MedisGroups® scores as predictors of death within 30 days of hospital admission Journal: American Journal of Public Health Author-Name: Iezzoni, L.I. Author-Name: Ash, A.S. Author-Name: Coffman, G. Author-Name: Moskowitz, M.A. Year: 1991 Volume: 81 Issue: 1 Pages: 74-78 Abstract: We examined the ability of MedisGroups, a severity measure based on clinical data abstracted from the medical record, to predict mortality 30 days following admission. MedisGroups measures severity both on admission and approximately one week into the hospital stay. The data base was a random sample of 20,985 admissions of Medicare beneficiaries with one of six conditions from 833 hospitals in seven states between January 1985 and May 1986. In all six conditions, higher admission and mid-stay severity scores were generally associated with higher risk of death. Across the six conditions, the R-squared values for predicting death using admission scores ranged from 0.01 to 0.16; R-squared values using mid-stay scores ranged from 0.03 to 0.34; and R-squared values from combining admission and mid-stay scores ranged from 0.05 to 0.41. Admission MedisGroups scores was thus only modestly predictive of 30-day mortality. While the mid-stay score was more powerful, it may not be an appropriate severity adjuster to screen for quality using hospital mortality rates because it could be influenced by substandard care. Handle: RePEc:aph:ajpbhl:1991:81:1:74-78_5 Template-Type: ReDIF-Article 1.0 Title: Morbidity and disability in older persons in the years prior to death Journal: American Journal of Public Health Author-Name: Guralnik, J.M. Author-Name: LaCroix, A.Z. Author-Name: Branch, L.G. Author-Name: Kasl, S.V. Author-Name: Wallace, R.B. Year: 1991 Volume: 81 Issue: 4 Pages: 443-447 Abstract: Background: A large proportion of the disease and disability which affects older persons occurs in the years just prior to death. Little prospective evidence is available which quantifies the burden of morbidity and disability during these years. Methods: In three community-based cohorts of persons age 65 and older, chronic conditions and disability were evaluated for the three years prior to death in 531 persons who had three annual assessments and then died within one year of the third assessment. Number of chronic conditions, prevalence of disability in activities of daily living (ADLs), and prevalence of disability on a modified Rosow-Breslau scale were determined for these decedents and compared to 8821 members of the cohorts known to have survived. Results: Prevalence rates of disease and disability increased during the follow-up for both decendents and survivors, with decedents generally having higher rates than survivors. Disability rates prior to death, but not the number of diseases, increased with increasing age at death. The odds ratio for disability in ADLs at any of the three assessments for decedents versus survivors ranged from 3.0 to 4.2 in the three communities. In each community the odds ratio for ADL disability was higher in women decedents versus survivors than in men decedents versus survivors. Conclusions: These results have important implications for disability levels in future older populations in which death is projected to occur at increasingly higher ages. Handle: RePEc:aph:ajpbhl:1991:81:4:443-447_8 Template-Type: ReDIF-Article 1.0 Title: Psychosocial factors in maternal phenylketonuria: Prevention of unplanned pregnancies Journal: American Journal of Public Health Author-Name: Waisbren, S.E. Author-Name: Shiloh, S. Author-Name: St. James, P. Author-Name: Levy, H.L. Year: 1991 Volume: 81 Issue: 3 Pages: 299-304 Abstract: Background. Women with phenylketonuria (PKU) not treated prior to conception can have a pregnancy that results in serious fetal damage. In this report, factors associated with preventing unplanned (and hence late treated) pregnancies are described. Methods. Subjects included 60 phenylketonuric women and two comparison groups composed of female acquaintances and diabetic women. All were interviewed and administered tests of intelligence, general well-being, knowledge, and personality. Results. Thirty-five percent of the sexually active women with PKU used contraception only sporadically. The variables that best predicted reported frequency of birth control use were the extent to which women felt social support to use contraception (r = .64) along with positive attitudes about birth control (r = .66) and knowledge of family planning (r = .43). For the comparison groups, a different pattern of variables predicted contraceptive use, with locus of control figuring most prominently for the diabetics (r = .39) and social support for birth control being most important for the acquaintances (r = .46). Conclusions. As more girls with PKU enter childbearing ages, there will be an increased need for specific programs that address psychosocial factors in maternal PKU. Handle: RePEc:aph:ajpbhl:1991:81:3:299-304_4 Template-Type: ReDIF-Article 1.0 Title: VI. HIV infection among women entering the New York State Correctional System Journal: American Journal of Public Health Author-Name: Smith, P.F. Author-Name: Mikl, J. Author-Name: Truman, B.I. Author-Name: Lessner, L. Author-Name: Lehman, J.S. Author-Name: Stevens, R.W. Author-Name: Lord, E.A. Author-Name: Broaddus, R.K. Author-Name: Morse, D.L. Year: 1991 Volume: 81 Issue: SUPPL. Pages: 35-40 Abstract: Human immunodeficiency virus infection is the leading medical problem among prison inmates in several states. In 1988 a blinded seroprevalence study was conducted on 480 New York female prison entrants to determine the prevalence of and risk factors for HIV infection in this population. Ninety (18.8 percent) women were HIV-seropositive. Seroprevalence was highest among women ages 30-39 (25.0 percent) and varied by ethnicity (Hispanics, 29.4 percent; Blacks, 14.4 percent; Whites, 7.1 percent) and residence (New York City, 23.8 percent; Upstate, 5.1 percent). Nearly half (44.9 percent) of the 136 acknowledged intravenous drug users and one-third (33.8 percent) of the 71 women with a positive syphilis serology were HIV-seropositive. There was no difference in fertility histories between seropositive and seronegative women, and two of 21 pregnant women were seropositive. This study led to increased clinical and prevention services for this high-risk population. Handle: RePEc:aph:ajpbhl:1991:81:SUPPL.:35-40_6 Template-Type: ReDIF-Article 1.0 Title: Evaluating needle exchange: Do distributed needles come back? Journal: American Journal of Public Health Author-Name: Guydish, J. Author-Name: Clark, G. Author-Name: Garcia, D. Author-Name: Downing, M. Author-Name: Case, P. Author-Name: Sorensen, J.L. Year: 1991 Volume: 81 Issue: 5 Pages: 617-619 Abstract: We employed capture-recapture methods as a strategy for evaluating needle exchange. Needles distributed by the exchange at two time periods were marked with color coded bands indicating the date and site of distribution. Half of the marked needles (2,068/4,239) returned within two weeks of distribution, and 61 percent (2,593/4,239) returned during the study period. The rate of return for stationary exchange sites (63 percent) was greater than that for roving/mobile sites (51 percent; χ2 = 28.6, p < .001). Of all needles returned, 87 percent (2,248/2,593) returned to the site of original distribution. Handle: RePEc:aph:ajpbhl:1991:81:5:617-619_5 Template-Type: ReDIF-Article 1.0 Title: Erratum: Modeling the Impact of Breast-Feeding by HIV-Infected Women on Child Survival (American Journal of Public Health 1990; 80:1305-1309 Journal: American Journal of Public Health Author-Name: Heymann, S.J. Year: 1991 Volume: 81 Issue: 5 Pages: 658-659 Handle: RePEc:aph:ajpbhl:1991:81:5:658-659_6 Template-Type: ReDIF-Article 1.0 Title: Racial/ethnic differences in smoking, drinking, and illicit drug use among American high school seniors, 1976-89 Journal: American Journal of Public Health Author-Name: Bachman, J.G. Author-Name: Wallace Jr., J.M. Author-Name: O'Malley, P.M. Author-Name: Johnston, L.D. Author-Name: Kurth, C.L. Author-Name: Neighbors, H.W. Year: 1991 Volume: 81 Issue: 3 Pages: 372-377 Abstract: Background. This paper reports racial/ethnic differences in the use of licit and illicit drugs by high school seniors in the United States. Methods. The study uses questionnaire data from annual, nationally representative surveys of seniors from 1976 through 1989. Combined sample sizes were 57,620 for 1976-79; 75,772 for 1980-84; and 73,527 for 1985-89. Results. Native Americans had the highest prevalence rates for cigarettes, alcohol, and most illicit drugs; White students had the next highest rates for most drugs. Asian Americans had the lowest prevalence rates, and Black students had levels nearly as low except for marijuana. Prevalence rates for the Hispanic groups were mostly in the intermediate ranges except for relatively high cocaine use among the males. Trend patterns for most forms of drug use were similar across subgroups, although cigarette use declined more sharply for Black than White seniors, resulting in greater Black-White differences in recent years. Conclusions. This study, other school-based studies, and general population surveys all show relatively low levels of drug use by most non-White youth, especially Black Americans and Asian Americans. Multivariate analyses indicate that such subgroup differences in high school seniors' drug use are not primarily attributable to family composition, parents' education, region, or urban-rural distinctions. Handle: RePEc:aph:ajpbhl:1991:81:3:372-377_3 Template-Type: ReDIF-Article 1.0 Title: Tuberculosis in Miami [2] Journal: American Journal of Public Health Author-Name: Burr, J.M. Author-Name: Simmons, J.R. Year: 1991 Volume: 81 Issue: 6 Pages: 804 Handle: RePEc:aph:ajpbhl:1991:81:6:804_8 Template-Type: ReDIF-Article 1.0 Title: Effects of an intervention program on AIDS-related drug and needle behavior among intravenous drug users Journal: American Journal of Public Health Author-Name: Stephens, R.C. Author-Name: Feucht, T.E. Author-Name: Roman, S.W. Year: 1991 Volume: 81 Issue: 5 Pages: 568-571 Abstract: Background: Behaviors which entail high risk for human immunodeficiency virus (HIV) infection among intravenous drug users can be significantly reduced through educational intervention. Methods: The educational intervention was conducted by a health educator in a one-on-one format and provided information about acquired immunodeficiency syndrome (AIDS) and strategies for reducing the risk of infection. Risk was assessed prior to the intervention and was compared to a follow-up assessment obtained approximately three months later (n = 322). Results: The percentage who reported using drugs intravenously decreased from 92.2 to 70.5, and the percentage who reported sharing syringes dropped from 67.4 to 24.3. Reductions of these and other high-risk behaviors were detected across various demographic subgroups, and analyses show that the impact of the intervention endured for several months. Conclusions: The findings suggest that intravenous drug users conform to a model of rational choice when confronted with accurate information about the devastating consequences of HIV infection. Handle: RePEc:aph:ajpbhl:1991:81:5:568-571_0 Template-Type: ReDIF-Article 1.0 Title: Vietnam era and vietnam combat veterans among the homeless Journal: American Journal of Public Health Author-Name: Rosenheck, R. Author-Name: Gallup, P. Author-Name: Leda, C.A. Year: 1991 Volume: 81 Issue: 5 Pages: 643-646 Abstract: Of 10,524 homeless veterans assessed in a 43-site VA program, 50 percent served during the Vietnam War era, compared to only 29 percent of all veterans in the general population. This reflects the greater risk of homelessness among men aged 30-44 rather than the impact of Vietnam Era service. The proportion of homeless veterans who served in the Vietnam Theater (44.9 percent), and the proportion exposed to combat fire (40.5 percent) were similar to those of nonhomeless veterans. Homeless combat veterans who are not White were more likely to have psychiatric, alcohol, and medical problems than homeless noncombat Vietnam veterans who are not White. Handle: RePEc:aph:ajpbhl:1991:81:5:643-646_8 Template-Type: ReDIF-Article 1.0 Title: Mass flea outbreak at a child care facility: Case report Journal: American Journal of Public Health Author-Name: Corpus, L.D. Author-Name: Corpus, K.M. Year: 1991 Volume: 81 Issue: 4 Pages: 497-498 Abstract: Cat fleas, Ctenocephalides felis Bouchet, were collected at a Mississippi child care facility after reports of large numbers of adult fleas occurring on children and personnel. One building yielded 161 (99 percent) of the fleas collected. Urticarial lesions due to flea bites occurred on the legs of six children. Flea presence was due to cats occupying the crawl space. Fleas were eradicated by eliminating entry of cats and using residual insecticides throughout the facility. Handle: RePEc:aph:ajpbhl:1991:81:4:497-498_0 Template-Type: ReDIF-Article 1.0 Title: What makes infant mortality rates fall in developing countries? Journal: American Journal of Public Health Author-Name: Koch-Weser, D. Author-Name: Yankauer, A. Year: 1991 Volume: 81 Issue: 1 Pages: 12-13 Handle: RePEc:aph:ajpbhl:1991:81:1:12-13_6 Template-Type: ReDIF-Article 1.0 Title: Bone cancer incidence rates in New York state: Time trends and fluoridated drinking water Journal: American Journal of Public Health Author-Name: Mahoney, M.C. Author-Name: Nasca, P.C. Author-Name: Burnett, W.S. Author-Name: Melius, J.M. Year: 1991 Volume: 81 Issue: 4 Pages: 475-479 Abstract: Background: Recent animal studies of the potential carcinogenicity of fluoride prompted an examination of bone cancer incidence rates. Methods: Trends in the incidence of primary bone cancers, including the incidence of osteosarcomas were examined among residents of New York State, exclusive of New York City. Average annual osteosarcoma incidence rates in fluoridated and non-fluoridated areas were also compared. Results: Among persons less than 30 years of age at diagnosis, bone cancer incidence among males demonstrated a significant increase since 1955, while incidence among females has remained unchanged. A significant decrease in bone cancer incidence rates since 1955 was observed among both males and females age 30 years and over at time of diagnosis. Osteosarcoma incidence rates have remained essentially unchanged since 1970, among both younger and older males and females. The average annual age adjusted incidence of osteosarcomas (1976-1987) in areas served by fluoridated water supplies was not found to differ from osteosarcoma incidence rates in non-fluoridated areas. Conclusions: These data do not support an association between fluoride in drinking water and the occurrence of cancer of the bone. Handle: RePEc:aph:ajpbhl:1991:81:4:475-479_5 Template-Type: ReDIF-Article 1.0 Title: Cervical papillomavirus infection and cervical dysplasia in Hispanic, Native American, and non-Hispanic White women in New Mexico Journal: American Journal of Public Health Author-Name: Becker, T.M. Author-Name: Wheeler, C.M. Author-Name: McGough, N.S. Author-Name: Jordan, S.W. Author-Name: Dorin, M. Author-Name: Miller, J. Year: 1991 Volume: 81 Issue: 5 Pages: 582-586 Abstract: Background: Human papillomavirus infections of the cervix are found with varying frequencies in different populations worldwide, and have been associated with cervical cytologic abnormalities. Methods: We studied 1,603 randomly selected Hispanic, Native American, and non-Hispanic White women in New Mexico to determine the prevalence of cervical HPV infection in these ethnic groups, and its association with Pap smear abnormalities, using a new commercial dot-blot hybridization assay. Results: Nine percent of all women screened had evidence of cervical HPV infection (13.7% of non-Hispanic White women, 9.7% of Hispanics, and 6.6% of Native American women). Prevalence was higher in younger women ages 14-19 years than in older age groups. Over half of women with cervical HPV infection (n = 145) had normal Pap smears. The proportion of infected women increased among those with more advanced cytopathologic abnormalities; 5.6 percent with normal Pap smears had cervical HPV vs 66.7 percent with moderate-severe dysplasia. Conclusions: Cervical HPV infection is common among New Mexico clinic attendees, varies in prevalence among the three major ethnic groups, and is strongly associated with cervical cytopathologic abnormalities. Handle: RePEc:aph:ajpbhl:1991:81:5:582-586_9 Template-Type: ReDIF-Article 1.0 Title: Caffeine consumption during pregnancy and fetal growth Journal: American Journal of Public Health Author-Name: Fenster, L. Author-Name: Eskenazi, B. Author-Name: Windham, G.C. Author-Name: Swan, S.H. Year: 1991 Volume: 81 Issue: 4 Pages: 458-461 Abstract: Background: The purpose of this study was to examine the association between maternal caffeine consumption and low birthweight, intrauterine growth retardation, and prematurity, adjusting for multiple confounders. Methods: Data obtained from birth certificates and interviews on 1,230 women with singleton live births were analyzed to evaluate the potential influence of caffeine consumption during the first trimester on fetal growth. Results: The crude odds ratio for intrauterine growth retardation in infants of women reporting heavy caffeine consumption (>300 mg/day) was 3.86 (95% CI = 1.80, 8.40) which decreased to 2.90 (95% CI = 1.23, 6.87) after controlling for confounding factors. The adjusted odds ratio for low birthweight and heavy maternal caffeine consumption was also elevated (OR = 2.05; 95% CI = 0.86, 4.88). Women who reduced their caffeine intake from greater than 300 mg/day to less than that early in pregnancy had lower risks of delivering infants with either intrauterine growth retardation or low birthweight than women who continued to consume that amount. Preterm delivery appeared to be unrelated to caffeine consumption. Conclusions: Taken together with studies reporting similar findings, these results suggest that heavy caffeine consumption increases the risk for fetal growth retardation. Handle: RePEc:aph:ajpbhl:1991:81:4:458-461_6 Template-Type: ReDIF-Article 1.0 Title: A comparison of injury death rates in China and the United States, 1986 Journal: American Journal of Public Health Author-Name: Li, G. Author-Name: Baker, S.P. Year: 1991 Volume: 81 Issue: 5 Pages: 605-609 Abstract: Background: The importance of injury as a public health problem is not well recognized in many developing countries. Data have recently become available on injury mortality in China. Method: We compared Chinese injury data based on a 100 million population segment for 1986 with data for the United States. Results: The age-adjusted death rate from all injuries for China exceeds the rate for the US (69.0 vs 61.3 per 100,000). The US has higher death rates from motor vehicle crashes, fires, and homicide; China has greater mortality from drowning, poisoning, falls, and suicide. Especially noteworthy in China are the high drowning rates among young children and the elderly and the high suicide rates in rural areas among young adults and the elderly. Conclusion: Injury is an important public health problem in China, exceeding in many respects the problem in the United States. It is urgent for China to place high priority on injury research and prevention. Handle: RePEc:aph:ajpbhl:1991:81:5:605-609_0 Template-Type: ReDIF-Article 1.0 Title: A county consortium for access to health care Journal: American Journal of Public Health Author-Name: Dawson, P. Year: 1991 Volume: 81 Issue: 5 Pages: 655-656 Handle: RePEc:aph:ajpbhl:1991:81:5:655-656_7 Template-Type: ReDIF-Article 1.0 Title: Cancer rates after the Three Mile Island nuclear accident and proximity of residence to the plant Journal: American Journal of Public Health Author-Name: Hatch, M.C. Author-Name: Wallenstein, S. Author-Name: Beyea, J. Author-Name: Nieves, J.W. Author-Name: Susser, M. Year: 1991 Volume: 81 Issue: 6 Pages: 719-724 Abstract: Background: In the light of a possible link between stress and cancer promotion or progression, and of previously reported distress in residents near the Three Mile Island (TMI) nuclear power plant, we attempted to evaluate the impact of the March 1979 accident on community cancer rates. Methods: Proximity of residence to the plant, which related to distress in previous studies, was taken as a possible indicator of accident stress; the postaccident pattern in cancer rates was examined in 69 ''study tracts'' within a 10-mile radius of TMI, in relation to residential proximity. Results: A modest association was found between postaccident cancer rates and proximity (OR = 1.4; 95% CI = 1.3, 1.6). After adjusting for a gradient in cancer risk prior to the accident, the odds ratio contrasting those closest to the plant with those living farther out was 1.2 (95% CI = 1.0, 1.4). A postaccident increase in cancer rates near the Three Mile Island plant was notable in 1982, persisted for another year, and then declined. Radiation emissions, as modeled mathematically, did not account for the observed increase. Conclusion: Interpretation in terms of accident stress is limited by the lack of an individual measure of stress and by uncertainty about whether stress has a biological effect on cancer in humans. An alternative mechanism for the cancer increase near the plant is through changes in care-seeking and diagnostic practice arising from postaccident concern. Handle: RePEc:aph:ajpbhl:1991:81:6:719-724_8 Template-Type: ReDIF-Article 1.0 Title: Response of hospitals, skilled nursing facilities, and home health agencies in Oregon to AIDS: Reports of nursing executives Journal: American Journal of Public Health Author-Name: White, C.M. Author-Name: Berger, M.C. Year: 1991 Volume: 81 Issue: 4 Pages: 495-496 Abstract: To describe experience and readiness to provide care for persons with acquired immunodeficiency syndrome (AIDS), responses to a mailed survey from 86 percent of chief nursing executives of the 207 hospitals, skilled nursing facilities (SNFs) and home health agencies (HHAs) in Oregon were summarized. As of January 1989, 44 percent reported having provided care; even in low incidence counties, 64 percent of hospitals had provided care. Adequate resources were reported by 79 percent in hospitals, 26 percent in SNFs, and 69 percent in HHAs. Handle: RePEc:aph:ajpbhl:1991:81:4:495-496_3 Template-Type: ReDIF-Article 1.0 Title: Research on women's health Journal: American Journal of Public Health Author-Name: Kirschstein, R.L. Year: 1991 Volume: 81 Issue: 3 Pages: 291-293 Abstract: The Acting Associate Director for Research on Women's Health describes the background and purpose of the Office of Research on Women's Health, established in September 1990 as part of the National Institutes of Health (NIH). The Office is responsible for assuring that research conducted and/or supported by NIH appropriately addresses issues regarding women's health, and that there is appropriate participation by women in clinical research. Handle: RePEc:aph:ajpbhl:1991:81:3:291-293_6 Template-Type: ReDIF-Article 1.0 Title: Healthy cities Indiana: Mainstreaming community health in the United States Journal: American Journal of Public Health Author-Name: Flynn, B.C. Author-Name: Rider, M.S. Year: 1991 Volume: 81 Issue: 4 Pages: 510-511 Handle: RePEc:aph:ajpbhl:1991:81:4:510-511_2 Template-Type: ReDIF-Article 1.0 Title: Female homicides in United States workplaces, 1980-1985 Journal: American Journal of Public Health Author-Name: Bell, C.A. Year: 1991 Volume: 81 Issue: 6 Pages: 729-732 Abstract: Background: Women, while noted for low occupational injury mortality rates, are more likely to die as victims of assault than from any other manner of injury at work. Methods: From the National Traumatic Occupational Fatality surveillance data, 950 women were identified who were fatally assaulted at work. Homicide rates were calculated for the demographic and employment characteristics of these women. Risk ratios among types of lethal injuries were examined. Results: During 1980-1985, the crude six-year workplace homicide rate was 4.0 deaths per million working women: one twentieth the homicide rate of the US female population. Decedents ranged from 16 years (the lowest age included in the data base) to 93 years of age. Working women older than 65 years had the highest age-specific homicide rate, 11.3 per million. Women younger than 20 had the lowest, 2.5 per million per year. Homicide rates for women of races other than White were nearly twice as high as those of Whites. The leading causes of death were gunshot wounds (64 percent), stabbings (19 percent), asphyxiations (7 percent), and blunt force trauma (6 percent). Nearly 43 percent of the decreased women had been employed in retail trade: 8.7 per million employed women annually. Conclusions: During 1980-1985, only 6 percent of the nation's victims of work-related injury deaths were female: 41 percent of those women were murdered. Homicide is currently the leading manner of traumatic workplace death among women in the United States. Handle: RePEc:aph:ajpbhl:1991:81:6:729-732_1 Template-Type: ReDIF-Article 1.0 Title: Capacity of US labs to provide TLI in support of early HIV-1 intervention Journal: American Journal of Public Health Author-Name: Valdiserri, R.O. Author-Name: Cross, G.D. Author-Name: Gerber, A.R. Author-Name: Schwartz, R.E. Author-Name: Hearn, T.L. Year: 1991 Volume: 81 Issue: 4 Pages: 491-494 Abstract: We surveyed laboratories to assess their capacity to perform T-lymphocyte immunophenotyping. Of the 1026 respondents, 279 located in 41 states and the District of Columbia performed this type of testing. Most laboratories were located in hospitals, reported a low weekly test volume, and indicated that it took 6-24 weeks for flow cytometer operators to become proficient. Many laboratories appear to have the capacity to perform additional CD4+ cell testing, but training additional operators may be necessary. The paucity of laboratories performing T-lymphocyte immunophenotyping in the public sector may affect referral patterns from that setting. Handle: RePEc:aph:ajpbhl:1991:81:4:491-494_7 Template-Type: ReDIF-Article 1.0 Title: IV. Geographic distribution of newborn HIV seroprevalence in relation to four sociodemographic variables Journal: American Journal of Public Health Author-Name: Morse, D.L. Author-Name: Lessner, L. Author-Name: Medvesky, M.G. Author-Name: Glebatis, D.M. Author-Name: Novick, L.F. Year: 1991 Volume: 81 Issue: SUPPL. Pages: 25-29 Abstract: The geographic distribution of newborn human immunodeficiency virus seroprevalence at zip code level was compared with the distribution of four sociodemographic variables. For New York City significant univariate correlations were found between HIV and low birthweight, drug use (as measured by hospital discharges), maternal education less than 12 years, and race/ethnicity. Less significant correlations were found for New York State exclusive of New York City. For New York City a model comprising low birthweight and all drug discharges was shown by multiple regression analysis to be most strongly associated with HIV status (r2 = .77). Elsewhere a model comprising race/ethnicity (percent Black, percent Hispanic) and cocaine drug discharges had the best, but less strong association (r2 = .39). However, because of intercorrelations, race/ethnicity added little when the other variables were included first. Knowledge of the geographic association between HIV seroprevalence and sociodemographic status can be useful in designing and focusing prevention efforts in areas at highest risk for future HIV/AIDS activity. Handle: RePEc:aph:ajpbhl:1991:81:SUPPL.:25-29_3 Template-Type: ReDIF-Article 1.0 Title: Non-Hodgkin's lymphoma in a cohort of Vietnam veterans Journal: American Journal of Public Health Author-Name: O'Brien, T.R. Author-Name: Decoufle, P. Author-Name: Boyle, C.A. Year: 1991 Volume: 81 Issue: 6 Pages: 758-760 Abstract: We examined the incidence of non-Hodgkin's lymphoma (NHL) in a cohort of 18,313 United States Army veterans from the Vietnam era. Diagnoses were confirmed through a review of hospital records. Among veterans who had died after discharge or who had participated in a telephone interview (8,170 Vietnam veterans and 7,564 non-Vietnam veterans), seven Vietnam veterans and one non-Vietnam veteran had developed non-Hodgkin's lymphoma (p = 0.07). As none of the NHL cases had military job titles which suggest that they were occupationally exposed to herbicides while in Vietnam, the reasons for the excess are unclear. Handle: RePEc:aph:ajpbhl:1991:81:6:758-760_7 Template-Type: ReDIF-Article 1.0 Title: Report of an association between race and thyroid stimulating hormone level Journal: American Journal of Public Health Author-Name: Schectman, J.M. Author-Name: Kallenberg, G.A. Author-Name: Hirsch, R.P. Author-Name: Shumacher, R.J. Year: 1991 Volume: 81 Issue: 4 Pages: 505-506 Abstract: We examined the association between race and thyroid stimulating hormone (TSH) level in 809 consecutive Black or White adults tested for mild suspicion of hypothyroidism with a normal TSH result. The mean TSH level of Blacks was 0.4 (SE .053) mU/L lower than that for Whites after age and sex adjustment, race explaining 6.5 percent of the variation in TSH levels. A validation sample yield similar results. This finding supports the possibility that differences in thyroid function and/or regulation may be associated with race. Handle: RePEc:aph:ajpbhl:1991:81:4:505-506_3 Template-Type: ReDIF-Article 1.0 Title: Occupation, industry, and fatal motor vehicle crashes in 20 states, 1986-1987 Journal: American Journal of Public Health Author-Name: Loomis, D.P. Year: 1991 Volume: 81 Issue: 6 Pages: 733-735 Abstract: Background: Motor vehicles are a leading cause of injury on and off the job. Methods: To describe the occurrence of fatal motor vehicle crashes in the working-age population, a case-control study was conducted among persons 15-64 years old who died in 1986 or 1987 in any of 20 states reporting death certificate occupational data to the National Center for Health Statistics. Cases were occupants of motor vehicles (excluding motorcycles) who died of injuries sustained in a crash (E810-E825, 9th revision International Classification of Diseases), and controls died of any other cause. Results: Transportation-related occupations had more than the expected number of deaths for men (odds ratio = 1.6, 95% confidence interval = 1.4 - 1.9) and women (odds ratio = 2.1, 95% confidence interval = 1.0 - 4.5), as did managerial occupations (odds ratio = 1.3 and 1.7, 95% confidence interval = 1.1 - 1.5 and 1.3 - 2.2 for men and women, respectively). Men in mining and oil drilling occupations and the wholesale trade industry also had excess crash deaths. Among women, additional excesses were observed among professional specialists and in several groups with few deaths, including agriculture, construction, and the military, whereas homemakers had markedly fewer vehicle crash deaths than expected. Conclusions: These findings encourage further investigation of this important safety hazard, but also call attention to a need for more detailed studies and improved data. Handle: RePEc:aph:ajpbhl:1991:81:6:733-735_8 Template-Type: ReDIF-Article 1.0 Title: Lead exposure in sandblasting [3] Journal: American Journal of Public Health Author-Name: Silbergeld, E.K. Author-Name: Schirmer, J. Year: 1991 Volume: 81 Issue: 4 Pages: 514-515 Handle: RePEc:aph:ajpbhl:1991:81:4:514-515_3 Template-Type: ReDIF-Article 1.0 Title: Cost-effectiveness of alpha-1 antitrypsin replacement therapy in treatment of congenital chronic obstructive pulmonary disease Journal: American Journal of Public Health Author-Name: Hay, J.W. Author-Name: Robin, E.D. Year: 1991 Volume: 81 Issue: 4 Pages: 427-433 Abstract: Background: Alpha1-antitrypsin (AAT) replacement therapy is an expensive intervention ($20,000-$30,000 per patient annually) which may slow or arrest the progression of chronic obstructive pulmonary disease (COPD) in AAT-deficient patients. While FDA-approved, therapy efficacy is unknown. The costs and benefits of AAT replacement therapy were evaluated for patients with congenital COPD. Methods: Epidemiological and disease cost data were taken from published sources. A discrete-time model of disease stage probability transition was developed to calculate the present-value expected cost of disease treatment, under a range of possible therapy efficacy and other parameter values. Results: At an efficacy of 70 percent, the cost per life year saved with AAT replacement therapy would be between $28,000 and $72,000 (1990 US dollars), depending on patient age, sex, and smoking status. At 30 percent efficacy, the cost per life year saved range would be between $50,000 and $128,000. A controlled efficacy study would cost $53 million or less, if the true efficacy were 50 percent or better. Conclusions: With efficacy of 30 percent or higher, therapy cost-effectiveness would be comparable to other widely used medical interventions. The economic assessment methodology was used to evaluate both the therapeutic innovation and the value of additional clinical research. Handle: RePEc:aph:ajpbhl:1991:81:4:427-433_9 Template-Type: ReDIF-Article 1.0 Title: Historian seeks memorabilia on George Rosen [2] Journal: American Journal of Public Health Author-Name: Morman, E.T. Year: 1991 Volume: 81 Issue: 3 Pages: 389 Handle: RePEc:aph:ajpbhl:1991:81:3:389_9 Template-Type: ReDIF-Article 1.0 Title: Older Americans present a double challenge: Preventing disability and providing care Journal: American Journal of Public Health Author-Name: Kovar, M.G. Author-Name: Feinleib, M. Year: 1991 Volume: 81 Issue: 3 Pages: 287-288 Handle: RePEc:aph:ajpbhl:1991:81:3:287-288_6 Template-Type: ReDIF-Article 1.0 Title: Responsible alcohol service: A study of server, manager, and environmental impact Journal: American Journal of Public Health Author-Name: Howard-Pitney, B. Author-Name: Johnson, M.D. Author-Name: Altman, D.G. Author-Name: Hopkins, R. Author-Name: Hammond, N. Year: 1991 Volume: 81 Issue: 2 Pages: 197-199 Abstract: A responsible alcohol-service training program was evaluated for its impact on changing beliefs, knowledge, and behavior in 97 servers and 43 managers and on changing establishment policies that encourage safer drinking environments. The training program had a significant impact on changing the beliefs and knowledge of both servers and managers. Observation 4 to 6 weeks after training showed no effects on server behavior, but there was a tendency toward more establishment policies compared with controls. Handle: RePEc:aph:ajpbhl:1991:81:2:197-199_4 Template-Type: ReDIF-Article 1.0 Title: HIV risk behavior reduction following intervention with key opinion leaders of population: An experimental analysis Journal: American Journal of Public Health Author-Name: Kelly, J.A. Author-Name: St. Lawrence, J.S. Author-Name: Diaz, Y.E. Author-Name: Stevenson, L.Y. Author-Name: Hauth, A.C. Author-Name: Brasfield, T.L. Author-Name: Kalichman, S.C. Author-Name: Smith, J.E. Author-Name: Andrew, M.E. Year: 1991 Volume: 81 Issue: 2 Pages: 168-171 Abstract: Background and Purpose. Peer norms influence the adoption of behavior changes to reduce risk for HIV (human immunodeficiency virus) infection. By experimentally intervening at a community level to modify risk behavior norms, it may be possible to promote generalized reductions in HIV risk practices within a population. Methods. We trained persons reliably identified as popular opinion leaders among gay men in a small city to serve as behavior change endorsers to their peers. The opinion leaders acquired social skills for making these endorsements and complied in talking frequently with friends and acquaintances. Before and after intervention, we conducted surveys of men patronizing gay clubs in the intervention city and in two matched comparison cities. Results. In the intervention city, the proportion of men who engaged in any unprotected anal intercourse in a two-month period decreased from 36.9 percent to 27.5 percent (-25 percent from baseline), with a reduction from 27.1 percent to 19.0 percent (-30 percent from baseline) for unprotected receptive anal intercourse. Relative to baseline levels, there was a 16 percent increase in condom use during anal intercourse and an 18 percent decrease in the proportion of men with more than one sexual partner. Little or no change was observed among men in the comparison cities over the same period of time. Conclusions. Interventions that employ peer leaders to endorse change may produce or accelerate population behavior changes to lessen risk for HIV infection. Handle: RePEc:aph:ajpbhl:1991:81:2:168-171_6 Template-Type: ReDIF-Article 1.0 Title: Targeted HIV screening at a Los Angeles prenatal/family planning health center Journal: American Journal of Public Health Author-Name: Fehrs, L.J. Author-Name: Hill, D. Author-Name: Kerndt, P.R. Author-Name: Rose, T.P. Author-Name: Henneman, C. Year: 1991 Volume: 81 Issue: 5 Pages: 619-622 Abstract: In 1988, the Los Angeles County Health Department conducted a blinded human immunodeficiency virus (HIV) seroprevalence study at a public prenatal (PN) and family planning (FP) center serving mostly Hispanic women in order to determine seroprevalence and to evaluate the center's targeted HIV screening program. Four women (0.13 percent) tested positive (3/1801 PN and 1/1167 FP). Three reported no risk factors; one reported a history of syphilis since 1978. Voluntary HIV testing was selectively offered to women who reported risk factors for HIV infection. Only 14 percent (96/685) of clients offered testing chose to do it: 28 percent (14/50) of clients classified as being at highest risk of infection, and 27 percent (16/59) of women who judged themselves to have some chance of being exposed to HIV. None of the four women who tested positive by blinded testing chose testing. While few women at this center were infected with HIV, higher risk women were not persuaded to be tested through a targeted screening program. Blinded HIV seroprevalence studies provide a tool for both tracking infection in a population and evaluating screening programs. Handle: RePEc:aph:ajpbhl:1991:81:5:619-622_3 Template-Type: ReDIF-Article 1.0 Title: The cost-effectiveness of orphan drugs Journal: American Journal of Public Health Author-Name: Weinstein, M.C. Year: 1991 Volume: 81 Issue: 4 Pages: 414-415 Handle: RePEc:aph:ajpbhl:1991:81:4:414-415_8 Template-Type: ReDIF-Article 1.0 Title: Drake Chemical Workers' Health Registry: Coping with community tension over toxic exposures Journal: American Journal of Public Health Author-Name: Leviton, L.C. Author-Name: Marsh, G.M. Author-Name: Talbott, E. Author-Name: Pavlock, D. Author-Name: Callahan, C. Year: 1991 Volume: 81 Issue: 6 Pages: 689-693 Abstract: Background: Programs to communicate health risk information and to protect the health of groups exposed to toxic substances need to tailor interventions to the political, economic, and cultural situation of the at-risk group. In particular, such programs must often cope with exceptional community tension and conflict over these exposures. Methods: This article uses interviews and written materials to document and describe the state of affairs that led up to community tension over an occupational exposure to a bladder carcinogen. The article describes the planning and design of a program to provide medical surveillance to workers, which also alleviated community concern. Results: The Drake Chemical Workers' Health Registry coped successfully with community conflict and obtained a high participation rate. Conclusions: General recommendations include the following: avoid identification with extraneous agendas; know the community and maintain communication; and match the intervention to the evolution of the community conflict. Handle: RePEc:aph:ajpbhl:1991:81:6:689-693_8 Template-Type: ReDIF-Article 1.0 Title: Measuring physical activity with a single question Journal: American Journal of Public Health Author-Name: Schechtman, K.B. Author-Name: Barzilai, B. Author-Name: Rost, K. Author-Name: Fisher Jr., E.B. Year: 1991 Volume: 81 Issue: 6 Pages: 771-773 Abstract: Using 1,004 subjects enrolled in a worksite health promotion program, this report evaluated the validity of a single question about participation in regular exercise. Measured at baseline, this one question had a significant age-adjusted association with body mass index (p < 0.0001 in women and p = 0.001 in men), HDL cholesterol (p < 0.0001 in women), and oxygen capacity (p = 0.0007 in women and p = 0.002 in men). Thus, one self-reported question can provide useful information about who is and who is not participating in regular exercise. The potential validity of a single exercise question is particularly relevant in complex epidemiologic studies where lengthy questionnaires highlight the importance of brief instruments. Handle: RePEc:aph:ajpbhl:1991:81:6:771-773_3 Template-Type: ReDIF-Article 1.0 Title: The Nursing Minimum Data Set: Abstraction tool for standardized, comparable, essential data Journal: American Journal of Public Health Author-Name: Werley, H.H. Author-Name: Devine, E.C. Author-Name: Zorn, C.R. Author-Name: Ryan, P. Author-Name: Westra, B.L. Year: 1991 Volume: 81 Issue: 4 Pages: 421-426 Abstract: The Nursing Minimum Data Set (NMDS) represents the first attempt to standardize the collection of essential nursing data. These minimum core data, used on a regular basis by the majority of nurses in the delivery of care across settings, can provide an accurate description of nursing diagnoses, nursing care, and nursing resources used. Collected on an ongoing basis, a standardized nursing data base will enable nurses to compare data across populations, settings, geographic areas, and time. Public health nurses will be able to evaluate and compare services. The purpose of this article is to discuss briefly the following aspects of the NMDS: background including definition, purposes, and elements; availability and reliability of the data; benefits; implications of the NMDS with emphasis on nursing research; and health policy decision making. Handle: RePEc:aph:ajpbhl:1991:81:4:421-426_5 Template-Type: ReDIF-Article 1.0 Title: Regular source of ambulatory care and access to health services Journal: American Journal of Public Health Author-Name: Hayward, R.A. Author-Name: Bernard, A.M. Author-Name: Freeman, H.E. Author-Name: Corey, C.R. Year: 1991 Volume: 81 Issue: 4 Pages: 434-438 Abstract: Background: To examine why people lack a regular source of ambulatory care (RSAC) and explore whether this commonly used access measure accurately identifies population subgroups at risk for barriers to continuity care. Methods: Using data from a 1986 national telephone survey, we performed a content analysis of subjects' verbatim reports as to why they lacked an RSAC (n = 5,748). Results: The 16.4 percent of respondents who lacked an RSAC gave the following reasons: 1) financial problems, 8 percent; 2) local resource inaccessibility, 5 percent; 3) not wanting a regular source of ambulatory care, 61 percent; and 4) transitory loss of their regular source of ambulatory care, 18 percent. However, some sociodemographic subgroups reported substantially more problems with access barriers, and these disparities were often not detected by the global measure, RSAC. The poor were not more likely than the non-poor to lack an RSAC (odds ratio [OR] = 0.8; 95% confidence interval, [0.6, 1.1]), but were much more likely to lack an RSAC for financial reasons (OR = 5.2 [2.6, 10.6]). Similarly, rural respondents were not more likely than urban dwellers to lack an RSAC, but were more likely to lack an RSAC because of local resource inaccessibility (OR = 5.8 [2.8, 11.9]). Conclusions: We conclude that the global measure, RSAC, is not an accurate indicator of whether population subgroups have access barriers to obtaining a source of continuity care. Handle: RePEc:aph:ajpbhl:1991:81:4:434-438_1 Template-Type: ReDIF-Article 1.0 Title: Condom use during pregnancy [4] Journal: American Journal of Public Health Author-Name: Schmid, B.C. Author-Name: Sharp, E.S. Author-Name: Hatcher, R.A. Author-Name: Cotsonis, G. Year: 1991 Volume: 81 Issue: 6 Pages: 805 Handle: RePEc:aph:ajpbhl:1991:81:6:805_4 Template-Type: ReDIF-Article 1.0 Title: Erratum: Discharges against medical advice at regional acute care hospitals (Am J Public Health 1991; 81:212-215) Journal: American Journal of Public Health Author-Name: Smith, D.B. Author-Name: Telles, J.L. Year: 1991 Volume: 81 Issue: 5 Pages: 567 Handle: RePEc:aph:ajpbhl:1991:81:5:567_6 Template-Type: ReDIF-Article 1.0 Title: II. Newborn seroprevalence study: Methods and results Journal: American Journal of Public Health Author-Name: Novick, L.F. Author-Name: Glebatis, D.M. Author-Name: Stricof, R.L. Author-Name: MacCubbin, P.A. Author-Name: Lessner, L. Author-Name: Berns, D.S. Year: 1991 Volume: 81 Issue: SUPPL. Pages: 15-21 Abstract: For the 28-month period, November 30, 1987 through March 31, 1990, 653,117 blood specimens obtained on all newborn infants in New York State for detection of metabolic disorders were also analyzed for HIV serologic status. The overall seroprevalence rate was 0.66 percent: 1.24 percent in New York City and 0.17 percent in New York State exclusive of New York City. Rates of seropositivity were highest in the Bronx (1.72 percent) and Manhattan (1.59 percent). Outside of New York City, HIV seropositivity was concentrated in certain areas. Sixty-four zip codes with two or more seropositives and an HIV seroprevalence rate twice the average outside of New York City contained 65 percent of the HIV seropositives but only 16 percent of the newborns tested. Newborn seropositivity increased with maternal age. In New York City, the seroprevalence rates increased from 0.16 percent (1 in 624) for 14-year-olds to 1.41 percent (1 in 71) for 24-year-olds, a nine-fold rise. This survey has provided the impetus for a number of preventive initiatives. Handle: RePEc:aph:ajpbhl:1991:81:SUPPL.:15-21_7 Template-Type: ReDIF-Article 1.0 Title: A carbon monoxide mass poisoning in an ice arena in Vermont [4] Journal: American Journal of Public Health Author-Name: Paulozzi, L.J. Author-Name: Satink, F. Author-Name: Spengler, R.F. Year: 1991 Volume: 81 Issue: 2 Pages: 222 Handle: RePEc:aph:ajpbhl:1991:81:2:222_5 Template-Type: ReDIF-Article 1.0 Title: The status of restrictive smoking policies: A survey of medical schools in the United States and Canada Journal: American Journal of Public Health Author-Name: Stillman, F.A. Author-Name: Becker, D.M. Year: 1991 Volume: 81 Issue: 1 Pages: 101-102 Abstract: All schools of medicine in the United States (N = 128) and Canada (N = 16) were surveyed by telephone to determine if they had instituted policies to restrict smoking. Some policy restricting smoking was reported by 80.56 percent of US schools (N = 103) and by 93.8 percent of Canadian schools (N = 15). However, only 52.3 percent of US (N = 67) and 56.3 percent of Canadian medical schools (N = 9) indicated they had formal written policy statements. Only 13 percent of US schools and 19 percent of Canadian schools had banned smoking totally. Handle: RePEc:aph:ajpbhl:1991:81:1:101-102_9 Template-Type: ReDIF-Article 1.0 Title: VIII. Hospitalization of HIV-seropositive newborns with AIDS-related disease within the first year of life Journal: American Journal of Public Health Author-Name: Glebatis, D.M. Author-Name: Novick, L.F. Author-Name: Stacy, A. Year: 1991 Volume: 81 Issue: SUPPL. Pages: 46-49 Abstract: The purpose of this study was to estimate the proportion of HIV-seropositive newborns hospitalized for an AIDS-related diagnosis within 12 months of birth and to characterize these hospitalizations. The number of HIV-seropositive infants born December 1987 through June 1988 was derived from the blinded New York State Newborn HIV Seroprevalence Study. The number of infants who were born in these same months and hospitalized with an ARD within 12 months of birth was obtained from a data base containing information on all hospital discharges in New York State. Comparisons were made on the basis of month of birth. Of infants born during the study period, 995 tested positive for HIV antibody, and 151 infants (15 percent) were hospitalized with an ARD within 12 months of birth. The 151 ARD cases had a total of 240 hospitalizations, accounting for 5,772 patient days. Fifty-six percent of the ARD cases were diagnosed within six months of birth. Handle: RePEc:aph:ajpbhl:1991:81:SUPPL.:46-49_9 Template-Type: ReDIF-Article 1.0 Title: Effect of pregnancy during TMI crisis on mothers' mental health and their child's development Journal: American Journal of Public Health Author-Name: Houts, P.S. Author-Name: Tokuhata, G.K. Author-Name: Bratz, J. Author-Name: Bartholomew, M.J. Author-Name: Sheffer, K.W. Year: 1991 Volume: 81 Issue: 3 Pages: 384-386 Abstract: Five years after the Three Mile Island nuclear accident, the mental health of women who had been pregnant and living within 10 miles of Three Mile Island at the time of the accident was similar to that of women from the same area who became pregnant after the accident. Ratings of the development of the two groups of children when they were 5 years old were also similar. However, women who were pregnant during the crisis and had been ''extremely disturbed'' about their pregnancies rated their children's health as poorer than did the women who were pregnant later. Handle: RePEc:aph:ajpbhl:1991:81:3:384-386_6 Template-Type: ReDIF-Article 1.0 Title: Self-injection and needle sharing among migrant farmworkers [1] Journal: American Journal of Public Health Author-Name: Lafferty, J. Year: 1991 Volume: 81 Issue: 2 Pages: 221 Handle: RePEc:aph:ajpbhl:1991:81:2:221_3 Template-Type: ReDIF-Article 1.0 Title: Security measures for AIDS and HIV Journal: American Journal of Public Health Author-Name: Torres, C.G. Author-Name: Turner, M.E. Author-Name: Harkess, J.R. Author-Name: Istre, G.R. Year: 1991 Volume: 81 Issue: 2 Pages: 210-211 Abstract: This study describes the measures being taken by AIDS surveillance offices across the country to ensure the security of information regarding patients with AIDS and HIV infection. Security measures were evaluated according to the cumulative number of AIDS cases reported, whether partner notification services were provided, and whether HIV seropositive reporting by name was also required. This study showed that public health departments have taken extra steps to ensure the security of AIDS and HIV data. Handle: RePEc:aph:ajpbhl:1991:81:2:210-211_5 Template-Type: ReDIF-Article 1.0 Title: Predicting onset and chronicity of women's problem drinking: A five-year longitudinal analysis Journal: American Journal of Public Health Author-Name: Wilsnack, S.C. Author-Name: Klassen, A.D. Author-Name: Schur, B.E. Author-Name: Wilsnack, R.W. Year: 1991 Volume: 81 Issue: 3 Pages: 305-318 Abstract: Background. Longitudinal studies of adult drinking have typically excluded or sampled only small numbers of problem drinking women, and have measured a limited range of influences on women's drinking behavior. Methods. To study the development of women's problem drinking over time, five-year follow-up interviews were conducted with two groups of respondents from a 1981 national survey of women's drinking: 143 problem drinkers and 157 nonproblem drinkers. Regression analyses examined effects of 1981 predictors on six measures of 1986 problem drinking, for problem drinkers and nonproblem drinkers separately. Results. Among 1981 nonproblem drinkers, predictors of onset of problem drinking indicators by 1986 included younger age, cohabiting, and lifetime use of drugs other than alcohol. The most consistent predictor of persistent (chronic) problem drinking was sexual dysfunction; other predictors included being employed part-time or never married, and experiencing recent depression. Divorce or separation predicted lower levels of subsequent alcohol dependence among problem drinkers. Conclusions. Findings suggest that different personal and social factors predict the onset of problem drinking as compared with its continuation, and point to nontraditional life-style, sexual dysfunction, and role deprivation as potentially important variables. Handle: RePEc:aph:ajpbhl:1991:81:3:305-318_0 Template-Type: ReDIF-Article 1.0 Title: Premature death in jazz musicians: Fact or fiction? [3] Journal: American Journal of Public Health Author-Name: Spencer, F.J. Year: 1991 Volume: 81 Issue: 6 Pages: 804-805 Handle: RePEc:aph:ajpbhl:1991:81:6:804-805_8 Template-Type: ReDIF-Article 1.0 Title: Discharges against medical advice at regional acute care hospitals Journal: American Journal of Public Health Author-Name: Smith, D.B. Author-Name: Telles, J.L. Year: 1991 Volume: 81 Issue: 2 Pages: 212-215 Abstract: Data from 67 acute care hospitals in the Philadelphia metropolitan area indicate that there were 7,613 discharges against medical advice (AMA) in fiscal year 1987, or 1.20 percent of all discharges that year. Diagnosis-related group (DRG), type of insurance, and sex had independent effects on the rate of AMA discharges. Urban community hospitals had the highest percent of AMA discharges. Previous studies, done in teaching facilities, may have underestimated the rate of AMA discharges. Handle: RePEc:aph:ajpbhl:1991:81:2:212-215_8 Template-Type: ReDIF-Article 1.0 Title: Case definitions in public health Journal: American Journal of Public Health Author-Name: Seligman, P.J. Author-Name: Matte, T.D. Year: 1991 Volume: 81 Issue: 2 Pages: 161-162 Handle: RePEc:aph:ajpbhl:1991:81:2:161-162_6 Template-Type: ReDIF-Article 1.0 Title: The course of the HIV epidemic among intravenous drug users in Amsterdam, The Netherlands Journal: American Journal of Public Health Author-Name: Van Haastrecht, H.J.A. Author-Name: Van den Hoek, J.A.R. Author-Name: Bardoux, C. Author-Name: Leentvaar-Kuypers, A. Author-Name: Coutinho, R.A. Year: 1991 Volume: 81 Issue: 1 Pages: 59-62 Abstract: To determine if behavioral changes in intravenous drug users in Amsterdam have retarded the HIV (human immunodeficiency virus) epidemic in this group in recent years, we report that: HIV-antibody seroprevalence in annual samples of injectors has been constant over the years 1986-89; HIV-antibody incidence in a cohort of injectors appears to have decreased from 1986 to 1987 and stabilized after that until 1989; acute hepatitis B incidence in all drug users in Amsterdam declined rapidly between 1985-89. It is concluded that changes in drug use behavior so far appear to have resulted in a stabilization of the epidemic among injectors, at a level with a still disturbingly high incidence rate of 5-6 per 100 person-years. Handle: RePEc:aph:ajpbhl:1991:81:1:59-62_0 Template-Type: ReDIF-Article 1.0 Title: Socioeconomic status and survival from soft-tissue sarcomas: A population-based study in northern Italy Journal: American Journal of Public Health Author-Name: Ciccone, G. Author-Name: Magnani, C. Author-Name: Delsedime, L. Author-Name: Vineis, P. Year: 1991 Volume: 81 Issue: 6 Pages: 747-749 Abstract: Background and Purpose: Differential prognosis among cancer patients according to socioeconomic status (SES) has been reported. We analyzed survival from soft tissue sarcomas (STS) according to different SES indicators. Methods: We followed up all the adult patients with a new diagnosis of STS occurring between 1.1.1981 and 31.12.1983 in an area of Northern Italy (N = 86). Results: The overall three-year survival rate was 57 percent. After adjustment for confounders, both low education and blue collar jobs were negatively associated with survival. Conclusions: The results suggest that patients of low SES have a poorer prognosis for STS. Handle: RePEc:aph:ajpbhl:1991:81:6:747-749_9 Template-Type: ReDIF-Article 1.0 Title: Erratum: Lead in the modern workplace (American Journal of Public Health, August 1990) Journal: American Journal of Public Health Author-Name: Landrigan, P.J. Author-Name: Silbergeld, E.K. Author-Name: Froines, J.R. Author-Name: Pfeffer, R.M. Year: 1991 Volume: 81 Issue: 2 Pages: 162 Handle: RePEc:aph:ajpbhl:1991:81:2:162_4 Template-Type: ReDIF-Article 1.0 Title: Erratum: Antibiotic use among children in an urban Brazilian slum: A risk factor for diarrhea? (Am J Public Health 1991;81:99-100) Journal: American Journal of Public Health Author-Name: Schorling, J.B. Author-Name: DeSouza, M.A. Author-Name: Guerrant, R.L. Year: 1991 Volume: 81 Issue: 4 Pages: 417 Handle: RePEc:aph:ajpbhl:1991:81:4:417_3 Template-Type: ReDIF-Article 1.0 Title: Social origins, medical education, and medical practice Journal: American Journal of Public Health Author-Name: Wegman, M.E. Year: 1991 Volume: 81 Issue: 1 Pages: 13-14 Handle: RePEc:aph:ajpbhl:1991:81:1:13-14_5 Template-Type: ReDIF-Article 1.0 Title: An analysis of occupational blood lead trends in Manitoba, 1979 through 1987 Journal: American Journal of Public Health Author-Name: Yassi, A. Author-Name: Cheang, M. Author-Name: Tenenbein, M. Author-Name: Bawden, G. Author-Name: Spiegel, J. Author-Name: Redekop, T. Year: 1991 Volume: 81 Issue: 6 Pages: 736-740 Abstract: Background: While regulations for workplace lead exposure become more strict, their effectiveness in decreasing blood lead concentrations and the method by which this is attained have not been evaluated. Methods: An analysis was conducted of 10,190 blood lead samples from employees of 10 high-risk workplaces collected in Manitoba, 1979-87, as part of regulated occupational surveillance. Results: A significant decrease in blood lead concentrations was observed overall as well as for each individual company. A 1979 government regulation to reduce blood lead to below 3.38 μmol/L (70 μg/dl) was followed by a drop in blood lead concentrations; a 1983 order to reduce blood leads to below 2.90 μmol/L (60 μg/dl) was not followed by such a drop. Longitudinal analysis by individual workers suggested that companies were complying by use of administrative control, i.e., removing workers to lower lead areas until blood lead levels had fallen, then returning them to high lead areas. Conclusion: Focusing upon blood lead as the sole criterion for compliance is not effective; regulations must specifically require environmental monitoring and controls. Biological surveillance serves as ''back-up'' to environmental surveillance and this database illustrates the usefulness of a comprehensive centralized surveillance system. Handle: RePEc:aph:ajpbhl:1991:81:6:736-740_4 Template-Type: ReDIF-Article 1.0 Title: The role of attitudes, beliefs, and personal characteristics of Italian physicians in the surgical treatment of early breast cancer Journal: American Journal of Public Health Author-Name: Liberati, A. Author-Name: Apolone, G. Author-Name: Nicolucci, A. Author-Name: Confalonieri, C. Author-Name: Fossati, R. Author-Name: Grilli, R. Author-Name: Torri, V. Author-Name: Masconi, P. Author-Name: Alexanian, A. Year: 1991 Volume: 81 Issue: 1 Pages: 38-42 Abstract: The influences of Italian physicans' attitudes, beliefs, and personal characteristics on medical decision making is examined in the case of surgical treatment of early breast cancer. Responses to a mail survey of 657 physicians from different specialities were analyzed comparing doctors recommending a radical procedure (9%) to those perferring a conservative procedure for younger patients only (25%), and those considering conservative surgery the treatment of choice regardless of patients' age (66%). The findings suggest that the likelihood of physicians' preferring a conservative procedure is influenced by their specialty and the extent to which they feel that a patient should have a role in the treatment decision more than by differences in the beliefs of treatment outcomes. Only preferences of the small group indicating radical surgery as the sole admissible treatment can be accounted for by ignorance or distrust of results of recent trials. These findings suggest that other than scientific factors guide many doctors in their decision making; they may help to explain why the diffusion of research results into clinical practice is often disappointingly slow. Handle: RePEc:aph:ajpbhl:1991:81:1:38-42_2 Template-Type: ReDIF-Article 1.0 Title: OSHA's four inconsistent carcinogen policies Journal: American Journal of Public Health Author-Name: Robinson, J.C. Year: 1991 Volume: 81 Issue: 6 Pages: 775-780 Handle: RePEc:aph:ajpbhl:1991:81:6:775-780_7 Template-Type: ReDIF-Article 1.0 Title: Early identical twin studies [2] Journal: American Journal of Public Health Author-Name: Torfs, C. Author-Name: Newman, B. Author-Name: Quesenberry Jr., C.P. Author-Name: King, M.-C. Author-Name: Selby, J.V. Author-Name: Friedman, G.D. Year: 1991 Volume: 81 Issue: 1 Pages: 112-113 Handle: RePEc:aph:ajpbhl:1991:81:1:112-113_2 Template-Type: ReDIF-Article 1.0 Title: Cost of smoking cessation clinics Journal: American Journal of Public Health Author-Name: Murphy, R. Year: 1991 Volume: 81 Issue: 2 Pages: 221 Handle: RePEc:aph:ajpbhl:1991:81:2:221_4 Template-Type: ReDIF-Article 1.0 Title: Changes with the New Year Journal: American Journal of Public Health Author-Name: Ibrahim, M.A. Year: 1991 Volume: 81 Issue: 1 Pages: 11-12 Handle: RePEc:aph:ajpbhl:1991:81:1:11-12_5 Template-Type: ReDIF-Article 1.0 Title: The microbiologic quality of drinking water in North Carolina migrant labor camps Journal: American Journal of Public Health Author-Name: Ciesielski, S. Author-Name: Handzel, T. Author-Name: Sobsey, M. Year: 1991 Volume: 81 Issue: 6 Pages: 762-764 Abstract: A two-year study of the microbiological quality of drinking water in 27 randomly selected North Carolina migrant labor camps yielded total and fecal coliform prevalences of 44 percent and 26 percent, respectively in 1988 and similar but higher prevalences in 1989. Preoccupancy testing by county sanitarians had found virtually no total coliform contamination. These findings suggest that a potential source of contamination existed and that current testing protocols which rely on preoccupancy testing may be inadequate. Handle: RePEc:aph:ajpbhl:1991:81:6:762-764_9 Template-Type: ReDIF-Article 1.0 Title: Effects on serum lipids of adding instant oats to usual American diets Journal: American Journal of Public Health Author-Name: Van Horn, L. Author-Name: Moag-Stahlberg, A. Author-Name: Liu, K. Author-Name: Ballew, C. Author-Name: Ruth, K. Author-Name: Hughes, R. Author-Name: Stamler, J. Year: 1991 Volume: 81 Issue: 2 Pages: 183-188 Abstract: This study was designed as a test of the serum lipid response and dietary adaptation to recommended daily inclusion of instant oats in an otherwise regular diet. Hypercholesterolemic adults were randomly assigned to a control or intervention group. Participants in the intervention group were given packages of instant oats and requested to eat two servings per day (approximately two ounces dry weight), substituting the oats for other carbohydrate foods in order to maintain baseline calorie intake and keep weight stable. Serum lipids were measured in blood collected by venipuncture at baseline, four weeks, and eight weeks. Baseline mean total cholesterol (TC) levels were 6.56 mmol/L and 6.39 mmol/L for intervention and control groups, respectively. After eight weeks, mean serum total cholesterol of the intervention group was lower by -0.40 mmol/L, and mean net difference in TC between the two groups was 0.32 mmol/L (95% CI: 0.09, 0.54). Low-density lipoprotein-cholesterol was similarly reduced with mean net difference of 0.25 mmol/L (95% CI: 0.02, 0.48) between the two groups. Mean soluble fiber intake increased along with slight self-imposed reductions in mean total fat, saturated fat, and dietary cholesterol intake in the intervention group. Neither group changed mean body weight. Daily inclusion of two ounces of oats appeared to facilitate reduction of serum total cholesterol and LDL-C in these hyperlipidemic individuals. Handle: RePEc:aph:ajpbhl:1991:81:2:183-188_9 Template-Type: ReDIF-Article 1.0 Title: Agricultural machine-related deaths Journal: American Journal of Public Health Author-Name: Etherton, J.R. Author-Name: Myers, J.R. Author-Name: Jensen, R.C. Author-Name: Russell, J.C. Author-Name: Braddee, R.W. Year: 1991 Volume: 81 Issue: 6 Pages: 766-768 Abstract: Analysis of 1980-1985 death certificate data for the United States indicated that an average of 369 occupational deaths per year involved agricultural machinery as the external cause of death. Out of all agricultural machine-related deaths, tractors accounted for 69 percent. Over half of these tractor-related deaths were rollovers. There is a need for public health programs to affect greater use of rollover protective structures (ROPS) on farm tractors. Handle: RePEc:aph:ajpbhl:1991:81:6:766-768_7 Template-Type: ReDIF-Article 1.0 Title: Can stress cause cancer? Journal: American Journal of Public Health Author-Name: Janerich, D.T. Year: 1991 Volume: 81 Issue: 6 Pages: 687-688 Handle: RePEc:aph:ajpbhl:1991:81:6:687-688_4 Template-Type: ReDIF-Article 1.0 Title: IX. HIV seroprevalence in a facility for runaway and homeless adolescents Journal: American Journal of Public Health Author-Name: Stricof, R.L. Author-Name: Kennedy, J.T. Author-Name: Nattell, T.C. Author-Name: Weisfuse, I.B. Author-Name: Novick, L.F. Year: 1991 Volume: 81 Issue: SUPPL. Pages: 50-53 Abstract: In October 1987, the New York State Department of Health initiated a study to determine the prevalence of antibody to HIV in clients of a facility for runaway and homeless adolescents in New York City. A risk-assessment component was added in May 1988. As of December 1989, a total of 2,667 adolescents had been tested, and 142 (5.3 percent) were found to be HIV-seropositive (males 6.0 percent, females 4.2 percent). The seroprevalence rate increased from 1.3 percent for 15-year-olds to 8.6 percent for 20-year-olds. Hispanics had the highest seroprevalence rate (6.8 percent), followed by non-Hispanic Whites (6.0 percent) and non-Hispanic Blacks (4.6 percent). HIV seropositivity was associated with intravenous drug use, male homosexual/bisexual activity, prostitution, and history of another sexually transmitted disease. The alarmingly high prevalence of HIV infection in this selected population illustrates the immediate need for prevention programs for adolescents. Handle: RePEc:aph:ajpbhl:1991:81:SUPPL.:50-53_6 Template-Type: ReDIF-Article 1.0 Title: Reporting of occupational injury and illness in the semiconductor manufacturing industry Journal: American Journal of Public Health Author-Name: McCurdy, S.A. Author-Name: Schenker, M.B. Author-Name: Samuels, S.J. Year: 1991 Volume: 81 Issue: 1 Pages: 85-89 Abstract: In the United States, occupational illness and injury cases meeting specific reporting criteria are recorded on company Occupational Safety and Health Administration (OSHA) 200 logs; case description data are submitted to participating state agencies for coding and entry in the national Supplementary Data System (SDS). We evaluated completeness of reporting (the percentage of reportable cases that were recorded in the company OSHA 200 log) in the semiconductor manufacturing industry by reviewing company health clinic records for 1984 of 10 manufacturing sites of member companies of a national semiconductor manufacturing industry trade association. Of 416 randomly selected work-related cases, 101 met OSHA reporting criteria. Reporting completeness was 60 percent and was lowest for occupational illnesses (44 percent). Case-description data from 150 reported cases were submitted twice to state coding personnel to evaluate coding reliability. Reliability was high (kappa 0.82-0.93) for ''nature,'' ''affected body part,'' ''source,'' and ''type'' variables. Coding for the SDS appears reliable; reporting completeness may be improved by use of a stepwise approach by company personnel responsible for reporting decisions. Handle: RePEc:aph:ajpbhl:1991:81:1:85-89_9 Template-Type: ReDIF-Article 1.0 Title: Risk communication activities of state health agencies Journal: American Journal of Public Health Author-Name: Chess, C. Author-Name: Salomone, K.L. Author-Name: Sandman, P.M. Year: 1991 Volume: 81 Issue: 4 Pages: 489-491 Abstract: Surveys concerning the risk communication practices and needs of state health agencies were completed by agency commissioners and designated staff of 48 states and territories. These data indicate that agencies are expending more effort on responding to requests for information than on initiating dialogues with interested constituencies or altering the public to risk. The data also suggest a gap between the stated philosophy and practice of the agencies. Handle: RePEc:aph:ajpbhl:1991:81:4:489-491_8 Template-Type: ReDIF-Article 1.0 Title: Maternal feeding behavior and child acceptance of food during diarrhea, convalescence, and health in the Central Sierra of Peru Journal: American Journal of Public Health Author-Name: Bentley, M.E. Author-Name: Stallings, R.Y. Author-Name: Fukumoto, M. Author-Name: Elder, J.A. Year: 1991 Volume: 81 Issue: 1 Pages: 43-47 Abstract: Feeding patterns by mothers and child acceptance of food were measured in a Peruvian village to determine changes on days when children had diarrhea as compared to days of convalescence and health. Morbidity surveillance identified 40 children, aged 4-36 months, with diarrhea. Children were followed using twelve-hour in-home structured observations during two to four days each of diarrhea, convalescence, and health. Using scales of maternal encouragement to eat and child acceptance of food and cumulative logistic regression analyses, maternal encouragement to eat decreased significantly during convalescence compared to diarrheal days (OR: 0.54, 90% CI: 0.35, 0.82) and health compared to diarrhea (OR: 0.65, 90% CI: 0.46, 0.93). In contrast, child acceptance of food increased during health compared to diarrhea (OR: 1.55, 90% CI: 1.02, 2.35). Results illustrate the importance of carefully examining the behavioral aspects of nutritional intake. Decreases in intake during diarrhea are due to anorexia and not withdrawal of food by mothers. In response to reductions in child appetite during illness, mothers are more likely to encourage children to eat, while they tend to become more passive feeders after the diarrhea has stopped. Program efforts should focus on messages to feed children more actively especially after diarrhea episodes, when appetite levels increase. Handle: RePEc:aph:ajpbhl:1991:81:1:43-47_1 Template-Type: ReDIF-Article 1.0 Title: Alcohol drinking patterns and blood pressure Journal: American Journal of Public Health Author-Name: Russell, M. Author-Name: Cooper, M.L. Author-Name: Frone, M.R. Author-Name: Welte, J.W. Year: 1991 Volume: 81 Issue: 4 Pages: 452-457 Abstract: Background: Although blood pressure tends to increase with average alcohol consumption, little is known about the effects of drinking patterns on blood pressure. Therefore, the effects of average drinks per day and drinking pattern (defined as the independent and interactive effects of quantity and frequency) on blood pressure were compared. Methods: Data were obtained from a random sample survey of 1,635 household residents in Erie County, New York. Alcohol-blood pressure relationships were examined using multiple regression analyses that controlled for the potentially confounding influence of 13 additional risk factors for elevated blood pressure. Results: Consistent with prior research, a positive relationship was found between average drinks per day and diastolic and systolic blood pressure. Analyses examining the effect of drinking pattern indicated that drinking frequency had a positive effect on both diastolic and systolic blood pressure, whereas drinking quantity did not affect either. Furthermore, there was little evidence that the frequency-by-quantity interaction affected blood pressure. Conclusions: Low average alcohol intake and low blood pressure were associated with infrequent drinking, rather than with frequent drinking of small amounts of alcohol. Results suggest that the standard practice of averaging alcohol consumption may obscure important effects of drinking frequency on health. Handle: RePEc:aph:ajpbhl:1991:81:4:452-457_7 Template-Type: ReDIF-Article 1.0 Title: Adult survivors of childhood sexual abuse and subsequent risk of HIV infection Journal: American Journal of Public Health Author-Name: Zierler, S. Author-Name: Feingold, L. Author-Name: Laufer, D. Author-Name: Velentgas, P. Author-Name: Kantrowitz-Gordon, I. Author-Name: Mayer, K. Year: 1991 Volume: 81 Issue: 5 Pages: 572-575 Abstract: Background: Epidemiologic description of long-term adverse health effects of childhood sexual abuse is lacking, despite estimates that perhaps 30 percent of adults have experienced sexual assault in childhood. Methods: In an adult cohort enrolled to investigate causes of transmission of human immunodeficiency virus, we identified current behaviors affecting risk of infection that were associated with a history of early sexual abuse. One hundred and eighty-six individuals provided information on the occurrence of abuse and subsequent sexual and drug using activities. Results: Approximately half of the women and one-fifth of the men reported a history of rape during childhood or adulthood. Twenty-eight percent of the women and 15 percent of the men recalled that they had been sexually assaulted during childhood. People who reported childhood rape compared with people who did not were four times more likely to be working as prostitutes (90 percent confidence interval = 2.0, 8.0). Women were nearly three times more likely to become pregnant before the age of 18 (90% CI = 1.6, 4.1). Men who reported a history of sexual abuse had a twofold increase in prevalence of HIV infection relative to unabused men (90% CI = 1.0, 3.9). Conclusions: The disturbing prevalence of early sexual abuse and its possible health-related consequences call for prompt and routine investigation of sexual abuse histories. Identification of sexual victimization may be an important component for management of risk factors for human immunodeficiency virus. Handle: RePEc:aph:ajpbhl:1991:81:5:572-575_2 Template-Type: ReDIF-Article 1.0 Title: Oral public health programs for the elderly: 1989 Journal: American Journal of Public Health Author-Name: Strayer, M.S. Year: 1991 Volume: 81 Issue: 3 Pages: 382-384 Abstract: Forty-eight of the 50 state dental directors, program managers, or state health officials were interviewed by telephone about the nature of current oral health programs for the elderly and factors that aided or hindered the development of such programs. Oral health programs for the elderly were reported in 30 states (63 percent of respondents). A majority of respondents indicated that a perceived or documented need for oral health programs for the elderly and lobbying by local advocacy groups were instrumental in implementing or planning such programs. Handle: RePEc:aph:ajpbhl:1991:81:3:382-384_2 Template-Type: ReDIF-Article 1.0 Title: Foreword Journal: American Journal of Public Health Author-Name: Axelrod, D. Year: 1991 Volume: 81 Issue: SUPPL. Pages: 7 Handle: RePEc:aph:ajpbhl:1991:81:SUPPL.:7_5 Template-Type: ReDIF-Article 1.0 Title: Ascertainment of maternal deaths in New York City Journal: American Journal of Public Health Author-Name: Allen, M.H. Author-Name: Chavkin, W. Author-Name: Marinoff, J. Year: 1991 Volume: 81 Issue: 3 Pages: 380-382 Abstract: Maternal deaths in New York City are defined as deaths from any cause in a woman while pregnant or within six months of pregnancy termination. Pilot studies seeking to improve maternal death ascertainment found that selected medical examiner reports contributed an additional 10.5 percent of the total maternal deaths, vital statistics review contributed 6.3 percent, linkage of death tapes of women of reproductive age to live birth and fetal death tapes contributed 1.0 percent. Medical examiner cases should be incorporated into surveillance data for accurate ascertainment of pregnancy associated deaths. Handle: RePEc:aph:ajpbhl:1991:81:3:380-382_6 Template-Type: ReDIF-Article 1.0 Title: Validation of a surveillance case definition of carpal tunnel syndrome Journal: American Journal of Public Health Author-Name: Katz, J.N. Author-Name: Larson, M.G. Author-Name: Fossel, A.H. Author-Name: Liang, M.H. Year: 1991 Volume: 81 Issue: 2 Pages: 189-193 Abstract: The National Institute for Occupational Safety and Health (NIOSH) has proposed a surveillance case definition for work-related carpal tunnel syndrome (CTS). The case definition requires the presence of median nerve symptoms; one or more occupational risk factors; and objective evidence of CTS including one of three physical examination findings or nerve conduction tests diagnostic of CTS. We evaluated the performance of the NIOSH case definition, restricting our analysis to cases in which physical examination findings served as the objective criterion. Nerve conduction studies were used as the gold standard. Seventy-eight workers were studied; 38 percent had CTS. The NIOSH case definition had sensitivity of 0.67 (95% CI = 0.57, 0.77), specificity of 0.58 (95% CI = 0.47, 0.69), and positive and negative predictive values of 0.50 (95% CI = 0.39, 0.61) and 0.74 (95% CI = 0.64, 0.84), respectively. Overall 38 percent of subjects were classified incorrectly. In a sample with a prevalence of 15 percent, as might be encountered in high risk workplaces, the positive predictive value would be 0.22. In conclusion, when physical examination findings serve as the objective criterion the performance of the case definition is modest reflecting the limited diagnostic value of its component tests and indicating that effective screening for CTS awaits improved diagnostic techniques. Handle: RePEc:aph:ajpbhl:1991:81:2:189-193_4 Template-Type: ReDIF-Article 1.0 Title: The nursing minimum data set: A major priority for public health nursing but not a panacea Journal: American Journal of Public Health Author-Name: Williams, C.A. Year: 1991 Volume: 81 Issue: 4 Pages: 413-414 Handle: RePEc:aph:ajpbhl:1991:81:4:413-414_8 Template-Type: ReDIF-Article 1.0 Title: Preventing homicide: An evaluation of the efficacy of a Detroit Gun Ordinance Journal: American Journal of Public Health Author-Name: O'Carroll, P.W. Author-Name: Loftin, C. Author-Name: Waller Jr., J.B. Author-Name: McDowall, D. Author-Name: Bukoff, A. Author-Name: Scott, R.O. Author-Name: Mercy, J.A. Author-Name: Wiersema, B. Year: 1991 Volume: 81 Issue: 5 Pages: 576-581 Abstract: Background: In November 1986, a Detroit, Michigan city ordinance requiring mandatory jail sentences for illegally carrying a firearm in public was passed to preserve ''the public peace, health, safety, and welfare of the people.'' Methods: We conducted a set of interrupted time-series analyses to evaluate the impact of the law on the incidence of homicides, hypothesizing that the ordinance, by its nature, would affect only firearm homicides and homicides committed outside (e.g., on the street). Results: The incidence of homicide in general increased after the law was passed, but the increases in non-firearm homicides and homicides committed inside (e.g., in a home) were either statistically significant or approached statistical significance (p = .006 and p = .070, respectively), whereas changes in the incidence of firearm homicides and homicides committed outside were not statistically significant (p = .238 and p = .418, respectively). We also determined that the ordinance was essentially unenforced, apparently because of a critical shortage of jail space. Conclusions: Our findings are consistent with a model in which the ordinance had a dampening effect on firearm homicides occurring in public in Detroit. The apparent preventive effect evident in the time series analyses may have been due to publicity about the ordinance, whereas the small nature of the effect may have been due to the lack of enforcement. Handle: RePEc:aph:ajpbhl:1991:81:5:576-581_5 Template-Type: ReDIF-Article 1.0 Title: XI. HIV seroprevalence surveys: Impetus for preventive activities Journal: American Journal of Public Health Author-Name: Novick, L.F. Year: 1991 Volume: 81 Issue: SUPPL. Pages: 61-63 Abstract: Seroprevalence determinations of human immunodeficiency virus are essential for design and implementation of preventive strategies. By demonstrating the severity of HIV infections within communities, New York State surveys have spurred preventive interventions, including information to the public and health care providers and increased counseling and testing of women of reproductive age. In high-prevalence areas the community health workers have been employed in preventive activities. Specific information has been provided to county health departments on zip code areas with high HIV seroprevalence rates. Serosurveys revealed that the magnitude of HIV infection in adolescents is much larger than indicated by case reports. Various seroprevalence studies confirmed higher rates of infection with increasing age and minority status and a strong association with intravenous drug use. Combining data provided by seroprevalence studies in a given community enables planners to assess the extent of infection in that community and in groups important to transmission of the virus. Handle: RePEc:aph:ajpbhl:1991:81:SUPPL.:61-63_5 Template-Type: ReDIF-Article 1.0 Title: Assessment of drug abuser treatment needs in Rhode Island Journal: American Journal of Public Health Author-Name: McAuliffe, W.E. Author-Name: Breer, P. Author-Name: Ahmadifar, N.W. Author-Name: Spino, C. Year: 1991 Volume: 81 Issue: 3 Pages: 365-371 Abstract: Background. Rhode Island's Division of Substance Abuse asked us to assess the State's drug treatment needs and make recommendations regarding its treatment system for the next three years. Methods. We used a statewide telephone drug use survey of 5,176 households supplemented by drug-related hospital discharges, Division of Drug Control statistics, and interviews with providers, state officials, and out-of-state experts. Drug abuse was measured with items from the Diagnostic Interview Schedule. Abusers were asked if they were receiving or wanted to receive treatment. Results. Survey responses, used to estimate the unmet need for drug treatment, indicated a need to triple drug treatment services. Regression models using survey data indicated that the treatment network was overly centralized in the Providence area. Interviews with state officials, clinicians, and out-of-state experts provided material for recommendations on reimbursement policy, treatment mix, quality assurance, and cost containment. Conclusions. The RI Department of Health's certificate-of-need program adopted our overall recommendation for tripling the drug treatment system as its guideline in evaluating proposals for new treatment facilities. With State funding of a new adolescent center and expansion of outpatient slots in the private sector, this recommendation has now been fully implemented. Handle: RePEc:aph:ajpbhl:1991:81:3:365-371_5 Template-Type: ReDIF-Article 1.0 Title: A cross-sectional study of pulmonary function in autobody repair workers Journal: American Journal of Public Health Author-Name: Parker, D.L. Author-Name: Waller, K. Author-Name: Himrich, B. Author-Name: Martinez, A. Author-Name: Martin, F. Year: 1991 Volume: 81 Issue: 6 Pages: 768-771 Abstract: This study evaluated pulmonary function in workers from 39 autobody repair shops. Based on 152 White male workers with known smoking status, the mean percent predicted FEV1, FVC, and FEV1/FVC were 93.6, 96.8, and 96.6, respectively. Twenty-three percent of workers had a FEV1/FVC ratio less than the fifth percentile. Isocyanate levels ranged from nondetectable to 0.06 parts per million (STEL = 0.02 ppm). No shop had an adequate respiratory protection program. We concluded that there was an increase in abnormal pulmonary function in autobody workers. Three recommendations were made to shop owners: functional paint booths should be maintained, respiratory protection programs should be developed, and isocyanate-free paints should be used. Handle: RePEc:aph:ajpbhl:1991:81:6:768-771_1 Template-Type: ReDIF-Article 1.0 Title: The United Mine Workers of America and the recognition of occupational respiratory diseases, 1902-1968 Journal: American Journal of Public Health Author-Name: Derickson, A. Year: 1991 Volume: 81 Issue: 6 Pages: 781-789 Abstract: This study examines the early efforts of the United Mine Workers of America to illuminate the problem of occupational respiratory diseases in the coal fields. The union used the hearings of the US Anthracite Coal Strike Commission of 1902-3 to draw public attention to ''miners' asthma''. In 1915, it began to agitate for the provision of workers' compensation benefits for victims of this disorder. Throughout the 1950s and 1960s, the union's Welfare and Retirement Fund disseminated information on advances in understanding chronic pulmonary diseases of mining. In particular, the miners' fund promoted the British conceptualization of a distinctive coal workers' pneumoconiosis. At the same time, the staff of the union health plan pressed the US Public Health Service and the Pennsylvania Department of Health to investigate the prevalence of occupational respiratory diseases among bituminous miners. Taken together, these endeavors contributed significantly to growing recognition of the severity and extent of this important public health problem and thus helped lay the foundation for the Federal Coal Mine Health and Safety Act of 1969. Handle: RePEc:aph:ajpbhl:1991:81:6:781-789_4 Template-Type: ReDIF-Article 1.0 Title: Urolithiasis in Tennessee: An occupational window into a regional problem Journal: American Journal of Public Health Author-Name: Thun, M.J. Author-Name: Schober, S. Year: 1991 Volume: 81 Issue: 5 Pages: 587-591 Abstract: Background: Urinary tract stones (stones) are believed to be unusually common in the southeastern United States but neither the incidence of nor the risk factors for stones are known. Methods: In three well-defined occupational populations in eastern Tennessee, we assessed the prevalence, incidence, and cumulative incidence of stones and measured biochemical risk factors for lithogenesis. Results: The age-adjusted prevalence of stones was 18.5 percent in Tennessee compared to 7.7 percent among White males in US NHANES (prevalence ratio 2.4, 95% CI 1.7, 3.3). The cumulative incidence (risk) was 27.8 percent by age 65, higher than in any other reported population. Risk factors were age, a family history, and urinary saturation with calcium-oxalate (COAX). Persons with a positive family history and the highest measured CAOX index had a predicted lifetime risk of 88.8 percent. Biochemical factors affecting lithogenesis were hypercalcuria, hyperoxaluria, and low urine volume. Conclusion: Future research should characterize the geographic boundaries of a southeastern ''stone-belt'' and explore genetic and dietary hypotheses that might explain it. Handle: RePEc:aph:ajpbhl:1991:81:5:587-591_0 Template-Type: ReDIF-Article 1.0 Title: VII. HIV seroprevalence in clients of sentinel family planning clinics Journal: American Journal of Public Health Author-Name: Stricof, R.L. Author-Name: Nattell, T.C. Author-Name: Novick, L.F. Year: 1991 Volume: 81 Issue: SUPPL. Pages: 41-45 Abstract: In February 1988 the New York State Department of Health initiated a study to determine the prevalence of HIV antibody in women attending selected, publicly subsidized family planning clinics. During a 26-month study period, 27,549 blood specimens were obtained from women having an initial medical examination in 41 clinic sites throughout the state. Of these clients 144 (0.52 percent) were seropositive. The HIV seroprevalence rate increased with age to a high of 1.56 percent for 831 women ages 35 to 39. The seroprevalence rate for non-Hispanic Black or Hispanic clients (0.76 percent) was about six times the rate for non-Hispanic Whites (0.13 percent). No overall increasing or decreasing trend in prevalence of HIV infection was detected during the study period. Handle: RePEc:aph:ajpbhl:1991:81:SUPPL.:41-45_5 Template-Type: ReDIF-Article 1.0 Title: Elevated nicotine levels in cervical lavages from passive smokers Journal: American Journal of Public Health Author-Name: Jones, C.J. Author-Name: Schiffman, M.H. Author-Name: Kurman, R. Author-Name: Jacob III, P. Author-Name: Benowitz, N.L. Year: 1991 Volume: 81 Issue: 3 Pages: 378-379 Abstract: One hundred forty-five non-smokers found to have normal cytologic diagnoses on routine Pap smears were interviewed regarding environmental exposure to tobacco smoke, and a 3 ml saline lavage of the cervix was collected for measurement of cervical nicotine levels by gas chromatography-mass spectroscopy. Nicotine levels tended to be highest among women exposed to tobacco smoke in the home, intermediate in women exposed only outside the home, and lowest in women recalling no exposure (p = 0.001). Handle: RePEc:aph:ajpbhl:1991:81:3:378-379_2 Template-Type: ReDIF-Article 1.0 Title: Patterns of medical employment: A survey of imbalances in Urban Mexico Journal: American Journal of Public Health Author-Name: Frenk, J. Author-Name: Alagon, J. Author-Name: Nigenda, G. Author-Name: Munoz-delRio, A. Author-Name: Robledo, C. Author-Name: Vaquez-Segovia, L.A. Author-Name: Ramirez-Cuadra, C. Year: 1991 Volume: 81 Issue: 1 Pages: 23-29 Abstract: This article quantifies the magnitude and correlates of the major imbalances affecting the employment of physicians in the urban areas of Mexico. Since the early 1970s the country has experienced a rapid increase in the supply of doctors, which its health system was unable to absorb fully. In 1986, we conducted a survey in the 16 most important cities based on a probability sample of households where someone with an MD degree lived. A total of 604 physicans were interviewed for a response rate of 97 percent. The unemployment rate was 7 percent of potentially active physicians; 11 percent held a nonmedical job, and another 11 percent exhibited low productivity and/or income. All in all, we project that 23,500 physicians in these cities were either unemployed or underemployed. This medical employment pattern was analyzed against five independent variables: generation (i.e. the year in which the physician started medical school), gender, social origin, medical school quality, and specialty. Apart from generation, type of specialty exhibited the strongest correlation with the employment situation of a physician. The results suggest that higher education and health care in Mexico may be producing rather than correcting social inequalities. Policy alternatives are discussed to restore a balance between the training of physicians, their gainful employment, and the health needs of the population. Handle: RePEc:aph:ajpbhl:1991:81:1:23-29_5 Template-Type: ReDIF-Article 1.0 Title: Preventing high-risk behavior Journal: American Journal of Public Health Author-Name: Dryfoos, J.G. Year: 1991 Volume: 81 Issue: 2 Pages: 157-158 Handle: RePEc:aph:ajpbhl:1991:81:2:157-158_5 Template-Type: ReDIF-Article 1.0 Title: Disease control priorities in developing countries: Health policy responses to epidemiological change Journal: American Journal of Public Health Author-Name: Jamison, D.T. Author-Name: Mosley, W.H. Year: 1991 Volume: 81 Issue: 1 Pages: 15-22 Abstract: Health systems in developing countries are facing major challenges in the 1990s and beyond because of a growing epidemiological diversity as a consequence of rapid economic development and declining fertility. The infectious and parastic diseases of childhood must remain a priority at the same time the chronic diseases among adults are emerging as a serious problem. Health policymakers must engage in undertaking an epidemiological and economic analysis of the major disease problems, evaluating the cost-effectiveness of alternative intervention strategies; designing health care delivery systems; and, choosing what governments can do through persuasion, taxation, regulation, and provision of services. The World Bank has commissioned studies of over two dozen diseases in developing countries which have confirmed the priority of child survival interventions and revealed that interventions for many neglected and emerging adult health problems have comparable cost-effectiveness. Most developing countries lack information about most major diseases among adults, reflecting lack of national capacities in epidemiological and economic analyses, health technology assessment, and environmental monitoring and control. There is a critical need for national and international investment in capacity building and essential national health research to build the base for health policies. Handle: RePEc:aph:ajpbhl:1991:81:1:15-22_0 Template-Type: ReDIF-Article 1.0 Title: Lyme disease: A proposed ecological index to assess areas of risk in the northeastern United States Journal: American Journal of Public Health Author-Name: Schulze, T.L. Author-Name: Taylor, R.C. Author-Name: Taylor, G.C. Author-Name: Bosler, E.M. Year: 1991 Volume: 81 Issue: 6 Pages: 714-718 Abstract: Background: Recent public awareness has resulted in a demand for information about ways to reduce the risk of acquiring Lyme disease. Methods: Twenty-two school properties and recreational areas within a Lyme disease endemic area of central Monmouth County, New Jersey were evaluated for risk of transmission using an ecological index on the suitability, amount, and access to Ixodes dammini habitat by target human populations and the abundance of infected adult ticks. Results: The characterization of tick habitat accurately predicted the elimination of 11 sites from concern. Of the remaining 11 sites, six were classified high risk and five as moderate risk. On-site tick surveys identified infected I. dammini adults at only four sites (three risk; one moderate risk). Conclusions: These results indicate that the use of selected ecological parameters provides a cost-effective method to rapidly identify areas at risk for Lyme disease transmission. Handle: RePEc:aph:ajpbhl:1991:81:6:714-718_4 Template-Type: ReDIF-Article 1.0 Title: Clinical and epidemiological features of neurotoxic shellfish poisoning in North Carolina Journal: American Journal of Public Health Author-Name: Morris, P.D. Author-Name: Campbell, D.S. Author-Name: Taylor, T.J. Author-Name: Freeman, J.I. Year: 1991 Volume: 81 Issue: 4 Pages: 471-474 Abstract: Background: In October 1987, a red tide due to P. brevis affected the North Carolina coast for the first time. The purpose of our study was to describe the clinical and epidemiological features of neurotoxic shellfish poisoning (NSP), an illness caused by eating shellfish contaminated with the neurotoxins of P. brevis. Methods: Active surveillance was established for cases of NSP. A descriptive study of the NSP cases was then completed. Results: Forty-eight persons, who had eaten oysters at 20 meals, met the case definition. A variety of gastrointestinal tract and neurological symptoms were reported. The illnesses were generally mild and of short duration, and there were no deaths. Forty-one (85 percent) affected persons lived in five communities located within a 70-kilometer area along the coast. Cases occurred from October 27 to December 9; 27 (56 percent) of the cases occurred before the first closure of affected shellfish waters on November 2. There was a significant increase in the illness attack rate with an increase in the number of oysters eaten. Conclusions: Routine monitoring of coastal waters for P. brevis is needed to facilitate earlier recognition of red tides, closure of affected areas, and education of the public before substantial exposure to contaminated shellfish occurs. Handle: RePEc:aph:ajpbhl:1991:81:4:471-474_6 Template-Type: ReDIF-Article 1.0 Title: HIV-1 prevalence in selected tijuana sub-populations Journal: American Journal of Public Health Author-Name: Guerena-Burgueno, F. Author-Name: Benenson, A.S. Author-Name: Sepulveda-Amor, J. Year: 1991 Volume: 81 Issue: 5 Pages: 623-625 Abstract: To assess the prevalence of HIV-1 (human immunodeficiency virus) infection among high-risk populations in Tijuana, Mexico, HIV-1 antibody status was determined and information on risk behavior was obtained from 1,069 individuals in three high-risk groups. The prevalence of HIV-1 among 415 prostitutes was 0.5 percent; 410 prisoners, 1.2 percent; 233 homosexual/bisexual men, 11.6 percent; and 106 intravenous drug abusers, 1.9 percent. The potential for spread of HIV-1 exists in Tijuana despite the current relatively low seroprevalence of HIV-1. Handle: RePEc:aph:ajpbhl:1991:81:5:623-625_6 Template-Type: ReDIF-Article 1.0 Title: The silence: The asbestos industry and early occupational cancer research - A case study Journal: American Journal of Public Health Author-Name: Lilienfeld, D.E. Year: 1991 Volume: 81 Issue: 6 Pages: 791-800 Abstract: To gain insight into corporate activities regarding the identification of occupational carcinogens earlier in this century, the actions of one industry, the asbestos industry, were reviewed. This industry, in concert with many of its insurers, systematically developed and then suppressed information on the carcinogenicity of asbestos. The development of warnings for those exposed to the asbestos was delayed. As a result, millions of workers were exposed to the carcinogen and hundreds of thousands died. These events are placed into the context of similar activities in other industries during this time. Handle: RePEc:aph:ajpbhl:1991:81:6:791-800_9 Template-Type: ReDIF-Article 1.0 Title: Determinants of condom use among French heterosexuals with multiple partners Journal: American Journal of Public Health Author-Name: Moatti, J.-P. Author-Name: Bajos, N. Author-Name: Durbec, J.-P. Author-Name: Menard, C. Author-Name: Serrand, C. Year: 1991 Volume: 81 Issue: 1 Pages: 106-109 Abstract: In September 1988, a sample of French individuals between 18 and 49 years of age, who reported more than one sexual partner in the past six months and who considered themselves heterosexuals (n = 1088), were interviewed at home about risk perception of human immunodeficiency virus (HIV) transmission, sexual behavior, and condom use. Systematic or occasional use of condoms during the previous 12 months was reported by 46.9 percent of respondents. Among condom users, 38.7 percent declared they had never used condoms before the last 12 months, fear of acquired immunodeficiency syndrome (AIDS) rather than contraception being the main motivation of these recent users. Multivariate analysis indicates that voluntary testing for HIV, average or more than average fear of sexually transmitted diseases (STDs), and knowledge of HIV carrier in personal relations are associated with condom use. Handle: RePEc:aph:ajpbhl:1991:81:1:106-109_9 Template-Type: ReDIF-Article 1.0 Title: The effect of mandatory premarital HIV testing on marriage: The case of Illinois Journal: American Journal of Public Health Author-Name: McKillip, J. Year: 1991 Volume: 81 Issue: 5 Pages: 650-654 Handle: RePEc:aph:ajpbhl:1991:81:5:650-654_9 Template-Type: ReDIF-Article 1.0 Title: Predictors of successful aging: A twelve-year study of Manitoba elderly Journal: American Journal of Public Health Author-Name: Roos, N.P. Author-Name: Havens, B. Year: 1991 Volume: 81 Issue: 1 Pages: 63-68 Abstract: In Manitoba, Canada, a representative cohort of elderly individuals ages 65 to 84 (n = 3,573) were interviewed in 1971 and the survivors of this cohort were reinterviewed in 1983. This analysis assesses the determinants of successful aging - whether or not an individual will live to an advanced age, continue to function well at home, and remain mentally alert. Over 100 separate indicators of demographic and socioeconomic status, social supports, health and mental status in 1971 were available as potential predictors of successful aging. Indicators of access to health care over the period 1970-82 and indicators of diseases over this period were also available as predictors. Those who aged successfully were shown to have greater satisfaction with life in 1983 and to have made fewer demands on the health care system than those who aged less well. Despite the large number of potential predictors of successful aging which were examined, only age, four measures of health status, two measures of mental status, and not having one's spouse die or enter a nursing home were shown to be predictive of successful aging. Handle: RePEc:aph:ajpbhl:1991:81:1:63-68_9 Template-Type: ReDIF-Article 1.0 Title: The impact of HIV-related illness on employment Journal: American Journal of Public Health Author-Name: Yelin, E.H. Author-Name: Greenblatt, R.M. Author-Name: Hollander, H. Author-Name: McMaster, J.R. Year: 1991 Volume: 81 Issue: 1 Pages: 79-84 Abstract: We used structured telephone interviews to determine the extent of work loss following onset of symptoms, the interval between onset of symptoms and cessation of work, and the risk factors for work loss among 193 persons with symptoms of human immunodeficiency virus (HIV)-related illness attending the AIDS Clinic at the University of California, San Francisco, between October 1, 1988, and September 30, 1989. Estimates of the duration of time between onset of HIV-related symptoms and work loss derive from the life table method of Kaplan and Meier. A Cox proportional hazards model is used to estimate the effect of risk factors on the probability of withdrawing from work in each time interval. Eighty-six percent of the respondents worked prior to onset of the first symptom of HIV-related illness; 40 percent were working at the time of the most recent interview, a mean of 958 days later. The total number of hours worked declined by 59 percent during this time. Kaplan-Meier analysis indicates that 50 percent who worked prior to onset of HIV-related illness stopped working within two years and all had stopped within 10 years after onset of the first symptom. Handle: RePEc:aph:ajpbhl:1991:81:1:79-84_9 Template-Type: ReDIF-Article 1.0 Title: Association of waist to hip ratio and family history with the prevalence of NIDDM among 25,272 adult, white females Journal: American Journal of Public Health Author-Name: Morris, R.D. Author-Name: Rimm, A.A. Year: 1991 Volume: 81 Issue: 4 Pages: 507-509 Abstract: The independent association of waist to hip ratio (WHR), relative weight, and family history with the prevalence of non-insulin dependent diabetes mellitus (NIDDM) was investigated in a population of 25,254 White females in the United States and Canada. A multivariate logistic analysis yielded standardized odds ratios of 1.47, 1.46, 1.54, and 1.14 for family history index, WHR, relative weight, and age, respectively. Handle: RePEc:aph:ajpbhl:1991:81:4:507-509_5 Template-Type: ReDIF-Article 1.0 Title: Sexual risk behaviors, AIDS knowledge, and beliefs about AIDS among runaways Journal: American Journal of Public Health Author-Name: Rotheram-Borus, M.J. Author-Name: Koopman, C. Year: 1991 Volume: 81 Issue: 2 Pages: 208-210 Abstract: Sexual risk behaviors, knowledge of acquired immunodeficiency syndrome (AIDS), and beliefs about AIDS prevention were examined among 126 runaways. In the previous 3 months, 65 percent of youths had been sexually active. Among the sexually active runaways, males reported a median of 2.7 partners and females reported 1.3 partners, and only 18 percent reported consistent condom use. Runaways demonstrated moderately high AIDS knowledge and beliefs endorsing AIDS prevention. Condom use and abstinence were directly related to beliefs about preventing AIDS. Handle: RePEc:aph:ajpbhl:1991:81:2:208-210_9 Template-Type: ReDIF-Article 1.0 Title: The role of the local health department in traffic safety Journal: American Journal of Public Health Author-Name: Jurs, J. Author-Name: Berington, J. Year: 1991 Volume: 81 Issue: 4 Pages: 511-512 Handle: RePEc:aph:ajpbhl:1991:81:4:511-512_2