Template-Type: ReDIF-Article 1.0 Title: Condom use and risk factors for HIV-1 infection among female commercial sex workers in Thailand. Journal: American Journal of Public Health Author-Name: Limanonda, B. Author-Name: van Griensven, G.J. Author-Name: Chongvatana, N. Author-Name: Tirasawat, P. Author-Name: Coutinho, R.A. Author-Name: Auwanit, W. Author-Name: Nartpratarn, C. Author-Name: Likhityingvara, C. Author-Name: Poshyachinda, V. Year: 1994 Volume: 84 Issue: 12 Pages: 2026-2027 Handle: RePEc:aph:ajpbhl:1994:84:12:2026-2027_9 Template-Type: ReDIF-Article 1.0 Title: Health care-seeking behavior related to the transmission of sexually transmitted diseases in Kenya Journal: American Journal of Public Health Author-Name: Moses, S. Author-Name: Ngugi, E.N. Author-Name: Bradley, J.E. Author-Name: Njeru, E.K. Author-Name: Eldridge, G. Author-Name: Muia, E. Author-Name: Olenja, J. Author-Name: Plummer, F.A. Year: 1994 Volume: 84 Issue: 12 Pages: 1947-1951 Abstract: Objectives. The purpose of this study was to identify health-care seeking and related behaviors relevant to controlling sexually transmitted diseases in Kenya. Methods. A total of 380 patients with sexually transmitted diseases (n = 189 men and 191 women) at eight public clinics were questioned about their health-care seeking and sexual behaviors. Results. Women waited longer than men to attend study clinics and were more likely to continue to have sex while symptomatic. A large proportion of patients had sought treatment previously in both the public and private sectors without relief of symptoms, resulting in delays in presenting to study clinics. For women, being married and giving a recent history of selling sex were both independently associated with continuing to have sex while symptomatic. Conclusions. Reducing the transmission of sexually transmitted diseases in Kenya will require improved access, particularly for women, to effective health services, preferably at the point of first contact with the health system. It is also critical to encourage people to reduce sexual activity while symptomatic, seek treatment promptly, and increase condom use. Handle: RePEc:aph:ajpbhl:1994:84:12:1947-1951_3 Template-Type: ReDIF-Article 1.0 Title: Correlates of employment after AIDS diagnosis in the Boston Health Study Journal: American Journal of Public Health Author-Name: Massagli, M.P. Author-Name: Weissman, J.S. Author-Name: Seage III, G.R. Author-Name: Epstein, A.M. Year: 1994 Volume: 84 Issue: 12 Pages: 1976-1981 Abstract: Objectives. The purpose of this study was to determine the impact of personal and job characteristics on the time to employment loss after diagnosis of the acquired immunodeficiency syndrome (AIDS) and to examine how job loss affects patients' income. Methods. Data were collected from 305 patients with AIDS at three sites in Boston, Mass, between February 1990 and July 1991. Life-table methods were used to estimate the number of months employed after diagnosis. A Cox proportional hazards model was used to estimate the effect of risk factors on the probability of ceasing employment in a month. Results. Seventy-six percent of respondents were working at the time of diagnosis; 53% still had a job at the time of the baseline interview, which averaged 16 months later, but about one in three was on sick or disability leave. Mental and physical demands of jobs significantly influenced the likelihood of employment loss. The loss of earnings reduced monthly income by 75%. Conclusions. Job characteristics affect the likelihood of employment loss, which in turn has a deleterious effect on income. Programs supporting persons with AIDS during the transition out of work or enabling them to modify their job demands may also reduce these problems. Handle: RePEc:aph:ajpbhl:1994:84:12:1976-1981_9 Template-Type: ReDIF-Article 1.0 Title: The evaluation of needle exchange programs. Journal: American Journal of Public Health Author-Name: Vlahov, D. Author-Name: Brookmeyer, R.S. Year: 1994 Volume: 84 Issue: 12 Pages: 1889-1891 Handle: RePEc:aph:ajpbhl:1994:84:12:1889-1891_5 Template-Type: ReDIF-Article 1.0 Title: Contraceptive efficacy and acceptability of the female condom Journal: American Journal of Public Health Author-Name: Farr, G. Author-Name: Gabelnick, H. Author-Name: Sturgen, K. Author-Name: Dorflinger, L. Year: 1994 Volume: 84 Issue: 12 Pages: 1960-1964 Abstract: Objectives. The purpose of the study was to determine the contraceptive efficacy of the female condom and to provide data about the device to the US Food and Drug Administration. Methods. The clinical trial was conducted at six US sites and three sites in Latin America. Eligible subjects were in mutually monogamous relationships and agreed to use the female condom as their only means of contraception for 6 months. Results. A total of 328 subjects contributed to the analysis of contraceptive efficacy. Twenty-two US subjects and 17 Latin American subjects became pregnant, yielding 6-month gross cumulative accidental pregnancy rates of 12.4 and 22.2, respectively. During perfect (consistent and correct) use of the method, the 6-month accidental pregnancy rates were 2.6 and 9.5 for the US and Latin American centers, respectively. There were no serious adverse events related to the use of the method. Conclusions. The female condom provides contraceptive efficacy in the same range as other barrier methods, particularly when used consistently and correctly, and has the added advantage of helping protect against sexually transmitted diseases. Handle: RePEc:aph:ajpbhl:1994:84:12:1960-1964_3 Template-Type: ReDIF-Article 1.0 Title: Homelessness in America. Journal: American Journal of Public Health Author-Name: Rosenheck, R. Year: 1994 Volume: 84 Issue: 12 Pages: 1885-1886 Handle: RePEc:aph:ajpbhl:1994:84:12:1885-1886_9 Template-Type: ReDIF-Article 1.0 Title: Anonymous HIV testing: The impact of availability on demand in Arizona Journal: American Journal of Public Health Author-Name: Hirano, D. Author-Name: Gellert, G.A. Author-Name: Fleming, K. Author-Name: Boyd, D. Author-Name: Englender, S.J. Author-Name: Hawks, H. Year: 1994 Volume: 84 Issue: 12 Pages: 2008-2010 Abstract: The purpose of this study was to evaluate the impact of anonymous testing availability on human immunodeficiency virus (HIV) test demand in Arizona. Testing patterns before and after the introduction of anonymous testing were compared. Client knowledge of new test policy and delay in testing until an anonymous option was available were assessed. Test numbers among men who have sex with men showed a statistically significant increase after introduction of an anonymous testing option. Arizona continues to maintain anonymous testing availability. Public health agencies should consider how test policy may influence people's HIV test decisions. Handle: RePEc:aph:ajpbhl:1994:84:12:2008-2010_2 Template-Type: ReDIF-Article 1.0 Title: Does the promotion and distribution of condoms increase teen sexual activity? Evidence from an HIV prevention program for Latino youth Journal: American Journal of Public Health Author-Name: Sellers, D.E. Author-Name: McGraw, S.A. Author-Name: McKinlay, J.B. Year: 1994 Volume: 84 Issue: 12 Pages: 1952-1959 Abstract: Objectives. Opponents of condom availability programs argue that the promotion and distribution of condoms increases adolescent sexual activity. This assertion was tested empirically with data from the evaluation of a human immunodeficiency virus (HIV) prevention program for Latino adolescents. Methods. The onset of sexual activity, changes in the frequency of sex, and changes in the proportion of respondents with multiple partners were compared for intervention and comparison groups. Multivariate regression analysis was used to assess the effect of the intervention on these outcomes after adjustment for baseline differences between the intervention and comparison groups. Results. Male respondents in the intervention city were less likely than those in the comparison city to initiate first sexual activity (odds ratio [OR] = 0.08). Female respondents in the intervention city were less likely to have multiple partners (OR = 0.06). The program promoting and distributing condoms had no effect on the onset of sexual activity for females, the chances of multiple partners for males, or the frequency of sex for either males or females. Conclusions. An HIV prevention program that included the promotion and distribution of condoms did not increase sexual activity among the adolescents in this study. Handle: RePEc:aph:ajpbhl:1994:84:12:1952-1959_6 Template-Type: ReDIF-Article 1.0 Title: The effects of HIV/AIDS intervention groups for high-risk women in urban clinics Journal: American Journal of Public Health Author-Name: Kelly, J.A. Author-Name: Murphy, D.A. Author-Name: Washington, C.D. Author-Name: Wilson, T.S. Author-Name: Koob, J.J. Author-Name: Davis, D.R. Author-Name: Ledezma, G. Author-Name: Davantes, B. Year: 1994 Volume: 84 Issue: 12 Pages: 1918-1922 Abstract: Objectives. This study reports the results of a behavior change intervention offered to women at high risk for human immunodeficiency virus (HIV) infection seen in an urban primary health care clinic. Methods. Participants were 197 women randomly assigned to either an HIV/acquired immunodeficiency syndrome (AIDS) risk reduction group or a comparison group. Women in the HIV/AIDS intervention group attended five group sessions focusing on risk education; skills training in condom use, sexual assertiveness, problem solving, and risk trigger self-management; and peer support for change efforts. Women in the comparison group attended sessions on health topics unrelated to AIDS. Results. At the 3-month follow-up, women in the HIV/AIDS intervention group had increased in sexual communication and negotiation skills. Unprotected sexual intercourse had declined significantly and condom use had increased from 26% to 56% of all intercourse occasions. Women in the comparison group showed no change. Conclusions. Socially disadvantaged women can be assisted in reducing their risk of contracting HIV infection. Risk reduction behavior change interventions should be offered routinely in primary health care clinics serving low-income and high-risk patients. Handle: RePEc:aph:ajpbhl:1994:84:12:1918-1922_2 Template-Type: ReDIF-Article 1.0 Title: Policies of containment: Immigration in the era of AIDS Journal: American Journal of Public Health Author-Name: Fairchild, A.L. Author-Name: Tynan, E.A. Year: 1994 Volume: 84 Issue: 12 Pages: 2011-2022 Abstract: The US Public Health Service began the medical examination of immigrants at US ports in 1891. By 1924, national origin had become a means to justify broad-based exclusion of immigrants after Congress passed legislation restricting immigration from southern and eastern European countries. This legislation was passed based on the alleged genetic inferiority of southern and eastern Europeans. Since 1987, the United States has prohibited the entrance immigrants infected with the human immunodeficiency virus (HIV). On the surface, a policy of excluding individuals with an inevitably fatal 'communicable disease of public health significance' rests solidly in the tradition of protecting public health. But excluding immigrants with HIV is also a policy that, in practice, resembles the 1924 tradition of selective racial restriction of immigrants from 'dangerous nations.' Since the early 1980s, the United States has erected barriers against immigrants from particular Caribbean and African nations, whose citizens were thought to pose a threat of infecting the US blood supply with HIV. Handle: RePEc:aph:ajpbhl:1994:84:12:2011-2022_9 Template-Type: ReDIF-Article 1.0 Title: Annotation: what will be the role of HIV infection reporting? Journal: American Journal of Public Health Author-Name: Ward, J.W. Author-Name: Fleming, P.L. Author-Name: Buehler, J.W. Year: 1994 Volume: 84 Issue: 12 Pages: 1888-1889 Handle: RePEc:aph:ajpbhl:1994:84:12:1888-1889_9 Template-Type: ReDIF-Article 1.0 Title: Three-year follow-up of an HIV risk-reduction intervention that used popular peers. Journal: American Journal of Public Health Author-Name: St Lawrence, J.S. Author-Name: Brasfield, T.L. Author-Name: Diaz, Y.E. Author-Name: Jefferson, K.W. Author-Name: Reynolds, M.T. Author-Name: Leonard, M.O. Year: 1994 Volume: 84 Issue: 12 Pages: 2027-2028 Handle: RePEc:aph:ajpbhl:1994:84:12:2027-2028_0 Template-Type: ReDIF-Article 1.0 Title: Weapon-related injury surveillance in the emergency department. Journal: American Journal of Public Health Author-Name: Ozonoff, V.V. Author-Name: Barber, C.W. Author-Name: Spivak, H. Author-Name: Hume, B. Author-Name: Jannelli, L. Author-Name: Scott, N.J. Year: 1994 Volume: 84 Issue: 12 Pages: 2024-2025 Handle: RePEc:aph:ajpbhl:1994:84:12:2024-2025_8 Template-Type: ReDIF-Article 1.0 Title: Factors mediating changes in sexual HIV risk behaviors among gay and bisexual male adolescents Journal: American Journal of Public Health Author-Name: Rotheram-Borus, M.J. Author-Name: Reid, H. Author-Name: Rosario, M. Year: 1994 Volume: 84 Issue: 12 Pages: 1938-1946 Abstract: Objectives. Factors mediating changes in sexual behaviors that increase the risk of human immunodeficiency virus (HIV) infection were monitored in a group of gay and bisexual male adolescents. Methods. One hundred thirty-six males aged 14 to 19 years (Hispanic, 51%; African-American, 31%) were recruited from one gay-identified agency, were assessed at four points over a 1-year period, and participated in HIV preventive intervention sessions. Results. Significant reductions occurred in the number of unprotected same- sex anal and oral acts. Those with less risk in their previous sexual history, those who did not engage in commercial sex, and those who attended more HIV intervention sessions were more likely to reduce their sexual risk. The impact of sessions varied significantly by race/ethnicity: African- American youths reduced their risk acts most dramatically. Abstinence was consistently and significantly more likely among younger youths and those who had been abstinent before enrollment. The youths significantly reduced the number of sexual partners following the intervention; this reduction in partners was maintained through the 12-month follow-up and was greatest among youths with no involvement in commercial sexual activity (prostitution). Conclusions. The efficacy of HIV prevention programs must be empirically evaluated. Handle: RePEc:aph:ajpbhl:1994:84:12:1938-1946_4 Template-Type: ReDIF-Article 1.0 Title: HIV infection, risk behaviors, and depressive symptoms among Puerto Rican sex workers Journal: American Journal of Public Health Author-Name: Alegria, M. Author-Name: Vera, M. Author-Name: Freeman Jr., D.H. Author-Name: Robles, R. Author-Name: Del Santos, C.M. Author-Name: Rivera, C.L. Year: 1994 Volume: 84 Issue: 12 Pages: 2000-2002 Abstract: This paper examines the association of depressive symptoms with human immunodeficiency virus (HIV) infection and risk behaviors among 127 sex workers. Data were obtained by a structured interview and blood specimens tested for HIV. Findings showed a high prevalence rate of depressive symptoms for all sex workers regardless of HIV infection status. Results of a logistic regression analysis indicated that the use of injected drugs and engaging in unprotected intercourse with clients were strongly associated with a high level of depressive symptoms. Handle: RePEc:aph:ajpbhl:1994:84:12:2000-2002_6 Template-Type: ReDIF-Article 1.0 Title: What was new at Yokohama--women's voices at the 1994 international HIV/AIDS conference. Journal: American Journal of Public Health Author-Name: Stein, Z. Year: 1994 Volume: 84 Issue: 12 Pages: 1887-1888 Handle: RePEc:aph:ajpbhl:1994:84:12:1887-1888_5 Template-Type: ReDIF-Article 1.0 Title: Who is Hispanic? Definitions and their consequences Journal: American Journal of Public Health Author-Name: Zimmerman, R.S. Author-Name: Vega, W.A. Author-Name: Gil, A.G. Author-Name: Warheit, G.J. Author-Name: Apospori, E. Author-Name: Biafora, F. Year: 1994 Volume: 84 Issue: 12 Pages: 1985-1987 Abstract: What is the appropriate method for classifying Spanish-speaking-origin inhabitants of the United States? This paper presents relevant data from the first wave of a longitudinal study of adolescents in the greater Miami area. As expected, the broadest definition-'up to third generation' Hispanic- identified the largest proportion of the sample as Hispanic, whereas parent self-report placed the smallest proportion into the Hispanic category. When policy-makers are concerned about enumerating the entire Hispanic population, a definition broader than self-identification should be used; in estimating prevalence rates, however, the use of self-identification may be adequate. Handle: RePEc:aph:ajpbhl:1994:84:12:1985-1987_3 Template-Type: ReDIF-Article 1.0 Title: Condom availability in schools: The need for improved program evaluations Journal: American Journal of Public Health Author-Name: Stryker, J. Author-Name: Samuels, S.E. Author-Name: Smith, M.D. Year: 1994 Volume: 84 Issue: 12 Pages: 1901-1906 Abstract: Objectives. This article examines the impact of contentious local debates on the design and implementation of school-based condom availability programs. Methods. Information about condom availability in schools was reviewed by 50 leading educators and health officials at a 1992 forum held in Menlo Park, Calif. Results. Few existing condom availability programs were designed to yield definitive data on sexual risk-taking behavior or other measures of program effectiveness. Conclusions. In the debate over school- based condom availability programs, as in many aspects of human immunodeficiency virus (HIV) prevention programs, scientific, moral, and political concerns overlap. Behavioral research into the potential effectiveness of such programs can help inform debates about fundamental values concerning sexual decision making and privacy, family integrity and parental autonomy, and public health. Handle: RePEc:aph:ajpbhl:1994:84:12:1901-1906_3 Template-Type: ReDIF-Article 1.0 Title: Changes in insurance status and access to care for persons with AIDS in the Boston Health Study Journal: American Journal of Public Health Author-Name: Weissman, J.S. Author-Name: Makadon, H.J. Author-Name: Seage III, G.R. Author-Name: Massagli, M.P. Author-Name: Gatsonis, C.A. Author-Name: Craven, D.E. Author-Name: Stone, V.E. Author-Name: Bennett, I.A. Author-Name: Epstein, A.M. Year: 1994 Volume: 84 Issue: 12 Pages: 1997-2000 Abstract: The purpose of this study was to measure unmet needs and changes in insurance status for persons with acquired immunodeficiency syndrome (AIDS). Thirty-six percent of the study's Boston-area respondents (n = 305) had a change in insurance coverage between AIDS diagnosis and interview. Medicaid coverage increased from 14% to 41%. Pneumocystis carinii pneumonia prophylaxis was nearly universal. Only 5% did not receive zidovudine, and intravenous drug users were at higher risk. Approximately 14% to 15% of patients reported problems in obtaining medical and dental services; Blacks, homeless persons, and those who were not high school graduates were at higher risk. Use of selected treatments for which there were clear clinical guidelines was adequate, yet disadvantaged groups were more likely than other persons with AIDS to face obstacles to other services. Handle: RePEc:aph:ajpbhl:1994:84:12:1997-2000_5 Template-Type: ReDIF-Article 1.0 Title: HIV infection in homosexual and bisexual men 18 to 29 years of Age: The San Francisco Young Men's Health Study Journal: American Journal of Public Health Author-Name: Osmond, D.H. Author-Name: Page, K. Author-Name: Wiley, J. Author-Name: Garrett, K. Author-Name: Sheppard, H.W. Author-Name: Moss, A.R. Author-Name: Schrager, L. Author-Name: Winkelstein, W. Year: 1994 Volume: 84 Issue: 12 Pages: 1933-1937 Abstract: Objectives. Recent studies suggest very high human immunodeficiency virus (HIV) infection rates in some populations of younger homosexual men, but these studies may represent only particularly high-risk populations. The current study obtained population-based on the HIV epidemic in young homosexual/bisexual men. Methods. A household survey of unmarried men 18 through 29 years of age involved a multistage probability sample of addresses in San Francisco. A follow-up interview and HIV test for men who were HIV negative at baseline were completed; the median follow-up was 8.9 months. Results. Sixty-eight of 380 homosexual/bisexual men (17.9%) tested HIV seropositive. Sixty-three percent of men reported one or more receptive anal intercourse partners in the previous 12 months, and 41% of those men did not use condoms consistently. The HIV seroincidence rate among those seronegative at first study was 2.6% per year. Conclusions. HIV infection rates in young homosexual men in San Francisco are lower than those in the early 1980s; however, the rate of infection in these men, most of whom became sexually active after awareness of AIDS had become widespread, threatens to continue the epidemic in the younger generation at a level not far below that of a decade ago. Handle: RePEc:aph:ajpbhl:1994:84:12:1933-1937_0 Template-Type: ReDIF-Article 1.0 Title: The effect of moderate alcohol use on the relationship between stress and depression Journal: American Journal of Public Health Author-Name: Lipton, R.I. Year: 1994 Volume: 84 Issue: 12 Pages: 1913-1917 Abstract: Objectives. The purpose of the study was to determine whether moderate school use mediates or buffers the effect of stress on depression in a group of non-Hispanic White men and women. Methods. Data are from the Los Angeles Epidemiological Catchment Area cohort. Individuals were assessed at two time periods, 1 year apart. Mean depression scores were analyzed for each level of stress and alcohol use. Results. In the simultaneous presence of both chronic strain and negative life events, a U-shaped pattern was observed in which abstainers and light and heavy drinkers had higher depression scores at the second time period than did light-moderate and moderate alcohol users. The U- shaped relationship remained when the effects of sex, age, and physical health status were controlled. Conclusions. Light-moderate and moderate drinkers had less depression in the presence of stress than persons in other more extreme drinking categories. Moderate alcohol use may serve as a proxy for a spectrum of generally moderate behaviors that either attenuate the effect of stress on depression or suppress the effects of stress. Handle: RePEc:aph:ajpbhl:1994:84:12:1913-1917_9 Template-Type: ReDIF-Article 1.0 Title: The consistency of self-reported HIV risk behavior among injection drug users Journal: American Journal of Public Health Author-Name: McElrath, K. Author-Name: Chitwood, D.D. Author-Name: Griffin, D.K. Author-Name: Comerford, M. Year: 1994 Volume: 84 Issue: 12 Pages: 1965-1970 Abstract: Objectives. Most studies of risk factors for human immunodeficiency virus (HIV) rely heavily on retrospective self-reports. The degree to which these reports provide reliable information has received little research attention. The purpose of this study was to assess the extent to which the reliability of retrospective self-report data is affected over time. Methods. Data were examined from a longitudinal study of risk behaviors among injection drug users. Structured interviews were administered to 366 injection drug users who were asked to recall behaviors that they had reported 6, 12, or 18 months earlier. Results. Kappa coefficients showed moderate initial memory loss for injection and sexual risk behaviors. After 6 months, time had little effect on the ability of injection drug users to recall injection and sexual risk behaviors. For ordinal measures of risk, subjects who gave different reports over time were most likely to disagree by one response category. Conclusions. These findings support the use of retrospective self-reports in assessing HIV risk behaviors among injection drug users. Retrospective inquiry is likely to remain an important method for collecting data over time. Handle: RePEc:aph:ajpbhl:1994:84:12:1965-1970_8 Template-Type: ReDIF-Article 1.0 Title: Extramarital sex and HIV risk behavior among US adults: Results from the National AIDS Behavioral Survey Journal: American Journal of Public Health Author-Name: Choi, K.-H. Author-Name: Catania, J.A. Author-Name: Dolcini, M.M. Year: 1994 Volume: 84 Issue: 12 Pages: 2003-2007 Abstract: Data from the National AIDS Behavioral Survey were used to examine the social distribution of extra-marital sex and risk for human immunodeficiency virus (HIV) infection among married individuals in the United States. Of 1686 married respondents living across the United States, 2.2% reported extramarital sex; of 3827 married respondents living in 23 urban areas with large Hispanic or African-American populations, 2.5% reported having sexual partners outside marriage. The data indicate that the correlates of extra- marital sex varied by race/ethnicity. Low levels of condom use were found among people reporting extramarital sex (8% to 19% consistent users). Handle: RePEc:aph:ajpbhl:1994:84:12:2003-2007_5 Template-Type: ReDIF-Article 1.0 Title: Clarification on the coding of hip fractures. Journal: American Journal of Public Health Author-Name: Barrett, J. Author-Name: Baron, J.A. Year: 1994 Volume: 84 Issue: 12 Pages: 2028 Handle: RePEc:aph:ajpbhl:1994:84:12:2028_5 Template-Type: ReDIF-Article 1.0 Title: A decline in HIV-infected needles returned to New Haven's needle exchange program: Client shift or needle exchange? Journal: American Journal of Public Health Author-Name: Kaplan, E.H. Author-Name: Khoshnood, K. Author-Name: Heimer, R. Year: 1994 Volume: 84 Issue: 12 Pages: 1991-1994 Abstract: The New Haven needle exchange program experienced a significant decline in the fraction of returned needles containing human immunodeficiency virus 1 (HIV-1) proviral DNA. Is this decline due to the operations of the needle ex- change or to a shift in clients? Analysis of demographic and behavioral data revealed that only one variable, the race of participating clients, changed significantly over time. However, HIV-1 prevalences in needles given to Whites and to non-Whites were not statistically different. Thus, client shift cannot be responsible for the decline in the observed HIV prevalence in needles. Instead, needle circulation times were a significant predictor of HIV prevalence. Handle: RePEc:aph:ajpbhl:1994:84:12:1991-1994_8 Template-Type: ReDIF-Article 1.0 Title: Predicting the effect of the Oregon Health Plan on medicaid coverage for outpatients with HIV Journal: American Journal of Public Health Author-Name: Conviser, R. Author-Name: Retondo, M.J. Author-Name: Loveless, M.O. Year: 1994 Volume: 84 Issue: 12 Pages: 1994-1996 Abstract: The Oregon Health Plan, which took effect in February 1994, extends Medicaid eligibility but limits coverage to conditions and treatments above a certain threshold on a prioritized list. Retrospective analysis was conducted on records of visits to two Oregon human immunodeficiency virus (HIV) outpatient clinics in 1991 and 1992 to determine Medicaid coverage if the plan had been operational. Of 1129 patients, 21-1% were Medicaid-eligible; an additional 56.5% would have been eligible under the Oregon plan. Only 5.0% to 6.8% of these patients' visits were for conditions listed below the plan's coverage threshold; almost none of these were for HIV-specific conditions. Handle: RePEc:aph:ajpbhl:1994:84:12:1994-1996_9 Template-Type: ReDIF-Article 1.0 Title: Challenges to the control of sexually transmitted diseases in Africa. Journal: American Journal of Public Health Author-Name: Abdool Karim, S.S. Year: 1994 Volume: 84 Issue: 12 Pages: 1891-1893 Handle: RePEc:aph:ajpbhl:1994:84:12:1891-1893_5 Template-Type: ReDIF-Article 1.0 Title: A national surveillance system for newly acquired HIV infection in Australia Journal: American Journal of Public Health Author-Name: McDonald, A.M. Author-Name: Gertig, D.M. Author-Name: Crofts, N. Author-Name: Kaldor, J.M. Year: 1994 Volume: 84 Issue: 12 Pages: 1923-1928 Abstract: Objectives. The purpose of this study was to describe the establishment of a national surveillance system for newly acquired human immunodeficiency virus (HIV) infection and present the first 3 years' results. Methods. All new cases of diagnosed HIV infection were reported to the national HIV surveillance center through state and territory health authorities. Information sought on each case included evidence of whether the infection had been newly acquired, defined by the diagnosis of HIV seroconversion illness or by the report of a negative or indeterminate HIV antibody test result occurring within the 12 months prior to diagnosis of infection. Results. Of 3602 reported cases of HIV infection in adults and adolescents newly diagnosed in Australia between 1991 and 1993, 11.4% were identified as newly acquired. The majority (85%) of cases of newly diagnosed HIV infection occurred among men who reported homosexual contact, and 15% of these cases were identified as newly acquired. Average age at diagnosis was 31 years for cases of newly acquired infection and 34 years for other cases. Conclusions. Surveillance for newly acquired HIV infection has been established at a national level in Australia and provides valuable information for planning primary HIV prevention programs. Handle: RePEc:aph:ajpbhl:1994:84:12:1923-1928_2 Template-Type: ReDIF-Article 1.0 Title: The incidence of defensive firearm use by US crime victims, 1987 through 1990 Journal: American Journal of Public Health Author-Name: McDowall, D. Author-Name: Wiersema, B. Year: 1994 Volume: 84 Issue: 12 Pages: 1982-1984 Abstract: It is well known that many crimes in the United States are committed with firearms. Less adequately documented is the frequency with which victims use guns in self-defense. We used National Crime Victimization Survey data to examine incidents where victims employed guns against offenders. Between 1987 and 1990 there were an estimated 258 460 incidents of firearm defense, an annual mean of 64 615. Victims used firearms in 0.18% of all crimes recorded by the survey and in 0.83% of violent offenses. Firearm self-defense is rare compared with gun crimes. Handle: RePEc:aph:ajpbhl:1994:84:12:1982-1984_9 Template-Type: ReDIF-Article 1.0 Title: Lifetime and five-year prevalence of homelessness in the United States Journal: American Journal of Public Health Author-Name: Link, B.G. Author-Name: Susser, E. Author-Name: Stueve, A. Author-Name: Phelan, J. Author-Name: Moore, R.E. Author-Name: Struening, E. Year: 1994 Volume: 84 Issue: 12 Pages: 1907-1912 Abstract: Objective. Intense debate exists concerning the number of homeless people in the United States. Previous studies, counting currently homeless people, have provided point-prevalence estimates of homelessness but have been criticized on methodological grounds. This study reports lifetime and 5-year prevalence estimates of homelessness using a different methodological approach. Methods. Random-digit dialing was used to interview 1507 adults living in households with telephones in the 48 contiguous states in the fall of 1990. Respondents were asked whether they had ever been homeless and if so, where they had slept while homeless. Results. Lifetime and 5-year prevalence of all types of homelessness combined were 14.0% (26 million people) and 4.6% (8.5 million people), respectively. Lifetime 'literal homelessness' (sleeping in shelters, abandoned buildings, bus and train stations, etc.) was 7.4% (13.5 million people). Five-year (1985 through 1990) prevalence of self-reported homelessness among those who had ever been literally homeless was 3.1% (5.7 million people). Conclusions. The magnitude of the problem of homelessness is much greater than most previous attempts to enumerate homeless people have led us to believe. This finding requires reconsideration of inferences about the causes of homelessness that were derived from point-prevalence studies of currently homeless people. Handle: RePEc:aph:ajpbhl:1994:84:12:1907-1912_9 Template-Type: ReDIF-Article 1.0 Title: Sexually transmitted diseases: a neglected public health priority. Journal: American Journal of Public Health Author-Name: Yankauer, A. Year: 1994 Volume: 84 Issue: 12 Pages: 1894-1897 Abstract: Sexually transmitted diseases remain uncontrolled although millions of cases occur annually in the United States. The advent of acquired immunodeficiency syndrome (AIDS), which is also a sexually transmitted disease, has not altered this situation. The major portion of federal funding for sexually transmitted diseases is allocated to a search for an AIDS vaccine or cure. State health department funding for sexually transmitted diseases, although only a small fraction of the $1.3 billion AIDS research budget of the National Institutes of Health, is largely consumed by AIDS. A single adequately funded sexually transmitted disease control program that applies well-established public health principles for the control of communicable diseases would make sense. However, a consensus to develop and support such a program does not exist in the United States. Handle: RePEc:aph:ajpbhl:1994:84:12:1894-1897_9 Template-Type: ReDIF-Article 1.0 Title: The troubadours: singing their stories of love and health. Journal: American Journal of Public Health Author-Name: Smith, R.J. Author-Name: Gavin, K. Year: 1994 Volume: 84 Issue: 12 Pages: 2023-2024 Handle: RePEc:aph:ajpbhl:1994:84:12:2023-2024_3 Template-Type: ReDIF-Article 1.0 Title: Standardized protocols for condom breakage and slippage trials: a proposal. Journal: American Journal of Public Health Author-Name: Steiner, M. Author-Name: Trussell, J. Author-Name: Glover, L. Author-Name: Joanis, C. Author-Name: Spruyt, A. Author-Name: Dorflinger, L. Year: 1994 Volume: 84 Issue: 12 Pages: 1897-1900 Abstract: In the absence of well-controlled studies on the clinical effectiveness of condoms against pregnancy and sexually transmitted diseases, breakage and slippage data may provide the best indication of the protection offered by condom use. According to the recent literature, condom breakage rates range from 0% to 12%, with many US studies falling in the 2% to 5% range. Few studies have collected slippage data. In addition to discussing methodological issues associated with these studies, we propose a standardized protocol for future condom breakage and slippage trials and discuss how results may be used to estimate perfect-use and typical-use pregnancy rates. Handle: RePEc:aph:ajpbhl:1994:84:12:1897-1900_0 Template-Type: ReDIF-Article 1.0 Title: The types of drugs used by HIV-infected injection drug users in a multistate surveillance project: Implications for intervention Journal: American Journal of Public Health Author-Name: Diaz, T. Author-Name: Chu, S.Y. Author-Name: Byers Jr., R.H. Author-Name: Hersh, B.S. Author-Name: Conti, L. Author-Name: Rietmeijer, C.A. Author-Name: Mokotoff, E. Author-Name: Fann, S.A. Author-Name: Boyd, D. Author-Name: Iglesias, L. Author-Name: Checko, P.J. Author-Name: Frederick, M. Author-Name: Hermann, P. Author-Name: Herr, M. Author-Name: Samuel, M.C. Year: 1994 Volume: 84 Issue: 12 Pages: 1971-1975 Abstract: Objectives. This study sought to describe the drugs used by drug injectors infected with human immunodeficiency virus (HIV) and to determine factors associated with the primary injection drug used. Methods. A cross-section of persons 18 years of age or older reported with HIV or acquired immunodeficiency syndrome (AIDS) to local health departments in 11 US states and cities was surveyed. Results. Of 4162 persons interviewed, 1147 (28%) reported ever having injected drugs. Of these 1147 injectors, 72% primarily injected a drug other than heroin. However, the types of drugs injected varied notably by place of residence. Heroin was the most commonly injected drug in Detroit (94%) and Connecticut (48%); cocaine was the most common in South Carolina (64%), Atlanta (56%), Delaware (55%), Denver (46%), and Arizona (44%); speedball was most common in Florida (46%); and amphetamines were most common in Washington (56%). Other determinants of the type of drug primarily injected were often similar by region of residence, except for heroin use. Polysubstance abuse was common; 75% injected more than one type of drug, and 85% reported noninjected drug use. Conclusions. Preventing the further spread of HIV will require more drug abuse treatment programs that go beyond methadone, address polysubstance abuse, and adapt to local correlates of the primary drug used. Handle: RePEc:aph:ajpbhl:1994:84:12:1971-1975_5 Template-Type: ReDIF-Article 1.0 Title: Mandatory anonymous HIV surveillance in Denmark: The first results of a new system Journal: American Journal of Public Health Author-Name: Smith, E. Author-Name: Rix, B.A. Author-Name: Melbye, M. Year: 1994 Volume: 84 Issue: 12 Pages: 1929-1932 Abstract: Objectives. This paper describes the principles and first results of the newly implemented anonymous mandatory human immunodeficiency virus (HIV) reporting system in denmark. Methods. The system is based on a serially numbered form that is circulated among the laboratories, the physicians, and the national surveillance unit. All laboratories doing confirmatory tests for HIV antibodies must send a report form along with any positive test results. Before forwarding the form, the laboratory is to fill in the top part with the name and address of the requesting physician and send the back copy to the surveillance unit. The physicians are mandated by law to fill in the form with data on the patient and to keep two copies for their own files before sending the original to the surveillance unit. Results. After a revision of the system, a response rate of 95% was obtained. Conclusions. We have established an anonymous mandatory HIV surveillance system in Denmark that enables routine evaluation of the completeness of reporting and nonresponding physicians to be reminded of their duty to report. Also, the physicians can act as mediators between patients and researchers; therefore, nested studies can be done without breaking the anonymity of the patient. Handle: RePEc:aph:ajpbhl:1994:84:12:1929-1932_8 Template-Type: ReDIF-Article 1.0 Title: A computerized surveillance system for disease outbreaks in Oklahoma. Journal: American Journal of Public Health Author-Name: Lanser, S. Author-Name: McNabb, S.J. Author-Name: Horan, J.M. Year: 1994 Volume: 84 Issue: 12 Pages: 2029 Handle: RePEc:aph:ajpbhl:1994:84:12:2029_7 Template-Type: ReDIF-Article 1.0 Title: A rapid public health response to a cryptic outbreak of cholera in Hawaii Journal: American Journal of Public Health Author-Name: Mintz, E.D. Author-Name: Effler, P.V. Author-Name: Maslankowski, L. Author-Name: Ansdell, V. Author-Name: Pon, E. Author-Name: Barrett, T.J. Author-Name: Tauxe, R.V. Year: 1994 Volume: 84 Issue: 12 Pages: 1988-1991 Abstract: In November 1991, toxigenic Vibrio cholerae O1 infection was confirmed in two unrelated persons in Hawaii. Cholera had not been acquired in Hawaii since 1895. To determine the source and extent of V cholerae O1 infections in Hawaii, both patients were interviewed, suspect food sources were investigated, and surveillance of physicians, laboratories, hospitals, and sewage treatment plants was instituted. One patient's husband had serologic titers consistent with recent V cholerae O1 infection; no other cases were confirmed and V cholerae O1 was not recovered from active surveillance of laboratories or sewage treatment plants. The investigation demonstrated that the outbreak had affected few persons and had ended. Handle: RePEc:aph:ajpbhl:1994:84:12:1988-1991_2 Template-Type: ReDIF-Article 1.0 Title: Tuberculosis control and social change. Journal: American Journal of Public Health Author-Name: Frieden, T.R. Year: 1994 Volume: 84 Issue: 11 Pages: 1721-1723 Handle: RePEc:aph:ajpbhl:1994:84:11:1721-1723_1 Template-Type: ReDIF-Article 1.0 Title: South Africa revisited. Journal: American Journal of Public Health Author-Name: Dohrn, J. Year: 1994 Volume: 84 Issue: 11 Pages: 1853 Handle: RePEc:aph:ajpbhl:1994:84:11:1853_9 Template-Type: ReDIF-Article 1.0 Title: Hypertension control, 1994. Journal: American Journal of Public Health Author-Name: Shea, S. Year: 1994 Volume: 84 Issue: 11 Pages: 1725-1727 Handle: RePEc:aph:ajpbhl:1994:84:11:1725-1727_8 Template-Type: ReDIF-Article 1.0 Title: Toward an epidemiology of disablement. Journal: American Journal of Public Health Author-Name: Patrick, D.L. Year: 1994 Volume: 84 Issue: 11 Pages: 1723-1725 Handle: RePEc:aph:ajpbhl:1994:84:11:1723-1725_9 Template-Type: ReDIF-Article 1.0 Title: A computerized network of general practices in Rotterdam, The Netherlands. Journal: American Journal of Public Health Author-Name: Middelkoop, B.J. Author-Name: Bohnen, A.M. Author-Name: Duisterhout, J.S. Author-Name: Pleumeekers, H.J. Author-Name: Prins, A. Year: 1994 Volume: 84 Issue: 11 Pages: 1852-1853 Handle: RePEc:aph:ajpbhl:1994:84:11:1852-1853_7 Template-Type: ReDIF-Article 1.0 Title: A community-based Needle Clean-Up Project. Journal: American Journal of Public Health Author-Name: McMillian, T. Author-Name: Dorsey, E. Author-Name: Beilenson, P. Author-Name: Vlahov, D. Year: 1994 Volume: 84 Issue: 11 Pages: 1854 Handle: RePEc:aph:ajpbhl:1994:84:11:1854_9 Template-Type: ReDIF-Article 1.0 Title: NRA claims distortions of Second Amendment in journal article. Journal: American Journal of Public Health Author-Name: Blackman, P.H. Author-Name: Gardiner, R.E. Year: 1994 Volume: 84 Issue: 11 Pages: 1854-1856 Handle: RePEc:aph:ajpbhl:1994:84:11:1854-1856_6 Template-Type: ReDIF-Article 1.0 Title: Tuberculosis: is the past once again prologue? Journal: American Journal of Public Health Author-Name: Comstock, G.W. Year: 1994 Volume: 84 Issue: 11 Pages: 1729-1731 Abstract: Tuberculosis has been considered the result of hereditary susceptibility, miasmas in the environment, and contact with contagious patients. During most of the latter half of this century, tuberculosis control efforts have concentrated almost exclusively on contagion by treating patients to make them noninfectious, treating latent tuberculosis to prevent reactivation, and in some countries, vaccinating uninfected persons to protect them from the consequences of infection. With the resurgence of tuberculosis in 1985, interest in all methods of tuberculosis control has been rekindled. Much remains to be discovered and much needs to be done. If renewed efforts succeed in again forcing tuberculosis rates downward, will we have the wisdom to eliminate tuberculosis in the United States, or will we relax and bring about another resurgence? Handle: RePEc:aph:ajpbhl:1994:84:11:1729-1731_0 Template-Type: ReDIF-Article 1.0 Title: Obesity in black and white mothers and daughters. Journal: American Journal of Public Health Author-Name: Garn, S.M. Year: 1994 Volume: 84 Issue: 11 Pages: 1727-1728 Handle: RePEc:aph:ajpbhl:1994:84:11:1727-1728_6 Template-Type: ReDIF-Article 1.0 Title: The role of city and state agencies in injury prevention. Journal: American Journal of Public Health Author-Name: Davidson, L.L. Author-Name: Durkin, M.S. Author-Name: Kuhn, L. Author-Name: O'Connor, P. Author-Name: Barlow, B. Author-Name: Heagarty, M.C. Year: 1994 Volume: 84 Issue: 11 Pages: 1853-1854 Handle: RePEc:aph:ajpbhl:1994:84:11:1853-1854_3 Template-Type: ReDIF-Article 1.0 Title: How effective is drug abuse resistance education? A meta-analysis of project DARE outcome evaluations Journal: American Journal of Public Health Author-Name: Ennett, S.T. Author-Name: Tobler, N.S. Author-Name: Ringwalt, C.L. Author-Name: Flewelling, R.L. Year: 1994 Volume: 84 Issue: 9 Pages: 1394-1401 Abstract: Objectives. Project DARE (Drug Abuse Resistance Education) is the most widely used school-based drug use prevention program in the United States, but the findings of rigorous evaluations of its effectiveness have not been considered collectively. Methods. We used meta-analytic techniques to review eight methodologically rigorous DARE evaluations. Weighted effect size means for several short-term outcomes also were compared with means reported for other drug use prevention programs. Results. The DARE effect size for drug use behavior ranged from .00 to .11 across the eight studies; the weighted mean for drug use across studies was .06. For all outcomes considered, the DARE effect size means were substantially smaller than those of programs emphasizing social and general competencies and using interactive teaching strategies. Conclusions. DARE's short-term effectiveness for reducing or preventing drug use behavior is small and is less than for interactive prevention programs. Handle: RePEc:aph:ajpbhl:1994:84:9:1394-1401_0 Template-Type: ReDIF-Article 1.0 Title: Developing leaders vs training administrators in the health services. Journal: American Journal of Public Health Author-Name: Legnini, M.W. Year: 1994 Volume: 84 Issue: 10 Pages: 1569-1572 Abstract: In these difficult times, health care institutions need leaders, not simply managers. Leaders' breadth of skills and perspective come from understanding the values involved in health care delivery; managers know the right way to do things, but leaders know which are the right things to do. Schools of public health are moving away from their potential contribution to leadership development in health services administration. The result is a lack of accountability to the community. Leadership skills and an examination of values should be part of health services administration programs in schools of public health, which should see their mission as helping to identify and train leaders, not simply technical specialists in management. Handle: RePEc:aph:ajpbhl:1994:84:10:1569-1572_3 Template-Type: ReDIF-Article 1.0 Title: Health care reform and health outcomes. Journal: American Journal of Public Health Author-Name: Robertson, L.S. Year: 1994 Volume: 84 Issue: 10 Pages: 1566-1567 Handle: RePEc:aph:ajpbhl:1994:84:10:1566-1567_9 Template-Type: ReDIF-Article 1.0 Title: Public health nursing: a model for the 21st century. Journal: American Journal of Public Health Author-Name: Cashman, S.B. Author-Name: Fulmer, H.S. Author-Name: Aaberg, A.A. Author-Name: Staples, L. Year: 1994 Volume: 84 Issue: 10 Pages: 1694-1695 Handle: RePEc:aph:ajpbhl:1994:84:10:1694-1695_8 Template-Type: ReDIF-Article 1.0 Title: The case-fatality rate of occupational injuries: the effect of aging. Journal: American Journal of Public Health Author-Name: Rossignol, M. Year: 1994 Volume: 84 Issue: 10 Pages: 1696-1697 Handle: RePEc:aph:ajpbhl:1994:84:10:1696-1697_2 Template-Type: ReDIF-Article 1.0 Title: Autopsy rates among patients reported with AIDS. Journal: American Journal of Public Health Author-Name: Schable, B. Author-Name: Chu, S.Y. Year: 1994 Volume: 84 Issue: 10 Pages: 1695-1696 Handle: RePEc:aph:ajpbhl:1994:84:10:1695-1696_8 Template-Type: ReDIF-Article 1.0 Title: Going smoke-free in the 1990s: lessons learned at a teaching hospital. Journal: American Journal of Public Health Author-Name: Radecki, S.E. Author-Name: Brunton, S.A. Year: 1994 Volume: 84 Issue: 10 Pages: 1689-1691 Handle: RePEc:aph:ajpbhl:1994:84:10:1689-1691_6 Template-Type: ReDIF-Article 1.0 Title: The Central Harlem playground injury prevention project: a model for change. Journal: American Journal of Public Health Author-Name: Laraque, D. Author-Name: Barlow, B. Author-Name: Davidson, L. Author-Name: Welborn, C. Year: 1994 Volume: 84 Issue: 10 Pages: 1691-1692 Handle: RePEc:aph:ajpbhl:1994:84:10:1691-1692_4 Template-Type: ReDIF-Article 1.0 Title: Toward a more population-based approach to immunization: fostering private- and public-sector collaboration. Journal: American Journal of Public Health Author-Name: Bernier, R.H. Year: 1994 Volume: 84 Issue: 10 Pages: 1567-1568 Handle: RePEc:aph:ajpbhl:1994:84:10:1567-1568_5 Template-Type: ReDIF-Article 1.0 Title: Screening for colorectal cancer: the role of the general practitioner. Journal: American Journal of Public Health Author-Name: Launoy, G. Author-Name: Herbert, C. Author-Name: Gignoux, M. Year: 1994 Volume: 84 Issue: 10 Pages: 1693-1694 Handle: RePEc:aph:ajpbhl:1994:84:10:1693-1694_4 Template-Type: ReDIF-Article 1.0 Title: Patient satisfaction with telemedicine in a rural clinic. Journal: American Journal of Public Health Author-Name: Allen, A. Author-Name: Hayes, J. Year: 1994 Volume: 84 Issue: 10 Pages: 1693 Handle: RePEc:aph:ajpbhl:1994:84:10:1693_0 Template-Type: ReDIF-Article 1.0 Title: The health hazards of leaf burning. Journal: American Journal of Public Health Author-Name: Curtis, L. Year: 1994 Volume: 84 Issue: 10 Pages: 1696 Handle: RePEc:aph:ajpbhl:1994:84:10:1696_3 Template-Type: ReDIF-Article 1.0 Title: Estimating the costs of pregnancy-related care. Journal: American Journal of Public Health Author-Name: McCormick, M.C. Author-Name: Lee, S.K. Year: 1994 Volume: 84 Issue: 9 Pages: 1376-1377 Handle: RePEc:aph:ajpbhl:1994:84:9:1376-1377_8 Template-Type: ReDIF-Article 1.0 Title: Tap water scalds in New Zealand. Journal: American Journal of Public Health Author-Name: Waller, A.E. Author-Name: Langley, J.D. Author-Name: Clarke, J. Year: 1994 Volume: 84 Issue: 9 Pages: 1524 Handle: RePEc:aph:ajpbhl:1994:84:9:1524_7 Template-Type: ReDIF-Article 1.0 Title: Gonorrhea rates among US men, adjusted for sexual activity. Journal: American Journal of Public Health Author-Name: Kassler, W.J. Author-Name: Tanfer, K. Author-Name: Aral, S.O. Year: 1994 Volume: 84 Issue: 9 Pages: 1524-1525 Handle: RePEc:aph:ajpbhl:1994:84:9:1524-1525_9 Template-Type: ReDIF-Article 1.0 Title: Self-reports yield invalid results on seat belt use. Journal: American Journal of Public Health Author-Name: Robertson, L.S. Year: 1994 Volume: 84 Issue: 9 Pages: 1525-1526 Handle: RePEc:aph:ajpbhl:1994:84:9:1525-1526_8 Template-Type: ReDIF-Article 1.0 Title: The future of community-based cardiovascular disease intervention studies. Journal: American Journal of Public Health Author-Name: Winkleby, M.A. Year: 1994 Volume: 84 Issue: 9 Pages: 1369-1372 Handle: RePEc:aph:ajpbhl:1994:84:9:1369-1372_4 Template-Type: ReDIF-Article 1.0 Title: More evidence for the public health value of family planning. Journal: American Journal of Public Health Author-Name: Klerman, L.V. Author-Name: Klerman, J.A. Year: 1994 Volume: 84 Issue: 9 Pages: 1377-1378 Handle: RePEc:aph:ajpbhl:1994:84:9:1377-1378_8 Template-Type: ReDIF-Article 1.0 Title: What you measure is what you get: prenatal care and women's health. Journal: American Journal of Public Health Author-Name: Wise, P.H. Year: 1994 Volume: 84 Issue: 9 Pages: 1374-1375 Handle: RePEc:aph:ajpbhl:1994:84:9:1374-1375_0 Template-Type: ReDIF-Article 1.0 Title: Women are organizing: environmental and population policies will never be the same. Journal: American Journal of Public Health Author-Name: Rodriguez-Trias, H. Year: 1994 Volume: 84 Issue: 9 Pages: 1379-1382 Handle: RePEc:aph:ajpbhl:1994:84:9:1379-1382_4 Template-Type: ReDIF-Article 1.0 Title: Betel chewing incompletely understood in journal supplement. Journal: American Journal of Public Health Author-Name: Marshall, M. Year: 1994 Volume: 84 Issue: 9 Pages: 1523 Handle: RePEc:aph:ajpbhl:1994:84:9:1523_3 Template-Type: ReDIF-Article 1.0 Title: The impressionable fetus? Fetal life and adult health. Journal: American Journal of Public Health Author-Name: Paneth, N. Year: 1994 Volume: 84 Issue: 9 Pages: 1372-1374 Handle: RePEc:aph:ajpbhl:1994:84:9:1372-1374_3 Template-Type: ReDIF-Article 1.0 Title: False-positive reports of neonatal seizures on birth certificates. Journal: American Journal of Public Health Author-Name: Lanska, M.J. Author-Name: Lanska, D.J. Author-Name: Baumann, R.J. Year: 1994 Volume: 84 Issue: 9 Pages: 1522 Handle: RePEc:aph:ajpbhl:1994:84:9:1522_2 Template-Type: ReDIF-Article 1.0 Title: Racial disparities in reported prenatal care advice: different explanations offered. Journal: American Journal of Public Health Author-Name: Pérez-Escamilla, R. Year: 1994 Volume: 84 Issue: 9 Pages: 1521-1523 Handle: RePEc:aph:ajpbhl:1994:84:9:1521-1523_9 Template-Type: ReDIF-Article 1.0 Title: Injection drug users' needle-cleaning practices. Journal: American Journal of Public Health Author-Name: Siegal, H.A. Author-Name: Carlson, R.G. Author-Name: Falck, R. Author-Name: Wang, J. Year: 1994 Volume: 84 Issue: 9 Pages: 1523-1524 Handle: RePEc:aph:ajpbhl:1994:84:9:1523-1524_5 Template-Type: ReDIF-Article 1.0 Title: The prevalence and demographic predictors of illicit and licit drug use among lesbians and gay men Journal: American Journal of Public Health Author-Name: Skinner, W.F. Year: 1994 Volume: 84 Issue: 8 Pages: 1307-1310 Abstract: Studies on illicit and licit drug use among homosexuals of both sexes have focused primarily on gay men, used limited drug measures, and been conducted in cities known for large homosexual populations. This paper examines (1) the prevalence of 12 illicit and licit drugs by sex and age group and (2) the demographic predictors of past-year frequency of marijuana, alcohol, and cigarette use. Organizational mailing lists were used to collect self-report data on 455 homosexuals living in a southern state. Differences were found between gay men and lesbians in the use of specific substances and in the demographic predictors of drug use. Handle: RePEc:aph:ajpbhl:1994:84:8:1307-1310_1 Template-Type: ReDIF-Article 1.0 Title: Drinking water mutagenicity and gastrointestinal and urinary tract cancers: An ecological study in Finland Journal: American Journal of Public Health Author-Name: Koivusalo, M. Author-Name: Jaakkola, J.J.K. Author-Name: Vartiainen, T. Author-Name: Hakulinen, T. Author-Name: Karjalainen, S. Author-Name: Pukkala, E. Author-Name: Tuomisto, J. Year: 1994 Volume: 84 Issue: 8 Pages: 1223-1228 Abstract: Objectives. The purpose of this study was to investigate the relationship between exposure to mutagenic drinking water and cancers of the gastrointestinal and urinary track. Methods. Past exposure to drinking water mutagenicity was assessed in 56 Finnish municipalities for the years 1955 and 1970. The cases of bladder, kidney, stomach, colon, and rectum cancers were derived from two periods (1967 to 1976 and 1977 to 1986). Age, sex, social class, urban living, and time period were taken into account in the Poisson regression analysis. Results. Statistically significant exposure-response association was observed between exposure and incidence of bladder, kidney, and stomach cancers. In an ordinary municipality using chlorinated surface water, this exposure would indicate a relative risk of 1.2 for bladder cancer and of 1.2 to 1.4 for kidney cancer compared with municipalities where nonmutagenic drinking water was consumed. Conclusions. The acidic mutagenic compounds present in drinking water may play a role in the etiology of kidney and bladder cancers, but, because the results are based on aggregate data, they should be interpreted with caution. Handle: RePEc:aph:ajpbhl:1994:84:8:1223-1228_8 Template-Type: ReDIF-Article 1.0 Title: Lifetime milk consumption and bone mineral density in older women Journal: American Journal of Public Health Author-Name: Soroko, S. Author-Name: Holbrook, T.L. Author-Name: Edelstein, S. Author-Name: Barrett-Connor, E. Year: 1994 Volume: 84 Issue: 8 Pages: 1319-1322 Abstract: This study examined the relation between lifetime milk consumption and both axial and appendicular bone mineral density in 581 postmenopausal White women. Positive significant, graded associations between milk consumption in adulthood and bone mineral density at the spine, total hip, trochanter, intertrochanter, and midradius, but not the ultradistal wrist or femoral neck, were observed. Adolescent milk consumption showed similar, statistically significant associations (spine and midradius). Associations were independent of age, body mass index, years postmenopausal, thiazide, estrogen and alcohol use, smoking, and exercise. Regular milk consumption in youth and adulthood is associated with better bone mineral density at cortical and trabecular sites in elderly women. Handle: RePEc:aph:ajpbhl:1994:84:8:1319-1322_8 Template-Type: ReDIF-Article 1.0 Title: Indicators for monitoring the growth of peruvian infants: Weight and length gain vs attained weight and length Journal: American Journal of Public Health Author-Name: Piwoz, E.G. Author-Name: De Romana, G.L. Author-Name: De Kanashiro, H.C. Author-Name: Black, R.E. Author-Name: Brown, K.H. Year: 1994 Volume: 84 Issue: 7 Pages: 1132-1138 Abstract: Objectives. To determine appropriate indicators and age intervals for growth monitoring in this population, the relationship between monthly weight and length indicators and nutritional status at 12 months was evaluated among 102 low-income Peruvian infants. Methods. Cutoffs for defining adequate vs slow growth were obtained from published reference data, and sensitivities and specificities of each indicator were calculated. Results. Low weight gain in early infancy, especially from 1 to 2 months, is useful for predicting low weight at 1 year (sensitivity = 81%, specificity = 65%, 25th percentile cutoff). Use of actual weight at 2 months, however, produces comparable results (sensitivity = 86%, specificity = 57%, 50th percentile cutoff). Monthly length gains were weak predictors of low length for age. Neither weight nor length gains accurately predicted the opposite form of undernutrition. Nonhuman milk consumption before 4 months and poor appetite from 3 to 12 months were related to low early weight gain and subsequent undernutrition. Conclusions. Growth monitoring programs in this population should enroll infants at birth, monitor actual weight, promote exclusive breast-feeding and delayed introduction of nonhuman milk, and provide specific feeding advice to mothers of infants with frequently depressed appetites. Handle: RePEc:aph:ajpbhl:1994:84:7:1132-1138_0 Template-Type: ReDIF-Article 1.0 Title: Popular films do not reflect current tobacco use Journal: American Journal of Public Health Author-Name: Hazan, A.R. Author-Name: Lipton, H.L. Author-Name: Glantz, S.A. Year: 1994 Volume: 84 Issue: 6 Pages: 998-1000 Abstract: This study examined trends in tobacco use in a random sample of 2 of the 20 top-grossing US films each year from 1960 through 1990 (62 films). The overall rate of tobacco use did not change. Films continue to portray smokers as successful, attractive White males. Smoking groups became larger, smoking alone declined, hostility and stress reduction were increasingly associated with smoking, and smoking by minor characters increased. Although smoking among elite characters fell, it remained nearly three times as prevalent as in actual population data during the 3 decades. Events involving young people more than doubled. Films do not accurately represent smoking in the United States. Handle: RePEc:aph:ajpbhl:1994:84:6:998-1000_0 Template-Type: ReDIF-Article 1.0 Title: More on disaster preparation by schools of public health. Journal: American Journal of Public Health Author-Name: Noji, E.K. Author-Name: Frumkin, H. Year: 1994 Volume: 84 Issue: 8 Pages: 1341-1342 Handle: RePEc:aph:ajpbhl:1994:84:8:1341-1342_4 Template-Type: ReDIF-Article 1.0 Title: Changing lives and changing social structures: common concerns of social science and public health. Journal: American Journal of Public Health Author-Name: Riley, M.W. Year: 1994 Volume: 84 Issue: 8 Pages: 1214-1217 Handle: RePEc:aph:ajpbhl:1994:84:8:1214-1217_9 Template-Type: ReDIF-Article 1.0 Title: Making aging a public health priority. Journal: American Journal of Public Health Author-Name: Kane, R. Year: 1994 Volume: 84 Issue: 8 Pages: 1213-1214 Handle: RePEc:aph:ajpbhl:1994:84:8:1213-1214_8 Template-Type: ReDIF-Article 1.0 Title: The underreporting of drug-related episodes in a Barcelona emergency room. Journal: American Journal of Public Health Author-Name: Domingo-Salvany, A. Author-Name: Perez, K. Author-Name: Hartnoll, R.L. Author-Name: Ortí, R.M. Year: 1994 Volume: 84 Issue: 8 Pages: 1340 Handle: RePEc:aph:ajpbhl:1994:84:8:1340_0 Template-Type: ReDIF-Article 1.0 Title: C.A.R.E. Fair: one-stop shopping for an underserved population. Journal: American Journal of Public Health Author-Name: Melland, R. Author-Name: Mauntel, B. Author-Name: Contreras, P. Year: 1994 Volume: 84 Issue: 8 Pages: 1337-1338 Handle: RePEc:aph:ajpbhl:1994:84:8:1337-1338_7 Template-Type: ReDIF-Article 1.0 Title: Cesarean section rates in Italy. Journal: American Journal of Public Health Author-Name: Signorelli, C. Author-Name: Cattaruzza, M.S. Year: 1994 Volume: 84 Issue: 8 Pages: 1340-1341 Handle: RePEc:aph:ajpbhl:1994:84:8:1340-1341_0 Template-Type: ReDIF-Article 1.0 Title: Grassroots efforts to promote tobacco-free schools in rural Missouri. Journal: American Journal of Public Health Author-Name: Eischen, M.H. Author-Name: Brownson, R.C. Author-Name: Davis, J.R. Author-Name: Cooperstock, L.R. Author-Name: Crawford, R. Author-Name: Freeman, D. Author-Name: Howard, G. Author-Name: Michael, M.J. Year: 1994 Volume: 84 Issue: 8 Pages: 1336-1337 Handle: RePEc:aph:ajpbhl:1994:84:8:1336-1337_3 Template-Type: ReDIF-Article 1.0 Title: A lead-safe family shelter in an urban minority community. Journal: American Journal of Public Health Author-Name: Farfel, M.R. Author-Name: Quinn, R. Year: 1994 Volume: 84 Issue: 8 Pages: 1338-1339 Handle: RePEc:aph:ajpbhl:1994:84:8:1338-1339_9 Template-Type: ReDIF-Article 1.0 Title: Water chlorination, mutagenicity, and cancer epidemiology. Journal: American Journal of Public Health Author-Name: Cantor, K.P. Year: 1994 Volume: 84 Issue: 8 Pages: 1211-1213 Handle: RePEc:aph:ajpbhl:1994:84:8:1211-1213_0 Template-Type: ReDIF-Article 1.0 Title: Voluntary and involuntary capture-recapture samples--problems in the estimation of hidden and elusive populations. Journal: American Journal of Public Health Author-Name: Neugebauer, R. Author-Name: Wittes, J. Year: 1994 Volume: 84 Issue: 7 Pages: 1068-1069 Handle: RePEc:aph:ajpbhl:1994:84:7:1068-1069_8 Template-Type: ReDIF-Article 1.0 Title: Public health interventions to reduce pediatric AIDS. Journal: American Journal of Public Health Author-Name: Goedert, J.J. Author-Name: Coté, T.R. Year: 1994 Volume: 84 Issue: 7 Pages: 1065-1066 Handle: RePEc:aph:ajpbhl:1994:84:7:1065-1066_7 Template-Type: ReDIF-Article 1.0 Title: Promoting the potential of community-oriented primary care. Journal: American Journal of Public Health Author-Name: Sapir, M. Year: 1994 Volume: 84 Issue: 7 Pages: 1180-1181 Handle: RePEc:aph:ajpbhl:1994:84:7:1180-1181_6 Template-Type: ReDIF-Article 1.0 Title: Trends in condom use among nonmonogamous heterosexual men in The Netherlands. Journal: American Journal of Public Health Author-Name: Dingelstad, A. Author-Name: de Vroome, E. Author-Name: Paalman, M. Author-Name: Sandfort, T. Year: 1994 Volume: 84 Issue: 7 Pages: 1184 Handle: RePEc:aph:ajpbhl:1994:84:7:1184_2 Template-Type: ReDIF-Article 1.0 Title: HIV and AIDS in Africa. Research priorities should not be limited to prophylaxis. Journal: American Journal of Public Health Author-Name: Colebunders, R. Author-Name: Van Renterghem, H. Author-Name: Buvé, A. Year: 1994 Volume: 84 Issue: 7 Pages: 1178-1179 Handle: RePEc:aph:ajpbhl:1994:84:7:1178-1179_9 Template-Type: ReDIF-Article 1.0 Title: Building partnerships for healthy communities--the role of the academic health center. Journal: American Journal of Public Health Author-Name: Lashof, J.C. Year: 1994 Volume: 84 Issue: 7 Pages: 1070-1071 Handle: RePEc:aph:ajpbhl:1994:84:7:1070-1071_5 Template-Type: ReDIF-Article 1.0 Title: The children's agenda for the 1990s and beyond. Journal: American Journal of Public Health Author-Name: Shelov, S.P. Year: 1994 Volume: 84 Issue: 7 Pages: 1066-1067 Handle: RePEc:aph:ajpbhl:1994:84:7:1066-1067_9 Template-Type: ReDIF-Article 1.0 Title: The stability of cotinine in unfrozen saliva mailed to the laboratory. Journal: American Journal of Public Health Author-Name: Foulds, J. Author-Name: Bryant, A. Author-Name: Stapleton, J. Author-Name: Jarvis, M.J. Author-Name: Russell, M.A. Year: 1994 Volume: 84 Issue: 7 Pages: 1182-1183 Handle: RePEc:aph:ajpbhl:1994:84:7:1182-1183_4 Template-Type: ReDIF-Article 1.0 Title: HIV and AIDS in Africa. 1. Assisting those in the early stages of HIV infection. Journal: American Journal of Public Health Author-Name: Foster, S. Year: 1994 Volume: 84 Issue: 7 Pages: 1178-1179 Handle: RePEc:aph:ajpbhl:1994:84:7:1178-1179_2 Template-Type: ReDIF-Article 1.0 Title: Rape resistance strategies and weapons used in assault. Journal: American Journal of Public Health Author-Name: Friedsam, D. Year: 1994 Volume: 84 Issue: 7 Pages: 1184-1185 Handle: RePEc:aph:ajpbhl:1994:84:7:1184-1185_3 Template-Type: ReDIF-Article 1.0 Title: Increasing the effectiveness of HIV counseling. Journal: American Journal of Public Health Author-Name: Hirano, D. Author-Name: Slaughter, F.R. Author-Name: Sands, L. Author-Name: Gellert, G.A. Year: 1994 Volume: 84 Issue: 7 Pages: 1179-1180 Handle: RePEc:aph:ajpbhl:1994:84:7:1179-1180_3 Template-Type: ReDIF-Article 1.0 Title: The validity of self-reported height and weight is questioned. Journal: American Journal of Public Health Author-Name: Sgro, S.L. Year: 1994 Volume: 84 Issue: 7 Pages: 1181-1182 Handle: RePEc:aph:ajpbhl:1994:84:7:1181-1182_0 Template-Type: ReDIF-Article 1.0 Title: State health departments' role in AIDS policy: a clarification. Journal: American Journal of Public Health Author-Name: Robins, L. Author-Name: Backstrom, C. Year: 1994 Volume: 84 Issue: 7 Pages: 1180 Handle: RePEc:aph:ajpbhl:1994:84:7:1180_7 Template-Type: ReDIF-Article 1.0 Title: Clarifying the legal definition of "undocumented aliens". Journal: American Journal of Public Health Author-Name: Loue, S. Author-Name: Foerstel, J. Year: 1994 Volume: 84 Issue: 6 Pages: 1032 Handle: RePEc:aph:ajpbhl:1994:84:6:1032_4 Template-Type: ReDIF-Article 1.0 Title: Formulating public health policy: the case of AIDS. Journal: American Journal of Public Health Author-Name: Gebbie, K.M. Year: 1994 Volume: 84 Issue: 6 Pages: 888-889 Handle: RePEc:aph:ajpbhl:1994:84:6:888-889_3 Template-Type: ReDIF-Article 1.0 Title: AIDS prevention and cultural sensitivity: are they compatible? Journal: American Journal of Public Health Author-Name: Bayer, R. Year: 1994 Volume: 84 Issue: 6 Pages: 895-898 Handle: RePEc:aph:ajpbhl:1994:84:6:895-898_2 Template-Type: ReDIF-Article 1.0 Title: Access to comprehensive health services is fundamental. Journal: American Journal of Public Health Author-Name: Sapir, M. Year: 1994 Volume: 84 Issue: 6 Pages: 1034 Handle: RePEc:aph:ajpbhl:1994:84:6:1034_7 Template-Type: ReDIF-Article 1.0 Title: Smoking and drug interactions. Journal: American Journal of Public Health Author-Name: Schein, J. Year: 1994 Volume: 84 Issue: 6 Pages: 1034 Handle: RePEc:aph:ajpbhl:1994:84:6:1034_9 Template-Type: ReDIF-Article 1.0 Title: The trials of Hanna Porn: the campaign to abolish midwifery in Massachusetts. Journal: American Journal of Public Health Author-Name: Declercq, E.R. Year: 1994 Volume: 84 Issue: 6 Pages: 1022-1028 Abstract: The case of Hanna Porn affords an opportunity to examine how the laws that led to the abolition of midwifery in Massachusetts evolved and were applied to the midwife whose case set the state legal precedent. Mrs Porn served primarily a Finnish-Swedish clientele of wives of laborers. The outcomes of the births she attended appear to have been positive, and she maintained a neonatal mortality rate of less than half that of local physicians. She also repeatedly defied court orders to stop practicing. Her case exemplifies the efforts that occurred nationally to abolish midwifery in the United States. Handle: RePEc:aph:ajpbhl:1994:84:6:1022-1028_3 Template-Type: ReDIF-Article 1.0 Title: A homeless teen pregnancy project: an intensive team case management model. Journal: American Journal of Public Health Author-Name: Borgford-Parnell, D. Author-Name: Hope, K.R. Author-Name: Deisher, R.W. Year: 1994 Volume: 84 Issue: 6 Pages: 1029-1030 Handle: RePEc:aph:ajpbhl:1994:84:6:1029-1030_9 Template-Type: ReDIF-Article 1.0 Title: A population-based screening mammography program in Saskatchewan. Journal: American Journal of Public Health Author-Name: Edouard, L. Author-Name: Eberts, L. Author-Name: Baldwin, J. Year: 1994 Volume: 84 Issue: 6 Pages: 1030-1031 Handle: RePEc:aph:ajpbhl:1994:84:6:1030-1031_7 Template-Type: ReDIF-Article 1.0 Title: Why a rising tide doesn't lift all the boats: Medicaid and medical care for children. Journal: American Journal of Public Health Author-Name: Silver, G.A. Year: 1994 Volume: 84 Issue: 6 Pages: 893-894 Handle: RePEc:aph:ajpbhl:1994:84:6:893-894_6 Template-Type: ReDIF-Article 1.0 Title: Elucidating the relationships between race, socioeconomic status, and health. Journal: American Journal of Public Health Author-Name: Pappas, G. Year: 1994 Volume: 84 Issue: 6 Pages: 892-893 Handle: RePEc:aph:ajpbhl:1994:84:6:892-893_1 Template-Type: ReDIF-Article 1.0 Title: The report of the surgeon general: Preventing tobacco use among young people Journal: American Journal of Public Health Author-Name: Elders, M.J. Author-Name: Perry, C.L. Author-Name: Eriksen, M.P. Author-Name: Giovino, G.A. Year: 1994 Volume: 84 Issue: 4 Pages: 543-547 Abstract: This year's surgeon general's report on smoking and health is the first such report to focus on young people. From extensive data that indicate that tobacco use is a pediatric epidemic, the report reached six major conclusions: (1) Nearly all first use of tobacco occurs by age 18. (2) Most adolescent smokers are addicted to nicotine. (3) Tobacco is often the first drug used by young people who subsequently use illegal drugs. (4) There are identified psychosocial risk factors for the onset of tobacco use. (5) Cigarette advertising also appears to increase young people's risk of smoking. (6) Communitywide efforts have successfully reduced adolescent use of tobacco. This commentary restates each of the six conclusions, summarizes the data that support each, and then considers the implications of the conclusions for public health action. Handle: RePEc:aph:ajpbhl:1994:84:4:543-547_8 Template-Type: ReDIF-Article 1.0 Title: The impact of the safe kids/healthy neighborhoods injury prevention program in Harlem, 1988 through 1991 Journal: American Journal of Public Health Author-Name: Davidson, L.L. Author-Name: Durkin, M.S. Author-Name: Kuhn, L. Author-Name: O'Connor, P. Author-Name: Barlow, B. Author-Name: Heagarty, M.C. Year: 1994 Volume: 84 Issue: 4 Pages: 580-586 Abstract: Objectives. This study evaluated the effectiveness of a community coalition to prevent severe injuries to children in Central Harlem, New York, NY. It was hypothesized that injury incidence rates would decline during the intervention (1989 through 1991) relative to preintervention years (1983 through 1988); that the decline would be greatest for the targeted age group (5 through 16 years) and targeted injury causes (traffic accidents, assaults, firearms, outdoor falls); and that the decline would occur in the intervention community rather than a control community. Methods. Surveillance of injuries that result in hospitalization and/or death among children in the two communities has been under way since 1983. Data from this surveillance were used to test whether the incidence of severe injury declined during the intervention; other temporal variations were controlled by Poisson regression. Results. The incidence of injury among school-aged children in central Harlem declined during the intervention. The decline was specific to the targeted age group and targeted causes. A nonspecific decline also occurred in the control community. Conclusions. The declining incidence rate in Central Harlem is consistent with a favorable program effect, but additional investigation of possible secular trend or spillover effects is needed. Handle: RePEc:aph:ajpbhl:1994:84:4:580-586_4 Template-Type: ReDIF-Article 1.0 Title: The frequency and nature of alcohol and tobacco advertising in televised sports, 1990 through 1992 Journal: American Journal of Public Health Author-Name: Madden, P.A. Author-Name: Grube, J.W. Year: 1994 Volume: 84 Issue: 2 Pages: 297-299 Abstract: This study examines the frequency and nature of alcohol and tobacco advertising in a random sample of 166 televised sports events representing 443.7 hours of network programming broadcast from fall 1990 through summer 1992. More commercials appear for alcohol products than for any other beverage. Beer commercials predominate and include images at odds with recommendations from former Surgeon General Koop. The audience is also exposed to alcohol and tobacco advertising through the appearances of stadium signs, other on-site promotions, and verbal or visual brief product sponsorships. Moderation messages and public service announcements are rare. Handle: RePEc:aph:ajpbhl:1994:84:2:297-299_0 Template-Type: ReDIF-Article 1.0 Title: Using physician correspondence and postcard reminders to promote mammography use Journal: American Journal of Public Health Author-Name: Taplin, S.H. Author-Name: Anderman, C. Author-Name: Grothaus, L. Author-Name: Curry, S. Author-Name: Montano, D. Year: 1994 Volume: 84 Issue: 4 Pages: 571-574 Abstract: Objectives. In a health maintenance organization that mails letters to women recommending that they schedule mammograms, we conducted a randomized trial to evaluate simple methods of increasing the use of screening mammography. Methods. Using a 2 x 2 factorial design, we tested the effects of (1) mailing the recommendation letter from each woman's primary care physician rather than from the program director and (2) sending a subsequent reminder postcard. Results. Sending a reminder postcard nearly doubled the odds that women would get mammograms within 1 year (participate). The letter from the woman's personal physician had no effect. Attending a clinic more than 45 minutes from the screening center, being a current smoker, or being in fair or poor health were negatively associated with subsequently obtaining a mammogram. The odds of participation doubled if women had had previous mammograms. Conclusions. When preceded by written recommendations to schedule mammograms, reminder postcards effectively increased participation. Future randomized trials to promote use of screening mammography should compare interventions with a reminder condition. Handle: RePEc:aph:ajpbhl:1994:84:4:571-574_2 Template-Type: ReDIF-Article 1.0 Title: The prevalence and demographics of pathological gamblers: Implications for public health Journal: American Journal of Public Health Author-Name: Volberg, R.A. Year: 1994 Volume: 84 Issue: 2 Pages: 237-241 Abstract: Objectives. A study of pathological gambling in five states provides information needed to address the public health threat that the expanding availability of legalized gambling poses to at-risk groups in the general population. Methods. Over the course of this project, epidemiological data were collected to determine the prevalence of probable pathological gambling in the general population in each study state and demographic data were collected from pathological gamblers entering treatment programs in each state. Results. Among the states surveyed, the availability of and involvement in gambling differ significantly, as does the prevalence of pathological gambling. Despite these differences, the demographics of pathological gamblers in these states are similar. Like those in the general population, pathological gamblers entering treatment in each state are similar. However, pathological gamblers entering treatment do not represent the full spectrum of individuals in the general population who experience gambling-related problems. Conclusions. These findings raise a number of issues, including the potential impacts of continued gambling legalization on the overall rate of gambling problems in the general population and on specific at-risk groups, including women, minorities, and children. They thus have implications for policy and program decisions now being made throughout the United States. Handle: RePEc:aph:ajpbhl:1994:84:2:237-241_4 Template-Type: ReDIF-Article 1.0 Title: Enhancing the self-report of alcohol consumption in the community: Two questionnaire formats Journal: American Journal of Public Health Author-Name: King, A.C. Year: 1994 Volume: 84 Issue: 2 Pages: 294-296 Abstract: Two questionnaire formats for assessing alcohol consumption in a community sample were compared. Subjects completed the Semi-Quantitative Food Frequency Questionnaire and a questionnaire specifically targeting alcohol use. Across all alcoholic beverages, subjects reported lower consumption on the alcohol questionnaire than on the food frequency questionnaire. The results suggest that food frequency questionnaires may provide a better means for enhancing self-report of alcohol use than questionnaires that target solely alcohol intake. Handle: RePEc:aph:ajpbhl:1994:84:2:294-296_6 Template-Type: ReDIF-Article 1.0 Title: The term "years of healthy life": misunderstood, defended, and challenged. A short term for "quality-adjusted life years". Journal: American Journal of Public Health Author-Name: Erickson, P. Author-Name: Wilson, R.W. Year: 1994 Volume: 84 Issue: 5 Pages: 866-867 Handle: RePEc:aph:ajpbhl:1994:84:5:866-867_9 Template-Type: ReDIF-Article 1.0 Title: The reporting efficiency of measles by hospitals in Los Angeles County, 1986 and 1989. Journal: American Journal of Public Health Author-Name: Ewert, D.P. Author-Name: Frederick, P.D. Author-Name: Run, G.H. Author-Name: Mascola, L. Year: 1994 Volume: 84 Issue: 5 Pages: 868-869 Handle: RePEc:aph:ajpbhl:1994:84:5:868-869_0 Template-Type: ReDIF-Article 1.0 Title: Trans fatty acids: are the effects only marginal? Journal: American Journal of Public Health Author-Name: Willett, W.C. Author-Name: Ascherio, A. Year: 1994 Volume: 84 Issue: 5 Pages: 722-724 Abstract: In the process of converting vegetable oils into solid fats, a process known as partial hydrogenation, some unsaturated bonds are converted to an unnatural trans position. In humans, trans fatty acids increase low-density lipoprotein cholesterol and decrease high-density lipoprotein cholesterol. In addition, positive associations between intake of trans fatty acids and coronary heart disease have been observed in epidemiological studies. The combined results of metabolic and epidemiological studies provide strong evidence that trans fatty acid intake is causally related to risk of coronary disease. Because the consumption of partially hydrogenated fats is almost universal in the United States, the number of deaths attributable to such fats is likely to be substantial. Federal regulations should require manufacturers to include trans fatty acid content in food labels and should aim to greatly reduce or eliminate the use of partially hydrogenated vegetable fats. Handle: RePEc:aph:ajpbhl:1994:84:5:722-724_8 Template-Type: ReDIF-Article 1.0 Title: The politics of dietary guidance--a new opportunity. Journal: American Journal of Public Health Author-Name: Nestle, M. Year: 1994 Volume: 84 Issue: 5 Pages: 713-715 Handle: RePEc:aph:ajpbhl:1994:84:5:713-715_2 Template-Type: ReDIF-Article 1.0 Title: The term "years of healthy life"; misunderstood, defended, and challenged. A measure that can capture gradations in health states. Journal: American Journal of Public Health Author-Name: McGinnis, J.M. Year: 1994 Volume: 84 Issue: 5 Pages: 865-867 Handle: RePEc:aph:ajpbhl:1994:84:5:865-867_7 Template-Type: ReDIF-Article 1.0 Title: Ecologic analysis as outlook and method. Journal: American Journal of Public Health Author-Name: Poole, C. Year: 1994 Volume: 84 Issue: 5 Pages: 715-716 Handle: RePEc:aph:ajpbhl:1994:84:5:715-716_6 Template-Type: ReDIF-Article 1.0 Title: Insulating public health from extremist politics--do we need boards of health? Journal: American Journal of Public Health Author-Name: Francis, D.P. Year: 1994 Volume: 84 Issue: 5 Pages: 720-721 Handle: RePEc:aph:ajpbhl:1994:84:5:720-721_6 Template-Type: ReDIF-Article 1.0 Title: Knowledge, preference, or both: it's hard to tell without the data. Journal: American Journal of Public Health Author-Name: Goodman, E. Year: 1994 Volume: 84 Issue: 5 Pages: 867-868 Handle: RePEc:aph:ajpbhl:1994:84:5:867-868_4 Template-Type: ReDIF-Article 1.0 Title: Birthweight and gestation in black, white, and mixed-race babies. Journal: American Journal of Public Health Author-Name: Emanuel, I. Year: 1994 Volume: 84 Issue: 5 Pages: 869-870 Handle: RePEc:aph:ajpbhl:1994:84:5:869-870_0 Template-Type: ReDIF-Article 1.0 Title: The term "years of healthy life": misunderstood, defended, and challenged. A shorthand term for policymakers. Journal: American Journal of Public Health Author-Name: Stoto, M.A. Year: 1994 Volume: 84 Issue: 5 Pages: 865-867 Handle: RePEc:aph:ajpbhl:1994:84:5:865-867_1 Template-Type: ReDIF-Article 1.0 Title: Using CD4 counts to evaluate the stages and epidemiology of HIV infection in South Carolina public clinic patients Journal: American Journal of Public Health Author-Name: Luby, S. Author-Name: Jones, J. Author-Name: Horan, J. Year: 1994 Volume: 84 Issue: 3 Pages: 377-381 Abstract: Objectives. CD4 lymphocyte counts decrease with the duration of human immunodeficiency virus (HIV) infection. We used CD4 counts collected for clinical reasons to evaluate the stage of HIV infection and the epidemiology of recent HIV infections among attendees of South Carolina's public health clinics. Methods. We measured the CD4 T-lymphocyte counts of persons newly diagnosed with HIV infection April 1989 through June 1990 at South Carolina public health clinics who returned for follow-up. Results. Of 812 newly diagnosed HIV-infected health department patients, 420 (52%) had their CD4 lymphocyte counts measured. Of these 420, 51 (12%) had CD4 counts of <200, the level below which prophylaxis for pneumocystis pneumonia prolongs survival, and 193 (46%) had CD4 counts of <500, the level below which zidovudine may prolong disease-free survival. The highest CD4 counts (≥900), which are associated with more recent HIV infection, were more common in females. Conclusions. In South Carolina, almost half of newly reported HIV- infected persons who agreed to CD4 testing at the health department might benefit from immediate drug therapy. Within this population, women may be an emerging risk group that requires specifically directed HIV prevention efforts. Handle: RePEc:aph:ajpbhl:1994:84:3:377-381_7 Template-Type: ReDIF-Article 1.0 Title: Tobacco use by black and white adolescents: The validity of self-reports Journal: American Journal of Public Health Author-Name: Bauman, K.E. Author-Name: Ennett, S.E. Year: 1994 Volume: 84 Issue: 3 Pages: 394-398 Abstract: Objectives. Previous studies concluded that Black adolescents use tobacco and other drugs less than White adolescents. The Black-White differences typically were attributed to variations in background and life-style. The objective of the research reported in this paper was to determine whether the presumed difference in tobacco use is due to Black-White differences in the validity of self-reports. Methods. We used biochemical measures to compare the validity of self-reports of tobacco use by 1823 Black and White adolescents and to assess the contribution of variation in validity to Black- White differences in reported tobacco use. Results. The sensitivity of Blacks' reports was significantly less than the sensitivity of Whites' reports. The specificity of Whites' reports was significantly less than the specificity of Blacks' reports. Much of the Black-White differences in reports of cigarette smoking and tobacco use were due to Black-White differences in validity. Conclusions. Studies of Black-White differences should adjust for the invalidity of reports or acknowledge that much of the difference may be due to measurement error. Handle: RePEc:aph:ajpbhl:1994:84:3:394-398_3 Template-Type: ReDIF-Article 1.0 Title: Smokeless tobacco use and increased cardiovascular mortality among Swedish construction workers Journal: American Journal of Public Health Author-Name: Bolinder, G. Author-Name: Alfredsson, L. Author-Name: Englund, A. Author-Name: De Faire, U. Year: 1994 Volume: 84 Issue: 3 Pages: 399-404 Abstract: Objectives. Little is known about the risks of cardiovascular disease associated with the use of smokeless tobacco, which produces blood nicotine levels similar to those caused by cigarette smoking. Methods. Male Swedish construction industry employees (n = 135 036) who attended a health examination were followed by studying cause-specific mortality during a 12- year period. The study population comprised 6297 smokeless tobacco users, 14 983 smokers of fewer than 15 cigarettes per day, 13 518 smokers of 15 or more cigarettes, per day, 17 437 ex-smokers, 50 255 'other' tobacco users, and 32 546 nonusers. Results. The age-adjusted relative risk of dying from cardiovascular disease was 1.4 for smokeless tobacco users and 1.9 for smokers of 15 or more cigarettes per day, compared with nonusers. Among men aged 35 through 54 years at the start of follow-up, the relative risk was 2.1 for smokeless tobacco users and 3.2 for smokers. When data were adjusted for body mass index, blood pressure, and history of heart symptoms, the results were essentially unchanged. Cancer mortality was not raised in smokeless tobacco users. Conclusions. Both smokeless tobacco users and smokers face a higher risk of dying from cardiovascular disease than nonusers. Although the risk is lower for smokeless tobacco users than for smokers, the excess risk gives cause for preventive actions. Handle: RePEc:aph:ajpbhl:1994:84:3:399-404_3 Template-Type: ReDIF-Article 1.0 Title: Translating state data into local programs: targeted research for intervention planning (TRIP) Journal: American Journal of Public Health Author-Name: Schensul, S.L. Author-Name: Eisenberg, M.R. Author-Name: Glasgow, J. Author-Name: Huettner, J. Year: 1994 Volume: 84 Issue: 4 Pages: 671-672 Handle: RePEc:aph:ajpbhl:1994:84:4:671-672_1 Template-Type: ReDIF-Article 1.0 Title: Reducing violence--how do we proceed? Journal: American Journal of Public Health Author-Name: Christoffel, K.K. Year: 1994 Volume: 84 Issue: 4 Pages: 539-541 Handle: RePEc:aph:ajpbhl:1994:84:4:539-541_0 Template-Type: ReDIF-Article 1.0 Title: Commentary: Lessons from Medicaid--improving access to office-based physician care for the low-income population. Journal: American Journal of Public Health Author-Name: Rowland, D. Author-Name: Salganicoff, A. Year: 1994 Volume: 84 Issue: 4 Pages: 550-552 Abstract: Medicaid offers important lessons about providing access to office-based physician services for the poor. First, differentials in physician fees between Medicaid and other payers compromise access to care and are difficult to reverse. Second, managed care alone is not enough to attain equity in access, especially if differentials in payment rates between Medicaid and private patients in managed care settings are allowed to grow. Finally, financing strategies alone are not sufficient to resolve the shortage of health care providers in medically underserved areas. In these areas, payment policy must be combined with resource development to ensure that vulnerable populations have access to care. Handle: RePEc:aph:ajpbhl:1994:84:4:550-552_7 Template-Type: ReDIF-Article 1.0 Title: Firearm-related violence--what we don't know is killing us. Journal: American Journal of Public Health Author-Name: Kellermann, A.L. Year: 1994 Volume: 84 Issue: 4 Pages: 541-542 Handle: RePEc:aph:ajpbhl:1994:84:4:541-542_3 Template-Type: ReDIF-Article 1.0 Title: In-line skating injuries, 1987 through 1992. Journal: American Journal of Public Health Author-Name: Callé, S.C. Year: 1994 Volume: 84 Issue: 4 Pages: 675 Handle: RePEc:aph:ajpbhl:1994:84:4:675_2 Template-Type: ReDIF-Article 1.0 Title: Unintentional childhood injury--where the buck should stop. Journal: American Journal of Public Health Author-Name: Pless, I.B. Year: 1994 Volume: 84 Issue: 4 Pages: 537-539 Handle: RePEc:aph:ajpbhl:1994:84:4:537-539_0 Template-Type: ReDIF-Article 1.0 Title: The Rhode Island Sun Smart Project: skin cancer prevention reaches the beaches. Journal: American Journal of Public Health Author-Name: Rossi, J.S. Author-Name: Blais, L.M. Author-Name: Weinstock, M.A. Year: 1994 Volume: 84 Issue: 4 Pages: 672-674 Handle: RePEc:aph:ajpbhl:1994:84:4:672-674_3 Template-Type: ReDIF-Article 1.0 Title: Promoting condom availability in schools. Journal: American Journal of Public Health Author-Name: Clark, M.P. Author-Name: Reynolds, J.H. Year: 1994 Volume: 84 Issue: 4 Pages: 676-677 Handle: RePEc:aph:ajpbhl:1994:84:4:676-677_3 Template-Type: ReDIF-Article 1.0 Title: Medicaid reimbursement--can we save money by paying doctors more? Journal: American Journal of Public Health Author-Name: Regan, M. Year: 1994 Volume: 84 Issue: 4 Pages: 548-550 Handle: RePEc:aph:ajpbhl:1994:84:4:548-550_7 Template-Type: ReDIF-Article 1.0 Title: HIV risk and injection drug users--evidence for behavioral change. Journal: American Journal of Public Health Author-Name: Chitwood, D.D. Year: 1994 Volume: 84 Issue: 3 Pages: 350 Handle: RePEc:aph:ajpbhl:1994:84:3:350_9 Template-Type: ReDIF-Article 1.0 Title: The possible effect of emigration on infant and child mortality from the Vietnam War. Journal: American Journal of Public Health Author-Name: Smith, M.C. Author-Name: Zaidi, S. Year: 1994 Volume: 84 Issue: 3 Pages: 499-500 Handle: RePEc:aph:ajpbhl:1994:84:3:499-500_8 Template-Type: ReDIF-Article 1.0 Title: Building ventilation and symptoms--where do we go from here? Journal: American Journal of Public Health Author-Name: Mendell, M.J. Author-Name: Fine, L. Year: 1994 Volume: 84 Issue: 3 Pages: 346-348 Handle: RePEc:aph:ajpbhl:1994:84:3:346-348_2 Template-Type: ReDIF-Article 1.0 Title: Occupational injury deaths in Norway's fishing industry. Journal: American Journal of Public Health Author-Name: Bratteboe, G. Author-Name: Aasjord, H.L. Year: 1994 Volume: 84 Issue: 3 Pages: 496-498 Handle: RePEc:aph:ajpbhl:1994:84:3:496-498_3 Template-Type: ReDIF-Article 1.0 Title: Narrow vs broad targeting of HIV/AIDS education. Journal: American Journal of Public Health Author-Name: Mintz, E. Year: 1994 Volume: 84 Issue: 3 Pages: 498-499 Handle: RePEc:aph:ajpbhl:1994:84:3:498-499_2 Template-Type: ReDIF-Article 1.0 Title: California's lead-poisoning prevention efforts among radiator-repair workers. Journal: American Journal of Public Health Author-Name: Maalouf, K.A. Author-Name: Durand, K. Author-Name: Kern, D.G. Year: 1994 Volume: 84 Issue: 3 Pages: 495-496 Handle: RePEc:aph:ajpbhl:1994:84:3:495-496_9 Template-Type: ReDIF-Article 1.0 Title: Fishing deaths in Alaska vary by fishery. Journal: American Journal of Public Health Author-Name: Kennedy, R. Author-Name: Veazie, M. Author-Name: Conway, G. Author-Name: Amandus, H. Year: 1994 Volume: 84 Issue: 3 Pages: 496 Handle: RePEc:aph:ajpbhl:1994:84:3:496_2 Template-Type: ReDIF-Article 1.0 Title: Commentary: setting the record straight--a reply to Howard Waitzkin. Journal: American Journal of Public Health Author-Name: Enthoven, A.C. Year: 1994 Volume: 84 Issue: 3 Pages: 490-493 Handle: RePEc:aph:ajpbhl:1994:84:3:490-493_5 Template-Type: ReDIF-Article 1.0 Title: Preventing adolescent drug use: the effectiveness of Project ALERT. Journal: American Journal of Public Health Author-Name: Gorman, D.M. Year: 1994 Volume: 84 Issue: 3 Pages: 500-501 Handle: RePEc:aph:ajpbhl:1994:84:3:500-501_5 Template-Type: ReDIF-Article 1.0 Title: How do we get enough folic acid to prevent some neural tube defects? Journal: American Journal of Public Health Author-Name: Beresford, S.A. Year: 1994 Volume: 84 Issue: 3 Pages: 348-350 Handle: RePEc:aph:ajpbhl:1994:84:3:348-350_6 Template-Type: ReDIF-Article 1.0 Title: Defending HIV seroprevalence surveys. Journal: American Journal of Public Health Author-Name: Buehler, J.W. Author-Name: Petersen, L.R. Author-Name: Ward, J.W. Author-Name: Valdiserri, R.O. Year: 1994 Volume: 84 Issue: 2 Pages: 319-320 Handle: RePEc:aph:ajpbhl:1994:84:2:319-320_5 Template-Type: ReDIF-Article 1.0 Title: Using race-specific community programs to increase organ donation among blacks. Journal: American Journal of Public Health Author-Name: Hong, B.A. Author-Name: Kappel, D.F. Author-Name: Whitlock, M. Author-Name: Parks-Thomas, T. Author-Name: Freedman, B. Year: 1994 Volume: 84 Issue: 2 Pages: 314-315 Handle: RePEc:aph:ajpbhl:1994:84:2:314-315_8 Template-Type: ReDIF-Article 1.0 Title: Perceived job stress, job strain, and hypertension. Journal: American Journal of Public Health Author-Name: Schnall, P.L. Author-Name: Landsbergis, P.A. Author-Name: Pickering, T.G. Author-Name: Schwartz, J.E. Year: 1994 Volume: 84 Issue: 2 Pages: 320-321 Handle: RePEc:aph:ajpbhl:1994:84:2:320-321_1 Template-Type: ReDIF-Article 1.0 Title: Commentary: recent reforms in the British National Health Service--lessons for the United States. Journal: American Journal of Public Health Author-Name: Holland, W.W. Author-Name: Graham, C. Year: 1994 Volume: 84 Issue: 2 Pages: 186-189 Abstract: President Clinton recently announced his reform plan for health care in the United States. The United Kingdom, along with other countries, has already enacted reforms in an effort to overcome the basic problem of having insufficient funds to provide a health service to meet modern demands. This paper briefly describes the recent health reforms in the United Kingdom and highlights some lessons for the United States, which include the need to choose procedures that should be universally provided. Health reforms that involve some fundamental restructuring need to be evaluated everywhere and agreed to by the staff in advance. Handle: RePEc:aph:ajpbhl:1994:84:2:186-189_9 Template-Type: ReDIF-Article 1.0 Title: Assessing community health concerns and implementing a microgrant program for self-help initiatives. Journal: American Journal of Public Health Author-Name: Paine-Andrews, A. Author-Name: Francisco, V.J. Author-Name: Fawcett, S.B. Year: 1994 Volume: 84 Issue: 2 Pages: 316-318 Handle: RePEc:aph:ajpbhl:1994:84:2:316-318_9 Template-Type: ReDIF-Article 1.0 Title: Clinica Tibas: a public-private partnership for health care delivery in Costa Rica. Journal: American Journal of Public Health Author-Name: Pezza, P.E. Author-Name: Barquero Bolanos, J.F. Year: 1994 Volume: 84 Issue: 2 Pages: 315-316 Handle: RePEc:aph:ajpbhl:1994:84:2:315-316_6 Template-Type: ReDIF-Article 1.0 Title: Participation in treatment decision might affect hysterectomy rates. Journal: American Journal of Public Health Author-Name: Cherkin, D. Year: 1994 Volume: 84 Issue: 2 Pages: 319 Handle: RePEc:aph:ajpbhl:1994:84:2:319_3 Template-Type: ReDIF-Article 1.0 Title: Alcohol advertising and public health: an urgent call for action. Journal: American Journal of Public Health Author-Name: Mosher, J.F. Year: 1994 Volume: 84 Issue: 2 Pages: 180-181 Handle: RePEc:aph:ajpbhl:1994:84:2:180-181_3 Template-Type: ReDIF-Article 1.0 Title: The efficacy of testing and counseling in limiting HIV transmission. Journal: American Journal of Public Health Author-Name: Cohen, D.A. Year: 1994 Volume: 84 Issue: 2 Pages: 321 Handle: RePEc:aph:ajpbhl:1994:84:2:321_1 Template-Type: ReDIF-Article 1.0 Title: The need to mobilize support for the Wellstone-McDermott-Conyers single-payer proposal. Journal: American Journal of Public Health Author-Name: Navarro, V. Year: 1994 Volume: 84 Issue: 2 Pages: 178-179 Handle: RePEc:aph:ajpbhl:1994:84:2:178-179_0 Template-Type: ReDIF-Article 1.0 Title: Health care reform and public health: weighing the proposals. Journal: American Journal of Public Health Author-Name: Susser, M. Year: 1994 Volume: 84 Issue: 2 Pages: 173-175 Handle: RePEc:aph:ajpbhl:1994:84:2:173-175_4 Template-Type: ReDIF-Article 1.0 Title: The reproducibility of data from a food frequency questionnaire among low- income Latina mothers and their children Journal: American Journal of Public Health Author-Name: Basch, C.E. Author-Name: Shea, S. Author-Name: Zybert, P. Year: 1994 Volume: 84 Issue: 5 Pages: 861-864 Abstract: We examined the 3-month and 1-year reproducibility of mothers' and children's dietary intakes of calories and 11 nutrients derived from oral administrations of a food frequency questionnaire to 166 Latina women. One- year correlations generally ranged from 0.40 to 0.55 for both mothers and children. For most nutrients, roughly half the children in the highest (lowest) quartile of intake at baseline were also in the highest (lowest) quartile 1 year later. The food frequency questionnaire has great potential for measuring typical nutrient intakes in these populations. Handle: RePEc:aph:ajpbhl:1994:84:5:861-864_9 Template-Type: ReDIF-Article 1.0 Title: The effects of occupational class transitions on hypertension: Racial disparities among working-age men Journal: American Journal of Public Health Author-Name: Waitzman, N.J. Author-Name: Smith, K.R. Year: 1994 Volume: 84 Issue: 6 Pages: 945-950 Abstract: Objectives. This study was undertaken to examine how the interaction between occupational class transitions and race affects the incidence of hypertension. Methods. A cohort of 1982 men (183 Black), ages 25 to 55, received a baseline medical exam between 1971 and 1975 and a follow-up between 1982 and 1984. Logistic regressions were estimated for hypertension at follow-up controlling for hypertension at baseline, other risk factors associated with blood pressure, and interaction terms identifying specific occupational class transitions among Blacks and Whites. The occupational class matrix was based largely on scores of US Census Bureau occupations from the Dictionary of Occupational Titles. Results. Relative to Whites who remained in professional and technical jobs between baseline and follow-up, Blacks and Whites who remained in lower occupational classes or made specific transitions-notably into the lowest class-had significantly higher incidence rates of hypertension. These differences were greater among Blacks, who are also more concentrated in and less likely to move upward from the lower end of the occupational class matrix. Conclusions. Widening racial disparities in high blood pressure over the period of study may be partly attributable to characteristics associated with occupational class position and dynamics. Handle: RePEc:aph:ajpbhl:1994:84:6:945-950_9 Template-Type: ReDIF-Article 1.0 Title: The effects of early education intervention on maternal employment, public assistance, and health insurance: The infant health and development program Journal: American Journal of Public Health Author-Name: Brooks-Gunn, J. Author-Name: McCormick, M.C. Author-Name: Shapiro, S. Author-Name: Benasich, A. Author-Name: Black, G.W. Year: 1994 Volume: 84 Issue: 6 Pages: 924-931 Abstract: Objectives. The purpose of this study was to test whether early education intervention influences maternal employment, education, fertility, and receipt of public assistance and health insurance. Methods. The Infant Health and Development Program is a randomized trial of the efficacy of early education on the outcomes of 985 low-birthweight, premature children. Families in eight sites received either pediatric follow-up and referral (follow-up only group) or pediatric services plus early intervention services (intervention group) for the first 3 years of the child's life. Results. Mothers in the intervention group were employed more months and returned to the work force earlier than those in the follow-up only group. Fertility and education were not associated with treatment. Mothers who had some college education received more months of public assistance in the intervention group compared with the follow-up only group. Mothers who were employed received more public assistance and public health insurance in the intervention group compared with the follow-up only group, when maternal employment was controlled. Conclusions. Findings are discussed in terms of the recent emphasis on two-generational programs directed to providing health, welfare, and child care services to young children and their families. Handle: RePEc:aph:ajpbhl:1994:84:6:924-931_5 Template-Type: ReDIF-Article 1.0 Title: Breast biopsy rate and positivity in Rhode Island Journal: American Journal of Public Health Author-Name: Richards, M.S. Author-Name: Feldman, J. Author-Name: Smith, R.A. Author-Name: DeBuono, B.A. Year: 1994 Volume: 84 Issue: 8 Pages: 1310-1312 Abstract: Breast biopsy is a common procedure for which few age-specific, population-based data are available. We identified all women who underwent breast biopsy in Rhode Island in 1989 by reviewing the specimen logs at each of 13 pathology laboratories. Among 425 000 women aged 15-97 years, 2685 underwent breast biopsy, for an overall rate of 6/1000. The rate increased with age, peaking among 45- to 54-year-olds and then declining in women over 75. Among those biopsied, 726 were diagnosed with breast cancer, for an overall biopsy positivity of 27%. In contrast to rate, positivity increased steadily with age. These results are within the range of estimates produced by smaller group studies. Handle: RePEc:aph:ajpbhl:1994:84:8:1310-1312_2 Template-Type: ReDIF-Article 1.0 Title: Estimating activity limitation in the noninstitutionalized population: A method for small areas Journal: American Journal of Public Health Author-Name: Lafata, J.E. Author-Name: Koch, G.G. Author-Name: Weissert, W.G. Year: 1994 Volume: 84 Issue: 11 Pages: 1813-1817 Abstract: Objectives. Although reliable direct state and local estimates of the activity-limited population are frequently unavailable, regression-adjusted synthetic estimates can be made. Such estimates use multivariate methods to model activity limitation at the national level and then apply model- predicted probabilities to corresponding community-specific demographic data. Methods. Using the 1989 National Health Interview Survey and the 1991 Area Resource File System, this study produced log-linear regression models that included person-level demographic and county-level contextual variables as predictors of activity limitation. Model-predicted rates were then multiplied by corresponding intercensal population data to generate state and local synthetic estimates of activity limitation. Results. Rates of activity limitation generally were found to increase with age and as the socioeconomic conditions of the county in which an individual resided worsened. Race and sex also tended to be statistically significant predictors of activity limitation. Conclusions. Activity limitation can be effectively modeled by age, sex, race, and community socioeconomic status. Synthetic estimates such as these are relatively simple to generate and can be useful for small-area planning in the absence of direct local estimates. Handle: RePEc:aph:ajpbhl:1994:84:11:1813-1817_6 Template-Type: ReDIF-Article 1.0 Title: Physicians' recommendations for mammography: Do tailored messages make a difference? Journal: American Journal of Public Health Author-Name: Skinner, C.S. Author-Name: Strecher, V.J. Author-Name: Hospers, H. Year: 1994 Volume: 84 Issue: 1 Pages: 43-49 Abstract: Objectives. Message tailoring, based on individual needs and circumstances, is commonly used to enhance face-to-face patient counseling. Only recently has individual tailoring become feasible for printed messages. This study sought to determine whether printed tailored recommendations addressing women's specific screening and risk status and perceptions about breast cancer and mammography are more effective than standardized printed recommendations. Methods. Computer-assisted telephone interviews were conducted with 435 women, aged 40 to 65 years, who had visited family practice groups within the previous 2 years. Subjects were randomly allocated to receive individually tailored or standardized mammography recommendation letters mailed from physicians to patients' homes. Follow-up interviews were conducted 8 months later. Results. Tailored letter recipients were more likely to remember and to have read more of their letters than standardized version recipients. After controlling for baseline status, tailored letter receipt was associated with more favorable follow-up mammography status for women with incomes below $26 000 and for Black women. Conclusions. Tailored messages are a more effective medium for physicians' mammography recommendations; tailoring may be especially important for women of low socioeconomic status. Handle: RePEc:aph:ajpbhl:1994:84:1:43-49_7 Template-Type: ReDIF-Article 1.0 Title: The reliability of racial classifications in hospital discharge abstract data Journal: American Journal of Public Health Author-Name: Blustein, J. Year: 1994 Volume: 84 Issue: 6 Pages: 1018-1021 Abstract: Many studies demonstrating an association between race and the use of medical services have used hospital discharge abstract data. The quality of the measures of race in such data sources has heretofore been unexplored. Hospital discharge abstract data from New York State were used to identify 767 cardiac patients who had been admitted to a hospital twice. Racial classifications during the two admissions were concordant 93.7% of the time. Kappa was .89 for Blacks, .72 for Whites, and .43 for all other racial groups. Evidence suggests that the misclassification of race in hospital discharge abstract data is nondifferential; racial discrepancies in access to medical services are thus probably even greater than those previously reported. Handle: RePEc:aph:ajpbhl:1994:84:6:1018-1021_6 Template-Type: ReDIF-Article 1.0 Title: Improving dietary behavior: The effectiveness of tailored messages in primary care settings Journal: American Journal of Public Health Author-Name: Campbell, M.K. Author-Name: DeVellis, B.M. Author-Name: Strecher, V.J. Author-Name: Ammerman, A.S. Author-Name: DeVellis, R.F. Author-Name: Sandler, R.S. Year: 1994 Volume: 84 Issue: 5 Pages: 783-787 Abstract: Objectives. To achieve the Healthy People 2000 objectives, public health professionals must develop effective dietary interventions that address psychosocial and behavioral components of change. This study tested the effect of individually computer-tailored messages designed to decrease fat intake and increase fruit and vegetable intake. Methods. Adult patients from four North Carolina family practices were surveyed at baseline and then randomly assigned to one of two interventions or to a control group. The first intervention consisted of individually computer-tailored nutrition messages; the second consisted of nontailored nutrition information based on the 1990 Dietary Guidelines for Americans. Patients were resurveyed 4 months postintervention. Results. The tailored intervention produced significant decreases in total fat and saturated fat scores compared with those of the control group (P < .05). Total fat was decreased in the tailored group by 23%, in the nontailored group by 9%, and in the control group by 3%. Fruit and vegetable consumption did not increase in any study group. Seventy-three percent of the tailored intervention group recalled receiving a message, compared with 33% of the nontailored intervention group. Conclusions. Tailored nutrition messages are effective in promoting dietary fat reduction for disease prevention. Handle: RePEc:aph:ajpbhl:1994:84:5:783-787_9 Template-Type: ReDIF-Article 1.0 Title: Predictors of mortality and institutionalization after hip fracture: The New Haven EPESE cohort Journal: American Journal of Public Health Author-Name: Marottoli, R.A. Author-Name: Berkman, L.F. Author-Name: Leo-Summers, L. Author-Name: Cooney Jr., L.M. Year: 1994 Volume: 84 Issue: 11 Pages: 1807-1812 Abstract: Objectives. Hip fractures can have devastating effects on the lives of older individuals. We determined the frequency of occurrence of hip fracture and the baseline factors predicting death and institutionalization at 6 months after hip fracture. Methods. A representative cohort of 2812 individuals aged 65 years and older was followed prospectively for 6 years. Hip fractures were identified, and the occurrence of death and institutionalization within 6 months of the fracture was determined. Prefracture information on physical and mental function, social support, and demographic features and in-hospital data on comorbid diagnoses, fracture site, and complications were analyzed to determine predictors of death and institutionalization after hip fracture. Results. Of 120 individuals suffering a hip fracture, 22 (18%) died within 6 months and 35 (29%) were institutionalized at 6 months. The predictors of death in multiple logistic regression included fracture site, a high number of comorbid conditions, a high number of complications, and poor baseline mental status. The primary predictor of institutionalization was poor baseline mental status. Conclusions. The frequency of death, institutionalization, and loss of function after hip fracture should prompt a reevaluation of the current approach to this problem. Handle: RePEc:aph:ajpbhl:1994:84:11:1807-1812_5 Template-Type: ReDIF-Article 1.0 Title: Drinking behavior in relation to cause of death among US adults Journal: American Journal of Public Health Author-Name: Li, G. Author-Name: Smith, G.S. Author-Name: Baker, S.P. Year: 1994 Volume: 84 Issue: 9 Pages: 1402-1406 Abstract: Objectives. Alcohol involvement is common in many fatal injuries. This study examines drinking behavior in a nationally representative sample of US adult decedents aged 25 through 64 years and its association with cause of death. Methods. Proxy-reported information from the 1986 National Mortality Followback Survey was used to profile the decedent's usual frequency and quantity of drinking. The association of drinking behavior with underlying cause of death was assessed while adjusting for demographic characteristics. Results. Of the decedents, 17% were daily drinkers, 22% usually consumed five drinks or more per occasion, and 27% were classified as heavier drinkers. Persons who died of injury drank more frequently and heavily than those who died of disease. The adjusted odds ratio of injury's being the underlying cause of death was 1.4 (95% confidence interval [CI] = 1.1, 1.8) for daily drinkers, 1.5 (95% CI = 1.1, 2.0) for those drinking five or more drinks per occasion, and 1.4 (95% CI = 1.1, 1.7) for heavier drinkers. Conclusions. Daily drinking, binge drinking, and heavier drinking were each associated with an increased likelihood of injury as the underlying cause of death. Persons who were young male, Native American, or divorced or separated were more likely to drink frequently and heavily. Handle: RePEc:aph:ajpbhl:1994:84:9:1402-1406_9 Template-Type: ReDIF-Article 1.0 Title: Lumbar spine surgery and mortality among Medicare beneficiaries, 1986 Journal: American Journal of Public Health Author-Name: Oldridge, N.B. Author-Name: Yuan, Z. Author-Name: Stoll, J.E. Author-Name: Rimm, A.R. Year: 1994 Volume: 84 Issue: 8 Pages: 1292-1298 Abstract: Objectives. The purpose of this study was to compare lumbar spine surgical procedures by age, gender, and number of comorbidities with respect to mortality in patients 65 years of age and older in the United States. Methods. A 100% sample of the 1986 Medicare inpatient Health Care Financing Administration claims files databases involving lumbar spine surgical procedures was analyzed. Results. Lumbar spine surgery in 34 418 patients (median age = 71 years) was associated with a significant increase in in- hospital and 1-year cumulative mortality only beyond 80 years of age. When adjusted for age, in-hospital and 1-year cumulative mortality with both decompression and excision procedures were significantly higher in men than in women. When adjusted for both age and gender, mortality increased significantly as the number of comorbidities increased. Conclusions. With lumbar spine surgery in elderly patients, mortality did not significantly increase until 80 years of age and was consistently associated with decompression and excision, with male gender, and with an increase in number of comorbidities. Handle: RePEc:aph:ajpbhl:1994:84:8:1292-1298_1 Template-Type: ReDIF-Article 1.0 Title: Sociodemographic and health factors in driving patterns after 50 years of age Journal: American Journal of Public Health Author-Name: Kington, R. Author-Name: Reuben, D. Author-Name: Rogowski, J. Author-Name: Lillard, L. Year: 1994 Volume: 84 Issue: 8 Pages: 1327-1329 Abstract: Data from the 1990 Panel Study of Income Dynamics were used to predict, by means of logistic regression, the likelihood that people who had previously driven would continue to drive and to drive after dark after 50 years of age. The results support the conclusion that driving patterns appear to be explained partly by a combination of sociodemographic factors and health status. Furthermore, it is shown that those reported to drive for nondrivers appear to be the same individuals known to provide most informal support for functionally impaired elderly people. Handle: RePEc:aph:ajpbhl:1994:84:8:1327-1329_0 Template-Type: ReDIF-Article 1.0 Title: Factors that influence clinicians' assessment and management of family violence Journal: American Journal of Public Health Author-Name: Tilden, V.P. Author-Name: Schmidt, T.A. Author-Name: Limandri, B.J. Author-Name: Chiodo, G.T. Author-Name: Garland, M.J. Author-Name: Loveless, P.A. Year: 1994 Volume: 84 Issue: 4 Pages: 628-633 Abstract: Objectives. High rates of family violence and low rates of detection, report, and therapeutic intervention by health professionals are well documented. This study was undertaken to determine what factors influence clinicians' decision making about identifying abuse and intervening with victims. Methods. Survey data about clinicians' experiences with and attitudes toward family violence were gathered by mailed questionnaire from a random sample of practicing clinicians in six disciplines (n = 1521). Results. Data showed similarities within and wide differences among three groups of subjects: dentists/dental hygienists, nurses/physicians, and psychologists/social workers. Overall, a third of subjects reported having received no educational content on child, spouse, or elder abuse in their professional training programs. Subjects with education on the topic more commonly suspected abuse in their patients than those without; among all subjects, spouse abuse was suspected more often than child abuse while elder abuse was suspected infrequently. Significant numbers of subjects did not view themselves as responsible for dealing with problems of family violence. Subjects indicated low confidence in and low compliance with mandatory reporting laws. Conclusions. There is a need for educators to expand curricula on family violence and for legislators to reexamine mandatory reporting laws. Handle: RePEc:aph:ajpbhl:1994:84:4:628-633_8 Template-Type: ReDIF-Article 1.0 Title: Effects of a restricted work-site smoking policy on employees who smoke Journal: American Journal of Public Health Author-Name: Brigham, J. Author-Name: Gross, J. Author-Name: Stitzer, M.L. Author-Name: Felch, L.J. Year: 1994 Volume: 84 Issue: 5 Pages: 773-778 Abstract: Objectives. This study evaluated the biological and subjective consequences observed in individual smokers after implementation of a workplace smoking-restriction policy. Methods. Employees were evaluated for 4 weeks before and 4 weeks after their workplace became smoke-free (n = 34). A comparison group of smokers whose work-site smoking was unrestricted served as controls (n = 33). Daily exposure to tobacco constituents and withdrawal effects were measured. Results. Smokers at the restricted site had verified smoking reduction (mean = four cigarettes per day) and significantly reduced nicotine and carbon monoxide during the work shift. There were increases in ratings of some common withdrawal symptoms (cravings/urges, concentration difficulties, increased eating, depression). No evidence of compensatory smoking during nonwork hours was found. Overall tobacco exposure, as measured in saliva cotinine, showed a nonsignificant 15% decline. Conclusions. Workplace smoking restriction markedly altered smoking patterns (i.e., reduced daytime smoking) and reduced cotinine levels to an amount consistent with cigarette reduction. Thus, work-site smoking restriction may promote meaningful, albeit limited, reductions in tobacco exposure and consequent health risks. Handle: RePEc:aph:ajpbhl:1994:84:5:773-778_4 Template-Type: ReDIF-Article 1.0 Title: Health insurance coverage among persons with AIDS: Results from a multistate surveillance project Journal: American Journal of Public Health Author-Name: Diaz, T. Author-Name: Chu, S.Y. Author-Name: Conti, L. Author-Name: Nahlen, B.L. Author-Name: Whyte, B. Author-Name: Mokotoff, E. Author-Name: Shields, A. Author-Name: Checko, P.J. Author-Name: Herr, M. Author-Name: Mukhtar, Q. Author-Name: Rietmeijer, C.A. Author-Name: Levy, A. Author-Name: Hermann, P. Author-Name: Buehler, J.W. Year: 1994 Volume: 84 Issue: 6 Pages: 1015-1018 Abstract: To determine factors associated with health insurance coverage among persons with acquired immunodeficiency syndrome (AIDS), we interviewed 1958 persons 18 years of age or older who were reported to have AIDS in 11 states and cities. Overall, 25% had no insurance, 55% had public insurance, and 20% had private insurance. Factors associated with lack of insurance varied by current employment status. Employed persons with an annual household income of less than $10 000 were 3.6 times more likely to lack insurance than employed persons with a higher income. Unemployed persons diagnosed with AIDS for less than 1 year were two times more likely to lack health insurance than unemployed persons diagnosed for a longer time. Making insurance available to persons identified as most likely to lack insurance should improve access to care for persons with AIDS. Handle: RePEc:aph:ajpbhl:1994:84:6:1015-1018_6 Template-Type: ReDIF-Article 1.0 Title: Porches, politics, and public health Journal: American Journal of Public Health Author-Name: Smith, D.R. Year: 1994 Volume: 84 Issue: 5 Pages: 725-726 Handle: RePEc:aph:ajpbhl:1994:84:5:725-726_0 Template-Type: ReDIF-Article 1.0 Title: A 6-year follow-up of behavior and activity disorders in the Taiwan Yu- cheng children Journal: American Journal of Public Health Author-Name: Chen, Y.-C.J. Author-Name: Yu, M.-L.M. Author-Name: Rogan, W.J. Author-Name: Gladen, B.C. Author-Name: Hsu, C.-C. Year: 1994 Volume: 84 Issue: 3 Pages: 415-421 Abstract: Objectives. The relationship of behavior and activity levels to the interval between outbreak and year of birth and to age of the children is explored in Taiwanese children exposed in utero to heat-degraded polychlorinated biphenyls (PCBs)-the Yu-cheng children. Additionally, the relationship of the scores to chemical, physical, and cognitive findings is described. Methods. With Rutter's Child Behavior Scale A and a modified Werry-Weiss-Peters Activity Scale, 118 Yu-cheng children and matched controls were followed biannually from 1985 to 1991. Results. At each year, the Yu- cheng children scored 7% to 43% worse (mean = 23%) than control children on the Rutter scale. At any fixed age, the Yu-cheng children scored 11% to 63% (mean = 28%) worse. The effect for children born later did not differ from that for those born earlier; neither was there any improvement as the children aged. A similar but weaker picture was seen for the activity score. These behavioral findings were not related to physical or cognitive findings or to serum PCB levels. Conclusions. In utero exposure to heat-degraded PCBs appears to cause mildly disordered behavior and increased activity level; the effect persists over time and is similar in children born up to 6 years after the mothers were exposed. Handle: RePEc:aph:ajpbhl:1994:84:3:415-421_5 Template-Type: ReDIF-Article 1.0 Title: The trading of sex for drugs or money and HIV seropositivity among female intravenous drug users Journal: American Journal of Public Health Author-Name: Astemborski, J. Author-Name: Vlahov, D. Author-Name: Warren, D. Author-Name: Solomon, L. Author-Name: Nelson, K.E. Year: 1994 Volume: 84 Issue: 3 Pages: 382-387 Abstract: Objectives. Data from 538 women in a cohort study recruited in 1988-1989 were analyzed to determine whether trading sex for drugs or money was independently associated with human immunodeficiency virus (HIV) seroprevalence in a population of female intravenous drug users. Methods. The women were grouped according to the number of partners with whom they reported trading sex for drugs or money during the previous 10 years: none, 1 through 49 (low), or 50 or more (high); the prevalence of HIV seropositivity in the three groups was 23.2%, 23.7%, and 47.6%, respectively. Logistic regression was used to compare the low- and high-trade groups separately with the group that reported no trading. Results. Low trading was not associated with seroprevalent HIV infection. In a multivariate model, high trading (compared with no trading) was significantly associated with HIV seropositivity after adjustment for cocaine use, history of sexually transmitted diseases, and duration of intravenous drug use. Conclusions. These data indicate that, among intravenous drug-using women, high levels of trading sex for drugs or money were independently associated with HIV infection. This group needs to be targeted for further intensive intervention. Handle: RePEc:aph:ajpbhl:1994:84:3:382-387_6 Template-Type: ReDIF-Article 1.0 Title: The danger of applying uniform clinical policies across populations: The case of breast cancer in American Indians Journal: American Journal of Public Health Author-Name: Nutting, P.A. Author-Name: Calonge, B.N. Author-Name: Iverson, D.C. Author-Name: Green, L.A. Year: 1994 Volume: 84 Issue: 10 Pages: 1631-1636 Abstract: Objectives. This study examined the implications of annual screening mammography for cost and mortality in American Indian populations with differing baseline breast cancer rates. Methods. A decision tree compared annual screening mammography and screening clinical breast examination with referral for diagnostic mammography when appropriate. The decision tree was constructed to examine the effect of different baseline cancer rates, stage at diagnosis, and stage-specific survival. Outcomes included 5-year relative survival, deaths prevented at 5 years, cost per death prevented, and total costs. Results. The findings suggest that the total cost of breast cancer is 3.6 times higher with the screening mammography program but results in a 27.9% reduction in breast cancer deaths over the first 5 years of the program. Both costs and deaths prevented are sensitive to the incidence of breast cancer in the population and are less favorable in the range of incidence seen in American Indians. Conclusions. The cost and impact of a given strategy for cancer screening vary among communities with different disease incidence, stage at diagnosis, and stage-specific survival, as seen in American Indian populations. Handle: RePEc:aph:ajpbhl:1994:84:10:1631-1636_2 Template-Type: ReDIF-Article 1.0 Title: Should single-payer advocates support President Clinton's proposal for health care reform? Journal: American Journal of Public Health Author-Name: Brown, E.R. Year: 1994 Volume: 84 Issue: 2 Pages: 182-185 Handle: RePEc:aph:ajpbhl:1994:84:2:182-185_8 Template-Type: ReDIF-Article 1.0 Title: The call for change in breast cancer screening guidelines. Journal: American Journal of Public Health Author-Name: Shapiro, S. Year: 1994 Volume: 84 Issue: 1 Pages: 10-11 Handle: RePEc:aph:ajpbhl:1994:84:1:10-11_5 Template-Type: ReDIF-Article 1.0 Title: Substance use and HIV-related sexual behaviors among US high school students: Are they related? Journal: American Journal of Public Health Author-Name: Lowry, R. Author-Name: Holtzman, D. Author-Name: Truman, B.I. Author-Name: Kann, L. Author-Name: Collins, J.L. Author-Name: Kolbe, L.J. Year: 1994 Volume: 84 Issue: 7 Pages: 1116-1120 Abstract: Objectives. This study was undertaken to examine whether use of alcohol, cigarettes, marijuana, cocaine, and other illicit drugs is related to the likelihood of sexual behaviors that increase risk for human immunodeficiency virus (HIV) infection among youth. Methods. The 1990 national Youth Risk Behavior Survey was used to collect self-reported information about a broad range of health risk behaviors from a representative sample of 11 631 high school students in the United States. Results. Students who reported no substance use were least likely to report having had sexual intercourse, having had four or more sex partners, and not having used a condom at last sexual intercourse. Adjusted for age, sex, and race/ethnicity, odds ratios for each of these sexual risk behaviors were greatest among students who had used marijuana, cocaine, or other illicit drugs. Students who had used only alcohol or cigarettes had smaller but still significant increases in the likelihood of having had sexual intercourse and of having had four or more sex partners. Conclusions. HIV prevention programs for youth should recognize that substance use may be an important indicator of risk for HIV infection and acquired immunodeficiency syndrome through its association with unsafe sexual behaviors. Handle: RePEc:aph:ajpbhl:1994:84:7:1116-1120_4 Template-Type: ReDIF-Article 1.0 Title: The logic in ecological: II. The logic of design Journal: American Journal of Public Health Author-Name: Susser, M. Year: 1994 Volume: 84 Issue: 5 Pages: 830-835 Abstract: The utility of ecological studies is considered in terms of the salience of their designs and is exemplified in four levels: obligate and apt; optional and apt; optional, not apt but convenient; and maladroit (neither obligate, apt, nor justifiable by convenience). Ecological studies are obligate when they are the only choice available, either because of the question asked (as in testing differences between groups and discovering group effects), or where there are 'dependent happenings' (as in transactions involving more than one individual), or because individual data are lacking. Apt studies are logically appropriate; analysis and results are not extrapolated beyond necessity or without precautions. Obligate studies enforced by lack of individual data may be apt or less than apt. Optional ecological studies may be apt or, if less than apt, they may yet be convenient. Maladroit studies are neither obligate, apt, nor convenient. Each class of study is illustrated by examples ordered according to a standard design hierarchy. Handle: RePEc:aph:ajpbhl:1994:84:5:830-835_7 Template-Type: ReDIF-Article 1.0 Title: Mass media and school interventions for cigarette smoking prevention: Effects 2 years after completion Journal: American Journal of Public Health Author-Name: Flynn, B.S. Author-Name: Worden, J.K. Author-Name: Secker-Walker, R.H. Author-Name: Pirie, P.L. Author-Name: Badger, G.J. Author-Name: Carpenter, J.H. Author-Name: Geller, B.M. Year: 1994 Volume: 84 Issue: 7 Pages: 1148-1150 Abstract: The long-term cigarette smoking prevention effects of mass media and school interventions were assessed. Adolescents in two communities received both mass media and school interventions; those in two matching communities received only school interventions. Surveys of 5458 students were conducted at baseline in grades 4 through 6 and 2 years after the 4-year interventions were completed, when students were in grades 10 through 12. Students exposed to the media-plus-school interventions were found to be at lower risk for weekly smoking (odds ratio = 0.62, 95% confidence interval = 0.49, 0.78) than those receiving school interventions only, indicating that the effects of the combined interventions persisted 2 years after the interventions' completion. Handle: RePEc:aph:ajpbhl:1994:84:7:1148-1150_0 Template-Type: ReDIF-Article 1.0 Title: Risk behavior and correlates of risk for HIV infection in the Dallas County household HIV survey Journal: American Journal of Public Health Author-Name: McQuillan, G.M. Author-Name: Ezzati-Rice, T.M. Author-Name: Siller, A.B. Author-Name: Visscher, W. Author-Name: Hurley, P. Year: 1994 Volume: 84 Issue: 5 Pages: 747-753 Abstract: Objectives. The Dallas County study of a proposed national household seroprevalence survey was designed to assess the feasibility of conducting a national survey and to estimate the prevalence of human immunodeficiency virus (HIV) and hepatitis B virus infection for Dallas County. Risk behavior data were collected and correlated with HIV infection. Methods. Participants in this survey represented a probability sample of the county. A self- administered questionnaire on demographic characteristics and HIV risk behavior was completed and a blood sample was obtained. Results. Of the 1724 adults eligible for the survey, 1446 completed the questionnaire and 1374 provided a blood sample. The prevalence estimates were 0.4% for HIV and 7.3% for hepatitis B virus. A strong relationship was observed between HIV and hepatitis B status and risk behavior. Conclusions. In this study population, receptive anal intercourse and increasing numbers of male partners had the strongest correlation with the prevalence of HIV and hepatitis B virus infection in men. The high level of risk reporting for individuals positive for HIV or hepatitis B suggests that survey participants who engage in risk behaviors were willing to report those behaviors. Handle: RePEc:aph:ajpbhl:1994:84:5:747-753_0 Template-Type: ReDIF-Article 1.0 Title: Self-reported physical activity in a rural county: A New York county health census Journal: American Journal of Public Health Author-Name: Eaton, C.B. Author-Name: Nafziger, A.N. Author-Name: Strogatz, D.S. Author-Name: Pearson, T.A. Year: 1994 Volume: 84 Issue: 1 Pages: 29-32 Abstract: Objectives. Few studies have described physical activity in rural populations. This study describes the frequency, types, and correlates of physical activity in 29 304 free-living adults in a rural county in New York State. Methods. Self-reported responses about regular physical activity (maintained long enough to work up a sweat) were analyzed from a private household census of Otsego County with an 86.6% response rate. Results. This survey categorized 46.2% of county residents as sedentary. Walking, the most frequent choice of activity (62% of the women, 36% of the men), increased in frequency with age of respondents whereas cycling, jogging, aerobics, team sports, and swimming (listed in rank order of frequency) generally tended to decrease in frequency with age. Farmers demonstrated an increased amount of 'sweat activity' compared with persons in most other occupations. Conclusions. This descriptive study of physical activity in a rural county shows that sedentary lifestyle is of high prevalence. The high frequency of walking and the gender differences in both the levels and choice of activity suggest that further research and public policy recommendations focus on these issues. Handle: RePEc:aph:ajpbhl:1994:84:1:29-32_1 Template-Type: ReDIF-Article 1.0 Title: Low-income neighborhoods and the risk of severe pediatric injury: A small- area analysis in Northern Manhattan Journal: American Journal of Public Health Author-Name: Durkin, M.S. Author-Name: Davidson, L.L. Author-Name: Kuhn, L. Author-Name: O'Connor, P. Author-Name: Barlow, B. Year: 1994 Volume: 84 Issue: 4 Pages: 587-592 Abstract: Objectives. The purpose of this study was to investigate the relationship between socioeconomic disadvantage and the incidence of severe childhood injury. Methods. Small-area analysis was used to examine socioeconomic risk factors for pediatric injury resulting in hospitalization or death in Northern Manhattan, New York, NY, during a 9-year period (1983 through 1991). Results. The average annual incidence of all causes of severe pediatric injury was 72.5 per 10 000 children; the case-fatality rate was 2.6%. Census tract proportions of low-income households, single-parent families, non-high school graduates, and unemployment were significant predictors of risk for both unintentional and intentional injury. Among the socioeconomic factors considered, low income was the single most important predictor of all injuries; other socioeconomic variables were not independent contributors once income was included in the model. Compared with children living in areas with few low-income households, children in areas with predominantly low- income households were more than twice as likely to receive injuries from all causes and four and one half times as likely to receive assault injuries. The effect of neighborhood income disparities on injury risk persisted after race was controlled. Conclusions. These results illuminate the impact of socioeconomic disparities on child health and point to the need for injury prevention efforts targeting low-income neighborhoods. Handle: RePEc:aph:ajpbhl:1994:84:4:587-592_8 Template-Type: ReDIF-Article 1.0 Title: Gynecologists' sex, clinical beliefs, and hysterectomy rates Journal: American Journal of Public Health Author-Name: Bickell, N.A. Author-Name: Earp, J.A. Author-Name: Garrett, J.M. Author-Name: Evans, A.T. Year: 1994 Volume: 84 Issue: 10 Pages: 1649-1652 Abstract: This study determined how gynecologists' sex, beliefs, appropriateness ratings, and practice characteristics influence hysterectomy rates in North Carolina. Gynecologists who performed hysterectomies at higher rates were further from training, practiced in areas with fewer gynecologists, and had more patients with abnormal bleeding or cancer. Male gynecologists performed 60% more hysterectomies than female gynecologists, but this may have been because they were further from their training. Appropriateness ratings were affected by gynecologists' attitudes toward surgery, recency of training, and practice case mix, and by patients' expressed desire to avoid surgery, but they did not predict hysterectomy rates. To decrease their chances of undergoing hysterectomy, patients should express their preferences and possibly seek the opinion of more recently trained gynecologists. Handle: RePEc:aph:ajpbhl:1994:84:10:1649-1652_3 Template-Type: ReDIF-Article 1.0 Title: Estimates of population smoking prevalence: Self-vs proxy reports of smoking status Journal: American Journal of Public Health Author-Name: Gilpin, E.A. Author-Name: Pierce, J.P. Author-Name: Cavin, S.W. Author-Name: Berry, C.C. Author-Name: Evans, N.J. Author-Name: Johnson, M. Author-Name: Bal, D.G. Year: 1994 Volume: 84 Issue: 10 Pages: 1576-1579 Abstract: Objectives. In the face of rising costs of surveillance systems, it is time to reexamine the feasibility of including proxy respondents in surveys designed to provide population estimates of smoking prevalence. Methods. Data are from the California Tobacco Surveys, which are random-digit dialed telephone surveys. One adult provided demographic information and smoking status for all household residents. Additionally, some adults were selected for in-depth interviews that also included smoking status questions. We matched information from proxy respondents and self-respondents and evaluated smoking status discrepancies between them relative to demographic and other factors (n = 2930 matched pairs) in 1992. We address the potential bias these discrepancies might introduce into the population estimate of smoking prevalence. Results. Overall, the discrepancy between proxy report and self- report was 4.3%, and it increased particularly when the self-respondent reported nondaily smoking or recent quitting. Discrepancies acted in both directions, and the net bias was that the screener survey overestimated smoking prevalence by 0.1% in 1992 (0.3% in 1990). Conclusions. Smoking status questions can be added to ongoing surveys such as the census or labor force surveys: one adult could provide smoking status for all household members. Handle: RePEc:aph:ajpbhl:1994:84:10:1576-1579_5 Template-Type: ReDIF-Article 1.0 Title: The provision and use of mental health services in nursing homes: Results from the National Medical Expenditure Survey Journal: American Journal of Public Health Author-Name: Smyer, M.A. Author-Name: Shea, D.G. Author-Name: Streit, A. Year: 1994 Volume: 84 Issue: 2 Pages: 284-287 Abstract: Data from the Institutional Population Component of the National Medical Expenditure Survey were used to provide national estimates of annual mental health service provision and use in nursing homes. In addition, the relationship between service provision and setting characteristics such as ownership, size, Medicaid certification, and chain status was examined. Although more than three quarters of residents with a mental disorder resided at a nursing home that provided counseling services, fewer than one fifth actually received any mental health services within the year. Handle: RePEc:aph:ajpbhl:1994:84:2:284-287_0 Template-Type: ReDIF-Article 1.0 Title: The future of public health in health care reform Journal: American Journal of Public Health Author-Name: Navarro, V. Year: 1994 Volume: 84 Issue: 5 Pages: 729-730 Handle: RePEc:aph:ajpbhl:1994:84:5:729-730_4 Template-Type: ReDIF-Article 1.0 Title: Health care reform - More than cost containment and universal access Journal: American Journal of Public Health Author-Name: Feingold, E. Year: 1994 Volume: 84 Issue: 5 Pages: 727-728 Handle: RePEc:aph:ajpbhl:1994:84:5:727-728_1 Template-Type: ReDIF-Article 1.0 Title: A national study of transitional hospital services in mental health Journal: American Journal of Public Health Author-Name: Dorwart, R.A. Author-Name: Hoover, C.W. Year: 1994 Volume: 84 Issue: 8 Pages: 1229-1234 Abstract: Objectives. Shifts in care for the seriously mentally ill from inpatient to community-based treatment have highlighted the importance of transitional care. Our objectives were to document the kinds and quantity of transitional services provided by psychiatric hospitals nationally and to assess the impact of hospital type (psychiatric vs general), ownership (public vs private), case mix, and revenue source on provision of these services. Methods. A national sample of nonfederal inpatient mental health facilities (n = 915) was surveyed in 1988, and data were analyzed by using multiple regression. Results. Half (46%) of the facilities surveyed provided patient follow-up of 1 week or less, and almost all (93%) conducted team review of discharge plans, but 74% provided no case management services. Hospital type was the most consistent predictor of transitional care, with psychiatric hospitals providing more of these services than general hospitals. Severity of illness, level of nonfederal funding, urbanicity, and teaching hospital affiliation were positively associated with provision of case management. Conclusions. Transitional care services for mentally ill patients leaving the hospital were found to be uneven and often inadequate. Reasons for broad variation in services are discussed. Handle: RePEc:aph:ajpbhl:1994:84:8:1229-1234_1 Template-Type: ReDIF-Article 1.0 Title: Cancer screening among African-American women: Their use of tests and social support Journal: American Journal of Public Health Author-Name: Soo Hyang Kang Author-Name: Bloom, J.R. Author-Name: Romano, P.S. Year: 1994 Volume: 84 Issue: 1 Pages: 101-103 Abstract: This study examined associations between social ties (as measured by the Social Network Index), instrumental and emotional support, and the use of three female cancer screening tests: mammography, cervical smear, and clinical breast examination. Data were taken from a household survey of 670 African-American women living in northern California in 1986. In multiple logistic regression models, Berkman's index was associated with increased use of mammography but not with the use of cervical smear or clinical breast examination. Instrumental and emotional support measures were not significant. These results suggest that social networks may have a role in early cancer detection. Handle: RePEc:aph:ajpbhl:1994:84:1:101-103_2 Template-Type: ReDIF-Article 1.0 Title: Job strain and health-related quality of life in a national sample Journal: American Journal of Public Health Author-Name: Lerner, D.J. Author-Name: Levine, S. Author-Name: Malspeis, S. Author-Name: D'Agostino, R.B. Year: 1994 Volume: 84 Issue: 10 Pages: 1580-1585 Abstract: Objectives. Studies of the health effects of job strain have focused on morbidity and mortality as outcomes. This is the first study to examine the relationship of job strain to more comprehensive health status measures that encompass health-related quality of life. Methods. In a national cross- sectional survey, 1319 working men and women, aged 18 through 64 years, completed a modified version of the Job Content Questionnaire that classified workers' jobs into four categories: high strain, passive, low strain, and active. Subjects also completed the Medical Outcomes Study Short-Form Health Survey and a health distress scale. Logistic regression analyses were employed that controlled for age, race/ethnicity, gender, and education. Both work and nonwork variables were included. Results. Job strain was significantly associated with five of nine components of health-related quality of life: physical functioning, role functioning related to physical health, vitality, social functioning, and mental health. Job strain made a modest yet statistically significant contribution beyond the effects of chronic illness and psychosocial variables. Conclusions. The results provide justification for further investigating the role of job strain as an independent risk factor for health-related quality of life. Handle: RePEc:aph:ajpbhl:1994:84:10:1580-1585_1 Template-Type: ReDIF-Article 1.0 Title: The fallacy of the ecological fallacy: The potential misuse of a concept and the consequences Journal: American Journal of Public Health Author-Name: Schwartz, S. Year: 1994 Volume: 84 Issue: 5 Pages: 819-824 Abstract: Ecological studies have been evaluated in epidemiological contexts in terms of the 'ecological fallacy.' Although the empirical evidence for a lack of comparability between correlations derived from ecological- and individual-level analyses is compelling, the conceptual meaning of the ecological fallacy remains problematic. This paper argues that issues in cross-level inference can be usefully conceptualized as validity problems, problems not peculiar to ecological-level analyses. Such an approach increases the recognition of both potential inference problems in individual- level studies and the unique contributions of ecological variables. This, in turn, expands the terrain for the location of causes for disease and interventions to improve the public's health. Handle: RePEc:aph:ajpbhl:1994:84:5:819-824_5 Template-Type: ReDIF-Article 1.0 Title: Mother-daughter correlations of obesity and cardiovascular disease risk factors in Black and White households: The NHLBI Growth and Health Study Journal: American Journal of Public Health Author-Name: Morrison, J.A. Author-Name: Payne, G. Author-Name: Barton, B.A. Author-Name: Khoury, P.R. Author-Name: Crawford, P. Year: 1994 Volume: 84 Issue: 11 Pages: 1761-1767 Abstract: Objectives. This study sought to evaluate obesity as a potential explanatory factor for the increased relative risk for cardiovascular disease in Black compared with White women. Methods. Familial associations for obesity and cardiovascular disease risk factors were assessed in 720 White and 580 Black mother-daughter pairs from the National Heart, Lung, and Blood Institute's Growth and Health Study by using Pearson's chi square, Spearman's correlations, and partial correlations. Results. Black girls and mothers were significantly heavier and had higher body mass indices than their White counterparts. In each racial group, significant, positive mother-daughter correlations existed for weight, body mass index, and triceps skinfolds, and for all cardiovascular disease risk factors. Obesity measures correlated positively with systolic blood pressure and triglycerides and inversely with high-density lipoprotein cholesterol in girls and mothers of both races. Correlations between mothers and daughters for exercise and ideal body shape were weak and did not explain obesity associations. Conclusions. Intrafamilial associations of obesity, cardiovascular disease risk factors, and the obesity-cardiovascular disease risk factor relationship support the position that increased cardiovascular disease morbidity and mortality rates in Black women may be linked to excess obesity in Black women compared with White ones. Handle: RePEc:aph:ajpbhl:1994:84:11:1761-1767_8 Template-Type: ReDIF-Article 1.0 Title: Using census and mortality data to target small areas for breast, colorectal, and cervical cancer screening Journal: American Journal of Public Health Author-Name: Andrews, H.F. Author-Name: Kerner, J.F. Author-Name: Zauber, A.G. Author-Name: Mandelblatt, J. Author-Name: Pittman, J. Author-Name: Struening, E. Year: 1994 Volume: 84 Issue: 1 Pages: 56-61 Abstract: Objectives. The goal of this study was to develop and validate quantitative models for estimating cancer incidence in small areas. Methods. The outcome for each cancer site was the incidence of disease that had reached a late stage at the time of diagnosis. Two sets of predictors were used: (1) census-based demographic variables and (2) census-based demographic variables together with the cancer-specific mortality rate. Results. The best models accounted for a substantial percentage of between-area variability in late-stage rates for cancer of the breast (46%), cervix (61%), and colon/rectum (58%). A validation procedure indicated that correct identification of small areas with high rates of late-stage disease was two to three times more likely when model-based estimates were used than when areas were selected at random. Conclusions. Additional testing is needed to establish the generality of the geographic targeting methodology developed in this paper. However, there are strong indications that small-area estimation models will be useful in many regions where planners wish to target cancer screening programs on a geographic basis. Handle: RePEc:aph:ajpbhl:1994:84:1:56-61_4 Template-Type: ReDIF-Article 1.0 Title: The driver's license list as a population-based sampling frame in Iowa Journal: American Journal of Public Health Author-Name: Lynch, C.F. Author-Name: Logsden-Sackett, N. Author-Name: Edwards, S.L. Author-Name: Cantor, K.P. Year: 1994 Volume: 84 Issue: 3 Pages: 469-472 Abstract: Driver's license lists are infrequently used for population-based sampling, presumably, because of suspicions of poor population coverage. The 1990 Iowa driver's license list was compared with the 1990 census to evaluate coverage by 5-year age group, sex, resident county, and urbanicity. Coverage exceeded 90% among 15- to 74-year-old men and 15- to 64-year-old women, with uniform coverage by county and county urbanicity group in these age ranges. In Iowa, these lists are convenient and cost-effective and appear to be representative for 25- to 64-year-olds. The representativeness of driver lists in regard to other factors and in other geographic regions deserves further evaluation. Handle: RePEc:aph:ajpbhl:1994:84:3:469-472_2 Template-Type: ReDIF-Article 1.0 Title: Counseling adolescents for smoking prevention: A survey of primary care physicians and dentists Journal: American Journal of Public Health Author-Name: Gregorio, D.I. Year: 1994 Volume: 84 Issue: 7 Pages: 1151-1153 Abstract: Pediatricians, family practitioners, and dentists were questioned in the spring of 1992 about whether they counseled adolescent patients (10 through 18 years old) not to smoke. Of the 674 questionnaires distributed, 443 (66%) were returned and analyzed. Most practitioners could not estimate cigarette use among their adolescent patients. Prevention counseling occurred infrequently, and least often among younger patients. Physicians were more likely than dentists to counsel adolescents. The data highlight the need for continuing training of primary health care practitioners about the importance of counseling adolescents not to smoke. Handle: RePEc:aph:ajpbhl:1994:84:7:1151-1153_3 Template-Type: ReDIF-Article 1.0 Title: Black-White differences in serum cotinine levels among pregnant women and subsequent effects on infant birthweight Journal: American Journal of Public Health Author-Name: English, P.B. Author-Name: Eskenazi, B. Author-Name: Christianson, R.E. Year: 1994 Volume: 84 Issue: 9 Pages: 1439-1443 Abstract: Objectives. Higher levels of serum cotinine (a metabolite of nicotine) have been found in Black smokers than in White smokers even after self- reported cigarette dose was controlled. It is unknown whether higher cotinine levels in Black pregnant smokers may increase the risk of delivering an infant of reduced birthweight. Methods. We analyzed serum cotinine levels of 374 Black and 829 White women who smoked during pregnancy and who delivered between April 1964 and April 1967. Racial differences in the relationship between cotinine and birthweight were examined. Results. Cotinine levels were 27.4 ng/mL higher in Black smokers after cigarette dose and confounding variables were controlled. Blacks had higher cotinine levels than Whites at each dose. No significant racial differences in the rate of decrease in birthweight per nanogram of cotinine per milliliter were found. Conclusions. Our results confirm previous research showing higher cotinine levels at each smoking dose in Black smokers than in White smokers. Because there was no difference in the rate of decrease in birthweight due to cotinine, our results suggest that cigarette smoking among Blacks may have a greater effect on birthweight than it does among Whites. Handle: RePEc:aph:ajpbhl:1994:84:9:1439-1443_9 Template-Type: ReDIF-Article 1.0 Title: Preventing occupational illness and injury: Nurse practitioners as primary care providers Journal: American Journal of Public Health Author-Name: Lipscomb, J. Author-Name: Burgel, B. Author-Name: McGill, L.W. Author-Name: Blanc, P. Year: 1994 Volume: 84 Issue: 4 Pages: 643-645 Abstract: Nurse practitioners with master's degrees were surveyed to assess the type and volume of occupational health services provided by primary care as compared with occupational health practitioners and the knowledge base in occupational health in these two groups. Thirty-six percent of 224 nonoccupational health nurse practitioners reported caseloads with 10% or more occupationally related chief complaints; 21% reported treating work- related injury or illness at least once per week. By contrast, a large percentage of nonoccupational health practitioners failed the knowledge- based exam. Large-scale prevention of occupational illness and injury warrants that primary care providers receive training in occupational health. Handle: RePEc:aph:ajpbhl:1994:84:4:643-645_9 Template-Type: ReDIF-Article 1.0 Title: Monitoring childhood immunizations: A Canadian approach Journal: American Journal of Public Health Author-Name: Roberts, J.D. Author-Name: Poffenroth, L.A. Author-Name: Roos, L.L. Author-Name: Bebchuk, J.D. Author-Name: Carter, A.O. Year: 1994 Volume: 84 Issue: 10 Pages: 1666-1668 Abstract: In Manitoba, Canada, a centralized, computerized childhood immunization monitoring system serves a population with insured medical coverage; each individual has a unique identification number. All physicians bill a single payer, and specific billing codes are used to identify immunizations given by physicians and by public health nurses. Together with dates of service, this information is used to construct immunizations-to-date and age-at- immunization profiles for individuals and groups. Reminders seeking missing information are built into the system and executed at strategic ages. The quality of input data has been assessed as high. The approach could be used readily by health maintenance organizations in the United States. Handle: RePEc:aph:ajpbhl:1994:84:10:1666-1668_2 Template-Type: ReDIF-Article 1.0 Title: The strange career of managed competition: From military failure to medical success? Journal: American Journal of Public Health Author-Name: Waitzkin, H. Year: 1994 Volume: 84 Issue: 3 Pages: 482-489 Abstract: Managed competition remains untested as the basis of a national health program. However, key principles of managed competition first emerged in the military. For this study, published works on systems analysis and the planning-programming-budgeting system (PPBS), developed by Alain Enthoven and colleagues at the US Department of Defense during the 1960s, were compared with published presentations of managed competition. The influence of PPBS waned after it generated controversy and opposition. PPBS and managed competition represent similar managerial strategies of policy reform. Although the origin of managed competition in failed military policy does not ensure failure in the medical arena, this history also does not augur success. Handle: RePEc:aph:ajpbhl:1994:84:3:482-489_0 Template-Type: ReDIF-Article 1.0 Title: The characteristics of northern Black churches with community health outreach programs Journal: American Journal of Public Health Author-Name: Thomas, S.B. Author-Name: Quinn, S.C. Author-Name: Billingsley, A. Author-Name: Caldwell, C. Year: 1994 Volume: 84 Issue: 4 Pages: 575-579 Abstract: Objectives. The Black church has a long history of addressing unmet health and human service needs, yet few studies have examined characteristics of churches involved in health promotion. Methods. Data obtained from a survey of 635 Black churches in the northern United States were examined. Univariate and multivariate statistical procedures identified eight characteristics associated with community health outreach programs: congregation size, denomination, church age, economic class of membership, ownership of church, number of paid clergy, presence of other paid staff, and education level of the minister. Results. A logistic regression model identified church size and educational level of the minister as the strongest predictors of church- sponsored community health outreach. The model correctly classified 88% of churches that conduct outreach programs. Overall, the model correctly classified 76% of churches in the sample. Conclusions. Results may be used by public health professionals and policy makers to enlist Black churches as an integral component for delivery of health promotion and disease prevention services needed to achieve the Year 2000 health objectives for all Americans. Handle: RePEc:aph:ajpbhl:1994:84:4:575-579_4 Template-Type: ReDIF-Article 1.0 Title: Smoking and mortality among residents of a California retirement community Journal: American Journal of Public Health Author-Name: Paganini-Hill, A. Author-Name: Hsu, G. Year: 1994 Volume: 84 Issue: 6 Pages: 992-995 Abstract: Smoking cessation decreases mortality among the elderly. Participants in the Leisure World Cohort Study initiated in 1981 were followed until death or January 1, 1991. The 8869 women and 4999 men (median age = 73 years at initial survey) contributed 105 952 person-years of follow-up; 4002 had died. All-cause mortality rates were highest among current smokers; compared with never smokers the age-adjusted relative risks (and 95% confidence intervals) were 1.67 (1.46, 1.92) for women and 1.95 (1.66, 2.30) for men. Current smokers had increased risks of coronary heart disease, other cardiovascular disease, and cancer. Risk of death from smoking-related cancers continued to be high among former smokers, although lower than the risk among current smokers. Relative risks of mortality from cancer and cardiovascular disease increased with the number of cigarettes smoked per day and with a decreasing number of years since cessation of smoking. Handle: RePEc:aph:ajpbhl:1994:84:6:992-995_8 Template-Type: ReDIF-Article 1.0 Title: Consequences of the North American Free Trade Agreement for health services: A perspective from Mexico Journal: American Journal of Public Health Author-Name: Frenk, J. Author-Name: Gomez-Dantes, O. Author-Name: Cruz, C. Author-Name: Chacon, F. Author-Name: Hernandez, P. Author-Name: Freeman, P. Year: 1994 Volume: 84 Issue: 10 Pages: 1591-1597 Abstract: Objectives. The purposes of the study were to assess the potential impact of the North American Free Trade Agreement (NAFTA) on medical care in Mexico and to identify internal measures Mexico could take to increase the benefits and minimize the risks of free trade. Methods. The dual nature of the health sector is examined; the Mexican, Canadian, and US health care systems are compared; and modes and consequences of international exchange of health services are analyzed. Results. Four issues require immediate attention: accreditation of health care facilities, licensing and certification of professionals, technology assessment, and financial equity. Conclusions. NAFTA offers opportunities for positive developments in Mexico, provided risks can be anticipated and preventive measures can be taken to avoid negative impacts on the health system. Medical services, like other elements of the Mexican economy, must be modernized to respond to the demands of global competition. The Mexican National Academy of Medicine has recommended to the Mexican government: (1) internal strengthening of the Mexican health care system to improve its ability to respond to the new conditions created by NAFTA and (2) a gradual process to facilitate equitable and mutually beneficial interactions among the three countries. Handle: RePEc:aph:ajpbhl:1994:84:10:1591-1597_1 Template-Type: ReDIF-Article 1.0 Title: Injecting risk behavior among drug users in Amsterdam, 1986 to 1992, and its relationship to AIDS prevention programs Journal: American Journal of Public Health Author-Name: Van Ameijden, E.J.C. Author-Name: Van den Hoek, A.A.R. Author-Name: Coutinho, R.A. Year: 1994 Volume: 84 Issue: 2 Pages: 275-281 Abstract: Objectives. Serial, cross-sectional trends in injecting risk behavior were studied among drug users from 1986 to 1992. Methods. From a cohort study in Amsterdam, 616 intake visits of drug users who had injected in the 6 months preceding intake were selected. Results. The proportion of drug users who reported borrowing and lending used injection equipment and reusing needles/syringes (in the previous 6 months), continuously declined from 51% to 20%, from 46% to 10% and from 63% to 39%, respectively. In multivariate analysis, it appeared unlikely that a selective recruitment of participants over time was responsible for these trends. Participants, recruited later in time, had been previously tested for human immunodeficiency virus (HIV) more often, had received daily methadone less often, and had obtained a higher proportion of new needles via exchange programs. Indications were found that (1) voluntary HIV testing and counseling leads to less borrowing, lending, and reusing equipment; and (2) obtaining needles via exchange programs leads to less reusing needles/syringes. It appeared that nonattenders of methadone and exchange programs have reduced borrowing and lending to the same extent as attenders. Conclusions. Methodologically, evaluating specific measures is difficult. However, the combination of various preventive measures in Amsterdam is likely to be responsible for the observed decrease in injecting risk behavior. Handle: RePEc:aph:ajpbhl:1994:84:2:275-281_1 Template-Type: ReDIF-Article 1.0 Title: Infant feeding policies in maternity wards and their effect on breast- feeding success: An analytical overview Journal: American Journal of Public Health Author-Name: Perez-Escamilla, R. Author-Name: Pollitt, E. Author-Name: Lonnerdal, B. Author-Name: Dewey, K.G. Year: 1994 Volume: 84 Issue: 1 Pages: 89-97 Abstract: Objectives. The purpose of this review is to examine the plausibility of a causal relationship between maternity ward practices and lactation success. Methods. Studies were located with MEDLINE, from our personal files, and by contacting researchers working in this field. Of the 65 studies originally reviewed, 18 met our inclusion criteria (i.e., hospital-based intervention, experimental design with randomization procedures, or quasi-experimental design with adequate documentation). Results. Meta-analysis indicated that commercial discharge packs had an adverse effect on lactation performance. The impact of early mother-infant contact on lactation success was unclear. Rooming-in and breast-feeding guidance in a rooming-in context had a beneficial impact on breast-feeding among primiparae. Breast-feeding on demand was positively associated with lactation success. In-hospital formula supplementation of 48 mL per day was not associated with poor breast-feeding performance. Conclusions. Hospital-based breast-feeding interventions can have a beneficial effect on lactation success, particularly among primiparous women. Handle: RePEc:aph:ajpbhl:1994:84:1:89-97_3 Template-Type: ReDIF-Article 1.0 Title: Changes in positions of authority held by US physicians: A fresh look at existing data Journal: American Journal of Public Health Author-Name: Osberg, J.S. Year: 1994 Volume: 84 Issue: 10 Pages: 1573-1575 Abstract: Some experts contend that physicians have lost positions of authority in the past 40 years. Others argue the opposite, yet neither side bases its arguments on empirical data. This study examined longitudinal variables measuring authority positions held by physicians. Data on the relative position of physicians in medical schools show that medical doctors held 65.6% of the sampled positions in 1970 vs 72.8% in 1990. Yet, in the wider society and within the nonmedical school portion of the health sector, other data indicate that physicians occupy a smaller proportion of authority positions. Handle: RePEc:aph:ajpbhl:1994:84:10:1573-1575_8 Template-Type: ReDIF-Article 1.0 Title: The use of mammography vans by low-income women: The accuracy of self- reports Journal: American Journal of Public Health Author-Name: Etzi, S. Author-Name: Lane, D.S. Author-Name: Grimson, R. Year: 1994 Volume: 84 Issue: 1 Pages: 107-109 Abstract: The objective of this study was to determine the accuracy of self-reports of mammography use by low-income women. Mammography van records were used to verify self-reports of mammography use in the past year by women aged 50 through 75 years who had visited five community health centers (n = 237). Van records verified mammography use for 99% of these women (82% within the previous year and 98% within the past 2 years). Forty percent of those with van records who reported both the month and year of the mammogram were accurate. Inaccurately reported dates were more frequently after (74%) rather than before (26%) the actual date. These findings indicate that self-reports of mammography use by low-income women are generally reliable. Handle: RePEc:aph:ajpbhl:1994:84:1:107-109_0 Template-Type: ReDIF-Article 1.0 Title: The accessibility of drug treatment for pregnant women: A survey of programs in five cities Journal: American Journal of Public Health Author-Name: Breitbart, V. Author-Name: Chavkin, W. Author-Name: Wise, P.H. Year: 1994 Volume: 84 Issue: 10 Pages: 1658-1661 Abstract: Through simulated calls to 294 drug treatment programs in five cities, this study investigated access for pregnant women and compared New York City's provision of services in 1989 to that in 1993. In all sites, the majority of programs accepted pregnant women. There was also a marked improvement in the availability of services in New York City. Yet options were more limited for Medicaid recipients and women needing child care, and an appointment of referral for prenatal care was usually not offered. Although the door for treatment may be opening for pregnant women, institutional barriers still remain. Handle: RePEc:aph:ajpbhl:1994:84:10:1658-1661_8 Template-Type: ReDIF-Article 1.0 Title: High temporal, geographic, and income variation in body mass index among adults in Brazil Journal: American Journal of Public Health Author-Name: Sichieri, R. Author-Name: Coitinho, D.C. Author-Name: Leao, M.M. Author-Name: Recine, E. Author-Name: Everhart, J.E. Year: 1994 Volume: 84 Issue: 5 Pages: 793-798 Abstract: Objectives. Population-based data on body mass index for developing countries are scarce. Body mass index data from two Brazilian surveys were examined to determine regional and temporal variations in the prevalences of underweight, overweight, and obesity. Methods. Nationwide surveys in 1974/75 and 1989 collected anthropometric data in Brazil from 55 000 and 14 455 households, respectively. Trained interviewers used the same methods to measure weight and stature in both surveys, and survey designs were identical. Prevalences of underweight, overweight, and obesity were determined for persons 18 years of age and older. Results. In the 1989 survey, body mass index varied greatly according to region of the country, urbanization, and income. In the wealthier South, the prevalence of overweight/obesity was the highest and the prevalence of underweight was the lowest; in the poorer rural Northeast, these patterns were reversed. For both surveys, overweight/obesity was more common among women than among men and peaked at age 45 to 64 years in both sexes. Over the 15 years between surveys, the prevalence of both overweight and obesity increased strikingly. Conclusions. In contrast to findings in developed countries, obesity in Brazil was positively associated with income and was much more prevalent among women than among men. For Brazilian women, the overall prevalence of overweight was nearly as high as that among women in the United States. Handle: RePEc:aph:ajpbhl:1994:84:5:793-798_8 Template-Type: ReDIF-Article 1.0 Title: Primary care and emergency department overcrowding. 1. Achieving proportionate representation in samples. Journal: American Journal of Public Health Author-Name: Ullman, R. Author-Name: Stratmann, W.C. Year: 1994 Volume: 84 Issue: 1 Pages: 123 Handle: RePEc:aph:ajpbhl:1994:84:1:123_1 Template-Type: ReDIF-Article 1.0 Title: Targeting cancer control: The State Cancer Control Map and Data Program Journal: American Journal of Public Health Author-Name: Pommerenke, F.A. Author-Name: Miller, R.W. Author-Name: Srivastava, S. Author-Name: Ackermann, S.P. Year: 1994 Volume: 84 Issue: 9 Pages: 1479-1482 Abstract: The State Cancer Control Map and Data Program (National Technical Information Service, Springfield, Va) allows state and county mortality maps and data tables to be tailored according to the user's choice of cancer site, age, gender, race, county, and time period between 1953 and 1987. Counties and subpopulations within these maps and data tables that are identified as having exceptionally high rates of specific cancers can then be targeted for early detection or primary prevention. These maps and data tables provide a means for focusing state, local, and individual efforts to reduce cancer mortality in appropriate populations in areas with high mortality rates. Handle: RePEc:aph:ajpbhl:1994:84:9:1479-1482_8 Template-Type: ReDIF-Article 1.0 Title: Promoting mammography use through progressive interventions: Is it effective? Journal: American Journal of Public Health Author-Name: King, E.S. Author-Name: Rimer, B.K. Author-Name: Seay, J. Author-Name: Balshem, A. Author-Name: Engstrom, P.F. Year: 1994 Volume: 84 Issue: 1 Pages: 104-106 Abstract: This study evaluated interventions implemented with women in a health maintenance organization who had not utilized their annual free mammogram referral 45 days (step 2) and 95 days (step 3) after its mailing. The step 2 evaluation compared mammography utilization for women randomly assigned to receive a brief reminder letter or no reminder: 42% of the reminder group vs 28% of the control group obtained mammograms. The step 3 evaluation compared utilization for women randomly assigned to receive a second reminder, a letter suggesting a preventive office visit, or telephone counseling: 29% of those who received telephone counseling, 14% of those who received a letter, and 12% of those who received a second reminder obtained mammograms. Handle: RePEc:aph:ajpbhl:1994:84:1:104-106_8 Template-Type: ReDIF-Article 1.0 Title: Is breast-feeding in infancy associated with adult longevity? Journal: American Journal of Public Health Author-Name: Wingard, D.L. Author-Name: Criqui, M.H. Author-Name: Edelstein, S.L. Author-Name: Tucker, J. Author-Name: Tomlinson-Keasey, C. Author-Name: Schwartz, J.E. Author-Name: Friedman, H.S. Year: 1994 Volume: 84 Issue: 9 Pages: 1458-1462 Abstract: Objectives. The purpose of the study was to determine whether breast- feeding is associated with increased longevity or cause-specific survival. Methods. Teachers throughout California identified intellectually gifted children as part of a prospective study begun in the 1920s by Lewis Terman. Information on breast-feeding was available on 1170 subjects, who have been followed for more than 65 years. Results. Survival analysis (Cox proportional hazards model) indicated that breast-feeding was associated with increased longevity, even after adjustment for age at baseline, birthweight, infant health, and childhood socioeconomic status, but only among men, and the association was not significant (P = .15). Neither cardiovascular disease nor cancer survival was significantly associated with duration of breast-feeding for either sex. Survival from deaths due to injuries was positively associated with breast-feeding after adjustment (P = .03) and demonstrated a clear gradient with duration, but only among men. Conclusions. Overall, the present study does not provide strong evidence that breast-feeding is associated with adult longevity. The reduced risk of death from injury may reflect chance, in that the association was significant only for men, or it may reflect psychosocial correlates of breast-feeding practices. Handle: RePEc:aph:ajpbhl:1994:84:9:1458-1462_1 Template-Type: ReDIF-Article 1.0 Title: Urinary biological monitoring markers of anticancer drug exposure in oncology nurses Journal: American Journal of Public Health Author-Name: Newman, M.A. Author-Name: Valanis, B.G. Author-Name: Schoeny, R.S. Author-Name: Shane Que Hee Year: 1994 Volume: 84 Issue: 5 Pages: 852-855 Abstract: People handling anticancer drugs or their wastes may absorb these potent genotoxic agents. The aim of this study was to determine the utility of some general urinary markers among 24 female oncology nurses handling these drugs in comparison with 25 'unexposed' nurses. The markers were the Salmonella typhimurium reverse and forward mutation assays, total thioethers, and D- glucaric acid. The reverse mutation assay was the most specific and sensitive marker for anti-cancer drug exposure. Use of the marker battery was no great advantage as a screening tool relative to use of the reverse mutation assay alone. Better recording of work practices in nurse work logs would have improved interpretation of results. Handle: RePEc:aph:ajpbhl:1994:84:5:852-855_3 Template-Type: ReDIF-Article 1.0 Title: Ethnicity and the use of outpatient mental health services in a national insured population Journal: American Journal of Public Health Author-Name: Padgett, D.K. Author-Name: Patrick, C. Author-Name: Burns, B.J. Author-Name: Schlesinger, H.J. Year: 1994 Volume: 84 Issue: 2 Pages: 222-226 Abstract: Objectives. Factors affecting ethnic differences in the use of outpatient mental health services are analyzed in an insured, nonpoor population to determine if lower use by Blacks and Hispanics persists when socioeconomic and other factors are controlled. Methods. To identify significant predictors of the probability and amount of use, insurance claims data for a population of 1.2 million federal employees insured by Blue Cross/Blue Shield in 1983 were analyzed with the Andersen and Newman model of health service utilization. Logistic and ordinary least squares regression models were estimated for each ethnic group. Results. Blacks and Hispanics had lower probabilities and amounts of use when compared with Whites after controlling for a number of variables. Conclusions. Since ethnic differences in the use of outpatient mental health services exist even in an insured, nonpoor population, factors other than lower socioeconomic status or insurance coverage-for example, cultural or attitudinal factors and service system barriers-are likely responsible. Such findings have policy implications in the current climate of health care reform to increase access to care for the underserved. Handle: RePEc:aph:ajpbhl:1994:84:2:222-226_8 Template-Type: ReDIF-Article 1.0 Title: The respiratory health impact of a large urban fire Journal: American Journal of Public Health Author-Name: Lipsett, M. Author-Name: Waller, K. Author-Name: Shusterman, D. Author-Name: Thollaug, S. Author-Name: Brunner, W. Year: 1994 Volume: 84 Issue: 3 Pages: 434-438 Abstract: Objectives. In July 1988, a fire destroyed a huge supermarket warehouse in Richmond, Calif, sending smoke into residential neighborhoods for nearly a week. There was no organized public health response. To evaluate the respiratory health impact on the general population, a survey of emergency room visits and hospital admissions to the two acute-care hospitals serving the population downwind was conducted. Methods. Medical records of 489 patients meeting specified diagnostic criteria during the week of the fire and several reference periods were abstracted. Ratios of proportions for respiratory diagnoses (i.e., emergency room visits for a given diagnosis/total emergency room visits) were calculated, comparing the fire week with the reference periods, and 1988 mortality data for the area were reviewed. Results. Ratios of proportions for emergency room visits for asthma and all lower respiratory conditions increased significantly during the fire. Respiratory-related hospitalizations also increased. However, there was no observable increase in respiratory mortality. Conclusions. This fire was found to have had a moderate impact on the respiratory health of local residents. Public health intervention is indicated to prevent respiratory morbidity when extended exposure to structural fire smoke is predictable. Handle: RePEc:aph:ajpbhl:1994:84:3:434-438_0 Template-Type: ReDIF-Article 1.0 Title: Risk factors for hip fracture in US men aged 40 through 75 years Journal: American Journal of Public Health Author-Name: Hemenway, D. Author-Name: Azrael, D.R. Author-Name: Rimm, E.B. Author-Name: Feskanich, D. Author-Name: Willett, W.C. Year: 1994 Volume: 84 Issue: 11 Pages: 1843-1845 Abstract: Relatively few studies have examined risk factors for hip fracture among men. This study analyzes data from the Health Professionals Follow-up Study, a prospective study of approximately 50 000 men who were between the ages of 40 and 75 years in 1986. Body mass index, smoking status, and alcohol consumption were not associated with hip fracture in this population. However, age and height were related to hip fracture. Men who were 65 and older had a significantly higher risk of sustaining a hip fracture than younger adults. Men 6 feet or taller were more than twice as likely to sustain a hip fracture as those under 5 feet, 9 inches. Handle: RePEc:aph:ajpbhl:1994:84:11:1843-1845_3 Template-Type: ReDIF-Article 1.0 Title: The medical care programs of the Farm Security Administration, 1932 through 1947: A rehearsal for national health insurance? Journal: American Journal of Public Health Author-Name: Grey, M.R. Year: 1994 Volume: 84 Issue: 10 Pages: 1678-1687 Abstract: At a time of renewed interest in universal health insurance, an examination of earlier periods when society grappled with the link between socioeconomic status and health is fruitful. Between 1935 and 1947, the federal government sponsored a comprehensive medical care program for low- income farmers, sharecroppers, and migrant workers under the auspices of the Farm Security Administration (FSA). Despite the strong opposition of the American Medical Association, humanitarian and economic concerns at the local level often promoted physicians' participation in the program's group prepayment plans. Many FSA leaders clearly saw the program as a model upon which national health insurance might advance. However, in the wake of World War II, the FSA program declined as physicians' income improved, the rural population declined, and traditional ideological objections to federal intervention in medical care resurfaced. The FSA experience illuminates the complex ideological, economic, and humanitarian motivations of American physicians in the face of health care reform. Handle: RePEc:aph:ajpbhl:1994:84:10:1678-1687_4 Template-Type: ReDIF-Article 1.0 Title: The effect of paternal smoking on the birthweight of newborns whose mothers did not smoke Journal: American Journal of Public Health Author-Name: Martinez, F.D. Author-Name: Wright, A.L. Author-Name: Taussig, L.M. Year: 1994 Volume: 84 Issue: 9 Pages: 1489-1491 Abstract: We examined the relationship of paternal smoking habits to birthweight in a cohort of infants enrolled at birth (n = 1219). To assess validity of parental smoking reports, cord serum levels of cotinine were measured in 175 newborns. A mean birthweight deficit of 88 g was found in newborns of nonsmoking mothers whose fathers smoked more than 20 cigarettes/day. Only 2 of 138 newborns whose mothers said they were nonsmokers had cotinine levels indicating that their mothers were active smokers. Among infants of nonsmoking mothers, detectability of cotinine in cord blood was significantly correlated with the number of cigarettes smoked daily by fathers. These data suggest that fetal growth may be adversely affected when the mother is passively exposed to tobacco smoke during pregnancy. Handle: RePEc:aph:ajpbhl:1994:84:9:1489-1491_2 Template-Type: ReDIF-Article 1.0 Title: Birthweight differentials among Asian Americans Journal: American Journal of Public Health Author-Name: Singh, G.K. Author-Name: Yu, S.M. Year: 1994 Volume: 84 Issue: 9 Pages: 1444-1449 Abstract: Objectives. This study examines differentials in mean birthweight and the risk for low birthweight among various Asian-American groups in New York State (n = 499 377). Methods. Using resident singleton live-birth records from New York State for 1985 and 1986, Asian-American births were compared with Black, American Indian, and White births. Multivariate ordinary least squares and logistic regression models were used to analyze ethnic differences. Results. Compared with White births, the expected mean difference in birthweight was -115 g for Chinese, -235 g for Japanese, -164 g for Filipinos, -120 g for Blacks, and 74 g for American Indians. The risk for low birthweight was 45% higher for Filipinos and 49% higher for Blacks as compared with Whites. Conclusions. Results of this study suggest substantial heterogeneity in mean birthweight and risk for low birthweight among ethnic groups in general and the major Asian-American groups in particular. Interestingly, after controlling for ethnic differences in sociodemographic risk factors, Filipinos appear to resemble Blacks much more closely than they do their Japanese and Chinese counterparts with respect to risk for low birthweight. Handle: RePEc:aph:ajpbhl:1994:84:9:1444-1449_6 Template-Type: ReDIF-Article 1.0 Title: CDC's consensus set of health status indicators: Monitoring and prioritization by state health departments Journal: American Journal of Public Health Author-Name: Zucconi, S.L. Author-Name: Carson, C.A. Year: 1994 Volume: 84 Issue: 10 Pages: 1644-1646 Abstract: A survey assessed the extent to which state health departments monitor and prioritize the Centers for Disease Control and Prevention's consensus set of health status indicators. A response rate of 100% was obtained. Although mortality indicators are often monitored, only 75.5% of the states monitor work-related injury deaths. Most states monitor the incidence of acquired immunodeficiency syndrome, measles, tuberculosis, and syphilis. Low birthweight, births to adolescents, and lack of prenatal care are monitored in nearly all states and are considered high-priority problems. Only 46.9% of states are monitoring poor air quality, and only 58.8% are monitoring childhood poverty. Survey results suggest a need for standardized assessment of indicators for policy development and program planning. Handle: RePEc:aph:ajpbhl:1994:84:10:1644-1646_1 Template-Type: ReDIF-Article 1.0 Title: Prenatal alcohol exposure, birthweight, and measures of child size from birth to age 14 years Journal: American Journal of Public Health Author-Name: Sampson, P.D. Author-Name: Bookstein, F.L. Author-Name: Barr, H.M. Author-Name: Streissguth, A.P. Year: 1994 Volume: 84 Issue: 9 Pages: 1421-1428 Abstract: Objectives. The purpose of the study was to examine the effect of prenatal alcohol exposure on offspring's weight, height, and head circumference from birth through 14 years of age. Methods. This longitudinal prospective study examined a cohort of approximately 500 offspring (over-sampled for heavier drinkers and stratified for smoking from a population of 1529 women in prenatal care at the 5th gestational month) at birth; 8 and 18 months; and 4, 7, and 14 years of age. Covariates were examined by means of multiple regression. Birth size measures were also examined as predictors of 7-year neurodevelopmental outcomes. Results. Effects of alcohol were observed on weight, length, and head circumference at birth; these effects were not altered by adjustment for covariates including smoking. However, the birthweight effect is clearly transient; although alcohol effects remained observable at 8 months, they were not measurable thereafter through age 14 years. Conclusions. In this population-based sample, neither birthweight nor any later size measure was as useful an indicator of the enduring effects of prenatal alcohol exposure as were certain neurodevelopmental outcomes. Handle: RePEc:aph:ajpbhl:1994:84:9:1421-1428_3 Template-Type: ReDIF-Article 1.0 Title: Comparing hospitals that perform coronary artery bypass surgery: The effect of outcome measures and data sources Journal: American Journal of Public Health Author-Name: Hartz, A.J. Author-Name: Kuhn, E.M. Year: 1994 Volume: 84 Issue: 10 Pages: 1609-1614 Abstract: Objectives. The relative quality of hospital care often is judged by comparing risk-adjusted rates of adverse outcomes. This study evaluated whether hospital quality comparisons are affected by the choice of outcome and the use of administrative data instead of clinical data. Methods. The data were collected from 2687 coronary artery bypass surgery patients from 17 hospitals. All patients were on Medicare. For 10 hospitals with 94 to 713 patients, risk-adjusted outcomes for death, major complications, and any complications were derived from a clinically rich database and an administrative database. Results. The correlations between adjusted hospital rankings derived from the clinical and administrative databases were not significant: .48 for mortality, .21 for major complications, and -.14 for any complication. When only the clinical database was used, the correlation between risk-adjusted hospital rankings for mortality and major complications was .77 (P < .01) and the correlation between major complications and any complication was -.45. Conclusions. These results suggest assessing quality of care by the use of administrative data may not be adequate and that quality assessment by the use of clinical data may depend greatly on the outcome chosen. Handle: RePEc:aph:ajpbhl:1994:84:10:1609-1614_7 Template-Type: ReDIF-Article 1.0 Title: The protective effect of nonoxynol-9 against HIV infection [1] Journal: American Journal of Public Health Author-Name: Feldblum, P.J. Author-Name: Weir, S.S. Year: 1994 Volume: 84 Issue: 6 Pages: 1032-1034 Handle: RePEc:aph:ajpbhl:1994:84:6:1032-1034_4 Template-Type: ReDIF-Article 1.0 Title: A decision-analytic approach to postexposure rabies prophylaxis Journal: American Journal of Public Health Author-Name: Cantor, S.B. Author-Name: Clover, R.D. Author-Name: Thompson, R.F. Year: 1994 Volume: 84 Issue: 7 Pages: 1144-1148 Abstract: The risks and benefits of postexposure rabies prophylaxis were analyzed from clinical and economic perspectives. A decision-analytic model was constructed by using probability and outcome data from the literature and the state health department. Health outcomes were measured in quality-adjusted life years. In the base case (overweight adult male), treatment is optimal when the probability of animal rabidity is greater than 1 in 2000. Sensitivity analysis showed robustness in the treatment decision; however, the incremental cost-effectiveness ratio ($140 000/quality-adjusted life year) is sensitive to the rabidity probability. Treatment is optimal from the patient's perspective; however, it may not be cost-effective when the probability of rabidity is low. Handle: RePEc:aph:ajpbhl:1994:84:7:1144-1148_0 Template-Type: ReDIF-Article 1.0 Title: Low birthweight at term and the timing of fetal exposure to maternal smoking Journal: American Journal of Public Health Author-Name: Lieberman, E. Author-Name: Gremy, I. Author-Name: Lang, J.M. Author-Name: Cohen, A.P. Year: 1994 Volume: 84 Issue: 7 Pages: 1127-1131 Abstract: Objectives. This study was undertaken to evaluate the risk of small-for- gestational-age birth for women who stop smoking or begin to smoke during pregnancy. Methods. Women with term singleton pregnancies from a hospital- based cohort of 11 177 were classified as (1) nonsmokers; (2) smoked throughout pregnancy; (3) smoked during first trimester only; (4) smoked during first and second trimesters only; and (5) smoked during second and third trimesters or during third trimester only. Risk of small-for- gestational-age birth according to smoking category was estimated and adjusted for confounding factors by logistic regression. Results. Women who stopped smoking by the third trimester were not at increased risk of small- for-gestational-age birth compared with nonsmokers. Women who began smoking during the second or third trimester had an elevated risk of small-for- gestational-age birth (odds ratio [OR] = 1.83; 95% confidence interval [CI] = 1.25, 2.67) similar to that for women who smoked throughout pregnancy (OR = 2.20; 95% CI = 1.90, 2.54). Risk of small-for-gestational-age birth increased with the number of cigarettes smoked during the third trimester. Conclusions. It is during the third trimester that smoking retards fetal growth, presenting a compelling opportunity for smoking cessation interventions. Programs must emphasize the importance of not resuming smoking late in pregnancy. Handle: RePEc:aph:ajpbhl:1994:84:7:1127-1131_5 Template-Type: ReDIF-Article 1.0 Title: Dietary sources of fats and cholesterol in US children aged 2 through 5 years Journal: American Journal of Public Health Author-Name: Thompson, F.E. Author-Name: Dennison, B.A. Year: 1994 Volume: 84 Issue: 5 Pages: 799-806 Abstract: Objectives. This study of lipid intakes among preschool children (1) analyzed the contributions of 38 food groups to fat, saturated fat, and cholesterol intakes; (2) estimated the effects of food substitutions on intakes; and (3) examined demographic differences in food group intake and food group sources of these lipids. Methods. The sample consisted of 547 children, aged 2 to 5 years, from the US Department of Agriculture's 1985 and 1986 Continuing Surveys of Food Intakes by Individuals. Dietary information for 4 nonconsecutive days throughout a year was used. All foods were classified into groups and the lipids contributed from each group were computed. Results. Over 80% of the children consumed more total fat, saturated fats, and cholesterol than is recommended. The major source of total fat and saturated fats was whole milk; the major sources of dietary cholesterol were eggs and whole milk. Children's food consumption patterns differed by region of the country and race/ethnicity, providing opportunities to refine nutrition education interventions and evaluations. Conclusions. By substituting lower-fat foods for the major sources of saturated fats, significant reductions in preschool children's intakes of saturated fats, fat, and dietary cholesterol could be achieved. Handle: RePEc:aph:ajpbhl:1994:84:5:799-806_6 Template-Type: ReDIF-Article 1.0 Title: The costs and financing of perinatal care in the United States Journal: American Journal of Public Health Author-Name: Long, S.H. Author-Name: Marquis, M.S. Author-Name: Harrison, E.R. Year: 1994 Volume: 84 Issue: 9 Pages: 1473-1478 Abstract: Objectives. The purpose of this study was to estimate the aggregate annual costs of maternal and infant health care and to describe the flow of funds that finance that care. Methods. Estimates of costs and financing based on household and provider surveys, third-party claims data, and hospital discharge data were combined into a single, best estimate. Results. The total cost of perinatal care in 1989 was $27.8 billion, or $6850 per mother-infant pair. Payments made directly by patients or third parties for this care totaled $25.4 billion, or about 7% of personal health care spending by the nonaged population. Payments were less than costs because they did not include a value for direct delivery care or for bad debt and charity care, which accounted for $2.4 billion. Private insurance accounted for about 63% of total payments, and Medicaid accounted for 17% of the total. Conclusions. National health reform would provide windfall receipts to hospitals, which would receive payment for the considerable bad debt and charity care they provide. Reform might also provide short-term gains to providers as private payment rates are substituted for those of Medicaid. Handle: RePEc:aph:ajpbhl:1994:84:9:1473-1478_6 Template-Type: ReDIF-Article 1.0 Title: Behavioral risk factors: A comparison of Latinos and non-Latino whites in San Francisco Journal: American Journal of Public Health Author-Name: Perez-Stable, E.J. Author-Name: Marin, G. Author-Name: VanOss Marin, B. Year: 1994 Volume: 84 Issue: 6 Pages: 971-976 Abstract: Objectives. The purpose of the study was to evaluate differences between Latino and non-Latino White adults in health-related behavioral risk factors. Methods. Telephone interviews were conducted with 652 Latinos and 584 non- Latino Whites in San Francisco selected by random-digit dialing. Results. Latino men and women, compared with their non-Latino White counterparts, were less likely to have consumed any alcoholic beverage in the previous month (59% and 29% vs 77% and 75%, respectively), consumed fewer drinks per week (6.6 and 3.0 vs 8.9 and 5.1, respectively), and were more likely to be sedentary (40% and 46% vs 17% and 23%). Latina women were less likely than non-Latina Whites to smoke cigarettes (8% vs 29%), to have ever had a Pap smear (76% vs 93%), and to have ever had a clinical breast examination (81% vs 96%). Multivariate analyses adjusting for sex, age, education, and employment confirmed univariate findings. Conclusions. Behavioral risk factor profiles by ethnicity help emphasize priorities of health promotion programs for a community. Latino needs include maintenance of limited consumption of alcohol and cigarettes, promotion of regular physical activity, and increasing use of low-cost cervical and breast cancer screening tests. Handle: RePEc:aph:ajpbhl:1994:84:6:971-976_9 Template-Type: ReDIF-Article 1.0 Title: Maternal smoking during pregnancy and smoking by adolescent daughters Journal: American Journal of Public Health Author-Name: Kandel, D.B. Author-Name: Wu, P. Author-Name: Davies, M. Year: 1994 Volume: 84 Issue: 9 Pages: 1407-1413 Abstract: Objectives. Since cigarette smoking in adolescence represents a crucial entry point in the progression to illicit drugs, risk factors for adolescent smoking have public health implications. The influence of mothers on children's smoking appears to be greater than that of fathers. To explain the selective influence of mothers, we examined the consequences of maternal smoking during pregnancy in two longitudinal samples. Methods. Analyses were conducted on follow-up interview data from two dyadic samples of mothers and firstborn adolescents for whom data on maternal smoking during and after pregnancy were available (192 mother-child pairs originating from New York State and 797 dyads from a national sample). Results. In both samples, maternal smoking during pregnancy, when postnatal smoking was controlled, selectively increased the probability that female children would smoke and would persist in smoking (adjusted odds ratios of about 4). Conclusions. The findings suggest that nicotine or other substances released by maternal smoking can affect the fetus, perhaps through the nicotinic input to the dopaminergic motivational system, so as to predispose the brain in a critical period of its development to the subsequent addictive influence of nicotine consumed more than a decade later in life. Handle: RePEc:aph:ajpbhl:1994:84:9:1407-1413_9 Template-Type: ReDIF-Article 1.0 Title: Exposure to hair-coloring products and the risk of multiple myeloma Journal: American Journal of Public Health Author-Name: Herrinton, L.J. Author-Name: Weiss, N.S. Author-Name: Koepsell, T.D. Author-Name: Daling, J.R. Author-Name: Taylor, J.W. Author-Name: Lyon, J.L. Author-Name: Swanson, G.M. Author-Name: Greenberg, R.S. Year: 1994 Volume: 84 Issue: 7 Pages: 1142-1144 Abstract: An interview study of persons diagnosed with multiple myeloma between 1977 and 1981 and suitable control subjects was conducted to test the hypothesis that exposure to hair dyes increases the risk of multiple myeloma. Among women, there was little evidence that prior regular use of hair dyes (odds ratio [OR] = 1.0; 95% confidence interval [CI] = 0.70, 1.4) or prior employment as a hairdresser (OR = 1.1; 95% CI = 0.43, 2.7) increased risk; however, the former comparison was limited by the lack of detailed information concerning the exposure. Among men, there was a modest association of regular use of hair dyes (OR = 1.5; 95% CI = 0.75, 2.9) with myeloma, but this was based on a small number of exposed persons. Handle: RePEc:aph:ajpbhl:1994:84:7:1142-1144_7 Template-Type: ReDIF-Article 1.0 Title: More on methadone treatment Journal: American Journal of Public Health Author-Name: Newman, R.G. Year: 1994 Volume: 84 Issue: 11 Pages: 1854 Handle: RePEc:aph:ajpbhl:1994:84:11:1854_3 Template-Type: ReDIF-Article 1.0 Title: Pap smear and mammogram screening in Mexican-American women: The effects of acculturation Journal: American Journal of Public Health Author-Name: Suarez, L. Year: 1994 Volume: 84 Issue: 5 Pages: 742-746 Abstract: Objectives. For Mexican Americans, acculturation is a multidimensional process of adopting attitudes, values, and behavior from the non-Hispanic White culture. This study examines the effects of different dimensions of acculturation on the cancer screening behavior of Mexican-American women. Methods. Subjects were 450 randomly selected Mexican-American women age 40 years and older living in El Paso, Texas. Personal interviews solicited information on age, income, education, health insurance, Pap smear and mammogram use, and acculturation. Acculturation was measured with five scales that assessed English proficiency, English use, value placed on culture, traditional family attitudes, and social interaction. Results. The 2-year prevalence of Pap smear and mammogram screening increased with each gain in acculturation on English proficiency and use. These associations disappeared when adjusted for age, income, insurance, and education. After adjusting for sociodemographic factors and other acculturation dimensions, a strong traditional Mexican attitude toward family was positively related to mammography use. Conclusions. Taking advantage of the positive influence of Hispanic familism on cancer screening behavior may increase the effectiveness of cancer control interventions in Mexican Americans. Handle: RePEc:aph:ajpbhl:1994:84:5:742-746_3 Template-Type: ReDIF-Article 1.0 Title: Risk factors for homelessness among schizophrenic men: A case-control study Journal: American Journal of Public Health Author-Name: Caton, C.L.M. Author-Name: Shrout, P.E. Author-Name: Eagle, P.F. Author-Name: Opler, L.A. Author-Name: Felix, A. Author-Name: Dominguez, B. Year: 1994 Volume: 84 Issue: 2 Pages: 265-270 Abstract: Objectives. To identify risk factors for homelessness among the severely mentally ill, we conducted a case-control study of 100 indigent schizophrenic men meeting criteria for literal homelessness and 100 such men with no homeless history. Methods. Subjects were recruited from shelter, clinic, and inpatient psychiatric programs in Upper Manhattan. Clinical interviewers employed standardized research instruments to probe three domains of risk factors: severity of mental illness, family background, and prior mental health service use. Results. Homeless subjects showed significantly higher levels of positive symptoms, higher rates of a concurrent diagnosis of drug abuse, and higher rates of antisocial personality disorder. Homeless subjects experienced greater disorganization in family settings from birth to 18 years and less adequate current family support. Fewer homeless subjects than subjects in the never-homeless comparison group had a long-term therapist. These differences remained when demographic variables were adjusted statistically. Conclusions. Homeless schizophrenic men differed from their domiciled counterparts in all three domains we investigated; family background, nature of illness, and service use history. Findings are discussed in relation to policy and programs for the severely mentally ill. Handle: RePEc:aph:ajpbhl:1994:84:2:265-270_8 Template-Type: ReDIF-Article 1.0 Title: Ethnic differences in midwife-attended US births Journal: American Journal of Public Health Author-Name: Parker, J.D. Year: 1994 Volume: 84 Issue: 7 Pages: 1139-1141 Abstract: This study examined US ethnic differences in midwifery care from 1982 through 1989. After adjustment for maternal characteristics, Native American mothers were most likely, and White and Asian mothers were least likely, to obtain midwifery care. For these three groups, midwifery use increased rapidly in the period from 1982 through 1989. Compared with White mothers, Black and Hispanic mothers were more likely to be attended by a midwife; however, their use of midwives increased more slowly. Though the local availability of obstetricians and midwives may determine a woman's choice of care provider, these data suggest that cultural factors also play a role. Handle: RePEc:aph:ajpbhl:1994:84:7:1139-1141_6 Template-Type: ReDIF-Article 1.0 Title: The effects of recall on estimating annual nonfatal injury rates for children and adolescents Journal: American Journal of Public Health Author-Name: Harel, Y. Author-Name: Overpeck, M.D. Author-Name: Jones, D.H. Author-Name: Scheidt, P.C. Author-Name: Bijur, P.E. Author-Name: Trumble, A.C. Author-Name: Anderson, J. Year: 1994 Volume: 84 Issue: 4 Pages: 599-605 Abstract: Objectives. This study used a recent national population survey on childhood and adolescent non-fatal injuries to investigate the effects of recall bias on estimating annual injury rates. Strategies to adjust for recall bias are recommended. Methods. The 1988 Child Health Supplement to the National Health Interview Survey collected 12-month recall information on injuries that occurred to a national sample of 17 110 children aged 0 through 17 years. Using information on timing of interviews and reported injuries, estimated annual injury rates were calculated for 12 accumulative recall periods (from 1 to 12 months). Results. The data show significantly declining rates, from 24.4 per 100 for a 1-month recall period to 14.7 per 100 for a 12-month recall period. The largest declines were found for the 0- through 4- year-old age group and for minor injuries. Rates of injuries that caused a school loss day, a bed day, surgery, or hospitalization showed higher stability throughout recall periods. Conclusions. Varying recall periods have profound effects on the patterns of childhood injury epidemiology that emerge from the data. Recall periods of between 1 and 3 months are recommended for use in similar survey settings. Handle: RePEc:aph:ajpbhl:1994:84:4:599-605_1 Template-Type: ReDIF-Article 1.0 Title: The validity of self-reported smoking: A review and meta-analysis Journal: American Journal of Public Health Author-Name: Patrick, D.L. Author-Name: Cheadle, A. Author-Name: Thompson, D.C. Author-Name: Diehr, P. Author-Name: Koepsell, T. Author-Name: Kinne, S. Year: 1994 Volume: 84 Issue: 7 Pages: 1086-1093 Abstract: Objectives. The purpose of this study was to identify circumstances in which biochemical assessments of smoking produce systematically higher or lower estimates of smoking than self-reports. A secondary aim was to evaluate different statistical approaches to analyzing variation in validity estimates. Methods. Literature searches and personal inquiries identified 26 published reports containing 51 comparisons between self-reported behavior and biochemical measures. The sensitivity and specificity of self-reports of smoking were calculated for each study as measures of accuracy. Results. Sensitivity ranged from 6% to 100% (mean = 87.5%), and specificity ranged from 33% to 100% (mean = 89.2%). Interviewer-administered questionnaires, observational studies, reports by adults, and biochemical validation with cotinine-plasma were associated with higher estimates of sensitivity and specificity. Conclusions. Self-reports of smoking are accurate in most studies. To improve accuracy, biochemical assessment, preferably with cotinine-plasma, should be considered in intervention studies and student populations. Handle: RePEc:aph:ajpbhl:1994:84:7:1086-1093_9 Template-Type: ReDIF-Article 1.0 Title: The effects of specific medical conditions on the functional limitations of elders in the Framingham study Journal: American Journal of Public Health Author-Name: Guccione, A.A. Author-Name: Felson, D.T. Author-Name: Anderson, J.J. Author-Name: Anthony, J.M. Author-Name: Zhang, Y. Author-Name: Wilson, P.W.F. Author-Name: Kelly-Hayes, M. Author-Name: Wolf, P.A. Author-Name: Kreger, B.E. Author-Name: Kannel, W.B. Year: 1994 Volume: 84 Issue: 3 Pages: 351-358 Abstract: Objectives. The purpose of this study was to identify associations between specific medical conditions in the elderly and limitations in functional tasks to compare risks of disability across medical conditions, controlling for age, sex, and comorbidity and to determine the proportion of disability attributable to each condition. Methods. The subjects were 709 noninstitutionalized men and 1060 women of the Framingham Study cohort (mean age 73.7 ± 6.3 years). Ten medical conditions were identified for study: knee osteoarthritis, hip fracture, diabetes, stroke, heart disease intermittent claudication, congestive heart failure, chronic obstructive pulmonary disease, depressive symptomatology and cognitive impairment. Adjusted odds ratios were calculated for dependence on human assistance in seven functional activities. Results. Stroke was significantly associated with functional limitations in all seven tasks depressive symptomatology and hip fracture were associated with limitations in five tasks: and knee osteoarthritis, heart disease, congestive heart failure, and chronic obstructive pulmonary disease, were associated with limitations in four tasks each. Conclusions. In general, stroke, depressive symptomatology, hip fracture, knee osteoarthritis, and heart disease account for more physical disability in noninstitutionalized elderly men and women than other diseases. Handle: RePEc:aph:ajpbhl:1994:84:3:351-358_9 Template-Type: ReDIF-Article 1.0 Title: Diagnoses, symptoms, and attribution of symptoms among black and white inpatients admitted for coronary heart disease Journal: American Journal of Public Health Author-Name: Raczynski, J.M. Author-Name: Taylor, H. Author-Name: Cutter, G. Author-Name: Hardin, M. Author-Name: Rappaport, N. Author-Name: Oberman, A. Year: 1994 Volume: 84 Issue: 6 Pages: 951-956 Abstract: Objectives. This study examined health care-seeking behaviors to elucidate factors that contribute to differences in patterns of coronary heart disease between African Americans and Whites. The prevalence of diagnosed coronary heart disease, patients' perceptions of symptoms and attribution of symptoms, and predictors of painful symptoms and attribution of cardiac symptoms were examined. Methods. The study involved 2416 patients admitted with diagnoses of coronary artery disease, ischemic heart disease, or myocardial infarction or to rule out myocardial infarction. Structured interview questions were used to obtain demographic information, symptoms precipitating admission, and patients' attribution of their symptoms. Discharge diagnoses were obtained from hospital records. Results. Acute myocardial infarction, unstable angina, nonacute ischemic heart disease, and atherosclerosis were more frequent in White patients. For Blacks, the odds of reporting painful symptoms were only 64% of the odds found for Whites when other factors were controlled, and the odds of attributing symptoms to cardiac origins were almost 50% lower for Blacks than for Whites. Conclusions. The tendency of Blacks to report fewer painful symptoms and to attribute their symptoms to noncardiac origins may contribute to differences in care-seeking and in medical management of heart disease in Blacks. Handle: RePEc:aph:ajpbhl:1994:84:6:951-956_4 Template-Type: ReDIF-Article 1.0 Title: Sex bias in the management of coronary artery disease in Quebec Journal: American Journal of Public Health Author-Name: D'Hoore, W. Author-Name: Sicotte, C. Author-Name: Tilquin, C. Year: 1994 Volume: 84 Issue: 6 Pages: 1013-1015 Abstract: This study tests the hypothesis that, given the absence of financial barriers to major coronary procedures in Quebec, women are as likely as men to undergo such procedures. The use of coronary procedures in 33 940 patients with ischemic heart disease, admitted during 1 year to 78 Quebec hospitals, was analyzed. The male-to-female age- and severity-adjusted odds ratios for the use of these procedures were 1.47 for diagnostic procedures, 1.38 for therapeutic procedures, and 1.26 for diagnostic and therapeutic procedures. These results suggest that differences in the use of coronary procedures by sex are influenced by factors other than financial accessibility. Handle: RePEc:aph:ajpbhl:1994:84:6:1013-1015_9 Template-Type: ReDIF-Article 1.0 Title: The relationship of prenatal care and pregnancy complications to birthweight in Winnipeg, Canada Journal: American Journal of Public Health Author-Name: Mustard, C.A. Author-Name: Roos, N.P. Year: 1994 Volume: 84 Issue: 9 Pages: 1450-1457 Abstract: Objectives. Prenatal care is commonly understood to have a beneficial impact on birthweight. This study describes socioeconomic differences in utilization of prenatal medical care and birthweight in a population with universal health insurance. Methods. Measures of prenatal care utilization, incidence of pregnancy complications, and birthweight were obtained from physician reimbursement claims and hospital separation abstracts for 12 646 pregnant women. Maternal socioeconomic status was derived from small-area census data. Results. Infants born to women in the poorest income quintile had lower birthweights than infants born to wealthier women. Much of the difference was associated with a higher prevalence of complications, smoking, unmarried status, and inadequate prenatal care among low-income women. The difference in birthweight between adequate and less than adequate care groups was small, and the benefit associated with prenatal care was no greater among women with pregnancy complications. Conclusions. The lower utilization of prenatal care by poorer women accounted for a small proportion of the difference in birthweight. Socioeconomic differences in birthweight are primarily attributable to factors not directly influenced by early prenatal medical care. Handle: RePEc:aph:ajpbhl:1994:84:9:1450-1457_9 Template-Type: ReDIF-Article 1.0 Title: The occupational risk of hepatitis C infection among hospital employees. Journal: American Journal of Public Health Author-Name: Germanaud, J. Author-Name: Barthez, J.P. Author-Name: Causse, X. Year: 1994 Volume: 84 Issue: 1 Pages: 122 Handle: RePEc:aph:ajpbhl:1994:84:1:122_1 Template-Type: ReDIF-Article 1.0 Title: Is cardiopulmonary resuscitation training deleterious for family members of cardiac patients? Journal: American Journal of Public Health Author-Name: Dracup, K. Author-Name: Moser, D.K. Author-Name: Guzy, P.M. Author-Name: Taylor, S.E. Author-Name: Marsden, C. Year: 1994 Volume: 84 Issue: 1 Pages: 116-118 Abstract: The purpose of the study was to determine the attitudes toward cardiopulmonary resuscitation (CPR) training and subsequent CPR use of 172 CPR-trained family members of cardiac patients. The majority (88.9%) reported positive attitudes. Only 14 (8.1%) reported feeling too responsible for their family member. One hundred and forty-one (81.9%) said that they would perform CPR if required to do so. Family members do not feel unduly burdened by learning CPR, and CPR training should be recommended to families of patients at risk for sudden cardiac death. Handle: RePEc:aph:ajpbhl:1994:84:1:116-118_9 Template-Type: ReDIF-Article 1.0 Title: HIV vaccine trials: Will intravenous drug users enroll? Journal: American Journal of Public Health Author-Name: Meyers, K. Author-Name: Metzger, D.S. Author-Name: Navaline, H. Author-Name: Woody, G.E. Author-Name: McLellan, A.T. Year: 1994 Volume: 84 Issue: 5 Pages: 761-766 Abstract: Objectives. The purpose of this study was to assess the willingness of intravenous drug users to participate in a preventive human immunodeficiency virus (HIV) vaccine efficacy trial. Methods. Of the 347 intravenous drug users in methadone treatment who were approached for participation, 257 completed a battery of self-administered questionnaires assessing risk behaviors, interest in vaccine trials, and other vaccine-related information. Data from 16 known seropositives and 1 inconsistent responder were dropped from analyses (n = 240). Results. Fifty-two percent of the subjects expressed a willingness to be one of the first individuals to participate in a preventive HIV vaccine efficacy trial. Subjects who had recently shared needles or works and subjects who trusted the government to ensure vaccine safety were both twice as likely to report interest in participation. Twenty- two percent of subjects reported that they would increase needle sharing if vaccinated. Thirty percent did not know what a vaccine was. Conclusions. These findings suggest that some in-treatment intravenous drug users would volunteer for a preventive HIV vaccine efficacy trial. Education and counseling will be required to ensure that subjects fully understand the trial's purposes, methods, risks and benefits. Handle: RePEc:aph:ajpbhl:1994:84:5:761-766_8 Template-Type: ReDIF-Article 1.0 Title: Building bridges between schools of public health and public health practice Journal: American Journal of Public Health Author-Name: Handler, A. Author-Name: Schieve, L.A. Author-Name: Ippoliti, P. Author-Name: Gordon, A.K. Author-Name: Turnock, B.J. Year: 1994 Volume: 84 Issue: 7 Pages: 1077-1080 Abstract: A 1988 Institute of Medicine report, The Future of Public Health, characterized the current public health system as fragmented, particularly with regard to relationships between public health agencies and academic institutions. As one response to the report, the Health Resources and Services Administration established the Center for the Development of Public Health Practice at the University of Illinois to advance linkages between schools of public health and public health agencies. Surveys of schools of public health and of state health agencies were conducted in 1992 to collect baseline data on the practice links between the two. Responses reveal that there is a substantial amount of informal collaboration between them. Formalization of collaborative activities between schools and agencies is beginning to occur and is expected to expand owing to increased focus on public health practice at schools of public health. Handle: RePEc:aph:ajpbhl:1994:84:7:1077-1080_6 Template-Type: ReDIF-Article 1.0 Title: Cesarean section and operative vaginal delivery in low-risk primiparous women, Western Australia Journal: American Journal of Public Health Author-Name: Read, A.W. Author-Name: Prendiville, W.J. Author-Name: Dawes, V.P. Author-Name: Stanley, F.J. Year: 1994 Volume: 84 Issue: 1 Pages: 37-42 Abstract: Objectives. A major component of the increasing trend in cesarean sections in Western Australia is the rise in emergency cesarean sections in primiparous women. The aim of this study was to identify independent risk factors (particularly those known early in pregnancy) associated with operative delivery in low-risk primiparous women. Methods. Retrospective multivariate logistic regression analyses of antenatal and perinatal data were conducted for all low-risk primiparous women entering labor spontaneously and giving birth in Western Australia in 1987 (n = 3641). Results. Of the subjects, 58% had a spontaneous vaginal delivery, 8% had an emergency cesarean section, and 34% had an operative vaginal delivery. The significant independent risk factors for emergency cesarean section were older maternal age, shorter maternal height, heavier infant birthweight, and long labor. The risk factors for operative vaginal delivery were older maternal age, shorter maternal height, heavier infant birthweight, epidural anesthesia, labor/delivery complications, male infant, private patient status, and being married. Conclusions. This multivariate analysis confirms known risk factors for operative delivery in low-risk primiparous women and suggests that it may be possible to predict the likelihood of operative delivery for an individual woman by using knowledge of maternal age and height and assessment of infant birthweight. Handle: RePEc:aph:ajpbhl:1994:84:1:37-42_0 Template-Type: ReDIF-Article 1.0 Title: Detecting children's passive exposure to cocaine and marijuana [1] Journal: American Journal of Public Health Author-Name: Bhushan, V. Author-Name: Ng, S. Author-Name: Spiller, D. Author-Name: Gang, H. Author-Name: Inamdar, S. Year: 1994 Volume: 84 Issue: 4 Pages: 675-676 Handle: RePEc:aph:ajpbhl:1994:84:4:675-676_4 Template-Type: ReDIF-Article 1.0 Title: Adolescent occupational injuries requiring hospital emergency department treatment: A nationally representative sample Journal: American Journal of Public Health Author-Name: Layne, L.A. Author-Name: Castillo, D.N. Author-Name: Stout, N. Author-Name: Cutlip, P. Year: 1994 Volume: 84 Issue: 4 Pages: 657-660 Abstract: Data from a nationally representative sample of emergency departments for the 6-month period July through December 1992 were used to examine nonfatal occupational injuries sustained by adolescents aged 14 through 17 years. There were 679 occupational injuries, corresponding to an estimated 37 405 injuries nationwide. Males constituted 65.8% of the injury victims. The injury rate for males was 7.0 per 100 full-time employees, compared with 4.4 for females. Lacerations to the hand or finger accounted for 25.6% of all injuries. The majority of injuries occurred in retail trades (53.7%), which also had the highest rate (6.3 per 100 full-time employees). Seventy-one percent of the injuries in retail trade occurred in eating and drinking establishments. Handle: RePEc:aph:ajpbhl:1994:84:4:657-660_9 Template-Type: ReDIF-Article 1.0 Title: Patients' rights to care under Clinton's Health Security Act: The structure of reform Journal: American Journal of Public Health Author-Name: Mariner, W.K. Year: 1994 Volume: 84 Issue: 8 Pages: 1330-1335 Abstract: Like most reform proposals, President Clinton's proposed Health Security Act offers universal access to care but does not significantly alter the nature of patients' legal rights to services. The act would create a system of delegated federal regulation in which the states would act like federal administrative agencies to carry out reform. To achieve uniform, universal coverage, the act would establish a form of mandatory health insurance, with federal law controlling the minimum services to which everyone would be entitled. Because there is no constitutionally protected right to health care and no independent constitutional standard for judging what insurance benefits are appropriate, the federal government would retain considerable freedom to decide what services would and would not be covered. If specific benefits are necessary for patients, they will have to be stated in the legislation that produces reform. Handle: RePEc:aph:ajpbhl:1994:84:8:1330-1335_5 Template-Type: ReDIF-Article 1.0 Title: Social influences on the sexual behavior of youth at risk for HIV exposure Journal: American Journal of Public Health Author-Name: Romer, D. Author-Name: Black, M. Author-Name: Ricardo, I. Author-Name: Feigelman, S. Author-Name: Kaljee, L. Author-Name: Galbraith, J. Author-Name: Nesbit, R. Author-Name: Hornik, R.C. Author-Name: Stanton, B. Year: 1994 Volume: 84 Issue: 6 Pages: 977-985 Abstract: Objectives. Adolescents are increasingly at risk for infection with human immunodeficiency virus (HIV) and other sexually transmitted diseases, especially in poor urban minority communities. To aid the design of interventions in these communities, this study investigated the role of knowledge, attitudes, perceived parental monitoring, and peer behavior in the onset and progression of sexual behavior in children at risk for exposure to HIV. Methods. A computerized personal interview was administered to 300 African-American 9- to 15-year-old children living in six public housing developments in a large US city. Results. Although children's knowledge about the hazards of sex increased with age, their sexual activity also increased (from 12% sexually experienced at 9 years of age to more than 80% experienced at 15 years of age). Parental monitoring appeared able to influence sexual activity. However, the perceived behavior of friends was associated with the rate at which sexual activity progressed with age and the degree to which condom use was maintained with age. Conclusions. The early onset and prevalence of sexual behavior and the importance of peer group influence call for early interventions that simultaneously influence the parents and peers in children's social networks. Handle: RePEc:aph:ajpbhl:1994:84:6:977-985_5 Template-Type: ReDIF-Article 1.0 Title: Estimating the number of HIV-infected injection drug users in Bangkok: A capture-recapture method Journal: American Journal of Public Health Author-Name: Mastro, T.D. Author-Name: Kitayaporn, D. Author-Name: Weniger, B.G. Author-Name: Vanichseni, S. Author-Name: Laosunthorn, V. Author-Name: Uneklabh, T. Author-Name: Uneklabh, C. Author-Name: Choopanya, K. Author-Name: Limpakarnjanarat, K. Year: 1994 Volume: 84 Issue: 7 Pages: 1094-1099 Abstract: Objectives. The purpose of the study was to estimate the number of injection drug users infected with the human immunodeficiency virus (HIV) in Bangkok to allow planning for health services for this population. Methods. A two-sample capture-recapture method was used. The first capture listed all persons on methadone treatment for opiate addiction from April 17 through May 17, 1991, at 18 facilities in Bangkok. The second capture involved urine testing of persons held at 72 Bangkok police stations from June 3 through September 30, 1991. Persons whose urine tests were positive for opiate metabolites or methadone were included on the second list. Results. The first capture comprised 4064 persons and the recapture 1540 persons. There were 171 persons included on both lists, yielding an estimate of 36 600 opiate users in Bangkok. Existing data indicate that 89% of opiate users in Bangkok inject drugs and that about one third are infected with HIV, yielding an estimate of approximately 12 000 HIV-infected injection drug users in Bangkok in 1991. Conclusions. During the 1990s the number of cases of acquired immunodeficiency syndrome (AIDS) and other HIV-related diseases, including tuberculosis, in the population of HIV-infected injection drug users in Bangkok will increase dramatically, placing new demands on existing health care facilities. The capture-recapture method may be useful in estimating difficult-to-count populations, including injection drug users. Handle: RePEc:aph:ajpbhl:1994:84:7:1094-1099_7 Template-Type: ReDIF-Article 1.0 Title: Childhood out-of-home care and current depressive symptoms among homeless adults Journal: American Journal of Public Health Author-Name: Herman, D.B. Author-Name: Susser, E.S. Author-Name: Struening, E.L. Year: 1994 Volume: 84 Issue: 11 Pages: 1849-1851 Abstract: Previous research indicates that adverse childhood experiences are associated with depression during adulthood under conditions of social stress. This relationship was examined in a large sample of homeless adults (n = 1849). Subjects with evidence of severe mental disorders such as schizophrenia were excluded. Those with out-of-home care (e.g., foster, group, or institutional care) during childhood were significantly more likely than those without such care to report current severe depressive symptoms (CES-D score greater than or equal to 30). The finding, which held up in multivariate analysis when potential confounders were statistically controlled, supports the theory that certain developmental experiences are risk factors for subsequent depressive symptoms. Handle: RePEc:aph:ajpbhl:1994:84:11:1849-1851_4 Template-Type: ReDIF-Article 1.0 Title: Black-White differences in risk for cutaneous, ocular, and visceral melanomas Journal: American Journal of Public Health Author-Name: Neugut, A.I. Author-Name: Kizelnik-Freilich, S. Author-Name: Ackerman, C. Year: 1994 Volume: 84 Issue: 11 Pages: 1828-1829 Abstract: Fair-skinned individuals have a much higher risk of cutaneous and ocular melanomas than dark-skinned individuals, possibly reflecting a protective effect of melanin against sun exposure. There are some reasons to believe that the effect of sunlight exposure is indirect (i.e., sunlight stimulates growth factor production, which then stimulates melanocytic proliferation, leading to melanoma). Visceral melanomas are extremely rare, and little is known about them. This study used US data on 25 184 melanoma cases to investigate the White-Black ratio for visceral melanoma and did not find a disproportionality similar to that for cutaneous and ocular melanomas. The findings support the hypothesis that the sunlight effect on melanoma is primarily direct. Handle: RePEc:aph:ajpbhl:1994:84:11:1828-1829_6 Template-Type: ReDIF-Article 1.0 Title: Temporal trends in the socioeconomic gradient for breast cancer mortality among US women Journal: American Journal of Public Health Author-Name: Wagener, D.K. Author-Name: Schatzkin, A. Year: 1994 Volume: 84 Issue: 6 Pages: 1003-1006 Abstract: Temporal trends in breast cancer mortality among US women were examined for 1969 through 1989 by age, race, and county-level socioeconomic status (SES). The mortality ratio for high- relative to low-SES counties declined significantly among women 25 to 44, 45 to 64, and more than 65 years of age, respectively, from 1.13 to 0.96, 1.32 to 1.19, and 1.48 to 1.26. The narrowing of mortality occurred among Whites and, to a lesser extent, Blacks. A relative increase in either breast cancer incidence among women in lower SES counties or improved survival among women in higher SES counties (reflecting greater use of screening and treatment) could account for this relative worsening of breast cancer mortality among lower SES women in lower SES counties. Handle: RePEc:aph:ajpbhl:1994:84:6:1003-1006_5 Template-Type: ReDIF-Article 1.0 Title: Changes in HIV-related information sources, instruction, knowledge, and behaviors among US high school students, 1989 and 1990 Journal: American Journal of Public Health Author-Name: Holtzman, D. Author-Name: Lowry, R. Author-Name: Kann, L. Author-Name: Collins, J.L. Author-Name: Kolbe, L.J. Year: 1994 Volume: 84 Issue: 3 Pages: 388-393 Abstract: Objectives. Few data have been available among adolescents to determine behavioral changes that may prevent human immunodeficiency virus (HIV) infection. This analysis examines changes in the prevalence of self-reported HIV-related information sources, instruction, knowledge, and behaviors among high school students in the United States. Methods. Two independent, multistage national probability samples of students in grades 9 through 12 were surveyed in 1989 (n = 8098) and 1990 (n = 11 631) with self- administered, anonymous questionnaires that included similar items. Results. Compared with students surveyed in 1989, a significantly greater proportion of students surveyed in 1990 had received HIV instruction in school. Significant decreases were found in the proportion of White and female students who reported having had sexual intercourse, in the proportion of White students reporting two or more lifetime sex partners, and in the proportion of 15- and 16-year-olds, White students, and female students who reported having had four or more lifetime sex partners. For both years, students who had a greater level of HIV knowledge were less likely to have had multiple lifetime sex partners or to have injected illicit drugs. Conclusions. The findings suggest that school-based HIV education and knowledge may be contributing factors in reducing certain risk behaviors that can lead to HIV transmission among secondary school youth. Handle: RePEc:aph:ajpbhl:1994:84:3:388-393_1 Template-Type: ReDIF-Article 1.0 Title: AIDS risk reduction and reduced HIV seroconversion among injection drug users in Bangkok Journal: American Journal of Public Health Author-Name: Des Jarlais, D.C. Author-Name: Choopanya, K. Author-Name: Vanichseni, S. Author-Name: Plangsringarm, K. Author-Name: Sonchai, W. Author-Name: Carballo, M. Author-Name: Friedmann, P. Author-Name: Friedman, S.R. Year: 1994 Volume: 84 Issue: 3 Pages: 452-455 Abstract: Human immunodeficiency virus (HIV) seroconversion was studied in a group of 173 injection drug users in Bangkok, Thailand, who had been previously tested for HIV and were interviewed and retested in the fall of 1989. Ten percent of the group had seroconverted. Two factors protected against HIV seroconversion: having stopped sharing injection equipment in response to the acquired immunodeficiency syndrome (AIDS) and having a regular sexual partner. The association between self-reported deliberate risk reduction and reduced HIV seroconversion among persons continuing to inject illicit drugs indicates that injection drug users can change their behavior in response to AIDS and will accurately report on the behavior change, and that the changes can protect against HIV infection. Handle: RePEc:aph:ajpbhl:1994:84:3:452-455_6 Template-Type: ReDIF-Article 1.0 Title: Cancer prevention: accomplishments and prospects. Journal: American Journal of Public Health Author-Name: Cole, P. Author-Name: Amoateng-Adjepong, Y. Year: 1994 Volume: 84 Issue: 1 Pages: 8-10 Handle: RePEc:aph:ajpbhl:1994:84:1:8-10_5 Template-Type: ReDIF-Article 1.0 Title: The relationship between mortality and intensity of inpatient alcoholism treatment Journal: American Journal of Public Health Author-Name: Bunn, J.Y. Author-Name: Booth, B.M. Author-Name: Cook, C.A.L. Author-Name: Blow, F.C. Author-Name: Fortney, J.C. Year: 1994 Volume: 84 Issue: 2 Pages: 211-214 Abstract: Objectives. Previous studies have examined mortality in alcoholics receiving extended inpatient alcoholism treatment, but few have investigated less intense treatment. This study examined mortality within 3 years after discharge from varying intensities of inpatient alcoholism treatment. Methods. Using the computerized database of the Department of Veterans Affairs, we identified men participating in varying intensities of inpatient alcoholism treatment and followed them for 3 years after discharge. Adjusted mortality rates were computed and survival analysis was performed to assess the risk of death, adjusting for factors that may be related to mortality. Results. The death rate was lower for men who completed extended formal inpatient treatment than for those who began, but did not complete, inpatient treatment or those who underwent short detoxification. Differences among the treatment groups remained after age, race, marital status, and disease severity were controlled. Conclusions. These results suggest that extended formal inpatient alcoholism treatment is associated with a lower risk of death than less intense forms of inpatient treatment. Handle: RePEc:aph:ajpbhl:1994:84:2:211-214_5 Template-Type: ReDIF-Article 1.0 Title: Projected numbers of cancers diagnosed in the US elderly population, 1990 through 2030 Journal: American Journal of Public Health Author-Name: Polednak, A.P. Year: 1994 Volume: 84 Issue: 8 Pages: 1313-1316 Abstract: As based on Bureau of the Census population projections and age-specific cancer incidence rates for 1985 to 1989 from the National Cancer Institute's Surveillance, Epidemiology and End Results program, the number of incident cancers diagnosed annually in the United States among persons aged 65 and over is projected to reach 1.5 million by the year 2030, or 2.4 times the number estimated for 1990. These projections, which may be conservative because birth cohort patterns (based on Connecticut rates) suggest possible future increases in incidence rates for all cancer sites combined, have implications for planning expanded primary prevention efforts, such as smoking cessation (especially for women) and dietary modification programs, and for projecting health care needs and costs. Handle: RePEc:aph:ajpbhl:1994:84:8:1313-1316_9 Template-Type: ReDIF-Article 1.0 Title: Erratum: Letter to the editor (American Journal of Public Health (1993) 83 (1641-1642)) Journal: American Journal of Public Health Author-Name: Karp, R. Author-Name: Birnbaum, J. Year: 1994 Volume: 84 Issue: 1 Pages: 125 Handle: RePEc:aph:ajpbhl:1994:84:1:125_2 Template-Type: ReDIF-Article 1.0 Title: Hearing impairment among 10-year-old children: Metropolitan Atlanta, 1985 through 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: 1994 Volume: 84 Issue: 7 Pages: 1164-1166 Abstract: The prevalence of hearing impairment among 10-year-old children in metropolitan Atlanta between 1985 and 1987 was evaluated. Hearing-impaired children were identified by reviewing records at public schools and health and social service agencies. The prevalence was 1.1 per 1000 and was slightly higher among Blacks and boys than among Whites and girls. The most common known causes of hearing impairment were meningitis (0.3 per 1000), genetic and hereditary conditions (0.2 per 1000), and congenital rubella syndrome (0.1 per 1000). For 55% of the children, the etiology of the hearing loss could not be determined. Most (74%) of the children were diagnosed after the age of 2, suggesting that methods of early identification need to be improved. Handle: RePEc:aph:ajpbhl:1994:84:7:1164-1166_7 Template-Type: ReDIF-Article 1.0 Title: The role of state health departments in formulating policy: A survey on the case of AIDS Journal: American Journal of Public Health Author-Name: Robins, L. Author-Name: Backstrom, C. Year: 1994 Volume: 84 Issue: 6 Pages: 905-909 Abstract: Objectives. Public health departments have been criticized for not being on the cutting edge of health policy formation in the United States and, in particular, for being ineffective in dealing with acquired immunodeficiency syndrome (AIDS). This study examines the attitudes and influence of public health officials on this problem. Methods. A survey of state health department officials was supplemented by surveys of state legislature health committee chairs and hospital association directors, as well as by interviews with key AIDS policymakers and observers in six states. Results. Both in their own eyes and in the eyes of legislative leaders and hospital association officials, public health officials were considered to be the principal initiators of public policy on AIDS. Conclusions. Contrary to the Institute of Medicine's 1988 report, state health departments are leaders in the fight against AIDS at the state level. Moreover, we argue that public health departments should be judged on how effectively they perform functions for which they have primary legal responsibilities, not for other roles for which they have been given neither responsibility nor resources. Handle: RePEc:aph:ajpbhl:1994:84:6:905-909_0 Template-Type: ReDIF-Article 1.0 Title: The ecological effects of individual exposures and nonlinear disease dynamics in populations Journal: American Journal of Public Health Author-Name: Koopman, J.S. Author-Name: Longini Jr., I.M. Year: 1994 Volume: 84 Issue: 5 Pages: 836-842 Abstract: To describe causally predictive relationships, model parameters and the data used to estimate them must correspond to the social context of causal actions. Causes may act directly upon the individual, during a contact between individuals, or upon a group dynamic. Assuming that outcomes in different individuals are independent puts the causal action directly upon individuals. Analyses making this assumption are thus inappropriate for infectious diseases, for which risk factors alter the outcome of contacts between individuals. Transmission during contact generates nonlinear infection dynamics. These dynamics can so attenuate exposure-infection relationships at the individual level that even risk factors causing the vast majority of infections can be missed by individual-level analyses. On the other hand, these dynamics amplify causal associations between exposure and infection at the ecological level. The amplification and attenuation derive from chains of transmission initiated by exposed individuals but involving unexposed individuals. A study of household exposure to the only vector of dengue in Mexico illustrates the phenomenon. An individual-level analysis demonstrated almost no association between exposure and infection. Ecological analysis, in contrast, demonstrated a strong association. Transmission models that are devoid of any sources of the ecological fallacy are used to illustrate how nonlinear dynamics generate such results. Handle: RePEc:aph:ajpbhl:1994:84:5:836-842_8 Template-Type: ReDIF-Article 1.0 Title: Family networks: Predictors of nursing home entry Journal: American Journal of Public Health Author-Name: Freedman, V.A. Author-Name: Berkman, L.F. Author-Name: Rapp, S.R. Author-Name: Ostfeld, A.M. Year: 1994 Volume: 84 Issue: 5 Pages: 843-845 Abstract: Despite the importance of kin in caring for older relatives, few studies have examined the relationship between the family network and the risk of nursing home placement. Data from a cohort of noninstitutionalized elderly persons living in New Haven in 1982 were used to predict nursing home admission through 1985. Logistic regression analyses show that older persons who have regular contact with kin have a lower risk of institutionalization. For men, the spouse is most important in reducing the risk of entry; for women, having regular contact with at least one family member-of any relation-reduces the risk of entry. Handle: RePEc:aph:ajpbhl:1994:84:5:843-845_9 Template-Type: ReDIF-Article 1.0 Title: Risk factors for violent behavior in elementary school boys: Have you hugged your child today? Journal: American Journal of Public Health Author-Name: Sheline, J.L. Author-Name: Skipper, B.J. Author-Name: Broadhead, W.E. Year: 1994 Volume: 84 Issue: 4 Pages: 661-663 Abstract: Seventeen Hispanic elementary schoolboys with violent behavior problems were compared with 27 matched control students who were not overtly violent at school. Violent boys were significantly more likely to not live with their fathers, to have unmarried parents, to have more siblings, and to have fathers who never show them affection. Parents of violent boys were more likely than those of matched control students to use spanking for discipline and to admit that they rarely express affection for their sons. Handle: RePEc:aph:ajpbhl:1994:84:4:661-663_1 Template-Type: ReDIF-Article 1.0 Title: Infertility in women and moderate alcohol use Journal: American Journal of Public Health Author-Name: Grodstein, F. Author-Name: Goldman, M.B. Author-Name: Cramer, D.W. Year: 1994 Volume: 84 Issue: 9 Pages: 1429-1432 Abstract: Objective. The purpose of this study was to investigate the relationship between moderate alcohol intake and fertility. Methods. Interviews were conducted with 3833 women who recently gave birth and 1050 women from seven infertility clinics. The case subjects were categorized based on the infertility specialist's assignment of the most likely cause of infertility: ovulatory factor, tubal disease, cervical factor, endometriosis, or idiopathy. Separate logistic regression models were used to assess the relationship between alcohol use and each type of infertility, adjusted for age, infertility center, cigarette smoking, caffeine use, number of sexual partners, use of an intrauterine device (for tubal disease), and body mass index and exercise (for ovulatory factor). Results. We found an increase in infertility, due to ovulatory factor or endometriosis, with alcohol use. The odds ratio for ovulatory factor was 1.3 (95% confidence interval [CI] = 1.0, 1.7) for moderate drinkers and 1.6 (95% CI = 1.1, 2.3) for heavier drinkers, compared with non-drinkers. The risk of endometriosis was roughly 50% higher in case subjects with any alcohol intake than in control subjects (OR = 1.6, 95% CI = 1.1, 2.3, at moderate levels; OR = 1.5, 95% CI = 0.8, 2.7, at heavier levels). Conclusions. Moderate alcohol use may contribute to the risk of specific types of infertility. Handle: RePEc:aph:ajpbhl:1994:84:9:1429-1432_1 Template-Type: ReDIF-Article 1.0 Title: Racial differences in cervical cancer mortality in Chicago Journal: American Journal of Public Health Author-Name: Samelson, E.J. Author-Name: Speers, M.A. Author-Name: Ferguson, R. Author-Name: Bennett, C. Year: 1994 Volume: 84 Issue: 6 Pages: 1007-1009 Abstract: Racial differences in cervical cancer mortality in Chicago were examined. Age-adjusted mortality in Blacks (10.0/100 000) was over twice the rate found in Whites (4.6/100 000). Age-specific rates also showed significant excess mortality among Blacks. After stratification by a group-level defined poverty indicator, the race differential in age-adjusted rates remained significant. The race differential in age-specific rates diminished in the group with more than 30% living below the national poverty level, in contrast to the group with 30% or fewer living below the national poverty level, in whom race differences were more marked. Methodological issues concerning hysterectomy prevalence, Hispanic ethnicity, and social class must be considered with respect to interpretation of these findings. Handle: RePEc:aph:ajpbhl:1994:84:6:1007-1009_8 Template-Type: ReDIF-Article 1.0 Title: Chronic fatigue syndrome: Have flawed assumptions been derived from treatment-based studies? Journal: American Journal of Public Health Author-Name: Richman, J.A. Author-Name: Flaherty, J.A. Author-Name: Rospenda, K.M. Year: 1994 Volume: 84 Issue: 2 Pages: 282-284 Abstract: Chronic fatigue syndrome is a disabling disorder that has been studied primarily in clinical settings. In the absence of an adequate epidemiological database, cultural stereotypes have influenced the characterization of chronic fatigue syndrome as 'the yuppie flu,' similar to the 19th century characterization of neurasthenia as a disease of the affluent. The limited epidemiological data available and the overall medical-sociological literature call this assumption into question. Only a community 'true' prevalence study that is unbiased by help seeking and access to health care can provide an accurate assessment of the risk factors for and the public health ramifications of this disease. Handle: RePEc:aph:ajpbhl:1994:84:2:282-284_5 Template-Type: ReDIF-Article 1.0 Title: Medicaid physician payment reform: Using the Medicare Fee Schedule for Medicaid payments Journal: American Journal of Public Health Author-Name: Reisinger, A.L. Author-Name: Colby, D.C. Author-Name: Schwartz, A. Year: 1994 Volume: 84 Issue: 4 Pages: 553-560 Abstract: Objectives. The purpose of this article is to provide estimates of the costs of basing Medicaid physician payment levels on the new resource-based Medicare Fee Schedule. Two possible policy options are considered: setting all Medicaid physician fees at the Medicare Fee Schedule level and setting only office visit fees at the new Medicare levels. Methods. Data on Medicaid physician fees, use patterns, and the Medicare Fee Schedule are used to develop state-level estimates of expenditure changes under each option. Results. Setting Medicaid rates at the Medicare Fee Schedule level could increase expenditures by $3.2 to $4.1 billion nationally; the other option would result in substantially lower increases in expenditures. Because of the current variations in Medicaid physician fees and in the breadth of eligibility across states, the cost of adopting the Medicare Fee Schedule varies considerably among states. Conclusions. Adopting the new Medicare Fee Schedule for Medicaid payments, proposed by policy-makers as a way to increase access to appropriate medical care, could double physician expenditures in some states. Adoption of more limited versions of the fee schedule might achieve some access gains at lower costs. Handle: RePEc:aph:ajpbhl:1994:84:4:553-560_8 Template-Type: ReDIF-Article 1.0 Title: The geographic variation of cancer incidence in Ontario Journal: American Journal of Public Health Author-Name: Walter, S.D. Author-Name: Birnie, S.E. Author-Name: Marrett, L.D. Author-Name: Taylor, S.M. Author-Name: Reynolds, D. Author-Name: Davies, J. Author-Name: Drake, J.J. Author-Name: Hayes, M. Year: 1994 Volume: 84 Issue: 3 Pages: 367-376 Abstract: Objectives. Our objectives were (1) to describe an analysis of the spatial pattern of cancer incidence in Ontario and (2) to discuss the quality of data in the Ontario Cancer Registry with respect to the accuracy of local cancer rates. Methods. Cancer incidence rates were calculated for 22 cancer sites in 49 counties of Ontario during 1976 to 1986. Capture-recapture methods were used to estimate completeness of case registration, and completeness of residence information was also assessed. Spatial autocorrelation was used in measuring the geographic pattern of incidence rates. Comparisons were also made between sexes and with earlier data from 1966 to 1975. Results. The quality of the geographic data in the registry appeared good, and corrections for incomplete or inaccurate registration had little impact. About one third of the sex-site combinations showed some evidence of spatial patterning in the cancer rate. Particularly strong regional variation was noted for cancers of the stomach lung, uterus, and prostate. Conclusions. The analysis revealed a number of cancers with significant spatial patterning of risk. Further work is needed to relate the cancer data to other information on potential life- style and environmental factors. Handle: RePEc:aph:ajpbhl:1994:84:3:367-376_0 Template-Type: ReDIF-Article 1.0 Title: Factors associated with the use of violence among urban Black adolescents Journal: American Journal of Public Health Author-Name: DuRant, R.H. Author-Name: Cadenhead, C. Author-Name: Pendergrast, R.A. Author-Name: Slavens, G. Author-Name: Linder, C.W. Year: 1994 Volume: 84 Issue: 4 Pages: 612-617 Abstract: Objectives. The purpose of this study was to examine social and psychological factors associated with the use and nonuse of violence among Black adolescents living in a community with a high level of violent crime. Methods. Adolescents (n = 225, 44% male) 11 to 19 years of age living in or around nine housing projects in an urban area were administered an anonymous questionnaire. Results. Self-reported use of violence was associated with exposure to violence and personal victimization, hopelessness, depression, family conflict, previous corporal punishment, purpose in life, self- assessment of the probability of being alive at age 25, and age and was higher among males. Conclusions. These data support the hypothesis that exposure to violence is associated with adolescents' self-reported use of violence. However, adolescents with a higher sense of purpose in life and less depression were better able to withstand the influence of exposure to violence in the home and in the community. Handle: RePEc:aph:ajpbhl:1994:84:4:612-617_7 Template-Type: ReDIF-Article 1.0 Title: AIDS, HIV infection, and illicit drug use within inner-city families and social networks Journal: American Journal of Public Health Author-Name: Pivnick, A. Author-Name: Jacobson, A. Author-Name: Eric, K. Author-Name: Doll, L. Author-Name: Drucker, E. Year: 1994 Volume: 84 Issue: 2 Pages: 271-274 Abstract: Objectives. Drug use is commonly depicted and treated as an individual problem. This study describes the extent of drug use, human immunodeficiency virus (HIV) infection, and acquired immunodeficiency syndrome (AIDS) among drug users' sexual partners and family and household members in order to broaden considerations of risk. Methods. Social network charts and structured interviews were administered to 126 women (predominantly African American and Latino) enrolled in methadone treatment. The charts elicited the prevalence of drug use and HIV infection among subjects' family and household members. Results. Drug use and HIV/AIDS permeated subjects' sexual, familial, and household relationships. More than half of the women who resided with a sexual partner reported that their partners currently used drugs. Almost one third of the subjects' siblings were drug users. Of the 715 total siblings (all subjects plus their siblings), 69 (9.7%) were known to be HIV positive or to have an AIDS diagnosis. Conclusions. The sexual, familial, and household expressions of drug use underscore the notion that drug use and attendant risks, including but not limited to HIV infection, might be usefully viewed and treated as an inter- and intracommunity problem rather than as an exclusively individual one. Handle: RePEc:aph:ajpbhl:1994:84:2:271-274_5 Template-Type: ReDIF-Article 1.0 Title: Elevated blood lead levels among construction workers in the Massachusetts Occupational Lead Registry Journal: American Journal of Public Health Author-Name: Rabin, R. Author-Name: Brooks, D.R. Author-Name: Davis, L.K. Year: 1994 Volume: 84 Issue: 9 Pages: 1483-1485 Abstract: Although the construction industry until recently was exempt from the Occupational Health and Safety Administration General Industry Lead Standard, including its medical monitoring provisions, periodic blood lead tests have been required for residential 'deleaders' and structural painters in Massachusetts. Sixty-three percent of the 381 registrants in the Massachusetts Occupational Lead Registry with blood lead levels of 1.93 μmol/L or higher are construction workers. This proportion is much higher than that reported by registries of several states selected for comparison. These data highlight the need for better protection from lead exposure and the effectiveness of mandatory medical surveillance in identifying elevated blood lead levels among construction workers. Handle: RePEc:aph:ajpbhl:1994:84:9:1483-1485_5 Template-Type: ReDIF-Article 1.0 Title: The incidence of tuberculosis among North Carolina migrant farmworkers, 1991 Journal: American Journal of Public Health Author-Name: Ciesielski, S. Author-Name: Esposito, D. Author-Name: Protiva, J. Author-Name: Piehl, M. Year: 1994 Volume: 84 Issue: 11 Pages: 1836-1838 Abstract: All locatable subjects (n = 94) for whom tuberculosis prevalence had been determined in an earlier study were tested with purified protein derivative (PPD) and control antigens, sputum sampling, and chest x-rays. Of the 46 who had been tuberculin negative (confirmed with control antigens) 3 years earlier, 2 had developed active tuberculosis in the interim and 14 (30%) were tuberculin positive. All had been engaged continuously in migrant farmwork. Lack of access to health care, an institutional feature of migrant farmwork, was significantly associated with primary infection. Handle: RePEc:aph:ajpbhl:1994:84:11:1836-1838_0 Template-Type: ReDIF-Article 1.0 Title: Racial differences in rural adults' attitudes toward issues of adolescent sexuality Journal: American Journal of Public Health Author-Name: Horner, R.D. Author-Name: Kolasa, K.M. Author-Name: Irons, T.G. Author-Name: Wilson, K. Year: 1994 Volume: 84 Issue: 3 Pages: 456-459 Abstract: This study, based on a random sample of adults in a rural North Carolina county, demonstrates racial differences in rural adults' attitudes relating to adolescent sexual issues. Blacks were 50% more likely than Whites to indicate that public schools should provide general health care services, including pregnancy testing and treatment of sexually transmitted diseases, to teenagers; however, they were only half as likely as Whites to approve of sexual experimentation by adolescents. The local community's attitudes must be considered in the implementation of rural adolescent health programs, including acquired immunodeficiency syndrome education. Handle: RePEc:aph:ajpbhl:1994:84:3:456-459_2 Template-Type: ReDIF-Article 1.0 Title: Socioeconomic factors and height of preschool children in the Czech Republic Journal: American Journal of Public Health Author-Name: Bobak, M. Author-Name: Kriz, B. Author-Name: Leon, D.A. Author-Name: Danova, J. Author-Name: Marmot, M. Year: 1994 Volume: 84 Issue: 7 Pages: 1167-1170 Abstract: The effect of socioeconomic factors on growth was investigated among 2275 children 3 to 6 years old attending nurseries in the Czech Republic. Measured heights of children were converted into height-for-age z scores. After adjustment for birthweight, parental height, and other socioeconomic variables, only mother's education was independently and significantly associated with children's height; adjusted differences in z scores between children of secondary- and university-educated mothers and children of mothers with only primary education were 0.12 and 0.31, respectively. This is equivalent to 0.5 and 1.5 cm, respectively, for children 5 years old. Handle: RePEc:aph:ajpbhl:1994:84:7:1167-1170_9 Template-Type: ReDIF-Article 1.0 Title: Correlates of needle sharing among injection drug users Journal: American Journal of Public Health Author-Name: Mandell, W. Author-Name: Vlahov, D. Author-Name: Latkin, C. Author-Name: Oziemkowska, M. Author-Name: Cohn, S. Year: 1994 Volume: 84 Issue: 6 Pages: 920-923 Abstract: Objectives. The sharing of contaminated injection equipment is the primary mode of human immunodeficiency virus (HIV) transmission for injection drug users. This study examined demographic factors, life events, and drug use practices that are potential risk factors for sharing injection equipment. Methods. Between February 1988 and March 1989, 2921 active injection drug users were interviewed and questioned about their backgrounds, life-styles, and patterns of injection drug use. Results. Of 2524 participants who reported injecting drugs within the 6 months prior to study enrollment, 70.4% reported recent needle sharing. A multivariate analysis found needle sharing to be more frequent among those with a history of arrest and lower socioeconomic status, even after accounting for other demographic and drug use variables. In addition, recent needle sharing was higher in male homosexual or bisexual men than in their heterosexual counterparts. Conclusions. These data suggest that injection drug users have an economic motive to share needles and that the availability of free and legal needles may reduce levels of needle sharing. Handle: RePEc:aph:ajpbhl:1994:84:6:920-923_5 Template-Type: ReDIF-Article 1.0 Title: Occupational injury deaths of 16- and 17-year-olds in the United States Journal: American Journal of Public Health Author-Name: Castillo, D.N. Author-Name: Landen, D.D. Author-Name: Layne, L.A. Year: 1994 Volume: 84 Issue: 4 Pages: 646-649 Abstract: Data from the National Traumatic Occupational Fatalities surveillance system were used to analyze occupational injury deaths of civilian 16- and 17-year-olds during 1980 through 1989. There were 670 deaths; the rate was 5.11 per 100 000 full-time equivalent workers. The leading causes of death were incidents involving motor vehicles and machines, electrocution, and homicide. Workers 16 and 17 years old appear to be at greater risk than adults for occupational death by electrocution, suffocation, drowning, poisoning, and natural and environmental factors. Improved enforcement of and compliance with federal child labor laws, evaluation of the appropriateness of currently permitted activities, and education are encouraged. Handle: RePEc:aph:ajpbhl:1994:84:4:646-649_3 Template-Type: ReDIF-Article 1.0 Title: State family planning and abortion expenditures: Their effect on public health Journal: American Journal of Public Health Author-Name: Meier, K.J. Author-Name: McFarlane, D.R. Year: 1994 Volume: 84 Issue: 9 Pages: 1468-1472 Abstract: Objectives. This study examines whether state family planning expenditures and abortion funding for Medicaid-eligible women might reduce the number of low-birthweight babies, babies with late or no prenatal care, and premature births, as well as the rates of infant and neonatal mortality. Methods. Using a pooled time-series analysis from 1982 to 1988 with the 50 states as units of analysis, this study assessed the impact of family planning expenditures and abortion funding on several public health outcomes while controlling for other important variables and statistical problems inherent in pooled time- series studies. Results. States that funded abortions had a significantly higher rate of abortions and significantly lower rates of teen pregnancy, low-birthweight babies, premature births, and births with late or no prenatal care. States that had higher expenditures for family planning had significantly fewer abortions, low-birthweight babies, births with late or no prenatal care, infant deaths, and neonatal deaths. Conclusions. Funding abortions for Medicaid-eligible women and increasing the level of expenditures for family planning are associated with major differences in infant and maternal health in the United States. Handle: RePEc:aph:ajpbhl:1994:84:9:1468-1472_8 Template-Type: ReDIF-Article 1.0 Title: The utility of HMO data for the surveillance of chronic diseases Journal: American Journal of Public Health Author-Name: Nordstrom, D.L. Author-Name: Remington, P.L. Author-Name: Layde, P.M. Year: 1994 Volume: 84 Issue: 6 Pages: 995-997 Abstract: In an area served by a single medical center that operates as both health maintenance organization (HMO) and fee-for-service clinic, we reviewed existing computerized medical records to determine the prevalence of 11 diseases. Standardized medical care utilization prevalence ratios, comparing the annual prevalences in the two groups, varied from 1,38 for rheumatoid arthritis to 0.60 for liver cirrhosis. Unless supplemented by data from hospitals, physicians, and other sources, HMO data may result in invalid estimates of the prevalence of chronic disease. Handle: RePEc:aph:ajpbhl:1994:84:6:995-997_0 Template-Type: ReDIF-Article 1.0 Title: Suicidal ideation and attempts among chemically dependent adolescents Journal: American Journal of Public Health Author-Name: Deykin, E.Y. Author-Name: Buka, S.L. Year: 1994 Volume: 84 Issue: 4 Pages: 634-639 Abstract: Objectives. Suicidal ideation and attempts were examined in a population of chemically dependent adolescents, a group at high risk of self-destructive behavior. Methods. The prevalence and correlates of suicidality and of major depressive disorder were assessed by the Diagnostic Interview Schedule and a structured family and social history interview with 300 addicts aged 15 through 19 years. Results. Suicidal ideation was reported by 31% to 75% of the subjects and suicide attempts were reported by 28% to 61%, with females predominating. Thoughts of suicide combined with prolonged thoughts of death in general and a desire to be dead were highly associated with suicide attempts. Exposure to physical or sexual abuse was associated with a significantly increased risk of suicide attempts for males but not for females. Conclusions. The probability of a suicide attempt increases when thoughts of suicide coincide with morbid ideation of extended duration, suggesting that risk assessment should be based on duration as well as presence of morbid thoughts. Substance abuse treatment requires an assessment of suicidal potential and counseling for those whose potential is high, with special attention to males exposed to abuse. Handle: RePEc:aph:ajpbhl:1994:84:4:634-639_1 Template-Type: ReDIF-Article 1.0 Title: International infant mortality rates: Bias from reporting differences Journal: American Journal of Public Health Author-Name: Howell, E.M. Author-Name: Blondel, B. Year: 1994 Volume: 84 Issue: 5 Pages: 850-852 Abstract: International infant mortality statistics have caused concern in the United States, since the US ranking relative to other developed countries has declined since World War II. This paper suggests that there may be international differences in reporting of very-low-birthweight infants and perinatal deaths and that such reporting differences bias comparisons of national perinatal and infant mortality rates. Efforts must be made to adopt standard conventions for the inclusion of small, early infants and fetal deaths in rate calculations. Handle: RePEc:aph:ajpbhl:1994:84:5:850-852_1 Template-Type: ReDIF-Article 1.0 Title: US dietary patterns associated with fat intake: The 1987 National Health Interview Survey Journal: American Journal of Public Health Author-Name: Subar, A.F. Author-Name: Ziegler, R.G. Author-Name: Patterson, B.H. Author-Name: Ursin, G. Author-Name: Graubard, B. Year: 1994 Volume: 84 Issue: 3 Pages: 359-366 Abstract: Objectives. This research used food frequency data to investigate dietary patterns associated with fat intake. Methods. Data from the 1987 National Health Interview Survey of 20 143 adults were used to determine correlations between fat (adjusted for kilocalories) and both nutrient and food group intakes. Median food and nutrient intakes were determined within quartiles of percentage of kilocalories from fat. Results. Intakes of vegetables, fruits, cereals, fish/chicken, low-fat milk, alcoholic beverages, vitamin C, percentage of kilocalories from carbohydrates, carotenoids, folate, dietary fiber, carbohydrates, and vitamin A decreased as percentage of kilocalories from fat increased. Intakes of salty snacks, peanuts, processed and red meats, whole milk and cheese, desserts, eggs, fried potatoes, table fats, cholesterol, vitamin E, sodium, protein, and energy increased with percentage of kilocalories from fat. Results by demographic subgroups showed few differences from those found in the total population. Conclusions. Fat intake is consistently associated with specific dietary patterns. Such patterns need to be evaluated concurrently in studies of diet and chronic disease. Handle: RePEc:aph:ajpbhl:1994:84:3:359-366_4 Template-Type: ReDIF-Article 1.0 Title: The 1966 enactment of Medicare: Its effect on discharges from Los Angeles county-operated hospitals Journal: American Journal of Public Health Author-Name: Glassman, P.A. Author-Name: Bell, R.M. Author-Name: Tranquada, R.E. Year: 1994 Volume: 84 Issue: 8 Pages: 1325-1327 Abstract: The effect of Medicare on two public hospitals in Los Angeles County was analyzed by examining the percentage of patients 65 years of age and older among all discharges from 1958 through 1971. At Harbor General Hospital, discharges of elderly patients had dropped from 21.7% to 7.9% by late 1966; at Los Angeles County General Hospital, discharges decreased from 15.3% to 10.7% between 1966 and 1967. Monitoring public hospitals' demographic changes after enacting a national health plan may provide information on patients' and providers' acceptance of insurance and on resources needed by public hospitals to care for those left without coverage. Handle: RePEc:aph:ajpbhl:1994:84:8:1325-1327_5 Template-Type: ReDIF-Article 1.0 Title: The logic in ecological: I. The logic of analysis Journal: American Journal of Public Health Author-Name: Susser, M. Year: 1994 Volume: 84 Issue: 5 Pages: 825-829 Abstract: This paper addresses ecological studies in public health research in terms of the logic of their analysis. It makes several distinctions between studies based on ecological and individual units. First, it identifies the variables common to both types of study and those particular to ecological studies. Second, it shows how ecological and individual units combine in two classes: unmixed (purely ecological, purely individual) and mixed. Third, it details how the relationships among and between individual and grouped units (expressed in terms of regression coefficients between independent and dependent variables) yield four coefficients: for all individual members; for all groups; for all individuals within each group; and for all individuals within groups (a weighted average). Equipped with an understanding of the dimensions involved at ecological and individual levels and of the relationships between them, researchers are in a position to exploit the public health potential of the ecological approach. Handle: RePEc:aph:ajpbhl:1994:84:5:825-829_4 Template-Type: ReDIF-Article 1.0 Title: The proportion of veterans among homeless men Journal: American Journal of Public Health Author-Name: Rosenheck, R. Author-Name: Frisman, L. Author-Name: Chung, A.-M. Year: 1994 Volume: 84 Issue: 3 Pages: 466-469 Abstract: This study used data from four surveys conducted in 1986/87 to identify age-race cohorts of homeless men in which veterans are overrepresented. The overall proportion of veterans among homeless men (41%) was somewhat higher than that in the general population (34%). This overrepresentation is largely attributable to the disproportionate representation of veterans in the youngest age cohort (20 to 34 years) of homeless White men. Veterans in this group are 4.76 times more likely to be homeless than nonveterans. Other national data on this cohort reveal higher rates of unemployment, substance abuse, and antisocial personality among veterans than among non-veterans. Handle: RePEc:aph:ajpbhl:1994:84:3:466-469_2 Template-Type: ReDIF-Article 1.0 Title: Estimating clinical morbidity due to ischemic heart disease and congestive heart failure: The future rise of heart failure Journal: American Journal of Public Health Author-Name: Bonneux, L. Author-Name: Barendregt, J.J. Author-Name: Meeter, K. Author-Name: Bonsel, G.J. Author-Name: Van der Maas, P.J. Year: 1994 Volume: 84 Issue: 1 Pages: 20-28 Abstract: Objectives. Many developed countries have seen declining mortality rates for heart disease, together with an alleged decline in incidence and a seemingly paradoxical increase in health care demands. This paper presents a model for forecasting the plausible evolution of heart disease morbidity. Methods. The simulation model combines data from different sources. It generates acute coronary event and mortality rates from published data on incidences, recurrences, and lethalities of different heart disease conditions and interventions. Forecasts are based on plausible scenarios for declining incidence and increasing survival. Results. Mortality is postponed more than incidence. Prevalence rates of morbidity will decrease among the young and middle-aged but increase among the elderly. As the milder disease states act as risk factors for the more severe states, effects will culminate in the most severe disease states with a disproportionate increase in older people. Conclusions. Increasing health care needs in the face of declining mortality rates are no contradiction, but reflect a tradeoff of mortality for morbidity. The aging of the population will accentuate this morbidity increase. Handle: RePEc:aph:ajpbhl:1994:84:1:20-28_9 Template-Type: ReDIF-Article 1.0 Title: The sexual assault of women at work in Washington State, 1980 to 1989 Journal: American Journal of Public Health Author-Name: Alexander, B.H. Author-Name: Franklin, G.M. Author-Name: Wolf, M.E. Year: 1994 Volume: 84 Issue: 4 Pages: 640-642 Abstract: Sexual assault in the workplace and the related factors have not been well studied. Workers' compensation claims data were used to describe work- related sexual assaults in Washington State between 1980 and 1989. Sixty- three cases of work-related rape were identified during this study period. The occupations of the rape victims were similar to occupations identified as high risk for other intentional injuries, and the rape incidents were characterized by isolation from the public and from coworkers. Estimates of industry-specific rates are presented. The identification, evaluation, and prevention of sexual assault and other workplace violence are discussed. Handle: RePEc:aph:ajpbhl:1994:84:4:640-642_9 Template-Type: ReDIF-Article 1.0 Title: Changes in the use of screening mammography: Evidence from the 1987 and 1990 National Health Interview Surveys Journal: American Journal of Public Health Author-Name: Breen, N. Author-Name: Kessler, L. Year: 1994 Volume: 84 Issue: 1 Pages: 62-67 Abstract: Objectives. Mammography rates reported by women in the National Health Interview Surveys of 1990 and 1987 are examined. Why this screening modality is not more frequently used is explored. Methods. Data from the 1987 and 1990 National Health Interview Surveys, conducted by the National Center for Health, Statistics, are cross-tabulated and compared. Results. In 1987, approximately 17% of women over 40 years of age reported having had a screening mammogram in the previous year. In 1990, the rate doubled. Race declined in importance; income and education remained strong, positive predictors of screening. Conclusions. Despite this dramatic increase, two thirds of women are not having screening mammograms. Use was not higher primarily because women did not realize that screening mammography tests for breast cancer in asymptomatic women. Primary care physicians are the main source of health education for screening mammography. The data suggest that public health programs to promote screening mammography should especially target primary care physicians and women with low incomes and education. Likewise, health care providers should ensure that their patients are referred to facilities that deliver high-quality mammography at low cost to make the procedure more accessible. Handle: RePEc:aph:ajpbhl:1994:84:1:62-67_4 Template-Type: ReDIF-Article 1.0 Title: Health status differentials in the People's Republic of China Journal: American Journal of Public Health Author-Name: Lawson, J.S. Author-Name: Lin, V. Year: 1994 Volume: 84 Issue: 5 Pages: 737-741 Abstract: Objectives. This study sought to demonstrate that health status varies markedly in different parts of China. Methods. The main source of data was statistics compiled by the Chinese Ministry for Public Health for 1978 to 1990 regarding causes of death. However, because mortality statistics in China are based on localities that have the capacity to provide data, they are not entirely representative. The international classification of disease categories was also used, together with anatomically based disease descriptions. Rates were calculated using the 1982 and 1990 population censuses. Results. Death rates differ markedly between urban and rural areas. Deaths due to infectious diseases, respiratory diseases, pregnancy and childbirth, and injuries and poisoning are much higher in rural areas; those due to pertussis, dysentery, typhoid, hepatitis, rabies, and anthrax are much more common in the apparently poorer provinces. Schistosomiasis remains a major problem in some provinces. Goiter and cretinism are still major diseases in many parts of China, especially those areas with iodine deficiency. Conclusions. Cause-of-death patterns in Chinese cities are similar to those of industrially developed countries such as Australia, Japan, and the United States. Such patterns in the poorer rural areas are much more typical of those of developing countries. Handle: RePEc:aph:ajpbhl:1994:84:5:737-741_5 Template-Type: ReDIF-Article 1.0 Title: The perinatal and infant health status of native Hawaiians Journal: American Journal of Public Health Author-Name: Kieffer, E.C. Author-Name: Mor, J.M. Author-Name: Alexander, G.R. Year: 1994 Volume: 84 Issue: 9 Pages: 1501-1504 Abstract: Hawaii vital record data for 1979 through 1990 were analyzed to examine potentially differing relationships between maternal and infant risks and outcomes in native Hawaiian and White infants. Despite high rates of inadequate prenatal care and teenage and unmarried child-bearing, the Hawaiian low-birthweight rate was below the US average. Hawaiian infants experienced an elevated risk of mortality, particularly among those of normal birthweight during the postneonatal period. Public health initiatives to reduce infant mortality must go beyond preventing teenage pregnancy and low birthweight to address Hawaiian infants' unique pattern of risk factors and the social and economic environment in which such risks abound. Handle: RePEc:aph:ajpbhl:1994:84:9:1501-1504_9 Template-Type: ReDIF-Article 1.0 Title: Why did black life expectancy decline from 1984 through 1989 in the United States? Journal: American Journal of Public Health Author-Name: Kochanek, K.D. Author-Name: Maurer, J.D. Author-Name: Rosenberg, H.M. Year: 1994 Volume: 84 Issue: 6 Pages: 938-944 Abstract: Objectives. The objective of this study was to partition the change in US life expectancy into those major causes of death and age groups that contributed most to the decline in life expectancy for Black males and females and to the increase in life expectancy for White males and females in the period from 1984 through 1989. Methods. By means of a life table partitioning technique, the positive and negative contributions of age and cause of death to changes in life expectancy were estimated. Results. Causes contributing most to the decrease in life expectancy for Black males included human immunodeficiency virus (HIV) infection (<5 and 20-69 years of age) and homicide (1-4 and 10-34 years of age); for Black females the causes included HIV infection (<5 and 20-59 years of age) and cancer (65-79 and ≥85 years of age). Conclusions. Mortality trends between the two major race groups in the United States diverged sharply, and without precedent, during the late 1980s. A description of these trends in terms of contributions to change in life expectancy may help us better analyze and interpret changes in the health of these groups and may contribute to a better allocation of resources for research, education, and public health programs. Handle: RePEc:aph:ajpbhl:1994:84:6:938-944_5 Template-Type: ReDIF-Article 1.0 Title: The weights and heights of Mexican-American adolescents: The accuracy of self-reports Journal: American Journal of Public Health Author-Name: Davis, H. Author-Name: Gergen, P.J. Year: 1994 Volume: 84 Issue: 3 Pages: 459-462 Abstract: The accuracy of Mexican-American adolescents' self-reported weights, heights, and body mass indexes was evaluated with data from the Hispanic Health and Nutrition Examination Survey. On average, adolescents with low measured body mass indexes and high measured body mass indexes overestimated and underestimated their weights, respectively. Categories of low and high body mass indexes created by applying cutoffs to reported body mass indexes had low sensitivities. For weight, height, and body mass indexes, measured and reported values were highly correlated. This high correlation suggests that adolescents' reported values can be used as continuous variables in multivariate analyses with only small errors resulting in the coefficients for weight, height, and body mass index. Handle: RePEc:aph:ajpbhl:1994:84:3:459-462_4 Template-Type: ReDIF-Article 1.0 Title: The impact of depressive symptomatology on physical disability: MacArthur studies of successful aging Journal: American Journal of Public Health Author-Name: Bruce, M.L. Author-Name: Seeman, T.E. Author-Name: Merrill, S.S. Author-Name: Blazer, D.G. Year: 1994 Volume: 84 Issue: 11 Pages: 1796-1799 Abstract: Objectives. The purpose of these analyses was to test the hypothesis that depressive symptomatology affects the risk of onset of physical disability in high-functioning elderly adults. Methods. The data come from the MacArthur Study of Successful Aging, a community-based cohort of high-functioning adults aged 70 through 79 years who were assessed twice at a 2.5-year interval. Physical and cognitive status was assessed by performance as well as by self-report measures. Results. In gender-stratified logistic regression models, high depressive symptoms as measured by the depression subscale of the Hopkins Symptom Checklist were associated with an increased risk of onset of disability in activities of daily living for both men and women, adjusting for baseline sociodemographic factors, physical health status, and cognitive functioning. Conclusions. Joined with evidence that physical disability is a potential risk factor for depression, these findings suggest that both depressive symptoms and physical disability can initiate a spiralling decline in physical and psychological health. Given the important impact of activities-of-daily-living functioning on utilization of medical services and quality of life, prevention or reduction of depressive symptoms should be considered an important point of intervention. Handle: RePEc:aph:ajpbhl:1994:84:11:1796-1799_5 Template-Type: ReDIF-Article 1.0 Title: Weight control practices in adults: Results of a multistate telephone survey Journal: American Journal of Public Health Author-Name: Serdula, M.K. Author-Name: Williamson, D.F. Author-Name: Anda, R.F. Author-Name: Levy, A. Author-Name: Heaton, A. Author-Name: Byers, T. Year: 1994 Volume: 84 Issue: 11 Pages: 1821-1824 Abstract: In this study, data collected in 1989 in a random-digit dialing telephone survey of 60 590 adults in 38 states and the District of Columbia were analyzed. Approximately 38% of women and 24% of men reported that they were currently trying to lose weight. Methods reported were counting calories (24% of women, 14% of men), participating in organized weight loss programs (10%, 3%), taking special supplements (10%, 7%), taking diet pills (4%, 2%), and fasting for 24 hours or longer (5%, 5%). Among both sexes, only half of those trying to lose weight reported using the recommended method of caloric restriction combined with physical activity. Handle: RePEc:aph:ajpbhl:1994:84:11:1821-1824_8 Template-Type: ReDIF-Article 1.0 Title: Patient adherence to guidelines for diabetes eye care: Results from the diabetic eye disease follow-up study Journal: American Journal of Public Health Author-Name: Will, J.C. Author-Name: German, R.R. Author-Name: Schurman, E. Author-Name: Michael, S. Author-Name: Kurth, D.M. Author-Name: Deeb, L. Year: 1994 Volume: 84 Issue: 10 Pages: 1669-1671 Abstract: Early detection and treatment of diabetic eye disease can prevent blindness, yet many persons with diabetes lack regular eye care. This study followed 569 people with diabetes participating in blindness prevention programs during 1985 through 1987; it was found that 35% of subjects received dilated eye examinations before entering the programs, in comparison with 60% afterward. About 85% of participants referred for proliferative retinopathy treatment began such treatment, and, of these, 85% completed treatment. A lack of knowledge about the disease and limited finances were primary reasons for nonadherence. To improve the effectiveness of prevention programs, eye care providers and program staff must strive to eliminate these educational and financial barriers. Handle: RePEc:aph:ajpbhl:1994:84:10:1669-1671_2 Template-Type: ReDIF-Article 1.0 Title: A community-based heart disease intervention: Predictors of change Journal: American Journal of Public Health Author-Name: Winkleby, M.A. Author-Name: Flora, J.A. Author-Name: Kraemer, H.C. Year: 1994 Volume: 84 Issue: 5 Pages: 767-772 Abstract: Objectives. This paper presents a prospective examination of sociodemographic, psychosocial, and physiologic characteristics associated with positive change in cardiovascular disease risk factors during a 6-year multiple risk factor intervention study. Methods. Data are presented on 221 women and 190 men (aged 25 through 74 years) who participated in four cohort surveys (1979 through 1985). A signal detection model was used to identify baseline variables that best divide the sample into subgroups on the basis of the probability of positive change in a composite risk factor score. Results. Sixty-nine percent of the respondents showed a positive change in risk factor score during the intervention. The subgroup with the highest proportion of positive changers (83%) was composed of older adults (> 55 years) with the highest perceived risk, highest health media use, and highest blood pressure and cholesterol levels. The subgroup with the lowest proportion of positive changers (42%) was the least educated, was the most likely to be Hispanic, and had the lowest health knowledge and self-efficacy scores. Conclusions. The differing composition of subgroups who respond or do not respond to community cardiovascular disease interventions illustrates the need to develop specific interventions that target different age, socioeconomic, and cultural subgroups. Handle: RePEc:aph:ajpbhl:1994:84:5:767-772_1 Template-Type: ReDIF-Article 1.0 Title: The consumption of well-done red meat and the risk of colorectal cancer Journal: American Journal of Public Health Author-Name: Muscat, J.E. Author-Name: Wynder, E.L. Year: 1994 Volume: 84 Issue: 5 Pages: 856-858 Abstract: Heterocyclic aromatic amines and polycyclic aromatic hydrocarbons are mutagens that are produced in highly cooked meats. A case-control study of 511 patients with colorectal cancer and 500 matched control subjects examined whether consumption of well-done cooked beef is related to the risk of developing large bowel cancer. Approximately 16% of men and women consumed well-done beef, and 50% ate medium-cooked beef. For both sexes, there was no association between consumption of well-done or medium-cooked beef and colorectal cancer. This paper discusses whether questionnaire data accurately reflect dietary intake of heterocyclic aromatic amines and polycyclic aromatic hydrocarbons. Handle: RePEc:aph:ajpbhl:1994:84:5:856-858_4 Template-Type: ReDIF-Article 1.0 Title: Urinary tract infection during pregnancy: Its association with maternal morbidity and perinatal outcome Journal: American Journal of Public Health Author-Name: Schieve, L.A. Author-Name: Handler, A. Author-Name: Hershow, R. Author-Name: Persky, V. Author-Name: Davis, F. Year: 1994 Volume: 84 Issue: 3 Pages: 405-410 Abstract: Objectives. The effects of antepartum urinary tract infection on adverse maternal and perinatal outcomes were examined. Antepartum urinary tract infection has been previously implicated as a risk factor for numerous outcomes. Methods. Crude and multivariable analyses were performed with a perinatal registry cohort of 25 746 mother/infant pairs. Results. Elevated risks were observed for exposure to urinary tract infection and low birthweight, prematurity, preterm low birthweight, premature labor, hypertension, preeclampsia, maternal anemia, and amnionitis. Urinary tract infection was associated with perinatal death only among subjects 20 to 29 years of age. Conclusions. These findings underscore the importance of antepartum urine screening to identify patients at risk for adverse outcomes. Handle: RePEc:aph:ajpbhl:1994:84:3:405-410_3 Template-Type: ReDIF-Article 1.0 Title: The prevalence of intrauterine growth retardation in Mexican Americans Journal: American Journal of Public Health Author-Name: Balcazar, H. Year: 1994 Volume: 84 Issue: 3 Pages: 462-465 Abstract: This study evaluated the prevalence of intrauterine growth retardation in Mexican Americans compared with non-Hispanic Whites in the state of Arizona. Data came from all live birth certificates in 1986 and 1987. Rates of intrauterine growth retardation in Mexican-American and non-Hispanic White infants in Arizona were lower than those in White infants in California. Differences in patterns of the 10th percentile growth distribution curves were observed between infants born in Arizona and those born in California. Compared with non-Hispanic Whites, Mexican Americans had lower adjusted odds ratios for intrauterine growth retardation according to several maternal risk characteristics. Handle: RePEc:aph:ajpbhl:1994:84:3:462-465_6 Template-Type: ReDIF-Article 1.0 Title: Nonclient factors in the reporting of prenatal psychosocial risk assessments Journal: American Journal of Public Health Author-Name: Wilkinson, D.S. Author-Name: Korenbrot, C.C. Author-Name: Fuentes-Afflick, E. Year: 1994 Volume: 84 Issue: 9 Pages: 1511-1514 Abstract: Psychosocial and nutrition risk assessments at 27 randomly selected sites of a Medicaid-funded enhanced prenatal program were examined for completeness and uniformity of reporting. The recording of psychosocial data, but not of nutrition data, was found to be associated with a substantial number of nonclient factors, including geographical location and abstractor, assessor, and service provider characteristics. The variability in recording of psychosocial problems reflects the numerous ways that assessments are performed and the subsequent difficulty in interpreting the practice of psychosocial assessment. A uniform system of defining and classifying risks is needed to improve both service delivery and service evaluation. Handle: RePEc:aph:ajpbhl:1994:84:9:1511-1514_6 Template-Type: ReDIF-Article 1.0 Title: Neural tube defects in Jamaica following Hurricane Gilbert Journal: American Journal of Public Health Author-Name: Duff, E.M.W. Author-Name: Cooper, E.S. Year: 1994 Volume: 84 Issue: 3 Pages: 473-476 Abstract: An increased incidence of obvious live-birth neural tube defects (i.e., spina bifida cystica and encephalocele) occurred in Jamaica 11 to 18 months after Hurricane Gilbert. The conceptions of the affected babies coincided with a rise in megaloblastic change in sickle cell patients, suggesting a wide-spread drop in dietary folate intake. A detailed history was taken from each of the 17 affected mothers (case subjects) and 51 unaffected mothers (matched control subjects). The case subjects reported a significantly lower mean intake of dietary folate in the periconceptional period (154 μg/day) than did the control subjects (254 μg/day). The temporary increase in neural tube defects was associated with a diet comparatively low in folate in the periconceptional period, suggesting the dietary level of folate that fails to protect against neural tube defects under natural conditions. Handle: RePEc:aph:ajpbhl:1994:84:3:473-476_9 Template-Type: ReDIF-Article 1.0 Title: Educating patients with limited literacy skills: The effectiveness of printed and videotaped materials about colon cancer Journal: American Journal of Public Health Author-Name: Meade, C.D. Author-Name: McKinney, W.P. Author-Name: Barnas, G.P. Year: 1994 Volume: 84 Issue: 1 Pages: 119-121 Abstract: We investigated whether printed or videotaped information is more effective in enhancing colon cancer knowledge. Subjects (n = 1100) were randomized into three groups: to receive a booklet, view a videotape, or receive no intervention. Subjects receiving the intervention showed increased knowledge compared with control subjects (booklet = 23% and videotape = 26% vs no intervention = 3%). Findings suggest that personalized educational materials are effective in enhancing colon cancer knowledge. Handle: RePEc:aph:ajpbhl:1994:84:1:119-121_4 Template-Type: ReDIF-Article 1.0 Title: Societal-level predictors of groups' drinking patterns: A research synthesis from the collaborative alcohol-related longitudinal project Journal: American Journal of Public Health Author-Name: Fillmore, K.M. Author-Name: Golding, J.M. Author-Name: Leino, E.V. Author-Name: Ager, C.R. Author-Name: Ferrer, H.P. Author-Name: Ahlstrom, S. Author-Name: Allebeck, P. Author-Name: Amundsen, A. Author-Name: Angst, J. Author-Name: Bagnall, G. Author-Name: Brunswick, A. Author-Name: Casswell, S. Author-Name: De Labry, L. Author-Name: Giesbrecht, N. Author-Name: Grant, B. Author-Name: Greenfield, T. Author-Name: Grube, J. Author-Name: Guether, B. Author-Name: Harford, T. Year: 1994 Volume: 84 Issue: 2 Pages: 247-253 Abstract: Objectives. Period effects of per capita consumption of alcohol and divorce rates are assessed for change in quantity and frequency among age/sex groups in multiple longitudinal studies. Methods. Twenty-five studies of quantity and 29 studies of frequency are used. Studies are from 15 nations and cover periods of 1 to 21 years. Models predict the standardized mean difference for quantity and frequency based on period effects and group- level and methodological variables. Results. When both the period effects of per capita consumption and the divorce rate are considered, the divorce rate significantly predicts change in quantity and frequency. An increase in the divorce rate is associated with a stronger decrease in frequency among younger people; men are more likely than women to decrease their frequency of drinking when divorce rates rise. Conclusions. Multiple societal-level factors should be considered critical in influencing the drinking patterns of groups. These results suggest that an increase in the divorce rate is associated with more 'dry' social contexts, characterized possibly by drinking patterns of a more 'volitive' nature (i.e., heavier quantity per occasion and less frequent drinking). Handle: RePEc:aph:ajpbhl:1994:84:2:247-253_4 Template-Type: ReDIF-Article 1.0 Title: Trends in the US prevalence of drug-using parturient women and drug- affected newborns, 1979 through 1990 Journal: American Journal of Public Health Author-Name: Dicker, M. Author-Name: Leighton, E.A. Year: 1994 Volume: 84 Issue: 9 Pages: 1433-1438 Abstract: Objectives. There has been a lack of reliable national data on the number of pregnant women using drugs and the number of newborns affected by such use. The major reasons for this lack have been inadequate sampling and data collection procedures and the lack of a risk assessment perspective in analysis. This paper corrects for these inadequacies. Methods. Data from 1979 through 1990 from the National Hospital Discharge Survey, an annual survey by the National Center for Health Statistics, were analyzed. Results. Between 1979 and 1990 there was a 576% increase in the rate of discharges of drug- using parturient women in the United States and a 456% increase in the rate of discharges of drug-affected newborns. After adjustment for undereporting, a 'best estimate' of the number of discharges from 1988 through 1990 was about 88 000 per year for drug-using parturient women and about 48 000 per year for drug-affected newborns. Conclusions. Although the data support the occurrence of a national epidemic of drug use among pregnant women during the 1980s, the size and severity of this epidemic have been overstated. Handle: RePEc:aph:ajpbhl:1994:84:9:1433-1438_0 Template-Type: ReDIF-Article 1.0 Title: Outbreak and sporadic egg-associated cases of Salmonella enteritidis: New York's experience Journal: American Journal of Public Health Author-Name: Morse, D.L. Author-Name: Birkhead, G.S. Author-Name: Guardino, J. Author-Name: Kondracki, S.F. Author-Name: Guzewich, J.J. Year: 1994 Volume: 84 Issue: 5 Pages: 859-860 Abstract: Since 1985, egg-associated Salmonella enteritidis has emerged as a major cause of foodborne disease. New York State has been especially affected, with 47 documented egg-associated S enteritidis outbreaks involving 2279 cases and 10 deaths. Individual case reports of salmonella have also increased 56%, and sporadic cases of S enteritidis have been shown to be associated with egg consumption. Further educational and regulatory activities are needed to control this continuing public health problem. Handle: RePEc:aph:ajpbhl:1994:84:5:859-860_7 Template-Type: ReDIF-Article 1.0 Title: What determines mortality risk in male former cigarette smokers? Journal: American Journal of Public Health Author-Name: Ben-Shlomo, Y. Author-Name: Smith, G.D. Author-Name: Shipley, M.J. Author-Name: Marmot, M.G. Year: 1994 Volume: 84 Issue: 8 Pages: 1235-1242 Abstract: Objectives. The purpose of this study was to examine what factors determine the mortality experience of male ex-cigarette smokers, those who no longer smoke at all and those who changed to pipe or cigar smoking. Methods. A cohort study was undertaken with 18-year mortality data on 19018 men. Results. Ex-cigarette smokers had an intermediate mortality risk compared with never and current smokers. Ex-cigarette smokers who switched to pipe smoking had higher mortality than those who no longer smoked at all. The mortality rates for pipe and cigar smokers who were former cigarette smokers were higher than those for pipe or cigar smokers who had never smoked cigarettes. Ex-cigarette smokers who consumed more than 20 cigarettes per day for more than 20 years experienced increased mortality for both coronary heart disease and neoplasms, even after 30 years of cessation. Conclusions. These results support the notion that an elevated mortality risk may be seen for ex-cigarette smokers, even after they have given up smoking for many years. Ex-cigarette smokers who change to a pipe have a greater mortality risk than those who no longer smoke at all. Handle: RePEc:aph:ajpbhl:1994:84:8:1235-1242_4 Template-Type: ReDIF-Article 1.0 Title: Dioxins and dibenzofurans in adipose tissue of the general US population and selected subpopulations Journal: American Journal of Public Health Author-Name: Orban, J.E. Author-Name: Stanley, J.S. Author-Name: Schwemberger, J.G. Author-Name: Remmers, J.C. Year: 1994 Volume: 84 Issue: 3 Pages: 439-445 Abstract: Objectives. The Environmental Protection Agency's National Human Adipose Tissue Survey (NHATS) was conducted in fiscal year (FY) 1987 to (1) estimate average concentrations of polychlorinated dibenzo-p-dioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs) in the adipose tissue of humans in the US population, (2) identify differences in average concentrations among subpopulations, and (3) compare average concentrations with those from the FY 1982 NHATS. Methods. Population estimates of the average levels of PCDDs and PCDFs were established on the basis of 865 human adipose tissue specimens collected in FY 1987. Average levels among subpopulations were compared. Results. The average concentration of 2,3,7,8-tetrachlorodibenzo-p-dioxin in the adipose tissue of the US population was 5.38 pg/g, increasing from 1.98 pg/g in children under 14 years of age to 9.40 pg/g in adults over 45. The effect of age was significant for nine compounds. Regional differences in the levels of 2,3,4,7,8-pentachlorinated dibenzofurans were statistically significant, but there were no significant differences associated with sex or race. Conclusions. The survey provides a baseline of average levels of PCDDs and PCDFs in the adipose tissue of humans in the US population. Handle: RePEc:aph:ajpbhl:1994:84:3:439-445_2 Template-Type: ReDIF-Article 1.0 Title: Subsequent hip fracture among older adults Journal: American Journal of Public Health Author-Name: Wolinsky, F.D. Author-Name: Fitzgerald, J.F. Year: 1994 Volume: 84 Issue: 8 Pages: 1316-1318 Abstract: Subsequent hip fracture among the 368 Longitudinal Study on Aging respondents who fractured their hips from 1984 through 1991 was prospectively examined. Case-by-case review of the billing records indicated that 27 subsequent hip fractures occurred, for a rate of 1 every 33.8 person-years. Multivariable proportional hazard regression revealed that increased risks of subsequent hip fracture were associated with poor perceived health status and dizziness. Handle: RePEc:aph:ajpbhl:1994:84:8:1316-1318_2 Template-Type: ReDIF-Article 1.0 Title: The burden and outcomes associated with dehydration among US elderly, 1991 Journal: American Journal of Public Health Author-Name: Warren, J.L. Author-Name: Bacon, W.E. Author-Name: Harris, T. Author-Name: McBean, A.M. Author-Name: Foley, D.J. Author-Name: Phillips, C. Year: 1994 Volume: 84 Issue: 8 Pages: 1265-1269 Abstract: Objectives. Dehydration has been underappreciated as a cause of hospitalization and increased hospital-associated mortality in older people. This study used national data to analyze the burden and outcomes following hospitalizations with dehydration in the elderly. Methods. Data from 1991 Medicare files were used to calculate rates of hospitalization with dehydration, to examine demographic characteristics and concomitant diagnoses associated with dehydration, and to analyze the contribution of dehydration to mortality. Results. In 1991, 6.7% (731 695) of Medicare hospitalizations had dehydration listed as one of the five reported diagnoses, a rate of 236.2/10 000 elderly Medicare beneficiaries. In 1991, Medicare reimbursed over $446 million for hospitalizations with dehydration as the principal diagnosis. Older people, men, and Blacks had elevated risks for hospitalization with dehydration. Acute infections, such as pneumonia and urinary tract infections, were frequent concomitant diagnoses. About 50% of elderly Medicare beneficiaries hospitalized with dehydration died within a year of admission. Conclusions. Hospitalization of elderly people with dehydration is a serious and costly medical problem. Attention should be focused on understanding predisposing factors and devising strategies for prevention. Handle: RePEc:aph:ajpbhl:1994:84:8:1265-1269_9 Template-Type: ReDIF-Article 1.0 Title: Seat belt use among drinking drivers in Minnesota Journal: American Journal of Public Health Author-Name: Foss, R.D. Author-Name: Beirness, D.J. Author-Name: Sprattler, K. Year: 1994 Volume: 84 Issue: 11 Pages: 1732-1737 Abstract: Objectives. Among the reasons cited for recent declines in alcohol- related traffic fatalities is the enactment of seat belt use laws by most states. It is suspected that drinking drivers are less likely to comply with such laws, although evidence on the relationship between belt use and drinking by drivers is sparse and conflicting. The purpose of this study was to examine the relationship of drinking to driver seat belt use. Methods. Observational, self-report, and chemical breath test data were collected on nighttime drivers in 16 Minnesota communities during September, 1990. Results. Drivers with an illegal blood alcohol concentration (≥ 100 mg/dL) were substantially less likely to be wearing a seat belt (odds ratio [OR] = 2.17). Belt use was also more common among females (OR = 2.02) and before midnight (OR = 1.47). Males who had been drinking were less likely to be belted. Belt use was related to drinking before, but not after, midnight. Belt use was not related to drinking status among college graduates, but it was strongly related to drinking status among those with less education. Conclusions. The present findings provide further argument for rapid implementation of passive countermeasures (airbags) and for development of creative, carefully focused interventions to target high-risk populations. Handle: RePEc:aph:ajpbhl:1994:84:11:1732-1737_4 Template-Type: ReDIF-Article 1.0 Title: Treatment and survival among elderly Americans with hip fractures: A population-based study Journal: American Journal of Public Health Author-Name: Lu-Yao, G.L. Author-Name: Baron, J.A. Author-Name: Barrett, J.A. Author-Name: Fisher, E.S. Year: 1994 Volume: 84 Issue: 8 Pages: 1287-1291 Abstract: Objectives. This study was undertaken to examine the patterns of treatment and survival among elderly Americans with hip fracture. Methods. A 5% national sample of Medicare claims was used to identify patients who sustained hip fractures between 1986 and 1989. In comparing treatment patterns across regions, direct standardization was used to derive age- and race-adjusted percentages. Logistic regression and Cox regression were used to examine short- and long-term survival. Results. In the United States, 64% of femoral neck fractures were treated with arthroplasty; 90% of pertrochanteric fractures were treated with internal fixation. Higher short- and long-term mortality was associated with being male, being older, residing in a nursing home prior to fracture, having a higher comorbidity score, and having a pertrochanteric fracture. Blacks and Whites had similar 90-day postfracture mortality, but Blacks had a higher mortality later on. For femoral neck fracture, internal fixation has a modestly lower short-term mortality associated with it than arthroplasty has. Conclusion. Variation in the treatment of hip fracture was modest. The increased delayed mortality after hip fracture among Blacks requires further study. Handle: RePEc:aph:ajpbhl:1994:84:8:1287-1291_1 Template-Type: ReDIF-Article 1.0 Title: Chronic neurological sequelae to organophosphate pesticide poisoning Journal: American Journal of Public Health Author-Name: Steenland, K. Author-Name: Jenkins, B. Author-Name: Ames, R.G. Author-Name: O'Malley, M. Author-Name: Chrislip, D. Author-Name: Russo, J. Year: 1994 Volume: 84 Issue: 5 Pages: 731-736 Abstract: Objectives. This work was undertaken to determine whether there are any chronic neurological sequelae to acute organophosphate pesticide poisoning. Methods. California surveillance data were used in a study of neurological function among 128 men poisoned by organophosphate pesticides in California from 1982 to 1990 and 90 referents. Tests included a neurological physical examination, 5 nerve conduction tests, 2 vibrotactile sensitivity tests, 10 neurobehavioral tests, and 1 postural sway test. Results. After correcting for confounding, the poisoned group performed significantly worse than the referent group on two neurobehavioral tests (sustained visual attention and mood scales). When the data were restricted to men with documented cholinesterase inhibition (n = 83) or to men who had been hospitalized (n = 36), the poisoned subjects also showed significantly worse vibrotactile sensitivity of finger and toe. Significant trends of increased impairment were found with increased days of disability on a wide spectrum of tests of both central and peripheral nerve function. Conclusions. While these findings are limited by low response rates and by small sample sizes for specific pesticides, this study was based on a large surveillance database and is the largest study to date of the chronic effects of organophosphate pesticide poisoning. The evidence of some long-term effects of poisoning is consistent with two prior studies. Handle: RePEc:aph:ajpbhl:1994:84:5:731-736_5 Template-Type: ReDIF-Article 1.0 Title: Aggression and fighting behavior among African-American adolescents: Individual and family factors Journal: American Journal of Public Health Author-Name: Cotten, N.U. Author-Name: Resnick, J. Author-Name: Browne, D.C. Author-Name: Martin, S.L. Author-Name: McCarraher, D.R. Author-Name: Woods, J. Year: 1994 Volume: 84 Issue: 4 Pages: 618-622 Abstract: Objectives. This study examined the extent to which individual and family factors are associated with aggression and fighting behavior among African- American middle school adolescents. Methods. Four hundred thirty-six African- American boys and girls from two middle schools in a predominantly low- income North Carolina school system were surveyed and their school records examined. Information was collected concerning students' aggression levels, school fighting behavior, school suspensions for fighting, attitudes toward violence, perceptions of their families' attitudes toward violence, weapon- carrying behavior, and sociodemographics. Multivariate analyses were employed to predict the students' aggression levels, fighting behavior, and school suspensions. Results. Factors related to the individual adolescents, such as gender, age, weapon-carrying behavior, and attitudes toward violence, were associated with students' reports of aggression and fighting behavior. Factors related to family and school were associated with school suspension for fighting. Conclusions. This study suggests that violence prevention programs set in our elementary and middle schools may reduce aggression and fighting among our youth. School teachers and public health practitioners are encouraged to work together in understanding and preventing adolescent violence. Handle: RePEc:aph:ajpbhl:1994:84:4:618-622_5 Template-Type: ReDIF-Article 1.0 Title: A pilot syringe exchange program in Washington, DC Journal: American Journal of Public Health Author-Name: Vlahov, D. Author-Name: Ryan, C. Author-Name: Solomon, L. Author-Name: Cohn, S. Author-Name: Holt, M.R. Author-Name: Akhter, M.N. Year: 1994 Volume: 84 Issue: 2 Pages: 303-304 Abstract: The Washington, DC, City Council authorized a pilot syringe exchange program to operate for only 60 days at a single drug abuse treatment facility in the District. Only adults on the waiting list for treatment were eligible (n = 467). Of the 33 who enrolled, median duration of drug injection was 18 years. Twenty-seven participants denied needle sharing. Of 209 needles distributed, 69% were returned. Low enrollment might have been due to restrictive entry criteria, inconvenient location, incorrect syringe size, and attitudes of treatment staff. For future efforts to have a public health impact, wider accessibility will be needed. Handle: RePEc:aph:ajpbhl:1994:84:2:303-304_9 Template-Type: ReDIF-Article 1.0 Title: Federal funding of primary vs specialized medical education. Journal: American Journal of Public Health Author-Name: Strelnick, A.H. Year: 1994 Volume: 84 Issue: 1 Pages: 124-125 Handle: RePEc:aph:ajpbhl:1994:84:1:124-125_5 Template-Type: ReDIF-Article 1.0 Title: Acanthosis nigricans among native Americans: An indicator of high diabetes risk Journal: American Journal of Public Health Author-Name: Stuart, C.A. Author-Name: Smith, M.M. Author-Name: Gilkison, C.R. Author-Name: Shaheb, S. Author-Name: Stahn, R.M. Year: 1994 Volume: 84 Issue: 11 Pages: 1839-1842 Abstract: Prevalence of the skin lesion acanthosis nigricans was determined in two tribal communities in Texas and Nebraska. Thirty-eight percent of the Alabama-Coushatta tribe of Texas had acanthosis nigricans. Nineteen percent of Omaha and Winnebago tribal children had the skin lesion; the youngest children had the least acanthosis nigricans. Among weight-matched Alabama- Coushatta, fasting insulin concentrations were twofold higher in subjects with the lesion. It was concluded that acanthosis nigricans is highly prevalent among Native Americans and that its presence suggests insulin resistance. Thus, it may identify those with the highest risk for non- insulin-dependent diabetes mellitus in this population. Handle: RePEc:aph:ajpbhl:1994:84:11:1839-1842_3 Template-Type: ReDIF-Article 1.0 Title: Risk factors for acute non-A, non-B hepatitis and their relationship to antibodies for hepatitis C virus: A case-control study Journal: American Journal of Public Health Author-Name: Mele, A. Author-Name: Sagliocca, L. Author-Name: Manzillo, G. Author-Name: Converti, F. Author-Name: Amoroso, P. Author-Name: Stazi, M.A. Author-Name: Ferrigno, L. Author-Name: Rapicetta, M. Author-Name: Franco, E. Author-Name: Adamo, B. Author-Name: Palumbo, F. Author-Name: Sbreglia, C. Author-Name: Pana, A. Author-Name: Pasquini, P. Year: 1994 Volume: 84 Issue: 10 Pages: 1640-1643 Abstract: A case-control study was carried out comparing 333 case subjects with non- A, non-B hepatitis and 1095 hospital control subjects. Of 333 case subjects, 197 (59%) were positive for hepatitis C antibody (anti-HCV). Excluding blood transfusion and intravenous drug use, surgical intervention and dental therapy were strongly associated with anti-HCV-positive cases: in particular, obstetric and gynecology surgical intervention was found to be strongly associated with HCV positivity (odds ratio [OR] = 32; 95% confidence interval [CI] = 7, 147). Raw shellfish consumption was a risk factor for anti-HCV- negative cases (OR = 2.2; 95% CI = 1.0, 5.1), thus suggesting an enterically transmitted virus in sporadic non-A, non-B hepatitis in Italy. Handle: RePEc:aph:ajpbhl:1994:84:10:1640-1643_9 Template-Type: ReDIF-Article 1.0 Title: Television beer advertising and drinking knowledge, beliefs, and intentions among schoolchildren Journal: American Journal of Public Health Author-Name: Grube, J.W. Author-Name: Wallack, L. Year: 1994 Volume: 84 Issue: 2 Pages: 254-259 Abstract: Objectives. The relationships between television beer advertising and drinking knowledge, beliefs, and intentions were investigated in a survey of schoolchildren. The research was guided by a theoretical model specifying that awareness of advertising, and not mere exposure, is necessary for it to have an effect on beliefs or behaviors. Methods. Participants were a random sample of 468 fifth- and sixth-grade schoolchildren from a northern California community. Data were collected in the home with a combination of self-administered questionnaires and structured interviews. Results. Nonrecursive statistical modeling indicated that awareness of television beer advertising was related to more favorable beliefs about drinking, to greater knowledge of beer brands and slogans, and to increased intentions to drink as an adult. The effects of advertising awareness on knowledge, beliefs, and intentions were maintained when the reciprocal effects of beliefs, knowledge, and intentions on awareness were controlled. Conclusions. The findings suggest that alcohol advertising may predispose young people to drinking. As a result, efforts to prevent drinking and drinking problems among young people should give attention to countering the potential effects of alcohol advertising. Handle: RePEc:aph:ajpbhl:1994:84:2:254-259_2 Template-Type: ReDIF-Article 1.0 Title: The agrarian myth and policy responses to farm safety Journal: American Journal of Public Health Author-Name: Kelsey, T.W. Year: 1994 Volume: 84 Issue: 7 Pages: 1171-1177 Abstract: Agriculture's status as one of the nation's most hazardous occupations has been an impetus for a reexamination of the federal role in agricultural safety and for various proposals to make farming safer. During the 1970s congressional debate and farm group testimony that led to agriculture's current exemption from the Occupational Safety and Health Administration's enforcement efforts, regulation foes made use of the 'Agrarian Myth.' The myth portrays farmers as the bedrock of democracy, suffering so that society may prosper and living a natural life away from the artificiality and evils of cities. Despite the inaccuracy of its images, the myth is a potent symbol in American culture, and its influence could arise again in current policy debates. This paper examines specific issues that may be obscured by the myth but that must be addressed in any agricultural safety policy debate. It then recommends that responses to agricultural safety be carefully considered and that value judgments about what the issues are, who would benefit, and who would bear the costs be explicitly discussed during debate. Handle: RePEc:aph:ajpbhl:1994:84:7:1171-1177_5 Template-Type: ReDIF-Article 1.0 Title: Pesticide exposures, cholinesterase depression, and symptoms among North Carolina migrant farmworkers Journal: American Journal of Public Health Author-Name: Ciesielski, S. Author-Name: Loomis, D.P. Author-Name: Mims, S.P. Author-Name: Auer, A. Year: 1994 Volume: 84 Issue: 3 Pages: 446-451 Abstract: Objectives. We conducted a clinic-based study of erythrocyte cholinesterase levels, pesticide exposures, and health effects among farmworkers and nonfarmworkers to determine risks for exposure and associated morbidity. Methods. Two hundred two farmworkers and 42 nonfarmworkers were recruited sequentially at two community health centers. Erythrocyte cholinesterase levels were measured colorimetrically. Questionnaires obtained data on demographics, occupational history, exposures, and symptoms. Results. Cholinesterase levels were significantly lower among farmworkers (30.28 U/g hemoglobin) than among nonfarmworkers (32.3 U/g hemoglobin). Twelve percent of farmworkers, but no nonfarmworkers, had very low levels. Farmworkers applying pesticides also had lower cholinesterase levels. One half of farmworkers reported being sprayed by pesticides and working in fields with an obvious chemical smell. Of reported symptoms, only diarrhea was associated with cholinesterase levels. Reported exposures, however, were strongly associated with symptoms. Conclusions. Farmworkers reported many pesticide exposures that violate state and federal regulations. Farmworkers had cholinesterase levels significantly lower than those of nonfarmworkers, although only spraying pesticides was associated with very low levels. Handle: RePEc:aph:ajpbhl:1994:84:3:446-451_9 Template-Type: ReDIF-Article 1.0 Title: An evaluation of the Kessner Adequacy of Prenatal Care Index and a proposed Adequacy of Prenatal Care Utilization Index Journal: American Journal of Public Health Author-Name: Kotelchuck, M. Year: 1994 Volume: 84 Issue: 9 Pages: 1414-1420 Abstract: Objectives. The assessment of the adequacy of prenatal care utilization is heavily shaped by the way in which utilization is measured. Although it is widely used, the current major index of utilization, the Kessner/Institute of Medicine Index, has not been subjected to systematic examination. This paper provides such an examination. Methods. Data from the 1980 National Natality Survey are used to disaggregate the components of the Kessner Index for detailed analysis. An alternative two-part index, the Adequacy of Prenatal Care Utilization Index, is proposed that combines independent assessments of the timing of prenatal care initiation and the frequency of visits received after initiation. Results. The Kessner Index is seriously flawed. It is heavily weighted toward timing of prenatal care initiation, does not distinguish timing of initiation from poor subsequent utilization, inaccurately measures utilization for full- or post-term pregnancies, and lacks sufficient documentation for consistent computer programming. Conclusions. The Adequacy of Prenatal Care Utilization Index offers a more accurate and comprehensive set of measures of prenatal care utilization than the Kessner Index. Handle: RePEc:aph:ajpbhl:1994:84:9:1414-1420_1 Template-Type: ReDIF-Article 1.0 Title: The Adequacy of Prenatal Care Utilization Index: Its US distribution and association with low birthweight Journal: American Journal of Public Health Author-Name: Kotelchuck, M. Year: 1994 Volume: 84 Issue: 9 Pages: 1486-1489 Abstract: The proposed Adequacy of Prenatal Care Utilization Index is applied to data from the 1980 National Natality Survey to assess the adequacy of prenatal care utilization and its association with low birthweight in the United States. The index suggests that only 61.1% of women received adequate prenatal care, including 17.7% with more intensive care; 16.7% received inadequate care. More White women (63.4%) than Black women (51.9%) received adequate prenatal care. Low-birthweight rates were elevated among women with inadequate prenatal care and among those who received more intensive prenatal care. Handle: RePEc:aph:ajpbhl:1994:84:9:1486-1489_2 Template-Type: ReDIF-Article 1.0 Title: Air recirculation and sick building syndrome: A blinded crossover trial Journal: American Journal of Public Health Author-Name: Jaakkola, J.J.K. Author-Name: Tuomaala, P. Author-Name: Seppanen, O. Year: 1994 Volume: 84 Issue: 3 Pages: 422-428 Abstract: Objective. This study tested the hypothesis that recirculated air in mechanically ventilated buildings causes symptoms commonly referred to as the sick building syndrome and perceptions of poor indoor air quality. Methods. A blinded, four-period crossover trial was carried out in two identical buildings, contrasting 70% return air (index phase) with 0% of return air (reference phase). Each period lasted 1 work-week. The study population comprised 75 workers who had reported symptoms related to the work environment or perceptions of poor indoor air quality. Participants reported their ratings of symptoms, their perceptions, and related information in a daily diary. The outcome criteria included aggregative symptom scores for mucosal irritation, skin reaction, allergic reaction, and general symptoms formed of ratings of component symptoms. Perceptions of unpleasant odor, stuffiness, or dustiness were additional outcome criteria. Results. All 75 participants returned their diaries. For no symptoms did the scores differ between the two phases more than could be expected by chance. Mean rating of unpleasant odor was significantly smaller during the index phase, but mean ratings of dustiness and stuffiness did not differ materially between the two phases. Conclusions. Our results suggest that 70% recirculated air, when accompanied by an adequate intake of outdoor air, can be used without causing adverse effects. Handle: RePEc:aph:ajpbhl:1994:84:3:422-428_9 Template-Type: ReDIF-Article 1.0 Title: Alcohol and drug disorders among physically abusive and neglectful parents in a community-based sample Journal: American Journal of Public Health Author-Name: Kelleher, K. Author-Name: Chaffin, M. Author-Name: Hollenberg, J. Author-Name: Fischer, E. Year: 1994 Volume: 84 Issue: 10 Pages: 1586-1590 Abstract: Objectives. The purpose of this study was to compare the frequency of substance use disorders and symptoms between adults reporting child physical abuse or neglect and individually matched control subjects in a community sample. Methods. In a nested case-control study, 169 adults reporting physical abuse of a child and 209 adults reporting neglect of a child from 11 662 individuals successfully interviewed in a probabilistic survey in four communities were individually matched with control subjects drawn from the participants. Case subjects were compared with control subjects on the number of alcohol- or drug-related symptoms and disorder diagnoses as determined by symptoms from the Diagnostic Interview Schedule. Results. Respondents reporting either physical abuse or neglect of children were much more likely than their matched control subjects to report substance abuse or dependence. These differences persisted after potential confounding variables were controlled for. Conclusions. Parental substance abuse and dependence, independent of confounding factors, are highly associated with child maltreatment. Inconsistent results in previous studies may have arisen from reliance on referred samples and unstandardized assessment methods. Agencies involved in the care of abused or neglected children and their families should consider incorporating routine substance abuse evaluations with treatment, or referral for treatment, where indicated. Handle: RePEc:aph:ajpbhl:1994:84:10:1586-1590_4 Template-Type: ReDIF-Article 1.0 Title: The outcomes of patients newly admitted to nursing homes after hip fracture Journal: American Journal of Public Health Author-Name: Kiel, D.P. Author-Name: Eichorn, A. Author-Name: Intrator, O. Author-Name: Silliman, R.A. Author-Name: Mor, V. Year: 1994 Volume: 84 Issue: 8 Pages: 1281-1286 Abstract: Objectives. The outcomes of elderly, hospitalized patients discharged to nursing homes after hip fracture were examined. Methods. For 2624 hip fracture patients admitted to any of 43 proprietary nursing homes between 1984 and 1988, admission assessments were examined in relation to 1-month outcomes. Results. Mean patients age was 82 ± 7 y: 85% of the sample were female. Within 1 month after discharge, 24% had returned home, 12% had been rehospitalized, 3% had died, and 61% remained in the nursing home. Characteristics significantly associated with mortality included disorientation, functional dependency, neurologic diagnoses, and use of cardiac medications, antidepressants, or narcotics. Rehospitalization was significantly associated with age, gender, living with someone, being ambulatory, and functional dependency. Returning home was associated with younger age, living with someone, being ambulatory, and having no disorientation, functional dependency, or psychiatric or neurologic diagnoses, nor any pressure sores. Conclusions. Better-functioning persons and those with social support returned home; physically and cognitively impaired persons and those taking narcotics, cardiac medications, or antidepressants were likely to die; and younger men, those with social support, those with functional dependency, and those who were free of disorientation were more likely to be rehospitalized. Handle: RePEc:aph:ajpbhl:1994:84:8:1281-1286_4 Template-Type: ReDIF-Article 1.0 Title: Using a geographic information system to understand child pedestrian injury Journal: American Journal of Public Health Author-Name: Braddock, M. Author-Name: Lapidus, G. Author-Name: Cromley, E. Author-Name: Cromley, R. Author-Name: Burke, G. Author-Name: Banco, L. Year: 1994 Volume: 84 Issue: 7 Pages: 1158-1161 Abstract: Data from police accident reports involving pedestrians less than 20 years of age in Hartford, Conn, during 1988 through 1990 were abstracted and entered into a geographic information system. Two high-frequency collision areas were identified and compared. There were 374 child pedestrians involved in collisions (a rate of 28 per 10 000). Two high-occurrence areas accounted for 30% of collisions. Collisions in one of these areas were more likely to involve younger children (8.1 vs 10.2 years of age) and to occur in the late afternoon, and occurred closer to the child's residence, than collisions in the other area. The geographic information system is a useful tool in the study of child pedestrian collisions. Handle: RePEc:aph:ajpbhl:1994:84:7:1158-1161_7 Template-Type: ReDIF-Article 1.0 Title: Mammography screening: How important is cost as a barrier to use? Journal: American Journal of Public Health Author-Name: Urban, N. Author-Name: Anderson, G.L. Author-Name: Peacock, S. Year: 1994 Volume: 84 Issue: 1 Pages: 50-55 Abstract: Objectives. Recent legislation will improve insurance coverage for screening mammography and effectively lower its cost to many women. Although cost has been cited as a barrier to use, evidence of the magnitude of its effect on use is limited. Methods. Mammography use in the past 2 years among women aged 50 to 75 residing in four suburban or rural counties in Washington State was estimated from 1989 survey data. Logistic regression analysis was used to estimate the odds ratio of mammography use as a function of economic and other variables. Within a residential area, averages were used to measure the market price of mammography and the time cost to obtain a mammogram. Results. Use was lower among women who faced a higher net price or who preferred to obtain a mammogram during weekend or evening hours and higher among women with higher incomes. Visiting no doctor regularly and smoking were predictors of failure to use mammography. Conclusion. The effects of economic variables on mammography use are important and stable across subsets of the population, but they are modest in size. Handle: RePEc:aph:ajpbhl:1994:84:1:50-55_3 Template-Type: ReDIF-Article 1.0 Title: Infant mortality and related risk factors among Asian Americans Journal: American Journal of Public Health Author-Name: Morrow, H.W. Author-Name: Chavez, G.F. Author-Name: Giannoni, P.P. Author-Name: Shah, R.S. Year: 1994 Volume: 84 Issue: 9 Pages: 1497-1500 Abstract: To examine differences in perinatal health among nine Asian ethnic subgroups, a descriptive epidemiological study was conducted using linked birth/infant death certificates for 1982 to 1987. When compared with Whites, Asians had a lower proportion of young mothers, unmarried mothers, and women who received first trimester prenatal care; a higher proportion of foreign- born mothers; and a different birthweight distribution. A great deal of heterogeneity was found in risk factors and infant mortality rates among the various Asian ethnic subgroups. Paradoxically, although Asian ethnic subgroups had a higher perinatal risk profile, they had more favorable birth outcomes than did Whites. Handle: RePEc:aph:ajpbhl:1994:84:9:1497-1500_8 Template-Type: ReDIF-Article 1.0 Title: Hysterectomy use: The correspondence between self-reports and hospital records Journal: American Journal of Public Health Author-Name: Brett, K.M. Author-Name: Madans, J.H. Year: 1994 Volume: 84 Issue: 10 Pages: 1653-1655 Abstract: Studies of the relationship between hysterectomy use and sociodemographic factors tend to use self-reported data. In the current study, data were collected from a representative sample of US women who have been prospectively followed since 1971. Hysterectomy status was obtained by self- report and from hospital records. Although these two measures of hysterectomy were highly related, more women reported hysterectomy than could be confirmed by hospital records. The two measures showed similar associations between several obstetric and demographic characteristics and hysterectomy status, suggesting that the use of self-reported hysterectomy data does not bias analyses of potentially associated factors. Handle: RePEc:aph:ajpbhl:1994:84:10:1653-1655_6 Template-Type: ReDIF-Article 1.0 Title: Head injuries incurred by children and young adults during informal recreation Journal: American Journal of Public Health Author-Name: Baker, S.P. Author-Name: Fowler, C. Author-Name: Li, G. Author-Name: Warner, M. Author-Name: Dannenberg, A.L. Year: 1994 Volume: 84 Issue: 4 Pages: 649-652 Abstract: To examine injuries related to playground equipment, children's vehicles, roller skates, and skateboards, 1991 data on emergency room patients younger than 25 years in the Consumer Product Safety Commission's 91 surveillance hospitals were used. Head injury was the primary diagnosis for an estimated 58 480 patients, exceeding the total number of head injuries to bicyclists younger than 25 years. The head injury rate decreased with age. The large number and high rate of head injuries in children involved in a variety of recreational activities suggests the value of multipurpose helmets. Handle: RePEc:aph:ajpbhl:1994:84:4:649-652_9 Template-Type: ReDIF-Article 1.0 Title: The academic health center and the healthy community Journal: American Journal of Public Health Author-Name: Naughton, J. Author-Name: Vana, J.E. Year: 1994 Volume: 84 Issue: 7 Pages: 1071-1076 Abstract: US medical care reflects the priorities and influence of academic health centers. This paper describes the leadership role assumed by one academic health center, the State University at Buffalo's School of Medicine and Biomedical Sciences and its eight affiliated hospitals, to serve its region by promoting shared governance in educating graduate physicians and in influencing the cost and quality of patient care. Cooperation among hospitals, health insurance payers, the business community, state government, and physicians helped establish priorities to meet community needs and reduce duplication of resources and services; to train more primary care physicians; to introduce shared governance into rural health care delivery; to develop a regional management information system; and to implement health policy. This approach, spearheaded by an academic health center without walls, may serve as a model for other academic health centers as they adapt to health care reform. Handle: RePEc:aph:ajpbhl:1994:84:7:1071-1076_6 Template-Type: ReDIF-Article 1.0 Title: The determinants of hypertension awareness, treatment, and control in an insured population Journal: American Journal of Public Health Author-Name: Stockwell, D.H. Author-Name: Madhavan, S. Author-Name: Cohen, H. Author-Name: Gibson, G. Author-Name: Alderman, M.H. Year: 1994 Volume: 84 Issue: 11 Pages: 1768-1774 Abstract: Objectives. The purpose of the study was to identify the determinants of awareness, treatment, and control of hypertension in a population with full access to medical care. Methods. Unionized New York City health care workers (n = 1394) with comprehensive medical insurance were screened for hypertension. Union records documenting all physician visits and prescription medications for the year before screening provided the opportunity to relate patterns of treatment to blood pressure outcomes. Results. Of the 409 employees found to have hypertension, 289 (71%) were aware of their condition and 201 (49%) had been treated, but only 51 (12%) had their blood pressure controlled at the recommended level (< 140/90 mm Hg). In a logistic regression model, the only variable of treatment associated with control was days of antihypertensive medication. The total number of physician visits was not associated with control. Conclusions. These findings demonstrate that in conventional community settings, even in the absence of financial barriers, treatment for hypertension continues to be characterized by poor outcomes. Improving access to primary care, without changes in the nature of that care, may not substantially improve blood pressure control. Handle: RePEc:aph:ajpbhl:1994:84:11:1768-1774_7 Template-Type: ReDIF-Article 1.0 Title: Overweight schoolchildren in New York State: Prevalence and characteristics Journal: American Journal of Public Health Author-Name: Wolfe, W.S. Author-Name: Campbell, C.C. Author-Name: Frongillo Jr., E.A. Author-Name: Haas, J.D. Author-Name: Melnik, T.A. Year: 1994 Volume: 84 Issue: 5 Pages: 807-813 Abstract: Objectives. Childhood overweight is an increasing public health concern. This study was undertaken to determine the prevalence of overweight in elementary school children in New York State and to identify characteristics associated with child fatness. Methods. Weight, height, triceps skinfold, midarm circumference, and a 24-hour dietary recall were taken on 1797 second- and fifth-grade students from 51 randomly selected schools in New York State outside of New York City. Parents completed a brief questionnaire. Results. In comparison with 1974 and 1980 national reference data, up to twice the expected percentages of children had values above the 85th, 90th, and 95th percentiles for body mass index, triceps skinfold, and arm fat area. Regression analyses suggested that children who tended to be fatter were members of low socioeconomic status, two-parent (but not single-parent) households; those with few or no siblings; those who ate school lunch; and those who skipped breakfast. Conclusions. The findings suggest that overweight is a problem among many elementary school children in New York State and that sociodemographic characteristics may be useful for targeting preventive efforts. Handle: RePEc:aph:ajpbhl:1994:84:5:807-813_3 Template-Type: ReDIF-Article 1.0 Title: Recruitment activities and sociodemographic factors that predict attendance at a mammographic screening program Journal: American Journal of Public Health Author-Name: Hurley, S.F. Author-Name: Huggins, R.M. Author-Name: Jolley, D.J. Author-Name: Reading, D. Year: 1994 Volume: 84 Issue: 10 Pages: 1655-1658 Abstract: A random sample of 2266 women aged 50 to 69 years was used to investigate factors that predict attendance at a free. Australian mammographic screening program. The most important predictor was receipt of a personal invitation letter. A letter that included an appointment time increased attendance 132- fold initially and decreased to 20 times baseline after 14 days. A letter that did not include an appointment time increased attendance 12-fold, and a second letter to nonattenders increased attendance approximately 13-fold. Attendance declined with increasing distance from the program and with increases in the percentage of non-English speaking women in a neighborhood, but was higher in areas of higher socioeconomic status. Handle: RePEc:aph:ajpbhl:1994:84:10:1655-1658_8 Template-Type: ReDIF-Article 1.0 Title: Psychotic inpatients' social class and their first admission to state or private psychiatric Baltimore hospitals Journal: American Journal of Public Health Author-Name: Muntaner, C. Author-Name: Wolyniec, P. Author-Name: McGrath, J. Author-Name: Pulver, A.E. Year: 1994 Volume: 84 Issue: 2 Pages: 287-289 Abstract: Social class differences were investigated among patients admitted to public and private psychiatric hospitals. Participants included first admission White psychotic men admitted to Baltimore metropolitan area hospitals between 1983 and 1989. After adjusting for age and diagnosis, patients with low levels of skills/credentials were found to be more likely than patients with higher levels to be admitted to state psychiatric hospitals. These findings underscore the persistence of social class as a determinant of differences in the use of psychiatric care. Handle: RePEc:aph:ajpbhl:1994:84:2:287-289_3 Template-Type: ReDIF-Article 1.0 Title: Promoting participation in breast cancer screening. Journal: American Journal of Public Health Author-Name: Zapka, J.G. Year: 1994 Volume: 84 Issue: 1 Pages: 12-13 Handle: RePEc:aph:ajpbhl:1994:84:1:12-13_0 Template-Type: ReDIF-Article 1.0 Title: The US economic and social costs of Alzheimer's disease revisited Journal: American Journal of Public Health Author-Name: Ernst, R.L. Author-Name: Hay, J.W. Year: 1994 Volume: 84 Issue: 8 Pages: 1261-1264 Abstract: Objectives. An earlier paper estimated the per-case and national incidence costs of Alzheimer's disease for 1983. This paper updates the estimates of costs per case to 1991 and presents new national prevalence estimates of the economic and social costs of the disease. Methods. All data for the cost estimates were taken from published sources or provided by other researchers. Results. At midrange values of the estimated cost and epidemiological parameters, the discounted (at 4%) direct and total costs of Alzheimer's disease were $47 581 and $173 932 per case, respectively. The estimated 1991 national direct and total prevalence costs were $20.6 billion and $67.3 billion, respectively. Assuming conservatively that the prevalence of the disease remains constant, the estimated discounted present values of the direct and total costs of all current and future generations of Alzheimer's patients are $536 billion and $1.75 trillion, respectively. Conclusions. The $536 billion and $1.75 trillion figures are minimum estimates of the long- term dollar losses to the US economy in 1991 caused by Alzheimer's disease. Handle: RePEc:aph:ajpbhl:1994:84:8:1261-1264_5 Template-Type: ReDIF-Article 1.0 Title: The prevalence of back pain, hand discomfort, and dermatitis in the US working population Journal: American Journal of Public Health Author-Name: Behrens, V. Author-Name: Seligman, P. Author-Name: Cameron, L. Author-Name: Mathias, C.G.T. Author-Name: Fine, L. Year: 1994 Volume: 84 Issue: 11 Pages: 1780-1785 Abstract: Objectives. The purpose of the study was to provide the health care and public health communities with national prevalence estimates of selected conditions in the US working population. Methods. National prevalence estimates of self-reported conditions among working people were calculated from data collected for the 1988 Occupational Health Supplement to the National Health Interview Survey. Results. The highest prevalence estimates were found among occupational groups. For example, the prevalence of back pain due to an injury at work among truck drivers was 6.7%; back pain due to repeated activities at work among mechanics and repairers of heavy equipment and machinery was 10.5%; hand discomfort among operators of machines that process metal, plastic, stone, and glass was 23.5%; and dermatitis due to contact with substances at work among physicians, dentists, nurses, pharmacists, and dietitians was 5.6%. Conclusions. A substantial proportion of these conditions among occupational groups with the highest prevalence estimates are occupational in origin. These prevalence estimates identify occupations in which efforts are needed to prevent these conditions. Handle: RePEc:aph:ajpbhl:1994:84:11:1780-1785_3 Template-Type: ReDIF-Article 1.0 Title: Emotional and behavioral problems and severe academic delays among sheltered homeless children in Los Angeles County Journal: American Journal of Public Health Author-Name: Zima, B.T. Author-Name: Wells, K.B. Author-Name: Freeman, H.E. Year: 1994 Volume: 84 Issue: 2 Pages: 260-264 Abstract: Objectives. Few studies have estimated the extent of specific emotional, behavioral, and academic problems among sheltered homeless children. The objectives of this study were to describe such problems, identify those children with the problems, and evaluate the relationship between child problems and use of physical and mental health services. Methods. From February through May 1991, 169 school-age children and their parents living in 18 emergency homeless family shelters in Los Angeles County were interviewed. To evaluate the answers, interviewers used standardized measures of depression, behavioral problems, receptive vocabulary, and reading. Results. The vast majority (78%) of homeless children suffered from either depression, a behavioral problem, or severe academic delay. Among children having a problem, only one third of the parents were aware of any problem, and few of those children (15%) had ever received mental health care or special education. Conclusions. Almost all school-age sheltered homeless children in Los Angeles County have symptoms of depression, a behavioral problem, or academic delay severe enough to merit a clinical evaluation, yet few receive specific care. Programs targeted at sheltered homeless school- age children are needed to close this gap. Handle: RePEc:aph:ajpbhl:1994:84:2:260-264_1 Template-Type: ReDIF-Article 1.0 Title: Completion rates of clients discharged from drug and alcohol treatment programs in Washington State Journal: American Journal of Public Health Author-Name: Wickizer, T. Author-Name: Maynard, C. Author-Name: Atherly, A. Author-Name: Frederick, M. Author-Name: Koepsell, T. Author-Name: Krupski, A. Author-Name: Stark, K. Year: 1994 Volume: 84 Issue: 2 Pages: 215-221 Abstract: Objectives. The primary goal of this study was to analyze completion rates of clients in drug and alcohol abuse treatment programs in Washington State and to assess the factors associated with treatment completion. A secondary goal was to examine the utility of a state information system as a source of evaluative data. Methods. Analyses were conducted of 5827 client records contained in the Washington State Substance Abuse Monitoring System, representing a census of public clients discharged during the last quarter of 1990 from all state-funded alcohol and drug treatment programs in four treatment modalities. Logistic regression was performed to determine the independent predictors of treatment completion. Results. Completion rates were highest for intensive inpatient alcohol treatment (75%) and lowest for intensive outpatient drug programs (18%). Factors associated with treatment completion included screening at a referral assessment center, education, age, ethnicity, and existence of a secondary drug problem. Conclusions. The fit between clients and treatment programs may be an important factor explaining why some clients complete treatment and others drop out. State client information systems are an important source of data for analyzing treatment completion and other outcomes. Handle: RePEc:aph:ajpbhl:1994:84:2:215-221_0 Template-Type: ReDIF-Article 1.0 Title: 'Eat for Health': A supermarket intervention for nutrition and cancer risk reduction Journal: American Journal of Public Health Author-Name: Rodgers, A.B. Author-Name: Kessler, L.G. Author-Name: Portnoy, B. Author-Name: Potosky, A.L. Author-Name: Patterson, B. Author-Name: Tenney, J. Author-Name: Thompson, F.E. Author-Name: Krebs-Smith, S.M. Author-Name: Breen, N. Author-Name: Mathews, O. Author-Name: Kahle, L.L. Year: 1994 Volume: 84 Issue: 1 Pages: 72-76 Abstract: Objectives. The results of an evaluation of 'Eat for Health,' a supermarket nutrition intervention, are presented. The study tested whether such a program could be successfully carried out and whether it could effect changes in knowledge, attitudes, and food purchasing behavior in line with nutrition and cancer risk reduction guidelines. Methods. The evaluation consisted of an in-store monitoring element, an in-store and telephone consumer survey, and an analysis of sales data on selected foods. A matched- pair design, using a total of 40 stores in the intervention and comparison groups, was used. Results. The intervention was successfully implemented and had limited success in changing some food purchasing behaviors. There appeared to be no effect on knowledge and attitudes except for increased awareness of a link between diet and cancer and of the program itself. Conclusions. Despite the intervention's success, limitations of the consumer survey and sales data analyses and the continuing diffusion of nutrition messages throughout society make it difficult to specify the impact of this program on consumer nutrition knowledge and behaviors. Handle: RePEc:aph:ajpbhl:1994:84:1:72-76_9 Template-Type: ReDIF-Article 1.0 Title: The urgent need for a vaginal microbicide in the prevention of HIV transmission Journal: American Journal of Public Health Author-Name: Potts, M. Year: 1994 Volume: 84 Issue: 6 Pages: 890-891 Handle: RePEc:aph:ajpbhl:1994:84:6:890-891_7 Template-Type: ReDIF-Article 1.0 Title: A cost-benefit analysis of legislation for bicycle safety helmets in Israel Journal: American Journal of Public Health Author-Name: Ginsberg, G.M. Author-Name: Silverberg, D.S. Year: 1994 Volume: 84 Issue: 4 Pages: 653-656 Abstract: Legislation requiring bicyclists to wear helmets in Israel will, over a helmet's 5-year duration (assuming 85% compliancy, 83.2% helmet efficiency for morbidity, and 70% helmet efficiency for mortality), save approximately 57 lives and result in approximately 2544 fewer hospitalizations; 13 355 and 26 634 fewer emergency room and ambulatory visits, respectively; and 832 and 115 fewer short-term and long-term rehabilitation cases, respectively. Total benefits ($60.7 million) from reductions in health service use ($44.2 million), work absences ($7.5 million), and mortality ($8.9 million) would exceed program costs ($20.1 million), resulting in a benefit-cost ratio of 3.01:1. Handle: RePEc:aph:ajpbhl:1994:84:4:653-656_5 Template-Type: ReDIF-Article 1.0 Title: Harsh social conditions and perinatal survival: An age-period-cohort analysis of the World War II occupation of Norway Journal: American Journal of Public Health Author-Name: Wilcox, A.J. Author-Name: Skjaerven, R. Author-Name: Irgens, L.M. Year: 1994 Volume: 84 Issue: 9 Pages: 1463-1467 Abstract: Objectives. The hypothesis was tested that unfavorable social conditions are associated with poor perinatal survival through direct effects on pregnancy or, more indirectly, through effects on mothers born under such conditions. The occupation of Norway by Nazi Germany was used as a period of social hardship. Methods. Data from Norwegian vital statistics and the Medical Birth Registry were used to describe perinatal mortality during World War II and also a generation later, among babies born to mothers who had themselves been born during the war. Logistic regression was used to identify a possible cohort effect among mothers born in 1940 through 1944 compared with mothers born before or after that period. Results. Harsh conditions in Norway during the occupation increased childhood mortality. However, perinatal mortality declined during that period. Likewise, no adverse effect was seen on the survival of babies born to mothers who had themselves been born during the war (odds ratio = 1.00; 95% confidence interval = 0.96, 1.04). Conclusions. We find no evidence that wartime conditions in Norway impaired perinatal survival, either directly or through an effect on women born during the war. These data underscore how little is known about the ways that social conditions influence perinatal mortality. Handle: RePEc:aph:ajpbhl:1994:84:9:1463-1467_1 Template-Type: ReDIF-Article 1.0 Title: Community education for cardiovascular disease prevention: Risk factor changes in the Minnesota Heart Health Program Journal: American Journal of Public Health Author-Name: Luepker, R.V. Author-Name: Murray, D.M. Author-Name: Jacobs Jr., D.R. Author-Name: Mittelmark, M.B. Author-Name: Bracht, N. Author-Name: Carlaw, R. Author-Name: Crow, R. Author-Name: Elmer, P. Author-Name: Finnegan, J. Author-Name: Folsom, A.R. Author-Name: Grimm, R. Author-Name: Hannan, P.J. Author-Name: Jeffrey, R. Author-Name: Lando, H. Author-Name: McGovern, P. Author-Name: Mullis, R. Author-Name: Perry, C.L. Author-Name: Pechacek, T. Author-Name: Pirie, P. Year: 1994 Volume: 84 Issue: 9 Pages: 1383-1393 Abstract: Objectives. The Minnesota Heart Health Program is a 13-year research and demonstration project to reduce morbidity and mortality from coronary heart disease in whole communities. Methods. Three pairs of communities were matched on size and type; each pair had one education site and one comparison site. After baseline surveys, a 5- to 6-year program of mass media, community organization, and direct education for risk reduction was begun in the education communities, whereas surveys continued in all sites. Results. Many intervention components proved effective in targeted groups. However, against a background of strong secular trends of increasing health promotion and declining risk factors, the overall program effects were modest in size and duration and generally within chance levels. Conclusions. These findings suggest that even such an intense program may not be able to generate enough additional exposure to risk reduction messages and activities in a large enough fraction of the population to accelerate the remarkably favorable secular trends in health promotion activities and in most coronary heart disease risk factors present in the study communities. Handle: RePEc:aph:ajpbhl:1994:84:9:1383-1393_0 Template-Type: ReDIF-Article 1.0 Title: Correlates of high-density lipoprotein cholesterol in Black and White women Journal: American Journal of Public Health Author-Name: Heath, G.W. Author-Name: Macera, C.A. Author-Name: Croft, J.B. Author-Name: Mace, M.L. Author-Name: Gillette, T. Author-Name: Wheeler, F.C. Year: 1994 Volume: 84 Issue: 1 Pages: 98-101 Abstract: The relationships of high-density lipoprotein (HDL) cholesterol with body composition, leisure-time physical activity, cigarette smoking, and education were examined in a community-based sample of 480 Black and 1337 White women. Univariate and multivariate analyses indicated inverse associations of HDL with body mass index and waist-to-hip ratio in both groups, and with cigarette smoking and low educational attainment among White women only. Since correlates of HDL cholesterol differ for Black and White women, further investigation of the differences in these correlates is warranted. Handle: RePEc:aph:ajpbhl:1994:84:1:98-101_6 Template-Type: ReDIF-Article 1.0 Title: Racial disparities in reported prenatal care advice from health care providers Journal: American Journal of Public Health Author-Name: Kogan, M.D. Author-Name: Kotelchuck, M. Author-Name: Alexander, G.R. Author-Name: Johnson, W.E. Year: 1994 Volume: 84 Issue: 1 Pages: 82-88 Abstract: Objectives. The relationship between certain maternal behaviors and adverse pregnancy outcomes has been well documented. One method to alter these behaviors is through the advice of women's health care providers. Advice from providers may be particularly important in minority populations, who have higher rates of infant mortality and prematurity. This study examines racial disparities according to women's self-report of advice received from health care providers during pregnancy in four areas: tobacco use, alcohol consumption, drug use, and breast-feeding. Methods. Health care providers' advice to 8310 White non-Hispanic and Black women was obtained from the National Maternal and Infant Health Survey. Results. After controlling for sociodemographic, utilization, and medical factors, Black women were more likely to report not receiving advice from their prenatal care providers about smoking cessation and alcohol use. The difference between Blacks and Whites also approached significance for breast-feeding. No overall difference was noted in advice regarding cessation of drug use, although there was a significant interaction between race and marital status. Conclusions. These data suggest that Black women may be at greater risk for not receiving information that could reduce their chances of having an adverse pregnancy outcome. Handle: RePEc:aph:ajpbhl:1994:84:1:82-88_9 Template-Type: ReDIF-Article 1.0 Title: A recent decline in cocaine use among youthful arrestees in Manhattan, 1987 through 1993 Journal: American Journal of Public Health Author-Name: Golub, A. Author-Name: Johnson, B.D. Year: 1994 Volume: 84 Issue: 8 Pages: 1250-1254 Abstract: Objectives. Cocaine use among youths as measured by several annual surveys was most popular from about 1979 to 1986, after which it declined. This study carefully examines the nature of the decline by focusing on microdata for youthful arrestees in Manhattan. Methods. Multiple statistical analyses examine whether the decline in cocaine use detected by urinalysis is attributable to fewer arrested youths born more recently having become regular users (cohort effect), to regular users decreasing their consumption (period effect), or to changes in arrest or sampling priorities (artifact). Results. All analyses suggest that the dramatic decline in detected cocaine use among arrestees-from 69% in 1987 to 17% in 1993-was a cohort effect. Detected cocaine use, which was highest (78%) among arrestees reaching 18 in 1986 at the height of the crack epidemic in New York City, subsequently declined to a low of 10% among arrestees reaching 18 in 1993. Discussion. These findings suggests that the epidemic in use of cocaine and crack entered a decline in the late 1980s. However, widespread use of these drugs will probably continue to prevail as an aging population with established habits persists in its use. Handle: RePEc:aph:ajpbhl:1994:84:8:1250-1254_7 Template-Type: ReDIF-Article 1.0 Title: The abundant natural sources and uses of chlorinated chemicals [1] Journal: American Journal of Public Health Author-Name: Gribble, G.W. Year: 1994 Volume: 84 Issue: 7 Pages: 1183 Handle: RePEc:aph:ajpbhl:1994:84:7:1183_2 Template-Type: ReDIF-Article 1.0 Title: The Groningen Activity Restriction Scale for measuring disability: Its utility in international comparisons Journal: American Journal of Public Health Author-Name: Suurmeijer, T.P.B.M. Author-Name: Doeglas, D.M. Author-Name: Moum, T. Author-Name: Briancon, S. Author-Name: Krol, B. Author-Name: Sanderman, R. Author-Name: Guillemin, F. Author-Name: Bjelle, A. Author-Name: Van den Heuvel, W.J.A. Year: 1994 Volume: 84 Issue: 8 Pages: 1270-1273 Abstract: Objectives. The Groningen Activity Restriction Scale (GARS) is a non- disease-specific instrument to measure disability in activities of daily living (ADL) and instrumental activities of daily living (IADL). It was developed in studies of Dutch samples consisting of elderly or chronically ill people. The psychometric properties of the GARS demonstrated in these studies were highly satisfactory. This paper addresses the psychometric properties of the GARS across countries. Methods. Data of 623 patients with recently diagnosed rheumatoid arthritis from four European countries were analyzed by means of a principal components analysis and a Mokken scale analysis for polychotomous items. Results. The results of the analyses were highly satisfactory; there was one strong and reliable general factor representing one underlying dimension of disability in ADL and IADL, and there was a clear hierarchical ordering of the items included in the GARS. The validity of the GARS was strongly suggested by the pattern of associations of the GARS with age, sex, and other existing health status measures. Conclusions. The psychometric characteristics of the GARS, which measures disability in ADL and IADL simultaneously, make this instrument very useful for comparative research across countries. Handle: RePEc:aph:ajpbhl:1994:84:8:1270-1273_9 Template-Type: ReDIF-Article 1.0 Title: The demographic distribution of US drinking patterns in 1990: Description and trends from 1984 Journal: American Journal of Public Health Author-Name: Midanik, L.T. Author-Name: Clark, W.B. Year: 1994 Volume: 84 Issue: 8 Pages: 1218-1222 Abstract: Objectives. Since 1981, per capita consumption of alcohol (based on sales figures) has decreased in the United States. This study describes drinking patterns in the 1990 national alcohol survey by demographic correlates and assesses changes in drinking patterns from the 1984 survey. Methods. Data were obtained from a national household probability sample within the 48 contiguous states; face-to-face interviews were conducted with 2058 adults. The instrument contained questions pertaining to the respondent's background, attitudes toward alcohol, and use of alcohol. Results. The proportions of current drinkers; current drinkers of wine, beer, and liquor; weekly drinkers; and drinkers who reported having five or more drinks per occasion at least once a week were significantly lower in 1990 than in 1984. These changes remained significant when demographic characteristics were controlled by logistic regression. The findings held for Whites only; there were no significant trends for Blacks or Hispanics. Conclusions. While there has been a downward turn in alcohol use in the United States, the correlates of alcohol use have not changed. How these shifts affect alcohol-related problems is an important area for future research. Handle: RePEc:aph:ajpbhl:1994:84:8:1218-1222_8 Template-Type: ReDIF-Article 1.0 Title: Employment status and depressive symptoms in middle-aged women: A longitudinal investigation Journal: American Journal of Public Health Author-Name: Bromberger, J.T. Author-Name: Matthews, K.A. Year: 1994 Volume: 84 Issue: 2 Pages: 202-206 Abstract: Objectives. This study investigated the psychological effects of paid employment and nonemployment, cross-sectionally and longitudinally, in 541 middle-aged women. Methods. Women were seen for an extensive baseline evaluation and were reevaluated in an identical manner 3 years later. They were divided into four 'synthetic' cohorts, based upon employment status at these two assessments. Results. At baseline, nonemployed women reported higher levels of depressive symptoms than employed women, with nonemployed women with less education, low support from family and friends, or low marital satisfaction the most symptomatic. Symptoms decreased in women who were nonemployed initially but employed at the later exam; in all other groups, symptoms increased. Unlike the cross-sectional findings, however, the longitudinal findings showed that women who were nonemployed at baseline and had low levels of education, social support, or marital satisfaction did not benefit more from subsequent employment than did their counterparts who had high levels of these factors. Conclusions. New paid work may have a positive effect on mood for middle-aged women. However, given the contradictions between our cross-sectional and longitudinal results, caution should be exercised in drawing conclusions from cross-sectional studies that likely confound employment status, symptoms, and moderating variables. Handle: RePEc:aph:ajpbhl:1994:84:2:202-206_1 Template-Type: ReDIF-Article 1.0 Title: Presumptive eligibility for pregnant medicaid enrollees: Its effects on prenatal care and perinatal outcome Journal: American Journal of Public Health Author-Name: Piper, J.M. Author-Name: Mitchel Jr., E.F. Author-Name: Ray, W.A. Year: 1994 Volume: 84 Issue: 10 Pages: 1626-1630 Abstract: Objectives. 'Presumptive eligibility' permits pregnant prospective Medicaid enrollees to obtain services during the application period. The purpose of this study was to assess the effects of presumptive eligibility on the receipt of prenatal care and the occurrence of low-birthweight births and neonatal, perinatal, and infant mortality. Methods. Outcome rates for pregnant women who enrolled in Tennessee Medicaid in the 6-month period before presumptive eligibility was enacted were compared with those obtained for pregnant women who enrolled in the 6-month period after presumptive eligibility had been in effect for 5 months. Results. Women in the 'after' group were 40% more likely to enroll and 30% more likely to obtain prenatal care in the first trimester. They were 300% more likely to fill a prescription for prenatal vitamins in the first trimester and 16% more likely to have begun prenatal care before the third trimester. However, they were similar to those enrolling in the 'before' time period in terms of the occurrence of adverse perinatal outcomes. Conclusions. When barriers to prenatal care, including bureaucratic ones, are removed, low-income women will seek care earlier and more frequently. Handle: RePEc:aph:ajpbhl:1994:84:10:1626-1630_1 Template-Type: ReDIF-Article 1.0 Title: Who participates in cardiovascular disease risk factor screenings? Experience with a religious organization-based program Journal: American Journal of Public Health Author-Name: Wells, B.L. Author-Name: Brown, C.C. Author-Name: Horm, J.W. Author-Name: Carleton, R.A. Author-Name: Lasater, T.M. Year: 1994 Volume: 84 Issue: 1 Pages: 113-115 Abstract: Adult members who declined participation in cardiovascular disease risk factor screenings offered at religious organizations were randomly selected and asked to participate in screenings at their homes. Relationships between screening participation and sociodemographic, behavioral, and physiological measures were examined. Age, knowledge of cardiovascular disease risk factors, body mass index, current smoking status, previous report of elevated blood pressure, current diastolic blood pressure measurement, frequency of worship service attendance, and residential distance from the religious organization screening site were important predictors of screening response. Those with conspicuous risk factors appeared less likely to initially respond to religious organization site screening invitations. Handle: RePEc:aph:ajpbhl:1994:84:1:113-115_5 Template-Type: ReDIF-Article 1.0 Title: Attitudes toward body size and dieting: Differences between elderly black and white women Journal: American Journal of Public Health Author-Name: Stevens, J. Author-Name: Kumanyika, S.K. Author-Name: Keil, J.E. Year: 1994 Volume: 84 Issue: 8 Pages: 1322-1325 Abstract: Eating restraint and body size perceptions of 404 White and African- American women 66 to 105 years of age (mean age = 73 years) were assessed by questionnaire. Compared with overweight White women, overweight Black women were 0.6 times as likely to feel guilty after overeating, 0.4 times as likely to diet, 2.5 times as likely to be satisfied with their weight, and 2.7 times as likely to consider themselves attractive. Among those who were not overweight, Black women were half as likely as White women to consider themselves overweight. Compared with Black women, White women perceived themselves to be larger and reported a lower ideal body weight. Handle: RePEc:aph:ajpbhl:1994:84:8:1322-1325_7 Template-Type: ReDIF-Article 1.0 Title: 5-A-DAY: Dietary behavior and the fruit and vegetable intake of Latino children Journal: American Journal of Public Health Author-Name: Basch, C.E. Author-Name: Zybert, P. Author-Name: Shea, S. Year: 1994 Volume: 84 Issue: 5 Pages: 814-818 Abstract: Objectives. The purpose of the study was to examine children's intake of fruits and vegetables in relation to the recent national '5-A-DAY' campaign. Methods. Four 24-hour dietary recalls per child collected from 205 mothers of 4- to 5-year-old urban Latino children were used to analyze average 5-A-DAY fruit and vegetable consumption and examine associations between 5-A-DAY consumption, nutrient intakes, and eating patterns. Results. The reported mean servings per day of fruits and vegetables, as defined by 5-A-DAY criteria, were 1.8 and 1.0, respectively, with only 6.8% (n = 14) of the children averaging five or more servings per day. Fruit juice accounted for 36% of 5-A-DAY servings. There were significant linear trends in intake of vitamins A and C, potassium, iron, cholesterol, protein, and fiber across quintiles of 5-A-DAY intake. There were no differences among quintiles in intake of saturated or total fat or in servings from most non-5-A-DAY food groups. Conclusions. Latino children's intake of fruits and vegetables falls far short of current recommendations. Fruit juice accounted for a disproportionate amount of 5-A-DAY intake in this population. Sensible 5-A- DAY interventions should take into consideration the existing eating patterns of the target population. Handle: RePEc:aph:ajpbhl:1994:84:5:814-818_6 Template-Type: ReDIF-Article 1.0 Title: The effects of denturism: New Zealand dentists' response to competition Journal: American Journal of Public Health Author-Name: Devlin, N.J. Year: 1994 Volume: 84 Issue: 10 Pages: 1675-1677 Abstract: The New Zealand Dental Act of 1988 allowed clinical dental technicians to deal directly with the public in fitting and supplying dentures. This study tested the hypothesis that dentists responded to competition from dental technicians by lowering their fees. The results indicate that there was no significant change in the fees charged by dentists for dentures. The apparent failure of deregulation to produce the expected outcome could be due to the competitive pressure imposed by dental technicians practicing illegally prior to 1988, to consumers' lack of information, or to barriers to 'consumer search' imposed by the act itself. Handle: RePEc:aph:ajpbhl:1994:84:10:1675-1677_0 Template-Type: ReDIF-Article 1.0 Title: Pregnancy risk factors and birth outcomes in Washington State: A comparison of Ethiopian-born and US-born women Journal: American Journal of Public Health Author-Name: Wasse, H. Author-Name: Holt, V.L. Author-Name: Daling, J.R. Year: 1994 Volume: 84 Issue: 9 Pages: 1505-1507 Abstract: This study compared birth outcomes of three cohorts of women with singleton live births in Washington State between 1980 and 1991: all Black Ethiopian-born women (n = 264) and samples of US-born Black (n = 526) and White (n = 546) women. Ethiopians were older, more likely to be married, and less likely to smoke than were US-born women, and they were less likely to have anemia than US-born Blacks. The adjusted low-birthweight risk among Ethiopians was similar to that of US-born Blacks (relative risk [RR] = 0.9) and Whites (RR = 1.1). Ethiopians were more likely to have high-birthweight infants than were US-born Blacks (RR = 4.0). Cultural and behavioral etiologies may explain these favorable birth outcomes. Handle: RePEc:aph:ajpbhl:1994:84:9:1505-1507_7 Template-Type: ReDIF-Article 1.0 Title: The effect of ordinances requiring smoke-free restaurants on restaurant sales Journal: American Journal of Public Health Author-Name: Glantz, S.A. Author-Name: Smith, L.R.A. Year: 1994 Volume: 84 Issue: 7 Pages: 1081-1085 Abstract: Objectives. The effect on restaurant revenues of local ordinances requiring smoke-free restaurants is an important consideration for restaurateurs themselves and the cities that depend on sales tax revenues to provide services. Methods. Data were obtained from the California State Board of Equalization and Colorado State Department of Revenue on taxable restaurant sales from 1986 (1982 for Aspen) through 1993 for all 15 cities where ordinances were in force, as well as for 15 similar control communities without smoke-free ordinances during this period. These data were analyzed using multiple regression, including time and a dummy variable for whether an ordinance was in force. Total restaurant sales were analyzed as a fraction of total retail sales and restaurant sales in smoke-free cities vs the comparison cities similar in population, median income, and other factors. Results. Ordinances had no significant effect on the fraction of total retail sales that went to restaurants or on the ratio of restaurant sales in communities with ordinances compared with those in the matched control communities. Conclusions. Smoke-free restaurant ordinances do not adversely affect restaurant sales. Handle: RePEc:aph:ajpbhl:1994:84:7:1081-1085_6 Template-Type: ReDIF-Article 1.0 Title: Longitudinal tracking of adolescent smoking, physical activity, and food choice behaviors Journal: American Journal of Public Health Author-Name: Kelder, S.H. Author-Name: Perry, C.L. Author-Name: Klepp, K.-I. Author-Name: Lytle, L.L. Year: 1994 Volume: 84 Issue: 7 Pages: 1121-1126 Abstract: Objectives. A major assumption underlying youth health promotion has been that physiological risk factors track from childhood into adulthood. However, few studies have systematically examined how behaviors change during adolescence. This paper describes longitudinal tracking of adolescent health behaviors in two Minnesota Heart Health Program communities. Methods. Beginning in sixth grade (1983), seven annual waves of behavioral measurements were taken from both communities (baseline n = 2376). Self- reported data included smoking behavior, physical activity, and food preferences. Results. A progressive increase in the change to weekly smoking status was observed across the smoking status categories. As students began to experiment with smoking, they were more likely to either begin to be or remain regular smokers. Tracking of physical activity and food choice variables was also apparent. In nearly all the follow-up periods, the students identified at baseline as measuring high remained high, and those measuring low remained low. Conclusions. These results indicate that there is evidence of early consolidation and tracking of physical activity, food preference, and smoking behavior. The early consolidation of health behaviors implies that interventions should begin prior to sixth grade, before behavioral patterns are resistant to change. The smoking results suggest that students are experiencing difficulty quitting smoking; thus, youth smoking cessation interventions are warranted. Handle: RePEc:aph:ajpbhl:1994:84:7:1121-1126_2 Template-Type: ReDIF-Article 1.0 Title: Risk factors for delayed immunization among children in an HMO Journal: American Journal of Public Health Author-Name: Lieu, T.A. Author-Name: Black, S.B. Author-Name: Ray, P. Author-Name: Chellino, M. Author-Name: Shinefield, H.R. Author-Name: Adler, N.E. Year: 1994 Volume: 84 Issue: 10 Pages: 1621-1625 Abstract: Objectives. Improving the timely delivery of childhood immunizations has become a national imperative. This study aimed to identify nonfinancial predictors of delayed immunization among patients with good financial access to preventive care. Methods. This prospective cohort study used telephone interviews and a computerized immunization tracking system to evaluate 13- month-old children (n = 530) in a regional group-model health maintenance organization. Results. More than one third of parents interviewed did not know when the next immunization was due. Thirteen percent were late for the measles-mumps-rubella immunization, recommended at 15 months of age, by 90 days or more. Independent predictors of delayed immunization included having a larger number of children (odds ratio [OR] = 1.4, P < .01), not having a regular doctor (OR = 2.9, P < .05), not knowing when the shot was due (OR = 2.0, P < .01), and not worrying about the risks of shots (OR = 1.4, P < .05). Conclusions. Financial access alone does not guarantee timely childhood immunization. In managed care settings, which may cover increasing numbers of children under health care reform, interventions are needed to better inform parents of when immunizations are due. Handle: RePEc:aph:ajpbhl:1994:84:10:1621-1625_6 Template-Type: ReDIF-Article 1.0 Title: The compliance of licensed US child care centers with national health and safety performance standards Journal: American Journal of Public Health Author-Name: Addiss, D.G. Author-Name: Sacks, J.J. Author-Name: Kresnow, M.-J. Author-Name: O'Neil, J. Author-Name: Ryan, G.W. Year: 1994 Volume: 84 Issue: 7 Pages: 1161-1164 Abstract: The American Public Health Association and the American Academy of Pediatrics recently published health and safety guidelines for child care centers. A survey was conducted to determine the extent to which practices in US child care centers are reflective of these guidelines. Compliance with 16 guidelines ranged from 19.5% to 98.6%, varied considerably by state, and was not consistently associated with selected center characteristics. Prevention efforts should focus on practices for which compliance is low and on those that have the greatest disease- and injury-reducing potential. Handle: RePEc:aph:ajpbhl:1994:84:7:1161-1164_4 Template-Type: ReDIF-Article 1.0 Title: Degree of acculturation and the risk of crack cocaine smoking among Hispanic Americans Journal: American Journal of Public Health Author-Name: Wagner-Echeagaray, F.A. Author-Name: Schutz, C.G. Author-Name: Chilcoat, H.D. Author-Name: Anthony, J.C. Year: 1994 Volume: 84 Issue: 11 Pages: 1825-1827 Abstract: Epidemiologic data from three national surveys conducted in 1988, 1990, and 1991 were used to investigate the association between acculturation and use of crack cocaine among Hispanic Americans living in the United States. Poststratification and conditional logistic regression were used to hold constant shared aspects of neighborhood environment, age, sex, and education. The analyses showed a strong inverse relationship between degree of acculturation and crack smoking among Mexican Americans (relative odds = 0.12, 95% confidence interval = 0.04, 0.34) but not among other Hispanics in the study population. This observed variation within the US Hispanic American population deserves special attention in future research. Handle: RePEc:aph:ajpbhl:1994:84:11:1825-1827_1 Template-Type: ReDIF-Article 1.0 Title: Maternal attitude toward pregnancy and the risk of neonatal death Journal: American Journal of Public Health Author-Name: Bustan, M.N. Author-Name: Coker, A.L. Year: 1994 Volume: 84 Issue: 3 Pages: 411-414 Abstract: Objectives. Reduced options for fertility control over the past decade have increased the rates of unwanted pregnancy. We evaluated whether a woman's negative attitude toward her pregnancy increased the risk of perinatal mortality, in a large, prospective cohort study. Methods. The association between attitude toward the pregnancy and perinatal mortality was evaluated in a longitudinal cohort study of 8823 married, pregnant patients enrolled from 1959 to 1966 in the Chile Health and Development Studies. Results. Women who reported during the first trimester of prenatal care that the pregnancy was unwanted were more than two times more likely to deliver infants who died within the first 28 days of life than were women reporting accepted pregnancies. A positive attitude toward pregnancy was not associated with fetal death of postneonatal death. Conclusions. These data, collected when induced abortions were illegal, may have important implications for the 1990s. If maternal attitude toward the pregnancy is associated with neonatal mortality and abortion laws change such that access is restricted, infant mortality may increase because a greater proportion of births will be unwanted. Handle: RePEc:aph:ajpbhl:1994:84:3:411-414_3 Template-Type: ReDIF-Article 1.0 Title: Medicare-certified home health services: National and regional supply in the 1980s Journal: American Journal of Public Health Author-Name: Scalzi, C.C. Author-Name: Zinn, J.S. Author-Name: Guilfoyle, M.J. Author-Name: Perdue, S.T. Year: 1994 Volume: 84 Issue: 10 Pages: 1646-1648 Abstract: The number of Medicare-certified home health agencies nearly doubled from 1980 to 1990. Using Health Care Financing Administration data, this study documented national and regional patterns of entry and exit by Medicare home health providers from 1980 to 1990. Nationally, agency origination rates accelerated during the early 1980s and then dropped abruptly in the second half of the decade. The proprietary sector, accounting for approximately 42% of agencies in existence during the period of the study, exhibited the greatest volatility. Regional differences are also evident. Both expansion and contraction in Medicare home health services appear to be a response to the incentives of legislation implemented during this period. Handle: RePEc:aph:ajpbhl:1994:84:10:1646-1648_6 Template-Type: ReDIF-Article 1.0 Title: Sedatives and hypnotics in Stockholm: Social factors and kinds of use Journal: American Journal of Public Health Author-Name: Blennow, G. Author-Name: Romelsjo, A. Author-Name: Leifman, H. Author-Name: Leifman, A. Author-Name: Karlsson, G. Year: 1994 Volume: 84 Issue: 2 Pages: 242-246 Abstract: Objectives. The aims of the study were (1) to estimate prevalence rates of current, regular, and long-term use of sedatives and hypnotics and the incidence of regular use in an urban population and (2) to study the association between such use of drugs and sociodemographic factors, symptoms of disease, and alcohol consumption. Methods. Data on drug use in a random sample of 6217 adults in Stockholm County were analyzed with logistic regression. Results. The prevalence rate for current use of sedatives or hypnotics was 12.8% among men and 18.6% among women; the rate for regular use was 3.7% among males and 4.7% among females. The odds ratio for current use increased with age and was higher among unemployed persons and disability pensioners, high consumers of alcohol, persons with an increased level of symptoms, and widows. More than 25% of the persons who had used sedatives or hypnotics during the previous 2 weeks were regular users 6 months later. For persons aged 25 through 64 years, the annual incidence rate was 1.8% among men and 2.7% among women. Conclusions. The comparatively low incidence and high prevalence of regular use implies that long-term use of sedatives and hypnotics is common. Handle: RePEc:aph:ajpbhl:1994:84:2:242-246_0 Template-Type: ReDIF-Article 1.0 Title: Rationing or rationalizing children's medical care: Comparison of a Medicaid HMO with fee-for-service care Journal: American Journal of Public Health Author-Name: Mauldon, J. Author-Name: Leibowitz, A. Author-Name: Buchanan, J.L. Author-Name: Damberg, C. Author-Name: McGuigan, K.A. Year: 1994 Volume: 84 Issue: 6 Pages: 899-904 Abstract: Objectives. This paper examines how medical care obtained by children enrolled in a Medicaid health maintenance organization (HMO) differs from that obtained by similar children who receive care from fee-for-service Medicaid providers. Methods. In a randomized trial, some Medicaid households were assigned to remain in a traditional fee-for-service arrangement and others were randomly selected to join a Medicaid prepaid plan (an HMO). Participating households recorded data on children's health status and use of medical care. Results. The prepaid plan members and the fee-for-service recipients received equivalent numbers of checkup visits, but the children in the prepaid plan made significantly fewer acute care visits. This plan appeared to target its services to children with the greatest health care needs. However, the content of health visits in the two systems did not differ, nor did prepaid and fee-for-service enrollees use the emergency room differently. Conclusions. It is possible to design a Medicaid HMO that achieves financial savings without reducing services to the most vulnerable patients. However, these findings alone do not provide a basis for widespread policy change in the direction of Medicaid HMOs. Further research is needed to establish whether the children treated in the HMO differed in health outcomes from those treated by fee-for-service care. Handle: RePEc:aph:ajpbhl:1994:84:6:899-904_3 Template-Type: ReDIF-Article 1.0 Title: Patients' rights after health care reform: Who decides what is medically necessary? Journal: American Journal of Public Health Author-Name: Mariner, W.K. Year: 1994 Volume: 84 Issue: 9 Pages: 1515-1520 Abstract: President Clinton's Health Security Act entitles individuals not to unlimited health care, but to a package of defined insurance benefits with specific exclusions and limitations. Like virtually all reform proposals, it would limit covered benefits to services that are medically necessary. If health reform is to control costs, not all medically necessary care can be covered. In the absence of a generally accepted definition of medical necessity, many services will not be guaranteed to all patients unless they are explicitly covered in the federal legislation or regulations. Without a federal definition of medical necessity or regulations listing covered services, health insurance plans will retain the primary authority to decide what is medically necessary for their patient subscribers. Handle: RePEc:aph:ajpbhl:1994:84:9:1515-1520_7 Template-Type: ReDIF-Article 1.0 Title: Circumcision and sexually transmitted diseases Journal: American Journal of Public Health Author-Name: Cook, L.S. Author-Name: Koutsky, L.A. Author-Name: Holmes, K.K. Year: 1994 Volume: 84 Issue: 2 Pages: 197-201 Abstract: Objectives. New evidence linking lack of circumcision with sexually transmitted human immunodeficiency virus revives concerns about circumcision and other sexually transmitted diseases. This study was undertaken to assess the relationship between circumcision and syphilis, gonorrhea, chlamydial infection, genital herpes, nongonococcal urethritis, and exophytic genital warts. Methods. A cross-sectional study of 2776 heterosexual men attending a sexually transmitted disease clinic in 1988 was used to investigate the relationship between circumcision and sexually transmitted diseases. Subjects with specific sexually transmitted diseases and those without such diseases were compared after adjustment for age, race, zip code of residence, other sexually transmitted diseases, and number of sexual partners. Results. A positive relationship was observed between uncircumcised status and both syphilis and gonorrhea. A negative relationship was found between warts and lack of circumcision. No apparent relationship was noted between uncircumcised status and genital herpes, chlamydial infection, or nongonococcal urethritis. Conclusions. Uncircumcised men were more likely than circumcised men to have syphilis and gonorrhea and were less likely to have visible warts. Handle: RePEc:aph:ajpbhl:1994:84:2:197-201_0 Template-Type: ReDIF-Article 1.0 Title: The risk of pregnancy-induced hypertension: Black and White differences in a military population Journal: American Journal of Public Health Author-Name: Irwin, D.E. Author-Name: Savitz, D.A. Author-Name: Hertz-Picciotto, I. Author-Name: St. Andre, K.A. Year: 1994 Volume: 84 Issue: 9 Pages: 1508-1510 Abstract: The relationship between race and risk of pregnancy-induced hypertension was investigated in a cohort of active-duty military women who gave birth during the period 1987 through 1989. Cases were identified through hospital discharge diagnoses and included transient gestational hypertension, pre- eclampsia, eclampsia, and unspecified hypertension complicating pregnancy. Multivariate analysis showed nulliparous Black women to be at a slightly increased risk for all pregnancy-induced hypertension (risk ratio [RR] = 1.2) and for pre-eclampsia (RR = 1.3) compared with nulliparous White women. Black parous women were found to have a slightly reduced risk of all pregnancy- induced hypertension (RR = 0.77) and pre-eclampsia (RR = 0.38) compared with White parous women. Handle: RePEc:aph:ajpbhl:1994:84:9:1508-1510_0 Template-Type: ReDIF-Article 1.0 Title: Maternal-infant HIV transmission and circumstances of delivery Journal: American Journal of Public Health Author-Name: Kuhn, L. Author-Name: Stein, Z.A. Author-Name: Thomas, P.A. Author-Name: Singh, T. Author-Name: Tsai, W.-Y. Year: 1994 Volume: 84 Issue: 7 Pages: 1110-1115 Abstract: Objectives. Circumstances of delivery among children with acquired immunodeficiency syndrome (AIDS) were investigated to assess whether they were consistent with predictions that intrapartum factors affect the risk of maternal-infant human immunodeficiency virus (HIV) transmission. Methods. Pediatric AIDS patients (maternal-infant transmission; n = 632) reported to the New York City Health Department through 1991 were compared with a series of infants born to predominantly uninfected women. For each case patient, five control subjects were selected and matched from birth certificate files. Hypothesized case-control comparisons for mode of delivery and preselected complications were tested. Results. Compared with control subjects, case patients were less likely to have been delivered by cesarean section without complications (odds ratio [OR] = 0.77; 95% confidence interval [CI] = 0.59, 1.01) and more likely to have been delivered with complications, whether delivery was by cesarean section (OR = 1.54; 95% CI = 0.98, 2.43) or vaginal (OR = 1.66; 95% CI = 1.15, 2.39). Conclusions. Assuming that HIV-infected and uninfected women have comparable circumstances of delivery, conditional on sociomedical characteristics, these results suggest that intrapartum events may be associated with maternal-infant HIV transmission. Handle: RePEc:aph:ajpbhl:1994:84:7:1110-1115_4 Template-Type: ReDIF-Article 1.0 Title: Adiposity and stroke among older adults of low socioeconomic status: The Chicago Stroke Study Journal: American Journal of Public Health Author-Name: DiPietro, L. Author-Name: Ostfeld, A.M. Author-Name: Rosner, G.L. Year: 1994 Volume: 84 Issue: 1 Pages: 14-19 Abstract: Objectives. The purpose of this study was to test the hypothesis that overall and truncal adiposity increase the risk of stroke independent of their association with cardiovascular disease risk factors and other preexisting illnesses. Methods. Analyses were conducted of longitudinal data from a poor, biracial cohort of noninstitutionalized adults 65 to 74 years of age who participated in the Chicago Stroke Study from 1965 to 1970. Results. Ponderal index (cm/kg(1/3)) and chest skinfold were significantly associated with systolic and diastolic blood pressure, serum cholesterol and triglycerides, plasma glucose, and smoking. Ponderal index was also associated with diabetes and risk of stroke. After potential confounders were controlled, the following variables showed significant independent associations with risk of stroke: Black race, female gender, and age 70+; hypertensive heart disease; and diabetes. Neither adiposity variable was associated with risk of stroke in the presence of these powerful predictors. Conclusions. Control of hypertension and diabetes continues to be important among older adults. Since excess adiposity seems to influence risk of stroke through its association with these disorders and other cardiovascular disease risk factors, control of weight and fat remains an important concern as well. Handle: RePEc:aph:ajpbhl:1994:84:1:14-19_1 Template-Type: ReDIF-Article 1.0 Title: Characteristics of adolescent work injuries reported to the Minnesota Department of Labor and Industry Journal: American Journal of Public Health Author-Name: Parker, D.L. Author-Name: Carl, W.R. Author-Name: French, L.R. Author-Name: Martin, F.B. Year: 1994 Volume: 84 Issue: 4 Pages: 606-611 Abstract: Objectives. The purpose of the study was to provide descriptive data and incidence data on adolescent work-related injuries and to determine whether such injuries are underreported to the Minnesota Department of Labor and Industry. Methods. The study consisted of a 1-year survey of 534 adolescent work-related injuries reported to the Department of Labor and Industry and a cross-sectional survey of 3312 public high school students from throughout Minnesota. The high school survey used an abbreviated questionnaire with a subset of items from the Department of Labor and Industry survey. Results. Ninety-six percent of the injuries were strains and sprains, cuts and lacerations, burns, bruises and contusions, and fractures. There were 11 hospitalizations; 4 were for burns that occurred during work in restaurants. Eighty workers (15%) reported permanent impairment as a result of their injuries. It was estimated that there were 2268 reportable injuries to working adolescents in Minnesota during the study year. Conclusions. The most common serious injuries were injuries to the lower back and burns. The demographic characteristics of adolescents whose injuries were reported to the Department of Labor and Industry were similar to those of injured adolescent workers identified through the high school survey. The results suggest that there is substantial underreporting of adolescent work injuries. Handle: RePEc:aph:ajpbhl:1994:84:4:606-611_3 Template-Type: ReDIF-Article 1.0 Title: Weight concerns, dieting behavior, and smoking initiation among adolescents: A prospective study Journal: American Journal of Public Health Author-Name: French, S.A. Author-Name: Perry, C.L. Author-Name: Leon, G.R. Author-Name: Fulkerson, J.A. Year: 1994 Volume: 84 Issue: 11 Pages: 1818-1820 Abstract: Students (n = 1705) in grades 7 through 10 were surveyed at baseline and 1 year later about their weight concerns, dieting behaviors, and smoking behavior. Three of six weight concerns and dieting behaviors assessed at baseline were prospectively related to smoking initiation in girls (trying to lose weight, eating disorder symptoms, constant thoughts about weight). Four of six weight concerns and dieting behaviors were cross-sectionally related to current smoking at baseline in girls (trying to lose weight, eating disorder symptoms, fear of weight gain, desire to be thin). Weight concerns and dieting behaviors were largely unrelated to current smoking in boys. Implications for smoking prevention efforts are discussed. Handle: RePEc:aph:ajpbhl:1994:84:11:1818-1820_1 Template-Type: ReDIF-Article 1.0 Title: A proposed method for assessing the performance of local public health functions and practices Journal: American Journal of Public Health Author-Name: Miller, C.A. Author-Name: Moore, K.S. Author-Name: Richards, T.B. Author-Name: Monk, J.D. Year: 1994 Volume: 84 Issue: 11 Pages: 1743-1749 Abstract: Objectives. One of the objectives for the nation for the year 2000 requires that 90% of the population be served by a local health department effectively carrying out the core functions of public health. This study proposes a method whereby determinations can be made of the extent to which a local public health jurisdiction is served by core public health functions, as well as the extent to which the functions are rendered by the health department. Methods. Fourteen health departments under longitudinal study between 1979 and 1992 were studied. Respondents in each department completed a survey protocol using 81 indicators linked to standard public health functions and practices. Results are presented in graphic form, which provides a visual profile of public health performance for a local jurisdiction. Results. The graphic profiles successfully differentiate one jurisdiction from another, and within each jurisdiction they differentiate the performance levels of different public health practices. The method enables identification of the full range of public health providers. Conclusions. Current definitions of public health practice have utility for evaluating public health performance. The validity of the proposed method deserves further study. Handle: RePEc:aph:ajpbhl:1994:84:11:1743-1749_4 Template-Type: ReDIF-Article 1.0 Title: Providing medical care to methadone clinic patients: Referral vs on-site care Journal: American Journal of Public Health Author-Name: Umbricht-Schneiter, A. Author-Name: Ginn, D.H. Author-Name: Pabst, K.M. Author-Name: Bigelow, G.E. Year: 1994 Volume: 84 Issue: 2 Pages: 207-210 Abstract: Objectives. Intravenous drug users are at high risk for medical illness, yet many are medically underserved. Most methadone treatment programs have insufficient resources to provide medical care. The purpose of this study was to test the efficacy of providing medical care at a methadone clinic site vs referral to another site. Methods. Patients with any of four target medical conditions were randomized into an on-site group offered medical care at the methadone treatment clinic and a referred group offered medical care at a nearby clinic. Entry to treatment and use of medical services were analyzed. Results. Of 161 intravenous drug users evaluated, 75 (47%) had one or more of the target medical conditions. Fifty-one were randomized. In the on-site group (n = 25), 92% received medical treatment; in the referred group (n = 26), only 35% received treatment. Conclusions. Providing medical care at a methadone treatment program site is more effective than the usual referral procedure and is a valuable public health intervention. Handle: RePEc:aph:ajpbhl:1994:84:2:207-210_1 Template-Type: ReDIF-Article 1.0 Title: Reflections on a half century of injury control Journal: American Journal of Public Health Author-Name: Waller, J.A. Year: 1994 Volume: 84 Issue: 4 Pages: 664-670 Abstract: Using both historical analysis and personal reminiscence, this article describes the development of injury control activities since about 1940, focusing particular attention on the rise and fall of the Public Health Service's Division of Accident Prevention. By the 1940s and 1950s, modest but useful efforts in injury control research and programming had been made. The 1960s and early 1970s then saw an explosion of new concepts, programs, and enthusiasm, but much of this soon dissipated. Since 1985 there has been a renaissance of interest and effort, and the development of a new cadre of injury control professionals. This progress is threatened, however, by both old and new problems. Handle: RePEc:aph:ajpbhl:1994:84:4:664-670_5 Template-Type: ReDIF-Article 1.0 Title: The risk of hospitalization for ischemic heart disease among Asian Americans in Northern California Journal: American Journal of Public Health Author-Name: Klatsky, A.L. Author-Name: Tekawa, I. Author-Name: Armstrong, M.A. Author-Name: Sidney, S. Year: 1994 Volume: 84 Issue: 10 Pages: 1672-1675 Abstract: To supplement sparse data about ischemic heart disease in Asian Americans, hospitalization risk was prospectively examined in a group of Asian Americans living in Northern California. Analyses used Cox models with ischemic heart disease risk traits as covariables. With Whites as the referent category, relative risks by ethnic group were as follows: Chinese, 0.6 (P = .001); Japanese, 1.0 (P = .97); Filipinos, 1.0 (P = .95); South Asians, 3.7 (P < .001); other Asian Americans, 0.8 (P = .55). Thus, unexplained differences in ischemic heart disease risk exist among Asian-American ethnic groups, with Chinese Americans at lowest risk and persons of South Asian origin at highest risk. Handle: RePEc:aph:ajpbhl:1994:84:10:1672-1675_3 Template-Type: ReDIF-Article 1.0 Title: Vitamin supplement use and mortality [2] Journal: American Journal of Public Health Author-Name: Enstrom, J.E. Author-Name: Kim, I. Author-Name: Williamson, D.F. Author-Name: Byers, T. Author-Name: Koplan, J.P. Year: 1994 Volume: 84 Issue: 6 Pages: 1034-1038 Handle: RePEc:aph:ajpbhl:1994:84:6:1034-1038_0 Template-Type: ReDIF-Article 1.0 Title: The use of nonoxynol-9 for protection against cervical gonorrhea Journal: American Journal of Public Health Author-Name: Weir, S.S. Author-Name: Feldblum, P.J. Author-Name: Zekeng, L. Author-Name: Roddy, R.E. Year: 1994 Volume: 84 Issue: 6 Pages: 910-914 Abstract: Objectives. Although condoms are the best defense against sexually transmitted disease, little is known about the effectiveness of female- controlled methods containing nonoxynol-9 as backup protection when condoms are not being used. Methods. To assess the extent to which nonoxynol-9 protects women against gonorrhea, a cohort of 303 female sex workers (prostitutes) in Yaounde, Cameroon, were asked to use condoms and suppositories containing nonoxynol-9 at every sexual encounter and to record daily sexual activity and use of condoms and suppositories on coital logs that were reviewed monthly. Evidence of gonorrheal infection was based on a positive gonorrhea culture. Stratified analysis and proportional hazards regression were used to estimate rate ratios. Results. Forty-one women enrolled in the study were excluded from the current analysis. The estimated incidence of gonorrhea was 6.2 infections per 100 person-months of observation. Incidence rate ratios estimated from proportional hazards regression models controlling for condom use showed that using nonoxynol-9 during acts not protected by condoms reduced the risk of infection. Conclusions. Although the protective effect of condoms against sexually transmitted disease is greater than that afforded by nonoxynol-9, using nonoxynol-9 when condoms are not used is a far better strategy in gonorrhea prevention than using no method at all. Handle: RePEc:aph:ajpbhl:1994:84:6:910-914_9 Template-Type: ReDIF-Article 1.0 Title: National and state spending on specialty alcoholism treatment: 1979 and 1989 Journal: American Journal of Public Health Author-Name: Huber, J.H. Author-Name: Pope, G.C. Author-Name: Dayhoff, D.A. Year: 1994 Volume: 84 Issue: 10 Pages: 1662-1666 Abstract: The National Drug and Alcohol Treatment Unit Survey was used to measure changes in specialty alcoholism treatment spending between 1979 and 1989 nationally and by state. National spending more than doubled from $1.6 billion to $3.8 billion in 1989 dollars. Private spending increased more rapidly than public spending, although most clients continue to be publicly funded. Dramatic differences across states in public funding growth were partially explained by differential increases in per capita income and in federal substance abuse block grants. Access to treatment continues to vary widely across the states. Handle: RePEc:aph:ajpbhl:1994:84:10:1662-1666_6 Template-Type: ReDIF-Article 1.0 Title: Self-reports of HIV risk factors by patients at a sexually transmitted disease clinic: Audio vs written questionnaires Journal: American Journal of Public Health Author-Name: Boekeloo, B.O. Author-Name: Schiavo, L. Author-Name: Rabin, D.L. Author-Name: Conlon, R.T. Author-Name: Jordan, C.S. Author-Name: Mundt, D.J. Year: 1994 Volume: 84 Issue: 5 Pages: 754-760 Abstract: Objectives. The purpose of this study was to determine how the method of assessment affects patient report of human immunodeficiency virus (HIV) risks. Methods. Patients at a sexually transmitted disease clinic randomly received either a written self-administered questionnaire or an audio self- administered questionnaire delivered by cassette player and headset. These questionnaires were followed by face-to-face interviews. Results. Audio questionnaires had fewer missing responses than written questionnaires. Audio questionnaires also identified more unprotected vaginal intercourse and sexual partners suspected or known to have HIV infection or acquired immunodeficiency syndrome than did written questionnaires. Although both the audio and written questionnaires identified more risks than the face-to-face interviews, the difference in the mean number of reported risks between the audio questionnaires and the face-to-face interviews was greater than that between the written questionnaires and the face-to-face interviews. Conclusions. Audio questionnaires may obtain more complete data and identify more HIV risk than written questionnaires. Research is warranted about whether audio questionnaires overcome barriers to the completion and accuracy of HIV risk surveys. This study emphasizes the need to elucidate the relative strengths and weaknesses of written questionnaires, audio questionnaires, and face-to-face interviews for HIV risk assessment. Handle: RePEc:aph:ajpbhl:1994:84:5:754-760_6 Template-Type: ReDIF-Article 1.0 Title: Is liquor intoxicating? Scientists, prohibition, and the normalization of drinking Journal: American Journal of Public Health Author-Name: Pauly, P.J. Year: 1994 Volume: 84 Issue: 2 Pages: 305-313 Abstract: The reliance of current advocates of recreational drug legalization on parallels between 'drug prohibition' and the repudiated experiment of National Prohibition in the 1920s invites renewed attention to the history of the legalization and normalization of drinking. A new scientific conception of the nature and effects of alcohol formed an important element in both the politics of repeal and the ensuing legitimation of alcohol consumption. The industrial toxicologist Yandell Henderson argued that alcohol should be considered analogous to carbon monoxide-clearly a poison, yet a normal part of civilized life and only problematic above a determinable and manageable exposure threshold. This argument had political force in the early 1930s as part of the contention that beer was not an 'intoxicating liquor.' It was more broadly persuasive because it was consistent with Americans' experience with industrial poisons, for which exposure levels had been set by toxicologists such as Henderson. This historical perspective illuminates the more recent reassessment of the risks of alcohol consumption. It also challenges the applicability of the model of the normalization of drinking to proposals to legalize cocaine and opiates. Handle: RePEc:aph:ajpbhl:1994:84:2:305-313_5 Template-Type: ReDIF-Article 1.0 Title: Work-site cholesterol screening and dietary intervention: The Staff Healthy Heart Project Journal: American Journal of Public Health Author-Name: Barratt, A. Author-Name: Reznik, R. Author-Name: Irwig, L. Author-Name: Cuff, A. Author-Name: Simpson, J.M. Author-Name: Oldenburg, B. Author-Name: Horvath, J. Author-Name: Sullivan, D. Year: 1994 Volume: 84 Issue: 5 Pages: 779-782 Abstract: Objectives. The Staff Healthy Heart Project was established to run a work- site cholesterol screening project and a randomized controlled trial of dietary interventions. Methods. Screening was offered to all staff at six Australian hospitals. Participants with blood cholesterol of 5.2 mmol/L (200 mg/dL) or above were randomly allocated to receive screening only (control group), a self-help package, or a nutrition course. Participants were seen 3 and 6 months after intervention to measure blood cholesterol and dietary changes. Results. Eighty percent of available staff (n = 2638) were screened. Of those eligible, 67% (n = 683) entered the trial. Follow-up measures of blood cholesterol and dietary intake were obtained for 63% and 38% of trial participants, respectively. A reduction in reported dietary fat was found for all groups, but there were no significant differences between groups. Reported dietary fiber rose by 0.6 g/MJ/day for those in the nutrition course. There were no changes in total blood or high-density lipoprotein cholesterol. Conclusions. Cholesterol reduction was not demonstrated, but this result is difficult to interpret given the poor ongoing participation rates. Strategies to improve ongoing participation in work-site projects are needed to achieve adequate assessment of dietary interventions used in cholesterol screening. Handle: RePEc:aph:ajpbhl:1994:84:5:779-782_2 Template-Type: ReDIF-Article 1.0 Title: Child and adolescent drownings in Harris County, Texas, 1983 through 1990 Journal: American Journal of Public Health Author-Name: Warneke, C.L. Author-Name: Cooper, S.P. Year: 1994 Volume: 84 Issue: 4 Pages: 593-598 Abstract: Objectives. This study described childhood drowning rates and circumstances in Harris County, a large metropolitan area in Texas, and compared case ascertainment between data sources. Methods. Drowning rates among Harris County residents newborn through 19 years of age were calculated from death certificate data (1983 through 1989), and local childhood drowning hazards were described on the basis of medical examiner data (1983 through 1990). Cases from both sources were compared to determine sensitivity of sources. Results. The drowning rate among Harris County residents newborn through 19 years of age was 3.8 per 100 000 person-years. The drowning rates among Blacks and Hispanics exceeded that of Whites by 56% and 19%, respectively. The majority of the 196 unintentional drownings occurred in swimming pools. Half of the pool drownings occurred in apartment pools and 33% in private home pools. The medical examiner logbook identified a slightly higher number of drownings than did death certificates. International Classification of Diseases external cause of death codes were of limited use in describing drowning circumstances. Conclusions. Childhood drowning hazards not previously reported were identified, specifically hazards in apartment pools and those among Hispanic children. Handle: RePEc:aph:ajpbhl:1994:84:4:593-598_1 Template-Type: ReDIF-Article 1.0 Title: First-trimester anesthesia exposure and the risk of central nervous system defects: A population-based case-control study Journal: American Journal of Public Health Author-Name: Sylvester, G.C. Author-Name: Khoury, M.J. Author-Name: Lu, X. Author-Name: Erickson, J.D. Year: 1994 Volume: 84 Issue: 11 Pages: 1757-1760 Abstract: Objectives. Although up to 2% of women undergo surgery during pregnancy, teratogenic effects of general anesthesia have not been adequately studied. Recently, an association between first-trimester operations and central nervous system defects has been described. This issue was explored in a population-based case-control study. Methods. Case patients included live- born and stillborn infants with central nervous system defects born to residents of metropolitan Atlanta, Ga, between 1968 and 1980. Control patients included normal babies frequency matched to case patients by race, birth hospital, and period of birth. Conditional logistic regression analysis was used to adjust for potential confounding factors. Results. Of 694 mothers of infants with central nervous system defects, 12 reported first-trimester anesthesia exposure; 34 of 2984 control mothers reported such exposure (odds ratio [OR] = 1.7, 95% confidence interval [CI] = 0.8, 3.3). A striking association was observed between reported anesthesia exposure and hydrocephalus with another major defect (OR = 9.6, 95% CI = 3.8, 24.6). The strongest association was that of anesthesia exposure with hydrocephalus and eye defects (OR = 39.6, 95% CI = 7.5, 209.2). Conclusions. An increased risk of hydrocephalus with other defects was found among offspring of mothers with reported first-trimester anesthesia. Further studies are needed to explore the possible teratogenic effects of general anesthesia. Handle: RePEc:aph:ajpbhl:1994:84:11:1757-1760_6 Template-Type: ReDIF-Article 1.0 Title: Acutely injured patients with trauma in Massachusetts: Differences in care and mortality, by insurance status Journal: American Journal of Public Health Author-Name: Haas, J.S. Author-Name: Goldman, L. Year: 1994 Volume: 84 Issue: 10 Pages: 1605-1608 Abstract: Objectives. This study was designed to determine whether resource use and mortality differed by insurance status for patients with acute trauma. Methods. All adults emergently hospitalized in Massachusetts during 1990 with acute trauma (n = 15 008) were examined. Results. After adjustment for confounders, uninsured patients were as likely to receive care in an intensive care unit as were patients with private insurance (odds ratio [OR] = 0.97, 95% confidence interval [CI] = 0.85, 1.11) but were less likely to undergo an operative procedure (OR = 0.68, 95% CI = 0.63, 0.74) or physical therapy (OR = 0.61, 95% CI = 0.57, 0.67) and were more likely to die in a hospital (OR = 2.15, 95% CI = 1.44, 3.19). Compared with patients with private insurance, those with Medicaid were less likely to receive an operative procedure (0.85, 0.75-0.97), were equally likely to receive care in an intensive care unit (OR = 1.05, 95% CI = 0.86, 1.30) or physical therapy (OR = 0.90, 95% CI = 0.79, 1.02), and were no more likely to die (OR = 1.28, 95% CI = 0.69, 2.39). Conclusions. These results suggest that the uninsured receive less trauma-related care and have a higher mortality rate. The excess mortality in uninsured patients may be avoided if their resource use is increased to that of insured patients. Handle: RePEc:aph:ajpbhl:1994:84:10:1605-1608_1 Template-Type: ReDIF-Article 1.0 Title: Diet, indicators of kidney disease, and later mortality among older persons in the NHANES I epidemiologic follow-up study Journal: American Journal of Public Health Author-Name: Dwyer, J.T. Author-Name: Madans, J.H. Author-Name: Tumbull, B. Author-Name: Cornoni-Huntley, J. Author-Name: Dresser, C. Author-Name: Everett, D.F. Author-Name: Perrone, R.D. Year: 1994 Volume: 84 Issue: 8 Pages: 1299-1303 Abstract: Objectives. The purpose of this study was to determine whether diet adversely affected survival among 2572 older persons with indicators of kidney disease in a population-based cohort. Average follow-up time for survivors, of whom 1453 (57%) had died at analysis, was 14.5 years. Methods. Kidney disease indicators were a 'yes' response to 'Has a doctor ever told you that you have kidney disease or renal stones?' and/or trace or greater amounts of protein in urine. Dietary protein intakes were calculated from 24- hour recalls. Results. Cox proportional hazards models were used, stratified by sex, with age, body mass index, blood pressure, education, smoking status, total caloric intake, and diabetes mellitus as covariates. Relative risk of total mortality with an additional 15 g of protein per day was 1.25 (95% confidence interval [CI] = 1.09, 1.42) among White men with kidney disease indicators, vs 1.00 (95% CI = 0.95, 1.06) among those without them; relative risks of renal-related mortality were 1.32 (95% CI = 0.97, 1.79) and 0.95 (95% CI = 0.81, 1.11), respectively. No significant differences were found for White women. Conclusions. Once chronic renal disease is present, diet may be associated with earlier mortality in White males. Handle: RePEc:aph:ajpbhl:1994:84:8:1299-1303_0 Template-Type: ReDIF-Article 1.0 Title: Self-rated health and mortality in people with diabetes Journal: American Journal of Public Health Author-Name: Dasbach, E.J. Author-Name: Klein, R. Author-Name: Klein, B.E.K. Author-Name: Moss, S.E. Year: 1994 Volume: 84 Issue: 11 Pages: 1775-1779 Abstract: Objectives. This study examined whether self-rated health is an independent and significant predictor of mortality in people with diabetes, using data collected in the Wisconsin Epidemiologic Study of Diabetic Retinopathy. Methods. Participants were asked to rate their health in comparison with others their age. A proportional hazards model was used to regress survival time on self-rated health and a number of covariates measuring physical health. Results. People with younger onset diabetes (n = 891) who rated their health relative to their peers as 'worse' or 'don't know' were no more likely to die than those rating their health as 'the same' or 'better' when physical health status was controlled. In contrast, those with older onset diabetes (n = 987) who rated their health as 'worse' or 'don't know' were almost twice as likely to die as those rating their health as 'the same' or 'better' when physical health status was controlled. Conclusions. Self-rated health is a significant predictor of mortality in people with older onset diabetes but not in those with younger onset diabetes when physical health status is controlled. Handle: RePEc:aph:ajpbhl:1994:84:11:1775-1779_0 Template-Type: ReDIF-Article 1.0 Title: Trends in asthma mortality among African Americans and Whites in Chicago, 1968 through 1991 Journal: American Journal of Public Health Author-Name: Targonski, P.V. Author-Name: Persky, V.W. Author-Name: Orris, P. Author-Name: Addington, W. Year: 1994 Volume: 84 Issue: 11 Pages: 1830-1833 Abstract: Death certificate data were used to examine asthma mortality among African Americans and Whites aged 5 through 34 years in Chicago from 1968 through 1991. African Americans experienced consistently higher asthma mortality throughout the period. Asthma mortality remained stable among Whites from 1968 through 1991 but increased by 337% among African Americans from 1976 through 1991 (P < .001). The increase was greatest among 20-through 34-year- olds. Between 1979 and 1991, outpatient and emergency department deaths increased significantly, while the proportion of dead-on-arrival cases remained stable at 51%. This shift to non-inpatient deaths suggests that lack of access to health care may play a role in increasing asthma mortality. Handle: RePEc:aph:ajpbhl:1994:84:11:1830-1833_4 Template-Type: ReDIF-Article 1.0 Title: Occupational impairment and disability among applicants for Social Security Disability benefits in Pennsylvania Journal: American Journal of Public Health Author-Name: Bresnitz, E.A. Author-Name: Frumkin, H. Author-Name: Goldstein, L. Author-Name: Neumark, D. Author-Name: Hodgson, M. Author-Name: Needleman, C. Year: 1994 Volume: 84 Issue: 11 Pages: 1786-1790 Abstract: Objective: The study goal was to assess the extent of workplace-related disease and injury among Social Security Disability Insurance applicants. Methods. A convenience sample of 240 consecutive applicants to the Pennsylvania Bureau of Disability Determination was studied to assess the prevalence of work-related disorders. An applicant had a work-related condition if there was a clear statement of a workplace illness or injury associated with the impairment, or if the applicant had worked at an occupation with a high likelihood of exposures known or suspected to contribute to the condition of interest. Results. Of the 240 applicants, 166 (69%) were awarded disability insurance benefits; a total of 27 (11%) had work-related conditions, including 14 of the 166 (8%) who were found to be disabled. Forty percent of the 27 had a disorder that was musculoskeletal in origin. Of 59 applicants with cancer, 10.2% had some work-related etiological component. Of an estimated 71 680 adult disability insurance applicants in Pennsylvania in 1990, 5134 new insurance beneficiaries had a projected occupationally related disability. Conclusions. A substantial number of applicants for disability insurance benefits suffer from an impairment caused or exacerbated by prior workplace exposures. These individuals may serve as sentinel events for initiating follow-up surveillance and prevention activities. Handle: RePEc:aph:ajpbhl:1994:84:11:1786-1790_3 Template-Type: ReDIF-Article 1.0 Title: The resurgence of tuberculosis in New York City: A mixed hierarchically and spatially diffused epidemic Journal: American Journal of Public Health Author-Name: Wallace, D. Year: 1994 Volume: 84 Issue: 6 Pages: 1000-1002 Abstract: For New York City from 1978 to 1990, plotting the 3-year running averages of citywide new tuberculosis cases against the middle year yielded an S- shaped curve, with the inflection point at 1983 between early slow and late rapid rise. The inflection in the S curve appears to be associated with hierarchical establishment of secondary epicenters, and the phase of rapid rise in new cases seems to be associated with spatial diffusion from both the primary and secondary epicenters. Handle: RePEc:aph:ajpbhl:1994:84:6:1000-1002_7 Template-Type: ReDIF-Article 1.0 Title: Traumatic child death and documented maltreatment history, Los Angeles Journal: American Journal of Public Health Author-Name: Sorenson, S.B. Author-Name: Peterson, J.G. Year: 1994 Volume: 84 Issue: 4 Pages: 623-627 Abstract: Objectives. Child abuse is a presumed but largely untested risk factor for child homicide. This research investigated the social and child protective service history of child homicide victims. Methods. A pairwise matched case- control design was used to assess documented child maltreatment as a risk factor for homicide vs unintentional injury death. Homicide victims aged 0 to 14 years were identified through Los Angeles Police Department case summaries. Control subjects (children who died of an unintentional injury) were matched to case subjects (children who died from homicide) by age, sex, race/ethnicity, and date of death. Case and control subjects were linked with county service records to determine any known history of maltreatment. Results. A total of 220 children were homicide victims during 1978 through 1987 in the city of Los Angeles. Only one in six children who died (of homicide or unintentional injury) or his/her family was known to county social or child protective services prior to the death. Recorded history of child protective services was associated with homicide victimization (adjusted odds ratio = 3.40, 95% confidence interval = 1.25, 9.27). Conclusions. Current service systems need assistance in identifying and protecting children at high risk of homicide. Handle: RePEc:aph:ajpbhl:1994:84:4:623-627_9 Template-Type: ReDIF-Article 1.0 Title: Dementia-free life expectancy in France Journal: American Journal of Public Health Author-Name: Ritchie, K. Author-Name: Robine, J.-M. Author-Name: Letenneur, L. Author-Name: Dartigues, J.-F. Year: 1994 Volume: 84 Issue: 2 Pages: 232-236 Abstract: Objectives. Increasing concern with the quality of gains in life years has led to the development of a new synthetic indicator of population health:health expectancy. Until now, calculations have been made for physical disabilities only. A first estimate of mental health expectancy is presented: dementia-free life expectancy. Methods. Sullivan's method was used to calculate dementia-free life expectancy for a random representative sample of 4134 persons over 65 years of age in the Bordeaux region of France. The diagnosis of senile dementia was made in two stages, based on Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) criteria. Results. At 65 years of age, a person's dementia-free life expectancy is 16.9 years within a total life-expectancy of 17.7 years; it decreases with age in parallel with the decrease in total life expectancy so that life expectancy with dementia stays constant at 0.8 years. Although dementia prevalence increases with age, if the prevalence is adjusted for mortality, the largest number of persons with dementia are in their early eighties. At each age women have a higher dementia-free life expectancy. Conclusions. Trends in dementia-free life expectancy are similar to those found in disability-free life expectancy. Because the dementia prevalence rates used in this estimate resemble a general model derived from meta-analysis, it can be assumed that similar results will be found in other Western countries with similar mortality rates. Handle: RePEc:aph:ajpbhl:1994:84:2:232-236_4 Template-Type: ReDIF-Article 1.0 Title: Screening for childhood lead poisoning: A cost-minimization analysis Journal: American Journal of Public Health Author-Name: Glotzer, D.E. Author-Name: Bauchner, H. Author-Name: Freedberg, K.A. Author-Name: Palfrey, S. Year: 1994 Volume: 84 Issue: 1 Pages: 110-112 Abstract: Decision analysis was used to compare the costs of three screening strategies for childhood lead poisoning: (1) venipuncture; (2) capillary sample with venipuncture confirmation if the blood lead level is elevated; (3) stratification by risk, with venipuncture for high-risk children and capillary sample for low-risk children. Under baseline conditions, the cost of screening by the venipuncture, stratification, and capillary strategies is $22, $25, and $27, respectively. Venipuncture remains the least expensive strategy unless the cost of venipuncture is more than three times that of capillary sampling. The annual cost of a national lead screening program that uses a single venipuncture sample would be $352 million. Initial screening with a capillary sample would cost $432 million, 23% more than venipuncture. Handle: RePEc:aph:ajpbhl:1994:84:1:110-112_9 Template-Type: ReDIF-Article 1.0 Title: Car mass and fatality risk: Has the relationship changed? Journal: American Journal of Public Health Author-Name: Evans, L. Author-Name: Frick, M.C. Year: 1994 Volume: 84 Issue: 1 Pages: 33-36 Abstract: Objectives. The finding that the relative safety disadvantage of small compared with large cars is less for post-1980 cars than for pre-1980 cars has stimulated speculation that increasing fuel economy standards would increase fatalities less than previously expected. Fatal crashes between two cars of similar model year were examined to see whether this would be the case. Methods. Driver fatality risk in relation to car mass was examined with Fatal Accident Reporting System data for crashes between two cars of a specific model year. Results. The relative risk for driver fatality in the lighter car compared with the other driver's risk in a car 50% heavier was as follows: for 1966 through 1979 cars, the risk was between 3.7 and 5.1; for 1984 cars, 2.6; and for 1990 cars, 4.1. Conclusions. The results suggest that the lesser mass effect observed for mid-1980s cars occurred because improved crashworthiness features appeared in small cars earlier than in large cars. As all cars are redesigned, the relationship between risk and mass can be expected to approach that observed earlier in pre-1980 cars. If so, future fatality increases from fuel economy increases will be greater than estimated on the basis of mid-1990 data. Handle: RePEc:aph:ajpbhl:1994:84:1:33-36_6 Template-Type: ReDIF-Article 1.0 Title: The illegal sale of cigarettes to US minors: Estimates by state Journal: American Journal of Public Health Author-Name: Cummings, K.M. Author-Name: Pechacek, T. Author-Name: Shopland, D. Year: 1994 Volume: 84 Issue: 2 Pages: 300-302 Abstract: Data available from recent national surveys on the cigarette consumption and purchasing practices of teenage smokers were used to generate state- specific estimates of the number of teenage smokers and cigarette sales to minors. In 1991, approximately 2.7 million teenage cigarette smokers consumed an average of 28.3 million cigarettes per day (516 million packs per year). An estimated 255 million packs of cigarettes were sold illegally to minors in 1991. To make cigarettes and other tobacco products less accessible to minors, policymakers should consider implementing various legislative and economic measures such as banning cigarette vending machines and raising tobacco excise taxes. Handle: RePEc:aph:ajpbhl:1994:84:2:300-302_0 Template-Type: ReDIF-Article 1.0 Title: Are bisexually identified men in San Francisco a common vector for spreading HIV infection to women? Journal: American Journal of Public Health Author-Name: Ekstrand, M.L. Author-Name: Coates, T.J. Author-Name: Guydish, J.R. Author-Name: Hauck, W.W. Author-Name: Collette, L. Author-Name: Hulley, S.B. Year: 1994 Volume: 84 Issue: 6 Pages: 915-919 Abstract: Objectives. This article examines sexual risk taking among self- identified bisexual men in San Francisco and whether risk reduction has occurred, with respect to both homosexual and heterosexual behaviors, among human immunodeficiency virus (HIV) antibody-positive and HIV antibody- negative men. It also examines psychosocial correlates of unprotected anal and vaginal intercourse. Methods. The participants were members of a population-based longitudinal cohort of 1034 single men aged 25 through 54 years recruited from the 19 census tracts in San Francisco that had the greatest prevalence of the acquired immunodeficiency syndrome in 1984. Of the total sample, 140 subjects initially identified themselves as bisexual; 85% of these men remained in the study. Results. The participants reported dramatic reductions in sexual risk taking. Prevalences of unprotected anal sex with men were similar among HIV-positive bisexual men (89% in 1984-1985 and 18% in 1988-1989) and those who were HIV negative (65% and 20%). The prevalence of unprotected vaginal sex was much lower for HIV-positive men (16% in 1984-1985 and 2% in 1988-1989) than for HIV-negative men (35% and 20%). Unprotected intercourse was associated primarily with situational and interpersonal factors. Conclusions. Striking reductions in risk behaviors were reported. This subgroup of single, bisexually identified men appears unlikely to be a common vector for spreading HIV infection to women. Handle: RePEc:aph:ajpbhl:1994:84:6:915-919_2 Template-Type: ReDIF-Article 1.0 Title: Access to family planning services and health insurance among low-income women in Arizona Journal: American Journal of Public Health Author-Name: Kirkman-Liff, B. Author-Name: Kronenfeld, J.J. Year: 1994 Volume: 84 Issue: 6 Pages: 1010-1012 Abstract: This paper uses 1984 and 1989 Arizona survey data to explore the importance of insurance coverage for access to family planning services. In Arizona, Medicaid was provided through the Arizona Health Care Cost Containment System, a managed care model. Family planning was not provided in 1984 but had been added by 1989. Low-income women were 2.3 times more likely to receive services in 1989 than in 1984. Women in the system were 60% more likely to have received services. To improve access, health reform proposals should explicitly include family planning in managed care benefits packages. Handle: RePEc:aph:ajpbhl:1994:84:6:1010-1012_8 Template-Type: ReDIF-Article 1.0 Title: Do blacks and whites differ in their use of health care for symptoms of coronary heart disease? Journal: American Journal of Public Health Author-Name: Crawford, S.L. Author-Name: McGraw, S.A. Author-Name: Smith, K.W. Author-Name: McKinlay, J.B. Author-Name: Pierson, J.E. Year: 1994 Volume: 84 Issue: 6 Pages: 957-964 Abstract: Objectives. The purpose of this study was to identify the role of race in seeking and receipt of care for symptoms of coronary heart disease. Methods. Data on medical care, sociodemographic characteristics, symptoms, risk factors, income, and insurance were collected in a telephone interview for a random sample of 2030 Black and White adults in inner-city Boston. Rates of care-seeking for symptoms, amounts of delay in seeking care, and rates of receipt of care were compared for Blacks and Whites after adjustment for other characteristics. Results. Before and after adjustment for other factors, Blacks and Whites were equally likely to seek care. Average delay time was shorter for Blacks, particularly Black women. With the exception of a lower rate of referral to cardiologists among Blacks, receipt of care was similar for Blacks and Whites who sought medical attention for symptoms. Conclusions. In an urban population of Blacks and Whites who were similar in socioeconomic status and access to medical care, there were few racial differences in coronary heart disease-related care patterns. Handle: RePEc:aph:ajpbhl:1994:84:6:957-964_9 Template-Type: ReDIF-Article 1.0 Title: Community-based services for pregnant substance-using women Journal: American Journal of Public Health Author-Name: LaFrance, S.V. Author-Name: Mitchell, J. Author-Name: Damus, K. Author-Name: Driver, C. Author-Name: Roman, G. Author-Name: Graham, E. Author-Name: Schwartz, L. Year: 1994 Volume: 84 Issue: 10 Pages: 1688-1689 Handle: RePEc:aph:ajpbhl:1994:84:10:1688-1689_7 Template-Type: ReDIF-Article 1.0 Title: Stage of cancer at diagnosis for medicare HMO and fee-for-service enrollees Journal: American Journal of Public Health Author-Name: Riley, G.F. Author-Name: Potosky, A.L. Author-Name: Lubitz, J.D. Author-Name: Brown, M.L. Year: 1994 Volume: 84 Issue: 10 Pages: 1598-1604 Abstract: Objectives. Health maintenance organizations (HMOs) with Medicare contracts often provide cancer screening and preventive services not covered under fee-for-service. This study compared cancer patients in HMOs and fee- for-service on stage at diagnosis. Methods. The study examined stage at diagnosis for aged Medicare enrollees in HMOs and fee-for-service, using information from the Surveillance, Epidemiology, and End Results program, linked with Medicare enrollment files. Twelve cancer sites were investigated, and demographics, area of residence, year of diagnosis (1985 to 1989), and education at the census tract level were controlled. Results. HMO enrollees were diagnosed at earlier stages for cancers of the female breast, cervix, colon, and melanomas and at later stages for stomach cancer. There were no differences for cancers of the prostate, rectum, buccal cavity and pharynx, bladder, uterus, kidney, and ovary. HMO effects were strongest in areas with large, mature HMOs. Conclusions. Compared with fee-for-service enrollees, HMO enrollees were diagnosed at earlier stages for cancer sites for which effective screening services are available. The earlier detection of certain cancers among HMO enrollees may result from coverage of screening services and, perhaps, promotion by HMOs of such services. Handle: RePEc:aph:ajpbhl:1994:84:10:1598-1604_5 Template-Type: ReDIF-Article 1.0 Title: A workplace intervention for increasing outdoor workers' use of solar protection Journal: American Journal of Public Health Author-Name: Girgis, A. Author-Name: Sanson-Fisher, R.W. Author-Name: Watson, A. Year: 1994 Volume: 84 Issue: 1 Pages: 77-81 Abstract: Objectives. Outdoor workers are at high risk of developing skin cancer. Primary prevention in this group can potentially reduce the incidence of skin cancer, and also potentiates the spontaneous remission of existing solar keratoses. A randomized controlled trial was conducted to evaluate a solar protection intervention targeting outdoor workers. Methods. Outdoor workers were randomly allocated to an intervention (n = 65) or control group (n = 77). The intervention group received individual skin screening by a dermatologist and participated in an education session. Pre- and posttest outcome measures included solar protection behavior (assessed using a validated diary), knowledge, and attitudes. Results. There was a significant increase (16%) in the percentage of outdoor workers who were using a high level of solar protection at posttest compared to pretest in the intervention group, but there was no change in the control group. Although both groups improved in their knowledge score, the intervention group showed a significantly greater improvement at posttest. No changes in attitudes were detected. Conclusions. The findings suggest that changes in solar protection are achievable with outdoor workers. Handle: RePEc:aph:ajpbhl:1994:84:1:77-81_4 Template-Type: ReDIF-Article 1.0 Title: Psychiatric and substance abuse disorders among male urban jail detainees Journal: American Journal of Public Health Author-Name: Teplin, L.A. Year: 1994 Volume: 84 Issue: 2 Pages: 290-293 Abstract: This paper presents prevalence rates by race/ethnicity and age for nine psychiatric and substance use disorders found in a random sample of 728 male jail detainees. Two thirds of the sample detainees had had a disorder other than antisocial personality during their lifetimes; half of these had had an episode within 2 weeks of the interview. More than 30% currently had either a severe mental disorder or a substance use disorder. Detainees with severe mental disorders or substance use disorders were most often in jail because they had committed nonviolent crimes. Policy implications of the results are discussed. Handle: RePEc:aph:ajpbhl:1994:84:2:290-293_7 Template-Type: ReDIF-Article 1.0 Title: Disability determinations for adults with mental disorders: Social Security Administration vs independent judgments Journal: American Journal of Public Health Author-Name: Okpaku, S.O. Author-Name: Sibulkin, A.E. Author-Name: Schenzler, C. Year: 1994 Volume: 84 Issue: 11 Pages: 1791-1795 Abstract: Objectives. Disability determinations made by the Disability Determination Service for Social Security Administration (SSA) disability claims due to mental impairment were compared with the independent judgments of a team of mental health workers. The decisions of the Service and the team's agreement with those decisions were predicted from a set of explanatory variables. Methods. One hundred fifty-eight adult applicants for or beneficiaries of SSA benefit programs participated. The team used SSA disability criteria to judge disability based on in-depth interviews. Results. Team members voted yes, no, or maybe regarding approval for disability. Of the cases approved by the team, 89% were actually allowed by the Disability Determination Service. However, the team could not reach a yes or no decision for almost half of the subjects, contributing to a total agreement with the Service on only 40% of the cases. Conclusions. Sufficient evidence exists to question the reliability of SSA disability determinations for mental disorders. Although the Disability Determination Service decision for mental impairments can be predicted above chance, a direct test of the reliability of such determinations should be conducted, with particular attention to the effect of the quality of the medical information. Handle: RePEc:aph:ajpbhl:1994:84:11:1791-1795_5 Template-Type: ReDIF-Article 1.0 Title: The social correlates of regional rates of abortion. Journal: American Journal of Public Health Author-Name: Lester, D. Year: 1994 Volume: 84 Issue: 1 Pages: 122-123 Handle: RePEc:aph:ajpbhl:1994:84:1:122-123_6 Template-Type: ReDIF-Article 1.0 Title: The use of commercial tanning facilities by suburban Minnesota adolescents Journal: American Journal of Public Health Author-Name: Oliphant, J.A. Author-Name: Forster, J.L. Author-Name: McBride, C.M. Year: 1994 Volume: 84 Issue: 3 Pages: 476-478 Abstract: In 1991, 1008 suburban St. Paul, Minn, high school students were surveyed via self-administered questionnaire regarding use of commercial tanning facilities, injuries experienced from tanning, use of protective measures while tanning indoors, and knowledge of the risks of tanning. Overall, 34% of the respondents had used commercial tanning facilities. Fifty percent said they had not been warned by tanning facility operators about the risks of tanning indoors, 28% reported not being told to wear goggles, and 17% reported never wearing goggles. The results indicate that these adolescents use commercial tanning services at high rates, and often in ways that increase their risk for a variety of health problems. Handle: RePEc:aph:ajpbhl:1994:84:3:476-478_5 Template-Type: ReDIF-Article 1.0 Title: Homicide, handguns, and the crime gun hypothesis: Firearms used in fatal shootings of law enforcement officers, 1980 to 1989 Journal: American Journal of Public Health Author-Name: Wintemute, G.J. Year: 1994 Volume: 84 Issue: 4 Pages: 561-564 Abstract: Objectives. Many policies seeking to limit handgun violence rest on the largely untested 'crime gun hypothesis,' which holds that subclasses of handguns differ in their risk for use in violent crime. This study tests that hypothesis for handguns used in homicides of law enforcement officers and describes the population of homicide-involved handguns. Methods. A cross- sectional study was done of civilian (criminal) handguns used in homicides of law enforcement officers from 1980 to 1989. Life tables were generated for each year's cohort of new handguns to estimate gun-years at risk, analogous to person-years, for rate and relative risk calculations. Results. Four hundred thirty-five deaths involved 428 civilian handguns. Revolvers were at greater risk than pistols. For both, risk was lowest for .22-caliber handguns. Risk was greatest for .32-caliber pistols and .38-caliber revolvers. Forty-six percent of handguns had a barrel length of 3 in or less. Conclusions. Subclasses of handguns differ substantially in their risk for use in fatal shootings of law enforcement officers. Such epidemiological data may be useful in formulating efforts to prevent these and similar instances of firearm violence. Handle: RePEc:aph:ajpbhl:1994:84:4:561-564_4 Template-Type: ReDIF-Article 1.0 Title: The US prevalence of self-reported carpal tunnel syndrome: 1988 National Health Interview Survey data Journal: American Journal of Public Health Author-Name: Tanaka, S. Author-Name: Wild, D.K. Author-Name: Seligman, P.J. Author-Name: Behrens, V. Author-Name: Cameron, L. Author-Name: Putz-Anderson, V. Year: 1994 Volume: 84 Issue: 11 Pages: 1846-1848 Abstract: To estimate the prevalence of carpal tunnel syndrome among US adults, data from the Occupational Health Supplement of the 1988 National Health Interview Survey were analyzed. Based on a sample of 44 233 households (response rate, 91.5%), an estimated 1.55% (2.65 million) of 170 million adults self-reported carpal tunnel syndrome in 1988. Females and Whites had a higher prevalence of self-reporting carpal tunnel syndrome than males and non-Whites, respectively. Among 127 million adults who worked during the 12 months before the survey, 0.53% (0.68 million) reported that their 'prolonged' hand discomfort was called carpal tunnel syndrome by a health care provider. Handle: RePEc:aph:ajpbhl:1994:84:11:1846-1848_3 Template-Type: ReDIF-Article 1.0 Title: Tuberculosis risk factors in adults in King County, Washington, 1988 through 1990 Journal: American Journal of Public Health Author-Name: Buskin, S.E. Author-Name: Gale, J.L. Author-Name: Weiss, N.S. Author-Name: Nolan, C.M. Year: 1994 Volume: 84 Issue: 11 Pages: 1750-1756 Abstract: Objectives. Tuberculosis has become a resurgent public health problem in the United States. Because resources are limited, control programs frequently must target populations at greatest risk. The purpose of the study was to examine risk factors for tuberculosis in adults. Methods. In King County, Washington State, from 1988 through 1990, the characteristics of patients with tuberculosis were compared with census data, and a case-control study was conducted. Self-administered questionnaires were completed by 151 patients with active tuberculosis and 545 control subjects. Results. Infection with the human immunodeficiency virus, non-White race/ethnicity, and foreign birthplace were each associated with a sixfold or greater increase in risk. Each of the following was associated with at least a doubled risk: history of selected underlying medical conditions; low weight for height; low socioeconomic status; and age 70 years or older. Men had 1.9 times the risk of women, smokers of 20 years' or more duration had 2.6 times the risk of nonsmokers, and heavy alcohol consumers had 2.0 times the risk of nondrinkers. Conclusions. Intervention targeting easily identified groups may be an effective way to reduce the incidence of tuberculosis. Handle: RePEc:aph:ajpbhl:1994:84:11:1750-1756_8 Template-Type: ReDIF-Article 1.0 Title: The use of vitamin supplements and the risk of cataract among US male physicians Journal: American Journal of Public Health Author-Name: Seddon, J.M. Author-Name: Christen, W.G. Author-Name: Manson, J.E. Author-Name: LaMotte, F.S. Author-Name: Glynn, R.J. Author-Name: Buring, J.E. Author-Name: Hennekens, C.H. Year: 1994 Volume: 84 Issue: 5 Pages: 788-792 Abstract: Objectives. The purpose of this study was to examine prospectively the association between reported use of vitamin supplements and risk of cataract and cataract extraction. Methods. The study population consisted of 17 744 participants in the Physicians' Health Study, a randomized trial of aspirin therapy and beta-carotene among US male physicians 40 to 84 years of age in 1982 who did not report cataract at baseline and provided complete information about vitamin supplementation and other risk factors for cataract. Self-reports of cataract and cataract extraction were confirmed by medical record review. Results. During 60 months of follow-up, there were 370 incident cataracts and 109 cataract extractions. In comparison with physicians who did not use any supplements, those who took only multivitamins had a relative risk of cataract of 0.73 after adjustment for other risk factors. For cataract extraction, the corresponding relative risk was 0.79. Use of vitamin C and/or E supplements alone was not associated with a reduced risk of cataract, but the size of this subgroup was small. Conclusions. These data suggest that men who took multivitamin supplements tended to experience a decreased risk of cataract and support the need for rigorous testing of this hypothesis in large-scale randomized trials in men and women. Handle: RePEc:aph:ajpbhl:1994:84:5:788-792_9 Template-Type: ReDIF-Article 1.0 Title: Selected antepartum medical complications and very-low-birthweight infants among Black and White women Journal: American Journal of Public Health Author-Name: DeBaun, M. Author-Name: Rowley, D. Author-Name: Province, M. Author-Name: Stockbauer, J.W. Author-Name: Cole, F.S. Year: 1994 Volume: 84 Issue: 9 Pages: 1495-1497 Abstract: This study estimated the risk of very-low-birthweight delivery among Black and White women with selected treatable antepartum medical conditions. A logistic regression model was applied to a retrospective, population-based data set identified by computerized, linked birth certificate and maternal hospital discharge records. For Black mothers, the adjusted odds ratio for very-low-birthweight delivery was statistically significant for essential hypertension and urinary tract infection. For White mothers, the adjusted odds ratio was statistically significant for essential hypertension, urinary tract infection, pregnancy-induced hypertension, and diabetes mellitus. Public policy designed to reduce the risk of very-low-birthweight delivery must include strategies for attenuating the impact of treatable antepartum medical conditions. Handle: RePEc:aph:ajpbhl:1994:84:9:1495-1497_2 Template-Type: ReDIF-Article 1.0 Title: Preventing disability and falls in older adults: A population-based randomized trial Journal: American Journal of Public Health Author-Name: Wagner, E.H. Author-Name: LaCroix, A.Z. Author-Name: Grothaus, L. Author-Name: Leveille, S.G. Author-Name: Hecht, J.A. Author-Name: Artz, K. Author-Name: Odle, K. Author-Name: Buchner, D.M. Year: 1994 Volume: 84 Issue: 11 Pages: 1800-1806 Abstract: Objectives. Because preventing disability and falls in older adults is a national priority, a randomized controlled trial was conducted to test a multicomponent intervention program. Methods. From a random sample of health maintenance organization (HMO) enrollees 65 years and older, 1559 ambulatory seniors were randomized to one of three groups: a nurse assessment visit and follow-up interventions targeting risk factors for disability and falls (group 1, n = 635); a general health promotion nurse visit (group 2, n = 317); and usual care (group 3, n = 607). Data collection consisted of a baseline and two annual follow-up surveys. Results. After 1 year, group 1 subjects reported a significantly lower incidence of declining functional status and a significantly lower incidence of falls than group 3 subjects. Group 2 subjects had intermediate levels of most outcomes. After 2 years of follow-up, the differences narrowed. Conclusions. The results suggest that a modest, one-time prevention program appeared to confer short-term health benefits on ambulatory HMO enrollees, although benefits diminished by the second year of follow-up. The mechanisms by which the intervention may have improved outcomes require further investigation. Handle: RePEc:aph:ajpbhl:1994:84:11:1800-1806_0 Template-Type: ReDIF-Article 1.0 Title: Acute chest pain in African Americans: Factors in the delay in seeking emergency care Journal: American Journal of Public Health Author-Name: Ell, K. Author-Name: Haywood, L.J. Author-Name: Sobel, E. Author-Name: DeGuzman, M. Author-Name: Blumfield, D. Author-Name: Ning, J.-P. Year: 1994 Volume: 84 Issue: 6 Pages: 965-970 Abstract: Objectives. African Americans have been shown to have longer delay times than the majority population in seeking care for acute cardiac problems. The purpose of this study was to determine whether socioeconomic factors affect delay times. Methods. Structured interviews were administered to 254 African Americans admitted to a public hospital and 194 African Americans admitted to a private hospital for suspected acute myocardial infarction. Results. Patient characteristics found by multiple regression analysis to affect decision-making and travel time for care-seeking were structural access to care, persistence of symptoms, degree of incapacitation, consultation with a layperson, consultation with medical professionals, and mode of transportation. Conclusions. Within-group differences were found to be related to socioeconomic status. Strategies to increase knowledge about heart attack symptoms, improve access to care, and improve the socioeconomic status of at-risk African Americans are indicated. Handle: RePEc:aph:ajpbhl:1994:84:6:965-970_2 Template-Type: ReDIF-Article 1.0 Title: HIV infection among women in prison: An assessment of risk factors using a nonnominal methodology Journal: American Journal of Public Health Author-Name: Hankins, C.A. Author-Name: Gendron, S. Author-Name: Handley, M.A. Author-Name: Richard, C. Author-Name: Tung, M.T.L. Author-Name: O'Shaughnessy, M. Year: 1994 Volume: 84 Issue: 10 Pages: 1637-1640 Abstract: The relative contributions of needle use practices and sexual behaviors to human immunodeficiency virus (HIV) antibody seropositivity among 394 women incarcerated in Quebec were determined by risk factor assessment and serology with a nonnominal methodology. HIV positivity was found in 6.9% (95% confidence interval [CI] = 4.6, 9.9) of all participants and in 13% (95% CI = 8.6, 18.6) of women with a history of injection drug use. HIV seropositivity among women with a history of injection drug use was predicted by sexual or needle contact with a seropositive person, self-reported genital herpes, and having had a regular sexual partner who injected drugs, but it was not predicted by prostitution. Nonnominal testing is an ethical alternative to mandatory and anonymous unlinked testing among correctional populations. Handle: RePEc:aph:ajpbhl:1994:84:10:1637-1640_1 Template-Type: ReDIF-Article 1.0 Title: Rates, patterns, causes, and costs of hospitalization of nursing home residents: A population-based study Journal: American Journal of Public Health Author-Name: Barker, W.H. Author-Name: Zimmer, J.G. Author-Name: Hall, W.J. Author-Name: Ruff, B.C. Author-Name: Freundlich, C.B. Author-Name: Eggert, G.M. Year: 1994 Volume: 84 Issue: 10 Pages: 1615-1620 Abstract: Objectives. Hospitalization of nursing home residents is a growing, poorly defined problem. The purposes of this study were to define rates, patterns, costs, and outcomes of hospitalizations from nursing homes and to consider implications for reducing this problem as part of health care reform. Methods. Communitywide nursing home utilization review and hospital discharge data were used to define retrospectively a cohort of 2120 patients newly admitted to nursing homes; these patients were followed for 2 years to identify all hospitalizations. Resident characteristics were analyzed for predictors of hospitalization. Charges and outcomes were compared with hospitalization of community-dwelling elders. Results. Hospitalization rates were strikingly higher for intermediate vs skilled levels of care (566 and 346 per 1000 resident years, respectively). Approximately 40% of all hospitalizations occurred within 3 months of admission. No strong predictors were identified. Length of stay, charges, and mortality rates were higher than for hospitalizations from the community. Conclusions. Hospitalizations from nursing homes are not easily predicted but may in large part be prevented through health care reforms that integrate acute and long-term care. Handle: RePEc:aph:ajpbhl:1994:84:10:1615-1620_9 Template-Type: ReDIF-Article 1.0 Title: The adequacy of prenatal care and incidence of low birthweight among the poor in Washington State and British Columbia Journal: American Journal of Public Health Author-Name: Katz, S.J. Author-Name: Armstrong, R.W. Author-Name: LoGerfo, J.P. Year: 1994 Volume: 84 Issue: 6 Pages: 986-991 Abstract: Objectives. The purpose of this study was to examine differences in adequacy of prenatal care and incidence of low birthweight between low- income women with Medicaid in Washington State and low-income women with Canadian provincial health insurance in British Columbia. Methods. A population-based cross-sectional study was done by using linked birth certificates and claims data. Results. Overall, the adjusted odds ratio for inadequate prenatal care in Washington (comparing women with Medicaid with those with private insurance) was 3.2. However, the risk varied by time of Medicaid enrollment relative to pregnancy (2.0, 1.0, 2.7, 6.3; for women who enrolled prior to pregnancy, during the first trimester, during the second trimester, or during the third trimester, respectively). In British Columbia, the adjusted odds ratio for inadequate care (comparing women receiving a health premium subsidy with those receiving no subsidy) was 1.5 for women receiving a 100% subsidy and 1.2 for women receiving a 95% subsidy. The risk for low birthweight followed a similar trend in both regions, but there was no association with enrollment period in Washington. Conclusions. Overall, the risk for inadequate prenatal care among poor women was much greater in Washington than in British Columbia. Most of the difference was due to Washington women's delayed enrollment in Medicaid. In both regions, the poor were at similar risk for low birthweight relative to their more affluent counterparts. Handle: RePEc:aph:ajpbhl:1994:84:6:986-991_1 Template-Type: ReDIF-Article 1.0 Title: Mental health status as a predictor of morbidity and mortality: A 15-year follow-up of members of a health maintenance organization Journal: American Journal of Public Health Author-Name: Vogt, T. Author-Name: Pope, C. Author-Name: Mullooly, J. Author-Name: Hollis, J. Year: 1994 Volume: 84 Issue: 2 Pages: 227-231 Abstract: Objectives. This study sought to relate preexisting depression, worries, affect balance, and mental health symptoms to subsequent risk of morbidity and mortality. Methods. A random sample of members of a health maintenance organization were interviewed at home in a 1970/71 survey. Baseline psychological measures from that survey were then related to 15-year mortality and first incidence of cancer, heart disease, hypertension, stroke, functional gastrointestinal disease, and hyperimmune diseases. Results. Baseline depression and the Langner Mental Health Index predicted incidence of functional gastrointestinal and hyperimmune diseases. The relationship of the Langner index to hyperimmune diseases was particularly strong; mortality, cancer, heart disease, hypertension, and stroke incidence were not related to that index. Except for affect balance, which was worst in the elderly, indications of psychological dysfunction were strongest in the young. Conclusions. Psychological indices detected increased risk for functional gastrointestinal and hyperimmune diseases but were not related to mortality risk. Further research is needed to disaggregate relationships of the specific conditions that were included in the hyperimmune group. Functional gastrointestinal disease might be preventable with early attention to depressed persons and to those scoring high on the Langner index. Handle: RePEc:aph:ajpbhl:1994:84:2:227-231_6 Template-Type: ReDIF-Article 1.0 Title: Cognitive impairment and mortality in older community residents Journal: American Journal of Public Health Author-Name: Kelman, H.R. Author-Name: Thomas, C. Author-Name: Kennedy, G.J. Author-Name: Cheng, J. Year: 1994 Volume: 84 Issue: 8 Pages: 1255-1260 Abstract: Objectives. Cognitive impairment among the elderly has been linked to mortality in studies of clinical populations. The purpose of this study was to examine the mortality risk associated with cognitive impairment among elderly populations in the community. Methods. Cognitive impairment and other social and health factors were assessed in 1855 elderly community residents. This sample was reinterviewed periodically to assess changes in health and survival. Results. At baseline 33% of the sample were mildly impaired and 8% were severely impaired. Across a 48-month observation period the survival probability was .85 for the cognitively unimpaired, .69 for the mildly impaired, and .51 for severely impaired respondents. When adjustments were made for the effects of other health and social covariates, severely impaired persons were twice as likely to die as unimpaired persons. Those who were mildly impaired were also at an increased risk. Conclusions. Other investigators have found that cognitive impairment is a significant predictor of dementia. We found that it is a significant predictor of mortality as well. Early detection of impaired cognition and attention to associated health problems could improve the quality of life of these older adults and perhaps extend their survival. Handle: RePEc:aph:ajpbhl:1994:84:8:1255-1260_2 Template-Type: ReDIF-Article 1.0 Title: Functional transitions among the elderly: Patterns, predictors, and related hospital use Journal: American Journal of Public Health Author-Name: Mor, V. Author-Name: Wilcox, V. Author-Name: Rakowski, W. Author-Name: Hiris, J. Year: 1994 Volume: 84 Issue: 8 Pages: 1274-1280 Abstract: Objectives. This paper describes 6-year rates and correlates of functional change in the elderly, as well as associated hospital use. Methods. The Longitudinal Study on Aging (n = 7527) and matched Medicare claims were used to calculate 6-year functional status transition rates and hospital use rates. A hierarchical measure that incorporated activities of daily living, instrumental activities of daily living, and competing risks of institutionalization and death was used to assess functional status. Multinomial logistic regression was used to predict 1990 status. Results. The functional status of 12% of men and women 70 to 79 years of age who were initially impaired in instrumental activities of daily living improved, and about half of the initially independent people in that age group remained so. Multivariate analyses revealed that age, baseline functioning, self-rated health, and comorbidity predicted 1990 status. Both baseline functioning and functional change were related to hospitalization. Conclusions. This study supports others that have shown some long-term functional improvement, but more commonly decline, in the elderly. Furthermore, it documents the link between functional decline and increased hospital use. Handle: RePEc:aph:ajpbhl:1994:84:8:1274-1280_0 Template-Type: ReDIF-Article 1.0 Title: The prevalence and correlates of fear of falling in elderly persons living in the community Journal: American Journal of Public Health Author-Name: Arfken, C.L. Author-Name: Lach, H.W. Author-Name: Birge, S.J. Author-Name: Miller, J.P. Year: 1994 Volume: 84 Issue: 4 Pages: 565-570 Abstract: Objectives. Fear of falling has been recognized as a potentially debilitating consequence of falling in elderly persons. However, the prevalence and the correlates of this fear are unknown. Methods. Prevalence of fear of falling was calculated from the 1-year, follow-up of an age- and gender-stratified random sample of community-dwelling elderly persons. Cross- sectional associations of fear of falling with quality of life, frailty, and falling were assessed. Results. The prevalence of fear increased with age and was greater in women. After adjustment for age and gender, being moderately fearful of falling was associated with decreased satisfaction with life, increased frailty and depressed mood, and recent experience with falls. Being very fearful of falling was associated with all of the above plus decreased mobility and social activities. Conclusions. Fear of falling is common in elderly persons and is associated with decreased quality of life, increased frailty, and recent experience with falls. Handle: RePEc:aph:ajpbhl:1994:84:4:565-570_1 Template-Type: ReDIF-Article 1.0 Title: Nitrogen dioxide exposures inside ice skating rinks Journal: American Journal of Public Health Author-Name: Brauer, M. Author-Name: Spengler, J.D. Year: 1994 Volume: 84 Issue: 3 Pages: 429-433 Abstract: Objectives. The common operation of fuel powered resurfacing equipment in enclosed ice skating rinks has the potential for producing high concentrations of carbon monoxide and nitrogen dioxide. Exposures to these gaseous combustion products may adversely affect the health of those inside the rink. Little information is available on pollutant concentrations under normal operating conditions. Methods. One-week average nitrogen dioxide concentrations in 70 northeastern US rinks were measured with passive samplers during normal winter season conditions. Results. The median nitrogen dioxide level inside rinks was 180 ppb more than 10 times higher than the median outdoor concentration. One-week average nitrogen dioxide concentrations above 1000 ppb were measured in 10% of the rinks. Conclusions. Considering that short-term peak concentrations were likely to have reached two to five times the measured 1-week averages our results suggest that nitrogen dioxide levels were well above short-term air quality guidelines and constitute a public health concern of considerable magnitude. Handle: RePEc:aph:ajpbhl:1994:84:3:429-433_8 Template-Type: ReDIF-Article 1.0 Title: The risk of HIV infection in a national sample of women with injection drug-using partners Journal: American Journal of Public Health Author-Name: Tortu, S. Author-Name: Beardsley, M. Author-Name: Deren, S. Author-Name: Davis, W.R. Year: 1994 Volume: 84 Issue: 8 Pages: 1243-1249 Abstract: Objectives. This study reports on a large, national cohort of women with injection drug-using sex partners. Information is provided on demographic characteristics; human immunodeficiency virus (HIV) risk factors, including unprotected sex and incidence of sexually transmitted diseases; use of noninjected drugs; HIV serostatus; and other selected health variables. Methods. A sample of 5162 heterosexual women was recruited for a national acquired immunodeficiency syndrome (AIDS) research and demonstration project. A structured interview was administered, and the women had the option of undergoing HIV testing. Statistical analyses compared three groups on variables of interest: women with single sex partners, women with multiple partners, and women with multiple partners who exchanged sex for drugs and/or money. Results. These groups differed significantly on virtually all of the demographic and risk variables examined. Women with multiple partners who exchanged sex for drugs and/or money were at higher risk for HIV than women in the other groups, even when selected demographic variables were controlled. Conclusions. Research is needed on the efficacy of prevention efforts involving these diverse groups of women at risk for AIDS. Handle: RePEc:aph:ajpbhl:1994:84:8:1243-1249_7 Template-Type: ReDIF-Article 1.0 Title: An increase in Haemophilus influenzae type B vaccination among preschool- aged children in inner-city Los Angeles, 1990 through 1992 Journal: American Journal of Public Health Author-Name: Ewert, D.P. Author-Name: Westman, S. Author-Name: Ward, B. Author-Name: Bendana, N. Author-Name: Halbert, R. Author-Name: Vadheim, C.M. Author-Name: Ward, J.I. Author-Name: Mascola, L. Year: 1994 Volume: 84 Issue: 7 Pages: 1154-1157 Abstract: Haemophilus influenzae type b (Hib) vaccination coverage and disease incidence were measured among preschool-aged children residing in inner-city Los Angeles. Among children 1.5 to 14 months of age, vaccination coverage of at least one dose increased from 0% in 1990 to 82% (95% confidence interval [CI] = 73%, 91%) in 1992. Among children 15 to 59 months old, vaccination coverage of at least one Hib dose administered at or after age 15 months increased from 35% (95% CI = 29%, 41%) in 1990 to 63% (95% CI = 56%, 70%) in 1992. Although Hib vaccination has reduced disease incidence in this population, greater use of vaccine can result in further reductions. Handle: RePEc:aph:ajpbhl:1994:84:7:1154-1157_0 Template-Type: ReDIF-Article 1.0 Title: Intrauterine cocaine, lead, and nicotine exposure and fetal growth Journal: American Journal of Public Health Author-Name: Neuspiel, D.R. Author-Name: Markowitz, M. Author-Name: Drucker, E. Year: 1994 Volume: 84 Issue: 9 Pages: 1492-1495 Abstract: Intrauterine tobacco, lead, and cocaine exposure often co-occur and may affect fetal growth and development, yet studies of gestational cocaine effects have not adequately measured lead or tobacco. In this anonymous survey, blood lead and urine cotinine levels were determined and mothers were queried about tobacco use. Eighteen cocaine-exposed mother-infant dyads had higher lead and cotinine levels than 46 random nonexposed dyads, regardless of reported cigarette smoking. Crude growth decrements in cocaine-exposed newborns were attenuated after control for lead and cotinine. Future studies of gestational cocaine effects should measure other toxic exposures with more precision. Handle: RePEc:aph:ajpbhl:1994:84:9:1492-1495_3 Template-Type: ReDIF-Article 1.0 Title: Work-related traumatic brain injury in Washington State, 1988 through 1990 Journal: American Journal of Public Health Author-Name: Heyer, N.J. Author-Name: Franklin, G.M. Year: 1994 Volume: 84 Issue: 7 Pages: 1106-1109 Abstract: Objectives. Brain trauma is a major cause of disability in the United States, especially among young adults. Work-related brain trauma cases represent a subpopulation that may be amenable to intervention efforts, but largely because of unavailability of data, this group has not previously been studied. Methods. Washington State workers' compensation data were used to identify brain trauma cases and to describe incidence rates with respect to age, gender, and industrial classification. Cause of injury was evaluated for industrial classifications with numerous cases. Results. Washington State workers experienced 301 brain traumas over a 3-year period (9.4/100 000 full- time-equivalent workers per year). One third of all traumatic brain injury claims were concentrated among seven industrial classifications. Cause of injury was highly correlated with specific industrial classifications. Conclusions. This study demonstrates the usefulness of diagnosis-related group codes to identify cases of traumatic brain injury. These injuries are concentrated among a few industries, with a dominant specific cause for each industry. This suggests that intervention methods may be efficiently introduced to reduce traumatic brain injuries in the workplace. Handle: RePEc:aph:ajpbhl:1994:84:7:1106-1109_6 Template-Type: ReDIF-Article 1.0 Title: Screening for insecticide overexposure under field conditions: A reevaluation of the tintometric cholinesterase kit Journal: American Journal of Public Health Author-Name: McConnell, R. Author-Name: Magnotti, R. Year: 1994 Volume: 84 Issue: 3 Pages: 479-481 Abstract: A semiquantitative tintometric field kit has been used in the developing world for almost 30 years to measure whole blood cholinesterase levels in persons exposed to organophosphate pesticides. The validity of this screening kit was evaluated among 79 workers heavily exposed to organophosphates by comparison with a reference assay for erythrocyte cholinesterase. Overall correlation between the two methods was good. However, either sensitivity or specificity of the tintometric kit was less than 75% for each of the three tintometric categories commonly used to define the limit of normal. Because baseline erythrocyte cholinesterase levels were not available for this population the true sensitivity and specificity of the tintometric assay may be even lower. Handle: RePEc:aph:ajpbhl:1994:84:3:479-481_1 Template-Type: ReDIF-Article 1.0 Title: Emotional disability days: Prevalence and predictors Journal: American Journal of Public Health Author-Name: Kouzis, A.C. Author-Name: Eaton, W.W. Year: 1994 Volume: 84 Issue: 8 Pages: 1304-1307 Abstract: This study considered days missed from work or usual activities for emotional reasons associated with a range of specific psychopathologic disorders, psychosocial distress, and persons found to be asymptomatic. Analyses were performed with the presence or absence of emotional disability days as the dependent variable using logistic regression. The effects of specific mental disorders were compared with the effects of chronic physical conditions for labor force participants and for the total population. The odds ratio (and 95% confidence interval) for subjects with major depressive disorder was 27.8 (6.93, 108.96); for panic disorder, 21.1 (2.25, 198.44); and for schizophrenia, 17.8 (1.73, 182.99). Workplace adjustments for persons with psychopathology are encouraged. Handle: RePEc:aph:ajpbhl:1994:84:8:1304-1307_8 Template-Type: ReDIF-Article 1.0 Title: The next generation: Poor compliance with risk factor guidelines in the children of parents with premature coronary heart disease Journal: American Journal of Public Health Author-Name: Langner, N.R. Author-Name: Rowe, P.C. Author-Name: Davies, R. Year: 1994 Volume: 84 Issue: 1 Pages: 68-71 Abstract: Objectives. The offspring of individuals with premature coronary heart disease are themselves at increased risk for myocardial infarction before the age of 55. Consensus panels have recommended that all such offspring undergo an evaluation of cardiovascular risk, including cholesterol testing. Methods. To examine self-reported rates of cardiovascular risk factor assessment in this population, we conducted a telephone survey of 318 Canadian adults with premature coronary heart disease and of one offspring from 298 (94%) of the 318 families. Results. The median age of the offspring was 20 years (range 2 to 39 y). Among the 219 late adolescent and young adult offspring, only 97 (44%) reported having had a blood cholesterol measurement during the preceding 3 years. Thirty-seven percent reported being current smokers, 31% were overweight, and 30% exercised fewer than three times per week. Men were less likely than women to report having had their blood pressure measured in the preceding year (57% vs 80%). Conclusions. These low rates of cardiac risk factor assessment in families of patients with premature coronary heart disease represent missed opportunities for primary prevention. More effective strategies to prevent atherosclerosis in this population are needed. Handle: RePEc:aph:ajpbhl:1994:84:1:68-71_3 Template-Type: ReDIF-Article 1.0 Title: The association between two windchill indices and daily mortality variation in the Netherlands Journal: American Journal of Public Health Author-Name: Kunst, A.E. Author-Name: Groenhof, F. Author-Name: Mackenbach, J.P. Year: 1994 Volume: 84 Issue: 11 Pages: 1738-1742 Abstract: Objectives. The purpose of this study was to compare temperature and two windchill indices with respect to the strength of their association with daily variation in mortality in the Netherlands during 1979 to 1987. The two windchill indices were those developed by Siple and Passel and by Steadman. Methods. Daily numbers of cause-specific deaths were related to the meteorological variables by means of Poisson regression with control for influenza incidence. Lag times were taken into account. Results. Daily variation in mortality, especially mortality from heart disease, was more strongly related to the Steadman windchill index than to temperature or the Siple and Passel index (34.9%, 31.2%, and 31.5%, respectively, of mortality variation explained). The strongest relation was found with daytime values of the Steadman index. Conclusions. In areas where spells of cold are frequently accompanied by strong wind, the use of the Steadman index probably adds much to the identification of weather conditions involving an increased risk of death. The results of this study provide no justification for the widespread use (e.g., in the United States) of the Siple and Passel index. Handle: RePEc:aph:ajpbhl:1994:84:11:1738-1742_3 Template-Type: ReDIF-Article 1.0 Title: Primary care and emergency department overcrowding. 2. Successful referrals to primary care clinics. Journal: American Journal of Public Health Author-Name: Derlet, R.W. Year: 1994 Volume: 84 Issue: 1 Pages: 123-124 Handle: RePEc:aph:ajpbhl:1994:84:1:123-124_6 Template-Type: ReDIF-Article 1.0 Title: Factors influencing the duration of work-related disability: A population- based study of Washington State workers' compensation Journal: American Journal of Public Health Author-Name: Cheadle, A. Author-Name: Franklin, G. Author-Name: Wolfhagen, C. Author-Name: Savarino, J. Author-Name: Liu, P.Y. Author-Name: Salley, C. Author-Name: Weaver, M. Year: 1994 Volume: 84 Issue: 2 Pages: 190-196 Abstract: Objectives. The purpose of this study was to examine factors predictive of duration of work-related disability. Methods. Multivariate survival analysis techniques were used to conduct a population-based, retrospective cohort study on a random sample of 28 473 workers' compensation claims from Washington State filed for injuries occurring in 1987 to 1989. The principal outcome measure was length of time for which compensation for lost wages was paid, used as a surrogate for duration of temporary total disability. Results. The findings suggest that, even after adjusting for severity of injury, older age, female gender, and a diagnosis of carpal tunnel syndrome or back/neck sprain significantly predict longer duration of disability. Other predictors that were stable and significant, but involved lower magnitudes of effect included divorced marital status, firm size of fewer than 50 employees, higher county unemployment rates, and construction and agricultural work. Conclusions. Greater disability prevention efforts targeting these higher risk subgroups could have significant economic and public health effects. The greatest impact may be on claimants who remain disabled at 6 months after an injury that did not require hospitalization. Handle: RePEc:aph:ajpbhl:1994:84:2:190-196_9 Template-Type: ReDIF-Article 1.0 Title: Self-rated health and survival: A 7-year follow-up study of Australian elderly Journal: American Journal of Public Health Author-Name: McCallum, J. Author-Name: Shadbolt, B. Author-Name: Wang, D. Year: 1994 Volume: 84 Issue: 7 Pages: 1100-1105 Abstract: Objectives. This study tested the hypothesis, from North American findings, that global self-ratings of health predict survival for older Australians. Methods. A stratified sample of Australians 60 years of age and older surveyed in 1981 was resurveyed in 1988. Cox proportional hazard general linear models were constructed separately for men and women to predict survival over 7 years. Results. Better self-ratings of health had an incremental association with survival for women, but only men with poor ratings had significantly worse survival than others. After major illnesses, comorbidities, disability, depression, and social support were controlled for, poor ratings of health for both men and women were not significantly different from excellent ratings in predicting survival. Only women's good and fair health ratings remained significant predictors. Conclusions. People rate their health as poor on the objective basis of illness and disability. Australian findings show gender differences relative to North American results; methodological differences and site and gender variability in health profiles are discussed as reasons for the varying results. Handle: RePEc:aph:ajpbhl:1994:84:7:1100-1105_7 Template-Type: ReDIF-Article 1.0 Title: The size of mortality differences associated with educational level in nine industrialized countries Journal: American Journal of Public Health Author-Name: Kunst, A.E. Author-Name: Mackenbach, J.P. Year: 1994 Volume: 84 Issue: 6 Pages: 932-937 Abstract: Objectives. This study addresses the question of whether inequalities in premature mortality related to educational level differ among countries. Methods. Data on mortality by educational level were obtained from longitudinal studies from nine industrialized countries. The data referred to men between 35 and 64 years of age. The follow-up periods occurred between 1970 and 1982. The size of mortality differences associated with educational level was measured by means of two inequality indices, both based on Poisson regression analysis. Results. Inequalities in mortality are relatively small in the Netherlands, Sweden, Denmark, and Norway and about two times as large in the United States, France, and Italy. Finland and England and Wales occupy intermediate positions. The large inequalities in mortality in the United States and France can be attributed in part to large inequalities in education in these countries. Conclusions. The international pattern found in this study was also observed in a comparison that used occupation as the socioeconomic indicator. Differences between countries in levels of inequality in mortality may be partially explained by the countries' different levels of egalitarian social and economic policies. Handle: RePEc:aph:ajpbhl:1994:84:6:932-937_4 Template-Type: ReDIF-Article 1.0 Title: The teaching of occupational health in US medical schools: Little improvement in 9 years Journal: American Journal of Public Health Author-Name: Burstein, J.M. Author-Name: Levy, B.S. Year: 1994 Volume: 84 Issue: 5 Pages: 846-849 Abstract: A questionnaire survey of the 127 US medical schools was undertaken to assess the present status of occupational health teaching as a follow-up to two prior similar studies. The present study revealed that 78 (68%) of the 115 responding schools specifically taught occupational health during the 1991/92 academic year, in comparison with 50% in the 1977/78 and 66% in the 1982/83 academic years. The median required curriculum time was 6 hours in 1991/92, as compared with 4 hours in both previous surveys. Despite the increasing recognition of occupational health and growth of information in this field of medicine, occupational health teaching to medical students has not progressed proportionately. Handle: RePEc:aph:ajpbhl:1994:84:5:846-849_3 Template-Type: ReDIF-Article 1.0 Title: A cluster of tuberculosis among crack house contacts in San Mateo County, California Journal: American Journal of Public Health Author-Name: Leonhardt, K.K. Author-Name: Gentile, F. Author-Name: Gilbert, B.P. Author-Name: Aiken, M. Year: 1994 Volume: 84 Issue: 11 Pages: 1834-1836 Abstract: In March 1992, a cluster of 89 persons with tuberculosis infection was identified in San Mateo County, California. Thirteen persons (15%), including 11 children, were diagnosed with active pulmonary tuberculosis. All contacts were African Americans who resided in or visited one of two houses used for crack cocaine smoking or dealing. The patient with the index case, a male infected with human immunodeficiency virus, contributed to the transmission of tuberculosis as a transient resident of several dwellings. Public health authorities applied unique intervention methods to control the outbreak, including the use of a mobile health van. Further innovative strategies will be necessary to meet the challenge of this reemerging disease. Handle: RePEc:aph:ajpbhl:1994:84:11:1834-1836_6 Template-Type: ReDIF-Article 1.0 Title: Illegal sales to minors and retailers' responsibility [5] Journal: American Journal of Public Health Author-Name: Clapp, E.J. Author-Name: Wildey, M.B. Year: 1993 Volume: 83 Issue: 12 Pages: 1793-1794 Handle: RePEc:aph:ajpbhl:1993:83:12:1793-1794_4 Template-Type: ReDIF-Article 1.0 Title: Cancer incidence among American Indians and Alaska Natives, 1980 through 1987 Journal: American Journal of Public Health Author-Name: Nutting, P.A. Author-Name: Freeman, W.L. Author-Name: Risser, D.R. Author-Name: Helgerson, S.D. Author-Name: Paisano, R. Author-Name: Hisnanick, J. Author-Name: Beaver, S.K. Author-Name: Peters, I. Author-Name: Carney, J.P. Author-Name: Speers, M.A. Year: 1993 Volume: 83 Issue: 11 Pages: 1589-1598 Abstract: Objectives. This study uses Indian Health Service inpatient data to estimate cancer incidence among American Indians and Alaska Natives. Methods. Hospital discharge data for 1980 through 1987 were used to identify cases of cancer for 21 sites in women and 18 sites in men. Estimates of incidence were directly standardized to data from the Surveillance, Epidemiology, and End Results Program for the same time frame. Results. Cancers of the gallbladder, kidney, stomach, and cervix show generally high rates among many American Indian and Alaska Native communities, and cancers of the liver and nasopharynx are high in Alaska. Of the relatively common cancers in Whites, American Indians and Alaska Natives experience lower rates for cancers of the breast, uterus, ovaries, prostate, lung, colon, rectum, and urinary bladder and for leukemia and melanoma. Variation among geographic areas and among tribal groups is observed for many important cancer sites. Conclusions. This study demonstrates significant variations of cancer rates among American Indians and Alaska Natives, with important implications for Indian Health Service cancer control programs. The study also supports the potential use of hospital discharge data for estimating chronic disease among diverse American Indian and Alaska Native communities. Handle: RePEc:aph:ajpbhl:1993:83:11:1589-1598_6 Template-Type: ReDIF-Article 1.0 Title: Causes of death among persons reported with AIDS Journal: American Journal of Public Health Author-Name: Chu, S.Y. Author-Name: Buehler, J.W. Author-Name: Lieb, L. Author-Name: Beckett, G. Author-Name: Conti, L. Author-Name: Costa, S. Author-Name: Dahan, B. Author-Name: Danila, R. Author-Name: Fordyce, E.J. Author-Name: Hirozawa, A. Author-Name: Shields, A. Author-Name: Singleton, J.A. Author-Name: Wold, C. Year: 1993 Volume: 83 Issue: 10 Pages: 1429-1432 Abstract: Objectives. This study describes causes of death in persons with acquired immunodeficiency syndrome (AIDS) and assesses the completeness of reporting of human immunodeficiency virus (HIV) infection or AIDS on death certificates of persons with AIDS. Methods. AIDS case reports were linked with death certificates in 11 local/state health departments; underlying and associated causes of death were available for 32 513 persons with AIDS who died. Results. HIV/AIDS was designed as the underlying cause of death for 46% of persons with AIDS who died between 1983 and 1986 and 81% of persons with AIDS who died since 1987 (the year specific coding procedures were implemented for HIV/AIDS). Most other underlying causes of death were conditions within the AIDS case definition (notably Pneumocystis carinii pneumonia), pneumonia, infections outside the AIDS case definition, and drug abuse. Unintentional injuries, suicide, and homicide were less common. HIV/AIDS was listed as underlying or associated on 88% of death certificates from 1987 to 1989; reporting primarily by HIV exposure category and time between diagnosis and death. Conclusions. Physicians and other health care professionals should realize their critical role in accurately documenting HIV-related mortality on death certificates. Such data can ultimately influence the allocation of health care resources for HIV-infected individuals. Handle: RePEc:aph:ajpbhl:1993:83:10:1429-1432_1 Template-Type: ReDIF-Article 1.0 Title: Project towards no tobacco use: 1-Year behavior outcomes Journal: American Journal of Public Health Author-Name: Sussman, S. Author-Name: Dent, C.W. Author-Name: Stacy, A.W. Author-Name: Sun, P. Author-Name: Craig, S. Author-Name: Simon, T.R. Author-Name: Burton, D. Author-Name: Flay, B.R. Year: 1993 Volume: 83 Issue: 9 Pages: 1245-1250 Abstract: Objectives. We present 1-year follow-up data from a school-based tobacco use prevention project designed to test the effectiveness of three main components of social influence programs. The components teach refusal skills, awareness of social misperceptions about tobacco use, and misconceptions about physical consequences. Methods. Four different curricula were developed and tested in a randomized experiment involving 48 junior high schools. The outcome variables examined were changes in initial and weekly cigarette and smokeless tobacco use 1 year after the intervention. Results. Analyses indicated that each of the component programs were effective in decreasing both the initial and the weekly use of cigarettes except for the curriculum in which refusal skills were taught. Also, each curriculum was effective in decreasing the initial use of smokeless tobacco except for the one aimed at correcting social misperceptions. Only the combined curriculum showed an effect on the weekly use of smokeless tobacco. Conclusions. The combined intervention was the most effective overall in reducing the initial and weekly use of cigarettes and smokeless tobacco. This suggests that different reasons for use exist and need to be counteracted simultaneously. However, since single programs were also effective in reducing all but weekly smokeless tobacco use, any of these components may be worthwhile prevention tools. Handle: RePEc:aph:ajpbhl:1993:83:9:1245-1250_6 Template-Type: ReDIF-Article 1.0 Title: From information to knowledge: Assimilating public health data Journal: American Journal of Public Health Author-Name: Feinleib, M. Year: 1993 Volume: 83 Issue: 9 Pages: 1205-1207 Handle: RePEc:aph:ajpbhl:1993:83:9:1205-1207_1 Template-Type: ReDIF-Article 1.0 Title: Editorial: Profits of doom Journal: American Journal of Public Health Author-Name: Warner, K.E. Year: 1993 Volume: 83 Issue: 9 Pages: 1211-1213 Handle: RePEc:aph:ajpbhl:1993:83:9:1211-1213_1 Template-Type: ReDIF-Article 1.0 Title: CDC WONDER: A comprehensive on-line public health information system of the Centers for Disease Control and Prevention Journal: American Journal of Public Health Author-Name: Friede, A. Author-Name: Reid, J.A. Author-Name: Ory, H.W. Year: 1993 Volume: 83 Issue: 9 Pages: 1289-1294 Abstract: Objectives. CDC WONDER, a comprehensive on-line public health information system of the Centers for Disease Control and Prevention (CDC), was developed to place timely, action-oriented information in the hands of public health professionals. Methods. A unified system was developed de novo to be used for and to evolve along with public health. All data are stored and updated on the CDC mainframe. Results. CDC WONDER provides menu-driven access to 24 databases with information on mortality, hospital discharges, cancer incidence, notifiable diseases, acquired immunodeficiency syndrome, the Morbidity and Mortality Weekly Report, etc.; each database has on-line documentation. Results can be tabulated and graphed, and there is full-text searching of textual databases. Non-CDC staff have access via telephone connection. From August 1991 through June 1992, system databases were accessed 10 698 times, and there were 842 users (mean of 97 new users per month). Conclusions. CDC WONDER has shown that it is possible to build a large, on-line database of scientific data for public health professionals. CDC WONDER provides a common foundation from which to build information- based public health plans and policy and could help strengthen the public health system. Handle: RePEc:aph:ajpbhl:1993:83:9:1289-1294_2 Template-Type: ReDIF-Article 1.0 Title: Toward a smoke-free society: Opportunities and obstacles Journal: American Journal of Public Health Author-Name: Wynder, E.L. Year: 1993 Volume: 83 Issue: 9 Pages: 1204-1205 Handle: RePEc:aph:ajpbhl:1993:83:9:1204-1205_2 Template-Type: ReDIF-Article 1.0 Title: The tobacco industry, state politics, and tobacco education in California Journal: American Journal of Public Health Author-Name: Begay, M.E. Author-Name: Traynor, M. Author-Name: Glantz, S.A. Year: 1993 Volume: 83 Issue: 9 Pages: 1214-1221 Abstract: Objectives. Proposition 99 added 25 cents to the California state cigarette tax and mandated that 20% of the new revenues be spent on tobacco education and prevention programs. This paper examines the implementation of these programs and the tobacco industry's response to Proposition 99. Methods. Political expenditure data for twelve tobacco firms and associations were gathered from California's Fair Political Practices Commission and secretary of state's Political Reform Division. Tobacco education expenditure data were collected from Governor's Budgets and the Department of Finance. Results. Since Proposition 99 passed, tobacco industry political expenditures in California have risen 10-fold, from $790 050 in the 1985-1986 election to $7 615 091 in the 1991-1992 election. The tobacco industry is contributing more heavily to the California legislature than to Congress. A statistical analysis of data on campaign contributions indicates that California legislators' policymaking is influenced by campaign contributions from the tobacco industry. Since fiscal year 1989-1990, the state has ignored the voters' mandate and spent only 14.7% of the new revenues to tobacco education. Medical care programs received more money than permitted by the voters. Conclusions. The tobacco industry has become politically active in California following the passage of Proposition 99. One result may be that the state has underfunded tobacco education by $174.7 million through the 1993-1994 fiscal year. The estimated redirection of funds to medical care would essentially eliminate the tobacco education campaign by the year 2000. Handle: RePEc:aph:ajpbhl:1993:83:9:1214-1221_1 Template-Type: ReDIF-Article 1.0 Title: Cigarette smoking and bone mineral density in older men and women Journal: American Journal of Public Health Author-Name: Hollenbach, K.A. Author-Name: Barrett-Connor, E. Author-Name: Edelstein, S.L. Author-Name: Holbrook, T. Year: 1993 Volume: 83 Issue: 9 Pages: 1265-1270 Abstract: Objectives. The association between cigarette smoking and bone mineral density was examined prospectively in a population-based study of older Caucasian men and women. Methods. Smoking patterns were determined at a 1972- 1974 baseline evaluation and, again, 16 years later when 544 men and 822 women had bone mineral density measurements taken. Results. Men and women who were cigarette smokers at baseline demonstrated significantly reduced bone mineral density of the hip compared with nonsmokers. Baseline smoking was not associated with significantly lower bone density at nonhip sites. Women demonstrated a significant dose-response relationship between baseline smoking status at all hip sites measured. Both sexes exhibited significant dose-response relationships between hip bone mineral density and change in smoking status between baseline and follow-up, demonstrating that smoking cessation in later life was beneficial in halting bone density loss associated with smoking. Conclusions. Smoking was positively and significantly associated with decreased hip bone mineral density in old age. Bone loss associated with smoking would be expected to predict an increased risk of hip fracture in those who do not succumb earlier to another complication of tobacco use. Handle: RePEc:aph:ajpbhl:1993:83:9:1265-1270_8 Template-Type: ReDIF-Article 1.0 Title: Tobacco use: A modifiable risk factor for dental disease among the elderly Journal: American Journal of Public Health Author-Name: Jette, A.M. Author-Name: Feldman, H.A. Author-Name: Tennstedt, S.L. Year: 1993 Volume: 83 Issue: 9 Pages: 1271-1276 Abstract: Objectives. Because the public health literature contains few analytic studies of modifiable behavioral risk factors for dental disease among older community-dwelling populations, the New England Elders Dental Study was undertaken as an epidemiologic study of the oral health status of a representative sample of older adults living within the six New England states. Methods. Five dentists conducted comprehensive in-home oral health examinations on 1156 community-dwelling adults aged 70 and older to determine whether lifetime use of tobacco products was a significant risk factor for tooth loss, caries, and periodontal disease. Results. Among New England elders, tobacco use was more common among men (18.1%) than women (7.9%), with a combined rate of 12.3%. Further, 64.7% of men and 36.6% of women were previous tobacco users. Years of exposure to tobacco products was a statistically significant risk factor for tooth loss, coronal and root caries, and periodontal disease, regardless of other social and behavioral factors. Conclusions. Lifelong tobacco use is a modifiable risk factor for poor dental health among older adults. Dental practitioners need to intervene with all their adult patients to discourage use of tobacco products for oral as well as general preventive health care. Handle: RePEc:aph:ajpbhl:1993:83:9:1271-1276_5 Template-Type: ReDIF-Article 1.0 Title: Black leaders' perceptions of the year 2000 public health goals for Black Americans Journal: American Journal of Public Health Author-Name: Schneider, D. Author-Name: Greenberg, M.R. Author-Name: Choi, D. Year: 1993 Volume: 83 Issue: 8 Pages: 1171-1173 Abstract: We surveyed 1196 Black health and political leaders on their perceptions about the US Department of Health and Human Services' Healthy People 2000 public health goals. Respondents identified reducing the incidence of acquired immunodeficiency syndrome, improving maternal and infant health, and controlling sexually transmitted diseases as the three most important public health goals for Black Americans that are amenable to intervention. The leaders assigned nearly all responsibility for prevention efforts to the federal government and the individual. With the American health care system now in flux, Black leaders need to organize to see that these priority issues are addressed. Handle: RePEc:aph:ajpbhl:1993:83:8:1171-1173_9 Template-Type: ReDIF-Article 1.0 Title: Early menopause, number of reproductive years, and bone mineral density in postmenopausal women Journal: American Journal of Public Health Author-Name: Kritz-Silverstein, D. Author-Name: Barrett-Connor, E. Year: 1993 Volume: 83 Issue: 7 Pages: 983-988 Abstract: Objectives. Previous studies have reported positive associations of age at menopause with bone density and inverse associations of age at menarche with bone density. This study examined the relationships of early age at menopause and number of reproductive years (defined as age at menopause minus age menarche) with bone density in postmenopausal women. Methods. The subjects were 555 women aged 60 to 89 years who had had either natural menopause (n = 391) or hysterectomy with bilateral oophorectomy (n = 164). Bone density was measured at the ultradistal wrist, midshaft radius, lumbar spine, and hip. Results. Women who had had early menopause and those with the fewest reproductive years had significantly lower bone density at all sites. After adjustment for covariates, both age at menopause and number of reproductive years had significant positive associations with bone density at every site, and total number of reproductive years explained more of the variance in bone mineral density than did either age at menarche or age at menopause. Conclusions. Elderly women reporting early menopause or fewer reproductive years have more osteoporosis. The number of reproductive years may be more helpful than age at menopause in identifying women at increased risk of osteoporosis. Handle: RePEc:aph:ajpbhl:1993:83:7:983-988_9 Template-Type: ReDIF-Article 1.0 Title: The ramifications of induced abortion. 2. Increases in unwanted births: origins and consequences. Journal: American Journal of Public Health Author-Name: Ferguson, B. Year: 1993 Volume: 83 Issue: 8 Pages: 1180 Handle: RePEc:aph:ajpbhl:1993:83:8:1180_3 Template-Type: ReDIF-Article 1.0 Title: A South African odyssey in community health: a memoir of the impact of the teachings of Sidney Kark. Journal: American Journal of Public Health Author-Name: Susser, M. Year: 1993 Volume: 83 Issue: 7 Pages: 1039-1042 Handle: RePEc:aph:ajpbhl:1993:83:7:1039-1042_4 Template-Type: ReDIF-Article 1.0 Title: Editorial: Alcohol, the heart, and health Journal: American Journal of Public Health Author-Name: Shaper, A.G. Year: 1993 Volume: 83 Issue: 6 Pages: 799-801 Handle: RePEc:aph:ajpbhl:1993:83:6:799-801_8 Template-Type: ReDIF-Article 1.0 Title: Women's contributions to the committee ignored. Journal: American Journal of Public Health Author-Name: Carlyon, W.H. Author-Name: Pollock, M.B. Year: 1993 Volume: 83 Issue: 6 Pages: 909 Handle: RePEc:aph:ajpbhl:1993:83:6:909_5 Template-Type: ReDIF-Article 1.0 Title: Commentary: The new female condom - Item 1 on a women's AIDS prevention agenda Journal: American Journal of Public Health Author-Name: Gollub, E.L. Author-Name: Stein, Z.A. Year: 1993 Volume: 83 Issue: 4 Pages: 498-500 Abstract: A US Food and Drug Administration (FDA) advisory panel has recommended that the female condom Reality be approved for contraception and acquired immunodeficiency syndrome (AIDS) prevention. Final FDA approval will mark the first official recognition of a woman-controlled method for protection against sexually transmitted disease. A female condom allows women to use just one method to respond to the twin anxieties of AIDS and unwanted pregnancy. In those couples in which the man refuses to wear a male condom, the availability of a female condom makes protection possible for the first time. Although the female condom has some advantages over the male condom- greater comfort for some women and men and nonreliance on male arousal- general population experience with the device is needed to achieve regular widespread use and hence effectiveness at population levels. The FDA still lags behind in responding to women's needs for information on AIDS and sexually transmitted disease. Handle: RePEc:aph:ajpbhl:1993:83:4:498-500_2 Template-Type: ReDIF-Article 1.0 Title: Study of hypertension in urban bus drivers questioned. Study design as source of bias. Journal: American Journal of Public Health Author-Name: Li, G. Year: 1993 Volume: 83 Issue: 4 Pages: 600-601 Handle: RePEc:aph:ajpbhl:1993:83:4:600-601_0 Template-Type: ReDIF-Article 1.0 Title: The smoking habits of Minnesota physicians Journal: American Journal of Public Health Author-Name: Hensrud, D.D. Author-Name: Sprafka, J.M. Year: 1993 Volume: 83 Issue: 3 Pages: 415-417 Abstract: The prevalence of smoking among physicians has gradually declined over the past 25 years. Few recent studies have examined specific smoking habits. Of 393 physicians in the Minnesota Medical Association who responded to a survey (response rate of 83%), 9% reported smoking any form of tobacco. The prevalence of cigarette smoking was 4.9%, while 5.1% smoked a pipe and 2.1% smoked cigars. The prevalence estimates of current and former smokers were greater among men than women and among older than younger physicians. Cigarette and overall smoking prevalence among physicians continues to be well below levels reported for the general population. Handle: RePEc:aph:ajpbhl:1993:83:3:415-417_8 Template-Type: ReDIF-Article 1.0 Title: Mental health services and outcome-driven health care Journal: American Journal of Public Health Author-Name: Fogel, B. Year: 1993 Volume: 83 Issue: 3 Pages: 319-321 Abstract: Mental disorders and mental symptoms often go untreated in both chronic care and primary care settings. However, they covary with functional disability. They are likely to impair social and occupational function in medical outpatients and to cause excess instrumental and cognitive disability in frail older persons. In both groups, they are frequent and often remediable. The costs of untreated mental disorders are often shifted to caregivers and to society in general. To ensure adequate mental health care requires a reorientation of medical care toward optimizing function and well- being as well as longevity. Such a reorientation will necessarily entail more attention to treatable mental disorders. Research is needed to (1) develop firm knowledge on which to base integrated medical and mental health treatment and (2) evaluate the potential economic benefits of combined care. Incentives must be changed if such a paradigm of care is to prosper. Handle: RePEc:aph:ajpbhl:1993:83:3:319-321_5 Template-Type: ReDIF-Article 1.0 Title: Can smoking be child abuse? [3] Journal: American Journal of Public Health Author-Name: Fontelo, P.A. Year: 1993 Volume: 83 Issue: 3 Pages: 429-430 Handle: RePEc:aph:ajpbhl:1993:83:3:429-430_5 Template-Type: ReDIF-Article 1.0 Title: Paternal smoking and birthweight in Shanghai Journal: American Journal of Public Health Author-Name: Zhang, J. Author-Name: Ratcliffe, J.M. Year: 1993 Volume: 83 Issue: 2 Pages: 207-210 Abstract: Objectives. Although maternal active smoking has been established to be associated with fetal growth retardation, evidence of an effect of environmental tobacco smoke exposure on birthweight is still limited and inconclusive. This study addressed the relationship between prenatal environmental tobacco smoke exposure and birthweight and fetal growth retardation in Shanghai, China. Methods. Data on 1785 full-term live-born normal infants of nonsmoking mothers were used from the Shanghai Birth Defects and Perinatal Death Monitoring conducted between October 1986 and September 1987. Environmental tobacco smoke exposure was defined as exposure to paternal smoking. Results. Infants with environmental tobacco smoking exposure were, on average, 30 g lower in birthweight than nonexposed infants, after adjustment for gestational age, parity, maternal age, and occupation. Conclusion. Consistent with previous research, this study suggests that environmental tobacco smoking exposure may have a modestly adverse effect on birthweight. Handle: RePEc:aph:ajpbhl:1993:83:2:207-210_9 Template-Type: ReDIF-Article 1.0 Title: Smoking cessation factors among African Americans and Whites Journal: American Journal of Public Health Author-Name: Royce, J.M. Author-Name: Hymowitz, N. Author-Name: Corbett, K. Author-Name: Hartwell, T.D. Author-Name: Orlandi, M.A. Year: 1993 Volume: 83 Issue: 2 Pages: 220-226 Abstract: Objectives. This study was undertaken to explore smoking patterns and attitudes that influence smoking cessation and relapse among African Americans. Methods. Baseline data from eight Community Intervention Trial for Smoking Cessation (COMMIT) sites were analyzed. Results. Compared with Whites, African Americans who smoke less than 25 cigarettes per day were 1.6 times more likely to smoke within 10 minutes of awakening (a behavioral indicator of nicotine dependence), adjusting for education, age, and gender (OR=1.2 for heavier smokers). African Americans reported a stronger desire to quit smoking and reported serious quit attempts in the past year. African Americans favored tobacco restrictions (they were 1.8 times more likely than Whites to view smoking as a serious community problem, 1.7 times more likely to favor restrictions on cigarette vending machines, and 2.1 times more likely to prohibit smoking in their car). African Americans were lighter/moderate, menthol smokers. Conclusions. African Americans find smoking socially unacceptable and are strongly motivated to quit, but their 'wake-up' smoking may indicate high nicotine dependence, making abstinence difficult even for lighter smokers. Handle: RePEc:aph:ajpbhl:1993:83:2:220-226_6 Template-Type: ReDIF-Article 1.0 Title: The effects of intrauterine cocaine exposure in newborns Journal: American Journal of Public Health Author-Name: Bateman, D.A. Author-Name: Ng, S.K.C. Author-Name: Hansen, C.A. Author-Name: Heagarty, M.C. Year: 1993 Volume: 83 Issue: 2 Pages: 190-193 Abstract: Objectives. We sought to determine the effects of intrauterine cocaine exposure in newborns, in an inner-city population in which cocaine use during pregnancy was common. Methods. During a 1-year period, 12.8% (361 of 2810) of all live singleton infants at Harlem Hospital in New York were identified as cocaine exposed, either by universal urine toxicologic screening or by maternal history. Cocaine-exposed infants were compared with a control group of 387 infants not known to be exposed to cocaine or other illicit drugs. Results. Low birthweight (< 2500 g) was more common among cocaine-exposed infants (31% vs 10%), as was preterm birth (< 37 completed weeks of gestation) (32% vs 14%). In multivariate analyses controlled for demographic and lifestyle factors and duration of gestation, cocaine was associated with decreased birthweight (154 g), length (1.02 cm), head circumference (0.69 cm), and duration of gestation (0.74 weeks). The birthweight deficits were larger for infants born to mothers who used cocaine in combination with other drugs (195 g) and for infants born to mothers who specifically admitted using crack (200 g). Conclusions. Intrauterine cocaine exposure is linked with fetal growth retardation and shortened gestation in this population. Handle: RePEc:aph:ajpbhl:1993:83:2:190-193_6 Template-Type: ReDIF-Article 1.0 Title: Benjamin Rush's educational campaign against hard drinking. Journal: American Journal of Public Health Author-Name: Katcher, B.S. Year: 1993 Volume: 83 Issue: 2 Pages: 273-281 Abstract: More than 200 years ago, during a period of unprecedented production and consumption of distilled alcoholic beverages in the United States, Benjamin Rush launched a health education campaign that warned the public about the hazards of such beverages. He corrected erroneous notions about their presumed beneficial effects and accurately described more than a dozen alcohol-related health problems. Although the temperance movement has had a tumultuous history in the United States, the origin and long-standing tradition of temperance as a health promotion activity needs to be recognized. Handle: RePEc:aph:ajpbhl:1993:83:2:273-281_0 Template-Type: ReDIF-Article 1.0 Title: Residential releases of number 2 fuel oil: A contributor to indoor air pollution Journal: American Journal of Public Health Author-Name: Kaplan, M.B. Author-Name: Brandt-Rauf, P. Author-Name: Axley, J.W. Author-Name: Shen, T.T. Author-Name: Sewell, G.H. Year: 1993 Volume: 83 Issue: 1 Pages: 84-88 Abstract: Objectives. Analysis of data from the New York City Fire Department showed that residential fuel oil releases frequently occur in quantities ranging from 5 to 1000 gal, primarily from storage tank leaks and overfill. A risk assessment was conducted to determine whether Number 2 fuel oil basement spills pose a significant risk to human health. Methods. Exposure was derived from a simulated field study spill of Number 2 fuel oil in a townhouse basement to develop emission rates for the indicator constituent xylene. Distribution of xylene throughout the townhouse was determined using a multizone contaminant dispersal model. Results. Spills of 85 and 21 gal resulted in xylene exposure estimates as high as 20 and 5 mg/kg/day, respectively. Conclusions. A spill of about 21 gal or more of Number 2 fuel oil would present a human health risk for central nervous and reproductive systems for 8 days or longer. Tank inspection and supervised delivery would provide effective prevention at minimal expense. Handle: RePEc:aph:ajpbhl:1993:83:1:84-88_0 Template-Type: ReDIF-Article 1.0 Title: Building-related asthma in Denver office workers Journal: American Journal of Public Health Author-Name: Hoffman, R.E. Author-Name: Wood, R.C. Author-Name: Kreiss, K. Year: 1993 Volume: 83 Issue: 1 Pages: 89-93 Abstract: Objectives. Reported cases of building-related asthma and hypersensitivity pneumonitis among workers in a Denver office building prompted an epidemiologic investigation. Methods. A cross-sectional, self-administered survey of employees in the office building of the reported cases was compared with that of employees in a comparison building. Results. A significant excess of respiratory disease existed among 512 Denver workers (case building) compared with 281 office workers in a suburban agency (control building). Denver employees had a higher prevalence of respiratory symptoms, and the prevalence of physician-diagnosed asthma with onset or exacerbation since building occupancy was 4.9 times greater for Denver employees than for suburban employees. Asthma was not associated with any particular ventilation system in the building. Water incursion from a below-grade wall may have contributed to the problem, but the etiology is unknown. Conclusions. This investigation provided evidence of office building-related asthma. Individual cases may be sentinel events for other cases of work-related asthma or hypersensitivity pneumonitis and may indicate a need for public health investigation of remediable causes. Handle: RePEc:aph:ajpbhl:1993:83:1:89-93_5 Template-Type: ReDIF-Article 1.0 Title: Bone mineral density in postmenopausal women as determined by prior oral contraceptive use Journal: American Journal of Public Health Author-Name: Kritz-Silverstein, D. Author-Name: Barrett-Connor, E. Year: 1993 Volume: 83 Issue: 1 Pages: 100-102 Abstract: The long-term consequences of prior oral contraceptive use for bone mineral density were examined in 239 postmenopausal women, 35.1% of whom reported prior oral contraceptive use. Women who had used oral contraceptives for 6 or more years had significantly higher bone densities of the lumbar spine and femoral neck, but not of the ultradistal wrist or radius, than women who never used oral contraceptives. Handle: RePEc:aph:ajpbhl:1993:83:1:100-102_0 Template-Type: ReDIF-Article 1.0 Title: Survival with AIDS in Massachusetts, 1979 to 1989 Journal: American Journal of Public Health Author-Name: Seage III, G.R. Author-Name: Oddleifson, S. Author-Name: Carr, E. Author-Name: Shea, B. Author-Name: Makarewicz-Robert, L. Author-Name: Van Beuzekom, M. Author-Name: De Maria, A. Year: 1993 Volume: 83 Issue: 1 Pages: 72-78 Abstract: Objectives. The goal of the study was to determine survival time after diagnosis of acquired immunodeficiency syndrome (AIDS) and to identify predictors of survival. Methods. We conducted a population-based prospective survival analysis of all Massachusetts-resident adult AIDS patients diagnosed from January 1, 1979, through December 31, 1988. Results. Median survival was 406 days, with a 5-year survival rate of 3%. Age older than 40 years (P = .001), a diagnosis other than Kaposi's sarcoma (P = .001), and a history of intravenous drug use (P ≤ .01) were associated with shorter survival after confounding was controlled. Survival increased as year of diagnosis became more recent (P < .0001). This temporal effect was strongest for patients with Pneumocystis carinii pneumonia. Individuals with Kaposi's sarcoma, Hispanics, homosexual men who were concurrent intravenous drug users, and residents of the greater Boston standard metropolitan statistical area, excluding the city of Boston, did not experience increases in survival over time. Conclusions. With the exception of cases initially defined by Kaposi's sarcoma, recently diagnosed AIDS case subjects survive longer than those diagnosed earlier in the epidemic. Further work is needed to determine whether this effect is due to lead-time bias or better treatment after diagnosis. Handle: RePEc:aph:ajpbhl:1993:83:1:72-78_0 Template-Type: ReDIF-Article 1.0 Title: Workplace smoking policies in New Jersey businesses Journal: American Journal of Public Health Author-Name: Lewit, E.M. Author-Name: Botsko, M. Author-Name: Shapiro, S. Year: 1993 Volume: 83 Issue: 2 Pages: 254-256 Abstract: A New Jersey law enacted in 1985 requires smoking policies for work sites with 50 or more employees. In 1988, we surveyed a sample of New Jersey businesses to determine their smoking policies. Eighty-three percent of respondents with 50 or more employees reported implementing restrictive smoking policies. Of respondents with 2 to 49 employees, 35% had implemented policies. Our findings identify some of the factors other than a legal mandate that lead employers to restrict smoking in the workplace. Handle: RePEc:aph:ajpbhl:1993:83:2:254-256_7 Template-Type: ReDIF-Article 1.0 Title: How accurate is the reflotron cholesterol analyzer? [2] Journal: American Journal of Public Health Author-Name: Van Beurden, E. Author-Name: James, R. Author-Name: Feil, J.M. Author-Name: Havas, S. Year: 1993 Volume: 83 Issue: 3 Pages: 428-429 Handle: RePEc:aph:ajpbhl:1993:83:3:428-429_1 Template-Type: ReDIF-Article 1.0 Title: Using a passive alcohol sensor to detect legally intoxicated drivers Journal: American Journal of Public Health Author-Name: Foss, R.D. Author-Name: Voas, R.B. Author-Name: Beirness, D.J. Year: 1993 Volume: 83 Issue: 4 Pages: 556-560 Abstract: Objectives. We examined whether a passive alcohol sensor could be used for mass screening of motorists to accurately and quickly detect drivers whose blood alcohol concentration exceeded a variety of levels often established as per se evidence of legal intoxication. Methods. In a voluntary roadside survey, 1181 late-night drivers in Minnesota were interviewed. Breath measurements were taken with both a passive alcohol sensor and an evidentiary quality portable breath-test device. Results. Measurements could be taken much more easily and quickly with the passive sensor, whose readings correlated very strongly (r = .87) with the evidentiary device. Moreover, for criterion blood alcohol concentration levels ranging from 100 mg/dL to 20 mg/dL, a large proportion of motorists could be accurately identified as being above or below the criterion, with relatively few false-negative or false-positive identifications. Conclusions. The use of passive alcohol sensors at sobriety checkpoints should allow motorists to be processed very quickly with minimal inconvenience. At the same time, detection of legally intoxicated motorists will probably be substantially increased and the general deterrent value of per se alcohol-impaired driving laws enhanced. Handle: RePEc:aph:ajpbhl:1993:83:4:556-560_4 Template-Type: ReDIF-Article 1.0 Title: HIV-related knowledge and precautions among Michigan nurses Journal: American Journal of Public Health Author-Name: Schillo, B.A. Author-Name: Reischl, T.M. Year: 1993 Volume: 83 Issue: 10 Pages: 1438-1442 Abstract: Objectives. The present study examined human immunodeficiency virus (HIV)- related knowledge and precautionary behaviors in a large random sample of registered nurses in all regions of the state of Michigan, allowing for comparisons among nurses in a wide range of occupational experiences, exposures, and backgrounds related to HIV. Methods. A random sample of all registered nurses living in Michigan completed surveys in the fall of 1989. Results. Although nearly all respondents indicated a high level of knowledge of known viable routes of HIV transmission, many respondents also reported misconceptions about several unverified nonviable routes of HIV transmission. Of the respondents who were involved in situations with potential risk of exposure to HIV, many failed to consistently use the universal precautions recommended by the Centers for Disease Control and Prevention. The respondents also reported significant barriers in applying infection control procedures. Conclusions. The findings of the present study support the need for continued and intensified efforts to ensure that nurses have the knowledge necessary to provide quality care, are aware of the risk of potential exposures to HIV, and are engaging in appropriate precautionary behaviors. Handle: RePEc:aph:ajpbhl:1993:83:10:1438-1442_0 Template-Type: ReDIF-Article 1.0 Title: Race/ethnicity patterns in the homicide of children in Los Angeles, 1980 through 1989 Journal: American Journal of Public Health Author-Name: Sorenson, S.B. Author-Name: Richardson, B.A. Author-Name: Peterson, J.G. Year: 1993 Volume: 83 Issue: 5 Pages: 725-727 Abstract: This study investigated age, sex, and race/ethnicity risk patterns for homicide based on 246 children (newborn to 14 years old) who were murdered in the city of Los Angeles 1980 through 1989. Rates of homicide are higher for newborn to 4-year-olds than for 5- to 14-year-olds. Boys and girls have similar rates of homicide at young ages; among 5- to 14-year-olds, however, boys have higher rates. Characteristics of the victim, suspect, and event were fairly consistent across victim race/ethnicity. Rates vary by the victim's race/ethnicity; paralleling patterns among adults, rates of homicide are lowest for non-Hispanic White, higher for Hispanic, and highest for Black children. Handle: RePEc:aph:ajpbhl:1993:83:5:725-727_3 Template-Type: ReDIF-Article 1.0 Title: The taking of free condoms in a drug abuse treatment clinic: The effects of location and posters Journal: American Journal of Public Health Author-Name: Amass, L. Author-Name: Bickel, W.K. Author-Name: Higgins, S.T. Author-Name: Budney, A.J. Author-Name: Foerg, F.E. Year: 1993 Volume: 83 Issue: 10 Pages: 1466-1468 Abstract: Drug abuse treatment programs can help reduce high-risk sexual behavior in drug users by promoting condom use. This study examined the influence of distribution location and poster prompts on the taking of free condoms in a drug abuse treatment clinic. Over 6 months, condoms were available alternately, with and without poster prompts, in the clinic's private restroom or public waiting area. Overall, 381% more condoms were taken from the restroom. The presence of poster prompts did not affect condom taking. These results suggest that distribution location is a critical factor in promoting condom taking in a public clinic. Handle: RePEc:aph:ajpbhl:1993:83:10:1466-1468_1 Template-Type: ReDIF-Article 1.0 Title: Young men's risk behaviors for HIV infection and sexually transmitted diseases, 1988 through 1991 Journal: American Journal of Public Health Author-Name: Ku, L. Author-Name: Sonenstein, F.L. Author-Name: Pleck, J.H. Year: 1993 Volume: 83 Issue: 11 Pages: 1609-1615 Abstract: Objectives. This paper analyzes age- and period-related changes in risk behaviors for human immunodeficiency virus (HIV) infection and sexually transmitted diseases among young men in the United States between 1988 and 1991. Methods. Data were from the 1988 and 1991 waves of the National Survey of Adolescent Males. The 1988 survey was a nationally representative survey of 1880 males aged 15 through 19 years. The 1991 survey was a longitudinal follow-up of 1676 males aged 17 through 22 years. Results. As they aged, the young men increased their levels of sexual activity and decreased their condom use. Period-related changes between 1988 and 1991 were examined by comparing similar cohorts of 17.5-through 19-year-old men: there were signs that sexual activity and intravenous drug injection increased, but condom use did not change significantly. In 1991 51% of the young men said they were occasionally 'high' during sex, a state that is related to reduced condom use. Conclusions. Early progress in fostering safer behaviors among young men slowed and possibly stopped as the nation entered the 1990s. Prevention efforts need to be renewed and should focus on older youth and young adults. Handle: RePEc:aph:ajpbhl:1993:83:11:1609-1615_0 Template-Type: ReDIF-Article 1.0 Title: Environmental tobacco smoke concentrations in no-smoking and smoking sections of restaurants Journal: American Journal of Public Health Author-Name: Lambert, W.E. Author-Name: Samet, J.M. Author-Name: Spengler, J.D. Year: 1993 Volume: 83 Issue: 9 Pages: 1339-1341 Abstract: To characterize the effectiveness of a local ordinance that restricts smoking in restaurants to one third of the seating area, this study made simultaneous measurements of two markers of environmental tobacco smoke, respirable suspended particles and nicotine, in the smoking and no-smoking sections of seven restaurants. The mean concentrations of respirable suspended particles and nicotine were 40% and 65% lower, respectively, in the no-smoking than in the smoking sections, indicating substantial but not complete protection against exposure. Handle: RePEc:aph:ajpbhl:1993:83:9:1339-1341_0 Template-Type: ReDIF-Article 1.0 Title: The health consequences of maquiladora work: Women on the US-Mexican border Journal: American Journal of Public Health Author-Name: Guendelman, S. Author-Name: Silberg, M.J. Year: 1993 Volume: 83 Issue: 1 Pages: 37-44 Abstract: Objectives. As more US companies take jobs to Mexico, complaints are growing that the assembly plants (maquiladoras) exert adverse effects on workers' health. This study assessed the health of female electronic and garment maquiladora workers, comparing them with women employed in services and non-wage earners. Methods. A survey was administered to 480 women living in Tijuana in 1990. The sample was stratified by occupation and length of employment. Functional impediments, nervousness, depression, and sense of control were used as outcome variables, controlling for other confounders. Results. Despite working longer hours, receiving lower wages, and having less decision latitude and education, maquiladora workers were not worse off than service workers. Maquiladora workers reported similar incidences of depression and lack of control over life. Electronics workers, especially, had lower incidences of nervousness and functional impediments, after controlling for other confounders. Also, maquiladora work did not add an extra health burden compared with non-wage earners. Conclusions. The adverse effects of maquiladoras previously reported may have been exaggerated. Subjective factors, including negative attitudes toward economic adversity and work dissatisfaction, were stronger predictors of health than were objective indicators. Handle: RePEc:aph:ajpbhl:1993:83:1:37-44_7 Template-Type: ReDIF-Article 1.0 Title: Michigan's public health program for indoor radon Journal: American Journal of Public Health Author-Name: Martin, J.E. Author-Name: Jacobson, A.P. Author-Name: Miklos, J.A. Year: 1993 Volume: 83 Issue: 10 Pages: 1488-1489 Handle: RePEc:aph:ajpbhl:1993:83:10:1488-1489_4 Template-Type: ReDIF-Article 1.0 Title: Alcohol, cigarette, and marijuana use among fourth-grade urban schoolchildren in 1988/89 and 1990/91 Journal: American Journal of Public Health Author-Name: Bush, P.J. Author-Name: Iannotti, R.J. Year: 1993 Volume: 83 Issue: 1 Pages: 111-115 Abstract: A public-school-based epidemiological survey of fourth-grade students in Washington, DC, was performed in 1988/89 (n = 4675) and 1990/91 (n = 4678). Comparisons of data for the two periods revealed that the lifetime prevalence of self-reported alcohol use, alcohol use without parental knowledge, and smoking more than a puff of cigarettes declined; marijuana use and cigarette experimentation did not. Seven variables were associated with use. Declines were observed in perceived peer pressure to use; seeing a family member/friend selling drugs; and being offered alcohol, cigarettes, or marijuana by peers. No declines were observed in family use, perceived friends' use, being bothered a lot if best friends use, or seeing someone else selling drugs. Handle: RePEc:aph:ajpbhl:1993:83:1:111-115_5 Template-Type: ReDIF-Article 1.0 Title: The underrecognition of HIV infection in women in an inner-city emergency room Journal: American Journal of Public Health Author-Name: Schoenbaum, E.E. Author-Name: Webber, M.P. Year: 1993 Volume: 83 Issue: 3 Pages: 363-368 Abstract: Objectives. This study analyzed the recognition of human immunodeficiency virus (HIV) infection and associated factors in women and men attending an emergency room in the Bronx, New York, NY. Methods. From April 16, 1989, to May 5, 1989, the emergency room records of 2102 consecutive patients 13 years of age or older were reviewed and, for 856 patients undergoing venipuncture, linked anonymously to results of HIV antibody tested in excess blood. Results. HIV seroprevalence was 7.8% in women and 14.6% in men. Among seropositive women, 5.0% had acquired immunodeficiency syndrome (AIDS), compared with 26.0% of men. Excluding patients with AIDS, HIV infection was recognized in 13.2% of women and 27.0% of men. HIV infection was recognized only in women aged 25 through 44 years. In men, recognition occurred in all age groups. Clinical presentation did not distinguish the seropositive from seronegative women. Risk assessments were recorded less frequently for women (11.2%) than men (15.9%). For 92.5% of persons with any behavioral risk assessment, injecting drug use was the only behavior assessed. Conclusions. HIV infection is underrecognized in women, in part, because of a lower prevalence of AIDS. Universal HIV risk assessment, which includes heterosexual behaviors, may help increase recognition of HIV in women and opportunities for early intervention. Handle: RePEc:aph:ajpbhl:1993:83:3:363-368_0 Template-Type: ReDIF-Article 1.0 Title: Reporting efficiency during a measles outbreak in New York City, 1991 Journal: American Journal of Public Health Author-Name: Davis, S.F. Author-Name: Strebel, P.M. Author-Name: Atkinson, W.L. Author-Name: Markowitz, L.E. Author-Name: Sutter, R.W. Author-Name: Scanlon, K.S. Author-Name: Friedman, S. Author-Name: Hadler, S.C. Year: 1993 Volume: 83 Issue: 7 Pages: 1011-1015 Abstract: Objectives. During an epidemic of measles among preschool children in New York City, an investigation was conducted in 12 city hospitals to estimate reporting efficiency of measles to the New York City Department of Health. Methods. Measles cases were identified by review of hospital emergency room and infection control logs and health department surveillance records. The Chandra Sekar Deming method was used (1) to estimate the total number of measles cases in persons less than 19 years old who presented to the 12 hospitals from January through March 1991 and (2) to estimate reporting efficiency. Information on mechanisms for reporting measles cases was collected from hospital infection control coordinators. Results. The Chandra Sekar Deming method estimated that 1487 persons with measles presented to the 12 hospitals during the study period. The overall reporting efficiency was 45% (range = 19% to 83%). All 12 hospitals had passive surveillance for measles; 2 also had an active component. These 2 hospitals had the first and third highest measles reporting efficiencies. Conclusions. The reporting efficiency of measles cases by New York City hospitals to the health department was low, indicating that the magnitude of the outbreak was substantially greater than suggested by the number of reported cases. Handle: RePEc:aph:ajpbhl:1993:83:7:1011-1015_1 Template-Type: ReDIF-Article 1.0 Title: The distribution of canine exposure to Borrelia burgdorferi in a Lyme- disease endemic area Journal: American Journal of Public Health Author-Name: Falco, R.C. Author-Name: Smith, H.A. Author-Name: Fish, D. Author-Name: Mojica, B.A. Author-Name: Bellinger, M.A. Author-Name: Harris, H.L. Author-Name: Hechemy, K.E. Year: 1993 Volume: 83 Issue: 9 Pages: 1305-1310 Abstract: Objectives. A serosurvey of canine exposure to Borrelia burgdorferi, the causative agent of human Lyme disease, was conducted in Westchester County, New York, to determine the distribution of exposure in an area endemic for Lyme disease. Methods. A total of 1446 blood samples was collected from resident dogs and tested by modified enzyme-linked immunosorbent assay. Equivocal samples were further tested by immunoblot. A mean number of 57.8 samples was collected from each of 25 towns and cities. Results. Seroprevalence rates for municipalities ranged from 6.5% to 85.2%. County seroprevalence was 49.2%. There was a significant difference among the rates for the northern (67.3%), central (45.2%), and southern (17.3%) regions. Multiple range analysis indicated homogeneity between the southern and central regions and the central and northern regions. Conclusions. Canine exposure to B burgdorferi increases in a south to north gradient within the county. Intensity of exposure, measured by enzyme-linked immunosorbent assay titers, indicates a similar pattern. The close association between dogs and humans suggests that human risk of acquiring Lyme disease within Westchester County is equally disparate and is inversely related to the degree of urbanization. Handle: RePEc:aph:ajpbhl:1993:83:9:1305-1310_2 Template-Type: ReDIF-Article 1.0 Title: Racial differences in the elderly's use of medical procedures and diagnostic tests Journal: American Journal of Public Health Author-Name: Escarce, J.J. Author-Name: Epstein, K.R. Author-Name: Colby, D.C. Author-Name: Schwartz, J.S. Year: 1993 Volume: 83 Issue: 7 Pages: 948-954 Abstract: Objectives. This study sought to examine racial differences in the use of medical procedures and diagnostic tests by elderly Americans. Methods. We used 1986 physician claims data for a 5% national sample of Medicare enrollees aged 65 years and older to study 32 procedures and tests. For each service, we calculated the age- and sex-adjusted rate of use by race and the corresponding White-Black relative risk. Results. Whites were more likely than Blacks to receive 23 services, and for many of these services, the differences in use were substantial. In contrast, Blacks were more likely than Whites to receive seven services. Whites had a particular advantage in access to higher-technology or newer services. Racial differences in use persisted among elders who had Medicaid in addition to Medicare coverage and increased among rural elders. Conclusions. There are pervasive racial differences in the use of medical services by elderly Americans that cannot be explained by differences in the prevalence of specific clinical conditions. Financial barriers to care do not fully account for these findings. Race may exacerbate the impact of other barriers to access. Handle: RePEc:aph:ajpbhl:1993:83:7:948-954_5 Template-Type: ReDIF-Article 1.0 Title: The epidemiology of child abuse: Findings from the Second National Incidence and Prevalence Study of Child Abuse and Neglect Journal: American Journal of Public Health Author-Name: Cappelleri, J.C. Author-Name: Eckenrode, J. Author-Name: Powers, J.L. Year: 1993 Volume: 83 Issue: 11 Pages: 1622-1624 Abstract: The epidemiology of child abuse was investigated with data from the Second National Incidence and Prevalence Study of Child Abuse and Neglect. A statistical comparison of incidence rates suggested that age, family income, and ethnicity were risk factors for both sexual abuse and physical abuse, but county metrostatus was not. Gender was a risk factor for sexual abuse but not for physical abuse. A logistic regression analysis showed that ethnicity, county metrostatus, and a gender-by-income interaction distinguished sexual abuse from physical abuse. Handle: RePEc:aph:ajpbhl:1993:83:11:1622-1624_3 Template-Type: ReDIF-Article 1.0 Title: From beer to crack: Developmental patterns of drug involvement Journal: American Journal of Public Health Author-Name: Kandel, D. Author-Name: Yamaguchi, K. Year: 1993 Volume: 83 Issue: 6 Pages: 851-855 Abstract: Objectives. Prior research has identified developmental stages in drug use in adolescence, from substances that are legal for adults to illicit drugs. The position of crack in patterns of drug involvement remains to be established. Methods. The analyses are based on a sample (n = 1108) representative of 12th graders attending New York State public and private schools. From reported ages of first use of five classes of drugs (alcoholic beverages, cigarettes, marijuana, cocaine but not crack, crack), alternate models of progression were tested for their goodness of fit through log- linear models. Results. The sequence involves at the earliest stage the use of at least one licit drug, alcohol or cigarettes. Subsequent stages involve marijuana and cocaine; crack is the last drug in the sequence. The results confirm the more important role of alcohol among males and cigarettes among females in the progression into various drug classes. Age of first drug use at a lower stage is a strong predictor of further progression. Conclusions. The developmental pattern of drug involvement identified in the early 1970s still characterizes adolescent pathways of drug involvement in the late 1980s. Handle: RePEc:aph:ajpbhl:1993:83:6:851-855_8 Template-Type: ReDIF-Article 1.0 Title: New lessons from China: Equity and economics in rural health care Journal: American Journal of Public Health Author-Name: Sidel, V.W. Year: 1993 Volume: 83 Issue: 12 Pages: 1665-1666 Handle: RePEc:aph:ajpbhl:1993:83:12:1665-1666_6 Template-Type: ReDIF-Article 1.0 Title: Drug abuse and illicit drug use in Puerto Rico Journal: American Journal of Public Health Author-Name: Canino, G. Author-Name: Anthony, J.C. Author-Name: Freeman Jr., D.H. Author-Name: Shrout, P. Author-Name: Rubio-Stipec, M. Year: 1993 Volume: 83 Issue: 2 Pages: 194-200 Abstract: Objectives. Based on an epidemiologic field survey of community households in Puerto Rico, this study estimates the frequency of illicit drug use and clinically defined drug abuse and/or dependence syndromes. Results are compared with those from surveys on the United States mainland. Suspected risk factors are studied as well, with a special focus on childhood misbehavior. Methods. Trained lay interviewers administered a Spanish Diagnostic Interview Schedule to 912 respondents aged 17 to 68 years who were selected by multistage probability sampling of island households. Results. An estimated 8.2% of the population had a history of illicit drug use and 1.2% qualified for a standardized lifetime diagnosis of drug abuse, dependence, or both. An estimated 18.4% of the male drug users and 7.7% of the female drug users met criteria for drug abuse and/or dependence. A history of drug use was related to the diagnoses of alcohol abuse and/or dependence and antisocial personality, but few persons who had used illicit drugs at least once in their lifetime reported a history of receiving treatment for alcohol, drug, or mental health problems. Conclusions. The data were consistent with a suspected association between level of childhood misbehavior and occurrence of illicit drug use, even after statistical control for potentially confounding variables. Handle: RePEc:aph:ajpbhl:1993:83:2:194-200_0 Template-Type: ReDIF-Article 1.0 Title: HIV-1 seroprevalence and risk behaviors in an urban African-American community cohort Journal: American Journal of Public Health Author-Name: Brunswick, A.F. Author-Name: Aidala, A. Author-Name: Dobkin, J. Author-Name: Howard, J. Author-Name: Titus, S.P. Author-Name: Banaszak-Holl, J. Year: 1993 Volume: 83 Issue: 10 Pages: 1390-1394 Abstract: Objectives. Previous attempts at obtaining population estimates of human immunodeficiency virus type 1 (HIV-1) seroprevalence have been beset by problems of cooperation bias. As part of the fourth round of study with an urban African-American community cohort, the following investigation was aimed at assessing HIV-1 prevalence and the relative importance of sex and drug injection as risk factors in infection. Methods. Personal interviews were conducted in the home with 364 respondents, followed by voluntary blood sample collection from 287 of these individuals. Results. Blood assays showed a point prevalence of 8.4% HIV-1 seropositivity in this community cross section, with a higher female-to-male ratio than appears among acquired immunodeficiency syndrome (AIDS) case reports. Most infected persons were unaware and unsuspecting of their infection. Conclusions. First, findings underscore the need to focus on risk behaviors rather than on risk groups. Second, the smaller than 2:1 ratio of infected men to women suggests that current AIDS case reports seriously underestimate HIV-1 infection among certain cohorts of African-American women. Finally, wide spread ignorance of own infected status and inaccurate risk assessment signal the substantial task for community health educators in reaching inner-city African-American men and women at risk. Handle: RePEc:aph:ajpbhl:1993:83:10:1390-1394_9 Template-Type: ReDIF-Article 1.0 Title: Depressive symptoms in blood donors notified 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: 1993 Volume: 83 Issue: 4 Pages: 534-539 Abstract: Objectives. Understanding more about the psychological state of persons notified of human immunodeficiency virus (HIV) infection is critical for designing notification and counseling programs that will have the most positive effect. Methods. The subjects were blood donors who had been notified of HIV infection by the New York Blood Center. A nurse elicited a medical history, performed a limited medical examination, and asked the subjects to complete a questionnaire that included questions about drug use, sexual behavior, and psychological characteristics. The subjects completed another questionnaire approximately 2 weeks later. Results. The average depressive symptom scores for both men and women were substantially higher than scores typically found in representative population samples. More than a quarter of the men and more than a third of the women reported seeking psychological or psychiatric services in the first few weeks following notification. Conclusions. Anticipating and meeting individuals' psychological needs may be necessary if HIV screening programs are to address effectively the needs of persons infected with HIV. Handle: RePEc:aph:ajpbhl:1993:83:4:534-539_9 Template-Type: ReDIF-Article 1.0 Title: Vietnamese infant and childhood mortality in relation to the Vietnam war Journal: American Journal of Public Health Author-Name: Savitz, D.A. Author-Name: Nguyen Minh Thang Author-Name: Swenson, I.E. Author-Name: Stone, E.M. Year: 1993 Volume: 83 Issue: 8 Pages: 1134-1138 Abstract: Objectives. There is obvious potential for war to adversely affect infant and childhood mortality through direct trauma and disruption of the societal infrastructure. This study examined trends in Vietnam through the period of the war. Methods. The 1988 Vietnam Demographic and Health Survey collected data on reproductive history and family planning from 4172 women aged 15 through 49 years in 12 selected provinces of Vietnam. The 13 137 births and 737 deaths to children younger than age 6 reported by the respondents were analyzed. Results. For the country as a whole, infant and childhood mortality dropped by 30% to 80% from the prewar period to the wartime period and was stable thereafter. In provinces in which the war was most intense, mortality did not decline from the prewar period to the wartime period but declined after the war, consistent with an adverse effect during the wartime period. Conclusions. The data are limited by assignment of birth location on the basis of mother's current residence and by inadequate information on areas of war activity. Nonetheless, the data do not indicate a widespread, sizable adverse effect of the war on national infant and childhood mortality in Vietnam but suggest detrimental effects in selected provinces. Handle: RePEc:aph:ajpbhl:1993:83:8:1134-1138_2 Template-Type: ReDIF-Article 1.0 Title: Lead content in 70 brands of dietary calcium supplements Journal: American Journal of Public Health Author-Name: Bourgoin, B.P. Author-Name: Evans, D.R. Author-Name: Cornett, J.R. Author-Name: Lingard, S.M. Author-Name: Quattrone, A.J. Year: 1993 Volume: 83 Issue: 8 Pages: 1155-1160 Abstract: Objectives. Elevated lead levels in calcium supplements may pose a health risk, particularly to children with milk intolerance who rely on these products to meet their calcium requirement. Earlier reports chiefly focused on the lead content in supplements derived from bonemeal and dolomite. This study undertook to determine the lead levels in the major forms of calcium supplements currently available. Methods. The lead content was measured in 70 brands of calcium supplements grouped in the following five categories: dolomite, bonemeal, refined and natural source calcium carbonate, and calcium chelates. Results. The lead levels measured in the supplements ranged from 0.03 μg/g to 8.83 μg/g. Daily lead ingestion rates revealed that about 25% of the products exceeded the US Food and Drug Administration's 'provisional' total tolerable daily intake of lead for children aged 6 years and under. Less than 20% of the supplements had 'normalized' lead levels comparable to or lower than that reported for cow's milk. Conclusions. Children are the most sensitive to the low-level effects of lead. If calcium supplements are to provide an alternate source of calcium to some of these individuals, they should also deliver concomitant lead dosages no greater than those obtained from milk products themselves. Handle: RePEc:aph:ajpbhl:1993:83:8:1155-1160_9 Template-Type: ReDIF-Article 1.0 Title: Out-of-hospital cardiac arrest: Racial differences in outcome in Seattle Journal: American Journal of Public Health Author-Name: Cowie, M.R. Author-Name: Fahrenbruch, C.E. Author-Name: Cobb, L.A. Author-Name: Hallstrom, A.P. Year: 1993 Volume: 83 Issue: 7 Pages: 955-959 Abstract: Objectives. Out-of-hospital sudden cardiac arrest is a key area in which to study the dual problem of the poorer health status of minority populations and their poorer access to the health care system. We proposed to examine the relationship between race (Black/White) and survival. Methods. We determined the incidence and outcome of cardiac arrests in Seattle for which medical assistance was requested. Results. Over a 26-month period, the age-adjusted incidence of out-of-hospital cardiac arrest was twice as great in Blacks than in Whites (3.4 vs 1.6 per 1000 aged 20 and over). The initial resuscitation rate was markedly poorer in the Black victims (17.1% vs 40.7%), and rates of survival to hospital discharge were also lower in Blacks (9.4% vs 17.1%). Both effective initial resuscitation and survival were significantly related to White race following adjustment for other covariates. Conclusion. The differences in outcomes were not fully explained by features of the collapse or relevant service factors. Possible explanations include delays in instituting therapy, less bystander-initiated cardiopulmonary resuscitation, poorer levels of health, and differences in the underlying cardiac disorders. Handle: RePEc:aph:ajpbhl:1993:83:7:955-959_8 Template-Type: ReDIF-Article 1.0 Title: The nitrate contamination of private well water in Iowa Journal: American Journal of Public Health Author-Name: Kross, B.C. Author-Name: Hallberg, G.R. Author-Name: Bruner, D.R. Author-Name: Cherryholmes, K. Author-Name: Johnson, J.K. Year: 1993 Volume: 83 Issue: 2 Pages: 270-272 Abstract: The State-Wide Rural Well-Water Survey was conducted between April 1988 and June 1989. About 18% of Iowa's private, rural drinking-water wells contain nitrate above the recommended health advisory level (levels of NO 3- N greater than 10 mg/L); 37% of the wells have levels greater than 3 mg/L, typically considered indicative of anthropogenic pollution. Thirty-five percent of wells less than 15 m deep exceed the health advisory level, and the mean concentration of nitrate-nitrogen for these wells exceeds 10 mg/L. Depth of well is the best predictor of well-water contamination. Individually, NO 3-N levels of more than 10 mg/L occurred alone in about 4% of the private wells statewide; pesticides were present alone in about 5%. Total coliform positives occurred alone at 27% of the sites. In a cumulative sense, these three contaminants were detected in nearly 55% of rural private water supplies. Handle: RePEc:aph:ajpbhl:1993:83:2:270-272_2 Template-Type: ReDIF-Article 1.0 Title: The prevalence of tympanostomy tubes in children in the United States, 1988 Journal: American Journal of Public Health Author-Name: Bright, R.A. Author-Name: Moore Jr., R.M. Author-Name: Jeng, L.L. Author-Name: Sharkness, C.M. Author-Name: Hamburger, S.E. Author-Name: Hamilton, P.M. Year: 1993 Volume: 83 Issue: 7 Pages: 1026-1028 Abstract: Information from the 1988 National Health Interview Survey Medical Device Implant Supplement was used to obtain the first population estimates of the prevalence of implanted tympanostomy tubes, a common treatment for otitis media. The prevalence rate was estimated to be 13 per 1000 children aged younger than 18 years. Statistically significant differences in prevalence were found for sex (boys, 15/1000; girls, 10/1000), race (Whites, 15/1000; others, 4/1000), and activity level ('limited,' 44/1000; others, 11/1000). Thirty percent of the tubes were replacements; infection was the reason for 75% of the original implants. The morbidity and costs associated with tympanostomy tubes are of public health importance. Handle: RePEc:aph:ajpbhl:1993:83:7:1026-1028_7 Template-Type: ReDIF-Article 1.0 Title: Prevalence of HIV infection among psychiatric patients in a New York City men's shelter Journal: American Journal of Public Health Author-Name: Susser, E. Author-Name: Valencia, E. Author-Name: Conover, S. Year: 1993 Volume: 83 Issue: 4 Pages: 568-570 Abstract: We report on the prevalence of human immunodeficiency virus (HIV) infection among psychiatric patients in a New York City shelter for homeless men. We reviewed the records of all 90 men discharged from the shelter psychiatry program to community housing over a 2-year period. HIV serostatus was recorded for 62 of the 90 men. Of these 62, 12 (19.4%) were positive. There were 28 men whose serostatus was not recorded. Data on the HIV risk behaviors of these 28 men suggested that seroprevalence could have been similarly high among them. The results indicate an urgent need to develop and apply preventive interventions for HIV in this population. Handle: RePEc:aph:ajpbhl:1993:83:4:568-570_0 Template-Type: ReDIF-Article 1.0 Title: Children and firearms: A gunshot injury prevention program in New Mexico Journal: American Journal of Public Health Author-Name: Becker, T.M. Author-Name: Olson, L. Author-Name: Vick, J. Year: 1993 Volume: 83 Issue: 2 Pages: 282-283 Handle: RePEc:aph:ajpbhl:1993:83:2:282-283_1 Template-Type: ReDIF-Article 1.0 Title: The alcohol warning label and adolescents: The first year Journal: American Journal of Public Health Author-Name: MacKinnon, D.P. Author-Name: Pentz, M.A. Author-Name: Stacy, A.W. Year: 1993 Volume: 83 Issue: 4 Pages: 585-587 Abstract: Awareness of the alcohol labeling law and exposure to, beliefs about, and memory for the government-mandated alcohol warning label were measured in a sample of adolescents immediately before the label was required to appear (in the fall of 1989) and 1 year after the label was required. After the label was required, there were increases in awareness, exposure, and recognition memory, but there were not substantial changes in alcohol use or beliefs about the risks written on the warning. Handle: RePEc:aph:ajpbhl:1993:83:4:585-587_3 Template-Type: ReDIF-Article 1.0 Title: Pregnancy and contraception use among urban Rwandan women after HIV testing and counseling Journal: American Journal of Public Health Author-Name: Allen, S. Author-Name: Serufilira, A. Author-Name: Gruber, V. Author-Name: Kegeles, S. Author-Name: Van de Perre, P. Author-Name: Carael, M. Author-Name: Coates, T.J. Year: 1993 Volume: 83 Issue: 5 Pages: 705-710 Abstract: Objectives. This study examined hormonal contraceptive use and pregnancy in urban Rwandan women, following human immunodeficiency virus (HIV) antibody testing and counseling. Methods. A sample of 1458 childbearing urban Rwandan women aged 18 to 35 years was tested and followed for 2 years. Results. At enrollment, 17% of 998 HIV-negative women and 11% of 460 HIV-positive women were pregnant, and 17% vs 23%, respectively, were using hormonal contraceptives. One year later, half of the HIV-positive and one third of the HIV-negative hormonal-contraceptive users had discontinued use. The 2-year incidence of pregnancy was 43% in HIV-positive and 58% in HIV-negative women. HIV-positive women with fewer than four children were more likely to become pregnant than those with four or more; this association persisted in multivariate analyses but was not noted among HIV-negative women. At the end of the study, over 40% of non-users said that they would use hormonal contraception if it was provided at the study clinic, but 40% of HIV-positive women desired more children. Conclusions. Research is needed to identify the practical and psychosocial obstacles to effective long-term contraception among HIV-positive women. HIV counseling programs must specifically address the issue of childbearing. Handle: RePEc:aph:ajpbhl:1993:83:5:705-710_2 Template-Type: ReDIF-Article 1.0 Title: Activating communities for health promotion: A process evaluation method Journal: American Journal of Public Health Author-Name: Wickizer, T.M. Author-Name: Von Korff, M. Author-Name: Cheadle, A. Author-Name: Maeser, J. Author-Name: Wagner, E.H. Author-Name: Pearson, D. Author-Name: Beery, W. Author-Name: Psaty, B.M. Year: 1993 Volume: 83 Issue: 4 Pages: 561-567 Abstract: Objectives. To date, evaluations of community-based prevention programs have focused on assessing outcomes, not the process of organizing communities for health promotion. An approach was developed to analyze community organization efforts aimed at advancing community health objectives. These organizational processes are referred to as community activation. Methods. Information was gathered from 762 informants through a key informant survey conducted in 28 western communities. The data collected included informant ratings of community activation and information about interorganizational activities analyzed through network analytic techniques. Results. Activation levels, as measured by informant ratings, varied across communities. Program coordination, as measured by network analysis, occurred, on average, approximately 30% of the time. Higher income communities tended to be more activated than lower income communities. Conclusions. There is a widely recognized need for improved information about health-related community organization activities. It appears possible to gather such information through key informant surveys and to develop measures of community organization status that can be used in the evaluation of community health promotion programs. Handle: RePEc:aph:ajpbhl:1993:83:4:561-567_6 Template-Type: ReDIF-Article 1.0 Title: Subjective knowledge of AIDS and use of HIV testing Journal: American Journal of Public Health Author-Name: Phillips, K.A. Year: 1993 Volume: 83 Issue: 10 Pages: 1460-1462 Abstract: Increasing knowledge is an important goal of human immunodeficiency virus (HIV) prevention strategies, although increased knowledge may not be associated with increased preventive behaviors. This study examines the association of (1) objective and subjective acquired immunodeficiency syndrome (AIDS) knowledge, and (2) both objective and subjective AIDS knowledge with HIV testing use. Data are from the 1988 National Health Interview Survey. Objective and subjective knowledge were only moderately correlated. In regression analyses, higher subjective knowledge was significantly associated with higher testing use, but objective knowledge was not. The results are relevant to other preventive behaviors for which knowledge is an important factor. Handle: RePEc:aph:ajpbhl:1993:83:10:1460-1462_0 Template-Type: ReDIF-Article 1.0 Title: Acculturation and alcohol consumption in Puerto Rican, Cuban-American, and Mexican-American women in the United States Journal: American Journal of Public Health Author-Name: Black, S.A. Author-Name: Markides, K.S. Year: 1993 Volume: 83 Issue: 6 Pages: 890-893 Abstract: Data from the Hispanic Health and Nutrition Examination Survey were used to examine the influence of acculturation on alcohol consumption among Puerto Rican, Cuban-American, and Mexican-American women in the United States. Acculturation was found to be positively related to frequency of consumption and probability of being a drinker among all three groups. A positive relationship was also evident for total drinks consumed among Cuban-American women, and volume (drinks per occasion) and total drinks consumed among Mexican-American women. Handle: RePEc:aph:ajpbhl:1993:83:6:890-893_2 Template-Type: ReDIF-Article 1.0 Title: Behavioral outcomes of AIDS educational interventions for drug users in short-term treatment Journal: American Journal of Public Health Author-Name: McCusker, J. Author-Name: Stoddard, A.M. Author-Name: Zapka, J.G. Author-Name: Lewis, B.F. Year: 1993 Volume: 83 Issue: 10 Pages: 1463-1466 Abstract: This paper reports the behavior outcomes of informational vs enhanced small-group educational interventions for drug users among 407 subjects in a short-term drug treatment program. Logistic regression was used to analyze drug use and sexual behaviors at the final follow-up visit. Among lower risk subjects, the enhanced intervention was more effective in reducing injection practices that produced risks in terms of human immunodeficiency virus infection; among those at highest risk, the informational interventions were more effective. The enhanced intervention was more effective than the informational interventions in reducing cocaine use at follow-up. No differential intervention effect on sexual behaviors was found. Handle: RePEc:aph:ajpbhl:1993:83:10:1463-1466_7 Template-Type: ReDIF-Article 1.0 Title: Lead exposure in bridge construction workers [7] Journal: American Journal of Public Health Author-Name: Gerwel, B. Author-Name: Valiante, D. Author-Name: Pescatore, J. Author-Name: Stanbury, M. Year: 1993 Volume: 83 Issue: 7 Pages: 1054-1055 Handle: RePEc:aph:ajpbhl:1993:83:7:1054-1055_2 Template-Type: ReDIF-Article 1.0 Title: Excise tax increases and cigarette sales [2] 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. Author-Name: Wasserman, J. Year: 1993 Volume: 83 Issue: 6 Pages: 910-911 Handle: RePEc:aph:ajpbhl:1993:83:6:910-911_9 Template-Type: ReDIF-Article 1.0 Title: The fluoridation of drinking water and hip fracture hospitalization rates in two Canadian communities Journal: American Journal of Public Health Author-Name: Suarez-Almazor, M.E. Author-Name: Flowerdew, G. Author-Name: Saunders, L.D. Author-Name: Soskolne, C.L. Author-Name: Russell, A.S. Year: 1993 Volume: 83 Issue: 5 Pages: 689-693 Abstract: Objectives. The purpose of this study was to compare hip fracture hospitalization rates between a fluoridated and a non-fluoridated community in Alberta, Canada: Edmonton, which has had fluoridated drinking water since 1967, and Calgary, which considered fluoridation in 1991 but is currently revising this decision. Methods. Case subjects were all individuals aged 45 years or older residing in Edmonton or Calgary who were admitted to hospitals in Alberta between January 1, 1981, and December 31, 1987, and who had a discharge diagnosis of hip fracture. Edmonton rates were compared with Calgary rates, with adjustment for age and sex using the Edmonton population as a standard. Results. The hip fracture hospitalization rate for Edmonton from 1981 through 1987 was 2.77 per 1000 person-years. The age-sex standardized rate for Calgary was 2.78 per 1000 person-years. No statistically significant difference was observed in the overall rate, and only minor differences were observed within age and sex subgroups, with the Edmonton rates being higher in males. Conclusions. These findings suggest that fluoridation of drinking water has no impact, neither beneficial nor deleterious, on the risk of hip fracture. Handle: RePEc:aph:ajpbhl:1993:83:5:689-693_3 Template-Type: ReDIF-Article 1.0 Title: Virus transmission in health care settings: Precautions, epidemiologic experience, and common sense Journal: American Journal of Public Health Author-Name: Mosley, J.W. Year: 1993 Volume: 83 Issue: 12 Pages: 1664-1665 Handle: RePEc:aph:ajpbhl:1993:83:12:1664-1665_1 Template-Type: ReDIF-Article 1.0 Title: Addressing low birthweight and infant mortality. Journal: American Journal of Public Health Author-Name: Stanley, F. Year: 1993 Volume: 83 Issue: 1 Pages: 119-120 Handle: RePEc:aph:ajpbhl:1993:83:1:119-120_1 Template-Type: ReDIF-Article 1.0 Title: Commentary: Balancing life and death - Proceed with caution Journal: American Journal of Public Health Author-Name: Dubler, N.N. Year: 1993 Volume: 83 Issue: 1 Pages: 23-25 Abstract: Hospital professionals' decisions to permit death are amalgams of medical, ethical, and legal judgments. Medical education and socialization and the business of health all focus on offering and providing treatment, not on facilitating death. Some patients are suspicious that rights to refuse care will foster abandonment by care providers. Lawyers and risk managers often let exaggerated fears of future liability limit patients' and families' rights. The culture of medical institutions must change to accommodate notions of negotiated death. Handle: RePEc:aph:ajpbhl:1993:83:1:23-25_6 Template-Type: ReDIF-Article 1.0 Title: The attribution of health problems to aging [7] Journal: American Journal of Public Health Author-Name: Strawbridge, W.J. Author-Name: Rakowski, W. Author-Name: Hickey, T. Year: 1993 Volume: 83 Issue: 9 Pages: 1351-1352 Handle: RePEc:aph:ajpbhl:1993:83:9:1351-1352_6 Template-Type: ReDIF-Article 1.0 Title: The ramifications of induced abortion [3] Journal: American Journal of Public Health Author-Name: Crum, G. Author-Name: Ferguson, B. Year: 1993 Volume: 83 Issue: 8 Pages: 1179-1180 Handle: RePEc:aph:ajpbhl:1993:83:8:1179-1180_5 Template-Type: ReDIF-Article 1.0 Title: Two random repeat recall methods to assess alcohol use Journal: American Journal of Public Health Author-Name: Midanik, L.T. Year: 1993 Volume: 83 Issue: 6 Pages: 893-895 Abstract: Two random repeat recall methods were compared with a summary measure to assess alcohol use. Subjects (n = 142) were randomly assigned to one of two groups; they were called either on 14 random days during three 30-day waves and asked about drinking yesterday, or on 2 random days during each wave and asked about drinking in the past week. Follow-up telephone interviews obtained summary measures for each wave. Random repeat methods generally obtained higher estimates. However, the high dropout rate makes questionable the feasibility of using this approach with general population samples. Handle: RePEc:aph:ajpbhl:1993:83:6:893-895_1 Template-Type: ReDIF-Article 1.0 Title: Prescription and nonprescription drug use among Black and White community- residing elderly Journal: American Journal of Public Health Author-Name: Fillenbaum, G.G. Author-Name: Hanlon, J.T. Author-Name: Corder, E.H. Author-Name: Ziqubu-Page, T. Author-Name: Wall Jr., W.E. Author-Name: Brock, D. Year: 1993 Volume: 83 Issue: 11 Pages: 1577-1582 Abstract: Objectives. To examine and compare concomitants of prescription and nonprescription drug use of Black and White community-dwelling elderly. Methods. Information on prescription and nonprescription drug use, demographic and health characteristics, and use of health services was obtained from a probability-based sample of Black (n = 2152) and White (n = 1821) community-resident elderly in the Piedmont area of North Carolina. Descriptive statistics were calculated. Linear regression, in which sample weights and design effects were taken into account, was used for the final models. Results. For prescription drug use, 37% and 32% of the variance was explained for Whites and Blacks, respectively (6% and 5% for nonprescription drugs). Health status and use of medical services were the strongest predictors of prescription drug use for both races (with Medigap insurance also important for Whites and Medicaid important for Blacks). Demographic characteristics and self-assessed health were significant factors in the use of nonprescription drugs. Race independently predicted use of both types of drugs but explained only a small proportion of the variance. Conclusions. Health status and use of health services are importantly related to prescription drug use. Nonprescription drug use is difficult to explain. Handle: RePEc:aph:ajpbhl:1993:83:11:1577-1582_4 Template-Type: ReDIF-Article 1.0 Title: Bicycle helmet laws and educational campaigns: An evaluation of strategies to increase children's helmet use Journal: American Journal of Public Health Author-Name: Dannenberg, A.L. Author-Name: Gielen, A.C. Author-Name: Beilenson, P.L. Author-Name: Wilson, M.H. Author-Name: Joffe, A. Year: 1993 Volume: 83 Issue: 5 Pages: 667-674 Abstract: Objectives. The passage of a mandatory bicycle helmet law for children in Howard County, Maryland, provided an opportunity to compare legislation and education as strategies to increase helmet use. Methods. In 1991, a survey was mailed to fourth-, seventh-, and ninth-grade students attending a stratified sample of public schools in Howard County and in two similar suburban/rural counties without helmet laws. Results. Of 7217 students surveyed, 3494 responded (48.4%). Self-reported helmet use in Howard County rose from 11% to 37% after the law and accompanying educational campaign went into effect. Helmet use changed from 8% to 13% in Montgomery County, where educational efforts were undertaken, and from 7% to 11% in Baltimore County, where helmet promotion activities were minimal. Predictors of helmet use included having friends who wore helmets, believing helmet laws are good, being in fourth grade, living in Howard County, and using seatbelts regularly. Conclusions. Legislation combined with education appears to increase bicycle helmet use substantially more than does education alone. The Howard County law may be considered a successful model of a strategy to increase children's helmet use. Handle: RePEc:aph:ajpbhl:1993:83:5:667-674_4 Template-Type: ReDIF-Article 1.0 Title: The long-term prevention of tobacco use among junior high school students: Classroom and telephone interventions Journal: American Journal of Public Health Author-Name: Elder, J.P. Author-Name: Wildey, M. Author-Name: De Moor, C. Author-Name: Sallis Jr., J.F. Author-Name: Eckhardt, L. Author-Name: Edwards, C. Author-Name: Erickson, A. Author-Name: Golbeck, A. Author-Name: Hovell, M. Author-Name: Johnston, D. Author-Name: Levitz, M.D. Author-Name: Molgaard, C. Author-Name: Young, R. Author-Name: Vito, D. Author-Name: Woodruff, S.I. Year: 1993 Volume: 83 Issue: 9 Pages: 1239-1244 Abstract: Objectives. The purpose of this study was to implement and evaluate the effectiveness of a long-term tobacco use prevention program for junior high school students that used college undergraduate change agents and telephone boosters. Methods. A psychosocial intervention combining refusal skills training, contingency management, and other tobacco use prevention methodologies such as telephone and mail boosters was implemented in 11 junior high schools in San Diego County, California. Eleven other junior high schools served as controls. Of the 2668 participants, 57% were White/non- Hispanic, 24% were Hispanic, and 19% were of other racial/ethnic groups. College undergraduates served as change agents for both the classroom and booster interventions, the latter of which was delivered in the third (ninth- grade) year of the program. Results. At the end of the third year, the prevalence of tobacco use within the past month was 14.2% among the intervention students and 22.5% among the controls, yielding an odds ratio of 0.71 for analysis at the school level. Conclusions. Both college undergraduate change agents and direct one-to-one telephone interventions appear to provide cost-effective tobacco-related behavior modification. Handle: RePEc:aph:ajpbhl:1993:83:9:1239-1244_1 Template-Type: ReDIF-Article 1.0 Title: Surface-specific fall injury rates on Utah school playgrounds Journal: American Journal of Public Health Author-Name: Sosin, D.M. Author-Name: Keller, P. Author-Name: Sacks, J.J. Author-Name: Kresnow, M.-J. Author-Name: Van Dyck, P.C. Year: 1993 Volume: 83 Issue: 5 Pages: 733-735 Abstract: The purpose of this study was to estimate surface-specific rates of fall injuries on school playgrounds. Playground injuries related to falls from climbing equipment and the surfaces involved were identified from injury reports for 1988 to 1990 from 157 Utah elementary schools. Enrollment data and playground inspections were used to estimate student-years spent over each surface. The fall injury rates per 10 000 student-years were asphalt, 44; grass, 12; mats, 16; gravel, 15; and sand, 7. These data did not show that impact-absorbing surfaces reduce fall injuries on playgrounds better than grass. Improved field studies are needed to guide policy decisions for playground surfacing. Handle: RePEc:aph:ajpbhl:1993:83:5:733-735_0 Template-Type: ReDIF-Article 1.0 Title: The prevalence of internal orthopedic fixation devices in children in the United States, 1988 Journal: American Journal of Public Health Author-Name: Moore Jr., R.M. Author-Name: Bright, R.A. Author-Name: Jeng, L.L. Author-Name: Sharkness, C.M. Author-Name: Hamburger, S.E. Author-Name: Hamilton, P.M. Year: 1993 Volume: 83 Issue: 7 Pages: 1028-1030 Abstract: This study provides the first estimated prevalence of implanted orthopedic fixation devices (e.g., pins or wires) among children in the United States, based on the Medical Device Implant Supplement to the 1988 National Health Interview Survey. The overall prevalence was 27 per 10 000 children younger than 18 years; prevalence was highest (59/10 000) among those aged 12 to 17 years. The lower extremities were the most frequent body site (43%) and injury was the leading specific reason for implantation (37%). Some (10%) were replacement implants. Handle: RePEc:aph:ajpbhl:1993:83:7:1028-1030_1 Template-Type: ReDIF-Article 1.0 Title: The sexual behavior of US adults: Results from a national survey Journal: American Journal of Public Health Author-Name: Leigh, B.C. Author-Name: Temple, M.T. Author-Name: Trocki, K.F. Year: 1993 Volume: 83 Issue: 10 Pages: 1400-1408 Abstract: Objectives. One consequence of the acquired immunodeficiency syndrome (AIDS) epidemic has been to highlight the need for population-based estimates of the numbers of individuals engaging in sexual behaviors that place them at risk for human immunodeficiency virus (HIV) infection. This paper describes the prevalence of various sexual behaviors in a nationally representative sample of adults in the United States. Methods. Data were collected as part of a household probability survey of adults (n = 2058) in the United States. Data collected on sexual behavior included sexual orientation, frequency of intercourse, condom use, and number of sexual partners. Results. Nearly all respondents were sexually experienced. Of those who were currently sexually active, 13% (1% of married respondents) had had sex with more than one partner in the previous year. Of those reporting having intercourse with more than one partner in the previous year, 7% used condoms consistently and 23% used condoms consistently with their casual partners. Conclusions. A significant proportion of individuals were found to have intercourse with multiple partners without using condoms. A minority of these respondents acknowledged that their behavior may place them at risk for HIV transmission. Handle: RePEc:aph:ajpbhl:1993:83:10:1400-1408_9 Template-Type: ReDIF-Article 1.0 Title: Bringing care to the people: Lillian Wald's legacy to public health nursing Journal: American Journal of Public Health Author-Name: Buhler-Wilkerson, K. Year: 1993 Volume: 83 Issue: 12 Pages: 1778-1786 Abstract: Lillian Wald invented public health nursing in 1893, making this year the field's centennial. One of nursing's visionaries, Wald secured reforms in health, industry, education, recreation, and housing. This historical inquiry examines three of Wald's critical experiments, each of which illuminates the past of public health nursing and its contemporary dilemmas: invention of public health nursing itself, establishment of a nationwide system of insurance payments for home-based care, and creation of a national public health nursing service. Handle: RePEc:aph:ajpbhl:1993:83:12:1778-1786_8 Template-Type: ReDIF-Article 1.0 Title: Alcohol-related mortality in California, 1980 to 1989 Journal: American Journal of Public Health Author-Name: Sutocky, J.W. Author-Name: Shultz, J.M. Author-Name: Kizer, K.W. Year: 1993 Volume: 83 Issue: 6 Pages: 817-823 Abstract: Objectives. This study sought to examine the impact of alcohol use and misuse on mortality in California during the 1980s. Methods. Alcohol-Related Disease Impact estimation software and California vital statistics data were used to calculate alcohol-related mortality, mortality rates, and years of potential life lost. Statistical tests were applied to detect significant differences in death rates by sex and race/ethnicity. Time trends in death rates for a subset of alcohol-defined diagnoses were examined using regression analysis. Results. An estimated 6.2% of all deaths for California residents during 1989 were related to alcohol, making it one of the top 10 leading causes of death. Injury diagnoses were major contributors to the total estimated number of alcohol-related deaths and years of potential life lost before age 65. Alcohol-related mortality rates were significantly higher for men and for Blacks. However, age-adjusted death rates for alcohol- defined diagnoses declined significantly from 1980 to 1989. Conclusions. A structured database approach to analyzing mortality data represents an important advance for alcohol research that has implications for policy and program planning. Future refinements and enhancements to the disease impact estimation methodology will add precision to determining how alcohol use and misuse affect public health in California. Handle: RePEc:aph:ajpbhl:1993:83:6:817-823_3 Template-Type: ReDIF-Article 1.0 Title: The validity of Medicaid diagnoses of hip fracture [2] Journal: American Journal of Public Health Author-Name: Wysowski, D.K. Author-Name: Baum, C. Year: 1993 Volume: 83 Issue: 5 Pages: 770 Handle: RePEc:aph:ajpbhl:1993:83:5:770_2 Template-Type: ReDIF-Article 1.0 Title: Preschool children at high risk for measles: Opportunities to vaccinate Journal: American Journal of Public Health Author-Name: Hutchins, S.S. Author-Name: Gindler, J.S. Author-Name: Atkinson, W.L. Author-Name: Mihalek, E. Author-Name: Ewert, D. Author-Name: LeBaron, C.E. Author-Name: Swint, E.B. Author-Name: Hadler, S.C. Year: 1993 Volume: 83 Issue: 6 Pages: 862-867 Abstract: Objectives. In 1989 and 1990 the United States experienced a measles epidemic with more than 18 000 and 27 000 reported cases, respectively. Nearly half of all persons with measles were unvaccinated preschool children under 5 years of age. We sought to identify potential sites for vaccine delivery. Methods. Preschool children with measles were surveyed in five inner cities with measles outbreaks in 1989 to 1990 to assess the children's use of health care services and federal assistance programs before contracting measles. Results. Of 972 case children surveyed, 618 (64%) were eligible for measles vaccination at measles onset. Of those, 93% had previously visited a health care provider (private physician, public clinic, hospital emergency department, or hospital outpatient department) and 65% were enrolled in a federal assistance program (AFDC, WIC, or food stamps). Based on parent-reported reasons for health care visits, in Dallas and New York City, health care providers of 24% of 172 children may have missed at least one opportunity to administer measles vaccine. Conclusions. Many potential opportunities exist to raise the vaccination coverage of unvaccinated preschool children. These opportunities depend on (1) health care providers taking advantage of all opportunities to vaccinate, and (2) immunization services being linked to federal assistance programs. Handle: RePEc:aph:ajpbhl:1993:83:6:862-867_1 Template-Type: ReDIF-Article 1.0 Title: Race and birthweight of biracial infants Journal: American Journal of Public Health Author-Name: Collins Jr., J.W. Author-Name: David, R.J. Year: 1993 Volume: 83 Issue: 8 Pages: 1125-1129 Abstract: Objectives. The purpose of the study was to determine the role of infant race as a determinant of the Black-White disparity in low birthweight (<2500 g). Methods. Univariate analysis and multivariate logistic regression were performed on Illinois vital records from 1982 and 1983 and on 1980 United States census income data. Results. Fourteen percent of the infants born to Black mothers and White fathers were of low birthweight, compared with 9% of infants born to White mothers and Black fathers and 6% of a random sample of White infants. Both groups of biracial infants were more likely to have been born to unmarried mothers and to reside in very low-income (<$10 000 per year) census tracts than were White infants. When all confounding variables were entered into a logistic model, the adjusted odds ratio of low birthweight for biracial infants born to Black mothers and White fathers equaled 1.4. When biracial infants born to White mothers and Black fathers were compared with White infants, the adjusted odds ratio of low birthweight equaled 1.0. Conclusions. Paternal and consequent infant race does not affect the birthweight distribution of those born to White mothers and Black fathers. Unidentified factors closely related to maternal race underlie the Black-White disparity in infant birthweight. Handle: RePEc:aph:ajpbhl:1993:83:8:1125-1129_3 Template-Type: ReDIF-Article 1.0 Title: Adult health: A legitimate concern for developing countries Journal: American Journal of Public Health Author-Name: Phillips, M. Author-Name: Feachem, R.G.A. Author-Name: Murray, C.J.L. Author-Name: Over, M. Author-Name: Kjellstrom, T. Year: 1993 Volume: 83 Issue: 11 Pages: 1527-1530 Abstract: Adults, defined here as people between 15 and 59 years of age, in developing countries have a high risk of premature death and suffer from frequent morbidity and high rates of chronic impairment. Their ill health imposes a major burden on health services and large negative consequences on families, communities, and societies. This paper describes the level and impact of adult mortality and morbidity, and highlights some of its characteristics and causes, which in some cases contradict commonly held beliefs. It concludes that 'adult health' is a legitimate public health concern for developing countries that is not being addressed. An agenda for remedial research and action is proposed. Handle: RePEc:aph:ajpbhl:1993:83:11:1527-1530_2 Template-Type: ReDIF-Article 1.0 Title: Misuse of pediatric emergency services and fathers' employment status [3] Journal: American Journal of Public Health Author-Name: Karp, R. Year: 1993 Volume: 83 Issue: 11 Pages: 1641-1642 Handle: RePEc:aph:ajpbhl:1993:83:11:1641-1642_3 Template-Type: ReDIF-Article 1.0 Title: Increase in unprotected anogenital intercourse among homosexual men Journal: American Journal of Public Health Author-Name: De Wit, J.B.F. Author-Name: Van den Hoek, J.A.R. Author-Name: Sandfort, T.G.M. Author-Name: Van Griensven, G.J.P. Year: 1993 Volume: 83 Issue: 10 Pages: 1451-1453 Abstract: Results are presented from two sources, data of which indicate an increase in high-risk sexual behaviors for human immunodeficiency virus infection among homosexual men. The number of cases of gonorrhea among homosexual and bisexual visions to municipal sexually transmitted disease clinics in Amsterdam, The Netherlands, is increasing. An increase was also observed in unprotected anogenital intercourse among homosexual participants in the Amsterdam cohort. These findings indicate that a rebound in the behavior change process among homosexual men is occurring. Furthermore, longitudinal behavioral data show that lapse and relapse into unsafe sex are prevalent in the Amsterdam cohort. Handle: RePEc:aph:ajpbhl:1993:83:10:1451-1453_4 Template-Type: ReDIF-Article 1.0 Title: Child care arrangements and repeated ear infections in young children Journal: American Journal of Public Health Author-Name: Hardy, A.M. Author-Name: Fowler, M.G. Year: 1993 Volume: 83 Issue: 9 Pages: 1321-1325 Abstract: Objectives. The purpose of this study was to assess the association between child care arrangements and repeated ear infections in young children. Methods. Data on 5818 children younger than 6 years of age were taken from the 1988 National Health Interview Survey of Child Health. Results. Seventeen percent of the children had had repeated ear infections in the year preceding the interview. Multiple logistic regression analysis showed that factors significantly associated with repeated ear infections were age (1 to 2 years), race (White), sex (male), and medical history (repeated tonsillitis; enlarged adenoids, or asthma). When these factors were controlled for, children in a current child care arrangement still had a 50% higher chance of repeated ear infections than did children not in care. Children in day care centers were at higher risk than children cared for in homes. Care in settings with more than six children elevated the risk, but hours per week of care did not. Conclusions. Decreasing the risk of repeated ear infections in young children in out-of-home child care settings may require smaller group sizes. Given the increasing use of child care, research should continue to identify specific aspects of child care that contribute to this problem. Handle: RePEc:aph:ajpbhl:1993:83:9:1321-1325_4 Template-Type: ReDIF-Article 1.0 Title: Smoking control in the 1990s: A National Cancer Institute model for change Journal: American Journal of Public Health Author-Name: Shopland, D.R. Year: 1993 Volume: 83 Issue: 9 Pages: 1208-1210 Handle: RePEc:aph:ajpbhl:1993:83:9:1208-1210_5 Template-Type: ReDIF-Article 1.0 Title: Estimates of the US health impact of influenza Journal: American Journal of Public Health Author-Name: Sullivan, K.M. Author-Name: Monto, A.S. Author-Name: Longini Jr., I.M. Year: 1993 Volume: 83 Issue: 12 Pages: 1712-1716 Abstract: Objectives. Data from the Tecumseh Community Health Study were used to estimate excess morbidity owing to influenza, and results were compared with estimates made previously using different methodology for an Institute of Medicine report. Methods. Study participants from Tecumseh, Michigan, were classified as infected or noninfected based on laboratory results. The excess numbers of respiratory illnesses, respiratory illness days, and bed and restricted activity days experienced by the infected compared with the noninfected were estimated. Results. The number of excess influenza-related respiratory illnesses was lower than that estimated in the Institute of Medicine report, in which all illnesses of certain characteristics occurring during an influenza season were attributed to influenza. It is now estimated that the US population under 20 years of age experiences a yearly average of 13.8 to 16.0 million influenza-related excess respiratory illnesses; for older individuals, the yearly estimate is 4.1 to 4.4 million excess illnesses. Conclusions. For public health purposes, estimates of excess morbidity as well as of total morbidity associated with influenza should be used in setting health priorities. Handle: RePEc:aph:ajpbhl:1993:83:12:1712-1716_8 Template-Type: ReDIF-Article 1.0 Title: Demographic factors in the use of children's mental health services Journal: American Journal of Public Health Author-Name: Cohen, P. Author-Name: Hesselbart, C.S. Year: 1993 Volume: 83 Issue: 1 Pages: 49-52 Abstract: Objectives. This study was designed to (1) determine mental health service use by children of varying age, sex, socioeconomic status, and urbanicity of residence; (2) compare the prevalence of mental disorder in children in these groups; and (3) determine the extent to which differences in service use are consonant with the prevalence differences. Methods. Data on psychiatric diagnoses and service use were taken from a random longitudinal sample of 760 children. Information was gathered by interviews of mothers and of youth aged 12 to 21. Results. Significant lags in mental health service use were found for youth 18 to 21 years of age, for those living in rural and semirural areas, and for those in middle-income families. To some extent, these service use differences paralleled differences in diagnostic rates. However, when diagnostic differences were controlled, the same patterns of service use inequalities were present. Conclusions. Mental health service use rates for youth vary by age, urbanicity, and family income. The underservice of middle- income and rural children may reasonably be ascribed to access problems; we explore explanations for the underservice of older youth. Handle: RePEc:aph:ajpbhl:1993:83:1:49-52_2 Template-Type: ReDIF-Article 1.0 Title: Male transvestite prostitutes and HIV risk Journal: American Journal of Public Health Author-Name: Elifson, K.W. Author-Name: Boles, J. Author-Name: Posey, E. Author-Name: Sweat, M. Author-Name: Darrow, W. Author-Name: Elsea, W. Year: 1993 Volume: 83 Issue: 2 Pages: 260-262 Abstract: Human immunodeficiency virus (HIV)-1, syphilis, and hepatitis B prevalence and associated risk factors were assessed among male transvestite prostitutes. Structured street-level interviews were conducted with 53 respondents in Atlanta, Ga, from July 1990 through July 1991. Test results from serum samples revealed that 68% were seropositive for HIV-1, 81% had seromarkers for syphilis, and 80% had seromarkers for hepatitis B. Univariate logistic regression analysis indicated that seromarkers for syphilis and Black race were the primary factors associated with HIV-1 infection. The results show that transvestite prostitutes are a heterogenous population and distinct from nontransvestite prostitutes; specific outreach is thus needed. Targeted interventions should address the sexual and drug-use-related HIV risk behaviors of transvestite prostitutes. Handle: RePEc:aph:ajpbhl:1993:83:2:260-262_1 Template-Type: ReDIF-Article 1.0 Title: Public health initiatives in South Africa in the 1940s and 1950s: Lessons for a post-apartheid era Journal: American Journal of Public Health Author-Name: Yach, D. Author-Name: Tollman, S.M. Year: 1993 Volume: 83 Issue: 7 Pages: 1043-1050 Abstract: Inspiration drawn from South African public health initiatives in the 1940s played an important role in the development of the network of community and migrant health centers in the United States. The first such center at Pholela in Natal emphasized the need for a comprehensive (preventive and curative) service that based its practices on empirical data derived from epidemiological and anthropological research. In addition, community consultation preceded the introduction of new service or research initiatives. The Institute of Family and Community Health in Durban pioneered community-based multidisciplinary training and developed Pholela and other sites as centers for service, teaching, and research. Several important lessons for South African health professionals emerge from the Pholela experience. First, public health models of the past need to be reintroduced locally; second, the training of public health professionals needs to be upgraded and reoriented; third, appropriate research programs need to respond to community needs and address service demands; fourth, community involvement strategies need to be implemented early on; and fifth, funding sources for innovation in health service provision should be sought. Handle: RePEc:aph:ajpbhl:1993:83:7:1043-1050_1 Template-Type: ReDIF-Article 1.0 Title: Defining maternal depletion syndrome [2] Journal: American Journal of Public Health Author-Name: Winikoff, B. Author-Name: Castle, M.A. Year: 1993 Volume: 83 Issue: 7 Pages: 1052 Handle: RePEc:aph:ajpbhl:1993:83:7:1052_3 Template-Type: ReDIF-Article 1.0 Title: Erratum: The social impact of dental problems and visits (Am J Public Health (1992) 82 (1663-1668)) Journal: American Journal of Public Health Author-Name: Gift, H.C. Author-Name: Reisine, S.T. Author-Name: Larach, D.C. Year: 1993 Volume: 83 Issue: 6 Pages: 816 Handle: RePEc:aph:ajpbhl:1993:83:6:816_7 Template-Type: ReDIF-Article 1.0 Title: Smoking control in restaurants: The effectiveness of self-regulation in Australia Journal: American Journal of Public Health Author-Name: Schofield, M.J. Author-Name: Considine, R. Author-Name: Boyle, C.A. Author-Name: Sanson-Fisher, R. Year: 1993 Volume: 83 Issue: 9 Pages: 1284-1288 Abstract: Objectives. The provision of smoke-free areas in restaurants has been a controversial issue; the restaurant industry largely opts for a self- regulation approach. This study aimed to examine the effectiveness of self- regulation as a strategy in meeting the industry's and customers' perceived needs. Methods. Restaurateur and customer perspectives on the provision of smoke-free areas in restaurants were examined by survey among 365 restaurateurs and 1327 customers in New South Wales, Australia. Results. Less than 2% of restaurants were totally smoke-free; 22% provided some smoke-free areas. Customers were much more likely than owners to think that smoke-free areas should be provided. Owners appeared to be unaware of customers' views about smoke-free areas in restaurants. Conclusions. Little evidence was found to support the effectiveness of the self-regulation policy adopted by the restaurant industry. Characteristics of restaurants and owners associated with the provision of smoke-free areas are presented and implications of the findings are discussed. Handle: RePEc:aph:ajpbhl:1993:83:9:1284-1288_3 Template-Type: ReDIF-Article 1.0 Title: The healthy worker project: A work-site intervention for weight control and smoking cessation Journal: American Journal of Public Health Author-Name: Jeffery, R.W. Author-Name: Forster, J.L. Author-Name: French, S.A. Author-Name: Kelder, S.H. Author-Name: Lando, H.A. Author-Name: McGovern, P.G. Author-Name: Jacobs Jr., D.R. Author-Name: Baxter, J.E. Year: 1993 Volume: 83 Issue: 3 Pages: 395-401 Abstract: Objectives. A randomized trial was conducted to evaluate the effectiveness of a work-site health promotion program in reducing obesity and the prevalence of cigarette smoking. Methods. Thirty-two work sites were randomized to treatment or no treatment for 2 years. Treatment consisted of health education classes combined with a payroll-based incentive system. Evaluation was based on cohort and cross-sectional surveys. Results. Of 10 000 total employees in treatment work sites, 2041 and 270 participated in weight control and smoking cessation programs, respectively. Weight losses averaged 4.8 lbs, and 43% of smoking participants quit. Net 2-year reductions in smoking prevalence in treatment vs control work sites were 4.0% and 2.1% in cross-sectional and cohort surveys, respectively. No treatment effect was found for weight. Treatment effects for smoking prevalence and weight were both positively correlated with participation rates in the intervention programs (r = .45 for smoking and r = .55 for weight). Conclusions. This work-site health promotion program was effective in reducing smoking prevalence at a cost that is believed to make the investment worthwhile. Handle: RePEc:aph:ajpbhl:1993:83:3:395-401_8 Template-Type: ReDIF-Article 1.0 Title: Automobile driver fatalities in frontal impacts: Air bags compared with manual belts Journal: American Journal of Public Health Author-Name: Zador, P.L. Author-Name: Ciccone, M.A. Year: 1993 Volume: 83 Issue: 5 Pages: 661-666 Abstract: Objectives. The effectiveness of air bags was estimated in this study by comparing driver fatalities in frontal crashes with driver fatalities in nonfrontal crashes, for cars with air bags and manual belts and cars with manual belts only. Methods. Fatal Accident Reporting System data for drivers fatally injured during 1985 to 1991 in 1985 to 1991 model year cars that were equipped with air bags in or before model year 1991 were analyzed. Results. Driver fatalities in frontal crashes in air bag cars were 28% lower than those in comparable cars with manual belts only. This percentage was used for estimating the overall fatality reduction in air bag cars. The reduction was greater in large cars (50%) than in midsize cars (19%) or in small cars (14%). Air bags reduced driver fatalities in frontal crashes involving ejection by about 9%. Fatalities in frontal crashes among drivers who were reportedly using manual belts at the time of the crash were reduced by about 15%. The comparable reduction among drivers who were reportedly not using manual belts was 31%. Conclusion. It was estimated that air bags reduced the total number of all driver fatalities by about 19%. Handle: RePEc:aph:ajpbhl:1993:83:5:661-666_2 Template-Type: ReDIF-Article 1.0 Title: Anthropometry and childhood mortality in Northwest and Southwest Uganda Journal: American Journal of Public Health Author-Name: Vella, V. Author-Name: Tomkins, A. Author-Name: Borghesi, A. Author-Name: Migliori, G.B. Author-Name: Ndiku, J. Author-Name: Adriko, B.C. Year: 1993 Volume: 83 Issue: 11 Pages: 1616-1618 Abstract: Two longitudinal studies were carried out in northwest and southwest Uganda to examine the relationship between anthropometry and childhood mortality. Although the prevalence of malnutrition was significantly different between the two geographic areas, the relative risk for mortality associated with low levels of anthropometry was similar. When the anthropometric parameters were compared among each other, mid-upper arm circumference was found to be the most powerful predictor of mortality. The findings of this study confirm that mid-upper arm circumference is the indicator of choice to identify children at higher risk of death. Handle: RePEc:aph:ajpbhl:1993:83:11:1616-1618_8 Template-Type: ReDIF-Article 1.0 Title: The validity of self-reported height and weight in perimenopausal women [4] Journal: American Journal of Public Health Author-Name: Zhang, J. Author-Name: Feldblum, P.J. Author-Name: Fortney, J.A. Year: 1993 Volume: 83 Issue: 7 Pages: 1052-1053 Handle: RePEc:aph:ajpbhl:1993:83:7:1052-1053_3 Template-Type: ReDIF-Article 1.0 Title: Decisions near the end of life: Professional views on life-sustaining treatments Journal: American Journal of Public Health Author-Name: Solomon, M.Z. Author-Name: O'Donnell, L. Author-Name: Jennings, B. Author-Name: Guilfoy, V. Author-Name: Wolf, S.M. Author-Name: Nolan, K. Author-Name: Jackson, R. Author-Name: Koch-Weser, D. Author-Name: Donnelley, S. Year: 1993 Volume: 83 Issue: 1 Pages: 14-23 Abstract: Objectives. How do health care professionals assess the care of hospital patients near the end of life? Are physicians and nurses aware of and in agreement with national recommendations regarding patients' rights to forgo life-sustaining medical treatments and to receive adequate pain control? Methods. We surveyed 687 physicians and 759 nurses in 5 hospitals. Results. Almost half (47%) of all respondents and fully 70% of the house officers reported that they had acted against their conscience in providing care to the terminally ill. Four times as many respondents were concerned about the provision of overly burdensome treatment than about undertreatment. Conclusions. In summary, many physicians and nurses were disturbed by the degree to which technological solutions influence care during the final days of a terminal illness and by the undertreatment of pain. However, changes in the care of dying patients may not have kept pace with national recommendations, in part because many physicians and nurses disagreed with and may have been unaware of some key guidelines, such as the permissibility of withdrawing treatments. Handle: RePEc:aph:ajpbhl:1993:83:1:14-23_1 Template-Type: ReDIF-Article 1.0 Title: The socioeconomic correlates of hysterectomies in the United States Journal: American Journal of Public Health Author-Name: Kjerulff, K. Author-Name: Langenberg, P. Author-Name: Guzinski, G. Year: 1993 Volume: 83 Issue: 1 Pages: 106-108 Abstract: The purpose of this study was to examine the relationship between incidence of prior hysterectomy and education, income, and race. Data concerning previous hysterectomy and socioeconomic information were collected from 12 465 women 18 years or older as part of the Behavioral Risk Factor Surveillance System conducted in 16 states in 1988. The results indicate that women with less education and lower incomes were more likely to have had a hysterectomy. Race was not related to hysterectomy rate. Handle: RePEc:aph:ajpbhl:1993:83:1:106-108_4 Template-Type: ReDIF-Article 1.0 Title: Socioeconomic and racial differences in obstetric procedures [2] Journal: American Journal of Public Health Author-Name: Leyland, A. Author-Name: Zahniser, S.C. Author-Name: Kendrick, J.S. Year: 1993 Volume: 83 Issue: 8 Pages: 1178-1179 Handle: RePEc:aph:ajpbhl:1993:83:8:1178-1179_4 Template-Type: ReDIF-Article 1.0 Title: Modern contraception use in Ethiopia: Does involving husbands make a difference? Journal: American Journal of Public Health Author-Name: Terefe, A. Author-Name: Larson, C.P. Year: 1993 Volume: 83 Issue: 11 Pages: 1567-1571 Abstract: Objectives. This study was undertaken to determine the relative efficacy of home visitation with and without husband participation on the use of modern contraception in Ethiopia. Methods. A randomized field trial of a family planning education intervention using home visitation with and without husband participation was conducted in Addis Ababa, Ethiopia, from August 1990 to December 1991 and included a 12-month postintervention follow-up. A total of 266 experimental and 261 control subjects were entered, of whom 91.7% and 88.9%, respectively, were followed through 12 months. Results. A greater proportion of couples in the experimental group were practicing modern contraception at 2 months (25% vs 15%) and 12 months (33% vs 17%) following the home visit intervention. By 12 months following the home visits, experimental subjects were less likely to have defaulted and more likely to have started using modern contraception following an initial delay. Conclusions. The inclusion of husbands in family planning programs will result in relevant increases in the use of modern contraception. However, there exists an important 'sleeper' effect to the education intervention, reflected by a delay of greater than 2 months in the initiation of modern contraception for most couples. Handle: RePEc:aph:ajpbhl:1993:83:11:1567-1571_6 Template-Type: ReDIF-Article 1.0 Title: Frequent cocaine users and their use of treatment Journal: American Journal of Public Health Author-Name: Gfroerer, J.C. Author-Name: Brodsky, M.D. Year: 1993 Volume: 83 Issue: 8 Pages: 1149-1154 Abstract: Objectives. Despite decreases in the number of cocaine users since 1985, the consequences of cocaine use continue to rise. This paper provides descriptive data on frequent cocaine users that will help to explain these diverging trends and enable treatment planners to better predict the types of cocaine users who are likely to seek treatment. Methods. Data from the National Household Survey on Drug Abuse were used to study the characteristics of frequent cocaine users since 1985. The 1991 data were used to compare frequent users with infrequent users and nonusers. Results. Since 1985, frequent cocaine users have become older. In 1991, they were likely to be unemployed (32.4%), unmarried (82.3%), and without health insurance (39.4%). Most were cigarette smokers (86.8%) and marijuana users (88.4%), and 32.0% reported getting drunk weekly. Criminal behavior was more likely among frequent cocaine users than among infrequent users and nonusers. Almost a third (30.0%) reported drug abuse treatment experience in the past year. Conclusions. Despite the recent decreases in overall prevalence of cocaine use, the need for treatment of cocaine abusers will continue. Treatment must address multiple problems that occur in conjunction with cocaine abuse. Handle: RePEc:aph:ajpbhl:1993:83:8:1149-1154_0 Template-Type: ReDIF-Article 1.0 Title: When ideals meet reality - The global challenge of HIV/AIDS Journal: American Journal of Public Health Author-Name: Biggar, R.J. Year: 1993 Volume: 83 Issue: 10 Pages: 1383-1384 Handle: RePEc:aph:ajpbhl:1993:83:10:1383-1384_5 Template-Type: ReDIF-Article 1.0 Title: Epidemiologic evidence for a potentiating effect of malnutrition on child mortality Journal: American Journal of Public Health Author-Name: Pelletier, D.L. Author-Name: Frongillo Jr., E.A. Author-Name: Habicht, J.-P. Year: 1993 Volume: 83 Issue: 8 Pages: 1130-1133 Abstract: Objectives. Despite broad agreement that severe malnutrition contributes to child mortality in developing countries and that malnutrition has a physiologically synergistic relationship with morbidity, evidence of an epidemiologic synergism has been lacking. Also, the literature provides conflicting evidence concerning the existence of elevated mortality among children with mild to moderate malnutrition. A review of published population-based studies of anthropometry-mortality relationships was undertaken to clarify these relationships. Methods. Six studies with the relevant data were reanalyzed to test for synergism and elevated mortality in mild to moderate malnutrition. Results. The results demonstrate that mortality increases exponentially with declining weight for age. This effect is consistent across studies and there is no apparent threshold effect on mortality. The primary difference across studies is in baseline levels of mortality, which determine the quantitative impact of malnutrition on mortality in a population. Conclusions. These results indicate that mild to moderate malnutrition is associated with elevated mortality and that there is an epidemiologic synergism between malnutrition and morbidity. This previously undemonstrated finding has significant implications for child survival policies and research. Handle: RePEc:aph:ajpbhl:1993:83:8:1130-1133_0 Template-Type: ReDIF-Article 1.0 Title: Medicare patients' use of overpriced procedures before and after the Omnibus Budget Reconciliation Act of 1987 Journal: American Journal of Public Health Author-Name: Escarce, J.J. Year: 1993 Volume: 83 Issue: 3 Pages: 349-355 Abstract: Objectives. Under the Omnibus Budget Reconciliation Act of 1987, Medicare reduced physician fees for 12 procedures identified as overpriced. This paper describes trends in the use of these procedures and other physician services by Medicare patients during the 4-year period surrounding the implementation of the 1987 budget act. Methods. Medicare physician claims files were used to develop trends in physician-services use from 1986 to 1989. Services were grouped into four categories: overpriced procedures, other surgery, medical care, and ancillary tests. Results. Growth in the volume of overpriced procedures slowed substantially after the 1987 budget act was implemented. Moreover, the reduction in the rate of volume growth for these procedures differed little among specialties or areas. In comparison, the rate of volume growth fell modestly for other surgery, was unchanged for medical care, and increased for ancillary tests. Conclusions. Increases do not necessarily occur in the volume of surgical procedures whose Medicare fees are reduced. Although the conclusions that may be drawn from a descriptive analysis are limited, these findings suggest that concerns that the resource-based Medicare fee schedule will lead to higher surgery rates may be unwarranted. Handle: RePEc:aph:ajpbhl:1993:83:3:349-355_0 Template-Type: ReDIF-Article 1.0 Title: Left-handedness and mortality Journal: American Journal of Public Health Author-Name: Salive, M.E. Author-Name: Guralnik, J.M. Author-Name: Glynn, R.J. Year: 1993 Volume: 83 Issue: 2 Pages: 265-267 Abstract: We examined mortality associated with handedness in two ways. A simulation using national data suggests that lower mean age at death among left-handed persons, previously offered as evidence of higher mortality, can be explained exclusively by the age distribution of laterality. Second, empiric evidence from a 6-year cohort study of 3774 older adults from East Boston, Massachusetts, demonstrates that left-handedness is not associated with mortality (relative odds = 1.04, 95% confidence interval = 0.79, 1.36). Handle: RePEc:aph:ajpbhl:1993:83:2:265-267_7 Template-Type: ReDIF-Article 1.0 Title: Distinguishing health expectancies and health-adjusted life expectancies from quality-adjusted life years Journal: American Journal of Public Health Author-Name: Robine, J.-M. Author-Name: Mathers, C.D. Author-Name: Bucquet, D. Year: 1993 Volume: 83 Issue: 6 Pages: 797-798 Handle: RePEc:aph:ajpbhl:1993:83:6:797-798_2 Template-Type: ReDIF-Article 1.0 Title: The bell tolls for a school of public health-and for thee? Journal: American Journal of Public Health Author-Name: Susser, M. Year: 1993 Volume: 83 Issue: 11 Pages: 1524-1525 Handle: RePEc:aph:ajpbhl:1993:83:11:1524-1525_6 Template-Type: ReDIF-Article 1.0 Title: Prior, duplicate, repetitive, fragmented, and redundant publication and editorial decisions Journal: American Journal of Public Health Author-Name: Susser, M. Author-Name: Yankauer, A. Year: 1993 Volume: 83 Issue: 6 Pages: 792-793 Handle: RePEc:aph:ajpbhl:1993:83:6:792-793_6 Template-Type: ReDIF-Article 1.0 Title: Remember the family in public health [1] Journal: American Journal of Public Health Author-Name: Gavagan, T. Author-Name: O'Sullivan, S. Author-Name: Benson, J. Year: 1993 Volume: 83 Issue: 7 Pages: 1051-1052 Handle: RePEc:aph:ajpbhl:1993:83:7:1051-1052_9 Template-Type: ReDIF-Article 1.0 Title: Forging the future: The public health imperative Journal: American Journal of Public Health Author-Name: Allukian Jr., M. Year: 1993 Volume: 83 Issue: 5 Pages: 655-660 Abstract: During the 1980s, national policy promoted military expenditures and downsized domestic programs. These priorities, along with tax reform and deregulation, created a 'domestic gulf crisis' with a new wave of vulnerable populations-poor children, the homeless, the elderly, and the uninsured. Our lack of a national health program compounds the problem. The 1990s will be a decade of change and challenge. To forge a healthier and stronger future for our nation, we must implement five public health imperatives: (1) We must have a national health program that is universal, comprehensive, and prevention-oriented, with built-in assurances for quality, efficiency, and a strong public health infrastructure. (2) We must have a comprehensive national health education and promotion program for all schoolchildren. (3) Women must have freedom of choice. (4) Prevention and public health must become one of our country's highest health priorities. (5) The federal government must increase its leadership, commitments, and resources to reach the goals set forth in Healthy Communities 2000 and Healthy People 2000. Handle: RePEc:aph:ajpbhl:1993:83:5:655-660_9 Template-Type: ReDIF-Article 1.0 Title: Emancipate CDC Journal: American Journal of Public Health Author-Name: Susser, M. Year: 1993 Volume: 83 Issue: 4 Pages: 491-492 Handle: RePEc:aph:ajpbhl:1993:83:4:491-492_8 Template-Type: ReDIF-Article 1.0 Title: The effect of previous cesarean sections on current cesarean rates [2] Journal: American Journal of Public Health Author-Name: Leyland, A. Author-Name: Bertollini, R. Author-Name: Di Lallo, D. Author-Name: Spadea, T. Author-Name: Perucci, C.A. Year: 1993 Volume: 83 Issue: 1 Pages: 115-117 Handle: RePEc:aph:ajpbhl:1993:83:1:115-117_8 Template-Type: ReDIF-Article 1.0 Title: Demographic predictors of mammography and Pap smear screening in US women Journal: American Journal of Public Health Author-Name: Calle, E.E. Author-Name: Flanders, W.D. Author-Name: Thun, M.J. Author-Name: Martin, L.M. Year: 1993 Volume: 83 Issue: 1 Pages: 53-60 Abstract: Objectives. Proven screening technologies exist for both breast and cervical cancer, but they are underused by many women. We sought to evaluate the effect of demographic characteristics on the underuse of mammography and Pap smear screening. Methods. We analyzed responses from 12 252 women who participated in the 1987 National Health Interview Survey Cancer Control Supplement. Demographic profiles were produced to target severely underserved groups of women. Results. Low income was a strong predictor of mammography underuse, as was Hispanic ethnicity and other race, low educational attainment, age greater than 65, and residence in a rural area. A strong predictor of never having had a Pap smear was never having been married; however, the importance of this characteristic is difficult to interpret in the absence of data on sexual activity. Hispanic women and women of other races of all ages and all income levels underused Pap smear screening, as did older women, particularly older Black women. Conclusions. The tendency of women to underuse screening technologies varies greatly across levels of basic demographic characteristics. The importance of these characteristics differs for mammography screening versus Pap smear screening. Handle: RePEc:aph:ajpbhl:1993:83:1:53-60_5 Template-Type: ReDIF-Article 1.0 Title: The President's Committee on Health Education [1] Journal: American Journal of Public Health Author-Name: Ogden, H.G. Author-Name: Guinta, M.A. Author-Name: Allegrante, J.P. Author-Name: Carlyon, W.H. Author-Name: Pollock, M.B. Year: 1993 Volume: 83 Issue: 6 Pages: 908-909 Handle: RePEc:aph:ajpbhl:1993:83:6:908-909_0 Template-Type: ReDIF-Article 1.0 Title: Violence, injury, drugs, and maternal mortality [5] Journal: American Journal of Public Health Author-Name: Chavkin, W. Author-Name: Allen, M. Year: 1993 Volume: 83 Issue: 10 Pages: 1494 Handle: RePEc:aph:ajpbhl:1993:83:10:1494_4 Template-Type: ReDIF-Article 1.0 Title: Changes in HIV rates and sexual behavior among homosexual men, 1984 to 1988/92 Journal: American Journal of Public Health Author-Name: Silvestre, A.J. Author-Name: Kingsley, L.A. Author-Name: Wehman, P. Author-Name: Dappen, R. Author-Name: Ho, M. Author-Name: Rinaldo, C.R. Year: 1993 Volume: 83 Issue: 4 Pages: 578-580 Abstract: Data were collected from 1614 homosexual and bisexual men in 1984 through 1985 and from 1988 to 1992 in Pittsburgh. Of the men entering the study since 1988, 16% reported engaging in unprotected anal receptive intercourse with more than one partner during the 6 months before their visit. Approximately 7% of the younger men and 18% of the men over 22 years of age in the recent cohort were already infected with the human immunodeficiency virus, the same rates as those described 8 years ago. Aggressive risk-reduction programs are needed in high schools and existing networks in the gay community. Handle: RePEc:aph:ajpbhl:1993:83:4:578-580_4 Template-Type: ReDIF-Article 1.0 Title: Occupational and environmental exposures reported to poison centers Journal: American Journal of Public Health Author-Name: Litovitz, T. Author-Name: Oderda, G. Author-Name: White, J.D. Author-Name: Sheridan, M.J. Year: 1993 Volume: 83 Issue: 5 Pages: 739-743 Abstract: This analysis of 25 368 occupational and 7565 environmental exposure cases characterizes the occupational and environmental exposures reported to the American Association of Poison Control Centers Toxic Exposure Surveillance System. Compared with other poisonings, occupational and environmental exposures were predominantly inhalation exposures rather than ingestions, were more often subacute or chronic, and demonstrated greater morbidity, mortality, and increased use of health care resources. As regional poison centers evolve to fill a critical information void in the management and assessment of environmental and occupational exposures, the American Association of Poison Control Centers Toxic Exposure Surveillance System provides an important, untapped passive surveillance mechanism. Handle: RePEc:aph:ajpbhl:1993:83:5:739-743_7 Template-Type: ReDIF-Article 1.0 Title: Health as a human right: An epidemiologist's perspective on the public health Journal: American Journal of Public Health Author-Name: Susser, M. Year: 1993 Volume: 83 Issue: 3 Pages: 418-426 Abstract: The modern idea of health as a human right is examined, as it evolved from the 18th century, in terms of its origins, its essential content, and 20th- century attempts at implementation. Equity for social groups is seen as a guiding principle. Two attempts at implementation, in Britain and in Cuba, are examined for their effects on equity in health service and in health states. The British National Health Service achieved equity between social classes in services but failed to achieve it in health states (as measured by mortality). Deficiencies in commitment to public health services, it is argued, contributed largely to this failure. The Cuban experiment appears to have moved beyond equity solely in services and toward equity in health states. This success reflects an overall Cuban commitment to the public health. Two important elements of that commitment are, first, continuous evaluation with flexible response and, second, community involvement. Handle: RePEc:aph:ajpbhl:1993:83:3:418-426_0 Template-Type: ReDIF-Article 1.0 Title: Editorial: Over-the-counter oral contraceptives - An immodest proposal? Journal: American Journal of Public Health Author-Name: Grimes, D.A. Year: 1993 Volume: 83 Issue: 8 Pages: 1092-1094 Handle: RePEc:aph:ajpbhl:1993:83:8:1092-1094_1 Template-Type: ReDIF-Article 1.0 Title: Race, ethnicity, and access to ambulatory care among US adolescents Journal: American Journal of Public Health Author-Name: Lieu, T.A. Author-Name: Newacheck, P.W. Author-Name: McManus, M.A. Year: 1993 Volume: 83 Issue: 7 Pages: 960-965 Abstract: Objectives. Improving the health of minority adolescents will require a better understanding of factors that influence their access to and use of health care. This study describes the differences in health care access and use among White, Black and Hispanic adolescents and evaluates how such differences are influenced by insurance. Methods. We used data on 7465 10- to 17-year-olds included in the child health supplement to the 1988 National Health Interview Survey. Results. Much higher proportions of Blacks (16%) and Hispanics (28%) than of Whites (11%) were uninsured. Despite having worse reported health status, Black and Hispanic adolescents made notably fewer doctor visits in the past year than their White peers, and were more apt to lack usual sources of routine and acute care as well as continuity between sources of care. Having health insurance was associated with greater increases in access and usage measures for minority youth than for White youth. However, racial differences persisted even after adjusting for health insurance, family income, need, and other factors. Conclusions. Minority adolescents are particularly vulnerable to the problems of health care access that affect all youth. While health insurance is especially important for increasing appropriate health care use among minority youth, nonfinancial methods of enabling more equitable use also deserve further study. Handle: RePEc:aph:ajpbhl:1993:83:7:960-965_8 Template-Type: ReDIF-Article 1.0 Title: Integrating smoking control policies into employee benefits: A survey of large California corporations Journal: American Journal of Public Health Author-Name: Schauffler, H.H. Year: 1993 Volume: 83 Issue: 9 Pages: 1226-1230 Abstract: Objectives. Public health policy promotes the use of risk-rating health insurance and payment for smoking cessation as economic incentives to encourage smoking cessation. This study was undertaken to learn more about the adoption of these policies in large corporations. Methods. A random sample survey of 280 private California corporations with more than 500 employees was undertaken to document the prevalence of policies integrating smoking control into employee benefit designs. Results. Only 8.6% of large corporations had ever considered risk-rating health insurance premiums using smoking status and only 2.15% had implemented a risk-rating policy. Nearly 20% of the companies offered health insurance plans that covered smoking cessation services. Subsidization or payment for smoking cessation outside health insurance was provided by over 37% of the companies surveyed, and 87% had adopted formal work-site smoking policies. Conclusion. Benefit policies that provide financial support to smokers to participate in smoking cessation services are much more prevalent and are viewed more positively by the benefits managers in large corporations than are policies to risk-rate health insurance premiums on the basis of smoking. Handle: RePEc:aph:ajpbhl:1993:83:9:1226-1230_0 Template-Type: ReDIF-Article 1.0 Title: We are all Berliners: Notes from the Ninth International Conference on AIDS Journal: American Journal of Public Health Author-Name: Mann, J.M. Year: 1993 Volume: 83 Issue: 10 Pages: 1378-1379 Handle: RePEc:aph:ajpbhl:1993:83:10:1378-1379_7 Template-Type: ReDIF-Article 1.0 Title: What does America's Public Health Report Card reflect? [4] Journal: American Journal of Public Health Author-Name: Gellert, G.A. Author-Name: Maxwell, R.M. Author-Name: Lashof, J.C. Author-Name: McBeath, W.H. Author-Name: McCarter, K. Year: 1993 Volume: 83 Issue: 9 Pages: 1348-1349 Handle: RePEc:aph:ajpbhl:1993:83:9:1348-1349_9 Template-Type: ReDIF-Article 1.0 Title: Size, not mass, of car affects severity of injury in accidents [1] Journal: American Journal of Public Health Author-Name: Robertson, L.S. Author-Name: Evans, L. Year: 1993 Volume: 83 Issue: 5 Pages: 769-770 Handle: RePEc:aph:ajpbhl:1993:83:5:769-770_3 Template-Type: ReDIF-Article 1.0 Title: Nutrition and health risks in the elderly: The nutrition screening initiative Journal: American Journal of Public Health Author-Name: Posner, B.M. Author-Name: Jette, A.M. Author-Name: Smith, K.W. Author-Name: Miller, D.R. Year: 1993 Volume: 83 Issue: 7 Pages: 972-978 Abstract: Objectives. The Nutrition Screening Initiative is a national collaborative effort committed to the identification and treatment of nutritional problems in older persons. Methods. A 14-item checklist of characteristics associated with nutritional status was administered to a random sample of Medicare beneficiaries, aged 70 years and older, in New England. Regression analysis was used to derive item weights that would predict poor nutrient intakes and low perceived health status. Sensitivity and specificity values were reviewed to define low, moderate, and high nutritional risk scores. Results. A revised checklist containing 10 yes/no items was adopted. Scores of 6 or more points defined persons at high nutritional risk. Twenty-four percent of the Medicare population was estimated to be at high nutritional risk according to the checklist. Among those in the high-risk group, 56% perceived their health to be 'fair' or 'poor' and 38% had dietary intakes below 75% of the recommended dietary allowances for three or more nutrients. Conclusions. The Nutrition Screening Initiative Checklist is a brief, easily scored instrument that can accurately identify noninstitutionalized older persons at risk for low nutrient intake and health problems. Handle: RePEc:aph:ajpbhl:1993:83:7:972-978_8 Template-Type: ReDIF-Article 1.0 Title: Continuing female predominance in depressive illness Journal: American Journal of Public Health Author-Name: Leon, A.C. Author-Name: Klerman, G.L. Author-Name: Wickramaratne, P. Year: 1993 Volume: 83 Issue: 5 Pages: 754-757 Abstract: This paper examines gender differences in temporal trends for major depressive disorder in childhood, adolescence, and young adulthood. The study sample, a high-risk group from the National Institute of Mental Health Collaborative Study on the Psychobiology of Depression, includes 2000 first- degree relatives of probands with affective disorder. The age-specific incidence rates were analyzed to determine the effect of gender, age, period, and cohort on depression by age 35. Women had nearly a twofold increase in risk of major depressive disorder, with rates peaking between adolescence and early adulthood. Vulnerability to depression was highest in the 1960s and 1970s. The rate increase in recent decades has not corresponded to a reduction in the gender differences. Handle: RePEc:aph:ajpbhl:1993:83:5:754-757_6 Template-Type: ReDIF-Article 1.0 Title: The effect of federal grants on medical school's production of primary care physicians Journal: American Journal of Public Health Author-Name: Rosenblatt, R.A. Author-Name: Whitcomb, M.E. Author-Name: Cullen, T.J. Author-Name: Lishner, D.M. Author-Name: Hart, L.G. Year: 1993 Volume: 83 Issue: 3 Pages: 322-328 Abstract: Objectives. Title VII of the Health Professions Educational Assistance Act of 1976 was created to encourage the production of primary care physicians. This study explored recent trends in the proportion of US medical school graduates entering primary care in relationship to Title VII funding. Methods. The American Medical Association Physician Masterfile was used to determine the specialty choice of all students graduating from American medical schools between 1960 and 1985. Results. The proportion of graduates entering primary care rose from 19.7% in 1967 to 31.1% in 1976 and remained stable for the subsequent decade. The increase occurred before implementation of Title VII. Rural, state-owned medical schools with departments of family medicine tend to produce a greater proportion of primary care physicians than urban private schools without family medicine departments. Conclusions. The values of American medical schools and the reward structure of American medical practice favor the production of specialists over primary care physicians. Although Title VII helped to encourage and sustain the development of primary care educational programs at both the medical student and graduate levels, an increase in the proportion of primary care physicians will require fundamental changes. Handle: RePEc:aph:ajpbhl:1993:83:3:322-328_3 Template-Type: ReDIF-Article 1.0 Title: Risk factors associated with HIV infection among male prostitutes Journal: American Journal of Public Health Author-Name: Elifson, K.W. Author-Name: Boles, J. Author-Name: Sweat, M. Year: 1993 Volume: 83 Issue: 1 Pages: 79-83 Abstract: Objectives. This study documents the human immunodeficiency virus (HIV) and sexually transmitted disease seroprevalence rate for male prostitutes, identifies the risk factors for HIV, and provides baseline information for the development and implementation of appropriate prevention and intervention strategies. Methods. Structured interviews were conducted with and blood samples were collected from 235 actively working male prostitutes in Atlanta, Georgia, from July 1988 through July 1991. Results. The HIV seroprevalence was 29.4%; 25.1% of the sample had seromarker for syphilis and 58.3% for hepatitis B. Multivariate logistic regression analysis showed the following significant HIV risk factors: history of receptive anal sex with nonpaying partners, serologic history of hepatitis B or syphilis, and history of childhood physical abuse. Conclusions. The reported seroprevalence rates among these male prostitutes indicate they are a high-risk group. The striking difference in HIV seroprevalence by sexual orientation may warrant special attention. Considering the public health consequences, there is a clear need for innovative HIV prevention and intervention among these men. Handle: RePEc:aph:ajpbhl:1993:83:1:79-83_7 Template-Type: ReDIF-Article 1.0 Title: The risk of childhood injury on Boston's playground equipment and surfaces Journal: American Journal of Public Health Author-Name: Bond, M.T. Author-Name: Peck, M.G. Year: 1993 Volume: 83 Issue: 5 Pages: 731-733 Abstract: The Childhood Injury Prevention Program of the Boston Department of Health and Hospitals conducted a survey of injury risk in Boston's playgrounds. A standardized checklist was used to assess a 25% sample of public playgrounds for hazards. Climbers accounted for 34% of the hazards observed and had the greatest proportion of significant hazards. The surfacing material in 100% of the playgrounds observed was unsafe. Urban children risk exposure to hazardous playground equipment frequency situated above unsafe surfacing material. Handle: RePEc:aph:ajpbhl:1993:83:5:731-733_9 Template-Type: ReDIF-Article 1.0 Title: Home health clients: Characteristics, outcomes of care, and nursing interventions Journal: American Journal of Public Health Author-Name: Martin, K.S. Author-Name: Scheet, N.J. Author-Name: Stegman, M.R. Year: 1993 Volume: 83 Issue: 12 Pages: 1730-1734 Abstract: Objectives. The purpose of the study was to provide descriptive data about the characteristics of home health clients, the services that nurses provide, and the outcomes of those services. Such data have been sparse. Methods. This study examined 2403 home health clients served by four agencies in Nebraska, New Jersey, and Wisconsin. Demographic, health history, and clinical data were analyzed. The Omaha System was used as the model for describing and measuring data specific to clients' health-related problems, nursing interventions, and outcomes of care. Results. The median age of home health clients was 68.6 years. Nurses conducted 70% of all home visits, identified 9107 client problems, and provided over 96 000 interventions. Between admission and dismissal, clients improved by at least 0.52 point on three 5- point problem-specific outcome subscales (Knowledge, Behavior, and Status). Conclusions. These data show important characteristics of home health clients in a large national sample. They also support the usefulness of the Omaha System in describing and quantifying nursing practice in the community health setting. The magnitude of positive client change between admission and dismissal suggests that community health services do make a difference. Handle: RePEc:aph:ajpbhl:1993:83:12:1730-1734_7 Template-Type: ReDIF-Article 1.0 Title: Water cost and availability: Key determinants of family hygiene in a Peruvian shantytown Journal: American Journal of Public Health Author-Name: Gilman, R.H. Author-Name: Marquis, G.S. Author-Name: Ventura, G. Author-Name: Campos, M. Author-Name: Spira, W. Author-Name: Diaz, F. Year: 1993 Volume: 83 Issue: 11 Pages: 1554-1558 Abstract: Objectives. This study was conducted to determine whether poor hygiene practices are owing to difficulty in getting enough water and/or to ignorance of sanitary principles. Methods. In a water-scarce shantytown in Lima, Peru, we observed in 12-hour periods over 3 consecutive days the amount of water and soap used for personal and domestic activities in 53 families and the frequency with which direct fecal contamination of hands was interrupted by washing. We also surveyed women in a similar shantytown concerning their knowledge of hygiene to ascertain whether noncompliance was owing to ignorance. Results. Three hundred fecal contamination events were registered, of which only 38 (13%) were interrupted by hand washing within 15 minutes. The mean 12-hour per capita amount of water and soap used by the families was low. More than 80% of the water stored by these families had fecal coliforms. Yet the level of knowledge concerning the importance of hand washing and other hygienic practices was high. Conclusions. In water-scarce areas, sanitary education programs probably will not change hygiene practices. In these areas, an adequate supply of water is essential for good hygiene. Handle: RePEc:aph:ajpbhl:1993:83:11:1554-1558_7 Template-Type: ReDIF-Article 1.0 Title: An evaluation of the workplace smoking bylaw in the city of Toronto Journal: American Journal of Public Health Author-Name: Pederson, L.L. Author-Name: Bull, S.B. Author-Name: Ashley, M.J. Author-Name: Garcia, J.M. Author-Name: Lefcoe, N.M. Year: 1993 Volume: 83 Issue: 9 Pages: 1342-1345 Abstract: Random-digit dialing surveys were conducted before (n = 1543) and 8 to 9 months after (n = 1430) implementation of the city of Toronto workplace smoking bylaw. Compared with workers in the rest of metropolitan Toronto and persons not working outside the home, city workers evidenced more positive changes in regard to knowledge of the bylaw, its requirements, and enforcement provisions. City workers reported more changes in workplace restrictions and satisfaction with such restrictions. Patterns of smoking at work changed. Handle: RePEc:aph:ajpbhl:1993:83:9:1342-1345_2 Template-Type: ReDIF-Article 1.0 Title: Patterns of drug use among Cuban-American, African-American, and White non-Hispanic boys Journal: American Journal of Public Health Author-Name: Vega, W.A. Author-Name: Gil, A.G. Author-Name: Zimmerman, R.S. Year: 1993 Volume: 83 Issue: 2 Pages: 257-259 Abstract: This study examined initiation into drug use during grade school years in a sample of Cuban-American, Black, and White non-Hispanic students in the greater Miami, Fla, area. Findings indicate that first use of alcohol occurs in fifth grade and cigarettes in sixth grade for all subgroups except White non-Hispanics, who peak in the fifth grade. White non-Hispanics had the highest lifetime levels of alcohol and cigarette use. Foreign-born Cuban Americans had a lower lifetime prevalence of alcohol and cigarette use than US-born Cuban Americans. Higher acculturation level was related to first use of alcohol. One important implication of this study is that alcohol interventions should begin no later than third grade and smoking interventions no later than fourth grade. Handle: RePEc:aph:ajpbhl:1993:83:2:257-259_9 Template-Type: ReDIF-Article 1.0 Title: Error in smoking measures: Effects of intervention on relations of cotinine and carbon monoxide to self-reported smoking Journal: American Journal of Public Health Author-Name: Murray, R.P. Author-Name: Connett, J.E. Author-Name: Lauger, G.G. Author-Name: Voelker, H.T. Year: 1993 Volume: 83 Issue: 9 Pages: 1251-1257 Abstract: Objectives. Sources of measurement error in assessing smoking status are examined. Methods. The Lung Health Study, a randomized trial in 10 clinical centers, includes 3923 participants in a smoking cessation program and 1964 usual care participants. Smoking at first annual follow-up was assessed by salivary cotinine, expired air carbon monoxide, and self-report. Each of these measures is known to contain some error. Sensitivity and specificity were calculated by comparing a biochemical measure with self-report to produce an undifferentiated estimate of error. Classification error rates due to imprecision of the biochemical measures and to the error in self-report were estimated separately. Results. For cotinine compared with self-report, the sensitivity was 99.0% and the specificity 91.5%. For carbon monoxide compared with self-report, the sensitivity was 93.7% and the specificity 87.2%. The classification error attributed to self-report, estimated by comparing the results from intervention and control groups, was associated with the responses of 3% and 5% of participants, indicating a small but significant bias toward a socially desirable response. Conclusions. In absolute terms in these data, both types of error were small. Handle: RePEc:aph:ajpbhl:1993:83:9:1251-1257_4 Template-Type: ReDIF-Article 1.0 Title: Editorial: Beliefs vs behaviors in healthcare decision making Journal: American Journal of Public Health Author-Name: Vladeck, B.C. Year: 1993 Volume: 83 Issue: 1 Pages: 13-14 Handle: RePEc:aph:ajpbhl:1993:83:1:13-14_2 Template-Type: ReDIF-Article 1.0 Title: Work-site smoking policies: Their population impact in Washington State Journal: American Journal of Public Health Author-Name: Kinne, S. Author-Name: Kristal, A.R. Author-Name: White, E. Author-Name: Hunt, J. Year: 1993 Volume: 83 Issue: 7 Pages: 1031-1033 Abstract: This article presents data from a population-based, random-digit dialing telephone survey of 1228 employed adults in Washington State, conducted 1989 through 1990. Eighty-one percent of men and 91% of women reported work-site smoking restrictions. Employees in work sites with no-smoking policies were less likely to be current smokers; men in work sites with policies restricting smoking smoked fewer cigarettes on both workdays and nonworkdays. Forty-eight percent of male and 53% of female smokers reported reduced smoking as a result of a work-site policy. Work-site smoking policies, intended to protect against smoke exposure, may also reduce employee smoking. Handle: RePEc:aph:ajpbhl:1993:83:7:1031-1033_2 Template-Type: ReDIF-Article 1.0 Title: Sudden infant death syndrome and maternal smoking conclusions questioned [2] Journal: American Journal of Public Health Author-Name: Golding, J. Author-Name: Malloy, M.H. Author-Name: Hoffman, H.J. Author-Name: Peterson, D.R. Year: 1993 Volume: 83 Issue: 9 Pages: 1346-1347 Handle: RePEc:aph:ajpbhl:1993:83:9:1346-1347_9 Template-Type: ReDIF-Article 1.0 Title: Physicians who have practiced in both the United States and Canada compare the systems Journal: American Journal of Public Health Author-Name: Hayes, G.J. Author-Name: Hayes, S.C. Author-Name: Dykstra, T. Year: 1993 Volume: 83 Issue: 11 Pages: 1544-1548 Abstract: Objectives. The aim of this study was to examine the US and Canadian systems from the unique perspective of physicians who have practiced in both Canada and the United States. Methods. Questionnaires were sent to 355 Canadian physicians who graduated from US medical schools and 347 US physicians who graduated from Canadian medical schools. Results. The overall response rate was 59% (65% of US-graduated Canadian physicians and 54% of Canadian-graduated US physicians). Thirty-six percent of the respondents were 'dual experience' physicians; that is, they had practiced medicine in both countries after completing their medical training. Physicians who left Canada were more likely than those who left the United States to indicate dissatisfaction with the health care system as a reason for leaving. Respondents expressed greater professional satisfaction with their current country of practice, but overall, dual-experience physicians in the United States favored that system only slightly more than the Canadian system, whereas those in Canada rated the Canadian system significantly better than the US system. Conclusions. The comparatively weak rating of the US system by dual-experience physicians underlines the need for health care reform. Handle: RePEc:aph:ajpbhl:1993:83:11:1544-1548_1 Template-Type: ReDIF-Article 1.0 Title: An epidemic of pesticide poisoning in Nicaragua: Implications for prevention in developing countries Journal: American Journal of Public Health Author-Name: McConnell, R. Author-Name: Hruska, A.J. Year: 1993 Volume: 83 Issue: 11 Pages: 1559-1562 Abstract: Objectives. The purpose of this study was to demonstrate the usefulness of the Northwestern Nicaraguan Ministry of Health surveillance system for detecting pesticide poisonings. Methods. Cases were reported to the regional department of epidemiology through daily telephone reports and through monthly consolidated reports from each of the 18 health centers of the National Health Service. Reporting forms were also distributed to the four area hospitals. Results. During June and July 1987, an epidemic of 548 pesticide poisonings was detected in northwestern Nicaragua. Seventy-seven percent of the poisonings were caused by carbofuran or methamidophos. Of the work-related cases (91% of reported poisonings), more than 80% occurred among maize farmers and on small to medium land holdings (fewer than 140 hectares). Nineteen percent of the work-related cases involved children under 16 years of age. Conclusions. Unsafe working conditions such as manual application of pesticides and the use of backpack sprayers, the introduction of a hazardous powdered formulation of carbofuran highly restricted in the developed world, and agricultural subsidies that encouraged the use of hazardous pesticides all contributed to the epidemic. Handle: RePEc:aph:ajpbhl:1993:83:11:1559-1562_6 Template-Type: ReDIF-Article 1.0 Title: The US temporal and geographic variations of diseases related to Helicobacter pylori Journal: American Journal of Public Health Author-Name: Sonnenberg, A. Year: 1993 Volume: 83 Issue: 7 Pages: 1006-1010 Abstract: Objectives. If Helicobacter pylori plays an important role in the occurrence of three distinct diseases - gastric cancer, gastric ulcer, and duodenal ulcer - their individual epidemiologic behaviors should show a resemblance to one common pattern. Methods. To test this hypothesis, birth cohort and linear regression analyses were used to study the US temporal and geographic variations, respectively, of mortality from the three diseases. Results. US mortality from gastric ulcer in males and duodenal ulcer in both sexes showed a clear-cut peak of occurrence in subjects born around 1885, whereas gastric cancer declined continuously in all Americans born since 1855. The geographic distributions showed a strong correlation between gastric and duodenal ulcer, as opposed to weak correlations between either ulcer type and gastric cancer. Conclusions. The similarities in the behavior of the three diseases support the idea that identical risk factors play a crucial role in their occurrence. However, the time lag between the decline in mortality from gastric cancer and the decline in mortality from peptic ulcer and their weak geographic correlations indicate that factors besides H pylori must have influenced their epidemiology. Handle: RePEc:aph:ajpbhl:1993:83:7:1006-1010_4 Template-Type: ReDIF-Article 1.0 Title: Racial misclassification of American Indians: Its effect on injury rates in Oregon, 1989 through 1990 Journal: American Journal of Public Health Author-Name: Sugarman, J.R. Author-Name: Soderberg, R. Author-Name: Gordon, J.E. Author-Name: Rivara, F.P. Year: 1993 Volume: 83 Issue: 5 Pages: 681-684 Abstract: Objectives. We assessed the extent to which injury rates among American Indians in Oregon are underestimated owing to misclassification of race in a surveillance system. Methods. The Oregon Injury Registry, a population-based surveillance system, was linked with the Indian Health Service patient registration file from Oregon, and injury rates for American Indians were calculated before and after correcting for racial misclassification. Results. In 1989 and 1990, 301 persons in the Oregon registry were coded as American Indian. An additional 89 injured persons who were coded as a race other than American Indian in the registry were listed as American Indian in the Indian Health Service records. The age-adjusted annual injury rate for health service-registered American Indians was 6.9/1000, 68% higher than the rate calculated before data linkage. American Indian ancestry, female sex, and residence in metropolitan counties were associated with a higher likelihood of concordant racial classification in both data sets. Conclusion. Injury rates among American Indians in an Oregon surveillance system are substantially underestimated owing to racial misclassification. Linkage of disease registries and vital records with Indian Health Service records in other states may improve health-related data regarding American Indians. Handle: RePEc:aph:ajpbhl:1993:83:5:681-684_7 Template-Type: ReDIF-Article 1.0 Title: Commentary: Tuberculosis in New York City - The consequences and lessons of failure Journal: American Journal of Public Health Author-Name: Landesman, S.H. Year: 1993 Volume: 83 Issue: 5 Pages: 766-768 Abstract: The resurgent tuberculosis epidemic represents-especially in New York City-a failure to maintain a public health infrastructure that was focused on preventing active disease in high-risk populations (i.e., individuals with the human immunodeficiency virus [HIV]) and on treating active tuberculosis patients until cured. Although the tuberculosis problem in New York City and other localities is worsened by homelessness, poverty, and substance abuse, it is possible to bring tuberculosis under control by directing public health resources into targeted programs that enhance compliance with tuberculosis treatment regimen and expand chemoprophylaxis efforts among HIV-infected individuals. These two avenues will decrease, respectively, the number of cases of multidrug-resistant tuberculosis and the total number of new cases. Handle: RePEc:aph:ajpbhl:1993:83:5:766-768_9 Template-Type: ReDIF-Article 1.0 Title: Nemesis revisited: Tuberculosis infection in a New York City men's shelter Journal: American Journal of Public Health Author-Name: Paul, E.A. Author-Name: Lebowitz, S.M. Author-Name: Moore, R.E. Author-Name: Hoven, C.W. Author-Name: Bennett, B.A. Author-Name: Chen, A. Year: 1993 Volume: 83 Issue: 12 Pages: 1743-1745 Abstract: In November 1990, a screening was conducted to determine the point prevalence of tuberculosis infection in a volunteer sample of homeless men (n = 161) living in a congregate shelter in New York City. Of those for whom we have results (n = 134), 79% were positive for tuberculosis. The mean length of shelter stay from date of shelter entry was 31.8 months and was significantly associated with the tuberculosis infection rate. The findings suggest that crowded living conditions and the presence of a stable resident pool in crowded congregate shelters may be associated with transmission of tuberculosis infection. Handle: RePEc:aph:ajpbhl:1993:83:12:1743-1745_2 Template-Type: ReDIF-Article 1.0 Title: Bias in weighted vs unweighted estimates [6] Journal: American Journal of Public Health Author-Name: Novikov, I.D. Author-Name: Ruskin, P.E. Author-Name: Korn, E.L. Author-Name: Graubard, B.I. Year: 1993 Volume: 83 Issue: 9 Pages: 1351 Handle: RePEc:aph:ajpbhl:1993:83:9:1351_6 Template-Type: ReDIF-Article 1.0 Title: Protecting construction workers from exposure to lead: Success in New Jersey [6] Journal: American Journal of Public Health Author-Name: Valiante, D.J. Author-Name: Stanbury, M. Author-Name: Gerwel, B. Year: 1993 Volume: 83 Issue: 11 Pages: 1644 Handle: RePEc:aph:ajpbhl:1993:83:11:1644_2 Template-Type: ReDIF-Article 1.0 Title: Needed: Universal monitoring of all serious diseases of global importance Journal: American Journal of Public Health Author-Name: LaPorte, R.E. Year: 1993 Volume: 83 Issue: 7 Pages: 941-943 Handle: RePEc:aph:ajpbhl:1993:83:7:941-943_8 Template-Type: ReDIF-Article 1.0 Title: Burn prevention through Weatherization Assistance Programs Journal: American Journal of Public Health Author-Name: Simon, J. Author-Name: Levensohn, A. Author-Name: Metzger, B.B. Author-Name: Hardman, S. Author-Name: Klein, S.J. Year: 1993 Volume: 83 Issue: 12 Pages: 1787-1788 Handle: RePEc:aph:ajpbhl:1993:83:12:1787-1788_6 Template-Type: ReDIF-Article 1.0 Title: The Northwest Center for Public Health Practice Journal: American Journal of Public Health Author-Name: Omenn, G.S. Author-Name: Oberle, M. Author-Name: Gale, J. Author-Name: Hoover, J.J. Author-Name: Sandlin, D. Author-Name: Tapp, J. Year: 1993 Volume: 83 Issue: 12 Pages: 1788-1789 Handle: RePEc:aph:ajpbhl:1993:83:12:1788-1789_3 Template-Type: ReDIF-Article 1.0 Title: The effects of resistance strategies on rape Journal: American Journal of Public Health Author-Name: Zoucha-Jensen, J.M. Author-Name: Coyne, A. Year: 1993 Volume: 83 Issue: 11 Pages: 1633-1634 Abstract: This investigation sought to clarify which resistance strategies were associated with rape avoidance and at what cost. Data were gathered from initial and supplemental police reports about 150 sexual assault victims, ages 16 and older, who were assaulted between June 1, 1988, and May 31, 1989, in Omaha, Neb. Although this analysis could not determine causality, it did indicate that forceful verbal resistance, physical resistance, and fleeing were all associated with rape avoidance, whereas nonforceful verbal resistance and no resistance were associated with being raped. Further, women who used forceful resistance were no more likely to be injured than women who did not resist. Handle: RePEc:aph:ajpbhl:1993:83:11:1633-1634_1 Template-Type: ReDIF-Article 1.0 Title: An outbreak of hepatitis A among health care workers: Risk factors for transmission Journal: American Journal of Public Health Author-Name: Doebbeling, B.N. Author-Name: Li, N. Author-Name: Wenzel, R.P. Year: 1993 Volume: 83 Issue: 12 Pages: 1679-1684 Abstract: Objectives. The purpose of this study was to investigate a nosocomial outbreak of hepatitis A that occurred in the burn treatment center of a referral hospital. Methods. Retrospective cohort and case-control studies were performed to determine acquisition rates and risk factors for transmission. Adjusted infection rates were calculated by week of exposure. A case-control study was conducted to determine potential mechanisms for nosocomial acquisition. Recently infected health care workers were defined as case patients; exposed, serosusceptible health care workers without infection served as controls. Results. The outbreak of hepatitis A affected 11 health care workers and 1 other burn patient (1 secondary patient case). All 11 health care workers became ill after the admission of a man and his 8-month- old son who developed hepatitis A while in the hospital. The cumulative incidence risk ratio was elevated for health care workers caring for either the infant or the father during the same week of exposure. The case-control study implicated the behavior of eating on the hospital ward as the single most important risk factor for infection. Conclusion. Inadequate handwashing and subsequent oral contamination appear responsible for the outbreak. Hospitals may witness other institutional outbreaks if health care workers regularly eat on the wards. Handle: RePEc:aph:ajpbhl:1993:83:12:1679-1684_7 Template-Type: ReDIF-Article 1.0 Title: Undocumented aliens and uncompensated care: Whose responsibility? Journal: American Journal of Public Health Author-Name: Siddharthan, K. Author-Name: Alalasundaram, S. Year: 1993 Volume: 83 Issue: 3 Pages: 410-412 Abstract: Undocumented aliens concentrated in metropolitan areas and certain Sunbelt states can financially burden local health agencies and may interfere with access to health care for indigent populations that are legally resident. Data collected from Jackson Memorial Hospital, which provides the bulk of indigent medical services in Dade County, Florida, are used to investigate the problem of providing uncompensated care to undocumented aliens. Policy alternatives concerning immigration issues and reimbursement are discussed. Handle: RePEc:aph:ajpbhl:1993:83:3:410-412_1 Template-Type: ReDIF-Article 1.0 Title: Telephone vs face-to-face interviewing in a community psychiatric survey Journal: American Journal of Public Health Author-Name: Fenig, S. Author-Name: Levav, I. Author-Name: Kohn, R. Author-Name: Yelin, N. Year: 1993 Volume: 83 Issue: 6 Pages: 896-898 Abstract: This study compared telephone with face-to-face interviewing in a community psychiatric survey. Two groups of women were investigated, Holocaust survivors and Europe-born respondents who were in pre-state Israel during World War II. Both were administered the Psychiatric Research Interview Demoralization Scale and a short item scale investigating World War II experiences. Results showed a high compliance rate to the telephone mode. The subjects' scores in the two modes were highly correlated. Telephone interviewing seems to be a reliable and efficient method in areas with a well-developed network of subscribers. Handle: RePEc:aph:ajpbhl:1993:83:6:896-898_3 Template-Type: ReDIF-Article 1.0 Title: Complications of BCG vaccinations in rural Haiti Journal: American Journal of Public Health Author-Name: Bonnlander, H. Author-Name: Rossignol, A.M. Year: 1993 Volume: 83 Issue: 4 Pages: 583-585 Abstract: This study investigated an outbreak of axillary lymphadenitis and abscesses after Bacillus Calmette-Guerin vaccination among rural Haitian children treated at the Hospital Albert Schweitzer from January 1986 through March 1991. Seventy-seven cases of vaccine-related complications were identified, all among children immunized before the age of 1 year. The proportions of children with complications were 0.017% for 1986 through 1989, 0.91% for 1990, and 2.2% for January through March 1991. Handle: RePEc:aph:ajpbhl:1993:83:4:583-585_6 Template-Type: ReDIF-Article 1.0 Title: Chlorination or ozonation? [3] Journal: American Journal of Public Health Author-Name: Chapdelaine Jr., P.A. Author-Name: Morris, R.D. Year: 1993 Volume: 83 Issue: 9 Pages: 1347-1348 Handle: RePEc:aph:ajpbhl:1993:83:9:1347-1348_4 Template-Type: ReDIF-Article 1.0 Title: Congenital hypothyroidism screening and the cutoff for thyrotropin measurement: Recommendations from the Netherlands Journal: American Journal of Public Health Author-Name: Verkerk, P.H. Author-Name: Buitendijk, S.E. Author-Name: Verloove-Vanhorick, S.P. Year: 1993 Volume: 83 Issue: 6 Pages: 868-871 Abstract: Objectives. There is little agreement as to the optimal cutoff point for thyrotropin testing in primary thyroxine screening programs for congenital hypothyroidism. Most programs in the United States use a cutoff point of 10% of the lowest thyroxine values, whereas in the Netherlands a cutoff point of 20% is used. Therefore, the results of the Dutch program may provide valuable information about the optimal cutoff point. Methods. The frequency distribution of screening thyroxine values was studied in all cases of permanent primary congenital hypothyroidism (n = 481) detected in 1 601 603 screened children born during the period from January 1, 1981, to December 31, 1989, in the Netherlands. Results. Programs using a 10% cutoff point would have missed 1.5% of cases. Above the 10% cutoff point, the marginal costs increase quite rapidly because of the escalating numbers of thyrotropin measurements necessary to detect one case of permanent primary congenital hypothyroidism: 20 000 in the range of 11% to 15% and 40 000 in the range of 16% to 20%. Conclusions. Based on these findings, a cutoff point of at least 10% is recommended. Handle: RePEc:aph:ajpbhl:1993:83:6:868-871_2 Template-Type: ReDIF-Article 1.0 Title: Improving response rates through incentive and follow-up: The effect on a survey of physicians' knowledge of genetics Journal: American Journal of Public Health Author-Name: Tambor, E.S. Author-Name: Chase, G.A. Author-Name: Faden, R.R. Author-Name: Geller, G. Author-Name: Hofman, K.J. Author-Name: Holtzman, N.A. Year: 1993 Volume: 83 Issue: 11 Pages: 1599-1603 Abstract: Objectives. This study assessed efforts to increase response rates to a mailed physician survey and examined whether, as a result, nonresponse bias was reduced. Methods. Randomly selected physicians and geneticists were mailed a questionnaire concerning genetics knowledge and attitudes. In the final but not the pilot survey, a $25 incentive and intensive follow-up were used to increase the response rate. Results. The response rate from physicians in the final survey was 64.8% (n = 1140), compared with 19.6% in the pilot test (n = 69). Sample representativeness in sociodemographic and practice characteristics was improved by follow-up. Respondents recruited with more difficulty did not differ on the principal outcome variable, genetics knowledge, except on one subscore. Pilot study and final survey respondents did not differ in knowledge. Conclusions. Although the effect of increased response rates on the principal outcome variable in this study was minimal, this may not be the case for other studies. Every effort should be made to attain as high a response rate as is practical and to establish that respondents are representative of the population being sampled. Handle: RePEc:aph:ajpbhl:1993:83:11:1599-1603_4 Template-Type: ReDIF-Article 1.0 Title: Commentary: Going to the people - Public health nursing today and tomorrow Journal: American Journal of Public Health Author-Name: Zerwekh, J.V. Year: 1993 Volume: 83 Issue: 12 Pages: 1676-1678 Handle: RePEc:aph:ajpbhl:1993:83:12:1676-1678_9 Template-Type: ReDIF-Article 1.0 Title: A comparison of prenatal care use in the United States and Europe Journal: American Journal of Public Health Author-Name: Buekens, P. Author-Name: Kotelchuck, M. Author-Name: Blondel, B. Author-Name: Kristensen, F.B. Author-Name: Chen, J.-H. Author-Name: Masuy- Stroobant, G. Year: 1993 Volume: 83 Issue: 1 Pages: 31-36 Abstract: Objectives. We sought to describe prenatal care use in the United States and in three European countries where accessibility to prenatal care has been reported to be better than it is in the United States. Methods. We analyzed the 1980 US National Natality Survey, the 1981 French National Natality Survey, a 1979 sample of Danish births, and a survey performed from 1979 to 1980 in one Belgian province. Results. The proportion of women who began prenatal care late (after 15 weeks) is highest in the United States (21.2%) and lowest in France (4.0%). This contrasts with the median number of visits, which is greater in the United States (11) than in Denmark (10) or in France (7). Across all maternal ages, parities, and educational levels, late initiation of prenatal care is more frequent in the United States, and median number of visits in the United States is equal to or higher than that in the other countries. Conclusions. In countries that offer nearly universal access to prenatal care, women begin care earlier during pregnancy and have fewer visits than women in the United States. Handle: RePEc:aph:ajpbhl:1993:83:1:31-36_8 Template-Type: ReDIF-Article 1.0 Title: Occupation as a risk identifier for breast cancer Journal: American Journal of Public Health Author-Name: Rubin, C.H. Author-Name: Burnett, C.A. Author-Name: Halperin, W.E. Author-Name: Seligman, P.J. Year: 1993 Volume: 83 Issue: 9 Pages: 1311-1315 Abstract: Objectives. Breast cancer mortality may be reduced if the disease is detected early through targeted screening programs. Current screening guidelines are based solely on a woman's age. Because working populations are accessible for intervention, occupational identification may be a way of helping to define and locate risk groups and target prevention. Methods. We used a database consisting of 2.9 million occupationally coded death certificates collected from 23 states between 1979 and 1987 to calculate age- adjusted, race-specific proportionate mortality ratios for breast cancer according to occupation. We performed case-control analyses on occupational groups and on stratifications within the teaching profession. Results. We found a number of significant associations between occupation and frequency of breast cancer. For example, white female professional, managerial, and clerical workers all had high proportions of breast cancer death. High rates of breast cancer in teachers were found in both proportionate mortality ratio and case-control analyses. Conclusions. These findings may serve as in an aid in the effective targeting of work-site health promotion programs. They suggest that occupationally coded mortality data can be a useful adjunct in the difficult task of identifying groups at risk of preventable disease. Handle: RePEc:aph:ajpbhl:1993:83:9:1311-1315_9 Template-Type: ReDIF-Article 1.0 Title: The relationship of Chlamydia trachomatis infection and male infertility Journal: American Journal of Public Health Author-Name: Greendale, G.A. Author-Name: Haas, S.T. Author-Name: Holbrook, K. Author-Name: Walsh, B. Author-Name: Schachter, J. Author-Name: Phillips, R.S. Year: 1993 Volume: 83 Issue: 7 Pages: 996-1001 Abstract: Objectives. Infertility affects at least 2 million couples in the United States. One third of infertility is attributed to male causes, but the etiology of most male infertility remains obscure. This study was designed to investigate the relationship between Chlamydia trachomatis and unexplained infertility in men. Methods. Questionnaires and serum were collected prospectively from 52 case subjects (men from couples with explicitly defined idiopathic infertility) and 79 control subjects (first-time expectant fathers). Results. Case subjects were significantly more likely than control subjects to be seropositive for antibody to C trachomatis at a titer of 1:64 or higher. By test of trend, higher titers were associated with higher odds ratios. Adjustment for age of either partner at initiation of pregnancy attempt, race, income, previous genitourinary symptoms or diagnoses, number of previous sexual partners, and barrier contraceptive use had no significant effect on the estimate of the odds ratio. One half of the men who were antibody positive had no history of genitourinary symptoms. Conclusions. Our results suggest an association between infection with C trachomatis in men and unexplained infertility and imply that infection is frequently asymptomatic. Handle: RePEc:aph:ajpbhl:1993:83:7:996-1001_5 Template-Type: ReDIF-Article 1.0 Title: Fatal car fires from rear-end crashes: The effects of fuel tank placement before and after regulation Journal: American Journal of Public Health Author-Name: Robertson, L.S. Year: 1993 Volume: 83 Issue: 8 Pages: 1168-1170 Abstract: A federal standard for fuel tank integrity in cars was applied to 1977 and subsequent models. National data indicate that fatalities per 10 000 occupants in rear-end crashes of small cars, where fire was the most harmful event, were reduced by approximately 57% if the fuel tank was located behind the rear axle and 77% if the tank was situated directly above or in front of the rear axle. Handle: RePEc:aph:ajpbhl:1993:83:8:1168-1170_3 Template-Type: ReDIF-Article 1.0 Title: Hip fracture incidence before and after the fluoridation of the public water supply, Rochester, Minnesota Journal: American Journal of Public Health Author-Name: Jacobsen, S.J. Author-Name: O'Fallon, W.M. Author-Name: Melton III, L.J. Year: 1993 Volume: 83 Issue: 5 Pages: 743-745 Abstract: Recent ecological comparison studies have suggested a positive association between fluoridation and hip fracture. Using data from the Rochester Epidemiology Project, we found the incidence of hip fracture for the 10 years before the fluoridation of the Rochester, Minn, public water supply was 484 per 100 000, compared with 450 per 100 000 in the following 10 years. When the effects of calendar time and age were controlled for, the relative risk associated with fluoridation was 0.63. These ecologic trend data suggest that the fluoridation of public water supplies is not associated with an immediate increase in rates of hip fracture. Further studies of this association at the individual level are clearly required before public policy decisions can be made. Handle: RePEc:aph:ajpbhl:1993:83:5:743-745_2 Template-Type: ReDIF-Article 1.0 Title: Prenatal weight gain and postpartum weight retention: A delicate balance Journal: American Journal of Public Health Author-Name: Abrams, B. Year: 1993 Volume: 83 Issue: 8 Pages: 1082-1084 Handle: RePEc:aph:ajpbhl:1993:83:8:1082-1084_1 Template-Type: ReDIF-Article 1.0 Title: The coding of underlying cause of death from fetal death certificates: Issues and policy considerations Journal: American Journal of Public Health Author-Name: Kirby, R.S. Year: 1993 Volume: 83 Issue: 8 Pages: 1088-1091 Abstract: Recently, plans to implement nationwide coding of underlying cause of fetal death have been promulgated. To examine the validity and potential utility of nationwide coding, this paper presents data from a five-state (Wisconsin, Arkansas, Maine, North Carolina, California) analysis of underlying causes of fetal death from vital records for 1985 through 1987. Nosological coding rules varied somewhat from state to state. Underlying causes were grouped into categories; distributions were similar for each state. Many deaths (20.3% to 32.9%) were coded as unspecified conditions. Congenital anomalies accounted for only 6.9% to 10.3% of fetal deaths, including implausible and nonspecific causes. In total, 29.5% to 42.8% of the reports were not valid or useful. To obtain better data, researchers must focus on improving fetal death reporting, which will entail the promotion of comprehensive autopsy, placental and laboratory evaluation, systematic vital records query procedures, and implementation of multiple-cause-of-fetal- death coding. Handle: RePEc:aph:ajpbhl:1993:83:8:1088-1091_1 Template-Type: ReDIF-Article 1.0 Title: Moderate drinking and coronary heart disease mortality: Evidence from NHANES I and the NHANES I follow-up Journal: American Journal of Public Health Author-Name: Coate, D. Year: 1993 Volume: 83 Issue: 6 Pages: 888-890 Abstract: Data from the National Health and Nutrition Examination Survey, conducted from 1971 through 1974, and the National Health and Nutrition Examination Survey Follow-up, conducted from 1982 through 1984, were used to test for a beneficial effect of moderate alcohol consumption on coronary heart disease mortality among White men and women. Evidence of such an effect was found for White men; accelerated time-to-failure models showed 3% to 4% longer life spans for moderate drinkers than for nondrinkers or light drinkers. Handle: RePEc:aph:ajpbhl:1993:83:6:888-890_6 Template-Type: ReDIF-Article 1.0 Title: Mortality in a public and a private hospital compared: The severity of antecedent disorders in medicare patients Journal: American Journal of Public Health Author-Name: Burns, R. Author-Name: Nichols, L.O. Author-Name: Graney, M.J. Author-Name: Applegate, W.B. Year: 1993 Volume: 83 Issue: 7 Pages: 966-971 Abstract: Objectives. The objectives of this study were to determine (1) if there were significant differences between patients who died at a public hospital and those who died at a university hospital that functions as a private, community hospital, and (2) if those differences were associated with an increased risk of death. Methods. Chart review collected variables used by the Health Care Financing Administration in mortality analyses to examine how severity of illness data contribute to accurate predictions of death in a public hospital compared with a university hospital. Results. Compared with patients who died at the university hospital, public hospital patients who died had more comorbid disease, were more severely ill, more likely to be emergently admitted, and more likely to be admitted from an extended-care facility. Inclusion of severity of illness with variables previously used to predict mortality significantly improved the accuracy of mortality prediction models for the public hospital but not for the university hospital. Conclusions. The results suggest that urban public hospitals provide care to more severely ill patients. Administrative data sets may not be adequate to identify these differences between patient populations. Handle: RePEc:aph:ajpbhl:1993:83:7:966-971_9 Template-Type: ReDIF-Article 1.0 Title: Screening for colorectal neoplasia: Physicians' adherence to complete diagnostic evaluation Journal: American Journal of Public Health Author-Name: Myers, R.E. Author-Name: Balshem, A.M. Author-Name: Wolf, T.A. Author-Name: Ross, E.A. Author-Name: Millner, L. Year: 1993 Volume: 83 Issue: 11 Pages: 1620-1622 Abstract: This prospective study was done in a health maintenance organization colorectal cancer screening program to determine whether 166 persons found to have abnormal fecal occult blood test results typically underwent complete diagnostic evaluation (i.e., either colonoscopy or barium enema x-ray plus flexible sigmoidoscopy). Chart audit data show that 137 (82%) subjects contacted a physician to discuss follow-up. A complete diagnostic evaluation was recommended to only 52 (38%) patients who talked with a physician. Forty- two (81%) patients who were advised to get a complete diagnostic evaluation actually complied. Significant differences in clinical findings were observed for patients who did and did not have a complete diagnostic evaluation. Handle: RePEc:aph:ajpbhl:1993:83:11:1620-1622_3 Template-Type: ReDIF-Article 1.0 Title: Health education for pregnant smokers: Its behavioral impact and cost benefit Journal: American Journal of Public Health Author-Name: Windsor, R.A. Author-Name: Lowe, J.B. Author-Name: Perkins, L.L. Author-Name: Smith-Yoder, D. Author-Name: Artz, L. Author-Name: Crawford, M. Author-Name: Amburgy, K. Author-Name: Boyd Jr., N.R. Year: 1993 Volume: 83 Issue: 2 Pages: 201-206 Abstract: Objectives. A randomized trial (the Birmingham Trial II) was conducted to evaluate the behavioral impact of health education methods among 814 female smokers at four public health maternity clinics. Methods. Four hundred patients were randomly assigned to an Experimental (E) Group, and 414 were assigned to a Control (C) Group. Self-reports and saliva cotinine tests confirmed smoking status at the first visit, at midpregnancy, and at end of pregnancy. Results. The E Group exhibited a 14.3% quit rate and the C Group an 8.5% quit rate. A Historical Comparison (C) Group exhibited a 3.0% quit rate. Black E and C Group patients had higher quit rates than White E and C Group patients. A cost-benefit analysis found cost-to-benefit ratios of $1:$6.72 (low estimate) and $1:$17.18 (high estimate) and an estimated savings of $247 296 (low estimate) and $699 240 (high estimate). Conclusion. Health education methods are efficacious and cost beneficial for pregnant smokers in public health maternity clinics. Handle: RePEc:aph:ajpbhl:1993:83:2:201-206_0 Template-Type: ReDIF-Article 1.0 Title: Antibodies to Borrelia burgdorferi and tick salivary gland proteins in New Jersey outdoor workers Journal: American Journal of Public Health Author-Name: Schwartz, B.S. Author-Name: Goldstein, M.D. Author-Name: Childs, J.E. Year: 1993 Volume: 83 Issue: 12 Pages: 1746-1748 Abstract: In 1990, a second cross-sectional study of outdoor workers (n = 758) at high risk for Lyme disease was conducted. A questionnaire was administered, and antibodies to Borrelia burgdorferi and tick salivary gland proteins (antitick saliva antibody, a biologic marker of tick exposure) were assayed by enzyme-linked immunosorbent assay. The statewide Lyme disease seroprevalence increased from 8.1% in 1988 to 18.7% in 1990. Antitick saliva antibody seropositivity varied by county and was associated with measures of self-reported tick exposure. The data suggested that the prevalence of B. burgdorferi infection increased in New Jersey outdoor workers from 1988 to 1990. Handle: RePEc:aph:ajpbhl:1993:83:12:1746-1748_1 Template-Type: ReDIF-Article 1.0 Title: HIV and trends in cervical cancer death rates among young women [4] Journal: American Journal of Public Health Author-Name: McKenna, M.T. Author-Name: Buehler, J.W. Author-Name: Qualters, J.R. Author-Name: Chu, S.Y. Year: 1993 Volume: 83 Issue: 12 Pages: 1792-1793 Handle: RePEc:aph:ajpbhl:1993:83:12:1792-1793_0 Template-Type: ReDIF-Article 1.0 Title: HIV surveillance testing: Taking advantage of the disadvantaged [1] Journal: American Journal of Public Health Author-Name: Isaacman, S.H. Year: 1993 Volume: 83 Issue: 4 Pages: 597-598 Handle: RePEc:aph:ajpbhl:1993:83:4:597-598_9 Template-Type: ReDIF-Article 1.0 Title: Class, race, and infant mortality in the United States Journal: American Journal of Public Health Author-Name: Hogue, C.J.R. Author-Name: Hargraves, M.A. Year: 1993 Volume: 83 Issue: 1 Pages: 9-12 Abstract: As a result of Sweden's efforts to eliminate poverty and to provide comprehensive health care, there are only small social class differences in infant mortality. The wider social differences in US infant mortality are a consequence of less consistent and thorough attempts at social equity and universal health care. US Black infant mortality continues to be twice that of Whites, and the excess may partially result from racism. Public health research should examine the role of racism in infant mortality and develop interventions to eliminate racism and its effects on the health of Black Americans. Handle: RePEc:aph:ajpbhl:1993:83:1:9-12_0 Template-Type: ReDIF-Article 1.0 Title: Level of education and alcohol abuse and dependence in adulthood: A further inquiry Journal: American Journal of Public Health Author-Name: Crum, R.M. Author-Name: Helzer, J.E. Author-Name: Anthony, J.C. Year: 1993 Volume: 83 Issue: 6 Pages: 830-837 Abstract: Objectives. Prospectively gathered data were used to reexamine and to strengthen previously described observations about education and the risk of alcohol abuse and dependence. The hypothesis was that individuals who dropped out of high school and those who entered college but failed to get a college degree might be at increased risk for an alcohol disorder. Methods. Study subjects were selected between 1980 and 1984 by taking probability samples of roughly 3000 adult household residents at each of the five Epidemiologic Catchment Area Program survey sites. To assess the occurrence of psychiatric conditions, staff administered the Diagnostic Interview Schedule soon after sampling and again at follow-up, roughly 1 year later. Results. Individuals who had dropped out of high school were 6.34 times more likely to develop alcohol abuse or dependence than were individuals with a college degree. For those who had entered college but failed to achieve a degree, the estimated relative risk was 3.01. To extend these analyses, estimates for annual incidence were calculated, and an exploratory evaluation of interaction is presented. Conclusions. If these findings can be replicated, they should help identify subgroups at higher risk for the development of alcohol disorders. Handle: RePEc:aph:ajpbhl:1993:83:6:830-837_8 Template-Type: ReDIF-Article 1.0 Title: Health promotion counseling of chronic-disease patients during primary care visits Journal: American Journal of Public Health Author-Name: Russell, N.K. Author-Name: Roter, D.L. Year: 1993 Volume: 83 Issue: 7 Pages: 979-982 Abstract: Objectives. This study was designed to provide an empirical description, based on a review of visit audiotapes, of primary care practice with chronic- disease patients. Methods. We analyzed 439 interactions between adult patients with chronic disease and 49 physicians. We explored the content, frequency, intensity, and dynamics of health promotion discussions during these routine visits. Results. There was evidence of health promotion discussion in more than half (53%) of the audiotapes reviewed. When life- style topics were discussed, the discussion lasted a mean of 4 1/2 minutes, or 20% of the length of the visit. Diet/weight control was the most frequently discussed topic, followed by exercise, stress, smoking, and alcohol. Stress was by far the most time-consuming topic; stress-related discussions took an average of 6 minutes. Conclusions. Nearly 60% of the discussions that took place were not merely perfunctory but were attempts to counsel or encourage behavior change in the patient. Physicians used a wide range of behavioral counseling strategies, including providing a rationale for the recommended change and specific instructions to facilitate change. Other strategies noted as 'effective' in the literature, however, were used infrequently and indicate obvious areas of weakness in physician performance. Handle: RePEc:aph:ajpbhl:1993:83:7:979-982_7 Template-Type: ReDIF-Article 1.0 Title: Bicycle helmet counseling by pediatricians: A random national survey Journal: American Journal of Public Health Author-Name: Ruch-Ross, H.S. Author-Name: O'Connor, K.G. Year: 1993 Volume: 83 Issue: 5 Pages: 728-730 Abstract: A random sample of 1201 pediatricians who are members of the American Academy of Pediatrics completed questionnaires regarding bicycle injury prevention counseling. Of the 871 pediatricians in the sample who provide health supervision, 80% reported that they discuss bicycle helmet use with their patients at least once before the patient reaches the age of 12 years. Provision of bicycle helmet counseling did not vary significantly by pediatricians' age, gender, or practice location. The most important predictor of provision of bicycle helmet counseling was professional experience with injured children, including having had a patient who experienced a serious injury or death due to a bicycle accident in the last year. Handle: RePEc:aph:ajpbhl:1993:83:5:728-730_7 Template-Type: ReDIF-Article 1.0 Title: Stroke mortality trends and antihypertensive drug use [5] Journal: American Journal of Public Health Author-Name: Smith, R.L. Author-Name: Pinckney, E.R. Author-Name: Casper, M. Author-Name: Wing, S. Author-Name: Strogatz, D. Author-Name: Davis, C.E. Author-Name: Tyroler, H.A. Year: 1993 Volume: 83 Issue: 11 Pages: 1642-1643 Handle: RePEc:aph:ajpbhl:1993:83:11:1642-1643_4 Template-Type: ReDIF-Article 1.0 Title: Computerized multiple cause-of-death information available from NCHS [6] Journal: American Journal of Public Health Author-Name: Wagener, D.K. Author-Name: Makuc, D.M. Author-Name: Rosenberg, H. Year: 1993 Volume: 83 Issue: 2 Pages: 290-291 Handle: RePEc:aph:ajpbhl:1993:83:2:290-291_1 Template-Type: ReDIF-Article 1.0 Title: Should oral contraceptives be available without prescription? Journal: American Journal of Public Health Author-Name: Trussell, J. Author-Name: Stewart, F. Author-Name: Potts, M. Author-Name: Guest, F. Author-Name: Ellertson, C. Year: 1993 Volume: 83 Issue: 8 Pages: 1094-1099 Abstract: In this paper, it is argued that oral contraceptives should be available without prescription. Prescription status entails heavy costs, including the dollar, time, and psychological costs of visiting a physician to obtain a prescription, the financial and human costs of unintended pregnancies that result from the obstacle to access caused by medicalization of oral contraceptives, and administrative costs to the health care system. After a review and evaluation of the reasons for strict medical control of oral contraceptives in the United States, safety concerns anticipated in response to the proposal discussed here are addressed. Also, concerns that prescription status is necessary for efficacious use are evaluated. It is concluded that neither safety nor efficacy considerations justify prescription status for oral contraceptives. Revised package design and patient labeling could allow women to screen themselves for contraindications, to educate themselves about danger signs, and to use oral contraceptives safely and successfully. Several alternatives to providing oral contraceptives by prescription with current package design and labeling and selling them over the counter are suggested; the proposals discussed would make these safe and effective contraceptives easier to obtain and to use. Handle: RePEc:aph:ajpbhl:1993:83:8:1094-1099_4 Template-Type: ReDIF-Article 1.0 Title: Infant feeding in Queensland, Australia: Long-term trends Journal: American Journal of Public Health Author-Name: Siskind, V. Author-Name: Del Mar, C. Author-Name: Schofield, F. Year: 1993 Volume: 83 Issue: 1 Pages: 103-106 Abstract: Infant feeding practices were retrospectively ascertained in a random cohort of parous women (mean age 54.8 years) from Brisbane, Australia. Reported proportions of infants who were ever breast-fed fell from around 90% before 1960 to around 70% in the early 1970s, with some subsequent increase. Similar but stronger trends were reported in proportions of infants breast- but not bottle-fed. Few maternal characteristics were associated with feeding practices, but women with more education appear to have led both the early retreat from and the later return to breast-feeding. Handle: RePEc:aph:ajpbhl:1993:83:1:103-106_9 Template-Type: ReDIF-Article 1.0 Title: Treatment for glaucoma: Adherence by the elderly Journal: American Journal of Public Health Author-Name: Gurwitz, J.H. Author-Name: Glynn, R.J. Author-Name: Monane, M. Author-Name: Everitt, D.E. Author-Name: Gilden, D. Author-Name: Smith, N. Author-Name: Avorn, J. Year: 1993 Volume: 83 Issue: 5 Pages: 711-716 Abstract: Objectives. The purpose of this study was to determine the extent of nonadherence to treatment for glaucoma among elderly patients. Methods. This was a retrospective cohort study of 2440 patients older than age 65 who were enrolled in the New Jersey Medicaid Program and who were newly initiated on a topical agent for the treatment of glaucoma. Two patient-specific measures of nonadherence were employed: (1) no filled prescription for any glaucoma medication over a 12-month period after the initiation of therapy and (2) number of days without therapy for glaucoma during this 12-month period. Results. By the first measure, 569 patients (23%) were found to be nonadherent. The mean number of days without therapy during the study year was 112. Factors associated with nonadherence included the use of glaucoma medication requiring more than 2 administrations per day and the presence of multiple other medications in the patient's drug regimen. Patients started on multiple glaucoma medications were more adherent than those started on a single agent. Age and sex were not found to be predictors of nonadherence. Conclusions. Substantial nonadherence was found to be common in this population. More attention to the issue of nonadherence could result in important benefits in the preservation of sight. Handle: RePEc:aph:ajpbhl:1993:83:5:711-716_5 Template-Type: ReDIF-Article 1.0 Title: The quality of the new birth certificate data: A validation study in North Carolina Journal: American Journal of Public Health Author-Name: Buescher, P.A. Author-Name: Taylor, K.P. Author-Name: Davis, M.H. Author-Name: Bowling, J.M. Year: 1993 Volume: 83 Issue: 8 Pages: 1163-1165 Abstract: A random sample of 395 December 1989 North Carolina birth certificates and the corresponding maternal hospital medical records were examined to validate selected items. Reporting was very accurate for birthweight. Apgar score, and method of delivery; fair to good for tobacco use, prenatal care, weight gain during pregnancy, obstetrical procedures, and events of labor and delivery; and poor for medical history and alcohol use. This study suggests that many of the new birth certificate items will support valid aggregate analyses for maternal and child health research and evaluation. Handle: RePEc:aph:ajpbhl:1993:83:8:1163-1165_6 Template-Type: ReDIF-Article 1.0 Title: Are HIV-infected injection drug users taking HIV tests? Journal: American Journal of Public Health Author-Name: Reardon, J. Author-Name: Warren, N. Author-Name: Keilch, R. Author-Name: Jenssen, D. Author-Name: Wise, F. Author-Name: Brunner, W. Year: 1993 Volume: 83 Issue: 10 Pages: 1414-1417 Abstract: Objectives. Knowledge of infection is essential for human immunodeficiency virus-type 1 (HIV-1) treatment initiation and epidemic control. This study evaluates infection knowledge among infected injection drug users and acceptance of confidential testing among injection drug users, particularly those infected with HIV-1. Methods. A total of 810 injection drug users entering treatment in Contra Costa County, Calif. were examined. Clients were tested with unlinked (blinded) tests and simultaneously counseled and offered voluntary confidential HIV-1 antibody testing. Data on confidential testing acceptance, previous testing, drug use, and demographic information were collected. Results. Of the 810 tested, 105 (13.0%) were infected. The current confidential test was accepted by 507 (62.6%). HIV seroprevalence in the unlinked survey was four times greater than in the voluntary survey (13% and 3.5%, respectively). HIV-1 infection was associated with refusal of a confidential test largely because most infected injection drug users (n = 58; 55.2%) already knew of their infection. Of the 47 injection drug users who were not aware of their infection, 12 (25.5%) accepted the test. Although African-American injection drug users presented with a higher infection rate (37.3%), they were three times less likely to know of their infection. Conclusions. 'In-clinic' HIV-1 testing is highly accepted, and most infected clients in treatment will learn their status. Nevertheless, voluntary testing data are likely to yield considerable underestimates of the true rate of infection among injection drug users. Handle: RePEc:aph:ajpbhl:1993:83:10:1414-1417_2 Template-Type: ReDIF-Article 1.0 Title: Academic medicine and the workplace Journal: American Journal of Public Health Author-Name: Alderman, M.H. Year: 1993 Volume: 83 Issue: 3 Pages: 313-314 Handle: RePEc:aph:ajpbhl:1993:83:3:313-314_1 Template-Type: ReDIF-Article 1.0 Title: The physical activity of fifth-grade students during physical education classes Journal: American Journal of Public Health Author-Name: Simons-Morton, B.G. Author-Name: Taylor, W.C. Author-Name: Snider, S.A. Author-Name: Huang, I.W. Year: 1993 Volume: 83 Issue: 2 Pages: 262-264 Abstract: One hundred fifty-seven fifth-grade students in 20 of the 355 elementary schools in one Texas county were systematically observed during physical education classes. On average, the students spent 8.5% of class time in moderate to vigorous physical activity, 23.3% in minimal activity, and 68.1% in sedentary activity. None of the schools averaged 20% of class time in moderate to vigorous physical activity. The levels of physical activity observed are substantially lower than the levels called for in national health objectives. Handle: RePEc:aph:ajpbhl:1993:83:2:262-264_0 Template-Type: ReDIF-Article 1.0 Title: Health care reform: A new public health movement Journal: American Journal of Public Health Author-Name: Young, Q.D. Year: 1993 Volume: 83 Issue: 7 Pages: 945-946 Handle: RePEc:aph:ajpbhl:1993:83:7:945-946_7 Template-Type: ReDIF-Article 1.0 Title: Firearm deaths in the United States and gun availability [4] Journal: American Journal of Public Health Author-Name: Lester, D. Year: 1993 Volume: 83 Issue: 11 Pages: 1642 Handle: RePEc:aph:ajpbhl:1993:83:11:1642_4 Template-Type: ReDIF-Article 1.0 Title: Mini funds, maxi impact: Subcontracting injury prevention projects Journal: American Journal of Public Health Author-Name: Monahan, C. Author-Name: Olson, L.M. Author-Name: Berger, L. Author-Name: Sklar, D.P. Year: 1993 Volume: 83 Issue: 10 Pages: 1487-1488 Handle: RePEc:aph:ajpbhl:1993:83:10:1487-1488_0 Template-Type: ReDIF-Article 1.0 Title: New York City's tuberculosis control efforts: The historical limitations of the 'war on consumption' Journal: American Journal of Public Health Author-Name: Lerner, B.H. Year: 1993 Volume: 83 Issue: 5 Pages: 758-766 Abstract: New York City began America's first campaign to control tuberculosis in 1893, and the disease declined until the 1970s. Throughout the 20th century, New York relied on three control strategies: screening, supervised therapy, and detention of noncompliant persons. Officials consistently identified the persistent foci of tuberculosis to be minorities and the poor, and they concentrated efforts among these populations. Recently, however, in the setting of rising human immunodeficiency virus infection and homelessness, tuberculosis-including multidrug-resistant strains-has returned to New York with a vengeance. Tuberculosis control in the city has been limited by two problems that hamper many public health programs: (1) antituberculosis measures, while appropriately targeting the poor, have been inconsistently funded and poorly coordinated; and (2) efforts have emphasized detection and treatment of individual cases rather than improvement of underlying social conditions. Renewed efforts by New York and other cities must address these limitations. Handle: RePEc:aph:ajpbhl:1993:83:5:758-766_5 Template-Type: ReDIF-Article 1.0 Title: HIV prevention: An update on the status of methods women can use Journal: American Journal of Public Health Author-Name: Stein, Z. Year: 1993 Volume: 83 Issue: 10 Pages: 1379-1381 Handle: RePEc:aph:ajpbhl:1993:83:10:1379-1381_0 Template-Type: ReDIF-Article 1.0 Title: Public reactions to AIDS in the United States: A second decade of stigma Journal: American Journal of Public Health Author-Name: Herek, G.M. Author-Name: Capitanio, J.P. Year: 1993 Volume: 83 Issue: 4 Pages: 574-577 Abstract: The pervasiveness of stigma in the United States related to the acquired immunodeficiency syndrome (AIDS) was assessed in telephone interviews with a general adult sample (n = 538) and an African-American sample (n = 607). Most respondents manifested at least some stigma. African Americans expressed greater support for policies separating persons with AIDS from others and a stronger desire to avoid these persons, whereas Whites expressed more negative feelings toward them and a greater willingness to blame them for their illness. Regardless of race, men were more likely than women to support policies such as quarantine and to say that they would avoid persons with AIDS. Handle: RePEc:aph:ajpbhl:1993:83:4:574-577_4 Template-Type: ReDIF-Article 1.0 Title: Smoking and pregnancy outcome: Trends among black teenage mothers in Missouri Journal: American Journal of Public Health Author-Name: Land, G.H. Author-Name: Stockbauer, J.W. Year: 1993 Volume: 83 Issue: 8 Pages: 1121-1124 Abstract: Objectives. The purpose of this study is to analyze the smoking changes that have occurred among pregnant Black teenagers in Missouri. The study also examines changes in Black teenage pregnancy outcomes in relation to smoking behavior changes. Methods. This analysis used computerized data files from the 1978 to 1990 Missouri birth certificates to acquire information on smoking during pregnancy for 41 544 Black teenagers and 105 170 White teenagers. All Missouri births with smoking history were included in the study. Results. During the study period, the rate for Blacks who smoked during pregnancy decreased from 37% in 1978 to less than 22% in 1990. A large part of this reduction is attributable to Black teenagers, whose smoking- during-pregnancy rate declined from 35.8% to 7.2%. Additionally, the Black teenage-specific low-birthweight rate decreased by 13.6% over the study period, possibly influenced by the decrease in smoking. Conclusions. The results indicate that a major norm has changed in smoking status among pregnant Black teenagers. Understanding the reasons behind this change could assist smoking cessation and other health promotion efforts. Handle: RePEc:aph:ajpbhl:1993:83:8:1121-1124_9 Template-Type: ReDIF-Article 1.0 Title: AIDS and the limits of control: Public health orders, quarantine, and recalcitrant behavior Journal: American Journal of Public Health Author-Name: Bayer, R. Author-Name: Fairchild-Carrino, A. Year: 1993 Volume: 83 Issue: 10 Pages: 1471-1476 Abstract: We undertook a survey to document the extent to which public health powers have been used to warn or restrict individuals infected with human immunodeficiency virus (HIV) whose behavior poses a risk of transmission to others. In the period from 1981 through 1990, 24 state health departments either had no mechanism for receiving reports about individuals whose behavior posed a risk of HIV transmission or took no action if they had received such reports. In states that had developed programs for dealing with such individuals, the most common response was the use of cease and desist orders. As of 1992, 10 instances of quarantine had been reported, almost all of which involved relatively brief periods of isolation. Whatever justification exists for using public health authority to confront individuals whose behavior poses a risk of HIV transmission to others, it is clear that the central focus of HIV prevention efforts must remain education, counseling, voluntary testing and partner notification, drug abuse treatment, and needle exchange programs. Handle: RePEc:aph:ajpbhl:1993:83:10:1471-1476_5 Template-Type: ReDIF-Article 1.0 Title: Study of hypertension in urban bus drivers questioned [4] Journal: American Journal of Public Health Author-Name: David, D.S. Author-Name: Albright, C.L. Author-Name: Li, G. Author-Name: Winkleby, M.A. Year: 1993 Volume: 83 Issue: 4 Pages: 599-601 Handle: RePEc:aph:ajpbhl:1993:83:4:599-601_3 Template-Type: ReDIF-Article 1.0 Title: AIDS deaths shift from hospital to home Journal: American Journal of Public Health Author-Name: Kelly, J.J. Author-Name: Chu, S.Y. Author-Name: Buehler, J.W. Year: 1993 Volume: 83 Issue: 10 Pages: 1433-1437 Abstract: Objective. This study monitors trends in place of death among persons with acquired immunodeficiency syndrome (AIDS) as a measure of health care usage patterns and terminal health care among persons infected with human immunodeficiency virus (HIV). Methods. Sixteen health departments collected death certificates for 55 186 persons with AIDS whose deaths occurred through 1991. Place of death was categorized as hospital, residence, hospice or nursing home, and other. Results. The percentage of AIDS deaths at hospital facilities decreased from 92% in 1983 to 57% in 1991. In 1988, 23% of deaths occurred at home or in hospices and nursing homes. This trend was more evident among men, Whites, and men who had sex with men; less so among persons with other modes of exposure; and not at all among injecting drug users and children with perinatally acquired AIDS. Place of death varied by geographic location, with the greatest percentage of hospital deaths in the Northeast (91%) and the greatest percentage of at-home deaths in the West (27%). Conclusions. The percentage of AIDS deaths at home or in hospices and nursing homes has increased since 1983. These trends may reflect changes in hospital use for end-stage HIV infection. Decreasing hospitalization and increasing outpatient services and home care will decrease costs and may allow HIV-infected persons improved social support. Handle: RePEc:aph:ajpbhl:1993:83:10:1433-1437_8 Template-Type: ReDIF-Article 1.0 Title: HIV infection in the women's jail, Orange County, California, 1985 through 1991 Journal: American Journal of Public Health Author-Name: Gellert, G.A. Author-Name: Maxwell, R.M. Author-Name: Higgins, K.V. Author-Name: Pendergast, T. Author-Name: Wilker, N. Year: 1993 Volume: 83 Issue: 10 Pages: 1454-1456 Abstract: The incidence and prevalence of human immunodeficiency virus (HIV) infection among injection drug users, prostitutes, and other women seeking confidential testing in the Orange County Women's Jail were assessed from 1985 to 1991. A total of 4616 voluntary tests were completed on 3051 women, and 865 women were tested repeatedly. Eighty-two women tested positively, a ratio of 1.8 positives per 100 tests or 2.7% of all persons tested. Cumulative HIV prevalence increased from 2.5% to 2.7% between 1985 and 1991, increased by age, and showed racial differences. Of women with multiple tests, 29 seroconverted. Incidence declined from 5.7 to 1.4 cases per 100 person-years of observation between 1985 and 1991. The overall rate of seroconversion was 1.6 per 100 person-years of observation. Handle: RePEc:aph:ajpbhl:1993:83:10:1454-1456_3 Template-Type: ReDIF-Article 1.0 Title: Preventing substance use: Rethinking strategies Journal: American Journal of Public Health Author-Name: Dryfoos, J.G. Year: 1993 Volume: 83 Issue: 6 Pages: 793-795 Handle: RePEc:aph:ajpbhl:1993:83:6:793-795_6 Template-Type: ReDIF-Article 1.0 Title: The control of iodine deficiency Journal: American Journal of Public Health Author-Name: Hetzel, B.S. Year: 1993 Volume: 83 Issue: 4 Pages: 494-495 Handle: RePEc:aph:ajpbhl:1993:83:4:494-495_4 Template-Type: ReDIF-Article 1.0 Title: Mortality differences between New York City municipal and voluntary hospitals, for selected conditions Journal: American Journal of Public Health Author-Name: Shapiro, M.F. Author-Name: Park, R.E. Author-Name: Keesey, J. Author-Name: Brook, R.H. Year: 1993 Volume: 83 Issue: 7 Pages: 1024-1026 Abstract: To determine if mortality differences between municipal and voluntary hospitals in New York City persist after adjustment for computerized administrative data (age, sex, principal diagnosis, and secondary diagnosis), six conditions in those hospitals from 1984 through 1987 were studied. Unadjusted mortality was significantly higher in municipal hospitals for myocardial infarction, stroke, and head trauma, and lower for congestive heart failure and pneumonia. Adjustment using administrative data eliminated differences for myocardial infarction, congestive heart failure, and pneumonia, but not for stroke and head trauma. We conclude that adjustment using administrative data eliminates some but not all mortality differences between municipal and voluntary hospitals. Medical record review is needed to determine why these differences persist. Handle: RePEc:aph:ajpbhl:1993:83:7:1024-1026_4 Template-Type: ReDIF-Article 1.0 Title: Retail stores compliance with a city no-smoking law Journal: American Journal of Public Health Author-Name: Rigotti, N.A. Author-Name: Stoto, M.A. Author-Name: Bierer, M.F. Author-Name: Rosen, A. Author-Name: Schelling, T. Year: 1993 Volume: 83 Issue: 2 Pages: 227-232 Abstract: Objectives. Laws restricting smoking in public places and workplaces can protect the public only if they are obeyed. We sought to assess compliance with a Cambridge, Mass, no-smoking ordinance. Methods. We prospectively observed 174 retail stores 1 month before and 3, 11, and 24 months after the law took effect. At 24 months, we interviewed one employee per store. Results. Full compliance with the law was low; at 24 months, only 4% of stores displayed the mandated sign and were free of smokers and smoke. Fewer than half the stores posted any no-smoking sign. Sign prevalence increased over 2 years (22% to 41%, P < .001), but the frequency of smoke or smokers (13% and 10%, respectively, at baseline) did not change. According to employees interviewed at 24 months, 38% of stores illegally permitted customers or employees to smoke. These stores had more smoke and fewer signs than did stores prohibiting smoking. Compliance was poor in liquor and convenience stores. Employees who had been told how to handle customers' smoking were more likely to enforce the law. Conclusions. Compliance with a no-smoking law is not guaranteed. For retail stores, compliance may improve if stores adopt no-smoking policies, post signs, and teach employees to enforce the law. Handle: RePEc:aph:ajpbhl:1993:83:2:227-232_7 Template-Type: ReDIF-Article 1.0 Title: Hormone replacement therapy: The need for reconsideration Journal: American Journal of Public Health Author-Name: Rosenberg, L. Year: 1993 Volume: 83 Issue: 12 Pages: 1670-1673 Abstract: Millions of menopausal women are taking hormone supplements. Observational studies suggest that unopposed estrogens reduce the risk of cardiovascular disease and fractures and increase the risk of endometrial cancer and, possibly, breast cancer. In the absence of information from randomized trials, how much of the apparent beneficial effect on heart disease is due to the tendency of healthier women to use these drugs is unknown. The effect on the cardiovascular system of estrogen taken with a progestin is unknown, and this regimen may increase the risk of breast cancer. An approach to health and illness that focuses on a single cause or preventive and on single organ systems is severely limited. Alternative ways to improve cardiovascular and skeletal health that do not increase the risk of cancer are available. A reconsideration of the appropriate use of hormone supplements is needed. Handle: RePEc:aph:ajpbhl:1993:83:12:1670-1673_2 Template-Type: ReDIF-Article 1.0 Title: Commentary: In search of innovative approaches to international health Journal: American Journal of Public Health Author-Name: Kark, S.L. Author-Name: Kark, E. Author-Name: Abramson, J.H. Year: 1993 Volume: 83 Issue: 11 Pages: 1533-1536 Abstract: The community health program of the Aga Khan University in Pakistan is reviewed from the perspective of historic and present-day developments in primary health care based in and focused on the community. The approach commonly referred to as community-oriented primary health care involves the complementary functions of clinical practice and epidemiology in partnership with the community. Encouragement and support by governments and other organizations for teaching and research in this field would ensure more adequate preparation of future practitioners and health scientists for community-oriented primary health care and would lead to improved health. Continuity of support for community health programs is important. Handle: RePEc:aph:ajpbhl:1993:83:11:1533-1536_5 Template-Type: ReDIF-Article 1.0 Title: Crack users' cracked lips: An additional HIV risk factor [2] Journal: American Journal of Public Health Author-Name: Porter, J. Author-Name: Bonilla, L. Year: 1993 Volume: 83 Issue: 10 Pages: 1490-1491 Handle: RePEc:aph:ajpbhl:1993:83:10:1490-1491_4 Template-Type: ReDIF-Article 1.0 Title: Reducing the use of physical restraints in nursing homes: Will it increase costs? Journal: American Journal of Public Health Author-Name: Phillips, C.D. Author-Name: Hawes, C. Author-Name: Fries, B.E. Year: 1993 Volume: 83 Issue: 3 Pages: 342-348 Abstract: Objectives. Reducing the widespread use of physical restraints in nursing homes is a primary goal of the federal nursing home reforms enacted as part of the Omnibus Budget Reconciliation Act of 1987. However, some nursing home operators assert that reducing restraint use could be prohibitively expensive, costing payors perhaps as much as $1 billion annually. We investigated whether nursing home residents free from physical restraint require more care and resources than similar residents who are restrained. Methods. We examined the major component of nursing home costs-staff time- and its allocation among residents who were physically restrained and those who were not restrained. The multivariate analysis used staff-time-study data on the care of 11 932 nursing home residents in 276 facilities in seven states. Results. The analyses indicate that, when differences in impairment and care needs are controlled for, residents who are physically restrained require more nursing care than other residents. Higher levels of nursing- assistant time were consistently provided to restrained residents. Conclusions. Residents free of restraints are less costly to care for than restrained residents. The 1987 federal requirements concerning restraint use, which are aimed at improving quality of care and quality of life, can be implemented without engendering a major increase in care costs. Handle: RePEc:aph:ajpbhl:1993:83:3:342-348_8 Template-Type: ReDIF-Article 1.0 Title: Socioeconomic status and prediction of ventricular fibrillation survival Journal: American Journal of Public Health Author-Name: Hallstrom, A. Author-Name: Boutin, P. Author-Name: Cobb, L. Author-Name: Johnson, E. Year: 1993 Volume: 83 Issue: 2 Pages: 245-248 Abstract: Objectives. The association between socioeconomic status and cardiac arrest is less well known than some other associations with cardiac arrest. We used property tax assessments as a measure of socioeconomic status in a study of victims of out-of-hospital cardiac arrest found in ventricular fibrillation. Methods. We studied patients attended by the Seattle Fire Department's emergency medical services system between May 1986 and August 1988. During the period studied, 356 episodes met the study criteria; 114 (32%) of these patients survived without major neurologic deficit. Residential property tax assessments were available for 253 of the patients. Results. After adjustments were made for age, witnessed collapse, bystander- initiated cardiopulmonary resuscitation, time from call to paramedic arrival, activity, location of collapse, and chronic morbidity, an association of survival with greater assessed value per living unit was observed. An increase of $50 000 in value per unit was associated with a 1.6-fold increase in survival rate. Conclusions. Not only are persons in the lower socioeconomic strata at greater risk for cardiac mortality, but they are also less likely to survive an episode of out-of-hospital cardiac arrest. Handle: RePEc:aph:ajpbhl:1993:83:2:245-248_0 Template-Type: ReDIF-Article 1.0 Title: The ethics of blinded HIV surveillance testing Journal: American Journal of Public Health Author-Name: Bayer, R. Year: 1993 Volume: 83 Issue: 4 Pages: 496-497 Handle: RePEc:aph:ajpbhl:1993:83:4:496-497_6 Template-Type: ReDIF-Article 1.0 Title: A method for identifying persons at high risk for sexually transmitted infections: Opportunity for targeting intervention Journal: American Journal of Public Health Author-Name: Richert, C.A. Author-Name: Peterman, T.A. Author-Name: Zaidi, A.A. Author-Name: Ransom, R.L. Author-Name: Wroten, J.E. Author-Name: Witte, J.J. Year: 1993 Volume: 83 Issue: 4 Pages: 520-524 Abstract: Objectives. The purpose of this study was to develop a method to identify persons at high risk for acquiring new sexually transmitted infections. Methods. Computerized medical records from sexually transmitted disease clinics in Dade County, Florida, were used to conduct a retrospective cohort study. For all patients who visited in 1987, risk factors were identified for returning to the clinics within a year with a new sexually transmitted infection. Predictor variables were derived from the index visit and any visits in the year prior to the index visit. Logistic regression was used to develop a model that was applied to all patients who attended in 1989. Results. Of 24 439 patients attending in 1987, 18.5% returned within a year with a new infection. Return rates were highest for 15-to 19-year-old Black males (31.8%). The highest odds ratios for returning were a diagnosis or treatment for an infection in the previous year and a diagnosis or treatment for infection at the index visit. The patients predicted to be at highest risk had a 39% return rate. There were as many new infections among the 2893 patients at highest risk as there were among the 13 326 patients at lowest risk. Conclusions. We developed a model that identifies persons at very high risk for sexually transmitted infection. These persons should be targeted for intensive intervention to reduce their risk. Handle: RePEc:aph:ajpbhl:1993:83:4:520-524_6 Template-Type: ReDIF-Article 1.0 Title: Estimated condom failure and frequency of condom use among gay men Journal: American Journal of Public Health Author-Name: Thompson, J.L.P. Author-Name: Yager, T.J. Author-Name: Martin, J.L. Year: 1993 Volume: 83 Issue: 10 Pages: 1409-1413 Abstract: Objectives. Condoms are designed to bar transmission of the human immunodeficiency virus (HIV), but they sometimes fail. This paper explores the effect of experience with condoms on condom failure among gay men. Methods. Risk of condom failure (breakage or slippage) on a single occasion is estimated for four sexual acts reported over 12 months by a sample of gay New York City men (n = 741). The estimation procedure assumes that each episode in which a condom is used is an independent event. Evidence is offered to support this assumption. Results. Risk of condom failure in a single episode was fairly high, particularly in anal intercourse, for men who had engaged in each act only a few times in the previous year. It declined rapidly with experience (e.g., to below 1% for receptive anal intercourse after about 10 episodes in the previous year). Condoms failed less are often in oral than anal sex, but estimated risk of failure also decreased with experience. Conclusions. Gay men should be especially cautious the first few times they use a condom; after moderate experience, however, they may expect a low risk of condom failure. Handle: RePEc:aph:ajpbhl:1993:83:10:1409-1413_8 Template-Type: ReDIF-Article 1.0 Title: HIV transmission: Women's risk from bisexual men Journal: American Journal of Public Health Author-Name: Wood, R.W. Author-Name: Krueger, L.E. Author-Name: Pearlman, T.C. Author-Name: Goldbaum, G. Year: 1993 Volume: 83 Issue: 12 Pages: 1757-1759 Abstract: The purpose of this study was to characterize the risk of human immunodeficiency virus (HIV) infection for men who have sex with men and to identify the risk such men pose to their female sex partners. The subjects were 5480 men who were tested for HIV between January 1987 and December 1991 and who reported having had sex with a man since 1977. Men who identified themselves as bisexual or straight were more likely to use injection drugs, had a substantial HIV seroprevalence, and reported many more female partners than men who identified themselves as gay. Men who identify themselves as bisexual pose the greatest risk to their female partners. Handle: RePEc:aph:ajpbhl:1993:83:12:1757-1759_8 Template-Type: ReDIF-Article 1.0 Title: Community hospitals can increase staff influenza vaccination rates Journal: American Journal of Public Health Author-Name: Shannon, S.C. Year: 1993 Volume: 83 Issue: 8 Pages: 1174-1175 Handle: RePEc:aph:ajpbhl:1993:83:8:1174-1175_6 Template-Type: ReDIF-Article 1.0 Title: Changing HIV risk behaviors: The case against pessimism [2] Journal: American Journal of Public Health Author-Name: Galavotti, C. Author-Name: Beeker, C. Year: 1993 Volume: 83 Issue: 12 Pages: 1791-1792 Handle: RePEc:aph:ajpbhl:1993:83:12:1791-1792_5 Template-Type: ReDIF-Article 1.0 Title: Fatal occupational injury rates: Quebec, 1981 through 1988 Journal: American Journal of Public Health Author-Name: Rossignol, M. Author-Name: Pineault, M. Year: 1993 Volume: 83 Issue: 11 Pages: 1563-1566 Abstract: Objectives. The purpose of the study was to estimate the death rates from occupational injuries in the province of Quebec for the period 1981 through 1988. Methods. Worker's compensation files were used to ascertain numbers of deaths, which were used as the numerators in figuring the rates (it was estimated that these files reported 83% of the true number of deaths among men). Annual average estimates of the labor force were used as denominators. Results. From 1981 through 1988, compensation was awarded for 1227 fatal work injuries. Among men (96% of the victims), rates declined from 1981 to 1988 (from 12.7 to 8.1 per 100 000); women's rates were stable (≤1.0 per 100 000). Compared with men, women had excess mortality from violent acts. Motor vehicle crashes accounted for 36% of all fatal injuries in 1984 and 1985 and declined thereafter. Fatal injury rates in forestry and mining rose to a 1987 maximum of 67.6 per 100 000. The construction sector had the largest number of deaths, despite a decline in rates from 1981 to 1988 (from 27.8 to 15.9 per 100 000). Conclusions. Except for construction and agriculture, reported fatal occupational injury rates in Quebec were similar to those in the United States. Motor vehicle crashes, falls, violent acts, and farming-related injuries were the most frequent causes of death. Handle: RePEc:aph:ajpbhl:1993:83:11:1563-1566_5 Template-Type: ReDIF-Article 1.0 Title: From Lillian Wald to Hillary Rodham Clinton: What will happen to public health nursing? Journal: American Journal of Public Health Author-Name: Reverby, S.M. Year: 1993 Volume: 83 Issue: 12 Pages: 1662-1663 Handle: RePEc:aph:ajpbhl:1993:83:12:1662-1663_1 Template-Type: ReDIF-Article 1.0 Title: Abnormal chest x-rays in intravenous drug users: Implications for tuberculosis screening programs Journal: American Journal of Public Health Author-Name: Bellin, E. Author-Name: Fletcher, D. Author-Name: Safyer, S. Year: 1993 Volume: 83 Issue: 5 Pages: 698-700 Abstract: Objectives. The purpose of the study was to (1) determine the prevalence of significant abnormalities in routine chest x-rays used to screen for pulmonary tuberculosis in intravenous drug users and (2) evaluate the ability of the purified protein derivative skin test to identify persons with such abnormalities. Methods. We conducted a cross-sectional screening study on 1314 persons admitted to an opiate detoxification unit in an urban jail. Purified protein derivative tuberculin reactivity and the prevalence of abnormalities consistent with tuberculosis on screening chest x-rays were evaluated. The chest x-ray was obtained independent of the skin test. Results. The chest x-rays of 73 of the inmates (5.6%) showed abnormalities consistent with tuberculosis. Tuberculin skin testing missed 17 of 26 chest x-rays (65%) with significant infiltrates. Conclusions. Purified protein derivative screening is insensitive to chest x-ray abnormalities that require additional diagnostic evaluation for tuberculosis. Routine chest studies should be performed on all intravenous drug users admitted to congregate housing settings. Handle: RePEc:aph:ajpbhl:1993:83:5:698-700_2 Template-Type: ReDIF-Article 1.0 Title: An injury prevention program in an urban African-American community Journal: American Journal of Public Health Author-Name: Schwarz, D.F. Author-Name: Grisso, J.A. Author-Name: Miles, C. Author-Name: Holmes, J.H. Author-Name: Sutton, R.L. Year: 1993 Volume: 83 Issue: 5 Pages: 675-680 Abstract: Objectives. Injury is a major US public health problem, particularly in urban minority communities. This paper evaluates the impact of the Safe Block Project, a comprehensive injury prevention trial, on home hazards and injury prevention knowledge in a poor urban African-American community. Methods. Nine census tracts in the community were allocated to either the intervention area or the control area. The intervention, carried out by trained community outreach workers, consisted of (1) home modification for simple prevention measures, (2) home inspection accompanied by information about home hazards, and (3) education about selected injury prevention practices. Approximately 12 months after the intervention, random samples of control and intervention homes were assessed for home hazards and injury prevention knowledge. Results. A significantly larger proportion of intervention homes than control homes had functioning smoke detectors, syrup of ipecac, safely stored medications, and reduced electrical and tripping hazards. No consistent differences were observed between control and intervention homes on home hazards requiring major effort to correct. Conclusions. There was a distinct difference between control and intervention homes with respect to safety knowledge and home hazards requiring minimal to moderate effort to correct. The Safe Block Project could serve as a model for future urban injury prevention efforts. Handle: RePEc:aph:ajpbhl:1993:83:5:675-680_8 Template-Type: ReDIF-Article 1.0 Title: Drug users' self-reported false-positive HIV status [5] Journal: American Journal of Public Health Author-Name: Ross, M.W. Author-Name: Loxley, W. Author-Name: Wodak, A. Author-Name: Buzolic, A. Author-Name: Monheit, B. Author-Name: Stowe, A. Author-Name: McCusker, J. Author-Name: Stoddard, A.M. Year: 1993 Volume: 83 Issue: 9 Pages: 1349-1351 Handle: RePEc:aph:ajpbhl:1993:83:9:1349-1351_5 Template-Type: ReDIF-Article 1.0 Title: Sentinel surveillance for HIV-2 infection in high-risk US populations Journal: American Journal of Public Health Author-Name: Onorato, I.M. Author-Name: O'Brien, T.R. Author-Name: Schable, C.A. Author-Name: Spruill, C. Author-Name: Holmberg, S.D. Year: 1993 Volume: 83 Issue: 4 Pages: 515-519 Abstract: Objectives. We conducted sentinel surveillance in persons practicing behaviors known to transmit retroviruses to determine the US presence and extent of human immunodeficiency virus type 2 (HIV-2). Methods. Sentinel surveillance for HIV-2 was conducted by testing 31 533 anonymous blood specimens from patients at sexually transmitted disease clinics, injecting drug users at treatment centers, and clients at HIV counseling and testing sites in 14 US cities where West African immigrants often settle. Specimens were tested by HIV-1 and HIV-2 whole virus and synthetic peptide enzyme immunoassay and confirmed by HIV-1 and HIV-2 Western blots. Results. Nearly 10% of 31 533 sera were positive for HIV-1. Two heterosexual Black male sexually transmitted disease patients were infected with HIV-2. One of the HIV-2 positive specimens did not cross-react on HIV-1 enzyme immunoassay screening. One client had antibodies consistent with malarial infection in West Africa; the other, who had syphilis, did not have antibodies to malaria or to any of 20 arboviruses present in Africa. Conclusions. Clinics serving clients from HIV-2 endemic areas should test persons practicing risk behaviors for both HIV-1 and HIV-2. Sentinel surveillance for HIV-2 serves as an early warning system for the possible spread of this virus in the United States. Handle: RePEc:aph:ajpbhl:1993:83:4:515-519_3 Template-Type: ReDIF-Article 1.0 Title: Cause of death in patients with end-stage renal disease: Death certificates vs registry reports Journal: American Journal of Public Health Author-Name: Perneger, T.V. Author-Name: Klag, M.J. Author-Name: Whelton, P.K. Year: 1993 Volume: 83 Issue: 12 Pages: 1735-1738 Abstract: Objectives. The purpose of this study was to assess agreement on cause of death reporting in end-stage renal disease patients by comparing death certificates and reports to an end-stage renal disease registry. Methods. Death certificates and registry reporting forms were retrieved for a random sample of 335 treated end-stage renal disease patients who died between 1980 and 1986 in Maryland. On the registry form, patient death was ascribed to 1 of 22 precoded causes by the patient's nephrologist of record. Corresponding death certificates were coded, according to rules of the International Classification of Diseases, 9th edition, by a trained observer unaware of the registry report. Agreement was measured by the kappa statistic. Results. Overall cause of death agreement was poor (31%), and varied by the following categories: renal disease (40% on death certificates vs 0% on registry reports), cardiovascular disease (26% vs 47%), infectious disease (16% vs 22%), cancer (7% vs 5%), and withdrawal from therapy (0% vs 3%). Agreement was higher for transplant recipients than for dialyzed patients. Conclusions. Death certificates and registry reports yield different descriptions of mortality in end-stage renal disease patients. These sources of information should not be used interchangeably. Improvements to International Classification of Diseases coding of renal diseases and the determination of the reliability and validity of the US Renal Data System reporting process are necessary steps in the development of renal disease epidemiology. Handle: RePEc:aph:ajpbhl:1993:83:12:1735-1738_2 Template-Type: ReDIF-Article 1.0 Title: The availability of disaster preparation courses at US schools of public health [6] Journal: American Journal of Public Health Author-Name: Landesman, L.Y. Year: 1993 Volume: 83 Issue: 10 Pages: 1494-1495 Handle: RePEc:aph:ajpbhl:1993:83:10:1494-1495_9 Template-Type: ReDIF-Article 1.0 Title: Safety behavior among Iowa junior high and high school students Journal: American Journal of Public Health Author-Name: Schootman, M. Author-Name: Fuortes, L.J. Author-Name: Zwerling, C. Author-Name: Albanese, M.A. Author-Name: Watson, C.A. Year: 1993 Volume: 83 Issue: 11 Pages: 1628-1630 Abstract: The goal of this study was to determine demographic factors associated with reported safety behavior by studying 2250 Iowa junior high and high school students via a self-administered questionnaire. Students attending rural schools used front seat belts and helmets less frequently than urban students. Seat belt and helmet use and swim safety decreased dramatically with age. Occurrences of driving or riding while drunk or high increased with age. Boys were less likely than girls to wear back seat belts and moped helmets and to check water depth before diving. Possession of a driver's license was not independently associated with any of the safety behaviors. Handle: RePEc:aph:ajpbhl:1993:83:11:1628-1630_3 Template-Type: ReDIF-Article 1.0 Title: Variation in cesarean section rates among hospital in Washington State Journal: American Journal of Public Health Author-Name: McKenzie, L. Author-Name: Stephenson, P.A. Year: 1993 Volume: 83 Issue: 8 Pages: 1109-1112 Abstract: Objectives. This study examined hospital characteristics and hospital population risk factors and their associations with hospital-specific cesarean section rates in Washington State. Methods. Data were obtained from 1987 birth certificates. The study population included all hospitals that had 12 or more singleton live births. Results. Hospital-specific cesarean section rates varied from 0% to 43% and were positively associated with proprietary ownership, size of delivery service, and the proportions of women who had complications or high-birthweight infants. The proportion of women who had late prenatal care was inversely associated with cesarean section rates. Although proprietary hospitals had higher cesarean section rates, their patient populations were lower risk than patients of public or teaching hospitals. Conclusions. Variation in cesarean section rates among hospitals cannot be fully explained by either hospital or patient population characteristics. A combined strategy may be necessary to lower unjustifiably high cesarean section rates. Handle: RePEc:aph:ajpbhl:1993:83:8:1109-1112_1 Template-Type: ReDIF-Article 1.0 Title: Erratum: The implications of an epidemiological mistake: A community's response to a perceived excess cancer risk (Am J Public Health (1993) 83 (233-239)) Journal: American Journal of Public Health Author-Name: Guidotti, T.L. Author-Name: Jacobs, P. Year: 1993 Volume: 83 Issue: 5 Pages: 666 Handle: RePEc:aph:ajpbhl:1993:83:5:666_9 Template-Type: ReDIF-Article 1.0 Title: Evaluating the nutrition screening initiative Journal: American Journal of Public Health Author-Name: Rush, D. Year: 1993 Volume: 83 Issue: 7 Pages: 944-945 Handle: RePEc:aph:ajpbhl:1993:83:7:944-945_9 Template-Type: ReDIF-Article 1.0 Title: Expenditures in caring for patients with dementia who live at home Journal: American Journal of Public Health Author-Name: Weinberger, M. Author-Name: Gold, D.T. Author-Name: Divine, G.W. Author-Name: Cowper, P.A. Author-Name: Hodgson, L.G. Author-Name: Schreiner, P.J. Author-Name: George, L.K. Year: 1993 Volume: 83 Issue: 3 Pages: 338-341 Abstract: Objectives. Given the national interest in progressive dementia, we estimated expenditures incurred in caring for dementia patients who live at home. Methods. Primary caregivers of 264 patients from a university-based memory disorders clinic were interviewed at baseline and asked to keep service use diaries for 6 months; 141 caregivers who returned the diaries are the focus of this report. We examined both formal and informal services (distinguished by whether money was exchanged) and associated expenditures. Results. Neither caregivers returning diaries nor their patients differed at baseline from those not returning diaries and their patients. Expenditures incurred over 6 months were extensive for both formal ($6986) and informal ($786) services. Out-of-pocket expenditures were high (e.g., in-home companion or sitter, adult day care, visiting nurse). Multivariable analyses indicated that patients with more severe symptoms of dementia and families with higher incomes reported significantly higher expenditures. Conclusions. The expense of caring for patients with progressive dementia living at home may be higher than previously estimated and frequently involves expenses paid directly by patients and their families. Handle: RePEc:aph:ajpbhl:1993:83:3:338-341_4 Template-Type: ReDIF-Article 1.0 Title: The choice of weapons in firearm suicides in Iowa Journal: American Journal of Public Health Author-Name: Zwerling, C. Author-Name: Lynch, C.F. Author-Name: Burmeister, L.F. Author-Name: Goertz, U. Year: 1993 Volume: 83 Issue: 11 Pages: 1630-1632 Abstract: This study reports the types of firearms used in firearm suicides in Iowa and tests the hypothesis that the use of handguns, rifles, and shotguns in such suicides reflects the availability of these weapons. The percentage of firearm suicides involving handguns increased from 36.6% in 1980 through 1984 to 43.3% during 1990 and 1991. In both time periods, the use of handguns was more likely than would be expected from their household prevalence. Our data suggest that handguns are disproportionately represented among firearm suicides and that this overrepresentation has increased during the last decade. Handle: RePEc:aph:ajpbhl:1993:83:11:1630-1632_2 Template-Type: ReDIF-Article 1.0 Title: Health insurance and subjective health status: Data from the 1987 National Medical Expenditure Survey Journal: American Journal of Public Health Author-Name: Franks, P. Author-Name: Clancy, C.M. Author-Name: Gold, M.R. Author-Name: Nutting, P.A. Year: 1993 Volume: 83 Issue: 9 Pages: 1295-1299 Abstract: Objectives. The relationship between health insurance and subjective health status was investigated. It was hypothesized that persons without health insurance would have lower levels of subjective health status than those with health insurance and that this relationship would hold for both poor and nonpoor persons. Methods. Data from the 1987 National Medical Expenditure Survey were analyzed to examine the relationship between health insurance and self-reported health status. The analysis controlled for sociodemographic and attitudinal variables and medical conditions. Results. Persons without health insurance had significantly lower levels of subjective health status than did persons with insurance. This adverse effect persisted after adjustments were made for the effects of age, sex, race, income, attitude toward the value of medical care and health insurance, and medical conditions. The detrimental effect of lacking health insurance on subjective health status was present for persons at all income levels and was greater than the effect on subjective health status found for 2 of the 11 reported medical conditions. Conclusions. Lacking health insurance is associated with clinically significant lower levels of subjective health status in both poor and non-poor persons. Handle: RePEc:aph:ajpbhl:1993:83:9:1295-1299_2 Template-Type: ReDIF-Article 1.0 Title: Chlamydial cervical infection in jailed women Journal: American Journal of Public Health Author-Name: Holmes, M.D. Author-Name: Safyer, S.M. Author-Name: Bickell, N.A. Author-Name: Vermund, S.H. Author-Name: Hanff, P.A. Author-Name: Phillips, R.S. Year: 1993 Volume: 83 Issue: 4 Pages: 551-555 Abstract: Objectives. The prevalence of Chlamydia trachomatis cervical infection in incarcerated adult women has not been reported. To develop a policy for testing and treatment, we determined the prevalence of and risk factors for chlamydial infection in women in a New York City jail. Methods. Interviews and cervical cultures for C trachomatis were obtained from 101 consenting female inmates. Results. Positive cultures for C trachomatis were found in 27% of the participants. Mucopurulent cervical discharge and education of 8 years or less were two independent risk factors for infection, but only 63% of the infected women had one or both of these factors. If pelvic tenderness were considered as a third factor, an additional 7% of the infected women would have been identified. Conclusions. The prevalence of chlamydial infection in this population was as high as that in populations for which presumptive treatment is recommended. Although the optimal policy for detection and treatment of chlamydial infection may vary depending on practical considerations, we suggest that women entering correctional facilities should be screened or offered presumptive therapy for C trachomatis infection. Handle: RePEc:aph:ajpbhl:1993:83:4:551-555_5 Template-Type: ReDIF-Article 1.0 Title: Preventing adolescent drug use: Long-term results of a junior high program Journal: American Journal of Public Health Author-Name: Ellickson, P.L. Author-Name: Bell, R.M. Author-Name: McGuigan, K. Year: 1993 Volume: 83 Issue: 6 Pages: 856-861 Abstract: Objectives. Although several studies have reported short-term gains for drug-use prevention programs targeted at young adolescents, few have assessed the long-term effects of such programs. Such information is essential for judging how long prevention benefits last. This paper reports results over a 6-year period for a multisite randomized trial that achieved reductions in drug use during the junior high school years. Methods. The 11-lesson curriculum, which was tested in 30 schools in eight highly diverse West Coast communities, focused on helping 7th and 8th grade students develop the motivation and skills to resist drugs. Schools were randomly assigned to treatment and control conditions. About 4000 students were assessed in grade 7 and six times thereafter through grade 12. Program effects were adjusted for pretest covariates and school effects. Results. Once the lessons stopped, the program's effects on drug use stopped. Effects on cognitive risk factors persisted for a longer time (many through grade 10), but were not sufficient to produce corresponding reductions in use. Conclusions. It is unlikely that early prevention gains can be maintained without additional prevention efforts during high school. Future research is needed to develop and test such efforts. Handle: RePEc:aph:ajpbhl:1993:83:6:856-861_0 Template-Type: ReDIF-Article 1.0 Title: Acculturation and gender differences in sexual attitudes and behaviors: Hispanic vs non-Hispanic White unmarried adults Journal: American Journal of Public Health Author-Name: Marin, B.V. Author-Name: Tschann, J.M. Author-Name: Gomez, C.A. Author-Name: Kegeles, S.M. Year: 1993 Volume: 83 Issue: 12 Pages: 1759-1761 Abstract: Understanding how acculturation and gender affect Hispanics' sexual behavior is needed to prevent infection with the human immunodeficiency virus. We examined differences in and correlates of condom use among 398 Hispanics and 540 non-Hispanic Whites in San Francisco who were part of a random probability sample of unmarried adults. Hispanic women reported fewer sexual partners than all other groups. Condom use was low in all groups, but Spanish-speaking Hispanic women reported lower condom use than White women. Hispanics, generally, had poorer attitudes toward condoms and were less likely than non-Hispanic Whites to believe they could avoid acquired immunodeficiency syndrome. Hispanics need targeted prevention interventions. Handle: RePEc:aph:ajpbhl:1993:83:12:1759-1761_8 Template-Type: ReDIF-Article 1.0 Title: Underreporting of diabetes on death certificates, King County, Washington Journal: American Journal of Public Health Author-Name: Andresen, E.M. Author-Name: Lee, J.A.H. Author-Name: Pecoraro, R.L. Author-Name: Koepsell, T.D. Author-Name: Hallstrom, A.P. Author-Name: Siscovick, D.S. Year: 1993 Volume: 83 Issue: 7 Pages: 1021-1024 Abstract: We estimated the reporting of diabetes on death certificates for persons known to have diabetes. Surveillance of 19 hospitals and two paramedic emergency medical services during 12 months in Seattle and King County, Washington, ascertained acute ischemic heart disease events for persons with diabetes and yielded 1235 persons with suspected ischemic heart disease. Mortality was 23.6%, and 41% of death certificates listed diabetes. The reporting of diabetes on the death certificate was not random, and it varied by patient and physician characteristics. Diabetes is strongly linked to fatal ischemic heart disease, but its importance is underrepresented by death certificates for some subgroups. Handle: RePEc:aph:ajpbhl:1993:83:7:1021-1024_0 Template-Type: ReDIF-Article 1.0 Title: Multidisciplinary findings on socioeconomic status and health [5] Journal: American Journal of Public Health Author-Name: Leigh, J.P. Author-Name: Winkleby, M. Author-Name: Jatulis, D.E. Author-Name: Frank, E. Year: 1993 Volume: 83 Issue: 2 Pages: 289-290 Handle: RePEc:aph:ajpbhl:1993:83:2:289-290_5 Template-Type: ReDIF-Article 1.0 Title: Cardiovascular diseases in a Canadian Arctic population Journal: American Journal of Public Health Author-Name: Young, T.K. Author-Name: Moffatt, M.E.K. Author-Name: O'Neil, J.D. Year: 1993 Volume: 83 Issue: 6 Pages: 881-887 Abstract: Objectives. The purpose of this study was to review cardiovascular mortality, morbidity, and risk factors in the multiethnic population of the Northwest Territories, Canada. Methods. We analyzed death certificates and hospital records, and used a community health and examination survey. Results. The age-standardized mortality rate for ischemic heart disease (but not for other heart diseases or stroke) among the Northwest Territories population was lower than among the Canadian population. Among the indigenous Inuit/Eskimos and Indians, the age-standardized mortality rate for all circulatory diseases was lower than Canadians. Among Indian women, the rate approached the Canadian rate and exceeded that of Inuit and non-Natives. Compared with residents of Manitoba, Northwest Territories Inuit adults had a higher prevalence of smoking in all age-sex groups. Obesity was prevalent among older Inuit women and hypertension among young Inuit men. Except for women aged 25 to 44, the total cholesterol and triglyceride levels among Inuit were lower than or not different from Manitoba residents. Relatively high levels of high-density lipoprotein were found in older Inuits. Conclusions. The epidemiologic pattern of cardiovascular diseases in Arctic Canada differs from that among non-Native, southern Canadians. Rapid sociocultural changes may alter the situation, and health agencies must anticipate such transitions and intensify culturally appropriate control programs. Handle: RePEc:aph:ajpbhl:1993:83:6:881-887_7 Template-Type: ReDIF-Article 1.0 Title: American adults' knowledge of HIV testing availability Journal: American Journal of Public Health Author-Name: Valdiserri, R.O. Author-Name: Holtgrave, D.R. Author-Name: Brackbill, R.M. Year: 1993 Volume: 83 Issue: 4 Pages: 525-528 Abstract: Objectives. Understanding client needs, knowledge, and preferences about services is necessary to ensure that human immunodeficiency virus (HIV) counseling and testing programs are accessible. This study addressed knowledge of HIV testing availability. Methods. To study American adults' knowledge of HIV testing availability, we collected data during 1990 by random digit-dialing telephone surveys of adults residing in 44 states and the District of Columbia. Results. Of the 81 557 persons who responded, almost two thirds identified medical doctors as a source of HIV testing. Fourteen percent identified public sites, and 12% said they didn't know where to go for HIV testing. Persons who were older, less educated, and had lower incomes were less likely to know where they could go for testing. Persons identifying public sites shared some characteristics with others who lacked adequate health care coverage. Conclusions. Physicians will be increasingly called upon to provide HIV counseling and testing to their patients. This may require additional training to provide effective, individualized, risk- reduction messages about sexual and drug use behaviors. Even when persons have adequate information about availability, sociodemographic characteristics are likely to influence preferences for HIV counseling and testing. Handle: RePEc:aph:ajpbhl:1993:83:4:525-528_1 Template-Type: ReDIF-Article 1.0 Title: New York City's Metropolitan Area Breast Cancer Awareness Partnership Journal: American Journal of Public Health Author-Name: Marconi, K.M. Author-Name: Pruzan, M. Author-Name: Johnson, A.M. Year: 1993 Volume: 83 Issue: 6 Pages: 905-907 Handle: RePEc:aph:ajpbhl:1993:83:6:905-907_7 Template-Type: ReDIF-Article 1.0 Title: A work-site nutrition intervention: Its effects on the consumption of cancer-related nutrients Journal: American Journal of Public Health Author-Name: Hebert, J.R. Author-Name: Harris, D.R. Author-Name: Sorensen, G. Author-Name: Stoddard, A.M. Author-Name: Hunt, M.K. Author-Name: Morris, D.H. Year: 1993 Volume: 83 Issue: 3 Pages: 391-394 Abstract: Objectives. In a work-site nutrition intervention targeting fat and fiber, we examined the intervention's effect on specific nutrients implicated in carcinogenesis, including trace metals, vitamins, and categories of fatty acids. The rationale was based on the association observed in a variety of epidemiologic studies between these nutrients and epithelial cancers. Methods. Data were taken from eight control companies and five intervention companies that fully implemented the Treatwell intervention. Analyses of variance were used preserving the study's nested design. Results. Significant intervention-related associations were observed for increased total vitamin A and carotene. Marginal intervention effects were observed for relative decreases in the percentage of calories from both saturated and monounsaturated fatty acids, a relatively smaller increase in the percentage of calories from polyunsaturated fatty acids, and an increase in the consumption of vitamin B6. Conclusions. Results indicate a broader effect of the intervention than on fat and fiber only. Increased intake of carotene, the single most important of these other nutrients, is plausibly related to a variety of epithelial cancers. Handle: RePEc:aph:ajpbhl:1993:83:3:391-394_5 Template-Type: ReDIF-Article 1.0 Title: Preventing tap water scalds: Do consumers change their preset thermostats? Journal: American Journal of Public Health Author-Name: Webne, S.L. Author-Name: Kaplan, B.J. Year: 1993 Volume: 83 Issue: 10 Pages: 1469-1470 Abstract: One goal of the regulatory approach to tap water scald prevention is the installation of hot water heaters at thermostat settings considered safe. In this strategy, it is assumed that consumers will not change preset thermostat settings, an assumption evaluated in a study of 62 families. It was found that 60% of the sample did not change their preset thermostats. Surprisingly, some of those families (27%) who did not increase their settings still had unsafe (>54°C) water temperatures. Handle: RePEc:aph:ajpbhl:1993:83:10:1469-1470_4 Template-Type: ReDIF-Article 1.0 Title: Weapon carrying among inner-city junior high school students: Defensive behavior vs aggressive delinquency Journal: American Journal of Public Health Author-Name: Webster, D.W. Author-Name: Gainer, P.S. Author-Name: Champion, H.R. Year: 1993 Volume: 83 Issue: 11 Pages: 1604-1608 Abstract: Objectives. The purpose of this study was to estimate associations between beliefs and experiences hypothesized to be related to weapon carrying among youths. Methods. Students in two inner-city junior high schools completed anonymous questionnaires. Logistic regression models were fit for having ever carried a weapon for protection or use in a fight and were stratified by sex and weapon type. Results. Among males, 47% had carried knives and 25% had carried guns. Key risk factors for knife carrying were being threatened with a knife, getting into fights, and disbelief that having a weapon increases the carrier's risk of injury. Gun carrying was associated with having been arrested, knowing more victims of violence, starting fights, and being willing to justify shooting someone. Among females, 37% had carried a knife; knowing many victims of violence and being willing to justify shooting someone predicted knife carrying. Conclusions. Knife carrying was associated with aggressiveness but did not appear to be related to serious delinquency. Gun carrying within this nonrandom sample appeared to be a component of highly aggressive delinquency rather than a purely defensive behavior. Handle: RePEc:aph:ajpbhl:1993:83:11:1604-1608_1 Template-Type: ReDIF-Article 1.0 Title: Sexual behavior and exposure to HIV infection: Estimates from a general- population risk index Journal: American Journal of Public Health Author-Name: Campostrini, S. Author-Name: McQueen, D.V. Year: 1993 Volume: 83 Issue: 8 Pages: 1139-1143 Abstract: Objectives. The spread of the human immunodeficiency virus (HIV) in the general population has been a much debated topic in the mass media. The aim of this study was to create an approach to estimating the risk of exposure to HIV resulting from sexual behaviors. Methods. A theoretical estimate was applied to data obtained from a large-scale risk factor survey carried out in Britain. An HIV infection-exposure risk index was constructed by ranking different sex-related categorizations derived from variables in the survey. Results. The risk index involved a Delphi-based assessment of self-reported behavioral factors associated with HIV exposure and subsequent transmission. Roughly 85% of the adult population aged 18 to 50 were estimated to be at some risk for behavioral exposure to HIV virus with regard to reported sexual behavior. Over time, those who could be considered at no risk have declined as a proportion of the population. Conclusions. The estimates appear to refute commonplace assertions that exposure to HIV through sexual behavior is not a problem for general populations. Handle: RePEc:aph:ajpbhl:1993:83:8:1139-1143_0 Template-Type: ReDIF-Article 1.0 Title: Activity, inactivity, and obesity: Racial, ethnic, and age differences among schoolgirls Journal: American Journal of Public Health Author-Name: Wolf, A.M. Author-Name: Gortmaker, S.L. Author-Name: Cheung, L. Author-Name: Gray, H.M. Author-Name: Herzog, D.B. Author-Name: Colditz, G.A. Year: 1993 Volume: 83 Issue: 11 Pages: 1625-1627 Abstract: Physical activity, inactivity, and obesity were assessed by questionnaire among a multiethnic sample of 552 girls in grades 5 through 12. Hispanics and Asians reported lower activity levels than other racial groups. Only 36% of the entire sample and less than one fifth of either Asians or Hispanics met the year 2000 goal for strenuous physical activity. Physical activity was inversely associated with age and age-adjusted body mass index. Obesity was unrelated to inactivity. Handle: RePEc:aph:ajpbhl:1993:83:11:1625-1627_3 Template-Type: ReDIF-Article 1.0 Title: The authorship and fate of international health papers submitted to the American Journal of Public Health in 1989 Journal: American Journal of Public Health Author-Name: Koch-Weser, D. Author-Name: Yankauer, A. Year: 1993 Volume: 83 Issue: 11 Pages: 1618-1620 Abstract: We reviewed the authorship characteristics, editorial processing, and final fate of 126 papers dealing with data from countries other than the United States and Canada and submitted to the American Journal of Public Health in 1989. The acceptance rate of these international health papers was 22%, similar to that of all papers (25%). Authors from developed countries had higher acceptance rates than authors from developing countries, but the highest acceptance rate (36%) was for international health papers with joint authorship from both developed and developing countries. Of 83 rejected papers, 72% were published in other journals. Of these, 45% were published in journals covered by Index Medicus, a figure similar to that for all papers rejected by the Journal. Handle: RePEc:aph:ajpbhl:1993:83:11:1618-1620_4 Template-Type: ReDIF-Article 1.0 Title: How safe is the consumption of trona? [5] Journal: American Journal of Public Health Author-Name: Sodipo, O.A. Year: 1993 Volume: 83 Issue: 8 Pages: 1181 Handle: RePEc:aph:ajpbhl:1993:83:8:1181_4 Template-Type: ReDIF-Article 1.0 Title: Cervical cancer and health care resources in Newark, New Jersey, 1970 to 1988 Journal: American Journal of Public Health Author-Name: Holland, B.K. Author-Name: Foster, J.D. Author-Name: Louria, D.B. Year: 1993 Volume: 83 Issue: 1 Pages: 45-48 Abstract: Objectives. In the past, the predominantly Black population of Newark, NJ, had little access to programs promoting or providing Pap tests. The ratio of in situ to invasive cases of cervical carcinoma was markedly reduced in all age categories, indicating inadequate screening for this cancer in this population. Funding became available to provide and publicize Pap smears but ceased after 5.5 years. We examined the effect of these changes in funding. Methods. Data came from all Newark hospitals and practitioners and from the state cancer registry. There are now data on incidence of in situ and invasive cervical cancer in Newark from 1970 through 1988, including years before, during, and after program funding. Results. The ratio of in situ to invasive cervical cancer increased and decreased in a striking parallel with the provision and subsequent cessation of funding. Conclusions. Cessation of funding of education and screening programs can result in resumption of an unfavorable in situ/invasive cervical carcinoma ratio in a poor population. Handle: RePEc:aph:ajpbhl:1993:83:1:45-48_0 Template-Type: ReDIF-Article 1.0 Title: Risk factors for early adolescent drug use in four ethnic and racial groups Journal: American Journal of Public Health Author-Name: Vega, W.A. Author-Name: Zimmerman, R.S. Author-Name: Warheit, G.J. Author-Name: Apospori, E. Author-Name: Gil, A.G. Year: 1993 Volume: 83 Issue: 2 Pages: 185-189 Abstract: Objectives. It is widely believed that risk factors identified in previous epidemiologic studies accurately predict adolescent drug use. Comparative studies are needed to determine how risk factors vary in prevalence, distribution, sensitivity, and pattern across the major US ethnic/racial groups. Methods. Baseline questionnaire data from a 3-year epidemiologic study of early adolescent development and drug use were used to conduct bivariate and multivariate risk factor analyses. Respondents (n = 6760) were sixth- and seventh-grade Cuban, other Hispanic, Black, and White non-Hispanic boys in the 48 middle schools of the greater Miami (Dade County) area. Results. Findings indicate 5% lifetime illicit drug use, 4% lifetime inhalant use, 37% lifetime alcohol use, and 21% lifetime tobacco use, with important intergroup differences. Monotonic relationships were found between 10 risk factors and alcohol and illicit drug use. Individual risk factors were distributed disproportionately, and sensitivity and patterning of risk factors varied widely by ethnic/racial subsample. Conclusions. While the cumulative prevalence of risk factors bears a monotonic relationship to drug use, ethnic/racial differences in risk factor profiles, especially for Blacks, suggest differential predictive value based on cultural differences. Handle: RePEc:aph:ajpbhl:1993:83:2:185-189_8 Template-Type: ReDIF-Article 1.0 Title: Oral contraceptives and the risk of gallbladder disease: A meta-analysis Journal: American Journal of Public Health Author-Name: Thijs, C. Author-Name: Knipschild, P. Year: 1993 Volume: 83 Issue: 8 Pages: 1113-1120 Abstract: Objectives. This study was designed to assess the risk of gallbladder disease due to oral contraceptive use by conducting a thorough literature review. Methods. Controlled epidemiologic studies published through March 1992 were systematically searched and evaluated. Of 25 studies (27 publications), 9 could stand the test of critical appraisal with respect to validity. Restriction to these studies was judged to circumvent publication bias at the same time. Results. Oral contraceptive use is associated with a slightly and transiently increased rate of gallbladder disease. The results of six selected studies in which asymptomatic women were screened for gallstones were strikingly similar. Pooling of these results yielded an odds ratio, for ever vs never oral contraceptive use, of 1.36. A dose-effect relationship was indicated, suggesting that modern low-dose oral contraceptives are safer than older formulas, but an effect cannot be excluded. Conclusions. Considering the large efforts already devoted to this exposure-disease relationship, the probably weak effect, and the rapidly changing formulas of oral contraceptives, the authors suggest that the safety of new oral contraceptives be evaluated by studying bile saturation and biliary function rather than by waiting for gallbladder disease to develop. Handle: RePEc:aph:ajpbhl:1993:83:8:1113-1120_5 Template-Type: ReDIF-Article 1.0 Title: Insurance, income, and access to ambulatory care in King County, Washington Journal: American Journal of Public Health Author-Name: Saver, B.G. Author-Name: Peterfreund, N. Year: 1993 Volume: 83 Issue: 11 Pages: 1583-1588 Abstract: Objectives. We studied simultaneous effects of income and insurance on access measures in an indigent population, focusing on Medicaid and the marginal effects of increasing income. Methods. Surveys were distributed in waiting rooms of county clinics and welfare offices. Models examined insurance (private, Medicaid, or none), income (to twice the poverty level), single-parent status, age, gender, and presence of a regular source of care; first-order interactions were evaluated. Results. In terms of ease of access, postponing care, and having a regular source of care, uninsured respondents fared worst and Medicaid recipients were at an intermediate level. However, relative to those with private insurance, Medicaid recipients had four times the odds, and uninsured respondents twice the odds of being denied care. Income had no consistent effect; however, older, poorer people may have greater problems. For preventive services, income was significant, while differences between Medicaid and private insurance were generally not significant. Conclusions. Except for denial of care, access for indigent people is improved by Medicaid but remains worse than the access of those with private insurance. Income had variable effects, but support for income criteria used for public insurance eligibility was not found. Handle: RePEc:aph:ajpbhl:1993:83:11:1583-1588_5 Template-Type: ReDIF-Article 1.0 Title: Predictors of alcoholism in young Swedish men Journal: American Journal of Public Health Author-Name: Andreasson, S. Author-Name: Allebeck, P. Author-Name: Brandt, L. Year: 1993 Volume: 83 Issue: 6 Pages: 845-850 Abstract: Objectives. The purpose of the study was to assess risk indicators for admission for alcoholism in young men. Methods. Level of alcohol consumption and background variables were analyzed in a survey of 49 464 Swedish conscripts. Admissions to psychiatric care were registered during a 15-year follow-up. Results. A strong association was found between level of alcohol consumption at conscription and future admission for alcoholism. The strongest risk indicator for admission for alcoholism, however, was 'Contacts with police or child care authorities,' with an odds ratio of 4.9. Conclusions. For conscripts reporting moderate alcohol consumption at conscription there was a clear association between an increasing burden of risk indicators and future alcoholism. Among men who already had a high level of alcohol consumption at conscription, additional risk indicators, with the exception of psychological factors, had relatively little impact on future admission for alcoholism. Poor emotional control and early symptoms of mental disorder, however, were instrumental not only in enhancing the risk for high consumption at conscription, but also in enhancing the risk for high consumers to become abusers or addicted. Handle: RePEc:aph:ajpbhl:1993:83:6:845-850_4 Template-Type: ReDIF-Article 1.0 Title: Home-delivered meals programs for the elderly: Distribution of services in New York State Journal: American Journal of Public Health Author-Name: Ellis, L. Author-Name: Roe, D.A. Year: 1993 Volume: 83 Issue: 7 Pages: 1034-1036 Abstract: This study examined the ability of six countywide home-delivered meals programs in upstate New York to meet the challenge of serving the elderly in geographically isolated and impoverished regions. The six counties were divided geographically into county subdivisions. For each subdivision, program client levels were analyzed in relation to two subdivision-level census statistics: poverty rates and population densities for community- residing individuals aged 65 years and older. Client levels were positively correlated with population densities but not with poverty rates. These findings suggest that service delivery was concentrated in densely populated regions. In contrast, impoverished and sparsely populated regions received minimal services. Handle: RePEc:aph:ajpbhl:1993:83:7:1034-1036_5 Template-Type: ReDIF-Article 1.0 Title: Potential health benefits of nutrition label changes Journal: American Journal of Public Health Author-Name: Zarkin, G.A. Author-Name: Dean, N. Author-Name: Mauskopf, J.A. Author-Name: Williams, R. Year: 1993 Volume: 83 Issue: 5 Pages: 717-724 Abstract: Objectives. The Nutrition Labeling and Education Act of 1990 mandates the Food and Drug Administration to promulgate changes in nutrition labeling regulations. This study investigates the potential health benefits associated with expected changes in food consumption resulting from the act. Methods. This paper provides four estimates of the potential health benefits from the dietary changes expected to occur as a result of the 1990 act. The upper bound estimates begin with the premise that all consumers will adopt the daily reference values of total fat, saturated fat, and cholesterol. The lower bound estimate is based on consumers' responses to a shelf-labeling program sponsored by the Food and Drug Administration in the 1980s. A computer model developed by Dr. Warren Browner and his associates was used to estimate the health benefits from reduced nutrient intakes. Results. Estimates of the number of discounted life-years gained nationwide for the first 20 years after the implementation of the act range from a high of 1.2 million to a low of 40 000. Conclusions. The results of the study highlight that relatively small changes in nutrient intakes may generate large public health benefits. Handle: RePEc:aph:ajpbhl:1993:83:5:717-724_1 Template-Type: ReDIF-Article 1.0 Title: A developing country's university oriented toward strengthening health systems: Challenges and results Journal: American Journal of Public Health Author-Name: Bryant, J.H. Author-Name: Marsh, D.R. Author-Name: Khan, K.S. Author-Name: D'Souza, R. Author-Name: Husein, K. Author-Name: Aslam, A. Author-Name: Qureshi, A.F. Author-Name: DeWit, V. Author-Name: Harnar, R.M. Year: 1993 Volume: 83 Issue: 11 Pages: 1537-1543 Abstract: Objectives. The Aga Khan University in Karachi has a mission to educate leaders and to contribute to the development of health systems for Pakistan amid challenges of scarcity and complexity. Methods. Its key activities are (1) to design and test urban and rural health system prototypes, (2) to develop faculty in medical and nursing postgraduate community health sciences programs, and (3) to design and implement community-based undergraduate medical and nursing curricula. Results. The university has developed equity- based, cost-effective primary health care prototypes in Karachi slums. With government counterparts it has tested village-, facility-, and district- level interventions in a poor rural district. Federal policymakers have taken models from each for widespread replication. The university is training 49 medical and 19 nursing faculty for postgraduate programs in community health sciences. Most faculty retain institutional leadership positions, including teaching community-based, problem-solving, community health sciences as 20% of the medical and nursing undergraduate curriculum. Conclusions. The mission and experience of the Aga Khan University in population-based health systems design and health sciences education can guide universities in both developing and developed countries. Handle: RePEc:aph:ajpbhl:1993:83:11:1537-1543_1 Template-Type: ReDIF-Article 1.0 Title: Diagnostic x-ray exposure and lens opacities: The Beaver Dam Eye Study Journal: American Journal of Public Health Author-Name: Klein, B.E.K. Author-Name: Klein, R. Author-Name: Linton, K.L.P. Author-Name: Franke, T. Year: 1993 Volume: 83 Issue: 4 Pages: 588-590 Abstract: The Beaver Dam Eye Study is a population-based study of common age- related eye diseases. During the standardized medical history, the 4926 subjects were asked whether they had ever had a chest x-ray, computerized axial tomography (CAT) scan of the head, other x-rays of the head, x-rays of the abdomen, or other diagnostic x-rays. The eye examination included photographs of the lenses of the eyes, which were subsequently graded according to protocol. Nuclear sclerosis and posterior subcapsular opacity were significantly associated with CAT scans. If these relationships are causal, it would highlight the importance of minimizing such exposure to the lens of the eye. Handle: RePEc:aph:ajpbhl:1993:83:4:588-590_6 Template-Type: ReDIF-Article 1.0 Title: Italian infant mortality attributable to low birthweight [3] Journal: American Journal of Public Health Author-Name: Parazzini, F. Author-Name: Overpeck, M.D. Author-Name: Hoffman, H.J. Author-Name: Prager, K. Author-Name: Stanley, F. Year: 1993 Volume: 83 Issue: 1 Pages: 117-120 Handle: RePEc:aph:ajpbhl:1993:83:1:117-120_0 Template-Type: ReDIF-Article 1.0 Title: Winkvist and colleagues respond [3] Journal: American Journal of Public Health Author-Name: Rasmussen, K.M. Author-Name: Habicht, J.-P. Year: 1993 Volume: 83 Issue: 7 Pages: 1052 Handle: RePEc:aph:ajpbhl:1993:83:7:1052_5 Template-Type: ReDIF-Article 1.0 Title: Helping nurse-midwives provide obstetrical care in rural North Carolina Journal: American Journal of Public Health Author-Name: Taylor Jr., D.H. Author-Name: Ricketts III, T.C. Year: 1993 Volume: 83 Issue: 6 Pages: 904-905 Handle: RePEc:aph:ajpbhl:1993:83:6:904-905_4 Template-Type: ReDIF-Article 1.0 Title: Seat belt study conclusions go beyond data [1] Journal: American Journal of Public Health Author-Name: Osuch, R. Author-Name: Colon, I. Year: 1993 Volume: 83 Issue: 3 Pages: 427-428 Handle: RePEc:aph:ajpbhl:1993:83:3:427-428_9 Template-Type: ReDIF-Article 1.0 Title: Custody of cocaine-exposed newborns: Determinants of discharge decisions Journal: American Journal of Public Health Author-Name: Neuspiel, D.R. Author-Name: Zingman, T.M. Author-Name: Templeton, V.H. Author-Name: DiStabile, P. Author-Name: Drucker, E. Year: 1993 Volume: 83 Issue: 12 Pages: 1726-1729 Abstract: Objectives. Maternal cocaine use is a leading grounds for newborn foster placement. This study was initiated to investigate the factors that predict custody status of infants born to substance-abusing women. Methods. A retrospective cohort design was used to study the correlates of discharge custody decisions for 99 consecutive infants testing positive for cocaine in a public hospital. Results. The population was 49% Black, 40% Hispanic, and 11% other or unknown. Custody at discharge was to mothers (38%), other family members (25%), or agency foster care (36%). Placement outside the family was greater when mothers had prior child welfare records, in Blacks vs others, with no prenatal care, and when mothers were younger at their first delivery or older at the index birth. Denial of custody to the mother was higher with prior child welfare involvement, in Blacks, and when the mother did not live in her own home. Both models also controlled for parity, child sex, and birthweight. Conclusions. Earlier involvement with child welfare authorities, race, and other factors predict continued separation of mothers and children at newborn discharge, suggesting the need to reexamine current policies and practices. Handle: RePEc:aph:ajpbhl:1993:83:12:1726-1729_4 Template-Type: ReDIF-Article 1.0 Title: The effects of immune status and race on health service use among people with HIV disease Journal: American Journal of Public Health Author-Name: Piette, J.D. Author-Name: Mor, V. Author-Name: Mayer, K. Author-Name: Zierler, S. Author-Name: Wachtel, T. Year: 1993 Volume: 83 Issue: 4 Pages: 510-514 Abstract: Objectives. The purpose of this study was to examine the relationship between CD4 lymphocyte count and health service use, and to determine whether differences in the rates of service use between Whites and people of color could be identified. Methods. Medical records for 571 HIV-infected individuals were analyzed. Incidence rates and relative rates across CD4 strata (defined by cell counts) were calculated for inpatient and outpatient events. Rate ratios comparing people of color with Whites were estimated within strata, adjusting for confounding factors using a Mantel-Haenszel pooling procedure. Results. Both inpatient and outpatient service use increased over progressively lower levels of CD4 counts. Within each CD4 stratum and controlling for other factors, White participants had more HIV clinic visits and fewer admissions than people of color. Among participants with fewer than 51 CD4 cells per cubic millimeter, people of color were admitted 20% more often, had 35% more inpatient days per person-year, and had only 74% as many HIV clinic visits as their White counterparts. Conclusions. These results indicate that CD4 lymphocyte count is strongly associated with increased usage of health services. People of color with HIV disease are more likely than similar Whites to be admitted to the hospital and less likely to use outpatient care. Handle: RePEc:aph:ajpbhl:1993:83:4:510-514_0 Template-Type: ReDIF-Article 1.0 Title: Alcohol and drug problems among diverse health and social service populations Journal: American Journal of Public Health Author-Name: Weisner, C. Author-Name: Schmidt, L. Year: 1993 Volume: 83 Issue: 6 Pages: 824-829 Abstract: Objectives. This study responds to clinical and research interest in identifying alcohol- and drug-related problems in health and social service agency populations. These problems are associated with a variety of illnesses and social problems, and community agencies serve important screening functions. Methods. Indicators of problematic alcohol and drug use are compared across representative samples of clients within a county's alcohol, mental health, and drug treatment systems; hospital emergency rooms; primary health clinics; criminal justice and welfare systems; and general population. Results. Agencies followed a consistent rank ordering in the prevalence of substance abuse indicators. Highest prevalences were found in the populations of behavioral health agencies, including alcohol, drug, and mental health treatment facilities and criminal justice, followed by welfare agencies. General medical agencies served populations with the lowest prevalence and problem severity. Conclusion. Health and social service agencies provide significant opportunities for the screening and referral of individuals with problematic alcohol and drug use. Although behavioral agencies have higher potential for referral and intervention, general medical services may be more effective in conducting prevention and early case-finding activities. Handle: RePEc:aph:ajpbhl:1993:83:6:824-829_6 Template-Type: ReDIF-Article 1.0 Title: Handedness, traffic crashes, and defensive reflexes: An indirect test [3] Journal: American Journal of Public Health Author-Name: James, W.H. Author-Name: Coren, S. Year: 1993 Volume: 83 Issue: 5 Pages: 771 Handle: RePEc:aph:ajpbhl:1993:83:5:771_6 Template-Type: ReDIF-Article 1.0 Title: Partner notification for control of HIV: Results after 2 years of a statewide program in Utah Journal: American Journal of Public Health Author-Name: Pavia, A.T. Author-Name: Benyo, M. Author-Name: Niler, L. Author-Name: Risk, I. Year: 1993 Volume: 83 Issue: 10 Pages: 1418-1424 Abstract: Objectives. We sought to evaluate the utility of partner notification for control of human immunodeficiency virus (HIV) infection and to identify subgroups in which it may be most effective. Methods. All persons reported to be HIV-positive during a 2-year period were interviewed. Outcome measures included proportion of index patients cooperating; number of partners named, located, counseled and tested; number of persons newly testing positive; and costs. Results. Of 308 index patients, 244 (79%) cooperated. They named 890 partners; 499 (70%) of in-state partners were located. Of these, 154 (24%) had previously tested HIV-positive. Of 279 partners tested for the first time, 39 (14%) were HIV-positive. Injecting drug users were significantly more likely to cooperate than persons in other risk groups (93% vs 76%) and named more partners (median 4 vs 1). Women and persons choosing confidential testing were more likely to cooperate and named more partners. The estimated cost of the program was $62 500 per year. Conclusions. Partner notification identified a group with a high seroprevalence of HIV. It was most successful among populations that may be difficult to reach with other interventions. Handle: RePEc:aph:ajpbhl:1993:83:10:1418-1424_0 Template-Type: ReDIF-Article 1.0 Title: Changes in sexually transmitted disease rates after HIV testing and posttest counseling, Miami, 1988 to 1989 Journal: American Journal of Public Health Author-Name: Otten Jr., M.W. Author-Name: Zaidi, A.A. Author-Name: Wroten, J.E. Author-Name: Witte, J.J. Author-Name: Peterman, T.A. Year: 1993 Volume: 83 Issue: 4 Pages: 529-533 Abstract: Objectives. The effects of posttest counseling on acquisition of sexually transmitted diseases in patients at a large urban sexually transmitted disease clinic were studied. Methods. Comparisons were made of the percentage of patients who had a positive gonorrhea culture (or any sexually transmitted disease) in the 6 months before and after human immunodeficiency virus (HIV) counseling and testing. Results. For 331 patients counseled about a positive HIV test, the percentage with gonorrhea was 6.3 before and 4.5 after posttest counseling (29% decrease). For 666 patients counseled about a negative test, the percentage with gonorrhea was 2.4 before and 5.0 after posttest counseling (106% increase). With any sexually transmitted disease as the outcome, patients who tested positive for HIV had a 12% decrease and patients who tested negative had a 103% increase after counseling. Conclusions. HIV counseling and testing was associated with a moderate decrease in sexually transmitted diseases among patients who tested positive for the virus, but risk increased for patients who tested negative. This suggests a need to improve posttest counseling in this clinic and to assess the effects of counseling and testing in other clinics. Handle: RePEc:aph:ajpbhl:1993:83:4:529-533_0 Template-Type: ReDIF-Article 1.0 Title: Cardiovascular disease risk factors: Improvements in knowledge and behavior in the 1980s Journal: American Journal of Public Health Author-Name: Frank, E. Author-Name: Winkleby, M. Author-Name: Fortmann, S.P. Author-Name: Farquhar, J.W. Year: 1993 Volume: 83 Issue: 4 Pages: 590-593 Abstract: This study surveyed 4158 adults residing in two control cities of the Stanford Five-City Project. Analysis of five cross-sectional surveys (conducted in 1979 through 1990) demonstrated improvements in respondents' general cardiovascular disease risk factor knowledge and behaviors. Cholesterol-related knowledge and behavior showed particularly marked improvements. Handle: RePEc:aph:ajpbhl:1993:83:4:590-593_3 Template-Type: ReDIF-Article 1.0 Title: 'Getting real' about HIV in adolescents Journal: American Journal of Public Health Author-Name: Hein, K. Year: 1993 Volume: 83 Issue: 4 Pages: 492-493 Handle: RePEc:aph:ajpbhl:1993:83:4:492-493_0 Template-Type: ReDIF-Article 1.0 Title: Editorial: Public health nursing - The opportunity of a century Journal: American Journal of Public Health Author-Name: Salmon, M.E. Year: 1993 Volume: 83 Issue: 12 Pages: 1674-1675 Handle: RePEc:aph:ajpbhl:1993:83:12:1674-1675_1 Template-Type: ReDIF-Article 1.0 Title: An update on New York City's dramatic increase in low birthweights Journal: American Journal of Public Health Author-Name: Joyce, T. Author-Name: Racine, A.D. Year: 1993 Volume: 83 Issue: 1 Pages: 109-111 Abstract: Monthly time-series data on rates of low birthweight and very low birthweight in New York City from 1963 to 1990 indicate that the dramatic increase, particularly among Blacks beginning in 1984, appears to have peaked in 1988. Based on vital statistics records, the rate of low birthweight for Blacks fell from 13.1% in 1988 to 12.1% in 1990. The rate of low birthweight among Whites and Hispanics has fallen slightly since 1988. Handle: RePEc:aph:ajpbhl:1993:83:1:109-111_8 Template-Type: ReDIF-Article 1.0 Title: Cervical cancer screening in hospitals: The effficacy of legislation in Maryland Journal: American Journal of Public Health Author-Name: Klassen, A.C. Author-Name: Celentano, D.D. Author-Name: Weisman, C.S. Year: 1993 Volume: 83 Issue: 9 Pages: 1316-1320 Abstract: Objectives. The purpose of the study was to examine the efficacy of a Maryland law requiring Pap testing to be offered during hospital admissions. 'In-reach' strategies emphasize cancer screening within existing health care contacts (such as inpatient stays) rather than additional visits solely for screening. Methods. Data from a 1986 telephone survey of Maryland women were used to examine the effect of hospitalization on self-reported Pap testing in a 3-year period. The effect of hospitalization on screening was examined by age and income to assess whether inpatient screening was more prevalent among certain subgroups of women. Results. For the group as a whole, the odds of Pap screening did not vary with hospitalization. However, among women aged 45 to 54 years with annual household incomes over $20 000, hospitalized women were more likely than nonhospitalized women to report recent Pap tests. For low-income women aged 75 years and older, hospitalization actually decreased the likelihood of reporting Pap tests. Conclusions. Despite legislation, inpatient cervical cancer screening appears to mirror outpatient patterns, leaving elderly and low-income women unscreened. Methods for increasing inpatient Pap testing for underscreened women are discussed. Handle: RePEc:aph:ajpbhl:1993:83:9:1316-1320_0 Template-Type: ReDIF-Article 1.0 Title: Firearms and health: The right to be armed with accurate information about the Second Amendment Journal: American Journal of Public Health Author-Name: Vernick, J.S. Author-Name: Teret, S.P. Year: 1993 Volume: 83 Issue: 12 Pages: 1773-1777 Abstract: An organized campaign by groups such as the National Rifle Association has sought to convince policymakers and others that the Second Amendment to the US Constitution grants an unfettered right to individuals to possess any firearm, free from federal or state regulation. Although advocates may debate the meaning that should be given to the Second Amendment, under the American legal system the meaning of any particular constitutional provision is determined by the controlling precedent of Supreme Court cases. Two cases, Presser v Illinois and United States v Miller, remain the Supreme Court's latest word on the meaning of the Second Amendment. In Presser, the Court held that the Second Amendment is applicable only to federal, not state, laws. In Miller and subsequent federal cases, any Second Amendment 'right' to bear arms is closely linked to the preservation of state militias, upholding a variety of federal gun legislation. Unless the Supreme Court modifies or reverses its Presser and Miller decisions, health advocates should understand that the Second Amendment poses no obstacle to even broad gun control legislation. Handle: RePEc:aph:ajpbhl:1993:83:12:1773-1777_2 Template-Type: ReDIF-Article 1.0 Title: Non-Hodgkin's lymphoma and occupational exposure to hair dyes among people with AIDS [3] Journal: American Journal of Public Health Author-Name: Cote, T.R. Author-Name: Dosemeci, M. Author-Name: Rothman, N. Author-Name: Banks, R.B. Author-Name: Biggar, R.J. Year: 1993 Volume: 83 Issue: 4 Pages: 598-599 Handle: RePEc:aph:ajpbhl:1993:83:4:598-599_9 Template-Type: ReDIF-Article 1.0 Title: Pregnancy-related weight gain and retention: Implications of the 1990 Institute of Medicine guidelines Journal: American Journal of Public Health Author-Name: Keppel, K.G. Author-Name: Taffel, S.M. Year: 1993 Volume: 83 Issue: 8 Pages: 1100-1103 Abstract: Objectives. Guidelines from the Institute of Medicine's 1990 report call for weight gains during pregnancy that are higher than those previously recommended. This study examines the potential implications of compliance with these guidelines for postpartum weight retention. Methods. Weight retention 10 to 18 months following delivery was examined for selected women who had live births in the 1988 National Maternal and Infant Health Survey. Women's actual weight gains during pregnancy were retrospectively classified according to the Institute of Medicine's guidelines. Results. Weight retention following delivery increased as weight gain increased, and Black women retained more weight than White women with comparable weight gain. The median retained weight for White women who gained the amount now being recommended was 1.6 lb whereas that for Black women was 7.2 lb. Conclusions. If pregnant White women gain weight according to the institute's guidelines, they need not be concerned about retaining a substantial amount of weight postpartum. Our findings suggest, however, that Black women are in need of advice about how to lose weight following delivery. Handle: RePEc:aph:ajpbhl:1993:83:8:1100-1103_5 Template-Type: ReDIF-Article 1.0 Title: Commentary: Primary care - Medical students' unpopular choice Journal: American Journal of Public Health Author-Name: Petersdorf, R.G. Year: 1993 Volume: 83 Issue: 3 Pages: 328-330 Abstract: Title VII funding to medical schools has not succeeded in correcting the shortage of primary care physicians. Although it is generally true that there is an inverse relationship between the amount of research funds awarded to a school and its success in producing primary care physicians, there are many exceptions. Neither Title VII, the amount of research funding, or Medicare's Direct Medical Education payments has had a substantial effect on the production of primary care physicians. These factors are comparatively insignificant when considered in the light of strong external incentives to specialize. Medical education cannot remedy the specialty imbalance unless the external environment becomes more friendly to generalists. Handle: RePEc:aph:ajpbhl:1993:83:3:328-330_9 Template-Type: ReDIF-Article 1.0 Title: Barrier contraceptive and sexually transmitted disease study is questioned [5] Journal: American Journal of Public Health Author-Name: Gunn, R.A. Author-Name: Greenspan, J.R. Author-Name: Rolfs, R.T. Year: 1993 Volume: 83 Issue: 7 Pages: 1053-1054 Handle: RePEc:aph:ajpbhl:1993:83:7:1053-1054_1 Template-Type: ReDIF-Article 1.0 Title: Cotinine concentrations in semen, urine, and blood of smokers and nonsmokers Journal: American Journal of Public Health Author-Name: Vine, M.F. Author-Name: Hulka, B.S. Author-Name: Margolin, B.H. Author-Name: Truong, Y.K. Author-Name: Hu, P.-C. Author-Name: Schramm, M.M. Author-Name: Griffith, J.D. Author-Name: McCann, M. Author-Name: Everson, R.B. Year: 1993 Volume: 83 Issue: 9 Pages: 1335-1338 Abstract: Cotinine levels in the semen, urine, and blood of 88 male smokers and nonsmokers, aged 18 to 35, were analyzed via radioimmunoassay. Detectable cotinine levels were found in all three body fluids, and cotinine levels in all three fluids were highly correlated. Cotinine levels in semen and blood were of similar magnitude; cotinine levels in urine were an order of magnitude or more higher. In all three fluids, cotinine levels increased with an increase in cigarette smoke exposure. Handle: RePEc:aph:ajpbhl:1993:83:9:1335-1338_1 Template-Type: ReDIF-Article 1.0 Title: Measuring the effects of vitamin A supplementation [4] Journal: American Journal of Public Health Author-Name: Stoltzfus, R.J. Author-Name: Habicht, J.-P. Author-Name: Abdeljaber, M.H. Author-Name: Monto, A.S. Author-Name: Tilden, R.L. Author-Name: Schork, A. Year: 1993 Volume: 83 Issue: 2 Pages: 288-289 Handle: RePEc:aph:ajpbhl:1993:83:2:288-289_5 Template-Type: ReDIF-Article 1.0 Title: Commentary: Condoms and HIV/STD prevention - Clarifying the message Journal: American Journal of Public Health Author-Name: Roper, W.L. Author-Name: Peterson, H.B. Author-Name: Curran, J.W. Year: 1993 Volume: 83 Issue: 4 Pages: 501-503 Abstract: In the United States and throughout the world, the majority of human immunodeficiency virus (HIV) infections are sexually transmitted. An estimated 12 million other sexually transmitted diseases occur annually in the United States. Avoiding sexual intercourse altogether or restricting sex to partners known to be uninfected will prevent infection; this needs to be promoted as the most effective strategy. Studies show that correct and consistent use of latex condoms is highly effective in preventing sexually transmitted HIV infection and other sexually transmitted diseases. The effectiveness of condoms depends on individual behavior leading to correct and consistent use. Further studies are needed to maximize the use and effectiveness of condoms for those who choose to be sexually active as well as to develop and evaluate other methods, particularly those more under the control of women. In the interim, our prevention message should be clear: When used correctly and consistently, condoms are highly effective; when used otherwise, they are not. Handle: RePEc:aph:ajpbhl:1993:83:4:501-503_2 Template-Type: ReDIF-Article 1.0 Title: HIV risk among Latino adolescents in two New England cities Journal: American Journal of Public Health Author-Name: Smith, K.W. Author-Name: McGraw, S.A. Author-Name: Crawford, S.L. Author-Name: Costa, L.A. Author-Name: McKinlay, J.B. Year: 1993 Volume: 83 Issue: 10 Pages: 1395-1399 Abstract: Objectives. Latino adolescents in two urban New England areas were surveyed to assess risk of human immunodeficiency virus (HIV) transmission. Methods. Probability of HIV infection during the previous 6 months was estimated from self-reported sexual contacts, condom usage rates, and number of partners. Teens were also asked to show condoms in their possession to the interviewer to validate self-reports of condom use. Results. Overall, 8% of the 586 respondents were classified as high risk for HIV infection (estimated infection probability greater than .0001), 34% were at moderate risk, and the remaining 58% were classified as not at risk (no sexual activity or needle sharing). Teens who said they had purchased condoms or claimed to have used them recently were more likely than others to have condoms in their possession at the time of the interview. Conclusions. These estimates suggest that a small percentage of Latino adolescents may be at substantial risk for HIV infection over periods as short as 6 months, that self-reports of recent condom use are strongly related to condom possession, and that questionnaire items regarding condom use at last intercourse are poor surrogates for HIV risk. Handle: RePEc:aph:ajpbhl:1993:83:10:1395-1399_3 Template-Type: ReDIF-Article 1.0 Title: Abortion in the Eastern Bloc, then and now [4] Journal: American Journal of Public Health Author-Name: Rosen, S.M. Author-Name: Stephenson, P. Author-Name: Wagner, M. Year: 1993 Volume: 83 Issue: 8 Pages: 1180-1181 Handle: RePEc:aph:ajpbhl:1993:83:8:1180-1181_1 Template-Type: ReDIF-Article 1.0 Title: Measuring HIV-1 seroprevalence among English newborns: Blood spot size [3] Journal: American Journal of Public Health Author-Name: McGarrigle, C. Author-Name: Parry, J. Author-Name: Nicoll, A. Year: 1993 Volume: 83 Issue: 12 Pages: 1792 Handle: RePEc:aph:ajpbhl:1993:83:12:1792_3 Template-Type: ReDIF-Article 1.0 Title: The Behavioral Risk Factor Surveillance System questionnaire: Its reliability in a statewide sample Journal: American Journal of Public Health Author-Name: Stein, A.D. Author-Name: Lederman, R.I. Author-Name: Shea, S. Year: 1993 Volume: 83 Issue: 12 Pages: 1768-1772 Abstract: The reliability of the Behavioral Risk Factor Surveillance System questionnaire was assessed in a random sample of adults (n = 122) and a separate sample of Black and Hispanic adults (n = 200) in Massachusetts. The questionnaire was administered twice, 21 to 44 days apart, by telephone (210 completed reinterviews, 65% response rate for second administration). There were no statistically significant differences in the distribution of demographic or risk factor variables across administrations. Individual- level reliability (kappa for categorical variables, correlation for continuous variables) for demographic characteristics was more than 0.80 for White respondents and more than 0.60 for Black and Hispanic respondents. Employment and income were reported less consistently than other variables. Reliability coefficients for behavioral risk factors were generally above 0.70. Exceptions were variables with extreme distributions. These data support the use of the Behavioral Risk Factor Surveillance System questionnaire for surveillance and research. Handle: RePEc:aph:ajpbhl:1993:83:12:1768-1772_3 Template-Type: ReDIF-Article 1.0 Title: Is access to home health care a problem in rural areas? Journal: American Journal of Public Health Author-Name: Kenney, G.M. Year: 1993 Volume: 83 Issue: 3 Pages: 412-414 Abstract: In 1987, urban Medicare beneficiaries were 13.7% more likely than their rural counterparts to use Medicare home health care services. Regression analysis shows that rural use rates, particularly those in sparsely populated areas, fall short of those in urban areas, other things being equal. Rural areas have lower Medicare ceilings, proportionately fewer visiting nurse associations, and lower availability of auxiliary services. These factors combined account for 82% of the difference between rural and urban use rates. Handle: RePEc:aph:ajpbhl:1993:83:3:412-414_7 Template-Type: ReDIF-Article 1.0 Title: Editorial: Tuberculosis, again Journal: American Journal of Public Health Author-Name: Joseph, S. Year: 1993 Volume: 83 Issue: 5 Pages: 647-648 Handle: RePEc:aph:ajpbhl:1993:83:5:647-648_3 Template-Type: ReDIF-Article 1.0 Title: The conflict between public health goals and the temperance mentality Journal: American Journal of Public Health Author-Name: Peele, S. Year: 1993 Volume: 83 Issue: 6 Pages: 805-810 Abstract: Objectives. The prevailing view today is that alcohol consumption is unambiguously a social and public health problem. This paper presents evidence to balance this view. Methods. Evidence of beneficial effects of alcohol against coronary artery disease is examined, together with cultural reasons for resistance in the United States to the implications of this evidence. Results. Alcohol use reduces the risk of coronary artery disease- the major cause of heart disease, America's leading killer-even for those at risk for such disease. Moreover, recent research indicates that alcohol continues to reduce risk at the higher levels of drinking measured in general populations. However, with consumption of more than two drinks daily, these gains are increasingly offset by greater mortality from other causes. Conclusions. Educators, public health commentators, and medical investigators are uneasy about findings of healthful effects of drinking. A cultural preoccupation with alcoholism and the negative effects of drinking works against frank scientific discussions in the United States of the advantages for the cardiovascular system of alcohol consumption. This set has deep roots in American history but is inconsistent with public health goals. Handle: RePEc:aph:ajpbhl:1993:83:6:805-810_1 Template-Type: ReDIF-Article 1.0 Title: Meningococcal disease in Los Angeles County, 1981 through 1990 [1] Journal: American Journal of Public Health Author-Name: Thomas, J.C. Author-Name: Bendana, N.S. Author-Name: Waterman, S.H. Year: 1993 Volume: 83 Issue: 12 Pages: 1790-1791 Handle: RePEc:aph:ajpbhl:1993:83:12:1790-1791_9 Template-Type: ReDIF-Article 1.0 Title: A proposal for the mandatory inclusion of helmets with new children's bicycles Journal: American Journal of Public Health Author-Name: Dannenberg, A.L. Author-Name: Vernick, J.S. Year: 1993 Volume: 83 Issue: 5 Pages: 644-646 Abstract: To reduce bicycle-related head injuries in children, we propose new regulations be established that mandate the inclusion of approved helmets with the sale of all new children's bicycles. Currently, purchasing a helmet is a separate economic decision that acts as a barrier to helmet ownership and use. The inclusion of a helmet with the bicycle would markedly increase helmet ownership. The increased demand would reduce the manufacturing cost per helmet, so the cost of the bicycle with the helmet would be lower than the current retail price of the two separately. This proposal could potentially be implemented by federal or state legislation, a Consumer Product Safety Commission regulation, or voluntary adoption of a practice or standard by bicycle manufacturers. Increased helmet ownership is necessary but not sufficient to raise helmet use rates. The increased ownership generated by this proposal, complemented by enhanced educational, promotional, and legal interventions, is probably the most practical and cost-effective public health strategy available to increase helmet usage and prevent bicycle-related head injuries in children. Handle: RePEc:aph:ajpbhl:1993:83:5:644-646_0 Template-Type: ReDIF-Article 1.0 Title: The health effects of swimming at Sydney beaches Journal: American Journal of Public Health Author-Name: Corbett, S.J. Author-Name: Rubin, G.L. Author-Name: Curry, G.K. Author-Name: Kleinbaum, D.G. Year: 1993 Volume: 83 Issue: 12 Pages: 1701-1706 Abstract: Objectives. The purpose of the study was to determine the health risks of swimming at ocean beaches in Sydney, Australia. Methods. From people attending 12 Sydney beaches in the period from December 5, 1989 to February 26, 1990, we recruited a cohort of 8413 adults who agreed to participate in this study. Of these, 4424 were excluded either because they had been swimming in the previous 5 days or because they reported a current illness. Of the remainder, 2839 successfully completed a follow-up telephone interview conducted within 10 days after recruitment. We recorded reported respiratory, gastrointestinal, eye, and ear symptoms and fever that occurred within the 10 days between initial interview on the beach and the follow-up interview. Results. A total of 683 participants (24.0%) reported experiencing symptoms in the 10 days following initial interview. Of these, 435 (63.7%) reported respiratory symptoms. Swimmers were almost twice as likely as nonswimmers to report symptoms. There was a linear relationship between water pollution and all reported symptoms with the exception of gastrointestinal complaints. Conclusions. Swimmers at Sydney ocean beaches are more likely to report respiratory, ear, and eye symptoms than beachgoers who do not swim. The incidence of these symptoms increases slightly with increasing levels of pollution. Handle: RePEc:aph:ajpbhl:1993:83:12:1701-1706_1 Template-Type: ReDIF-Article 1.0 Title: Mental health service use by the elderly in nursing homes Journal: American Journal of Public Health Author-Name: Burns, B.J. Author-Name: Wagner, H.R. Author-Name: Taube, J.E. Author-Name: Magaziner, J. Author-Name: Permutt, T. Author-Name: Landerman, L.R. Year: 1993 Volume: 83 Issue: 3 Pages: 331-337 Abstract: Objectives. Because current Omnibus Budget Reconciliation Act regulations influence the disposition of US nursing home residents who have mental illness, National Nursing Home Survey (1985) data are analyzed for predictors of mental health service use. Methods. Elderly residents' rates of mental health service use are presented. Logistic regression yielded odds ratios for treatment by both mental health specialists and general practitioners for client and service system variables. Results. Among the two thirds of elderly residents with a mental disorder (including dementia), only 4.5% receive any mental health treatment in a 1-month period. The ratio of specialist to general practitioner care is approximately 1:1. Patients seen by a specialist are likely to be younger (aged 65 to 74); live in the Northeast; and have a diagnosis of schizophrenia (13:1), dementia (3:1), or other mental disorders (5:1). Prior residence in a psychiatric hospital predicts care by both health professional types. Rural location, nonproprietary ownership of the nursing home, and aggressive behavior point to general physician care. Conclusions. Our findings indicate significant neglect of the mental health needs of older nursing home residents and underscore the importance of monitoring the regulations for screening and treatment of mental disorders under the Omnibus Budget Reconciliation Act. Handle: RePEc:aph:ajpbhl:1993:83:3:331-337_8 Template-Type: ReDIF-Article 1.0 Title: Symptoms of depression among Blacks and Whites Journal: American Journal of Public Health Author-Name: Jones-Webb, R.J. Author-Name: Snowden, L.R. Year: 1993 Volume: 83 Issue: 2 Pages: 240-244 Abstract: Objectives. We sought to examine relationships between sociodemographic indicators of risk and depression symptoms within the Black and White populations. Methods. In a national probability sample, differences in sex, age, marital status, religion, social class, employment status, urbanicity, and region were evaluated against a Center for Epidemiological Studies Depression Scale score of 16 or greater. Risk factors were identified within the two populations and compared between them. Results. For both races, females were at greater risk for depression than males, and respondents who were formerly married or separated were at greater risk than those who were currently married. Major differences in patterns of risk were also found between the races. Blacks who were 30 to 39 years of age, belonged to non- Western religious groups, and lived in the West were at greater risk than comparable Whites. Blacks who were widowed, members of the middle and lower- middle class, and unemployed were at less risk. Conclusions. Similarities and differences in patterns of risk were evident. The nature of the differences suggests important divergence in sociocultural and economic experience. Handle: RePEc:aph:ajpbhl:1993:83:2:240-244_7 Template-Type: ReDIF-Article 1.0 Title: Maternal reporting of birthweight in a peruvian shanty town [1] Journal: American Journal of Public Health Author-Name: Diaz, J.F. Author-Name: Gilman, R.H. Author-Name: Cabrera, L. Year: 1993 Volume: 83 Issue: 8 Pages: 1177-1178 Handle: RePEc:aph:ajpbhl:1993:83:8:1177-1178_3 Template-Type: ReDIF-Article 1.0 Title: A proposed classification code for farm and agricultural injuries Journal: American Journal of Public Health Author-Name: Murphy, D.J. Author-Name: Purschwitz, M. Author-Name: Mahoney, B.S. Author-Name: Hoskin, A.F. Year: 1993 Volume: 83 Issue: 5 Pages: 736-738 Abstract: A fundamental problem with classifying agriculturally related injury is that there is neither a rational nor a comprehensive scheme for grouping incidents into categories describing actual exposures encountered on farms and in agricultural work. Current surveillance systems are unable to differentiate between work that is related to farm production and work that is not, and to include all exposed persons in the surveillance. The proposed Farm and Agricultural Injury Classification Code is a step toward overcoming these problems. When it was applied to previously analyzed fatality data, 40% of cases previously identified as farm production work were reclassified into other categories. Handle: RePEc:aph:ajpbhl:1993:83:5:736-738_9 Template-Type: ReDIF-Article 1.0 Title: Groundwater surveying and management: An interagency effort in Michigan Journal: American Journal of Public Health Author-Name: Lieberman, D.J. Year: 1993 Volume: 83 Issue: 4 Pages: 594-595 Handle: RePEc:aph:ajpbhl:1993:83:4:594-595_4 Template-Type: ReDIF-Article 1.0 Title: Colorado's HIV partner notification program [2] Journal: American Journal of Public Health Author-Name: Vernon, T.M. Author-Name: Mangione, E.J. Author-Name: Hoffman, R.E. Author-Name: Spencer, N.E. Author-Name: Wolf, F.C. Year: 1993 Volume: 83 Issue: 4 Pages: 598 Handle: RePEc:aph:ajpbhl:1993:83:4:598_1 Template-Type: ReDIF-Article 1.0 Title: Commentary: Alcohol, the heart, and public policy Journal: American Journal of Public Health Author-Name: Stampfer, M.J. Author-Name: Rimm, E.B. Author-Name: Walsh, D.C. Year: 1993 Volume: 83 Issue: 6 Pages: 801-804 Handle: RePEc:aph:ajpbhl:1993:83:6:801-804_4 Template-Type: ReDIF-Article 1.0 Title: Smoking, alcohol consumption, and susceptibility to the common cold Journal: American Journal of Public Health Author-Name: Cohen, S. Author-Name: Tyrrell, D.A.J. Author-Name: Russell, M.A.H. Author-Name: Jarvis, M.J. Author-Name: Smith, A.P. Year: 1993 Volume: 83 Issue: 9 Pages: 1277-1283 Abstract: Objectives. This study was conducted to test the supposition that both smoking and consuming alcohol suppress host resistance to viral infections. Methods. The relations between smoking, alcohol consumption, and the incidence of documented clinical colds were prospectively studied among 391 subjects intentionally exposed to one of five respiratory viruses and 26 subjects given saline. Clinical colds were defined as clinical symptoms verified by the isolation of virus or by an increase in virus-specific antibody titer. Analyses included control variables for demographics; body weight; virus; and environmental, immunological and psychological factors. Results. Smokers were at greater risk for developing colds than nonsmokers because smokers were more likely both to develop infections and to develop illness following infection. Greater numbers of alcoholic drinks (up to three or four per day) were associated with decreased risk for developing colds because drinking was associated with decreased illness following infection. However, the benefits of drinking occurred only among nonsmokers. Conclusions. Susceptibility to colds was increased by smoking. Although alcohol consumption did not influence risk of clinical illness for smokers, moderate alcohol consumption was associated with decreased risk for nonsmokers. Handle: RePEc:aph:ajpbhl:1993:83:9:1277-1283_1 Template-Type: ReDIF-Article 1.0 Title: A meta-analysis of adolescent smoking prevention programs Journal: American Journal of Public Health Author-Name: Bruvold, W.H. Year: 1993 Volume: 83 Issue: 6 Pages: 872-880 Abstract: Objectives. A large number of studies evaluating adolescent smoking prevention programs have been published. Systematic quantitative reviews of this literature are needed to learn what does and does not work. The present meta-analysis focuses on the efficacy of school-based programs. Methods. Evaluations of 94 separate interventions were included in the meta-analysis. Studies were screened for methodological rigor and those with weaker methodology were segregated from those with more defensible methodology; major analyses focused on the latter. Results. Behavioral effect sizes were found to be largest for interventions with a social reinforcement orientation, moderate for interventions with either a developmental or a social norms orientation, and small for interventions with the traditional rational orientation. Attitude effect sizes followed the same pattern, but knowledge effect sizes were similar across all four orientation categories. Conclusions. Because behavioral effect represents the fundamental objective of programs for prevention of adolescent tobacco use, the present results indicate that school-based programs should consider adopting interventions with a social reinforcement, social norms, or developmental orientation. Handle: RePEc:aph:ajpbhl:1993:83:6:872-880_3 Template-Type: ReDIF-Article 1.0 Title: Classifying unspecified and/or unexplained causes of death [4] Journal: American Journal of Public Health Author-Name: Hanzlick, R. Author-Name: Parrish, R.G. Author-Name: Ing, R. Author-Name: Cragle, D.L. Author-Name: Butler, A.F. Year: 1993 Volume: 83 Issue: 10 Pages: 1492-1493 Handle: RePEc:aph:ajpbhl:1993:83:10:1492-1493_3 Template-Type: ReDIF-Article 1.0 Title: Social differences in Swedish infant mortality by cause of death, 1983 to 1986 Journal: American Journal of Public Health Author-Name: Nordstrom, M.-L. Author-Name: Cnattingius, S. Author-Name: Haglund, B. Year: 1993 Volume: 83 Issue: 1 Pages: 26-30 Abstract: Objective. We sought to investigate social differences in Swedish infant mortality by cause of death. Methods. All live single births in Sweden between 1983 and 1986 to mothers 15 to 44 years old with Nordic citizenship were studied. The causes of death were classified into six major groups. Mother's education was used as a social indicator. Logistic regression analysis was used with identical models for all groups of causes of death. Results. There were 355 601 births and 2012 infant deaths. Only for sudden infant death syndrome were significant social differences found, with crude odds ratios of 2.6 for mothers with less than 10 years of education and of 1.9 for mothers with 10 to 11 years, compared with 1.0 for mothers with 15 years or more. After adjusting for age, parity, and smoking habits, these ratios were no longer significant. Conclusions. The social differences obtained could be explained by the fact that mothers with less education smoke more, are younger, and have higher parity than those with more education. Handle: RePEc:aph:ajpbhl:1993:83:1:26-30_4 Template-Type: ReDIF-Article 1.0 Title: Public housing subsidies may improve poor children's nutrition [1] Journal: American Journal of Public Health Author-Name: Meyers, A. Author-Name: Rubin, D. Author-Name: Napoleone, M. Author-Name: Nichols, K. Year: 1993 Volume: 83 Issue: 1 Pages: 115 Handle: RePEc:aph:ajpbhl:1993:83:1:115_3 Template-Type: ReDIF-Article 1.0 Title: Chlorination, by chlorination by products, and cancer: A meta-analysis (Am J Public Health (1992) 82 (955-963)) 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: 1993 Volume: 83 Issue: 9 Pages: 1257 Handle: RePEc:aph:ajpbhl:1993:83:9:1257_0 Template-Type: ReDIF-Article 1.0 Title: Paradigms and prevention Journal: American Journal of Public Health Author-Name: Vogt, T.M. Year: 1993 Volume: 83 Issue: 6 Pages: 795-796 Handle: RePEc:aph:ajpbhl:1993:83:6:795-796_8 Template-Type: ReDIF-Article 1.0 Title: Suicide: Risk factors and the public health Journal: American Journal of Public Health Author-Name: Shaffer, D. Year: 1993 Volume: 83 Issue: 2 Pages: 171-172 Handle: RePEc:aph:ajpbhl:1993:83:2:171-172_9 Template-Type: ReDIF-Article 1.0 Title: Medical technology assessment - Intended for whom? Journal: American Journal of Public Health Author-Name: Mariner, W.K. Year: 1993 Volume: 83 Issue: 11 Pages: 1525-1526 Handle: RePEc:aph:ajpbhl:1993:83:11:1525-1526_8 Template-Type: ReDIF-Article 1.0 Title: Talking past each other about risks and the importance of context Journal: American Journal of Public Health Author-Name: Susser, M. Year: 1993 Volume: 83 Issue: 5 Pages: 642-643 Handle: RePEc:aph:ajpbhl:1993:83:5:642-643_1 Template-Type: ReDIF-Article 1.0 Title: Hip fracture rates in Hong Kong and the United States, 1988 through 1989 Journal: American Journal of Public Health Author-Name: Ho, S.C. Author-Name: Bacon, W.E. Author-Name: Harris, T. Author-Name: Looker, A. Author-Name: Maggi, S. Year: 1993 Volume: 83 Issue: 5 Pages: 694-697 Abstract: Objectives. Prior studies have suggested that hip fracture rates are substantially lower in Asian countries than in the United States. However, comparisons have been limited by unavailability of recent data, differences in case definition, lack of data from similar time periods, and small sample sizes. This study sought to examine trends by age and sex, with separate statistics for those aged 85 or older. Methods. Hospital discharge data were used to obtain hip fracture incidence in Hong Kong and the United States from 1988 through 1989. Results. Within each population, women had higher hip fracture rates than men. Fracture rates in the United States were significantly higher for both sexes than rates in Hong Kong. For persons over the age of 80, rates of hip fracture among White US males exceeded those for Hong Kong women. Inclusion of transferred cases in hip fracture rates minimized differences between the countries. Conclusions. Despite increasing hip fracture rates in Hong Kong, those rates are still substantially lower than the rates in the United States. Identifying factors responsible for this variation may prove useful in the search for preventive strategies. Handle: RePEc:aph:ajpbhl:1993:83:5:694-697_5 Template-Type: ReDIF-Article 1.0 Title: Risk due to inactivity in physically capable older adults Journal: American Journal of Public Health Author-Name: Simonsick, E.M. Author-Name: Lafferty, M.E. Author-Name: Phillips, C.L. Author-Name: Mendes de Leon, C.F. Author-Name: Kasl, S.V. Author-Name: Seeman, T.E. Author-Name: Fillenbaum, G. Author-Name: Hebert, P. Author-Name: Lemke, J.H. Year: 1993 Volume: 83 Issue: 10 Pages: 1443-1450 Abstract: Objectives. This study examined the association between recreational physical activity among physically capable older adults and functional status, incidence of selected chronic conditions, and mortality over 3 and 6 years. Methods. Data are from three sites of the Established Populations for Epidemiologic Studies of the Elderly. Results. A high level of recreational physical activity reduced the likelihood of mortality over both 3 and 6 years. Moderate to high activity reduced the risk of physical impairments over 3 years: this effect diminishes after 6 years. A consistent relationship between activity and new myocardial infarction or stroke or the incidence of diabetes or angina was not found after 3 or 6 years. Conclusions. Findings suggest that physical activity offers benefits to physically capable older adults, primarily in reducing the risk of functional decline and mortality. Future work must use more objective and quantifiable measures of activity and assess changes in activity levels over time. Handle: RePEc:aph:ajpbhl:1993:83:10:1443-1450_3 Template-Type: ReDIF-Article 1.0 Title: The HIV rates of injection drug users in less-populated areas [2] Journal: American Journal of Public Health Author-Name: Steel, E. Author-Name: Fleming, P.L. Author-Name: Needle, R. Year: 1993 Volume: 83 Issue: 2 Pages: 286-287 Handle: RePEc:aph:ajpbhl:1993:83:2:286-287_1 Template-Type: ReDIF-Article 1.0 Title: Analyzing socioeconomic and racial/ethnic patterns in health and health care Journal: American Journal of Public Health Author-Name: Krieger, N. Year: 1993 Volume: 83 Issue: 8 Pages: 1086-1087 Handle: RePEc:aph:ajpbhl:1993:83:8:1086-1087_1 Template-Type: ReDIF-Article 1.0 Title: Treating measles: The appropriateness of admission to a Wisconsin Children's Hospital Journal: American Journal of Public Health Author-Name: Havens, P.L. Author-Name: Butler, J.C. Author-Name: Day, S.E. Author-Name: Mohr, B.A. Author-Name: Davis, J.P. Author-Name: Chusid, M.J. Year: 1993 Volume: 83 Issue: 3 Pages: 379-384 Abstract: Objectives. A large number of children with measles were hospitalized at a children's hospital during a metropolitan measles outbreak. In this study we addressed the appropriateness of those admissions. Methods. Charts of all 634 patients with a diagnosis of measles who were treated between August 1989 and April 1990 were reviewed. Determination of the appropriateness of hospital admission was based on severity of illness and presence of severe complications of measles. Results. Of 564 patients with clinical measles or serologic evidence of recent infection, 252 were inpatients (median age 1.5 years) and 312 were outpatients (median age 2.1 years). Fifty-nine (23.4%) of the inpatients had been inappropriately admitted. Inpatients were significantly more likely than outpatients to have physiologic instability or a clinical complication. Children 15 months of age or younger were more likely to be hospitalized, as were children evaluated in the first 3 months of the outbreak period, even if admission was not appropriate on the basis of physiologic instability or complications. Conclusions. Younger patients with measles and patients evaluated earlier in the epidemic were more likely to be admitted to the hospital even when admission was inappropriate as assessed by degree of physiologic instability or presence of complications. Handle: RePEc:aph:ajpbhl:1993:83:3:379-384_4 Template-Type: ReDIF-Article 1.0 Title: Predictors of nursing home admission in a biracial population Journal: American Journal of Public Health Author-Name: Salive, M.E. Author-Name: Collins, K.S. Author-Name: Foley, D.J. Author-Name: George, L.K. Year: 1993 Volume: 83 Issue: 12 Pages: 1765-1767 Abstract: Racial differences in predictors of institutionalization were studied in a biracial North Carolina cohort (n = 4074). During 3 years of follow-up, 8.5% of Whites and 6.4% of African Americans were admitted to nursing homes. African Americans were one half as likely as Whites to be institutionalized after adjustment for other risk factors. Among Whites, impaired activities of daily living and cognition were the strongest predictors: among African Americans, impaired instrumental activities of daily living and prior history of nursing home use were strongest. Racial differences in nursing home use were not explained by financial and social support or physical and cognitive impairment. Handle: RePEc:aph:ajpbhl:1993:83:12:1765-1767_6 Template-Type: ReDIF-Article 1.0 Title: Why don't medical students choose primary care? Journal: American Journal of Public Health Author-Name: Geiger, H.J. Year: 1993 Volume: 83 Issue: 3 Pages: 315-316 Handle: RePEc:aph:ajpbhl:1993:83:3:315-316_4 Template-Type: ReDIF-Article 1.0 Title: Low birthweight and infant mortality in Puerto Rico Journal: American Journal of Public Health Author-Name: Becerra, J.E. Author-Name: Atrash, H.K. Author-Name: Perez, N. Author-Name: Saliceti, J.A. Year: 1993 Volume: 83 Issue: 11 Pages: 1572-1576 Abstract: Objectives. The purpose of this study was to quantify the relative contributions of maternal age, education, marital status, hospital of birth, and use of prenatal care to the high incidence of low birthweight and infant mortality in Puerto Rico. Methods. An analysis was conducted of 257 537 live births that occurred from 1986 through 1989 among Puerto Rico residents and the 3373 corresponding infant deaths. Binomial multiple regression models were used to calculate the adjusted population attributable risks for each variable. Results. Our estimates indicate that approximately 6 of every 10 infant deaths on the island are potentially preventable if low birthweight were eradicated, regardless of other associated factors. Eliminating risks associated with sociodemographic and socioeconomic factors (including hospital of birth) would potentially decrease the incidence of low birth- weight in Puerto Rico by one third. Specifically, the elimination of risks associated with the socioeconomic disadvantage of women delivering in public hospitals alone would potentially decrease Puerto Rico's low birthweight incidence by 28%, regardless of other factors considered in our study. Conclusions. Efforts to prevent low birthweight and infant mortality in Puerto Rico should focus on reducing the gap between the private and public sectors. Handle: RePEc:aph:ajpbhl:1993:83:11:1572-1576_0 Template-Type: ReDIF-Article 1.0 Title: Aggression, substance use, and suicidal behaviors in high school students Journal: American Journal of Public Health Author-Name: Garrison, C.Z. Author-Name: McKeown, R.E. Author-Name: Valois, R.F. Author-Name: Vincent, M.L. Year: 1993 Volume: 83 Issue: 2 Pages: 179-184 Abstract: Objectives. We sought to analyze the frequency and correlates of suicidal behaviors in a community sample of adolescents. Methods. Information concerning suicidal thoughts and acts, aggressive behaviors, substance use and physical recklessness were collected with the 70-item self-report Youth Risk Behavior Survey from a statewide sample of 3764 South Carolina public high school students. Results. Seventy-five percent of students reported no suicidal behaviors, 11% reported serious suicidal thoughts, 6.4% reported specific suicidal plans, 5.9% reported attempts not requiring medical care, and 1.6% reported attempts requiring medical care. All types of suicidal behaviors occurred more frequently in females than males. Odds ratios for aggressive behaviors and cigarette use were elevated across all categories of suicide behaviors, increasing in magnitude with severity of reported suicidal behavior. Substance use was associated with some but not all categories of suicidal behaviors. The relationships were most pronounced with the use of potentially more dangerous drugs. Conclusions. The results suggest that suicidal behaviors are not infrequent occurrences among adolescents and that they often coexist with other high-risk behaviors. Interventions designed to reduce suicidal behaviors should simultaneously address coexisting high-risk behaviors. Handle: RePEc:aph:ajpbhl:1993:83:2:179-184_4 Template-Type: ReDIF-Article 1.0 Title: The impact of a public health nurse intervention on influenza vaccine acceptance Journal: American Journal of Public Health Author-Name: Black, M.E. Author-Name: Ploeg, J. Author-Name: Walter, S.D. Author-Name: Hutchison, B.G. Author-Name: Scott, E.A.F. Author-Name: Chambers, L.W. Year: 1993 Volume: 83 Issue: 12 Pages: 1751-1753 Abstract: Public health clients in an Ontario community 65 years of age or older were randomly allocated to receive an intervention by a public health nurse during a home visit promoting either influenza immunization or safety measures. There was no statistically significant difference in influenza immunization rates between these two groups (56.1% vs 56.6%). Men were significantly more likely to receive immunization. Handle: RePEc:aph:ajpbhl:1993:83:12:1751-1753_6 Template-Type: ReDIF-Article 1.0 Title: The implications of an epidemiological mistake: A community's response to a perceived excess cancer risk Journal: American Journal of Public Health Author-Name: Guidotti, T.L. Author-Name: Jacobs, P. Year: 1993 Volume: 83 Issue: 2 Pages: 233-239 Abstract: Objectives. The response of community residents to a perceived cancer excess may include changes in attitude, health-related behavior, and property values. In 1986, a cancer agency conducted a study of cancer incidence (1979 to 1983) in two suburbs of Edmonton, Alberta, and reported elevations on the order of 25% over expected for most sites. Reanalysis of these data several months later revealed an error. Correction brought the rates into line with Alberta as a whole and with other communities surrounding Edmonton. Methods. We used public opinion trends and property value trends (during the period of concern) to study the two communities affected by the allegation of increased cancer risk. Results. A survey of residents found significant differences at the time in health-related behavior and beliefs suggesting increased perception of personal, family, and community risk and modest changes in behavior. Real estate values in one community temporarily lost an average of $4000, or about 5% of total value, compared with a similar, adjacent housing market. Conclusions. The perception of an elevated cancer risk, in the absence of a true risk, may have a substantial negative effect on the affected community, both psychologically and economically. Handle: RePEc:aph:ajpbhl:1993:83:2:233-239_4 Template-Type: ReDIF-Article 1.0 Title: Community-oriented primary care: The legacy of Sidney Kark Journal: American Journal of Public Health Author-Name: Geiger, H.J. Year: 1993 Volume: 83 Issue: 7 Pages: 946-947 Handle: RePEc:aph:ajpbhl:1993:83:7:946-947_3 Template-Type: ReDIF-Article 1.0 Title: Occupational injury deaths in Alaska's fishing industry, 1980 through 1988 Journal: American Journal of Public Health Author-Name: Schnitzer, P.G. Author-Name: Landen, D.D. Author-Name: Russell, J.C. Year: 1993 Volume: 83 Issue: 5 Pages: 685-688 Abstract: Objectives. Studies from other countries have identified fishing as a hazardous industry, but little is known about occupational injury mortality related to fishing in the United States. Alaska was chosen for this study because approximately 45 000 people annually participate in Alaska's fishing industry and fishing is thought to be a major contributor to occupational injury mortality in the state. Methods. Work-related injury deaths in Alaska's fishing industry were identified by means of death certificates and US Coast Guard mortality data. Fatality rates were calculated by using average annual fishing industry employment estimates. Results. The 5-year average annual fishing-related fatality rate was 414.6 per 100 000 fishermen. The majority of the decedents were Caucasian men who drowned while fishing. Conclusions. This study emphasizes that fishing is a dangerous industry in Alaska and demonstrates the benefit of using multiple data sources to identify fishing-related deaths in the state. Handle: RePEc:aph:ajpbhl:1993:83:5:685-688_8 Template-Type: ReDIF-Article 1.0 Title: Age patterns of smoking in US Black and White women of childbearing age Journal: American Journal of Public Health Author-Name: Geronimus, A.T. Author-Name: Neidert, L.J. Author-Name: Bound, J. Year: 1993 Volume: 83 Issue: 9 Pages: 1258-1264 Abstract: Objectives. The purpose of the study was to describe age patterns of smoking among Black and White women of reproductive age, with cohort membership controlled for. Method. Data from the 1987 National Health Interview Survey Cancer Supplement, weighted to be nationally representative, were used to calculate the fractions of women who were ever smokers, quitters, and current smokers by age and race. Summary distributions of age patterns of smoking behaviors by race were estimated; proportional hazard models were used to avoid confounding of age and cohort. Results. White women begin smoking at younger ages than do Blacks but are more likely to quit and to do so at young ages. Rates of current smoking converge between Blacks and Whites by age 25, and may cross over by 30. Education-standardized results show larger Black-White differentials in ever smoking and smaller differences in quitting. Conclusions. Our findings confirm that women's age patterns of smoking vary by race. Age x race interactions should be considered in smoking research and anti-tobacco interventions. For Black women, delayed initiation and failure to quit call for increased emphasis on interventions tailored to adults. These findings have possible implications for understanding Black- White differences in low birthweight, child health, and women's health. Handle: RePEc:aph:ajpbhl:1993:83:9:1258-1264_9 Template-Type: ReDIF-Article 1.0 Title: Self-exempting beliefs about smoking and health: Differences between smokers and ex-smokers Journal: American Journal of Public Health Author-Name: Chapman, S. Author-Name: Wai Leng Wong Author-Name: Smith, W. Year: 1993 Volume: 83 Issue: 2 Pages: 215-219 Abstract: Objectives. The purpose of the present study was to examine the role of self-exempting or cognitive dissonance-reducing beliefs about smoking and health. Such beliefs may hold important implications for the content and targeting of health promotion campaigns. Methods. A survey of smokers and ex- smokers was conducted in western Sydney, Australia. Six hypotheses were tested. Results. The principal findings were (1) that 27.9% of smokers and 42.1% of ex-smokers agreed that smokers were more likely than non-smokers to get five smoking-related diseases; (2) that for 11 of 14 beliefs tested, more smokers than ex-smokers agreed to a statistically significant degree; (3) that the median number of such beliefs agreed to by smokers was five, compared with three for ex-smokers; (4) that for only 5 of 14 beliefs was agreement expressed by more precontemplative smokers than smokers contemplating or taking action to quit; (5) that more than one in four smokers, despite agreeing that smokers are more likely than non-smokers to get five diseases, nonetheless maintain a set of self-exempting beliefs. Conclusions. Fewer smokers than ex-smokers accept that smoking causes disease, and smokers also maintain more self-exempting beliefs. Becoming an ex-smoker appears to involve shedding such beliefs in addition to accepting information about the diseases caused by smoking. Handle: RePEc:aph:ajpbhl:1993:83:2:215-219_6 Template-Type: ReDIF-Article 1.0 Title: Anergy compromises screening for tuberculosis in high-risk populations Journal: American Journal of Public Health Author-Name: Zoloth, S.R. Author-Name: Safyer, S. Author-Name: Rosen, J. Author-Name: Michaels, D. Author-Name: Alcabes, P. Author-Name: Bellin, E. Author-Name: Braslow, C. Year: 1993 Volume: 83 Issue: 5 Pages: 749-751 Abstract: Anergy may occur in groups at high risk for tuberculosis, compromising tuberculin skin testing. Within New York City's correctional system, anergy prevalence was 25% among opiate users referred to detoxification programs and 3% in the general population. Correlates of anergy were recent weight loss and needle sharing. The high prevalence of anergy among opiate users compromises the utility of tuberculosis screening and suggests the need for routine chest x-rays to detect pulmonary tuberculosis in some high-risk populations. Handle: RePEc:aph:ajpbhl:1993:83:5:749-751_8 Template-Type: ReDIF-Article 1.0 Title: Pennsylvania's birth rates after Medicaid abortion restrictions [3] Journal: American Journal of Public Health Author-Name: Kahn, E.M. Year: 1993 Volume: 83 Issue: 6 Pages: 911-912 Handle: RePEc:aph:ajpbhl:1993:83:6:911-912_2 Template-Type: ReDIF-Article 1.0 Title: The dissemination of smoking cessation methods for pregnant women: Achieving the Year 2000 Objectives Journal: American Journal of Public Health Author-Name: Windsor, R.A. Author-Name: Chang Qing Li Author-Name: Lowe, J.B. Author-Name: Perkins, L.L. Author-Name: Ershoff, D. Author-Name: Glynn, T. Year: 1993 Volume: 83 Issue: 2 Pages: 173-178 Abstract: The smoking prevalence rate among adult women and pregnant women has decreased only 0.3 to 0.5% per year since 1969. Without a nationwide dissemination of efficacious smoking cessation methods based on these trends, by the year 2000 the smoking prevalence among pregnant women will be approximately 18%. This estimate is well above the US Department of Health and Human Services Year 2000 Objective of 10%. The US dissemination of tested smoking cessation methods could help an additional 12 900 to 155 000 pregnant smokers annually and 600 000 to 1 481 000 cumulatively to quit smoking during the 1990s. Dissemination could help achieve 31 to 78% of the Year 2000 Objectives for pregnancy smoking prevalence. (With dissemination, at best a 15% smoking prevalence during pregnancy, rather than the 10% objective, is likely to be observed.) Our results confirm a well-documented need for a national campaign to disseminate smoking cessation methods. Handle: RePEc:aph:ajpbhl:1993:83:2:173-178_8 Template-Type: ReDIF-Article 1.0 Title: Religious advance directives: The convergence of law, religion, medicine, and public health Journal: American Journal of Public Health Author-Name: Grodin, M.A. Year: 1993 Volume: 83 Issue: 6 Pages: 899-903 Abstract: Because of the deep interpersonal significance of decisions made at the end of life, it is not surprising that religion has played an important role in patient and family decision making. Specific religious concerns about death and dying have led to religious advance directives. Advance directives offer a case study of models of interaction between religious communities and secular institutions. This paper examines why such directives have been created and how they may affect health care decisions. An analysis of their strengths and weaknesses concludes that specific religious instructions are unnecessary in written directives and may undermine both the religious and health care goals of patients. Handle: RePEc:aph:ajpbhl:1993:83:6:899-903_4 Template-Type: ReDIF-Article 1.0 Title: Antidepressants and falls among elderly people in long-term care Journal: American Journal of Public Health Author-Name: Ruthazer, R. Author-Name: Lipsitz, L.A. Year: 1993 Volume: 83 Issue: 5 Pages: 746-749 Abstract: All eligible residents of a long-term care facility (488 women and 147 men with a 6-month minimum stay) were prospectively followed for 1 month for the development of falls. Use of psychotropic medications (excluding as needed prescriptions), functional status, and a history of falls were assessed at the start of the study month. Results of analyses using logistic modeling procedures suggest that institutionalized women on antidepressants may have an increased risk of falling, regardless of fall history, functional status, or age. A relationship between antidepressants and falls was not found for men. These results may help target high-risk individuals for future preventive efforts. Handle: RePEc:aph:ajpbhl:1993:83:5:746-749_9 Template-Type: ReDIF-Article 1.0 Title: Understanding AIDS: Historical interpretations and the limits of biomedical individualism Journal: American Journal of Public Health Author-Name: Fee, E. Author-Name: Krieger, N. Year: 1993 Volume: 83 Issue: 10 Pages: 1477-1486 Abstract: The popular and scientific understanding of acquired immunodeficiency syndrome (AIDS) in the United States has been shaped by successive historical constructions or paradigms of disease. In the first paradigm, AIDS was conceived of as a 'gay plague,' by analogy with the sudden, devastating epidemics of the past. In the second, AIDS was normalized as a chronic disease to be managed medically over the long term. By examining and extending critiques of both paradigms, it is possible to discern the emergence of an alternative paradigm of AIDS as a collective chronic infectious disease and persistent pandemic. Each of these constructions of AIDS incorporates distinct views of the etiology, prevention, pathology, and treatment of disease; each tacitly promotes different conceptions of the proper allocation of individual and social responsibility for AIDS. This paper focuses on individualistic vs collective, and biomedical vs social and historical, understandings of disease. It analyzes the uses of individualism as methodology and as ideology, criticizes some basic assumption of the biomedical model, and discusses alternative strategies for scientific research, health policy, and disease prevention. Handle: RePEc:aph:ajpbhl:1993:83:10:1477-1486_2 Template-Type: ReDIF-Article 1.0 Title: Maternal age and cesarean delivery rate in Shanghai [3] Journal: American Journal of Public Health Author-Name: Chen, Y. Year: 1993 Volume: 83 Issue: 2 Pages: 287-288 Handle: RePEc:aph:ajpbhl:1993:83:2:287-288_9 Template-Type: ReDIF-Article 1.0 Title: A new approach to combatting iodine deficiency in developing countries: The controlled release of iodine in water by a silicone elastomer Journal: American Journal of Public Health Author-Name: Fisch, A. Author-Name: Pichard, E. Author-Name: Prazuck, T. Author-Name: Sebbag, R. Author-Name: Torres, G. Author-Name: Gernez, G. Author-Name: Gentilini, M. Year: 1993 Volume: 83 Issue: 4 Pages: 540-545 Abstract: Objectives. Four hundred million people or more may be exposed to iodine deficiency worldwide, in developing countries in particular. Because of the practical problems with existing methods for the large-scale prevention of iodine deficiency, the authors developed a new approach to collective prophylaxis. Methods. This approach relies on the controlled diffusion of iodine into water from a silicone elastomer. Silicone matrices installed in a bore well released iodine at a rate sufficient to permit the daily per capita intake of at least 100 μg of iodine, the amount recommended by the World Health Organization. The matrices were tested over 1 year in a village in Mali, West Africa, an area in which goiter was highly endemic. The effects on the well water and population were compared with those of a placebo system in a control village. Results. An increase in urinary iodine levels was observed in the treated population, and after 12 months the incidence of goiter had fallen from 53.2% to 29.2%. Conclusions. This new concept, adaptable to all sources of water supply, may contribute to the eradication of iodine deficiency. Handle: RePEc:aph:ajpbhl:1993:83:4:540-545_4 Template-Type: ReDIF-Article 1.0 Title: Medical technology assessment and practice guidelines: Their day in court Journal: American Journal of Public Health Author-Name: Anderson, G.F. Author-Name: Hall, M.A. Author-Name: Steinberg, E.P. Year: 1993 Volume: 83 Issue: 11 Pages: 1635-1639 Abstract: There is the expectation that outcomes research and the promulgation of medical practice guidelines will be able to identify and hopefully reduce the amount of unnecessary or inappropriate medical care through a variety of methods, including utilization review. However, past efforts by public and private insurers to deny claims on the basis of formal technology assessments or practice guidelines have frequently been overturned by the courts for multifarious reasons. This paper examines the court's reluctance to accept a variety of technology assessment methods in coverage policy decisions. The paper reviews the options that have been proposed to restrict judicial involvement in the formulation of coverage policy and then proposes a new option that employs a more precise taxonomy of medical practice assessment. Handle: RePEc:aph:ajpbhl:1993:83:11:1635-1639_7 Template-Type: ReDIF-Article 1.0 Title: After the flood Journal: American Journal of Public Health Author-Name: Richman, N. Year: 1993 Volume: 83 Issue: 11 Pages: 1522-1524 Handle: RePEc:aph:ajpbhl:1993:83:11:1522-1524_7 Template-Type: ReDIF-Article 1.0 Title: 'Getting real' about HIV and homeless youth [1] Journal: American Journal of Public Health Author-Name: Clatts, M.C. Year: 1993 Volume: 83 Issue: 10 Pages: 1490 Handle: RePEc:aph:ajpbhl:1993:83:10:1490_3 Template-Type: ReDIF-Article 1.0 Title: Reported asthma among Puerto Rican, Mexican-American, and Cuban children, 1982 through 1984 Journal: American Journal of Public Health Author-Name: Carter-Pokras, O.D. Author-Name: Gergen, P.J. Year: 1993 Volume: 83 Issue: 4 Pages: 580-582 Abstract: Data from the Hispanic Health and Nutrition Examination Survey (HHANES) (1982 through 1984) and the National Health and Nutrition Examination Survey (NHANES) II (1976 through 1980) were used to examine reported physician- diagnosed asthma among 6-month-old through 11-year-old children. The highest prevalence of active asthma was reported for Puerto Ricans: 11.2% compared with 3.3% for non-Hispanic Whites, 5.9% for non-Hispanic Blacks, 2.7% for Mexican Americans, and 5.2% for Cubans. Health services utilization and severity do not appear to explain the differences between Puerto Ricans and Mexican Americans. Educational programs on asthma should consider focusing on Puerto Ricans. Handle: RePEc:aph:ajpbhl:1993:83:4:580-582_4 Template-Type: ReDIF-Article 1.0 Title: The risk of measles, mumps, and varicella among young adults: A serosurvey of US navy and marine corps recruits Journal: American Journal of Public Health Author-Name: Struewing, J.P. Author-Name: Hyams, K.C. Author-Name: Tueller, J.E. Author-Name: Gray, G.C. Year: 1993 Volume: 83 Issue: 12 Pages: 1717-1720 Abstract: Objectives. To assess the risk of epidemic transmission and to guide immunization policy, the seroprevalence of antibody to measles, mumps, and varicella was determined in a group of young adults. Methods. A cross- sectional study of 1533 US Navy and Marine Corps recruits was conducted in June 1989. Antibody status was determined with commercially available enzyme- linked immunosorbent assays. Results. Direct sex and race adjustment to the 15- to 29-year-old US population resulted in seronegativity rates of 17.8% for measles, 12.3% for mumps, and 6.7% for varicella. Measles and mumps seronegativity rates were higher among Whites whereas varicella seronegativity was higher among non-Whites. Recruits enlisting from outside the 50 US states, especially those from island territories, were more likely to lack varicella antibody. The sensitivity of a positive history of vaccination or disease in predicting antibody status was less than 90% for all diseases. Conclusions. These results suggest a continued potential for epidemics, especially of measles, and the need for mandatory immunization policies. Immigrants to the United States, especially those from island territories, may be a high-risk group that could benefit from varicella vaccination. Handle: RePEc:aph:ajpbhl:1993:83:12:1717-1720_8 Template-Type: ReDIF-Article 1.0 Title: The influence of smoking cessation on body weight may be temporary Journal: American Journal of Public Health Author-Name: Chen, Y. Author-Name: Horne, S.L. Author-Name: Dosman, J.A. Year: 1993 Volume: 83 Issue: 9 Pages: 1330-1332 Abstract: The relationships of body weight and body mass index with smoking cessation were examined among 1633 adults in Humboldt, Saskatchewan, Canada. Mean body mass index was highest in ex-smokers and lowest in smokers, and that of non-smokers was intermediate. Body mass index decreased significantly with increasing years after smoking cessation in female ex-smokers after adjusting for age, education, location of work, and physical activity. This trend, however, was not significant in men. The body weight data showed similar results. The prevalence of obesity (body mass index greater than 30 kg/m2) in all subjects showed a decrease with increasing years after smoking cessation. Handle: RePEc:aph:ajpbhl:1993:83:9:1330-1332_7 Template-Type: ReDIF-Article 1.0 Title: Cigarette smoking and the risk of diabetes in women Journal: American Journal of Public Health Author-Name: Rimm, E.B. Author-Name: Manson, J.E. Author-Name: Stampfer, M.J. Author-Name: Colditz, G.A. Author-Name: Willett, W.C. Author-Name: Rosner, B. Author-Name: Hennekens, C.H. Author-Name: Speizer, F.E. Year: 1993 Volume: 83 Issue: 2 Pages: 211-214 Abstract: Objectives. Noninsulin-dependent diabetes mellitus, a major risk factor for cardiovascular disease, is prevalent in more than 12 million Americans. A voluminous amount of data demonstrates that cigarette smoking is an important cause of cancer and coronary heart disease. However, the association between cigarette smoking and the risk of diabetes is virtually unexplored, especially in women. Methods. We examined the association between smoking and the incidence of noninsulin-dependent diabetes mellitus among 114 247 female nurses who were free of diabetes, cardiovascular disease, and cancer in 1976. We collected exposure information and disease status prospectively for 12 years from biennially self-administered questionnaires. Results. Current smokers had an increased risk of diabetes, and we observed a significant dose-response trend for higher risk among heavier smokers. During 1 277 589 person-years of follow-up, 2333 women were clinically diagnosed with diabetes. The relative risk of diabetes, adjusted for obesity and other risk factors, was 1.42 among women who smoked 25 or more cigarettes per day compared with nonsmokers. Conclusions. These data suggest that cigarette smoking may be an independent, modifiable risk factor for noninsulin- dependent diabetes mellitus. Handle: RePEc:aph:ajpbhl:1993:83:2:211-214_9 Template-Type: ReDIF-Article 1.0 Title: HIV risk-related sex behaviors among injection drug users, crack smokers, and injection drug users who smoke crack Journal: American Journal of Public Health Author-Name: Booth, R.E. Author-Name: Watters, J.K. Author-Name: Chitwood, D.D. Year: 1993 Volume: 83 Issue: 8 Pages: 1144-1148 Abstract: Objectives. This study was designed to assess and compare sex risk behaviors for human immunodeficiency virus (HIV) transmission of three drug user groups: injectors who do not smoke crack, crack smokers who do not inject, and injectors who also smoke crack. Methods. Sexual risk behaviors for HIV were assessed among 246 drug users from Denver, Miami, and San Francisco. Respondents were classified into the three drug groups based on self-report and verified through urinalysis and physical inspection. Results. An increased risk for HIV through sexual transmission was associated with crack cocaine use, particularly among those who also injected. Crack smoking injectors were more likely to report sex with an injector, exchanging sex for drugs and/or money, drug use before or during sex, and unprotected sexual intercourse. They also injected more than injectors only, smoked crack as often as smokers only, and reported higher overall frequencies of drug use. Conclusions. These findings, together with the higher rates of gonorrhea and syphilis reported by smokers and injectors/smokers, are indicators of the risk crack poses for the heterosexual transmission of HIV. Handle: RePEc:aph:ajpbhl:1993:83:8:1144-1148_8 Template-Type: ReDIF-Article 1.0 Title: Neonatal tetanus in Peru: Risk assessment with modified enzyme-linked immunosorbent assay and toxoid skin test Journal: American Journal of Public Health Author-Name: Vernacchio, L. Author-Name: Madico, G. Author-Name: Verastegui, M. Author-Name: Diaz, F. Author-Name: Collins, T.S. Author-Name: Gilman, R.H. Year: 1993 Volume: 83 Issue: 12 Pages: 1754-1756 Abstract: We used a modified enzyme-linked immunosorbent assay (ELISA) to investigate tetanus immunity in 232 pregnant Peruvian women. One hundred forty-two (61.2%) had protective antitoxin titers (≥0.01 IU/mL). Protective titers correlated positively with the number of toxoid doses reported during the current pregnancy. A majority of women reporting no toxoid doses during the current pregnancy had at least one prenatal health care visit. We evaluated a toxoid skin test in 44 of the subjects, but it correlated poorly with the ELISA. The modified ELISA is a useful in vitro method for studying tetanus immunity in the developing world. Handle: RePEc:aph:ajpbhl:1993:83:12:1754-1756_0 Template-Type: ReDIF-Article 1.0 Title: Physical activity of public housing residents in Birmingham, Alabama Journal: American Journal of Public Health Author-Name: Lewis, C.E. Author-Name: Raczynski, J.M. Author-Name: Heath, G.W. Author-Name: Levinson, R. Author-Name: Cutter, G.R. Year: 1993 Volume: 83 Issue: 7 Pages: 1016-1020 Abstract: Objectives. Because few data are available concerning physical activity among minority and low-income persons, we characterized physical activity patterns among public housing residents. Methods. Two separate cross- sectional surveys were conducted 1 year apart of randomly selected residents of eight rental communities administered by the housing authority of Birmingham, Ala. Indigenous interviewers completed 687 interviews in survey 1 and 599 in survey 2. Results. In both surveys, respondents were most frequently young adult African-American women, reflecting the predominance of women in these communities. Participants were generally poorly educated and either unemployed or working in service occupations. Thirty percent of the respondents in both surveys reported no participation in any of 13 physical activities in the previous year; approximately half reported activity levels equivalent to or less than walking 4 hours per week for 8 months of the year. Respondents who were younger and male were significantly more likely to have higher activity levels. Conclusions. A sedentary lifestyle is common among this low-income minority group, and, thus, interventions to promote exercise in these communities are needed. Handle: RePEc:aph:ajpbhl:1993:83:7:1016-1020_5 Template-Type: ReDIF-Article 1.0 Title: Clinical research, prophylaxis, therapy, and care for HIV disease in Africa Journal: American Journal of Public Health Author-Name: De Cock, K.M. Author-Name: Lucas, S.B. Author-Name: Lucas, S. Author-Name: Agness, J. Author-Name: Kadio, A. Author-Name: Gayle, H.D. Year: 1993 Volume: 83 Issue: 10 Pages: 1385-1389 Abstract: By the end of the century, citizens of resource-poor countries will constitute 90% of the world's human immunodeficiency virus (HIV)-infected people. Clinical management of such persons in developing countries has been neglected; most AIDS research has concentrated on epidemiology, and donor agencies have generally invested in the prevention of HIV infection. The heavy burden of HIV disease in Africa requires that care for AIDS be addressed, and prevention and care should be seen as interrelated. Prevention and treatment of tuberculosis, the commonest severe infection in persons with AIDS in Africa, illustrate this interrelationship. We outline priorities for applied research on the management of HIV disease in a resource-poor environment, and disease prophylaxis, therapy for opportunistic diseases, terminal care, and use of antiretroviral therapy. Research should define the standard of care that can realistically be demanded for HIV disease in a resource-poor environment. Research and public health programs for AIDS in developing countries must address AIDS care and attempt to reduce the widening gap between interventions available for HIV-infected persons in different parts of the world. Handle: RePEc:aph:ajpbhl:1993:83:10:1385-1389_1 Template-Type: ReDIF-Article 1.0 Title: Work-site cardiovascular risk reduction: A randomized trial of health risk assessment, education, counseling, and incentives Journal: American Journal of Public Health Author-Name: Gomel, M. Author-Name: Oldenburg, B. Author-Name: Simpson, J.M. Author-Name: Owen, N. Year: 1993 Volume: 83 Issue: 9 Pages: 1231-1238 Abstract: Objectives. This study reports an efficacy trial of four work-site health promotion programs. It was predicted that strategies making use of behavioral counseling would produce a greater reduction in cardiovascular disease risk factors than screening and educational strategies. Methods. Twenty-eight work sites were randomly allocated to a health risk assessment, risk factor education, behavioral counseling, or behavioral counseling plus incentives intervention. Participants were assessed before the intervention and at 3, 6, and 12 months. Results. Compared with the average of the health risk assessment and risk factor education conditions, there were significantly higher validated continuous smoking cessation rates and smaller increases in body mass index and estimated percentage of body fat in the two behavioral counseling conditions. The behavioral counseling condition was associated with a greater reduction in mean blood pressure than was the behavioral counseling plus incentives condition. On average among all groups, there was a short-term increase in aerobic capacity followed by a return to baseline levels. Conclusions. Work-site interventions that use behavioral approaches can produce lasting changes in some cardiovascular risk factors and, if implemented routinely, can have a significant public health impact. Handle: RePEc:aph:ajpbhl:1993:83:9:1231-1238_4 Template-Type: ReDIF-Article 1.0 Title: Towards a more inclusive model of women's health Journal: American Journal of Public Health Author-Name: Ruzek, S.B. Year: 1993 Volume: 83 Issue: 1 Pages: 6-8 Handle: RePEc:aph:ajpbhl:1993:83:1:6-8_1 Template-Type: ReDIF-Article 1.0 Title: The origins of infant salmonellosis [5] Journal: American Journal of Public Health Author-Name: Haddock, R.L. Year: 1993 Volume: 83 Issue: 5 Pages: 772 Handle: RePEc:aph:ajpbhl:1993:83:5:772_9 Template-Type: ReDIF-Article 1.0 Title: The effects of a natural disaster on child behavior: Evidence for posttraumatic stress Journal: American Journal of Public Health Author-Name: Durkin, M.S. Author-Name: Khan, N. Author-Name: Davidson, L.L. Author-Name: Zaman, S.S. Author-Name: Stein, Z.A. Year: 1993 Volume: 83 Issue: 11 Pages: 1549-1553 Abstract: Objectives. A prospective study of children examined both before and after a flood disaster in Bangladesh is used to test the hypothesis that stressful events play a causal role in the development of behavioral disorders in children. Methods. Six months before the disaster, structured measures of selected behavioral problems were made during an epidemiological study of disability among 2- to 9-year-old children. Five months after the disaster, a representative sample of 162 surviving children was reevaluated. Results. Between the pre- and postflood assessments, the prevalence of aggressive behavior increased from zero to nearly 10%, and 45 of the 134 children who had bladder control before the flood (34%) developed enuresis. Conclusions. These results help define what may be considered symptoms of posttraumatic distress in childhood; they also contribute to mounting evidence of the need to develop and evaluate interventions aimed at ameliorating the behavioral and psychological consequences of children's exposure to extreme and traumatic situations. Handle: RePEc:aph:ajpbhl:1993:83:11:1549-1553_9 Template-Type: ReDIF-Article 1.0 Title: The dependence potential of short half-life benzodiazepines: A meta- analysis Journal: American Journal of Public Health Author-Name: Hallfors, D.D. Author-Name: Saxe, L. Year: 1993 Volume: 83 Issue: 9 Pages: 1300-1304 Abstract: Objectives. The dependence potential of benzodiazepine medications is now widely recognized, but uncertainty exists as to whether use of short half- life vs long half-life drugs results in greater dependence. The present study reports a meta-analysis of the extant research to evaluate the dependence potential of different types of benzodiazepines. Method. Seven studies were found that specifically compared long half-life and short half-life benzodiazepines and allowed statistical comparison by their homogeneous dependent variables. Drugs in these studies were used as daytime sedatives. Results. Substantial evidence was found for differential effects of short vs long half-life drugs at withdrawal. In all studies, dropouts were higher among short half-life subjects. In the random-assignment short-term use studies, Hamilton Anxiety Scale scores showed higher incidence of rebound among subjects who used the short half-life drugs. Conclusions. The present meta-analysis confirms clinical impressions of the greater dependence potential of short vs long half-life benzodiazepines. Doctors, patients, and policymakers need to be informed so as to avoid harm to the public health through unintended drug dependence. Handle: RePEc:aph:ajpbhl:1993:83:9:1300-1304_1 Template-Type: ReDIF-Article 1.0 Title: Changes in energy intakes during pregnancy and lactation in a national sample of US women Journal: American Journal of Public Health Author-Name: Murphy, S.P. Author-Name: Abrams, B.F. Year: 1993 Volume: 83 Issue: 8 Pages: 1161-1163 Abstract: Increases in energy intakes during pregnancy and lactation were evaluated by examining dietary data for 458 pregnant women who participated in the Continuing Surveys of Food Intakes by Individuals conducted in 1985 and 1986. Energy intakes were well below recommendations during all reproductive states; however, increases during pregnancy approximated recommendations, while increases during lactation were low. Postpartum nonlactating intakes did not return to prepregnancy levels for Black women or women with lower incomes. Handle: RePEc:aph:ajpbhl:1993:83:8:1161-1163_5 Template-Type: ReDIF-Article 1.0 Title: Erratum: The reporting of HIV/AIDS deaths in women (Am J Public Health (1992) 82 (1500-1505)) Journal: American Journal of Public Health Author-Name: Buehler, J.W. Author-Name: Hanson, D.L. Author-Name: Chu, S.Y. Year: 1993 Volume: 83 Issue: 5 Pages: 666 Handle: RePEc:aph:ajpbhl:1993:83:5:666_5 Template-Type: ReDIF-Article 1.0 Title: The prevalence of alcohol-related mortality in both sexes: Variation between indicators, Stockholm, 1987 Journal: American Journal of Public Health Author-Name: Romelsjo, A. Author-Name: Karlsson, G. Author-Name: Henningsohn, L. Author-Name: Jakobsson, S.W. Year: 1993 Volume: 83 Issue: 6 Pages: 838-844 Abstract: Objectives. The purpose of this study was to analyze the prevalence rates of alcohol-related mortality-according to various indicators-in both sexes in Stockholm, Sweden. Methods. A study of alcohol involvement at death was undertaken for all 668 deceased persons aged 15 through 54 years in 1987 in Stockholm. Death certificates, autopsy information, police records, and information about earlier conviction were analyzed. Results. When different measures of estimation were compared, there were great differences in the prevalence rates of alcohol involvement. According to the death certificates, 9.2% of the males and 11.2% of the females had alcoholism, alcohol intoxication, pancreatitis or liver cirrhosis as underlying cause of death. When all accessible information was used, potential alcohol involvement was found in 57.5% of the male and in 32.2% of the female deaths. There was a marked association between earlier drunken driving and alcohol involvement. After reevaluation of the diagnoses with autopsy findings, the number of cases with cardiac enlargement and suspected cardiomyopathy increased from 10 to 62. Conclusion. The results point to the serious underdiagnosis of alcohol involvement in death certificates and the misclassification of important causes of death (i.e., liver cirrhosis and cardiac disease); they also call for increased efforts regarding prevention. Handle: RePEc:aph:ajpbhl:1993:83:6:838-844_3 Template-Type: ReDIF-Article 1.0 Title: A stop-smoking telephone help line that nobody called Journal: American Journal of Public Health Author-Name: Glasgow, R.E. Author-Name: Lando, H. Author-Name: Hollis, J. Author-Name: McRae, S.G. Author-Name: La Chance, P.-A. Year: 1993 Volume: 83 Issue: 2 Pages: 252-253 Abstract: The purpose of this study was to evaluate the reach of a smoker's hotline that provided a variety of services to over 2100 health maintenance organization members. Formative evaluation procedures identified topics of concern, and repeated promotions advertised the service via multiple channels. Excluding a special giveaway promotion, an average of less than three calls per month were made during the 33 months of operation. To be cost-effective, smoker's hotlines should be offered to large populations and should be consistently and intensively publicized. Handle: RePEc:aph:ajpbhl:1993:83:2:252-253_1 Template-Type: ReDIF-Article 1.0 Title: Factors affecting gay and bisexual men's decisions and intentions to seek HIV testing Journal: American Journal of Public Health Author-Name: Myers, T. Author-Name: Orr, K.W. Author-Name: Locker, D. Author-Name: Jackson, E.A. Year: 1993 Volume: 83 Issue: 5 Pages: 701-704 Abstract: Objectives. This paper describes the relationships of sociodemographic, attitudinal, and behavioral variables to (1) decision to be tested, (2) expressed intention to be tested, and (3) reasons for not being tested for the human immunodeficiency virus (HIV) antibody. Methods. A sample of 1295 men completed an anonymous questionnaire in gay-identified venues. Factor analysis was used to group reasons for not being tested and logistic and multiple linear regression were used to model the dependent variables. Results. Fifty-three percent of the respondents had been tested, of whom 26% tested positive. Metropolitan residence and anal intercourse most strongly correlated with previous test-seeking. Previous test experience correlated most strongly with intention to be tested. Reasons for not being tested fell into three groups: (1) desire for anonymity, (2) self-perceived health, and (3) no benefit and denial. The odds were lower for gay men than bisexuals and men who did not participate in anal intercourse to express a desire for anonymity. Conclusions. Public health agencies should be prepared to individualize testing policies and education to deal with specific concerns and fears. Improving access to the test by removing some of the current psychological and physical barriers will enhance its medical and public health value. Handle: RePEc:aph:ajpbhl:1993:83:5:701-704_4 Template-Type: ReDIF-Article 1.0 Title: The dual epidemics of tuberculosis and AIDS: Ethical and policy issues in screening and treatment Journal: American Journal of Public Health Author-Name: Bayer, R. Author-Name: Dubler, N.N. Author-Name: Landesman, S. Year: 1993 Volume: 83 Issue: 5 Pages: 649-654 Abstract: As the recent increase in cases of tuberculosis is addressed, there is a danger that the need for increased protection of the public health will create a climate in which the rights of individuals with tuberculosis and human immunodeficiency virus (HIV) infection may be disregarded. This paper considers ethical and policy issues in the control of tuberculosis. The authors conclude that mandatory HIV testing is not critical to effective tuberculosis control, and that although individuals infected with HIV are at increased risk for developing tuberculosis, exclusionary employment practices are not justified. Because failure to complete the course of tuberculosis treatment increases the prospect that drug-resistant strains will develop, it is crucial to require all those who commence treatment to complete their therapy. To ensure the completion of treatment, special attention must be paid to the needs of the homeless, drug users, and those with psychiatric impairments. In addition, all tuberculosis patients should begin their posthospital care under direct observation. Patients who fail to complete treatment despite efforts to encourage and facilitate their cooperation should be subject to confinement after a hearing with full due process protections. Handle: RePEc:aph:ajpbhl:1993:83:5:649-654_4 Template-Type: ReDIF-Article 1.0 Title: The cost-effectiveness of rehabilitation in the home: A study of Swedish elderly Journal: American Journal of Public Health Author-Name: Melin, A.-L. Author-Name: Hakansson, S. Author-Name: Bygren, L.O. Year: 1993 Volume: 83 Issue: 3 Pages: 356-362 Abstract: Objectives. To investigate whether care of elderly and disabled patients could be more cost-effective after a short-term hospital stay, we examined the impact of a primary home care intervention program on functional status, use, and costs of care after 6 months. Methods. When clinically ready for discharge from the hospital, chronically ill patients with dependence in one to five functions in personal activities of daily living were randomized to physician-led primary home care with a 24-hour service, and the controls were offered ordinary care. Physical, cognitive, social, and medical functions were assessed in 110 team subjects and 73 controls. Data regarding inpatient days and outpatient visits were collected and converted to costs. Results. Team patients demonstrated better instrumental activities of daily living and outdoor walking and significantly fewer diagnoses and drugs at 6 months. They used less inpatient and more outpatient care compared with the control patients. Significant cost reductions were found in the team group. Conclusions. This primary home care intervention program is cost-effective, at least for a selection of patients at risk for long-term hospital care. Handle: RePEc:aph:ajpbhl:1993:83:3:356-362_6 Template-Type: ReDIF-Article 1.0 Title: Factors associated with late smoking initiation in Minnesota women Journal: American Journal of Public Health Author-Name: Daly, K.A. Author-Name: Lund, E.M. Author-Name: Harty, K.C. Author-Name: Ersted, S.A. Year: 1993 Volume: 83 Issue: 9 Pages: 1333-1335 Abstract: This case-control study investigated factors associated with late initiation (i.e., initiation after the age of 17 years) of smoking among young women. The most significantly elevated odds ratios for late initiation were having a significant other who smoked and having friends who found smoking acceptable at initiation. Peers, especially significant others, played an important role in smoking initiation among young women. Prevention efforts should focus on strategies that reduce the acceptability of smoking in the social environment. Handle: RePEc:aph:ajpbhl:1993:83:9:1333-1335_3 Template-Type: ReDIF-Article 1.0 Title: Mandating vitamin K prophylaxis for newborns in New York State Journal: American Journal of Public Health Author-Name: Tulchinsky, T.H. Author-Name: Patton, M.M. Author-Name: Randolph, L.A. Author-Name: Meyer, M.R. Author-Name: Linden, J.V. Year: 1993 Volume: 83 Issue: 8 Pages: 1166-1168 Abstract: New York State's infant deaths and hospitalizations attributed to hemorrhagic disease of the newborn and other neonatal hemorrhagic conditions were reviewed. In 65% of 34 deaths reviewed, vitamin K was not documented as given or was given only after the onset of hemorrhage. Vitamin K was not included in standing orders in any of 22 hospitals contacted. As a result of this review, vitamin K prophylaxis was made a mandatory newborn care procedure in the State Public Health Code. Handle: RePEc:aph:ajpbhl:1993:83:8:1166-1168_9 Template-Type: ReDIF-Article 1.0 Title: The initial impact of a workplace lead-poisoning prevention project Journal: American Journal of Public Health Author-Name: Bellows, J. Author-Name: Rudolph, L. Year: 1993 Volume: 83 Issue: 3 Pages: 406-410 Abstract: The California Department of Health Services began an occupational lead poisoning prevention project in cooperation with 275 radiator service companies. The agency developed and marketed resources to facilitate companies' own efforts, tracked the progress of each company, and urged the companies to conduct blood lead testing. Testing by participating employers increased from 9% to 95%, and 10 times as many companies with likely overexposures were identified as had been reported to the state's lead registry in the previous year. The success of this project indicates that the model should be applied more extensively. Handle: RePEc:aph:ajpbhl:1993:83:3:406-410_2 Template-Type: ReDIF-Article 1.0 Title: Potential bias in cardiovascular risk behavior study [4] Journal: American Journal of Public Health Author-Name: Siegel, P.Z. Author-Name: Franks, A.L. Author-Name: Jackson, C. Year: 1993 Volume: 83 Issue: 5 Pages: 771-772 Handle: RePEc:aph:ajpbhl:1993:83:5:771-772_4 Template-Type: ReDIF-Article 1.0 Title: Race, health, and health services Journal: American Journal of Public Health Author-Name: Bergner, L. Year: 1993 Volume: 83 Issue: 7 Pages: 939-941 Handle: RePEc:aph:ajpbhl:1993:83:7:939-941_0 Template-Type: ReDIF-Article 1.0 Title: Risk of HIV infection among Army Reserve Components Physicians [2] Journal: American Journal of Public Health Author-Name: Cowan, D.N. Author-Name: Brundage, J.F. Author-Name: Pomerantz, R.S. Author-Name: Wann, Z.F. Author-Name: Miller, R.N. Year: 1993 Volume: 83 Issue: 11 Pages: 1640-1641 Handle: RePEc:aph:ajpbhl:1993:83:11:1640-1641_1 Template-Type: ReDIF-Article 1.0 Title: Erratum: The mortality of lead smelter workers: An update (Am J Public Health (1992) 82 (1641-1644)) Journal: American Journal of Public Health Author-Name: Steenland, K. Author-Name: Selevan, S. Author-Name: Landrigan, P. Year: 1993 Volume: 83 Issue: 1 Pages: 60 Handle: RePEc:aph:ajpbhl:1993:83:1:60_2 Template-Type: ReDIF-Article 1.0 Title: Women's sexual behaviors: Only half the picture [4] Journal: American Journal of Public Health Author-Name: Clark, C.J.G. Author-Name: Aral, S.O. Year: 1993 Volume: 83 Issue: 6 Pages: 912 Handle: RePEc:aph:ajpbhl:1993:83:6:912_8 Template-Type: ReDIF-Article 1.0 Title: Active AIDS surveillance: Hospital-based case finding in a metropolitan California county Journal: American Journal of Public Health Author-Name: Elcock, M. Author-Name: Simon, T. Author-Name: Gilbert, B.P. Author-Name: Copello, A.G. Author-Name: Kelzer, P.J. Year: 1993 Volume: 83 Issue: 7 Pages: 1002-1005 Abstract: Objectives. Health departments that use passive surveillance alone cannot be sure of the level of complete and accurate reporting of acquired immunodeficiency syndrome (AIDS) cases. We sought to develop a model of active AIDS case reporting using limited county resources. Methods. A validation study of AIDS case reporting using discharge diagnosis codes was undertaken to assess underreporting. Hospital-specific protocols for active surveillance were developed. Results. The validation study revealed that 24% of AIDS cases in all hospitals were not reported through passive surveillance in 1990. In the first 3 months of 1991, active surveillance identified nine unreported cases (69% of the total cases reported) in one hospital. These underreporting estimates far exceed the 15% national underreporting rate estimated by the Centers for Disease Control. Conclusions. A method of hospital-based case finding was developed and serves as the model for implementing an ongoing program of active surveillance needed to ensure complete, accurate, and timely reporting of diagnosed AIDS cases. Application of this model may be helpful in attempts to minimize underreporting. Handle: RePEc:aph:ajpbhl:1993:83:7:1002-1005_8 Template-Type: ReDIF-Article 1.0 Title: Infectious diseases and mortality among US nursing home residents Journal: American Journal of Public Health Author-Name: Beck-Sague, C. Author-Name: Banerjee, S. Author-Name: Jarvis, W.R. Year: 1993 Volume: 83 Issue: 12 Pages: 1739-1742 Abstract: Data collected in the 1985 National Nursing Home Survey were analyzed to identify risk factors for infections and mortality and to explore their relationship in US nursing homes. An infection was recorded in 166 609 (14%) discharges. Risk of pneumonia was found to be higher among bedbound patients (54.5 vs 13.1 per 100 discharges); urinary tract and other infections were most frequent among residents with indwelling catheters (6.6 vs 1.0 per 100 discharges). Residents with pneumonia were more likely than those with other infections to die (35% vs 28%), or be discharged to hospitals if alive (94% vs 66%). Thus, immobility and catheterization were associated with infections in US nursing homes, and pneumonia was found to contribute to mortality. Handle: RePEc:aph:ajpbhl:1993:83:12:1739-1742_2 Template-Type: ReDIF-Article 1.0 Title: AIDS trends among Hispanics in the United States Journal: American Journal of Public Health Author-Name: Diaz, T. Author-Name: Buehler, J.W. Author-Name: Castro, K.G. Author-Name: Ward, J.W. Year: 1993 Volume: 83 Issue: 4 Pages: 504-509 Abstract: Objectives. In 1991 the incidence of acquired immunodeficiency syndrome (AIDS) in the United States was 31.6 per 100 000 population among Hispanics and 11.8 per 100 000 among non-Hispanic Whites. The purpose of this study was to further describe the AIDS epidemic among Hispanics by examining differences in risk factors among different Hispanic groups (as defined by birthplace). Methods. AIDS cases reported to the Centers for Disease Control and Prevention from 1988 through 1991 were reviewed. Results. For men, except for those born in Puerto Rico, the predominant exposure category was male- male sex. The proportion of cases due to injection drug use was 35% among Hispanic men born in the United States, 27% among men born in the Dominican Republic, and 61% among men born in Puerto Rico, but <10% among other Hispanic men and non-Hispanic White men. For women the predominant exposure category was injection drug use among Hispanics born in the United States (56%) and Puerto Rico (46%) and among non-Hispanic Whites (42%). The proportion of cases associated with injection drug use was significantly lower (<30%) among other Hispanic women. Conclusions. AIDS prevention strategies must be geared toward different exposure categories among different Hispanic groups. Handle: RePEc:aph:ajpbhl:1993:83:4:504-509_9 Template-Type: ReDIF-Article 1.0 Title: High-density lipoprotein cholesterol and alcohol consumption in US White and Black adults: Data from NHANES II Journal: American Journal of Public Health Author-Name: Linn, S. Author-Name: Carroll, M. Author-Name: Johnson, C. Author-Name: Fulwood, R. Author-Name: Kalsbeek, W. Author-Name: Briefel, R. Year: 1993 Volume: 83 Issue: 6 Pages: 811-816 Abstract: Objectives. High-density lipoprotein (HDL) cholesterol is known to be positively related to moderate alcohol consumption from studies in selected populations. This study describes the association in a representative sample of the US adult population. Methods. Stratification and multivariate regression analyses were used to examine HDL cholesterol levels and alcohol consumption. Results. Fewer women than men reported consumption of alcohol at any frequency. Similar percentages of Whites and Blacks reported alcohol consumption. Age-adjusted mean HDL cholesterol levels were higher among alcohol drinkers than among nondrinkers in all sex-race strata. Mean HDL cholesterol levels of Whites and Blacks of both sexes increased consistently with increased frequency of consumption of beer, wine, and liquor. With age, education, body mass index, smoking, and physical activity controlled for, there were higher age-adjusted HDL cholesterol levels with increasing reported quantities of alcohol consumed. Daily or weekly use of alcohol led to an increase of 5.1 mg/dL in mean HDL cholesterol level, whereas consumption of 1 g of alcohol led to an increase of 0.87 mg/dL. Conclusion. Even if there is a causal association between alcohol consumption and higher HDL cholesterol levels, it is suggested that efforts to reduce coronary heart disease risks concentrate on the cessation of smoking and weight control. Handle: RePEc:aph:ajpbhl:1993:83:6:811-816_3 Template-Type: ReDIF-Article 1.0 Title: Inappropriate Halsted mastectomy and patient volume in Italian hospitals Journal: American Journal of Public Health Author-Name: Grilli, R. Author-Name: Mainini, F. Author-Name: Penna, A. Author-Name: Bertolini, G. Author-Name: Scorpiglione, N. Author-Name: Torri, V. Author-Name: Liberati, A. Year: 1993 Volume: 83 Issue: 12 Pages: 1762-1764 Abstract: To study whether Halsted mastectomy was used only when properly indicated, a prospective survey was undertaken on the process of care of 985 breast cancer patients seen consecutively at 62 general hospitals in Northern and Central Italy. Overall, 79% of Halsted mastectomies were performed inappropriately. The procedure was less likely to be performed on more educated patients and, other factors considered, on those seen at hospitals with larger volume. We conclude that the measurement of utilization of a surgical procedure for which only a few appropriate indications exist may help identify important relationships between hospital characteristics and quality of surgical care. Handle: RePEc:aph:ajpbhl:1993:83:12:1762-1764_3 Template-Type: ReDIF-Article 1.0 Title: Race and survival time with AIDS: A synthesis of the literature Journal: American Journal of Public Health Author-Name: Curtis, J.R. Author-Name: Patrick, D.L. Year: 1993 Volume: 83 Issue: 10 Pages: 1425-1428 Abstract: Objective. This study summarizes the evidence concerning the association of Black and White race with acquired immunodeficiency syndrome (AIDS) survival time. Methods. English-language articles measuring survival time with AIDS for Black and White persons were reviewed. Each article was assigned to one of three groups based on the method of subject accrual. Results. Of the nine eligible studies identified, five studies had inclusive methods of accruing study subjects, and four of these five showed decreased survival time among Black persons. In the studies with more restrictive accrual methods, survival time for Blacks was not decreased. Conclusions. Although the published studies vary in their results, this variation appears to be systematic according to the method of accruing study subjects. If the accrual method serves to minimize socioeconomic differences between Blacks and Whites, there is no difference in survival time by race. However, if a more inclusive method is used, a significant decrease in AIDS survival time is observed among Blacks. This analysis suggests that, in some studies, race may function as a marker for socioeconomic factors and/or access to health care and that AIDS patients in the lowest socioeconomic or access group have significantly shorter survival times. Handle: RePEc:aph:ajpbhl:1993:83:10:1425-1428_5 Template-Type: ReDIF-Article 1.0 Title: The 1945 Gluckman Report and the establishment of South Africa's health centers Journal: American Journal of Public Health Author-Name: Phillips, H.T. Year: 1993 Volume: 83 Issue: 7 Pages: 1037-1038 Handle: RePEc:aph:ajpbhl:1993:83:7:1037-1038_1 Template-Type: ReDIF-Article 1.0 Title: Recognizing illicit drug use by pregnant women: Reports from Oregon birth attendants Journal: American Journal of Public Health Author-Name: Slutsker, L. Author-Name: Smith, R. Author-Name: Higginson, G. Author-Name: Fleming, D. Year: 1993 Volume: 83 Issue: 1 Pages: 61-64 Abstract: Objectives. This study was undertaken to determine the prevalence of recognized prenatal illicit substance abuse and the characteristics of women being identified as illicit drug users in a statewide population-based cohort. Methods. During a 1-month period, birth attendants of all singleton births in Oregon (n = 3200) were surveyed regarding their knowledge of prenatal illicit drug use by women who gave birth. Birth certificates were linked to surveys after removal of personal identifiers. Results. Illicit drug use was recognized in 5.2% of delivering women. Nearly half had used cocaine, methamphetamine, or heroin. Recognized users were significantly more likely than nonusers to be unwed and to have used tobacco or alcohol, have received inadequate prenatal care, and have public assistance as a source of payment. Drug use was recognized twice as frequently by practitioners who routinely questioned their patients about it compared with those who relied on clinical judgment or the occurrence of complications during pregnancy. Birth certificate reporting identified only 41% of recognized users. Conclusions. Oregon practitioners are identifying seven times as many drug- using women as can be accommodated by available treatment programs for this population. Increased efforts are needed to ensure the adequacy of resources necessary to cope with the problem as already recognized. Handle: RePEc:aph:ajpbhl:1993:83:1:61-64_4 Template-Type: ReDIF-Article 1.0 Title: The underreporting of cocaine-related trauma: Drug Abuse Warning Network reports vs hospital toxicology tests Journal: American Journal of Public Health Author-Name: Brookoff, D. Author-Name: Campbell, E.A. Author-Name: Shaw, L.M. Year: 1993 Volume: 83 Issue: 3 Pages: 369-371 Abstract: Objective. The purpose of this study was to assess whether cocaine- related trauma is underreported to the US Federal Drug Abuse Warning Network (DAWN). Methods. We compared DAWN reports filed by an urban emergency department with the department's toxicology results for patients treated for major trauma. DAWN regulations in effect during the study period required the reporting of all patients treated for injury who used drugs or who tested positive for drugs of abuse. Results. Of 520 patients treated for major trauma, 217 (42%) were tested for a variety of drugs. Of these, 82 (38%) tested positive for cocaine. Of the 102 patients injured in motor vehicle accidents, 20 (20%) tested positive for cocaine. Of the 59 patients injured in motor vehicle accidents who were under age 40, 18 (30%) tested positive for cocaine. Of 100 victims of violent assault, 57 tested positive for cocaine. During the time period studied, DAWN recorded 48 hospital visits associated with cocaine, none involving trauma or injury. Conclusions. Cocaine-related trauma was unreported to DAWN despite the hospital's compliance with the system's guidelines. The pattern of DAWN reports from other institutions suggests that underreporting of cocaine-related injury is widespread. Handle: RePEc:aph:ajpbhl:1993:83:3:369-371_2 Template-Type: ReDIF-Article 1.0 Title: Women and smoking Journal: American Journal of Public Health Author-Name: Ernster, V.L. Year: 1993 Volume: 83 Issue: 9 Pages: 1202-1203 Handle: RePEc:aph:ajpbhl:1993:83:9:1202-1203_6 Template-Type: ReDIF-Article 1.0 Title: The school-based immunization survey: An inexpensive tool for measuring vaccine coverage Journal: American Journal of Public Health Author-Name: Rodewald, L.E. Author-Name: Roghmann, K.J. Author-Name: Szilagyi, P.G. Author-Name: Winter, N.L. Author-Name: Campbell, J.R. Author-Name: Humiston, S.G. Year: 1993 Volume: 83 Issue: 12 Pages: 1749-1751 Abstract: A school-based immunization survey was conducted among the 36 Rochester, NY, elementary schools (n = 5584 children) to determine (1) the vaccination rates at 2 years of age by type of primary care provider and (2) the accuracy of school immunization records (by comparing them with medical charts for children attending hospital-based clinics). These rates varied by provider type from 58% to 86% and were all below the national goal of 90%. In comparison with medical chart review, the school data had error rates of 15%; however, these errors occurred in both directions and were thus unbiased. School-based surveys include children who lack connections to the primary care system. With minimal effort these surveys can help identify populations in need of intervention. Handle: RePEc:aph:ajpbhl:1993:83:12:1749-1751_3 Template-Type: ReDIF-Article 1.0 Title: Forecasting the number of diabetic patients in the Netherlands in 2005 Journal: American Journal of Public Health Author-Name: Ruwaard, D. Author-Name: Hoogenveen, R.T. Author-Name: Verkleij, H. Author-Name: Kromhout, D. Author-Name: Casparie, A.F. Author-Name: Van der Veen, E.A. Year: 1993 Volume: 83 Issue: 7 Pages: 989-995 Abstract: Objectives. There is evidence from past decades that the number of diabetic patients has increased independently of changes in demography. A static model that takes into account only demographic changes is therefore unable to forecast the expected number of diabetic patients correctly. Methods. We developed a dynamic model in which actual incidence, prevalence, and life expectancy data are used and alternative assumptions about future trends in these parameters can be incorporated. Results. This dynamic model forecasts higher numbers of diabetic patients than the less sophisticated static model. According to the dynamic model, a 46% increase in the number of diabetic patients in The Netherlands can be expected, from 244 000 in 1990 to 355 000 in 2005 (about 2.5% annually). The static model forecasts a 22% increase. Conclusions. Diabetes mellitus will become a more serious public health problem than can be expected from demographic changes only. In planning future health care, monitoring of trends in incidence, prevalence, remission, and mortality or life expectancy is a necessary prerequisite. Handle: RePEc:aph:ajpbhl:1993:83:7:989-995_5 Template-Type: ReDIF-Article 1.0 Title: Local health officers' views on hazardous waste remediation Journal: American Journal of Public Health Author-Name: Greenberg, M. Year: 1993 Volume: 83 Issue: 5 Pages: 752-754 Abstract: Hazardous waste sites are a priority for local health officers in New Jersey. However, most officers feel that they are not adequately briefed or consulted by federal and state officials who manage site remediation. Consequently, many local health officers tend to be neutral or negative about federal and state site remediation plans. Consultation with local health officers should be formally built into the site remediation process, and officers should directly approach their state governments to gain access. Handle: RePEc:aph:ajpbhl:1993:83:5:752-754_7 Template-Type: ReDIF-Article 1.0 Title: Commitment to the common good Journal: American Journal of Public Health Author-Name: Lashof, J.C. Year: 1993 Volume: 83 Issue: 9 Pages: 1222-1225 Handle: RePEc:aph:ajpbhl:1993:83:9:1222-1225_8 Template-Type: ReDIF-Article 1.0 Title: Progress and potential in injury control Journal: American Journal of Public Health Author-Name: Runyan, C.W. Year: 1993 Volume: 83 Issue: 5 Pages: 637-639 Handle: RePEc:aph:ajpbhl:1993:83:5:637-639_0 Template-Type: ReDIF-Article 1.0 Title: Primary health care and hospitalization: California and Cuba Journal: American Journal of Public Health Author-Name: Roemer, M.I. Year: 1993 Volume: 83 Issue: 3 Pages: 317-318 Handle: RePEc:aph:ajpbhl:1993:83:3:317-318_6 Template-Type: ReDIF-Article 1.0 Title: Smoking, depression, and suicide [1] Journal: American Journal of Public Health Author-Name: Shaffer, D. Year: 1993 Volume: 83 Issue: 9 Pages: 1346 Handle: RePEc:aph:ajpbhl:1993:83:9:1346_1 Template-Type: ReDIF-Article 1.0 Title: Multiethnic variations in the pregnancy outcomes of military dependents Journal: American Journal of Public Health Author-Name: Alexander, G.R. Author-Name: Baruffi, G. Author-Name: Mor, J.M. Author-Name: Kieffer, E.C. Author-Name: Hulsey, T.C. Year: 1993 Volume: 83 Issue: 12 Pages: 1721-1725 Abstract: Objectives. We examined the pregnancy outcomes of three ethnic groups: African-American Blacks, non-Hispanic Whites, and Filipinos. In an attempt to reduce ethnic dissimilarities in parental employment and access to health care, this investigation compared the single-live-birth outcomes of married, adult women who resided in the state of Hawaii and who indicated that their spouse was on active-duty status in the US military. Methods. The data for this study were obtained from the 1979-1989 Hawaii vital-record file that provides linked live birth-infant death information. Multiple logistic regression was used to calculate odds ratios for the independent effects of maternal factors on low birthweight and neonatal mortality. Results. Significant differences in maternal age, maternal education, paternal education, parity, hospital of delivery, and use of prenatal care were observed among the ethnic groups. The results of a logistic regression analysis of low birthweight indicated significantly higher risks for Filipinos and Blacks compared with Whites. For very low birthweight, only an increased risk for Blacks was observed. No ethnic differences in neonatal mortality were found. Conclusions. This investigation revealed more comparable infant mortality experiences among the ethnic groups in spite of persistent birthweight differences. Handle: RePEc:aph:ajpbhl:1993:83:12:1721-1725_6 Template-Type: ReDIF-Article 1.0 Title: Management issues in a major typhoid fever outbreak Journal: American Journal of Public Health Author-Name: Convery, H.T. Author-Name: Frank, L. Year: 1993 Volume: 83 Issue: 4 Pages: 595-596 Handle: RePEc:aph:ajpbhl:1993:83:4:595-596_4 Template-Type: ReDIF-Article 1.0 Title: Cat scratch disease in the United States: An analysis of three national databases Journal: American Journal of Public Health Author-Name: Jackson, L.A. Author-Name: Perkins, B.A. Author-Name: Wenger, J.D. Year: 1993 Volume: 83 Issue: 12 Pages: 1707-1711 Abstract: Objectives. Current knowledge of the epidemiology of cat scratch disease is based primarily on information from case series. We used three national databases to obtain more representative data to determine the incidence and demographics of cat scratch disease. Methods. Records coded with the diagnosis of cat scratch disease from two hospital discharge databases and an ambulatory care database were analyzed. Costs of diagnostic tests and hospitalization were obtained from a sample of providers and published data. Results. The incidence of patients discharged from hospitals with a diagnosis of cat scratch disease was between 0.77 and 0.86 per 100 000 population per year. Fifty-five percent of the case patients were 18 years of age or younger. Males accounted for 60% of cases. Incidence varied by season; approximately 60% of case patients were discharged in the months September through January. The estimated incidence of disease in ambulatory patients was 9.3 per 100 000 population per year. On the basis of these rates, we estimated the annual health care cost of the disease to be more than $12 million. Conclusions. The rates and seasonality of cat scratch disease found in this study were consistent with previous reports. Adults represented a higher percentage of the total than reported in previous case series, suggesting that the disease may affect more adults than previously recognized. Handle: RePEc:aph:ajpbhl:1993:83:12:1707-1711_8 Template-Type: ReDIF-Article 1.0 Title: Primary care and public emergency department overcrowding Journal: American Journal of Public Health Author-Name: Grumbach, K. Author-Name: Keane, D. Author-Name: Bindman, A. Year: 1993 Volume: 83 Issue: 3 Pages: 372-378 Abstract: Objectives. Our objective was to evaluate whether referral to primary care settings would be clinically appropriate for and acceptable to patients waiting for emergency department care for nonemergency conditions. Methods. We studied 700 patients waiting for emergency department care at a public hospital. Access to alternative sources of medical care, clinical appropriateness of emergency department use, and patients' willingness to use nonemergency services were measured and compared between patients with and without a regular source of care. Results. Nearly half (45%) of the patients cited access barriers to primary care as their reason for using the emergency department. Only 13% of the patients waiting for care had conditions that were clinically appropriate for emergency department services. Patients with a regular source of care used the emergency department more appropriately than did patients without a regular source of care. Thirty-eight percent of the patients expressed a willingness to trade their emergency department visit for an appointment with a physician within 3 days. Conclusions. Public emergency departments could refer large numbers of patients to appointments at primary care facilities. This alternative would be viable only if the availability and coordination of primary care services were enhanced for low- income populations. Handle: RePEc:aph:ajpbhl:1993:83:3:372-378_3 Template-Type: ReDIF-Article 1.0 Title: Smoking and suicide among nurses Journal: American Journal of Public Health Author-Name: Hemenway, D. Author-Name: Solnick, S.J. Author-Name: Colditz, G.A. Year: 1993 Volume: 83 Issue: 2 Pages: 249-251 Abstract: Current evidence suggests a strong positive correlation between cigarette consumption and depression; this study examined the relationship between cigarettes and suicide. Over 100 000 predominantly White, middle-aged, female registered nurses were followed via biannual questionnaires from 1976 through 1988. Respondents smoking 1 through 24 cigarettes per day had twice the risk and those smoking 25 or more cigarettes four times the risk of committing suicide, compared with those who had never smoked. Although no information on causation was available, this paper links cigarettes to another major health problem. Handle: RePEc:aph:ajpbhl:1993:83:2:249-251_5 Template-Type: ReDIF-Article 1.0 Title: California adults with elevated blood lead levels, 1987 through 1990 Journal: American Journal of Public Health Author-Name: Maizlish, N. Author-Name: Rudolph, L. Year: 1993 Volume: 83 Issue: 3 Pages: 402-405 Abstract: Objectives. Follow-up of California blood lead registry reports, 95% of which are of occupationally exposed adults, can guide interventions at specific high-risk work sites and measure the impact of targeted, industry- specific interventions. Methods. A protocol was implemented to follow up the most severe case reports (≥ 2.90 μmol/L) and establish a statistical database for descriptive analysis. Results. From 1987 through 1990, the California Department of Health Services received 17 951 reports for 4069 civilian, noninstitutionalized adults employed by at least 328 companies. Of 232 incident case subjects with severe lead toxicity (≥ 2.90 μmol/L), 182 were successfully traced and interviewed. Index case subjects were mostly male (95%) and disproportionately Hispanic (46%); 35% lived with children aged 7 or younger, and 10% had been hospitalized. Ninety-four percent involved overexposures at work sites that lacked medical removal (50%), ventilation (36%), appropriate respirators (62%), training (64%), clothing changes (45%), or showering (60%). Conclusions. Well-known risk factors for occupational lead poisoning clustered at the work sites of index case subjects. Despite standards of the Occupational Safety and Health Administration, lead overexposure in California adults remains a significant public and occupational health concern. Handle: RePEc:aph:ajpbhl:1993:83:3:402-405_3 Template-Type: ReDIF-Article 1.0 Title: Telephone health surveys: Potential bias from noncompletion Journal: American Journal of Public Health Author-Name: Mishra, S.I. Author-Name: Dooley, D. Author-Name: Catalano, R. Author-Name: Serxner, S. Year: 1993 Volume: 83 Issue: 1 Pages: 94-99 Abstract: Objectives. Little is known about the effect of noncompletion on telephone surveys of health issues. This paper identifies a little-studied source of noncompletion, passive refusal, and evaluates its contribution to noncompletion bias along with two other sources: noncooperation and noncontact. Passive refusals include respondents who repeatedly request callbacks and households where interviewers repeatedly encounter an answering machine. Methods. Measures of noncompletion (noncooperation, passive refusal, and noncontact), demographic and socioeconomic characteristics, health risk factors, and indicators of health care access and health status were collected through the Orange County Health Surveys on 4893 respondents. The surveys sampled by random-digit dialing and interviewed by computer-assisted telephone. Results. Passive refusals have a substantial impact on completion rates and bias due to noncompletion. Commonly used definitions for completion rates may underestimate the bias due to noncompletion because they omit passive refusals. After we controlled for demographic and socioeconomic factors, few noncompletion biases appeared on selected health indicators. Conclusions. These results suggest improved reporting of completion rates and support a multivariate framework for studying noncompletion in telephone health surveys. Handle: RePEc:aph:ajpbhl:1993:83:1:94-99_1 Template-Type: ReDIF-Article 1.0 Title: Hepatitis B control in China: Knowledge and practices among village doctors Journal: American Journal of Public Health Author-Name: Clayton, S. Author-Name: Yang, H. Author-Name: Guan, J. Author-Name: Lin, Z. Author-Name: Wang, R. Year: 1993 Volume: 83 Issue: 12 Pages: 1685-1688 Abstract: Objectives. To guide development of a hepatitis B control program in China, we investigated village doctors' sterilization practices, injection use, vaccination levels, and knowledge and counseling skills. Methods. The head doctor from each village health station in a rural county (n = 260) completed a self-administered questionnaire. Results. Of the respondents, 94.2% reported adequate sterilization of needles; however, inadequate sterilization of syringes and acupuncture needles was common. Injections were found to be frequent and profitable. Of head doctors, 16.2% reported that most infants in their villages are vaccinated against hepatitis B. There was very high knowledge of modes of hepatitis B transmission, but it was not used to formulate advice for a hypothetical carrier. Knowledge of the consequences, prevalence, and use of condoms to prevent sexual transmission was lower. Conclusions. The sterilization of acupuncture needles, reuse of syringes, and frequent injections are practices that may transmit the hepatitis B virus. Research into issues of vaccine acceptance is needed to expand immunization. A review of treatment practices and better training in counseling for village doctors is suggested. Handle: RePEc:aph:ajpbhl:1993:83:12:1685-1688_3 Template-Type: ReDIF-Article 1.0 Title: The methodology of fatal occupational injury surveillance [3] Journal: American Journal of Public Health Author-Name: Conroy, C. Author-Name: Stout, N. Year: 1993 Volume: 83 Issue: 10 Pages: 1491 Handle: RePEc:aph:ajpbhl:1993:83:10:1491_0 Template-Type: ReDIF-Article 1.0 Title: The prevalence of smoking among physicians in Japan [1] Journal: American Journal of Public Health Author-Name: Kawane, H. Year: 1993 Volume: 83 Issue: 11 Pages: 1640 Handle: RePEc:aph:ajpbhl:1993:83:11:1640_6 Template-Type: ReDIF-Article 1.0 Title: Editorial: Learning from health care experiences in developing countries Journal: American Journal of Public Health Author-Name: Taylor, C.E. Year: 1993 Volume: 83 Issue: 11 Pages: 1531-1532 Handle: RePEc:aph:ajpbhl:1993:83:11:1531-1532_0 Template-Type: ReDIF-Article 1.0 Title: Respiratory disease among military personnel in Saudi Arabia during Operation Desert Shield Journal: American Journal of Public Health Author-Name: Richards, A.L. Author-Name: Hyams, K.C. Author-Name: Watts, D.M. Author-Name: Rozmajzl, P.J. Author-Name: Woody, J.N. Author-Name: Merrell, B.R. Year: 1993 Volume: 83 Issue: 9 Pages: 1326-1329 Abstract: Objectives. The purpose of this study was to determine whether respiratory disease due to crowded living conditions and high levels of suspended and blowing sand had a major adverse impact on US military personnel during Operation Desert Shield. Methods. A questionnaire survey was administered to 2598 combat troops stationed in Northeast Saudi Arabia for a mean of 102 days. Samples of surface sand from seven different locations were analyzed by scanning electron microscopy and x-ray diffraction. Results. Among surveyed troops, 34.4% reported a sore throat, 43.1% complained of a cough, 15.4% complained of chronic rhinorrhea, and 1.8% were unable to perform their routine duties because of upper respiratory symptoms. Evaluation of sleeping accommodations indicated that complaints of a sore throat and cough were most closely associated with sleeping in air-conditioned buildings; in contrast, complaints of rhinorrhea were associated with exposure to the outdoor environment while living in tents. Sand samples consisted mostly of quartz, with just 0.21% by weight of respirable size (<10 μm in diameter). Conclusions. These findings indicate that upper respiratory complaints were frequent among Operation Desert Shield troops and were related both to the troops' housing and to their exposure to the outside environment. Handle: RePEc:aph:ajpbhl:1993:83:9:1326-1329_5 Template-Type: ReDIF-Article 1.0 Title: Fear, embarrassment, and relief: The tuberculosis epidemic and public health Journal: American Journal of Public Health Author-Name: Reichman, L.B. Year: 1993 Volume: 83 Issue: 5 Pages: 639-641 Handle: RePEc:aph:ajpbhl:1993:83:5:639-641_2 Template-Type: ReDIF-Article 1.0 Title: The effect of fish oil supplements on blood pressure Journal: American Journal of Public Health Author-Name: Lofgren, R.P. Author-Name: Wilt, T.J. Author-Name: Nichol, K.L. Author-Name: Crespin, L. Author-Name: Pluhar, R. Author-Name: Eckfeldt, J. Year: 1993 Volume: 83 Issue: 2 Pages: 267-269 Abstract: We conducted a double-blind, placebo-controlled crossover study to determine the effects of fish oil supplementation on blood pressure in middle-aged men. Subjects were randomly assigned to consume either 20 g of fish oil or safflower oil for 12 weeks and then consume the other oil for an additional 12 weeks after a 4-week washout period. We found no significant changes from the pretreatment value in systolic or diastolic blood pressure with the use of fish oil supplements. In addition, there were no significant differences in the posttreatment blood pressures comparing the fish and safflower oil phases of the study. Handle: RePEc:aph:ajpbhl:1993:83:2:267-269_9 Template-Type: ReDIF-Article 1.0 Title: Patient-to-patient transmission of hepatitis B in a dermatology practice Journal: American Journal of Public Health Author-Name: Hlady, W.G. Author-Name: Hopkins, R.S. Author-Name: Ogilby, T.E. Author-Name: Allen, S.T. Year: 1993 Volume: 83 Issue: 12 Pages: 1689-1693 Abstract: Objective. The purpose of the study was to investigate infection with hepatitis B virus (HBV) and human immunodeficiency virus (HIV) among patients in a dermatology practice. Methods. Historical cohort, matched case-control, and cross-sectional survey methods were used. Results. The age-specific incidence of reported HBV infection in the practice from 1985 through 1991 was more than 12 times the expected rate. The dermatologist was not an HBV carrier. He practiced neither universal precautions nor sterile surgical technique. Seroprevalence of markers for HBV infection was highest (36.8%) among patients who had had surgery on the same day that HBV was apparently acquired by an index case; seroprevalence was near the expected background level for patients not exposed to index cases. Of HBV-infected patients with known dates of onset, 72% had had surgery during their incubation periods. All of 30 HBV antigen specimens tested were of the same subtype. None of the patients tested, including 74 patients exposed to surgery on the same day as a patient with acquired immunodeficiency syndrome, had evidence of HIV infection. Conclusions. HBV, but not HIV, was transmitted from patient to patient by the dermatologist's failure to apply either universal precautions or sterile surgical technique. Handle: RePEc:aph:ajpbhl:1993:83:12:1689-1693_2 Template-Type: ReDIF-Article 1.0 Title: HIV infection in hospitalized patients and medicaid enrollees: The accuracy of medical record coding 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. Year: 1993 Volume: 83 Issue: 10 Pages: 1457-1459 Abstract: To evaluate the accuracy of computerized medical-record coding for human immunodeficiency virus (HIV), medical charts were reviewed in sex sites. In 7601 hospital and 867 Medicaid records with a listed diagnosis of HIV, the predictive value for HIV was 91% or higher. HIV was identified in 34% of 1155 Medicaid records listing immune disorder or illness in the acquired immunodeficiency syndrome (AIDS) surveillance definition (without an HIV code). In hospital and Medicaid records, AIDS was identified both in records listing AIDS and records listing HIV without AIDS. HIV codes on hospital and Medicaid records were highly predictive for HIV; undercoding of HIV occurred in Medicaid records. Handle: RePEc:aph:ajpbhl:1993:83:10:1457-1459_0 Template-Type: ReDIF-Article 1.0 Title: Improving cause-of-death statistics: The case of fetal deaths Journal: American Journal of Public Health Author-Name: Atkinson, D. Year: 1993 Volume: 83 Issue: 8 Pages: 1084-1085 Handle: RePEc:aph:ajpbhl:1993:83:8:1084-1085_5 Template-Type: ReDIF-Article 1.0 Title: Factors influencing the practice of vaginal birth after cesarean section Journal: American Journal of Public Health Author-Name: Goldman, G. Author-Name: Pineault, R. Author-Name: Potvin, L. Author-Name: Blais, R. Author-Name: Bilodeau, H. Year: 1993 Volume: 83 Issue: 8 Pages: 1104-1108 Abstract: Objectives. Vaginal birth after cesarean has been recommended for most women with previous cesarean sections for the past 10 years. This practice, however, has not yet been generalized because high variations can still be observed among countries, hospitals, and physicians. Methods. A case-control study involving 635 case patients and 2593 control patients was carried out to determine which characteristics of the physician, the patient, or the hospital were important in the adoption of this practice. Results. The results of the multiple stepwise logistic regression analysis indicate a higher likelihood that women will experience vaginal birth after cesarean if their physicians had cesarean rates under 20%, had less than 5% of their patients considered at risk, and were younger than 54 years old. Vaginal birth after cesarean was also favored by hospitals characterized by a high degree of neonatal and obstetrical specialization, and a patient population with a low level of education. Conclusions. This policy is still in the developmental stage, as evidenced by the great variability between hospitals and physicians in rates of vaginal birth after cesarean. Further efforts are required for this policy to become the norm. Handle: RePEc:aph:ajpbhl:1993:83:8:1104-1108_8 Template-Type: ReDIF-Article 1.0 Title: AIDS-related knowledge, perceptions, and behaviors among impoverished minority women Journal: American Journal of Public Health Author-Name: Nyamathi, A. Author-Name: Bennett, C. Author-Name: Leake, B. Author-Name: Lewis, C. Author-Name: Flaskerud, J. Year: 1993 Volume: 83 Issue: 1 Pages: 65-71 Abstract: Objectives. The aims of this study were to (1) describe AIDS-related knowledge, perceptions, and risky behaviors of impoverished African-American and high- and low-acculturated Latina women; (2) delineate relationships involving high-risk behaviors; and (3) determine whether risky behaviors differ by race and levels of acculturation. Methods. Survey instruments were administered to 1173 impoverished women of color residing in homeless shelters and drug recovery programs. Results. Differences based on ethnicity and level of acculturation were found in AIDS-related knowledge, perceived risk of acquiring AIDS, and risky behaviors. Low-acculturated Latinas reported low perceived risk and were least likely to engage in illegal drug use and sexual activity with multiple partners. Intravenous drug use was most prevalent among high-acculturated Latinas, whereas nonintravenous drug use and high-risk sexual activity was most prevalent among African-American women. Conclusions. The data indicate the need for culturally sensitive AIDS prevention programs for women that deal with general issues of drug use and unprotected sex, and that include separate sessions for women of different ethnic backgrounds and acculturation levels to address specialized areas of concern. Handle: RePEc:aph:ajpbhl:1993:83:1:65-71_3 Template-Type: ReDIF-Article 1.0 Title: Salmonella enteritidis infections in France and the United States: Characterization by a deterministic model Journal: American Journal of Public Health Author-Name: Watier, L. Author-Name: Richardson, S. Author-Name: Hubert, B. Year: 1993 Volume: 83 Issue: 12 Pages: 1694-1700 Abstract: Objectives. Epidemiological surveillance can be used to identify problems, suggest hypotheses, and assess the effectiveness of preventive actions. These objectives are pursued in the analysis of the dynamic evolution of Salmonella enteritidis infections. In this analysis, development of the epidemic in France and the United States is compared. Methods. This analysis is based on the formulation of a simple deterministic compartmental model, in which human contact with contaminated food is expressed in terms of a baseline transmission rate. Results. In France, the baseline transmission rate, stable up until 1986, is multiplied by 2.3 in 1987 and by 4.1 in 1988. There is no evidence of a slowdown of the linear rate of increase. In the Middle Atlantic region of the United States, the linear increase of the epidemic is similar to that observed in France. From 1990 a potential effect of the preventive measures is observed. Conclusions. The pattern of increase of the baseline transmission rate is similar in France and in the Middle Atlantic region of the United States. However, preventive measures, used in both areas, appeared more effective in the United States. Handle: RePEc:aph:ajpbhl:1993:83:12:1694-1700_1 Template-Type: ReDIF-Article 1.0 Title: A pilot study of HIV-infected immigrants [1] Journal: American Journal of Public Health Author-Name: Loue, S. Author-Name: Oppenheim, S. Year: 1993 Volume: 83 Issue: 2 Pages: 286 Handle: RePEc:aph:ajpbhl:1993:83:2:286_0 Template-Type: ReDIF-Article 1.0 Title: Harnessing the energy of the mass media: HIV awareness in Dallas Journal: American Journal of Public Health Author-Name: Krepcho, M. Author-Name: Smerick Jr., M. Author-Name: Freeman, A. Author-Name: Alfaro, A. Year: 1993 Volume: 83 Issue: 2 Pages: 283-285 Handle: RePEc:aph:ajpbhl:1993:83:2:283-285_1 Template-Type: ReDIF-Article 1.0 Title: The Hawaii pneumococcal disease initiative Journal: American Journal of Public Health Author-Name: Campbell, J.F. Author-Name: Donohue, M.A. Author-Name: Nevin-Woods, C. Author-Name: McBean, A.M. Author-Name: Pace, N.E. Author-Name: Williams, W.W. Author-Name: Spika, J.S. Year: 1993 Volume: 83 Issue: 8 Pages: 1175-1176 Handle: RePEc:aph:ajpbhl:1993:83:8:1175-1176_0 Template-Type: ReDIF-Article 1.0 Title: Depression, anxiety, and social disability show synchrony of change in primary care patients Journal: American Journal of Public Health Author-Name: Ormel, J. Author-Name: Von Korff, M. Author-Name: Van den Brink, W. Author-Name: Katon, W. Author-Name: Brilman, E. Author-Name: Oldehinkel, T. Year: 1993 Volume: 83 Issue: 3 Pages: 385-390 Abstract: Objectives. The purposes of this study were to (1) characterize the social disability associated with the common psychiatric illnesses of primary care patients in terms of role dysfunction (self-care, family role, social role, occupational role) and (2) establish whether severity of psychiatric illness and disability level show synchrony of change. Methods. A two-stage sample design was employed. In the first stage, 1994 consecutive attenders of 25 general practitioners were screened on psychiatric illness by their physicians and with the General Health Questionnaire. A stratified random sample (n = 285) with differing probabilities was selected for a second- stage interview. Patients with psychiatric symptoms were reinterviewed 1 and 3.5 years later (n = 143). Results. (1) Disability level among patients was increased (moderately for depression, mildly for anxiety) and was associated with severity of psychiatric illness. (2) Most disability was found in occupational and social roles. (3) Change in severity of psychiatric illness was concordant with change in level of disability and was largely invariant across diagnosis (depression, anxiety, mixed anxiety/depression). At follow- up, disability among improved patients had returned to normal levels. Conclusions. Psychiatric illness in primary care patients is associated with mild to moderate disability, and severity of psychiatric illness and disability show synchrony of change. Handle: RePEc:aph:ajpbhl:1993:83:3:385-390_9 Template-Type: ReDIF-Article 1.0 Title: Rosenberg and colleagues respond [6] 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: 1993 Volume: 83 Issue: 7 Pages: 1054 Handle: RePEc:aph:ajpbhl:1993:83:7:1054_9 Template-Type: ReDIF-Article 1.0 Title: Salmonella enteritidis infections in France and the United States: Causes vs causal models Journal: American Journal of Public Health Author-Name: Halloran, M.E. Year: 1993 Volume: 83 Issue: 12 Pages: 1667-1668 Handle: RePEc:aph:ajpbhl:1993:83:12:1667-1668_9 Template-Type: ReDIF-Article 1.0 Title: Vitamin and mineral supplement use and mortality in a US cohort Journal: American Journal of Public Health Author-Name: Kim, I. Author-Name: Williamson, D.F. Author-Name: Byers, T. Author-Name: Koplan, J.P. Year: 1993 Volume: 83 Issue: 4 Pages: 546-550 Abstract: Objectives. Vitamin and mineral supplementation is a common practice in the United States, yet little is known about the long-term health effects of regular supplement use. Methods. To examine the relationship between reported use of supplements and mortality, we analyzed data from US adults 25 to 74 years of age who were examined in the First National Health and Nutrition Examination Survey (1971 to 1975), with vital status determined through 1987. Results. At baseline, 22.5% of the cohort reported using supplements regularly and 10.0% reported irregular use. The risk of mortality for regular supplement users was similar to that for nonusers. No consistent mortality benefits or risks of supplement use were found across a number of population subgroups. The risk for those who reported supplement use at both the baseline and a follow-up interview approximately 10 years later was similar to the risk for those who reported not using supplements at either interview. Conclusions. We found no evidence of increased longevity among vitamin and mineral supplement users in the United States. Considering the wide use of supplements in the general population, the cost-effectiveness and the safety of supplement use need to be better defined. Handle: RePEc:aph:ajpbhl:1993:83:4:546-550_8 Template-Type: ReDIF-Article 1.0 Title: Increasing frequency of heterosexually transmitted AIDS in Southern Florida: Artifact or reality? Journal: American Journal of Public Health Author-Name: Nwanyanwu, O.C. Author-Name: Conti, L.A. Author-Name: Ciesielski, C.A. Author-Name: Stehr-Green, J.K. Author-Name: Berkelman, R.L. Author-Name: Lieb, S. Author-Name: Witte, J.J. Year: 1993 Volume: 83 Issue: 4 Pages: 571-573 Abstract: Acquired immunodeficiency syndrome (AIDS) cases reported as the result of heterosexual contact have been increasing in the United States, with Florida reporting a disproportionate number. We investigated 168 such AIDS cases from southern Florida. After follow-up, 50 (30%) patients were reclassified into other transmission categories. The data suggest that the increased rate of heterosexually acquired AIDS cases reported from southern Florida was partially related to misclassification of risk. Handle: RePEc:aph:ajpbhl:1993:83:4:571-573_9