Template-Type: ReDIF-Article 1.0 Title: Cocaine use and characteristics of young adult users from 1987 to 1992: The CARDIA study Journal: American Journal of Public Health Author-Name: Braun, B.L. Author-Name: Murray, D. Author-Name: Hannan, P. Author-Name: Sidney, S. Author-Name: Le, C. Year: 1996 Volume: 86 Issue: 12 Pages: 1736-1741 Abstract: Objectives. This study examined the relationship of sociodemographic factors and use of substances other than cocaine to cocaine use from 1987 to 1992 in a cohort of Black and White men and women 20 to 32 years of age. Methods. Data were collected as part of the Coronary Artery Risk Development in Young Adults study. Self-reported cocaine use was analyzed through chi-square tests and repeated measures analyses of variance to determine the bivariate and multivariate relationships of sociodemographics and substance use behaviors to cocaine use over the 5-year period. Results. Cocaine use declined in Whites but remained stable in Blacks from 1987 to 1992. Cross-sectional results showed that use was related to being Black, male and in the older half of the cohort, single, and unemployed; it was also related to higher levels of other substance use in 1987 and 1992. Over time, the magnitude and strength of the relationship were consistent for each variable except for increased odds of cocaine use among the unemployed and Blacks in 1992. Conclusions. Sociodemographic characteristics and substance use behavior consistently identify individuals at risk for cocaine use. As a result, intervention programs should be targeted at these high-risk groups. Handle: RePEc:aph:ajpbhl:1996:86:12:1736-1741_8 Template-Type: ReDIF-Article 1.0 Title: The protective effect of AIDS-related behavioral change among injection drug users: A cross-national study Journal: American Journal of Public Health Author-Name: Des Jarlais, D.C. Author-Name: Friedmann, P. Author-Name: Hagan, H. Author-Name: Friedman, S.R. Year: 1996 Volume: 86 Issue: 12 Pages: 1780-1785 Abstract: Objective. This study assessed the relationship between self-reported acquired immunodeficiency syndrome (AIDS) behavioral change and human immunodeficiency virus (HIV) serostatus among injection drug users. Methods. The study sample involved 4419 injection drug users recruited from drug abuse treatment and nontreatment settings in 11 cities in North America, South America, Europe, Asia, and Australia. The World Health Organization multisite risk behavior questionnaire was used, and either blood or saliva samples for HIV testing were obtained. Subjects were asked. 'Since you first heard about AIDS, have you done anything to avoid getting AIDS?' Results. The protective odds ratio for behavioral change against being infected with HIV was 0.50 (95% confidence interval = 0.42, 0.59). While there was important variation across sites, the relationship remained consistent across both demographic and drug use history subgroups. Conclusions. Injection drug users are capable of modifying their HIV risk behaviors and reporting accurately on behavioral changes. These behavioral changes are associated with their avoidance of HIV infection. Handle: RePEc:aph:ajpbhl:1996:86:12:1780-1785_0 Template-Type: ReDIF-Article 1.0 Title: Annotation: On the Holm, Simes, and Hochberg multiple test procedures Journal: American Journal of Public Health Author-Name: Levin, B. Year: 1996 Volume: 86 Issue: 5 Pages: 628-629 Handle: RePEc:aph:ajpbhl:1996:86:5:628-629_7 Template-Type: ReDIF-Article 1.0 Title: Incidences induced by anaesthesia and their medical legal examination [Der Anästhesiezwischenfall und seine Begutachtung aus der Sicht des Rechtsmediziners] Journal: American Journal of Public Health Author-Name: Schneider, V. Year: 1996 Volume: 86 Issue: 11 Pages: 33-37 Handle: RePEc:aph:ajpbhl:1996:86:11:33-37_5 Template-Type: ReDIF-Article 1.0 Title: Montana County creates local solution to health care crisis. Journal: American Journal of Public Health Author-Name: Frideres, M.B. Author-Name: Wilson, K.M. Year: 1996 Volume: 86 Issue: 12 Pages: 1819-1820 Handle: RePEc:aph:ajpbhl:1996:86:12:1819-1820_7 Template-Type: ReDIF-Article 1.0 Title: 150 years of anaesthesia - On the way to the physician of perioperative medicine [150 Jahre Anaesthesie - Was nun? oder Vom Narkotiseur zum Arzt für perioperative Medizin] Journal: American Journal of Public Health Author-Name: Landauer, B. Year: 1996 Volume: 86 Issue: 11 Pages: 5-6 Handle: RePEc:aph:ajpbhl:1996:86:11:5-6_8 Template-Type: ReDIF-Article 1.0 Title: Assessment of critical events in anaesthesia by a board of consultants [Der Anästhesiezwischenfall und seine Begutachtung aus der Sicht einer Gutachterstelle] Journal: American Journal of Public Health Author-Name: Hack, G. Year: 1996 Volume: 86 Issue: 11 Pages: 38-42 Handle: RePEc:aph:ajpbhl:1996:86:11:38-42_0 Template-Type: ReDIF-Article 1.0 Title: Peace in the Middle East: the implications for public health. Journal: American Journal of Public Health Author-Name: Kahan, E. Author-Name: Carel, R. Author-Name: Hart, J. Author-Name: Kimhi, A. Year: 1996 Volume: 86 Issue: 12 Pages: 1821 Handle: RePEc:aph:ajpbhl:1996:86:12:1821_2 Template-Type: ReDIF-Article 1.0 Title: Using social gatherings to encourage HIV risk reduction among drug users. Journal: American Journal of Public Health Author-Name: Wood, M. Author-Name: Rhodes, F. Year: 1996 Volume: 86 Issue: 12 Pages: 1815-1816 Handle: RePEc:aph:ajpbhl:1996:86:12:1815-1816_5 Template-Type: ReDIF-Article 1.0 Title: Faithful patients: The effect of long-term physician-patient relationships on the costs and use of health care by older Americans Journal: American Journal of Public Health Author-Name: Weiss, L.J. Author-Name: Blustein, J. Year: 1996 Volume: 86 Issue: 12 Pages: 1742-1747 Abstract: Objectives. This study examined the impact of duration of physician- patient ties on the processes and costs of medical care. Methods. The analyses used a nationally representative sample of Americans 65 years old or older who participated in the Medicare Current Beneficiary Survey in 1991 and had a usual source of care. Results. Older Americans have long-standing ties with their physicians; among those with a usual source of care, 35.8% had ties enduring 10 years or more. Longer ties were associated with a decreased likelihood of hospitalization and lower costs. Compared with patients with a tic of 1 year or less, patients with ties of 10 years or more incurred $316.78 less in Part B Medicare costs, after adjustment for key demographic and health characteristics. However, substantial impacts on the use of selected preventive care services and the adoption of certain healthy behaviors were not observed. Conclusions. This preliminary study suggests that long-standing physician-patient ties foster less expensive, less intensive medical care. Further studies are needed to confirm these findings and to understand how duration of tie influences the processes and outcomes of care. Handle: RePEc:aph:ajpbhl:1996:86:12:1742-1747_7 Template-Type: ReDIF-Article 1.0 Title: Clinical and prophylactic trials with assured new treatment for those at greater risk: II. Examples Journal: American Journal of Public Health Author-Name: Finkelstein, M.O. Author-Name: Levin, B. Author-Name: Robbins, H. Year: 1996 Volume: 86 Issue: 5 Pages: 696-702 Abstract: Objectives. The preceding article proposed an assured treatment design that would address certain diffculties in recruiting person who are at greater disk into randomized clinical trials. The purpose of this article is to illustrate the statistical validity of the design in a practical setting. Methods. Three actual randomized clinical trials were considered as case studies: in each, the data that would have been obtained under assured allocation were identified. Then, with only these data, together with a reasonable choice of model describing the response of subjects under standard treatment as a function of initial severity, the treatment effect was estimated for the subjects at greater risk. The estimates were compared with Conventional estimates for the sicker patients randomized in the original trials. Results. In each case, the estimates produced in the assured treatment trial were close to those observed in the randomized trial. Conclusions. Risk-based allocation trials deserve serious consideration when randomized clinical trials are difficult or impossible to rd The proposed designs and analyses would allow physicians to other persons at greater risk assurance that they would receive the new treatment, while researchers would retain the abaility to draw valid statistical conclusions about treatment efficacy. Handle: RePEc:aph:ajpbhl:1996:86:5:696-702_0 Template-Type: ReDIF-Article 1.0 Title: The timing of preventive services for women and children: The effect of having a usual source of care Journal: American Journal of Public Health Author-Name: Ettner, S.L. Year: 1996 Volume: 86 Issue: 12 Pages: 1748-1754 Abstract: Objectives. This study investigated the causal effect of having a usual source of medical care on the timing of preventive services by women and children. Methods. Data on 17 110 children and 23 488 women from the 1988 and 1990 National Health Interview Surveys were used to estimate ordered probit models of the effect of having a usual source of medical care on the time since the last receipt of each preventive service (routine checkups for children; blood pressure checks, Pap smears, and breast exams for adult women; mammograms for older women). Two-stage instrumental variables methods were used to eliminate simultaneity bias. Results. The existence of a usual source of medical care was strongly correlated with the earlier receipt of preventive services, and the relationship appears to be causal for Pap smears, breast exams, and mammograms. However, there was little evidence that having a regular provider caused an increased rate of routine checkups for children or blond pressure checks for adult women. Conclusions. Delivery systems that encourage the development of long-term relationships with medical providers may increase cancer screening rates among women. Handle: RePEc:aph:ajpbhl:1996:86:12:1748-1754_3 Template-Type: ReDIF-Article 1.0 Title: Assessing children's ultraviolet radiation exposure: The potential usefulness of a colorimeter Journal: American Journal of Public Health Author-Name: Eckhardt, L. Author-Name: Mayer, J.A. Author-Name: Creech, L. Author-Name: Johnston, M.R. Author-Name: Kong Jong Lui Author-Name: Sallis, J.F. Author-Name: Elder, J.P. Year: 1996 Volume: 86 Issue: 12 Pages: 1802-1804 Abstract: Objectives. This study evaluated the colorimeter as an objective measure of children's ultraviolet (UV) radiation exposure. Methods. Fifty-eight children, ages 6 to 9 years, attended two summer measurement sessions, with 46 attending a subsequent winter session. Results. Comparisons between summer sessions for the L* scale showed that only the upper arm significantly changed in the tanner direction, while b* scale values indicated significant tanning for all body sites. All exposed body sites changed significantly in the less tan direction between summer and winter measurements. Conclusions. Using colorimeters to objectively measure children's UV exposure has potential applications for skin cancer prevention programs. Handle: RePEc:aph:ajpbhl:1996:86:12:1802-1804_1 Template-Type: ReDIF-Article 1.0 Title: The school enrollment-based health insurance program: Socioeconomic factors in enrollees' use of health services Journal: American Journal of Public Health Author-Name: Shenkman, E. Author-Name: Pendergast, J. Author-Name: Reiss, J. Author-Name: Walther, E. Author-Name: Bucciarelli, R. Author-Name: Freedman, S. Year: 1996 Volume: 86 Issue: 12 Pages: 1791-1793 Abstract: Objectives. The School Enrollment-Based Health Insurance program is designed to reduce financial barriers to children's health care use. This study sought to determine if any socioeconomic measures differed between enrollees with at least one health care encounter and those with no encounters. Methods. Logistic regression was used to assess the impact of various predictors on the odds that a child would use health care services. Results. Children receiving free insurance premiums were less likely to use health care than those receiving partial subsidy. African-American and Hispanic children were less likely than Whites to use health care. Age, sex, and months enrolled also influenced the likelihood of health care use. Conclusions. Financial and non-financial factors must be considered when developing children's health care programs. Handle: RePEc:aph:ajpbhl:1996:86:12:1791-1793_9 Template-Type: ReDIF-Article 1.0 Title: Does advanced age imply a worse prognosis for intensive care patients? [Bedeutet ein höheres Lebensalter eine schlechtere Prognose in der Intensivmedizin?] Journal: American Journal of Public Health Author-Name: Holst, D. Author-Name: Möllmann, M. Author-Name: Feyerherd, F. Author-Name: Reichl, C. Author-Name: Wendt, M. Year: 1996 Volume: 86 Issue: 11 Pages: 18-21 Abstract: Limited resources in intensive care medicine keep raising the question of whether intensive care can be made available to all patients without restriction. Elder patients are often subjectively ascribed a worse prognosis without objectifying this decision with relevant data. A prospective data acquisition on a postoperative intensive care unit was undertaken to investigate whether age is a special risk factor in intensi-ve care medicine. The results of the present-study demonstrate that a higher age does not go along with a worse prognosis and that every effort towards an optimized intensive care is justified without restriction. Keywords: words={Aged; Critical care; Prognosis; Risk factors Handle: RePEc:aph:ajpbhl:1996:86:11:18-21_0 Template-Type: ReDIF-Article 1.0 Title: Body mass index in young adults: Associations with parental body size and education in the CARDIA study Journal: American Journal of Public Health Author-Name: Greenlund, K.J. Author-Name: Liu, K. Author-Name: Dyer, A.R. Author-Name: Kiefe, C.I. Author-Name: Burke, G.L. Author-Name: Yunis, C. Year: 1996 Volume: 86 Issue: 4 Pages: 480-484 Abstract: Objectives. Associations of parental education, parental body size, and offspring's education with body mass index and 7-year change in body mass index were examined among participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Methods. CARDIA is a study of coronary artery disease risk factors in 5115 Black and White persons aged 18 to 30 at baseline. Analyses of covariance were carried out with body mass index and change in body mass index as the dependent variables, and with parental education, parental body size, and participant education as the major independent variables. Results. Father's body size was positively associated with participant's baseline body mass index among Black men, White men, and White women. Mother's body size was positively associated with baseline body mass index among all race-sex groups, and with change in body mass index among White women. Father's education was inversely associated with baseline body mass index among Black men and White women, and with change among White women. Conclusions. Parental education may influence body mass index and changes in young adulthood, especially among White women. Such associations may be both genetic and environmental and may be important for obesity prevention efforts. Handle: RePEc:aph:ajpbhl:1996:86:4:480-484_5 Template-Type: ReDIF-Article 1.0 Title: Annotation: From disease surveillance to the surveillance of risk factors Journal: American Journal of Public Health Author-Name: Morabia, A. Year: 1996 Volume: 86 Issue: 5 Pages: 625-627 Handle: RePEc:aph:ajpbhl:1996:86:5:625-627_0 Template-Type: ReDIF-Article 1.0 Title: Anaesthetic implication of obstructive sleep apnoea [Die anästhesiologische Bedeutung der obstruktiven Schlafapnoe] Journal: American Journal of Public Health Author-Name: Dworschak, M. Author-Name: Maurer, J.T. Author-Name: Waschke, K.F. Year: 1996 Volume: 86 Issue: 11 Pages: 9-15 Abstract: Obstructive sleep apnoea (OSA) is a relatively common disease and is characterized by defective airway control during sleep. As its symptoms may be accentuated by anaesthesia, providing anaesthesia for OSA-patients poses quite a challenge to the anaesthesiologist. Airway management after induction of anaesthesia and after extubation can be difficult due to complete airway obstruction. A reduced drive to breathe can further complicate the situation in the recovery room. Furthermore, hypoxic and hypercarbic stress during, apnoea can result in cardiac arrhythmias, myocardial and brain ischemia or even frank cardiac failure. Thus, each patient with a history of snoring or OSA requires special attention. The anaesthesiologist must be prepared for OSA-inherent complications in order to be able to respond adequately. Perioperative management should be aimed at preventing asphyxie episodes and alleviating the harmful consequences of apnoea in order to prevent, exposing the patient to an additional risk. Keywords: words={Anaesthesia; Intraoperative care; Postoperative care; Sleep apnoea syndrome Handle: RePEc:aph:ajpbhl:1996:86:11:9-15_2 Template-Type: ReDIF-Article 1.0 Title: Annotation: The amphibole hypothesis of asbestos-related cancer - gone but not forgotten Journal: American Journal of Public Health Author-Name: Cullen, M.R. Year: 1996 Volume: 86 Issue: 2 Pages: 158-159 Handle: RePEc:aph:ajpbhl:1996:86:2:158-159_3 Template-Type: ReDIF-Article 1.0 Title: Annotation: Uncertainties in the estimation of HIV prevalence and incidence in the United States Journal: American Journal of Public Health Author-Name: Samuel, M.C. Author-Name: Osmond, D.E. Year: 1996 Volume: 86 Issue: 5 Pages: 627-628 Handle: RePEc:aph:ajpbhl:1996:86:5:627-628_5 Template-Type: ReDIF-Article 1.0 Title: Establishing an indigent health care clinic in an Indiana "healthy city" Journal: American Journal of Public Health Author-Name: Adams, C.J. Author-Name: Flynn, B.C. Year: 1996 Volume: 86 Issue: 12 Pages: 1818-1819 Handle: RePEc:aph:ajpbhl:1996:86:12:1818-1819_6 Template-Type: ReDIF-Article 1.0 Title: A survey of injuries among broadway performers Journal: American Journal of Public Health Author-Name: Evans, R.W. Author-Name: Evans, R.I. Author-Name: Carvajal, S. Author-Name: Perry, S. Year: 1996 Volume: 86 Issue: 1 Pages: 78-80 Abstract: To obtain more information about injuries of Broadway performers, 313 performers appearing in 23 Broadway companies were surveyed. The percentage of performers injured was 55.5%, with a mean of 1.08 injuries per performer. Lower extremity injuries were the most common. Sixty-two percent of performers believed that their injuries were preventable. As this study reports factors that significantly increase the risk of injury for dancers and actors, it may help to heighten concern with reducing the incidence of injuries to professional performers, theatrical students, and nonprofessionals world-wide. Handle: RePEc:aph:ajpbhl:1996:86:1:78-80_3 Template-Type: ReDIF-Article 1.0 Title: Annotation: Preventive screening for health risks among adolescents Journal: American Journal of Public Health Author-Name: Barnett, H.L. Year: 1996 Volume: 86 Issue: 12 Pages: 1701 Handle: RePEc:aph:ajpbhl:1996:86:12:1701_7 Template-Type: ReDIF-Article 1.0 Title: Documentation and data acquisition of a physician-guided emergency service system 1996 [Notärztliche Dokumentation und Datenerfassung -Stand 1996] Journal: American Journal of Public Health Author-Name: Messelken, M. Author-Name: Martin, J. Author-Name: Milewski, P. Year: 1996 Volume: 86 Issue: 11 Pages: 22-29 Abstract: Documentation by protocol in a physicianguided emergency service system (EMS) has to be reviewed. The multi-staging functions are: Transmission of patient state and information, evaluation of efficiency and quality assurance, maintaining the database for scientific research. Performance of data acquisition should be available a short distance away the emergency event and process. The best set-up would be more the computer system and the tool of documentation acted as a functional unit. There are three ways of process engineering: documentation by paperprotocol, paper-for-documentreader (OMR) and PC-aided off/online system. The idea of a standard protocol published by the DIVI depending on the common sense of all users has not yet spread over the whole country yet. However, a minimal data set (MIND) for EMS service can be used to integrate the content of the existing data acquisition models into a common concept. With this concept it will be possible to compare the different data sets in the aspects of internal and external quality assurance. Keywords: words={Data collection; Documentation; Emergency medical services Handle: RePEc:aph:ajpbhl:1996:86:11:22-29_3 Template-Type: ReDIF-Article 1.0 Title: Don't ask, they won't tell: The quality of adolescent health screening in five practice settings Journal: American Journal of Public Health Author-Name: Blum, R.W. Author-Name: Beuhring, T. Author-Name: Wunderlich, M. Author-Name: Resnick, M.D. Year: 1996 Volume: 86 Issue: 12 Pages: 1767-1772 Abstract: Objectives. This study examined the extent to which comprehensive, age- appropriate adolescent health screening is undertaken in the clinical setting and whether the extent of such screening varies by setting. Methods. Charts of adolescents 13 to 17 years old (n = 788) were randomly selected from five practice settings in Minneapolis, Minn. Each was assessed for the number of biomedical and sociobehavioral health risks screened. Results. In no practice setting was there screening to the level recommended. The two teen clinics screened more extensively for behavioral, psychosocial, substance use and sexual behavior risks than the community family practice setting, which, in turn, screened more extensively than either the private family practice or private pediatric practice settings, which did not differ from each other. Age differences and gender accounted for only small amounts of variance in total number of health risks screened, whereas differences among practice settings accounted for a larger amount. Conclusions. Results suggest substantive deficiencies in private practice settings' implementation of preventive care screening protocols for adolescents. Handle: RePEc:aph:ajpbhl:1996:86:12:1767-1772_8 Template-Type: ReDIF-Article 1.0 Title: From genes to public health: The applications of genetic technology in disease prevention Journal: American Journal of Public Health Author-Name: Khoury, M.J. Year: 1996 Volume: 86 Issue: 12 Pages: 1717-1722 Abstract: Objectives. With advances in the Human Genome Project, the implications of genetic technology in disease prevention should be assessed. Methods. The paradigm suggested in The Future of Public Health - assessment, policy development, and assurance - was used to examine the continuum from genetic technology to public health practice. Results. First, important public health functions are to (1) assess the impact of genes and their interactions with modifiable disease risk factors on the health status of the population and (2) assess the impact and safety of genetic testing on the population. Second, given the many implications of genetic testing, the public health community should participate in policy development related to the timing and use of genetic testing in disease prevention. Third, whenever appropriate, the public health community needs to ensure the development of public health genetics programs (e.g. newborn screening) and evaluate the quality and effectiveness of the use of genetic testing in disease prevention. Conclusions. Although most current genetic tests are not ready for disease prevention, there is an important role for the public health community in translating genetic technology into disease prevention. Handle: RePEc:aph:ajpbhl:1996:86:12:1717-1722_0 Template-Type: ReDIF-Article 1.0 Title: An intervention with high-risk mothers who abuse alcohol and drugs: the Seattle Advocacy Model. Journal: American Journal of Public Health Author-Name: Grant, T.M. Author-Name: Ernst, C.C. Author-Name: Streissguth, A.P. Year: 1996 Volume: 86 Issue: 12 Pages: 1816-1817 Handle: RePEc:aph:ajpbhl:1996:86:12:1816-1817_3 Template-Type: ReDIF-Article 1.0 Title: Bericht über die erste Jahrestagung der Gesellschaft für Atemwegs-Management (Society for Airway Management [SAM]) Journal: American Journal of Public Health Author-Name: Braun, U. Year: 1996 Volume: 86 Issue: 11 Pages: 43-44 Handle: RePEc:aph:ajpbhl:1996:86:11:43-44_0 Template-Type: ReDIF-Article 1.0 Title: Illicit drug use by persons with disabilities: Insights from the national household survey on drug abuse Journal: American Journal of Public Health Author-Name: Gilson, S.F. Author-Name: Chilcoat, H.D. Author-Name: Stapleton, J.M. Year: 1996 Volume: 86 Issue: 11 Pages: 1613-1615 Abstract: Objectives. This study sought to evaluate the association of drug use with disability in a representative sample of the US household population. Methods. The use of illicit drugs and alcohol reported by respondents in the 1991 National Household Survey on Drug Abuse who identified themselves as 'disabled, unable to work' was compared with respondents without disabilities. Results. Among younger adults (18-24 years), persons with diabilities were more likely than those without disabilities to report that they had used heroin (adjusted odds ratio [OR] = 6.89; 95% confidence interval [CI] = 1.35, 35.1) or crack cocaine (OR = 6.38; 95% CI = 1.05, 38.6). Among older adults (35 years and older), persons with disabilities were more likely to report the use of sedatives (OR = 2.46; 95% CI = 1.21, 4.94) or tranquilizers (OR = 2.18; 95% CI = 1.08; 4.42) not medically prescribed. Conclusions. These results suggest that use of illicit drugs is a potentially serious problem among persons with disabilities and requires both research and clinical attention. Handle: RePEc:aph:ajpbhl:1996:86:11:1613-1615_3 Template-Type: ReDIF-Article 1.0 Title: Childhood victimization and subsequent risk for promiscuity, prostitution, and teenage pregnancy: A prospective study Journal: American Journal of Public Health Author-Name: Widom, C.S. Author-Name: Kuhns, J.B. Year: 1996 Volume: 86 Issue: 11 Pages: 1607-1612 Abstract: Objectives. This study examined the extent to which being abused and/or neglected in childhood increases a person's risk for promiscuity, prostitution, and teenage pregnancy. Methods. A prospective cohorts design was used to match, on the basis of age, race, sex, and social class, cases of abused and/or neglected children from 1967 to 1971 with nonabused and nonneglected children; subjects were followed into young adulthood. From 1089 to 1995, 1196 subjects (676 abused and/or neglected and 520 control subjects) were located and interviewed. Results. Early childhood abuse and/or neglect was a significant predictor of prostitution for females (odds ratio [OR] = 2.96). For females, sexual abuse (OR = 2.54) and neglect (OR = 2.58) were associated with prostitution, whereas physical abuse was only marginally associated. Childhood abuse and neglect were not associated with increased risk for promiscuity or teenage pregnancy. Conclusions. These findings strongly support a relationship between childhood victimization and subsequent prostitution. The presumed causal sequence between childhood victimization and teenage pregnancy may need to be reevaluated. Handle: RePEc:aph:ajpbhl:1996:86:11:1607-1612_6 Template-Type: ReDIF-Article 1.0 Title: Socioeconomic differences in cervical cancer: Two case-control studies in Colombia and Spain Journal: American Journal of Public Health Author-Name: De Sanjosé, S. Author-Name: Bosch, F.X. Author-Name: Muñoz, N. Author-Name: Tafur, L. Author-Name: Gili, M. Author-Name: Izarzugaza, I. Author-Name: Izquierdo, A. Author-Name: Navarro, C. Author-Name: Vergara, A. Author-Name: Muñoz, M.T. Author-Name: Ascunce, N. Author-Name: Shah, K.V. Year: 1996 Volume: 86 Issue: 11 Pages: 1532-1538 Abstract: Objectives. This study examined the causes of socioeconomic differences in invasive cervical cancer in two countries that differ substantially in cervical cancer incidence and economic development. Method. Data were derived from two case-control studies carried out in Spain and Colombia; there were 373 case subjects, 387 control subjects, and 425 husbands interviewed with a structured questionnaire. Exfoliated cells were obtained from cervical or penile scrapes and tested for human papillomavirus (HPV) DNA. Results. Relative to better educated women, women with low educational levels in both countries reported fewer Pap smears and had a higher prevalence of HPV DNA. The prevalence ratio of HPV DNA across educational strata was twofold in Spain and fourfold in Colombia. In both countries, husbands of poorly educated women reported higher use of prostitutes than husbands of better educated women. In Colombia, 30% of husbands of poorly educated women harbored HPV DNA, compared with 10% of husbands of better educated women. Conclusions. Socioeconomic differences in invasive cervical cancer could be partly explained by differences in the prevalence of HPV DNA and by a lower use of preventive care. Handle: RePEc:aph:ajpbhl:1996:86:11:1532-1538_9 Template-Type: ReDIF-Article 1.0 Title: The sexual practices of adolescent virgins: Genital sexual activities of high school students who have never had vaginal intercourse Journal: American Journal of Public Health Author-Name: Schuster, M.A. Author-Name: Bell, R.M. Author-Name: Kanouse, D.E. Year: 1996 Volume: 86 Issue: 11 Pages: 1570-1576 Abstract: Objectives. The purpose of this study was to determine whether high school-aged virgins engage in sexual practices that can transmit sexually transmitted diseases, including the human immunodeficiency virus (HIV). Methods. Data were collected from an anonymous self-administered survey of 2026 urban students in 9th through 12th grades. Results. Forty-seven percent of adolescents were virgins (42% of male adolescents and 53% of female adolescents). Of those who were virgins, 29% and 31% reported that, during the prior year, they had engaged in heterosexual masturbation of a partner and masturbation by a partner, respectively. The corresponding rates for heterosexual fellatio with ejaculation, cunnilingus, and anal intercourse were 9%, 10%, and 1%. Homosexual sexual activities were rare. Condom use for fellatio was also rare. Level of risk of virgins' sexual activities was associated with illicit substance use and other nonsexual risk behaviors, even after demographic variables had been controlled. Conclusions. Few high school-aged virgins engaged in anal intercourse, but many engaged in other genital sexual activities. Some of these activities can transmit disease, and all can indicate a need for counseling about sexual decision making, risk, and prevention. Handle: RePEc:aph:ajpbhl:1996:86:11:1570-1576_0 Template-Type: ReDIF-Article 1.0 Title: Clarifying "biological," "natural," and "adoptive" parents. Journal: American Journal of Public Health Author-Name: McQuistion, H.L. Year: 1996 Volume: 86 Issue: 11 Pages: 1649 Handle: RePEc:aph:ajpbhl:1996:86:11:1649_9 Template-Type: ReDIF-Article 1.0 Title: HIV risk behaviors and obstacles to condom use among Puerto Rican men in New York City who have sex with men Journal: American Journal of Public Health Author-Name: Carballo-Diéguez, A. Author-Name: Dolezal, C. Year: 1996 Volume: 86 Issue: 11 Pages: 1619-1622 Abstract: Objectives. This paper describes the sexual risk behaviors of Puerto Rican men who have sex with men and their perceived obstacles to condom use. Methods. Interviews were conducted with 182 Puerto Rican men living in New York, NY. Results. Condoms were used inconsistently or not at all by half of the men who had anal sex with other men, by two thirds of the men who had vaginal sex, and by three fifths of those who had anal sex with women. Most of the men had had unprotected oral sex and more than one sexual partner in the previous year. Three of 10 were positive for the human immunodeficiency virus (HIV). Dislike of condoms was the most frequently cited obstacle, followed by perception of low risk, trust in and emotional connection with partner, unavailability and inconvenience of condom use, lack of control, and indifference. Conclusions. Barrier methods other than condoms, such as a microbicidal gel, need to be developed. Handle: RePEc:aph:ajpbhl:1996:86:11:1619-1622_8 Template-Type: ReDIF-Article 1.0 Title: Measles vaccination levels of children enrolled in WIC during the 1991 measles epidemic in New York City Journal: American Journal of Public Health Author-Name: LeBaron, C.W. Author-Name: Birkhead, G.S. Author-Name: Parsons, P. Author-Name: Grabau, J.C. Author-Name: Barr-Gale, L. Author-Name: Fuhrman, J. Author-Name: Brooks, S. Author-Name: Maes, E. Author-Name: Friedman, S. Author-Name: Hadler, S.C. Year: 1996 Volume: 86 Issue: 11 Pages: 1551-1556 Abstract: Objectives. This study assessed measles vaccination rates and risk factors for lack of vaccination among preschool children enrolled in the Special Supplemental Food Program for Women, Infants, and Children (WIC) during the 1991 measles epidemic in New York City. Methods. Children aged 12 to 59 months presenting for WIC certification between April 1 and September 30, 1991, at six volunteer WIC sites in New York City were surveyed. Results. Of the 6181 children enrolled in the study, measles immunization status was ascertained for 6074 (98%). Overall measles coverage was 86% (95% confidence interval [CI] = ±1%) and at least 90% by 21 months of age (95% CI = ±1%). Young age of the child, use of a private provider, and Medicaid as a source of health care payment were risk factors for lack of vaccination (P < .001). Conclusions. During the peak of a measles epidemic, measles immunization rates were more than 80% by 24 months of age in a sample of WIC children. The ease of ascertaining immunization status and the size of the total WIC population underscore the importance of WIC immunization initiatives. Handle: RePEc:aph:ajpbhl:1996:86:11:1551-1556_8 Template-Type: ReDIF-Article 1.0 Title: Preventing recurring injuries from violence: The risk of assault among Cleveland youth after hospitalization Journal: American Journal of Public Health Author-Name: Litaker, D. Year: 1996 Volume: 86 Issue: 11 Pages: 1633-1636 Abstract: Objectives. Although interpersonal violence has increased among urban youth, its epidemiology remains unclear. To prevent such violence, identifying the susceptible population is important. Methods. Medical records for 998 patients aged 5 to 25 years at an urban hospital were reviewed to compare data for patients admitted for assault-related injuries, those admitted for unintentional injuries, and those for problems other than injuries. Results. Those initially admitted for treatment of assault were found to be at greater risk of subsequent treatment for assault than those admitted for noninjuries. Conclusions. Admission for injuries caused by violence may increase risk for future assaults; hospitalization may offer an opportunity to interrupt these patterns. Handle: RePEc:aph:ajpbhl:1996:86:11:1633-1636_6 Template-Type: ReDIF-Article 1.0 Title: The relationship between cigarette smoking and education revisited: Implications for categorizing persons' educational status Journal: American Journal of Public Health Author-Name: Zhu, B.-P. Author-Name: Giovino, G.A. Author-Name: Mowery, P.D. Author-Name: Eriksen, M.P. Year: 1996 Volume: 86 Issue: 11 Pages: 1582-1589 Abstract: Objective. This study sought to reassess the relationship between cigarette smoking and education. Methods. Data from the 1983 to 1991 National Health Interview Survey for participants aged 25 years and older were used to plot the prevalence of current smoking, ever smoking, heavy smoking, and smoking cessation, as well as the adjusted log odds ratios, by years of education. Results. The 'less than high school graduate' category consisted of two groups with distinct smoking patterns: persons with 0 to 8 years and persons with 9 to 11 years of education. The latter were the most likely to be current, ever, and heavy smokers and the least likely to have quit smoking, whereas the former were similar to persons having 12 years of education. After 11 years of education, the likelihood of smoking decreased and that of smoking cessation increased with each successive year of education. These results persisted after the statistical adjustment for age, sex, ethnicity, poverty status, employment status, marital status, geographic region, and year of survey. Conclusions. The relationship between smoking and education is not monotonic. Thus, when evaluating smoking in relation to education, researchers should categorize years of education as follows: 0 to 8, 9 to 11, 12, 13 to 15, and 16 or more years. Handle: RePEc:aph:ajpbhl:1996:86:11:1582-1589_0 Template-Type: ReDIF-Article 1.0 Title: A nurse-managed smoking cessation program for hospitalized smokers Journal: American Journal of Public Health Author-Name: Taylor, C.B. Author-Name: Miller, N.H. Author-Name: Herman, S. Author-Name: Smith, P.M. Author-Name: Sobel, D. Author-Name: Fisher, L. Author-Name: DeBusk, R.F. Year: 1996 Volume: 86 Issue: 11 Pages: 1557-1560 Abstract: Objectives. This study evaluated a nurse-managed smoking cessation program for smokers hospitalized for a variety of conditions. Methods. Hospitalized patients who smoked prior to hospitalization and who were motivated to quit (n = 660) were randomized to intervention or usual-care groups and followed for the next year. The intervention included a meeting with the nurse-case manager; the use of a videotape, workbook, relaxation audiotape, and nicotine replacement therapy; and nurse-initiated phone contacts after discharge. Results. The 12-month confirmed cessation rates were 21% and 31% for, respectively, the usual-care and intervention groups (odds ratio = 1.7; 95% confidence interval = 1.1, 2.3). Conclusions. A nurse- managed smoking cessation intervention can significantly increase cessation rates for hospitalized patients. Handle: RePEc:aph:ajpbhl:1996:86:11:1557-1560_0 Template-Type: ReDIF-Article 1.0 Title: US emergency department costs: No emergency Journal: American Journal of Public Health Author-Name: Tyrance Jr., P.H. Author-Name: Himmelstein, D.U. Author-Name: Woolhandler, S. Year: 1996 Volume: 86 Issue: 11 Pages: 1527-1531 Abstract: Background. Many perceive emergency department (ED) overuse as an important cause of high medical care costs in the United States. Managed care plans and politicians have seen constraints on ED use as an important element of COSt control. Methods. We measured ED-associated and other medical care costs, using the recently released 1987 National Medical Expenditure Survey of approximately 35 000 persons in 14 000 households representative of the US civilian, noninstitutionalized population. Results. In 1987, total ED expenditures were $8.9 billion, or 1.9% of national health expenditures. People with health insurance represented 86% of the population and accounted for 88% of ED spending. The uninsured paid 47% of ED costs themselves; free care covered only 10%. For the uninsured, the cost of hospitalization initiated by ED visits totaled $3.3 billion, including $1.1 billion in free care. Whites accounted for 75% of total ED costs. The ED costs of poor and near-poor individuals accounted for only 0.47% of national health costs. Conclusions. ED use accounts for a small share of US medical care costs, and cost shifting to the insured to cover free ED care for the uninsured is modest. Constraining ED use cannot generate substantial cost savings but may penalize minorities and the poor, who receive much of their outpatient care in EDs. Handle: RePEc:aph:ajpbhl:1996:86:11:1527-1531_2 Template-Type: ReDIF-Article 1.0 Title: Assessing substance abuse treatment needs among the homeless: A telephone-based interactive voice response system Journal: American Journal of Public Health Author-Name: Alemagno, S.A. Author-Name: Cochran, D. Author-Name: Feucht, T.E. Author-Name: Stephens, R.C. Author-Name: Butts, J.M. Author-Name: Wolfe, S.A. Year: 1996 Volume: 86 Issue: 11 Pages: 1626-1628 Abstract: Objectives. We report on a pilot project that used a telephone-based interactive voice response system, accessed by cellular phones at diverse sites, to interview homeless persons on their need for alcohol and other drug treatment. Methods. Using this technique, we surveyed 207 homeless adults at eight shelters in Cleveland, Ohio. Results. The cellular approach was comparable to human-administered interviews in reliability and validity and yielded higher self-reported levels of drug use. Conclusions. Cellular telephones and interactive voice response interviewing systems can be useful tools in assessing for the health-service needs of difficult-to-reach populations. Handle: RePEc:aph:ajpbhl:1996:86:11:1626-1628_5 Template-Type: ReDIF-Article 1.0 Title: Exposure to varying levels of contaminants and symptoms among workers in two office buildings Journal: American Journal of Public Health Author-Name: Menzies, D. Author-Name: Tamblyn, R.M. Author-Name: Nunes, F. Author-Name: Hanley, J. Author-Name: Tamblyn, R.T. Year: 1996 Volume: 86 Issue: 11 Pages: 1629-1633 Abstract: Objectives. We hypothesized that exposure to contaminants would be associated with symptoms reported by office workers. Methods. In two mechanically ventilated office buildings in Montreal, the outdoor air supply was manipulated for 6 weeks, while symptoms were reported and environmental parameters were measured at multiple sites. Results. Contaminant concentrations varied considerably, in part related to experimental changes in outdoor air supply. Eye symptoms were reported with higher dust and with higher concentrations of nitrogen dioxide. Mucosal symptoms were increased with higher TVOCs, higher nitrogen dioxide, and higher total contaminant load. Systemic symptoms were associated with higher dust levels. Conclusions. Symptoms reported by the workers were associated with increased concentrations of several contaminants and a summary measure of all contaminants. Handle: RePEc:aph:ajpbhl:1996:86:11:1629-1633_8 Template-Type: ReDIF-Article 1.0 Title: Socioeconomic factors in Helicobacter pylori infection among Danish adults Journal: American Journal of Public Health Author-Name: Rosenstock, S.J. Author-Name: Andersen, L.P. Author-Name: Rosenstock, C.V. Author-Name: Bonnevie, O. Author-Name: Jørgensen, T. Year: 1996 Volume: 86 Issue: 11 Pages: 1539-1544 Abstract: Objectives. This study examined the relationship between housing conditions, educational level, occupational factors, and serologically diagnosed acute and chronic Helicobacter pylori infection. Methods. Immunoglobulin G and immunoglobulin M serum antibodies against H. pylori were measured in 3589 Danish adults who participated in a population study. Results. Low socioeconomic status (odds ratio [OR] = 2.2, 95% confidence interval [CI] = 1.7, 3.0), short duration of schooling (OR = 2.0, 95% CI = 1.3, 2.5), lack of training/education (OR = 1.4, 95% CI = 1.2, 1.7]), unskilled work (OR = 1.7, 95% CI = 1.2, 2.5), and high work-related energy expenditure (OR = 1.4, 95% CI = 1.1, 1.9) increased the likelihood of chronic H. pylori infection. Infection was frequent in people who had rived abroad. Increased levels solely of immunoglobulin M antibodies were found more often in people who were divorced (OR = 2.3, 95% CI = 1.2, 4.4) or unmarried (OR = 2.0, 95% CI = 1.1, 3.8) or who worked long hours (OR = 2.0, 95% CI = 1.1, 4.0). Conclusions. Educational and occupational factors relate to the likelihood of chronic H. pylori infection in adults. The rate of acute infection is high in single individuals. Handle: RePEc:aph:ajpbhl:1996:86:11:1539-1544_1 Template-Type: ReDIF-Article 1.0 Title: Burmese political dissidents in Thailand: Trauma and survival among young adults in exile Journal: American Journal of Public Health Author-Name: Allden, K. Author-Name: Poole, C. Author-Name: Chantavanich, S. Author-Name: Ohmar, K. Author-Name: Aung, N.N. Author-Name: Mollica, R.F. Year: 1996 Volume: 86 Issue: 11 Pages: 1561-1569 Abstract: Objectives. This study assessed the self-reported mental health, physical health, and social functioning of young adult political exiles and relates their psychiatric symptoms to their trauma and survival strategies. Methods. A 1992/93 survey of Burmese who fled to Bangkok, Thailand, after participating in a 1988 uprising against Burma's government elicited information on employment, education, disability, trauma, survival strategies, and depressive and post-traumatic stress symptoms. Results. The 104 participants reported a mean of 30 trauma events, including interrogation (89%), imprisonment (78%), threats of deportation (70%), and torture (38%). Many reported poor health and lack of social supports, but few reported substantial social disability. The prevalence of elevated symptom scores was 38% for depressive symptoms and 23% for criterion symptoms of posttraumatic stress disorder. Symptoms of avoidance and of increased arousal were the most strongly related to cumulative trauma. Two survival strategies, camaraderie and a Buddhist concept of self-confidence (weria), were associated with somewhat reduced levels of both classes of symptoms. Conclusions. Burmese political exiles in Thailand are young adults adversely affected by severe trauma. Their psychosocial well-being may deteriorate further without legal protections to reduce the continuing stress and violence. Handle: RePEc:aph:ajpbhl:1996:86:11:1561-1569_6 Template-Type: ReDIF-Article 1.0 Title: Patterns of health-compromising behaviors among Minnesota adolescents: Sociodemographic variations Journal: American Journal of Public Health Author-Name: Neumark-Sztainer, D. Author-Name: Story, M. Author-Name: French, S. Author-Name: Cassuto, N. Author-Name: Jacobs Jr., D.R. Author-Name: Resnick, M.D. Year: 1996 Volume: 86 Issue: 11 Pages: 1599-1606 Abstract: Objectives. This study compared prevalence rates of health-compromising behaviors among boys and girls from different ethnic backgrounds in early, middle, and late adolescence and compared co-occurrences of such behaviors across gender and ethnic groups. Methods. The study population included 123 132 adolescents in grades 6, 9, and 12. Adolescents completed a classroom- administered statewide survey focusing on high-risk behaviors, including unhealthy weight loss, substance abuse, suicide risk, delinquency, and sexual activity. Results. Prevalence rates of most health compromising behaviors differed by gender, increased with age, and tended to be highest among American Indian youth and lowest among Asian Americans. Strong associations were found between substance abuse and delinquency across all ethnic groups. Substance abuse and delinquency were associated with suicide risk across most ethnic groups. Covariations with sexual activity and unhealthy weight loss behaviors showed more ethnic variation. Conclusions. Prevention interventions should take into account the tendency for health-compromising behaviors to co-occur and should be sensitive to demographic and socioeconomic differences in behavior patterns. Handle: RePEc:aph:ajpbhl:1996:86:11:1599-1606_8 Template-Type: ReDIF-Article 1.0 Title: Associations between physical activity and other health behaviors in a representative sample of US adolescents Journal: American Journal of Public Health Author-Name: Pate, R.R. Author-Name: Heath, G.W. Author-Name: Dowda, M. Author-Name: Trost, S.G. Year: 1996 Volume: 86 Issue: 11 Pages: 1577-1581 Abstract: Objectives. This study examined the associations between physical activity and other health behaviors in a representative sample of US adolescents. Methods. In the 1990 Youth Risk Behavior Survey, 11 631 high school students provided information on physical activity; diet; substance use; and other negative health behaviors. Logistic regression analyses examined associations between physical activity and other health behaviors in a subset of 2652 high-active and 1641 low-active students. Results. Low activity was associated with cigarette smoking, marijuana use, lower fruit and vegetable consumption, greater television watching, failure to wear a seat belt, and low perception of academic performance. For consumption of fruit, television watching, and alcohol consumption, significant interactions were found with race/ethnicity or sex, suggesting that sociocultural factors may affect the relationships between physical activity and some health behaviors. Conclusions. Low physical activity was associated with several other negative health behaviors in teenagers. Future studies should examine whether interventions for increasing physical activity in youth can be effective in reducing negative health behaviors. Handle: RePEc:aph:ajpbhl:1996:86:11:1577-1581_3 Template-Type: ReDIF-Article 1.0 Title: Tobacco promotion and susceptibility to tobacco use among adolescents aged 12 through 17 years in a nationally representative sample Journal: American Journal of Public Health Author-Name: Altman, D.G. Author-Name: Levine, D.W. Author-Name: Coeytaux, R. Author-Name: Slade, J. Author-Name: Jaffe, R. Year: 1996 Volume: 86 Issue: 11 Pages: 1590-1593 Abstract: Objectives. The purpose of this study was to examine whether youth participation in tobacco promotion campaigns is associated with susceptibility to tobacco use. Methods. Data were collected from telephone interviews of a national random sample of 1047 adolescents 12 to 17 years of age. Results. A proportional odds model was used to estimate the effects of age, gender, presence of a tobacco user in the household, awareness of tobacco promotions, knowledge of a young adult or adolescent friend owning a promotional item, participation in tobacco promotions, and receipt of free tobacco samples or direct mail from tobacco companies on susceptibility to tobacco use. All of the covariates, except for receiving direct mailings and knowing a young adult friend who owned a promotional item, were significantly associated with susceptibility. Conclusions. There is a strong association between an awareness of and involvement with tobacco promotions and being susceptible to tobacco use or a user of tobacco products. Handle: RePEc:aph:ajpbhl:1996:86:11:1590-1593_7 Template-Type: ReDIF-Article 1.0 Title: Pneumococcal pneumonia and influenza vaccination: Access to and use by US Hispanic Medicare beneficiaries Journal: American Journal of Public Health Author-Name: Mark, T.L. Author-Name: Paramore, L.C. Year: 1996 Volume: 86 Issue: 11 Pages: 1545-1550 Abstract: Objectives. This study examined differences between elderly Hispanic Medicare beneficiaries and other Medicare beneficiaries in the probability of being immunized for pneumococcal pneumonia and influenza. Methods. We used the 1992 national Medicare Current Beneficiary Survey to evaluate influenza and pneumococcal pneumonia immunization rates. Results. Elderly Hispanic Medicare beneficiaries were less likely than non-Hispanic White Medicare beneficiaries to have received an influenza vaccine in the past year or to have ever been immunized for pneumococcal pneumonia. Speaking Spanish was statistically significantly associated with influenza vaccination but not with pneumococcal pneumonia vaccination. Supplemental insurance status, HMO enrollment, having a usual source of care, and being satisfied with access to care were positively associated with immunization. Conclusions. Strategies that may improve immunization rates among elderly Hispanics include reducing the inconvenience of being immunized, decreasing out-of-pocket costs, linking beneficiaries with providers, and educating Hispanic beneficiaries in Spanish about the benefits of vaccinations. Handle: RePEc:aph:ajpbhl:1996:86:11:1545-1550_2 Template-Type: ReDIF-Article 1.0 Title: Assessing immigration status and eligibility for publicly funded medical care: A questionnaire for public health professionals Journal: American Journal of Public Health Author-Name: Loue, S. Author-Name: Foerstel, J. Year: 1996 Volume: 86 Issue: 11 Pages: 1623-1625 Abstract: Objectives. After reviewing the requirements for establishing a legal presence in the United States and securing health care services under Medicaid and Medicare, this article reports on a questionnaire developed to determine patients' documentation status and eligibility for publicly funded medical care. Methods. The questionnaire was developed based on an integration of the relevant provisions of the Immigration and Nationality Act and the Social Security Act. Results. The questionnaire is both valid and reliable when compared with an instrument currently used by immigration attorneys. Conclusions. This assessment is useful provided there is no requirement that undocumented individuals be reported to the Immigration and Naturalization Service. Handle: RePEc:aph:ajpbhl:1996:86:11:1623-1625_3 Template-Type: ReDIF-Article 1.0 Title: Characteristics of women 50 years of age or older with heterosexually acquired AIDS Journal: American Journal of Public Health Author-Name: Schable, B. Author-Name: Chu, S.Y. Author-Name: Diaz, T. Year: 1996 Volume: 86 Issue: 11 Pages: 1616-1618 Abstract: Objectives. This study compared characteristics of older (≤50 years) and younger (<50 years) women with acquired immunodeficiency syndrome (AIDS) attributed to heterosexual contact. Methods. We interviewed women with heterosexually acquired AIDS reported to 12 state and local health departments. Of 556 women interviewed, 59 (11%) were 50 or older. Results. Older women were more likely than younger women to live alone (24% vs 11%), to have not completed high school (63% vs 37%), to be tested for human immunodeficiency virus (HIV) while hospitalized (51% vs 32%), and to have never used a condom before HIV diagnosis (86% vs 67%). Conclusions. Health care providers need to recognize HIV risk behavior in older women, encourage testing, and promote condom use. Handle: RePEc:aph:ajpbhl:1996:86:11:1616-1618_7 Template-Type: ReDIF-Article 1.0 Title: Trends in drug use among American Indian students and dropouts, 1975 to 1994 Journal: American Journal of Public Health Author-Name: Beauvais, F. Year: 1996 Volume: 86 Issue: 11 Pages: 1594-1598 Abstract: Objectives. This 20-year surveillance project tracks the trends in substance abuse among American Indian students and examines the observed patterns to discover implications for prevention and treatment. The current phase of this work includes data on drug use among Indian school dropouts. Methods. Anonymous drug use surveys are administered annually to a nationally representative sample of 7th- to 12th-grade Indian youths residing on or near reservations. An adjustment for dropouts is made to provide estimates for the entire age cohort. Results. Indian youth continue to show very high rates of drug use compared with their non-Indian peers. The trends in rates during the last 20 years parallel those of non-Indian youth. While overall drug use may be decreasing, about 20% of Indian adolescents continue to be heavily involved with drugs, a proportion that has not changed since 1980. Adjustment for school dropouts increases the estimate for the entire age cohort. Conclusions. Indian youth, particularly school dropouts, remain at high risk for drug use. The similarity to trends for non-Indians indicates that prevention strategies effective with other youth can be effective with this population. Handle: RePEc:aph:ajpbhl:1996:86:11:1594-1598_0 Template-Type: ReDIF-Article 1.0 Title: Lead poisoning among US Hispanic children Journal: American Journal of Public Health Author-Name: Carter-Pokras, O. Author-Name: Harrison, R. Year: 1996 Volume: 86 Issue: 10 Pages: 1479 Handle: RePEc:aph:ajpbhl:1996:86:10:1479_3 Template-Type: ReDIF-Article 1.0 Title: Lead-contaminated house dust and urban children's blood lead levels Journal: American Journal of Public Health Author-Name: Lanphear, B.P. Author-Name: Michael Weitzman, M.D. Author-Name: Winter, N.L. Author-Name: Eberly, S. Author-Name: Yakir, B. Author-Name: Tanner, M. Author-Name: Emond, M. Author-Name: Matte, T.D. Year: 1996 Volume: 86 Issue: 10 Pages: 1416-1421 Abstract: Objectives. This study assessed the relationship between lead- contaminated house dust and urban children's blood lead levels. Methods. A random-sample survey was used to identify and enroll 205 children, 12 to 31 months of age, who had resided in the same house since at least 6 months of age. Children's blood and household dust, water, soil, and paint were analyzed for lead, and interviews were conducted to ascertain risk factors for elevated blood lead (≤ 10 μg/dL). Results. Children's mean blood lead level was 7.7 μg/dL. In addition to dust lead loading (micrograms of lead per square foot), independent predictors of children's blood lead were Black race, soil lead levels, ingestion of soil or dirt, lead content and condition of painted surfaces, and water lead levels. For dust lead standards of 5 μg/sq ft, 20 μg/sq ft, and 40 μg/sq ft on noncarpeted floors, the estimated percentages of children having blood lead levels at or above 10 μg/dL were 4%, 15%, and 20%, respectively, after adjusting for other significant covariates. Conclusions. Lead-contaminated house dust is a significant contributor to lead intake among urban children who have low- level elevations in blood lead. A substantial proportion of children may have blood lead levels of at least 10 μg/dL at dust lead levels considerably lower than current standards. Handle: RePEc:aph:ajpbhl:1996:86:10:1416-1421_2 Template-Type: ReDIF-Article 1.0 Title: Spina bifida and cleft lip among newborns of Norwegian women with epilepsy: Changes related to the use of anticonvulsants Journal: American Journal of Public Health Author-Name: King, P.B. Author-Name: Lie, R.T. Author-Name: Irgens, L.M. Year: 1996 Volume: 86 Issue: 10 Pages: 1454-1456 Abstract: Objectives. This study examined the connection between the use of anticonvulsants for epilepsy during or before pregnancy and the risk of spina bifida and cleft lip in newborns. Methods. Among mothers registered from 1967 to 1992 by the Medical Birth Registry of Norway, 7588 who had epilepsy were identified and their newborns' prevalence of spina bifida and cleft lip examined. Results. The odds ratio of spina bifida in children of mothers with epilepsy compared with other children increased from 1.5 in 1967 through 1980 (95% confidence interval [CI] = 0.3, 4.5) to 4.4 in 1981 through 1992 (95% CI = 2.0, 8.5). The odds ratio of cleft lip, however, decreased from 3.0 before 1981 (95% CI = 1.6, 5.1) to 1.1 after 1981 (95% C1 = 0.4, 2.3). Conclusions. This shift toward more serious birth defects is consistent with the different teratogenic effects of newer and older anticonvulsants. Handle: RePEc:aph:ajpbhl:1996:86:10:1454-1456_1 Template-Type: ReDIF-Article 1.0 Title: HIV test-seeking before and after the restriction of anonymous testing in North Carolina Journal: American Journal of Public Health Author-Name: Hertz-Picciotto, I. Author-Name: Lee, L.W. Author-Name: Hoyo, C. Year: 1996 Volume: 86 Issue: 10 Pages: 1446-1450 Abstract: Objectives. This study assessed the impact on HIV test-seeking of North Carolina's restriction of anonymous testing to 18 of its 100 counties as of September 1, 1991. Methods. Trends from 4 months prerestriction to the 16- month restriction period in counties retaining vs counties eliminating anonymous testing were compared. Results. HIV testing increased throughout the state, but more rapidly where anonymous testing was retained than elsewhere: 64% vs 44%. These differences held for all sociodemographic subgroups and were most pronounced among adolescents and African Americans and other non-Whites. Conclusions. The data are consistent with a detrimental effect of elimination of anonymous testing, although confounding from differences in AIDS awareness or in repeat tests is possible. Handle: RePEc:aph:ajpbhl:1996:86:10:1446-1450_2 Template-Type: ReDIF-Article 1.0 Title: The recovery of Guatemalan children with mild to moderate wasting: Factors enhancing the impact of supplementary feeding Journal: American Journal of Public Health Author-Name: Rivera, J.A. Author-Name: Habicht, J.-P. Year: 1996 Volume: 86 Issue: 10 Pages: 1430-1434 Abstract: Objectives. The purpose of this study was to identify factors that enhance the recovery due to supplementary feeding in wasted children. Methods. Recovery rates were obtained in mild to moderately wasted 6- to 48- month-old rural Guatemalan children living in four villages. Children in two villages received a high protein-energy supplement (supplemented children), while children in the other villages received a low protein-energy supplement (nonsupplemented children). The difference in recovery rates between the groups was the attributable benefit. The net supplementation amounted to 11% of the recommended energy intake and its associated nutrients. Results. Attributable supplement benefits were achieved in younger children (6 to 24 months old) and increased with decreasing weight for length, longer duration of supplementation, and duration of diarrhea, but not with chronicity of wasting. Conclusions. Supplementation's effectiveness can be improved in similar populations by programs targeted according to these findings. Handle: RePEc:aph:ajpbhl:1996:86:10:1430-1434_7 Template-Type: ReDIF-Article 1.0 Title: Alcohol and drug use, abuse, and dependence among welfare recipients Journal: American Journal of Public Health Author-Name: Grant, B.F. Author-Name: Dawson, D.A. Year: 1996 Volume: 86 Issue: 10 Pages: 1450-1454 Abstract: Objectives. This paper presents national estimates of heavy drinking, drug use, and alcohol and drug abuse and/or dependence among recipients of selected welfare programs. Methods. Data from the 1992 National Longitudinal Alcohol Epidemiologic Survey were analyzed. Results. The percentages of welfare recipients using, abusing, or dependent on alcohol or drugs were relatively small and consistent with the general US population and those not receiving welfare benefits. Conclusions. Although a minority of welfare recipients have alcohol or drug problems, substance abuse prevention and treatment services are needed among high-risk subgroups. Handle: RePEc:aph:ajpbhl:1996:86:10:1450-1454_6 Template-Type: ReDIF-Article 1.0 Title: Preventing HIV/AIDS among high-risk urban women: The cost-effectiveness of a behavioral group intervention Journal: American Journal of Public Health Author-Name: Holtgrave, D.R. Author-Name: Kelly, J.A. Year: 1996 Volume: 86 Issue: 10 Pages: 1442-1445 Abstract: Objectives. A human immunodeficiency virus (HIV) intervention trial for women at high risk for acquired immunodeficiency syndrome and attending an urban clinic was reported previously. The behavioral group intervention was shown to increase condom use behaviors significantly. This study retrospectively assessed the intervention's cost-effectiveness. Methods. Standard methods of cost and cost-utility analysis were used. Results. The intervention cost was just over $2000 for each quality-adjusted life-year saved; this is favorable compared with other life-saving programs. However, the results are sensitive to changes in some model assumptions. Conclusions. Under most scenarios, the HIV prevention intervention was cost-effective. Handle: RePEc:aph:ajpbhl:1996:86:10:1442-1445_4 Template-Type: ReDIF-Article 1.0 Title: Race, asthma, and persistent wheeze in Philadelphia schoolchildren Journal: American Journal of Public Health Author-Name: Cunningham, J. Author-Name: Dockeiy, D.W. Author-Name: Speizer, F.E. Year: 1996 Volume: 86 Issue: 10 Pages: 1406-1409 Abstract: Objectives. Many studies show asthma to be more common in Black than in White children. This study assessed how much of this difference remains after adjustment for other potentially race-associated predictors of asthma. Methods. We assessed the predictors of active diagnosed asthma and persistent wheeze in 1416 Black and White Philadelphia children aged 9 to 11 years, as reported by parents. Results. Black race remained a significant predictor of active diagnosed asthma (odds ratio [OR] = 2.3; 95% confidence interval [CI] = 1.3, 4.1) but not of persistent wheeze (OR = 1.0; 95% CI = 0.6, 1.8). The excess risk of asthma in Black children was not appreciably altered by adjustment for other demographic and environmental factors. Conclusions. Black race is an important risk factor for active diagnosed asthma in these urban children, a relationship not explained by social factors. This finding and the lack of an association of race with persistent wheeze after adjustment for social factors suggest that race may be more important to the acquisition of an asthma diagnosis than to the prevalence of the symptoms. Handle: RePEc:aph:ajpbhl:1996:86:10:1406-1409_3 Template-Type: ReDIF-Article 1.0 Title: Racial differences in urban children's environmental exposures to lead Journal: American Journal of Public Health Author-Name: Lanphear, B.P. Author-Name: Weitztnan, M. Author-Name: Eberly, S. Year: 1996 Volume: 86 Issue: 10 Pages: 1460-1463 Abstract: Objectives. This study explored whether differences in environmental lead exposures explain the racial disparity in children's blood lead levels. Methods. Environmental sources of lead were identified for a random sample of 172 urban children. Results. Blood lead levels were significantly higher among Black children. Lead-contamination of dust was higher in Black children's homes, and the condition of floors and interior paint was generally poorer. White children were more likely to put soil in their mouths and to suck their fingers, whereas Black children were more likely to put their mouths on window sills and to use a bottle. Major contributors to blood lead were interior lead exposures for Black children and exterior lead exposures for White children. Conclusions. Differences in housing conditions and exposures to lead-contaminated house dust contribute strongly to the racial disparity in urban children's blood lead levels. Handle: RePEc:aph:ajpbhl:1996:86:10:1460-1463_9 Template-Type: ReDIF-Article 1.0 Title: Lower respiratory tract infections among Norwegian infants with siblings in day care Journal: American Journal of Public Health Author-Name: Nafstad, P. Author-Name: Hagen, J.A. Author-Name: Batten, C. Author-Name: Jaakkola, J.J.K. Year: 1996 Volume: 86 Issue: 10 Pages: 1456-1459 Abstract: Objectives. The purpose of this study was to assess the role of siblings in day care as a determinant of infants' risk of lower respiratory tract infections. Methods. A total of 3238 children (86%) out of 3754 Oslo, Norway, newborns recruited in 1992/93 were followed for 1 year. Results. In logistic regression analysis, the risk of infection was increased in (1) infants with one or more siblings compared with infants without siblings (adjusted odds ratio [OR] = 2.3; 95% confidence interval [CI] = 1.84, 2.85) and (2) infants with one or more siblings in day care compared with infants with siblings not in day care (adjusted OR = 1.7; 95% CI = 1.21, 2,26). Conclusions. The results suggest that siblings in day care outside the home increase infants' risk of lower respiratory tract infections. Handle: RePEc:aph:ajpbhl:1996:86:10:1456-1459_8 Template-Type: ReDIF-Article 1.0 Title: Factors associated with emergency department visits by children with asthma: Implications for health education Journal: American Journal of Public Health Author-Name: Wasilewski, Y. Author-Name: Clark, N.M. Author-Name: Evans, D. Author-Name: Levison, M. Author-Name: Levin, B. Author-Name: Meilins, R.B. Year: 1996 Volume: 86 Issue: 10 Pages: 1410-1415 Abstract: Objectives. This study investigated the relationship between psychosocial and behavioral factors and the frequency of emergency department visits for childhood asthma. Methods. Data obtained from a survey of parents of 445 children who were being treated for asthma in the emergency room of a large urban hospital were examined. Results. Factors associated with high emergency department use included the child's being of younger age, a greater number of days with symptoms of asthma, a higher number of asthma medicines prescribed, a prior hospitalization for asthma, a lower level of parental confidence in the efficacy of medicines, and a failure to use a criterion for deciding to seek emergency care. Conclusions. Younger children with asthma and children with previous hospitalization for asthma are at high risk for using emergency care. Families who use the emergency department frequently need to be further educated in the inflammatory nature of the disease, in the efficacy of proper use of medicine, in the need for ongoing care, and in criteria to distinguish those symptoms that can be handled at home from those requiring emergency care. Handle: RePEc:aph:ajpbhl:1996:86:10:1410-1415_6 Template-Type: ReDIF-Article 1.0 Title: Do beliefs, knowledge, and perceived norms about diet and cancer predict dietary change? Journal: American Journal of Public Health Author-Name: Patterson, R.E. Author-Name: Kristal, A.R. Author-Name: Vliite, E. Year: 1996 Volume: 86 Issue: 10 Pages: 1394-1400 Abstract: Objectives. We hypothesized that belief in an association between diet and cancer, knowledge of dietary recommendations and food composition, and perceived norms would predict healthful dietary changes. Methods. Data are from a population-based sample of Washington State residents (n = 607). Psychosocial constructs measured at baseline (1989/90) were used to predict changes in dietary practices, fat intake, fiber intake, and weight over 3 years. Results. Adults who strongly believed in a diet-cancer connection decreased the percentage of energy consumed from fat by 1.20 percentage points and increased fiber intake by 0.69 g, compared with decreases of 0.21 percentage points and 0.57 g among those with no belief (P < .05). Adults with knowledge of the National Cancer Institute fat and fiber goals decreased their percentage of energy from fat by 1.70 points compared with an increase of 0.27 points among those with little knowledge (P < .05). Food composition knowledge and perceived pressure to cat a healthful diet were not significant predictors of changes in fat intake, fiber intake, or weight. Conclusions. Interventions that increase the public's beliefs in diet and health associations and communicate diet recommendations can encourage healthful dietary change. Handle: RePEc:aph:ajpbhl:1996:86:10:1394-1400_9 Template-Type: ReDIF-Article 1.0 Title: Community health promotion via local minority youth: a model for academic medical centers. Journal: American Journal of Public Health Author-Name: Garfield, R. Year: 1996 Volume: 86 Issue: 10 Pages: 1475-1477 Handle: RePEc:aph:ajpbhl:1996:86:10:1475-1477_7 Template-Type: ReDIF-Article 1.0 Title: Judging hospitals by severity-adjusted mortality rates: The influence of the severity-adjustment method Journal: American Journal of Public Health Author-Name: Iezzoni, L.I. Author-Name: Ash, A.S. Author-Name: Shwartz, M. Author-Name: Daley, J. Author-Name: Hughes, J.S. Author-Name: Mackieman, Y.D. Year: 1996 Volume: 86 Issue: 10 Pages: 1379-1387 Abstract: Objectives. This research examined whether judgments about a hospital's risk-adjusted mortality performance are affected by the severity-adjustment method. Methods. Data came from 100 acute care hospitals nationwide and 11 880 adults admitted in 1991 for acute myocardial infarction. Ten severity measures were used in separate multivariable logistic models predicting in- hospital death. Observed-to-expected death rates and z scores were calculated with each severity measure for each hospital. Results. Unadjusted mortality rates for the 100 hospitals ranged from 4.8% to 26.4%. For 32 hospitals, observed mortality rates differed significantly from expected rates for I or more, but not for all 10, severity measures. Agreement between pairs of severity measures on whether hospitals were flagged as statistical mortality outliers ranged from fair to good. Severity measures based on medical records frequently disagreed with measures based on discharge abstracts. Conclusions. Although the 10 severity measures agreed about relative hospital performance more often than would be expected by chance, assessments of individual hospital mortality rates varied by different severity-adjustment methods. Handle: RePEc:aph:ajpbhl:1996:86:10:1379-1387_5 Template-Type: ReDIF-Article 1.0 Title: Predictors of mortality in children with severe mental retardation: The effect of placement Journal: American Journal of Public Health Author-Name: Strauss, D. Author-Name: Eyman, R.K. Author-Name: Grossman, H.J. Year: 1996 Volume: 86 Issue: 10 Pages: 1422-1429 Abstract: Objectives. This study was undertaken to assess the predictors of mortality in severely disabled children with mental retardation, and to compare risk-adjusted mortality rates for those living in institutions with rates for those living in the community. Methods. Statistical analysis was performed on a set of 24 469 person-years, derived from a population of all children with severe mental retardation and a fragile medical condition who are registered with the California Department of Developmental Services. Variables included age, several measures of mobility, the presence or absence of tube feeding, the level of retardation, and certain adaptive skills. Results. Reduced mobility and the use of tube feeding were associated with a large increase in mortality risk. Own home residence and community care facilities have an estimated 25% higher risk-adjusted odds on mortality than institutions and health facilities. Conclusions. The differential mortality in the placements points to a possible effect of quality of care. One consequence of the current trend toward deinstitutionalization may be an increased mortality rate in children with severe developmental disability. Handle: RePEc:aph:ajpbhl:1996:86:10:1422-1429_9 Template-Type: ReDIF-Article 1.0 Title: The risk of myocardial infarction among Finnish farmers seeking medical care for an infection Journal: American Journal of Public Health Author-Name: Penttinen, J. Author-Name: Valonen, P. Year: 1996 Volume: 86 Issue: 10 Pages: 1440-1442 Abstract: Objectives. This study determined whether people visiting a doctor because of infection had an increased risk of myocardial infarction. Methods. For 83 case patients and 249 matched control patients nested in a cohort of 3172 Finnish male farmers, comparisons were made on the basis of visits to a doctor because of infection. Results. Infections of the upper respiratory tract were statistically significantly associated with coronary artery disease. The odds ratio was 3.2 (95% confidence interval = 1.2, 8.5) for patients visiting a doctor four or more times because of infection of upper respiratory tract compared with patients with three or fewer visits. Conclusion. Men in this sample with recurrent or chronic infections of the upper respiratory tract exhibited a pronounced risk for myocardial infarction. Handle: RePEc:aph:ajpbhl:1996:86:10:1440-1442_3 Template-Type: ReDIF-Article 1.0 Title: Decreasing disability in the 21st century: The future effects of controlling six fatal and nonfatal conditions Journal: American Journal of Public Health Author-Name: Boult, C. Author-Name: Altmann, M. Author-Name: Gilbertson, D. Author-Name: Yu, C. Author-Name: Kane, R.L. Year: 1996 Volume: 86 Issue: 10 Pages: 1388-1393 Abstract: Objectives. This study assessed the effects of reducing fatal and nonfatal health conditions on the number of functionally limited older Americans in the coming decades. Methods. Data from the 1990 census and the Longitudinal Study of Aging were used to project the number of functionally limited older Americans from 2001 to 2049, assuming 1% biennial reductions in five conditions that shorten life expectancy (coronary artery disease, stroke, cancer, diabetes, and confusion) and one condition that decreases functional ability (arthritis). Results. Decreasing the prevalence of arthritis by 1% every 2 years would lead to a much greater reduction in functional limitation between 2001 and 2049 (4 million person-years) than would decreasing any of the other conditions by the same amount. Decreases in two fatal conditions (cancer and coronary artery disease) would lead to increases in functional limitation (0.9 and 0.1 million person-years, respectively). Conclusions. Advances against common nonfatal disabling conditions would be more effective than advances against fatal conditions in blunting the large increase in the functionally limited older population anticipated in the 21st century. Handle: RePEc:aph:ajpbhl:1996:86:10:1388-1393_2 Template-Type: ReDIF-Article 1.0 Title: The value of the population attributable risk percentage. Journal: American Journal of Public Health Author-Name: Hill, G.B. Year: 1996 Volume: 86 Issue: 10 Pages: 1483 Handle: RePEc:aph:ajpbhl:1996:86:10:1483_4 Template-Type: ReDIF-Article 1.0 Title: The effects of poverty, race, and family structure on US children's health: Data from the NHIS, 1978 through 1980 and 1989 through 1991 Journal: American Journal of Public Health Author-Name: Montgomery, L.E. Author-Name: Kiely, J.L. Author-Name: Pappas, G. Year: 1996 Volume: 86 Issue: 10 Pages: 1401-1405 Abstract: Objectives. This study investigated the independent and relative effects of family structure, race, and poverty on the health of US children and youth under 20 years of age at two time periods, 1978 through 1980 and 1989 through 1991. Methods. Data were from the National Health Interview Surveys. Multivariate logit regression methods were used to analyze the effects of family structure, poverty, and race on children's health. Results. Children in families headed by single mothers, Black children, and those living below 150% of the poverty index were much more likely to be in poor or fair health than children in two-parent families, White children, or those in more affluent families. Poverty had the strongest effect on child health in both time periods. Conclusions. The association between children's health and living below 150% of the poverty index is not explained by race or family structure. The disparity in child health by family income has serious consequences for both the child and society. Handle: RePEc:aph:ajpbhl:1996:86:10:1401-1405_7 Template-Type: ReDIF-Article 1.0 Title: Measuring access to prenatal care in New York City: a telephone survey of prenatal clinics. Journal: American Journal of Public Health Author-Name: Schwartz, L.R. Author-Name: Heagarty, M. Author-Name: Graham, E.H. Author-Name: Pirani, S. Year: 1996 Volume: 86 Issue: 10 Pages: 1474-1475 Handle: RePEc:aph:ajpbhl:1996:86:10:1474-1475_8 Template-Type: ReDIF-Article 1.0 Title: Detecting risk drinking during pregnancy: A comparison of four screening questionnaires Journal: American Journal of Public Health Author-Name: Russell, M. Author-Name: Martier, S.S. Author-Name: Sokol, R.J. Author-Name: Mudar, P. Author-Name: Jacobson, S. Author-Name: Jacobson, J. Year: 1996 Volume: 86 Issue: 10 Pages: 1435-1439 Abstract: Objectives. This study investigated the efficacy of screening for risk drinking during pregnancy, with two brief questionnaires, TWEAK and T-ACE. Both include an assessment of tolerance based on the number of drinks women report they can hold. Methods. Subjects were disadvantaged African-American obstetric patients in Detroit. Mich. Traditional alcoholism screens (Michigan Alcohol Screening Test [MAST], CAGE) and the tolerance question were administered (n = 2717); TWEAK and T-ACE were constructed from tolerance and embedded MAST and CAGE items. In a separate sample (n = 1420), only the T- ACE was administered. Periconceptional risk drinking was the gold standard. Screen evaluations were based on receiver-operating characteristic analyses. Results. At the cutpoint of 2, sensitivity/specificity for embedded screens were 91/77 for TWEAK and 88/79 for T-ACE: comparable values for T-ACE alone were 67/86. TWEAK and T-ACE screened more effectively than CAGE or MAST. Conclusions. Embedded versions of TWEAK and T-ACE were both highly sensitive to periconceptional risk drinking in thin population. Administering T-ACE alone reduced its sensitivity: this suggests that MAST and CAGE administration improves its performance. Handle: RePEc:aph:ajpbhl:1996:86:10:1435-1439_6 Template-Type: ReDIF-Article 1.0 Title: Racial discrimination and blood pressure: The CARDIA study of young black and white adults Journal: American Journal of Public Health Author-Name: Krieger, N. Author-Name: Sidney, S. Year: 1996 Volume: 86 Issue: 10 Pages: 1370-1378 Abstract: Objectives. This study examined associations between blood pressure and self-reported experiences of racial discrimination and responses to unfair treatment. Methods. Survey data were collected in year 7 (1992/93) of the Coronary Artery Risk Development in Young Adults (CARDIA) study, a prospective multisite community-based investigation. Participants included 831 Black men, 1143 Black women, 1006 White men, and 1106 White women 25 to 37 years old. Results. Systolic blood pressure among working-class Black adults reporting that they typically accepted unfair treatment and had experienced racial discrimination in none of seven situations was about 7 mm Hg higher than among those reporting that they challenged unfair treatment and experienced racial discrimination in one or two of the situations. Among professional Black adults, systolic blood pressure was 9 to 10 mm Hg lower among those reporting that they typically challenged unfair treatment and had not experienced racial discrimination. Black-White differences in blood pressure were substantially reduced by taking into account reported experiences of racial discrimination and responses to unfair treatment. Conclusions. Research on racial/ethnic distributions of blood pressure should take into account how discrimination may harm health. Handle: RePEc:aph:ajpbhl:1996:86:10:1370-1378_4 Template-Type: ReDIF-Article 1.0 Title: Needle exchange programs: New Zealand's experience. Journal: American Journal of Public Health Author-Name: Lichtenstein, B. Year: 1996 Volume: 86 Issue: 9 Pages: 1319 Handle: RePEc:aph:ajpbhl:1996:86:9:1319_8 Template-Type: ReDIF-Article 1.0 Title: Semivolatile organic compounds in adipose tissue: Estimated averages for the US population and selected subpopulations Journal: American Journal of Public Health Author-Name: Lordo, R.A. Author-Name: Dinh, K.T. Author-Name: Schwemberger, J.G. Year: 1996 Volume: 86 Issue: 9 Pages: 1253-1259 Abstract: Objectives. The fiscal year (FY) 1986 Environmental Protection Agency National Human Adipose Tissue Survey (NHATS) was conducted to estimate average concentrations of 111 semivolatiles in human adipose tissue within the US general population and selected subpopulations. Methods. Population and subpopulation estimates of average semivolatile concentrations were established from 671 adipose tissue specimens pooled across 50 analytical samples. Results. Among polychlorinated biphenyls (PCBs), average concentrations for the group aged 45 and older were from 188% to 706% higher than for the 0- through 14-year-old age group. Similar increases with age were observed for pesticides. Geographic effects on average concentration were mixed, and no significant race or sex effects were observed. Statistically significant increases from FY 1982 NHATS results were observed for PCBs and hexachlorohenzene, whereas a decrease from FY 1982 was significant for beta-BHC (benzene hexachloride). Increases from FY 1984 NHATS results were significant for p,p-DDT (dichlordiphenylethylene), p,p-DDE (dichlordiphenyldichlor), hexachlorobenzene, and PCBs. Conclusions. The survey establishes baseline average levels of semivolatile compounds in the adipose tissue of US residents. Handle: RePEc:aph:ajpbhl:1996:86:9:1253-1259_8 Template-Type: ReDIF-Article 1.0 Title: Daily exposure to environmental tobacco smoke: Smokers vs nonsmokers in California Journal: American Journal of Public Health Author-Name: Robinson, J.P. Author-Name: Switzer, P. Author-Name: Ott, W. Year: 1996 Volume: 86 Issue: 9 Pages: 1303-1305 Abstract: Objectives. This study examined the differences in environmental tobacco smoke exposure between smokers and non-smokers. Methods. A probability sample of 1579 California adults completed a 1-day time diary of a full day's activities in which they reported whether any smoker was present during each activity. Results. Some 61% of respondents reported at least some environmental tobacco smoke exposure in these diary accounts (for an average of up to 5 hours per day), and potential exposure rose monotonically with number of cigarettes actively smoked. Heaviest smokers reported about four times as much such exposure as nonsmokers. Conclusions. Because smokers lead life-styles that expose them to far higher levels of environmental tobacco smoke exposure, that factor needs to be controlled in studies estimating the effects of active smoking. Handle: RePEc:aph:ajpbhl:1996:86:9:1303-1305_0 Template-Type: ReDIF-Article 1.0 Title: New York inmates' HIV risk behaviors: The implications for prevention policy and programs Journal: American Journal of Public Health Author-Name: Mahon, N. Year: 1996 Volume: 86 Issue: 9 Pages: 1211-1215 Abstract: Objectives. The median incidence rate of acquired immunodeficiency syndrome (AIDS) among prisoners is 7 times higher than for the general population. Yet high-risk sexual activity and drug use in US correctional facilities remain unexamined. This study explores inmate perceptions of high- risk behavior in New York state prisons and New York City jails and seeks to generate hypotheses to inform policies and future research. Methods. Participants were 22 former New York state prisoners and 28 current New York City inmates. Participants attended one of six focus groups and completed an anonymous questionnaire. Audiotapes of the groups were transcribed and evaluated. Results. A range of consensual and nonconsensual sexual activity occurs among inmates and between inmates and staff. Without official access to latex barriers, prisoners use ineffective makeshift devices, like rubber gloves and used plastic wrap, in attempts to practice safer sex. Prisoners also shoot drugs intravenously with used syringes and pieces of pens and light bulbs. Conclusions. The absence of harm-reduction devices behind bars may create a greater risk of HIV transmission there than in the community. Officials should consider distributing risk-reduction devices to prisoners through anonymous methods. Handle: RePEc:aph:ajpbhl:1996:86:9:1211-1215_9 Template-Type: ReDIF-Article 1.0 Title: Lowering state legal blood alcohol limits to 0.08%: The effect on fatal motor vehicle crashes Journal: American Journal of Public Health Author-Name: Hingson, R. Author-Name: Heeren, T. Author-Name: Winter, M. Year: 1996 Volume: 86 Issue: 9 Pages: 1297-1299 Abstract: Objectives. This study was undertaken to determine whether reductions in alcohol related fatal crashes following adoption of 0.08% legal blood alcohol limits were independent of general regional trends. Methods. The first five states that lowered legal blood alcohol limits to 0.08% were paired with five nearby states that retained a 0.10% legal standard. Within each pair, comparisons were made for the maximum equal available number of preand postlaw years. Results. States adopting 0.08% laws experienced 16% and 18% relative postlaw declines in the proportions of fatal crashes involving fatally injured drivers whose blood alcohol levels were 0.08% or higher and 0.15% or higher. Conclusions. If all states adopted 0.08% legal blood alcohol limits, at least 500 to 600 lower fatal crashes would occur annually. Handle: RePEc:aph:ajpbhl:1996:86:9:1297-1299_0 Template-Type: ReDIF-Article 1.0 Title: Water and turf: Fluoridation and the 20th-century fate of waterworks engineers Journal: American Journal of Public Health Author-Name: Hunt, E. Year: 1996 Volume: 86 Issue: 9 Pages: 1310-1317 Abstract: Once central figures in American public health, waterworks engineers are no longer involved in many decisions made about the public water supplies. This paper argues that the profession's response to the early fluoridation movement of the 1940s and 1950s marked a change in the relationship between waterworks engineers and the other constitutive groups in public health and contributed to the disenfranchisement of the waterworks profession. Sensing a potentially divisive issue, two leaders of the profession. Abel Wolman and Linn Enslow, took steps they hoped would prevent a rift within the profession and allow waterworks engineering to continue its association with the wider public health community. Although the leaders saw the fluoridation issue differently, neither encouraged the profession to consider it openly or to take up the broader question of what limits, if any, should be placed on treating water supplies to meet human needs. Instead, they opted to locate authority for fluoridation outside the waterworks profession with dentists, doctors, and public health administrators. As a result, waterworks engineers conceded a great deal of the status and prestige associated with decision- making roles in community health issues, and have largely faded from view. Handle: RePEc:aph:ajpbhl:1996:86:9:1310-1317_5 Template-Type: ReDIF-Article 1.0 Title: Cancer risk and residential proximity to cranberry cultivation in Massachusetts Journal: American Journal of Public Health Author-Name: Aschengrau, A. Author-Name: Ozonoff, D. Author-Name: Coogan, P. Author-Name: Vezina, R. Author-Name: Heeren, T. Author-Name: Zhang, Y. Year: 1996 Volume: 86 Issue: 9 Pages: 1289-1296 Abstract: Objectives. This study evaluated the relationship between cancer risk and residential proximity to cranberry cultivation. Methods. A population- based case-control study was conducted. Cases, diagnosed during 1983 through 1986 among residents of the Upper Cape Cod area of Massachusetts, involved incident cancers of the lung (n = 252), breast (n = 265), colonrectum (n = 326), bladder (n = 63), kidney (n = 35), pancreas (n = 37), and brain (n = 37), along with leukemia (n = 35). Control subjects were randomly selected from among telephone subscribers (n = 184), Medicare beneficiaries (n = 464), and deceased individuals (n = 723). Results. No meaningful increases in risk were seen for any of the cancer sites except for the brain. When latency was considered, subjects who had ever lived within 2600 ft (780 m) of a cranberry hog had a twofold increased risk of brain cancer overall (95% confidence interval [CI] = 0.8, 4.9) and a 6.7-fold increased risk of astrocytoma (95% CI = 1.6, 27.8). Conclusions. Residential proximity to cranberry bog cultivation was not associated with seven of the eight cancers investigated: however, an association was observed with brain cancer, particularly astrocytoma. Larger, more detailed studies are necessary to elucidate this relationship. Handle: RePEc:aph:ajpbhl:1996:86:9:1289-1296_6 Template-Type: ReDIF-Article 1.0 Title: Trends in smokeless tobacco use among men in four states, 1988 through 1993 Journal: American Journal of Public Health Author-Name: Nelson, D.E. Author-Name: Tomar, S.L. Author-Name: Mowery, P. Author-Name: Siegel, P.Z. Year: 1996 Volume: 86 Issue: 9 Pages: 1300-1303 Abstract: Objectives. Trends in smokeless tobacco use were examined for men in Indiana, Iowa, Montana, and West Virginia from 1988 through 1993. Methods. State survey data from the Behavioral Risk Factor Surveillance System (BRFSS) were analyzed. Results. Demographic characteristics associated with smokeless tobacco use included age less than 35 years, a high school education or less, and rural residence. Overall, there was little change in smokeless tobacco use among men in these states (range = -0.4-0.4 percentage points annually); only West Virginia had a significant decline. Conclusions. Reasons for the overall lack of decline may include increased advertising and promotional expenditures or substitution of smokeless tobacco for cigarettes. Increased prevention and cessation efforts are needed. Handle: RePEc:aph:ajpbhl:1996:86:9:1300-1303_8 Template-Type: ReDIF-Article 1.0 Title: Risk factors for occupational injuries among older workers: An analysis of the health and retirement study Journal: American Journal of Public Health Author-Name: Zwerling, C. Author-Name: Sprince, N.L. Author-Name: Wallace, R.B. Author-Name: Davis, C.S. Author-Name: Whitten, P. Author-Name: Heeringa, S.G. Year: 1996 Volume: 86 Issue: 9 Pages: 1306-1309 Abstract: Objectives. This study examined risk factors for occupational injury among older workers. Methods. We analyzed data on 6854 employed nonfarmers from the Health and Retirement Study (HRS), a population-based sample of Americans 51 through 61 years old. Results. Occupational injuries were associated with the following: the occupations of mechanics and repairers (odds ratio [OR] = 2.27), service personnel (OR = 1.68), and laborers (OR = 2.18); jobs requiring heavy lifting (OR = 2.75); workers' impaired hearing (OR = 1.60) and impaired vision (OR = 1.53); and jobs requiring good vision (OR = 1.43). Self-employment was associated with fewer injuries (OR = 0.47). Conclusions. These results emphasize the importance of a good match between job demands and worker capabilities. Handle: RePEc:aph:ajpbhl:1996:86:9:1306-1309_9 Template-Type: ReDIF-Article 1.0 Title: Increased blood lead and decreased calcium levels during pregnancy: A prospective study of Swedish women living near a smelter Journal: American Journal of Public Health Author-Name: Lagerkvist, B.J. Author-Name: Ekesrydh, S. Author-Name: Englyst, V. Author-Name: Nordberg, G. Author-Name: Söderberg, H.-A. Author-Name: Wiklund, D.-E. Year: 1996 Volume: 86 Issue: 9 Pages: 1247-1252 Abstract: Objectives. The purpose of this study was to monitor blood lead in a northern Swedish cohort of mothers and children during pregnancy and at birth. Methods. Blood lead was analyzed during pregnancy and in the umbilical cords of 290 women living near a smelter and in 194 control subjects. Results. During pregnancy, there were statistically significant overall increases in blood lead concentrations by 20%, and 15% in the smelter and reference areas, respectively. Mean maternal blood lead concentrations at delivery were 0.15 μmol/L (3.11 μg/dL) in the smelter area and 0.13 μmol/L (2.69 μg/dL) in the control area. Umbilical cord blood lead levels were 80% to 87% of the maternal levels. Blood lead levels were influenced by place of residence, employment at the smelter, smoking, and wine consumption. Maternal serum calcium levels decreased during pregnancy and were significantly lower than those of the newborns. Conclusions. An increase in blood lead concentrations was found during pregnancy, despite increased blood volume and unchanged or decreasing environmental lead levels. The mobilization of lead from bone during pregnancy may explain the increase. Handle: RePEc:aph:ajpbhl:1996:86:9:1247-1252_1 Template-Type: ReDIF-Article 1.0 Title: Annotation: marine waters and nonenteric illness--matching the degree of analytical rigor to the biology of the infectious process. Journal: American Journal of Public Health Author-Name: Telford 3rd., S.R. Year: 1996 Volume: 86 Issue: 9 Pages: 1203-1204 Handle: RePEc:aph:ajpbhl:1996:86:9:1203-1204_1 Template-Type: ReDIF-Article 1.0 Title: Occasional smoking in a Minnesota working population Journal: American Journal of Public Health Author-Name: Hennrikus, D.J. Author-Name: Jeffery, R.W. Author-Name: Lando, H.A. Year: 1996 Volume: 86 Issue: 9 Pages: 1260-1266 Abstract: Objectives. This study examined the prevalence of occasional smoking in a population of working adults, compared the characteristics of occasional and daily smokers, and prospectively examined the long-term smoking patterns of occasional smokers. Methods. At 32 Minnesota work sites, 5681 randomly selected workers were surveyed at baseline; 5248 of these were surveyed again 2 years later. A cross-sectional sample of 5817 workers was also surveyed at follow-up. Results. Occasional smokers constituted 18.3% of all smokers in the baseline sample and 21.5% of all smokers in the cross-sectional sample surveyed 2 years later. Baseline occasional smokers were significantly more likely than daily smokers to have quit at follow-up. Job monotony or repetitiveness was related to an increase to daily smoking at follow-up among baseline occasional smokers, and a change to a more restrictive workplace smoking policy was associated with quitting. Conclusions. The results confirm that a substantial proportion of smokers are low-rate users and suggest that the proportion may be rising. Further research on this group is warranted. Handle: RePEc:aph:ajpbhl:1996:86:9:1260-1266_5 Template-Type: ReDIF-Article 1.0 Title: Neurodegenerative diseases: Occupational occurrence and potential risk factors, 1982 through 1991 Journal: American Journal of Public Health Author-Name: Schulte, P.A. Author-Name: Bumett, C.A. Author-Name: Boeniger, M. Author-Name: Johnson, J. Year: 1996 Volume: 86 Issue: 9 Pages: 1281-1288 Abstract: Objectives. To identify potential occupational risk factors, this study examined the occupational occurrence of various neurodegenerative diseases. Methods. Death certificates from 27 states in the National Occupational Mortality Surveillance System were evaluated for 1982 to 1991. Proportionate mortality ratios were calculated by occupation for presenile dementia, Alzheimer's disease, Parkinson's disease, and motor neuron disease. Results. Excess mortality was observed for all four categories in the following occupational categories: teachers; medical personnel; machinists and machine operators; scientists: writers/designers/entertainers: and support and clerical workers. Clusters of three neurodegenerative diseases were also found in occupations involving pesticides, solvents, and electromagnetic fields and in legal, library, social, and religious work. Early death from motor neuron disease was found for firefighters, janitors, military personnel, teachers, excavation machine operators, and veterinarians, among others. Conclusions. Neurodegenerative disease occurs more frequently in some occupations than in others, and this distribution, which may indicate occupational risk factors, should be further investigated. Handle: RePEc:aph:ajpbhl:1996:86:9:1281-1288_8 Template-Type: ReDIF-Article 1.0 Title: Polychlorinated biphenyl (PCB) and dichlorodiphenyl dichloroethylene (DDE) concentrations in the breast milk of women in Quebec Journal: American Journal of Public Health Author-Name: Dewailly, E. Author-Name: Ayotte, P. Author-Name: Laliberté, C. Author-Name: Weber, J.-P. Author-Name: Gingras, S. Author-Name: Nantel, A.J. Year: 1996 Volume: 86 Issue: 9 Pages: 1241-1246 Abstract: Objectives. This study documented the concentration of polychlorinated biphenyls (PCBs) and dichlorodiphenyl dichloroethylene (DDE) in the breast milk of women from Quebec, Canada, and assessed the impact of various sociodemographic and lifestyle factors on these levels. Methods. From 1988 to 1990, milk samples were obtained from 536 Quebec women and analyzed for seven PCB congeners and p,p'-DDE. Information was obtained on subjects' physical, sociodemographic, and lifestyle characteristics. Results. Mean concentrations were 0.52 mg/kg lipids (95% confidence interval [CI] = 0.50, 0.54) and 0.34 mg/kg lipids (95% CI = 0.32, 0.35) for PCBs (Aroclor 1260) and DDE, respectively. Age and history of breast-feeding showed statistically significant correlations with PCB and DDE concentrations. Conclusions. Concentrations of PCBs and DDE measured in this study are at the lower end of the concentration range recently reported for women living in industrialized countries. The modulating factors identified here should be considered when conducting studies on organochlorine exposure and disease. Handle: RePEc:aph:ajpbhl:1996:86:9:1241-1246_3 Template-Type: ReDIF-Article 1.0 Title: Marine waters contaminated with domestic sewage: Nonenteric illnesses associated with bather exposure in the United Kingdom Journal: American Journal of Public Health Author-Name: Fleisher, J.M. Author-Name: Kay, D. Author-Name: Salmon, R.L. Author-Name: Jones, F. Author-Name: Wyer, M. Author-Name: Godfree, A.F. Year: 1996 Volume: 86 Issue: 9 Pages: 1228-1234 Abstract: Objectives. This study identified possible dose-response relationships among bathers exposed to marine waters contaminated with domestic sewage and subsequent risk of nonenteric illness. Methods. Four intervention follow-up studies were conducted within the United Kingdom. Healthy volunteers (n = 1273) were randomized into bather and nonbather groups. Intensive water- quality monitoring was used to assign five bacteriological indices of water quality to individual bathers. Illnesses studied were acute febrile respiratory illness, and eye, ear, and skin ailments. Results. Focal streptococci exposure was predictive of acute febrile respiratory illness, while fecal coliform exposure was predictive of ear ailments. Estimated thresholds of effect occurred at bather exposures above 60 fecal streptococci and 100 fecal coliform per 100 ml of water, respectively. Although no relationship was found between eye ailments and indicator organism exposure, compared with nonbathers, bathers were at higher risk for eye ailments. Conclusions. Nonenteric illness can be transmitted via recreational contact with marine waters contaminated with sewage. These results argue against the use of a single indicator to establish water quality standards. Handle: RePEc:aph:ajpbhl:1996:86:9:1228-1234_3 Template-Type: ReDIF-Article 1.0 Title: Passive smoking, active smoking, and education: Their relationship to weight history in women in Geneva Journal: American Journal of Public Health Author-Name: Bernstein, M. Author-Name: Morabia, A. Author-Name: Héritier, S. Author-Name: Katchatrian, N. Year: 1996 Volume: 86 Issue: 9 Pages: 1267-1272 Abstract: Objectives. This study was undertaken to determine the relationship of education and tobacco smoke to lifetime weight history in women. Methods. Information on passive smoking, active smoking, and weight history was collected from 928 women aged 29 to 74 years selected from the general population of Geneva, Switzerland. Multivariate analysis of variance was performed for weight, weight at age 20, and weight change since age 20. Results. Education was inversely related to weight at age 20, current weight, and weight gain since age 20. The least educated group had a current weight of 4 kg more than the most educated group. Differences across smoking categories were small: passive smokers had the highest current weight (63.4 kg) and former active smokers had the lowest (60.4 kg). Weight gain since age 20 tended to be smaller in former and current active smokers (5.5 to 7.2 kg) than in passive smokers (8.3 to 10.4 kg) and those never exposed (9.1 kg). Conclusions. In this sample, education was an important predictor of women's current weight and weight history. Passive and active smoking had little long-term effect on weight. Handle: RePEc:aph:ajpbhl:1996:86:9:1267-1272_1 Template-Type: ReDIF-Article 1.0 Title: Low-level air pollution and hospital admissions for cardiac and cerebrovascular diseases in Helsinki Journal: American Journal of Public Health Author-Name: Pönkä, A. Author-Name: Virtanen, M. Year: 1996 Volume: 86 Issue: 9 Pages: 1273-1280 Abstract: Objectives. This study investigated whether low concentrations of ambient air pollutants are associated with hospital admissions for ischemic cardiac and cerebrovascular diseases. Methods. Associations between daily concentrations of sulfur dioxide, nitric oxide, nitrogen dioxide, ozone, and particulates and daily hospital admissions due to ischemic cardiac and cerebrovascular diseases were studied in Helsinki, Finland, 1987 through 1989. The regression analyses controlled for weather, day of the week, season, long-term trends, and influenza epidemics. Results. Admissions via emergency rooms due to ischemic cardiac diseases (n = 7005) were significantly associated with the prevailing levels of nitric oxide and ozone, and those due to cerebrovascular diseases (n = 3737) were associated with nitrogen dioxide; these levels were only moderate. Long-term transient myocardial ischemic attacks were related to particulates, and short-term ischemic attacks were related to nitrogen dioxide. Conclusions. Symptoms of ischemic cardiac and cerebrovascular diseases may be provoked by pollutants in concentrations lower than those given as guidelines in many countries and lower than previously shown. Handle: RePEc:aph:ajpbhl:1996:86:9:1273-1280_5 Template-Type: ReDIF-Article 1.0 Title: The use of breast milk substitutes in developing countries: The impact of women's employment Journal: American Journal of Public Health Author-Name: Hight-Laitkaran, V. Author-Name: Rutstein, S.O. Author-Name: Peterson, A.E. Author-Name: Labbok, M.H. Year: 1996 Volume: 86 Issue: 9 Pages: 1235-1240 Abstract: Objectives. This study quantified the influence of employment, specifically a mother's employment away from her infant, on the use of breast milk substitutes in developing countries. Methods. Data from the Demographic and Health Surveys were used to calculate the population attributable risk percentage for use of breast milk substitutes among women employed away from their babies in 15 countries for which suitable data were available. Results. The estimated proportion of breast milk substitute use attributable to employment away from the baby ranged from 0.74% to 20.9% in the various countries. Conclusions. Employment is not the main determinant of breast milk substitute use. Efforts to improve breast-feeding can be safely targeted at the majority of women who are not employed away from their babies while nevertheless giving appropriate attention to the minority of new mothers who are employed away from their babies. Handle: RePEc:aph:ajpbhl:1996:86:9:1235-1240_7 Template-Type: ReDIF-Article 1.0 Title: Seventh graders' self-reported exposure to cigarette marketing and its relationship to their smoking behavior Journal: American Journal of Public Health Author-Name: Schooler, C. Author-Name: Feighery, E. Author-Name: Flora, J.A. Year: 1996 Volume: 86 Issue: 9 Pages: 1216-1221 Abstract: Objectives. This study examined among youth the extent of their perceived exposure to cigarette marketing and the relationship of their perceptions to their smoking behavior. Methods. Surveys measuring exposure to cigarette advertisements and promotions were completed by 571 seventh graders in San Jose, Calif. Results. Eighty-eight percent of these 13-year-olds reported exposure to cigarette marketing: the majority often saw ads in magazines, on billboards, and at stores and events, and one quarter owned cigarette promotional items. After social influences to smoke were controlled for, exposure to cigarette marketing was related to self-reported smoking behavior. Likelihood of experimenting with smoking was 2.2 times greater among those who owned promotional items and 2.8 times greater among those who had received mail from a tobacco company. Seeing cigarette advertisements in magazines increased this likelihood by 21%, and seeing tobacco marketing in stores increased it by 38%. Conclusions. Youth are daily and widely exposed to tobacco industry marketing efforts; this exposure is related to smoking behavior. More effective regulation is needed. Handle: RePEc:aph:ajpbhl:1996:86:9:1216-1221_2 Template-Type: ReDIF-Article 1.0 Title: Toward a more realistic appraisal of the lung cancer risk from radon: The effects of residential mobility Journal: American Journal of Public Health Author-Name: Wanier, K.E. Author-Name: Mendez, D. Author-Name: Courant, P.N. Year: 1996 Volume: 86 Issue: 9 Pages: 1222-1227 Abstract: Objectives. A consideration of the effects of residential mobility produces much more realistic estimates of typical individuals' radon exposures and mortality risks than those of the Environmental Protection Agency (EPA). Methods. A model linking residential mobility, the distribution of radon in US homes, and lung cancer risk is used to simulate lifetime radon exposure, with and without mitigation of high-radon homes, for typical mobile individuals. Radon-related lung cancer mortality risks are then estimated for smokers and neversmokers. Results. Most individuals residing in high-radon homes have equivalent lifelong radon exposures well below those they are currently experiencing. Consequently, actual lung cancer risks are generally well below those implied in the EPA's radon risk charts. For most people who mitigate high-radon homes, risk reduction is modest. Conclusions. Radon may indeed be responsible for as large a population risk of lung cancer as the EPA estimates. However, caution must be used in interpreting the EPA's risk assessment for individuals; in many cases, mitigation will have little effect on residents' health risks. Handle: RePEc:aph:ajpbhl:1996:86:9:1222-1227_8 Template-Type: ReDIF-Article 1.0 Title: Ambient carbon monoxide and hospitalizations for heart failure: Earlier findings Journal: American Journal of Public Health Author-Name: Hexter, A.C. Author-Name: Morris, R.D. Author-Name: Naumova, E.N. Author-Name: Munasinghe, R.L. Year: 1996 Volume: 86 Issue: 7 Pages: 1031-1032 Handle: RePEc:aph:ajpbhl:1996:86:7:1031-1032_1 Template-Type: ReDIF-Article 1.0 Title: HIV infection and risk behaviors among male port workers in Santos, Brazil Journal: American Journal of Public Health Author-Name: Larcerda, R. Author-Name: Stall, R. Author-Name: Gravato, N. Author-Name: Tellini, R. Author-Name: Hudes, E.S. Author-Name: Hearst, N. Year: 1996 Volume: 86 Issue: 8 Pages: 1158-1160 Abstract: Objectives. This paper measured the extent to which human immunodeficiency virus (HIV) infection has spread among the male working- class population of Santos, Brazil. Methods. Questionnaires on risk behaviors and blood tests were administered to a random sample (n = 395) of male port workers employed by the Santos Port Authority. Results. Although the rate of HIV infection among these men-the working-class male population of Santos-remains low (1.1%), self-reported behavioral risks for HIV infection are common. Conclusions. There is still time to prevent a widespread outbreak of HIV infection among the heterosexual population of Santos and of the transportation corridors emanating from that city. Handle: RePEc:aph:ajpbhl:1996:86:8:1158-1160_4 Template-Type: ReDIF-Article 1.0 Title: Using volunteers to survey child restraint compliance among New Hampshire drivers. Journal: American Journal of Public Health Author-Name: Frank, E. Author-Name: Ascheim, J. Year: 1996 Volume: 86 Issue: 8 Pages: 1169-1170 Handle: RePEc:aph:ajpbhl:1996:86:8:1169-1170_2 Template-Type: ReDIF-Article 1.0 Title: Diagnosing children with attention deficit disorders through a health department-public school partnership. Journal: American Journal of Public Health Author-Name: Shea, K.M. Author-Name: Rahmani, C.H. Author-Name: Morris, P.J. Year: 1996 Volume: 86 Issue: 8 Pages: 1168-1169 Handle: RePEc:aph:ajpbhl:1996:86:8:1168-1169_9 Template-Type: ReDIF-Article 1.0 Title: A meningococcal vaccination campaign on a university campus: Vaccination rates and factors in nonparticipation Journal: American Journal of Public Health Author-Name: Roberts, C.L. Author-Name: Roome, A. Author-Name: Algert, C.S. Author-Name: Walsh, S.J. Author-Name: Kurland, M. Author-Name: Lawless, K. Author-Name: Cartter, M.L. Year: 1996 Volume: 86 Issue: 8 Pages: 1155-1158 Abstract: Objectives. This study was undertaken to determine an accurate vaccination rate and identify factors influencing nonvaccination in a meningococcal vaccination campaign on a Connecticut university campus in May 1993. Methods. Vaccination and student data were merged to determine factors associated with nonvaccination. A case-control study examined reasons for nonvaccination. Results. The estimated vaccination rate for students returning to the campus was 93%. Lower rates occurred among older students, students living off campus, graduate and nondegree students, and married students. Perceived poor access to the vaccination center was the strongest predictor of nonvaccination. Conclusions. Higher vaccination rates may be achieved by specifically targeting students who live off campus and by providing multiple vaccination sites with extended hours. Handle: RePEc:aph:ajpbhl:1996:86:8:1155-1158_7 Template-Type: ReDIF-Article 1.0 Title: The role of employee flexible spending accounts in health care financing Journal: American Journal of Public Health Author-Name: Schweitzer, M. Author-Name: Asch, D.A. Year: 1996 Volume: 86 Issue: 8 Pages: 1079-1081 Abstract: Employee flexible spending accounts for health care represent one component of the current health care financing system that merits serious reform. These accounts create a system of undesirable incentives, force employees and employers to take complicated gambles, reduce tax revenues, and fail to meet their purported policy objectives. This paper describes shortcomings in these accounts from both a theoretical and an empirical perspective. Some proposed alternatives, including medical spending accounts and zero balance accounts, resolve many of these concerns but not all of them. Handle: RePEc:aph:ajpbhl:1996:86:8:1079-1081_5 Template-Type: ReDIF-Article 1.0 Title: Directly observed therapy for tuberculosis: The Harlem Hospital experience, 1993 Journal: American Journal of Public Health Author-Name: El-Sadr, W. Author-Name: Medard, F. Author-Name: Barthaud, V. Year: 1996 Volume: 86 Issue: 8 Pages: 1146-1149 Abstract: Objectives. A directly observed therapy program was established at Harlem Hospital, New York, NY, in 1993 to promote high tuberculosis treatment completion rates. Methods. The Harlem program used an on-site surrogate family model. Treatment completion rate, visit adherence rate, human immunodeficiency virus seroprevalence, and time to sputum culture conversion were assessed. Results. Out of 145 enrolled patients with suspected and confirmed tuberculosis, 95 (92 confirmed and 3 suspected) continued treatment. The visit adherence rate was 91.1 ± 7.9%, with one patient (1%) lost to follow-up. Conclusion. High rates of treatment completion and visit adherence were achieved because of unique program characteristics. Thus, directly observed therapy is advocated as a means of ensuring treatment completion. Handle: RePEc:aph:ajpbhl:1996:86:8:1146-1149_0 Template-Type: ReDIF-Article 1.0 Title: Childhood sexual abuse and bulimic behavior in a nationally representative sample Journal: American Journal of Public Health Author-Name: Wonderlich, S.A. Author-Name: Wilsnack, R.W. Author-Name: Wilsnack, S.C. Author-Name: Harris, T.R. Year: 1996 Volume: 86 Issue: 8 Pages: 1082-1086 Abstract: Objectives. This study examines whether childhood sexual abuse is a significant risk factor for the development of bulimic behavior in women. Methods. Interviews were conducted among a representative national sample of 1099 US women regarding their sexual experiences during childhood as well as their lifetime prevalence of bulimic behavior. Logistic regression was used to calculate adjusted odds ratios to measure the contribution of childhood sexual abuse to the odds of several measures of bulimic behavior in the population, controlling for the respondent's age, ethnic group, and parents' educational level. Attributable risk analyses were conducted to estimate how much risk for bulimic behavior was due to childhood sexual abuse. Results. Victims of childhood sexual abuse were significantly more likely to display bulimic behavior, and a substantial fraction of cases of bulimic behavior could be attributed to such abuse. Conclusions. Childhood sexual abuse is a risk factor for bulimic behavior. Between one sixth and one third of the cases of significant bulimic disturbance could be attributed to childhood sexual abuse. Handle: RePEc:aph:ajpbhl:1996:86:8:1082-1086_5 Template-Type: ReDIF-Article 1.0 Title: Mass human exposure to rabies in New Hampshire: Exposures, treatment, and cost Journal: American Journal of Public Health Author-Name: Noah, D.L. Author-Name: Smith, M.G. Author-Name: Gotthardt, J.C. Author-Name: Krebs, J.W. Author-Name: Green, D. Author-Name: Childs, J.E. Year: 1996 Volume: 86 Issue: 8 Pages: 1149-1151 Abstract: Objectives. This study assessed the rabies exposure and treatment that at least 665 persons in Concord, NH, received as a result of one proven rabid pet-store kitten in October 1994. Methods. All treatment recipients were interviewed by person or phone. Results. The median age of the treatment recipients was 14 years; 58% were female. The must common exposures were low risk (e.g., picking up, petting, nuzzling, or being scratched by a potentially rabid kitten). Local reactions to vaccine or immune globulin were reported by 76.5% of recipients, while 48.8% reported at least one systemic reaction. Cost for the biologicals was estimated at more than $1.1 million. Conclusions. Because of the inadequacy of pet store records, the inconsistent application of treatment guidelines, and other factors, many people received postexposure treatment as a result of contacts that were unlikely to transmit rabies. The rates of local and systemic adverse reactions experienced were consistent with previous reports. Handle: RePEc:aph:ajpbhl:1996:86:8:1149-1151_4 Template-Type: ReDIF-Article 1.0 Title: Is genital mycosis associated with HIV risk behaviors among heterosexuals? Journal: American Journal of Public Health Author-Name: Warszawski, J. Author-Name: Meyer, L. Author-Name: Bajos, N. Year: 1996 Volume: 86 Issue: 8 Pages: 1108-1111 Abstract: Objectives. This study examined in both sexes whether genital mycosis is as strongly associated with human immunodeficiency virus (HIV) sexual risk behavior as are other sexually transmitted diseases. Methods. Heterosexuals in the French National Survey of Sexual Behavior who reported a history of either mycosis or another sexually transmitted disease in the previous 5 years were compared with heterosexuals who reported no such disease. Odds ratios were adjusted for age, education, place of residence, and number of sexual partners. Results. Among men, mycosis and other sexually transmitted diseases showed similar associations with age and number of sexual partners. Among women, mycosis was also associated with a high number of sexual partners, albeit to a lesser extent than other sexually transmitted diseases. Lifetime experience of heterosexual anal penetration was reported significantly more often by men with a history of mycosis. Conclusion. These results suggest that most male mycosis is sexually acquired and constitutes a self-reported indicator as good as other sexually transmitted diseases for high risk. Female mycosis may help define an intermediate HIV risk group. Handle: RePEc:aph:ajpbhl:1996:86:8:1108-1111_8 Template-Type: ReDIF-Article 1.0 Title: The legal strategies used in operating syringe exchange programs in the United States Journal: American Journal of Public Health Author-Name: Burris, S. Author-Name: Finucane, D. Author-Name: Gallagher, H. Author-Name: Grace, J. Year: 1996 Volume: 86 Issue: 8 Pages: 1161-1166 Abstract: Objectives. This study sought to identify the strategies used by syringe exchange programs to establish their legality. Methods. Statutes, court decisions, published studies of exchange programs, and news stories were reviewed, and telephone interviews were conducted with syringe exchange personnel. Results. Twenty-seven exchanges have been authorized by amendments to or judicial interpretations of state drug laws or by administrative action under such laws, or operate in a stale that has no laws regulating needles. At least 13 programs operate under claims of legality based on local interpretations of state law, principally public health law. The remaining syringe exchanges operate without a claim of legality. Conclusions. The deployment of syringe exchanges has been hindered by concerns about their legal status. This study shows that the applicability of drug laws to syringe exchange is open to dispute, and that local public health authorities may under some circumstances rely on their own legal authority to fund or operate syringe exchange programs. Handle: RePEc:aph:ajpbhl:1996:86:8:1161-1166_0 Template-Type: ReDIF-Article 1.0 Title: Gender differences in sexual practices and sexually transmitted infections among adults in Lima, Peru Journal: American Journal of Public Health Author-Name: Sánchez, J. Author-Name: Gotuzzo, E. Author-Name: Escamilla, J. Author-Name: Carrillo, C. Author-Name: Phillips, I.A. Author-Name: Barrios, C. Author-Name: Stamm, W.E. Author-Name: Ashley, R.L. Author-Name: Kreiss, J.K. Author-Name: Holmes, K.K. Year: 1996 Volume: 86 Issue: 8 Pages: 1098-1107 Abstract: Objectives. This study examined the prevalences of antibodies to Treponema pallidum, Chlamydia trachomatis, and herpes simplex virus type 2 in a sample of Peruvian adults. Methods. Among adults seeking health certification in Lima, Peru, 600 were randomly selected to undergo interviews and serologic testing. Results. Men's reported mean lifetime number of partners (10.6) far exceeded women's (1.1), yet antibody to sexually transmitted infection pathogens among sexually experienced participants was 2.8 times more prevalent among women than among men. Among men, female sex workers accounted for 37% of recent partners, and only sex with female sex workers while using condoms less than half of the time was independently associated with antibody (odds ratio = 3.6, 95% confidence interval = 1.5, 8.8). Among women, number of partners was associated with any sexually transmitted infection antibody, while intercourse before 18 years of age was associated with C. trachomatis antibody. At every level of perceived risk, sexually transmitted infection antibody was more frequent among women. Conclusions. Men having unprotected sex with female sex workers had the greatest risk of acquiring infections and (by inference) of transmitting them to women. Handle: RePEc:aph:ajpbhl:1996:86:8:1098-1107_6 Template-Type: ReDIF-Article 1.0 Title: Questioning the validity of self-reported heterosexual HIV transmission. Journal: American Journal of Public Health Author-Name: Brody, S. Year: 1996 Volume: 86 Issue: 8 Pages: 1172 Handle: RePEc:aph:ajpbhl:1996:86:8:1172_2 Template-Type: ReDIF-Article 1.0 Title: Meeting the public's need for information during the Arizona hantavirus outbreak. Journal: American Journal of Public Health Author-Name: Graham, G.J. Year: 1996 Volume: 86 Issue: 8 Pages: 1167-1168 Handle: RePEc:aph:ajpbhl:1996:86:8:1167-1168_3 Template-Type: ReDIF-Article 1.0 Title: Directly observed therapy for tuberculosis in rural South Africa, 1991 through 1994 Journal: American Journal of Public Health Author-Name: Wilkinson, D. Author-Name: Davies, G.R. Author-Name: Connolly, C. Year: 1996 Volume: 86 Issue: 8 Pages: 1094-1097 Abstract: Objectives. This paper describes an audit of a community-based tuberculosis treatment program involving directly observed therapy in South Africa. Methods. A program audit of 2473 consecutive tuberculosis patients in Hlabisa Health District, KwaZulu/Natal, South Africa, was conducted between 1991 and 1994. Results. Monthly admissions increased from 34 per month in 1991 to 66 in 1994. Of 2186 patients managed in Hlabisa, 1903 (87%) received directly observed therapy. Of those receiving directly observed therapy, 1034 (55%) were supervised by volunteers; 743 (72%) of these were supervised by storekeepers. Among those patients managed locally, 1679 (85%) of 1967 surviving patients completed treatment. Completion rates for patients supervised by health workers and non-health workers were the same. Completion fell from a high of 90% in 1992 to 78% in 1994. Mortality increased from 5% in 1991 to 10% in 1994. Conclusions. Community-based directly observed therapy that uses an intermittent drug regime and volunteers as supervisors can achieve high treatment completion rates for tuberculosis, even in resource-poor settings. Handle: RePEc:aph:ajpbhl:1996:86:8:1094-1097_7 Template-Type: ReDIF-Article 1.0 Title: A prospective study of syphilis and HIV infection among injection drug users receiving methadone in the Bronx, NY Journal: American Journal of Public Health Author-Name: Gourevitch, M.N. Author-Name: Hartel, D. Author-Name: Schoenbaum, E.E. Author-Name: Selwyn, P.A. Author-Name: Davenny, K. Author-Name: Friedland, G.H. Author-Name: Klein, R.S. Year: 1996 Volume: 86 Issue: 8 Pages: 1112-1115 Abstract: Objectives. The purpose of this study was to assess the relationship between syphilis and human immunodeficiency virus (HIV) infection in injection drug users. Methods. A 6-year prospective study of 790 injection drug users receiving methadone maintenance treatment in the Bronx, NY, was conducted. Results. Sixteen percent (4/25) of HIV-seroconverting patients, 4.8% (16/335) of prevalent HIV-seropositive patients, and 3.5% (15/430) of persistently HIV-seronegative patients were diagnosed with syphilis. Incidence rates for early syphilis (cases per 1000 person-years) were 15.9 for HIV-seroconverting patients, 8.9 for prevalent HIV-seropositive patients, and 2.9 for persistently HIV-seronegative patients. Early syphilis incidence was higher among women than men (8.4 vs 3.2 cases per 1000 person- years). Independent risks for early syphilis included multiple sex partners. HIV seroconversion, paid sex, and young age. All HIV seroconverters with syphilis were female. Conclusions. Diagnosis of syphilis in drug-using women reflects high-risk sexual activity and is associated with acquiring HIV infection. Interventions to reduce the risk of sexually acquired infections are urgently needed among female drug users. Handle: RePEc:aph:ajpbhl:1996:86:8:1112-1115_5 Template-Type: ReDIF-Article 1.0 Title: State tobacco lobbyists and organizations in the United States: Crossed lines Journal: American Journal of Public Health Author-Name: Goldstein, A.O. Author-Name: Bearman, N.S. Year: 1996 Volume: 86 Issue: 8 Pages: 1137-1142 Abstract: Objectives. This research took a quantitative look at state-level tobacco lobbying in the United States. Methods. Publicly available lobbying data were collected from all states during 1994. Data were compiled on tobacco industry lobbyists, their tobacco employers, health lobbyists, and factors associated with such lobbying. Results. In 1994, 450 tobacco industry lobbyists lobbied at a state level. Most lobbying was on behalf of four organizations: Philip Morris (34%), the Tobacco Institute (21%) RJ Reynolds (17%), and the Smokeless Tobacco Council (15%). Approximately one half of all tobacco lobbyists also lobbied for a health-related organization (e.g., state medical association, hospital, physician association). Conclusions. All US states have tobacco lobbyists. Many health organizations knowingly or unknowingly employ lobbyists who also lobby for the tobacco industry. Handle: RePEc:aph:ajpbhl:1996:86:8:1137-1142_8 Template-Type: ReDIF-Article 1.0 Title: Mortality after the death of a spouse: Rates and causes of death in a large Finnish cohort Journal: American Journal of Public Health Author-Name: Martikainen, P. Author-Name: Valkonen, T. Year: 1996 Volume: 86 Issue: 8 Pages: 1087-1093 Abstract: Objectives. This study examines excess mortality among Finnish persons after the death of a spouse, by sex, the subjects cause of death, duration of bereavement, and age. Methods. The subjects were 1 580 000 married Finnish persons aged 35 through 84 years who were followed up from 1986 through 1991. Results. Excess mortality among the bereaved was high from accidental, violent, and alcohol-related causes (50% to 150%), moderate for chronic ischemic heart disease and lung cancer (20% to 35%), and small for other causes (5% to 15%). Excess mortality was greater at short (<6 months) rather than long durations of bereavement and among younger rather than older bereaved persons for most causes of death; it was also greater among men than women. Conclusions. The results are consistent with the hypothesis that excess mortality after the death of a spouse is partly caused by stress. The loss of social support or the inability to cope with stress may explain why men suffer from bereavement more than do women. Handle: RePEc:aph:ajpbhl:1996:86:8:1087-1093_8 Template-Type: ReDIF-Article 1.0 Title: HIV risk behaviors among women living in low-income, inner-city housing developments Journal: American Journal of Public Health Author-Name: Sikkema, K.J. Author-Name: Heckman, T.G. Author-Name: Kelly, J.A. Author-Name: Anderson, E.S. Author-Name: Winett, R.A. Author-Name: Solomon, L.J. Author-Name: Wagstaff, D.A. Author-Name: Roffman, R.A. Author-Name: Perry, M.J. Author-Name: Cargill, V. Author-Name: Crumble, D.A. Author-Name: Fuqua, R.W. Author-Name: Norman, A.D. Author-Name: Mercer, M.B. Year: 1996 Volume: 86 Issue: 8 Pages: 1123-1128 Abstract: Objectives. This study describes the prevalence and predictors of human immunodeficiency virus (HIV) risk behaviors among women living in low- income, inner-city housing developments. Methods. Anonymous questionnaires were administered to 671 women living in 10 inner-city, low-income housing developments in five US cities to determine their levels of HIV risk behavior and predictors of HIV risk practices. Results. Approximately one third of women were at high risk for HIV because of the risk behavior of their sexual partners. HIV risk was highest among women who accurately perceived themselves to be at increased HIV risk, held strong beliefs about barriers to condom use, and reported weak behavioral intentions to reduce risk. Women at higher risk were also younger and reported higher rates of alcohol and substance use. Conclusions. HIV prevention efforts are needed for inner-city women. Interventions should focus on overcoming women's barriers to condom use, strengthening their intentions to change behaviors, and managing the risk related to their use of substances. Handle: RePEc:aph:ajpbhl:1996:86:8:1123-1128_7 Template-Type: ReDIF-Article 1.0 Title: HIV infection and AIDS in China, 1985 through 1994 Journal: American Journal of Public Health Author-Name: Yu, E.S.H. Author-Name: Xie, Q. Author-Name: Zhang, K. Author-Name: Lu, P. Author-Name: Chan, L.L. Year: 1996 Volume: 86 Issue: 8 Pages: 1116-1122 Abstract: Objectives. This paper analyzes data on the distribution of and risk factors for the acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) infection in China. Methods. Ten years of data on persons tested for HIV infection and AIDS and the proportion who tested positive were analyzed against the background of China's population count. The Chinese- and English-language literature on HIV and AIDS from 1985 through 1995 was also reviewed. Results. Overall, more males than females had HIV infection. Intravenous drug use was the primary source of transmission, followed by heterosexual contacts. Only a small number of the persons tested were homosexual, but their proportion of HIV seropositivity ranked third to that of drug users; that of general hospital patients ranked fourth. Conclusions. HIV infection and AIDS in China began as a highly regionalized and largely rural problem in Yunnan Province. However, HIV infection and AIDS have become an emerging urban problem. HIV seropositivity is low among several groups thought to have an elevated risk. Handle: RePEc:aph:ajpbhl:1996:86:8:1116-1122_6 Template-Type: ReDIF-Article 1.0 Title: Death rates among patients hospitalized with community-acquired pneumonia: A reexamination with data from three states Journal: American Journal of Public Health Author-Name: Markowitz, J.S. Author-Name: Pashko, S. Author-Name: Gutterman, E.M. Author-Name: Linde-Zwirble, W.T. Author-Name: Newbold III, R. Year: 1996 Volume: 86 Issue: 8 Pages: 1152-1154 Abstract: Objectives. Death rates for community-acquired pneumonia based on relatively small-scale, published studies tend to exceed 15% to 20%. This study reexamined these estimates by using very large, population-based databases. Methods. Death rates from 1993 associated with community-acquired pneumonia were reexamined with hospital discharge data from all of Washington, Illinois, and Florida. Results. These death rates were substantially lower (7.0%, 8.1%, and 9.7%, respectively) than what appears in the literature. Significant risk factors for dying were being 65 years of age or older (odds ratio [OR] = 2.9), being positive for human immunodeficiency virus (OR = 2.9), and having a high severity of illness (OR = 7.1). Conclusion. Sampling bias ass elated with selection for hospital admissions explain the discrepancy between previous and this study's results. Handle: RePEc:aph:ajpbhl:1996:86:8:1152-1154_8 Template-Type: ReDIF-Article 1.0 Title: The Mpowerment project: A community-level HIV prevention intervention for young gay men Journal: American Journal of Public Health Author-Name: Kegeles, S.M. Author-Name: Hays, R.B. Author-Name: Coates, T.J. Year: 1996 Volume: 86 Issue: 8 Pages: 1129-1136 Abstract: Objectives. Since young gay men are engaging in alarmingly high rates of unsafe sex and few seek help for changing risky behaviors, community- level programs to prevent infection with the human immunodeficiency virus (HIV) among them are urgently needed. Methods. Wc developed and implemented a community-level HIV prevention program in a midsized Oregon community. The peer-led program had three components: outreach, small groups, and a publicity campaign. Independently from the prevention program, a cohort of young gay men (n = 300) was surveyed in this and in a similar comparison community pre- and postintervention. Results. Following intervention, the proportion of men engaging in any unprotected anal intercourse decreased from 41.0% to 30.0% (-27% from baseline), decreased from 20.2% to 11.1% (- 45% from baseline) with nonprimary partners, and decreased from 58.9% to 44.7% (-24% from baseline) with boyfriends. No significant changes occurred in the comparison community over the same period. Conclusions. This prevention approach effectively led to HIV risk reduction. To reach risk- taking young gay men, HIV prevention activities must be embedded in social activities and community life. Handle: RePEc:aph:ajpbhl:1996:86:8:1129-1136_4 Template-Type: ReDIF-Article 1.0 Title: A new route of transmission for Escherichia coli: Infection from dry fermented salami Journal: American Journal of Public Health Author-Name: Tilden Jr., J. Author-Name: Young, W. Author-Name: McNamara, A.-M. Author-Name: Custer, C. Author-Name: Boesel, B. Author-Name: Lambert-Fair, M.A. Author-Name: Majkowski, J. Author-Name: Vugia, D. Author-Name: Werner, S.B. Author-Name: Hollingsworth, J. Author-Name: Morris Jr., J.G. Year: 1996 Volume: 86 Issue: 8 Pages: 1142-1145 Abstract: Objectives. This study evaluated the production of dry fermented salami associated with an outbreak of Escherichia coli O157:H7 infection in Washington State and California. Methods. Facility inspections, review of plant monitoring data, food handler interviews, and microbiological testing of salami products were conducted. Results. Production methods complied with federal requirements and industry-developed good manufacturing practices. No evidence suggested that postprocessing contamination occurred. Calculations suggested that the infectious dose was smaller than 50 E. coli O157:H7 bacteria. Conclusions. Dry fermented salami can serve as a vehicle of transmission for O157:H7 strains. Our investigation and prior laboratory studies suggest that E. coli O157:H7 can survive currently accepted processing methods. Handle: RePEc:aph:ajpbhl:1996:86:8:1142-1145_1 Template-Type: ReDIF-Article 1.0 Title: Prematurity as a public health problem: US policy from the 1920s to the 1960s Journal: American Journal of Public Health Author-Name: Oppenheimer, G.M. Year: 1996 Volume: 86 Issue: 6 Pages: 870-878 Abstract: During the 1920s and 1930s, a number of physicians created model premature infant stations in select hospitals, arguing that medicine could successfully treat premature infants, most of whom could be expected to live normal lives. Most hospitals and doctors, however, remained indifferent to the special medical needs of premature infants. Subsequently, public health officials, beginning in Chicago, took up the cause of the medical management of newborn premature infants, defining the problem and finding the resources for a community-wide solution. The latter included multiple, high-quality premature nurseries, infant transport, regionalization, and public financing. The 'Chicago model' was adapted by many state and municipal departments of health, particularly after World War II, to create community-based programs, the largest of which was in New York City. As premature infant care became of greater interest to pediatricians and hospitals, in part because of the success achieved by public health officials, the earlier, prominent role of the latter was increasingly diminished and historically forgotten. Handle: RePEc:aph:ajpbhl:1996:86:6:870-878_0 Template-Type: ReDIF-Article 1.0 Title: Vaginal douching and reduced fertility Journal: American Journal of Public Health Author-Name: Baird, D.D. Author-Name: Weinberg, C.R. Author-Name: Voigt, L.F. Author-Name: Dating, J.R. Year: 1996 Volume: 86 Issue: 6 Pages: 844-850 Abstract: Objectives. This study investigated douching and reduced fertility. Methods. The monthly probability of conception for douchers and nondouchers was compared in a sample of 840 married, parous women in King County, Washington. Data on the number of months required to conceive were analyzed. Results. In comparison with nondouchers, women who douched were 30% less likely to become pregnant each month they attempted pregnancy. This relationship remained after adjustment for covariates, and it could not be explained by women douching for medical reasons. The reduction was not related to the type of douching preparation used. Young women who douched had significantly greater reductions in monthly fertility than older women (50% reduction for women 18 to 24 years old, 29% reduction for women 25 to 29 years old, and 6% reduction for women 30 to 39 years old). Conclusions. Douching was associated with reduced fertility. Further research is needed to determine whether the relationship is causal and, if so, to what extent it is mediated by pelvic infection. In the meantime, women should be informed that douching may have adverse effects. Handle: RePEc:aph:ajpbhl:1996:86:6:844-850_0 Template-Type: ReDIF-Article 1.0 Title: Mammography use among sociodemographically diverse women: The accuracy of self-report Journal: American Journal of Public Health Author-Name: Zapka, J.G. Author-Name: Bigelow, C. Author-Name: Hurley, T. Author-Name: Ford, L.D. Author-Name: Egelhofer, J. Author-Name: Cloud, W.M. Author-Name: Sachsse, E. Year: 1996 Volume: 86 Issue: 7 Pages: 1016-1021 Abstract: Objective. This study sought to determine the accuracy of self-report of mammography experience among 392 ethnically diverse women aged 50 to 74. Methods. Subjects were randomized to the telephone or mail condition and surveyed. Results. Thirty-one percent of women reported accurately the exact month and year of their most recent mammogram; 54% reported accurately within ±3 months, and 83% reported accurately within the year. Greater accuracy was associated with exam recency. White race, and nonHispanic ethnicity, but not with age, education, or income. Most women could correctly report the reason for, the findings of, and the payor of their mammograms but knew little about how much they or their insurance paid. Conclusions. For population surveillance of mammography in the past year, self-report data are generally valid. However, clinical studies requiring more precise dates must use such data with caution. The telephone method, as compared with mail, appears to be a better option for some variables. Handle: RePEc:aph:ajpbhl:1996:86:7:1016-1021_0 Template-Type: ReDIF-Article 1.0 Title: High-density-lipoprotein cholesterol and types of alcoholic beverages consumed among men and women Journal: American Journal of Public Health Author-Name: Parker, D.R. Author-Name: McPhillips, J.B. Author-Name: Derby, C.A. Author-Name: Gans, K.M. Author-Name: Lasater, T.M. Author-Name: Carleton, R.A. Year: 1996 Volume: 86 Issue: 7 Pages: 1022-1027 Abstract: Objectives. Differences by sex in the relationship between high-density- lipoprotein (HDL) cholesterol and consumption of alcoholic beverages were examined in 1516 individuals. Methods. Questionnaires and blood-sample data from cross-sectional surveys were analyzed. Results. Both beer and liquor were independently associated with increased HDL cholesterol in the total group, in men, and in women after covariates were controlled for. Wine was associated with a significant increase in HDL cholesterol in women only. Conclusions. Among women and men, amount may be more important than type of alcoholic beverage consumed. The independent effect of wine on HDL cholesterol among men remains unclear since few men in this population consumed wine exclusively or in large quantities. Handle: RePEc:aph:ajpbhl:1996:86:7:1022-1027_5 Template-Type: ReDIF-Article 1.0 Title: A prison release program for HIV-positive women: Linking them to health services and community follow-up [1] Journal: American Journal of Public Health Author-Name: Flanigan, T.P. Author-Name: Kim, J.Y. Author-Name: Zierler, S. Author-Name: Rich, J. Author-Name: Vigilante, K. Author-Name: Bury-Maynard, D. Year: 1996 Volume: 86 Issue: 6 Pages: 886-887 Handle: RePEc:aph:ajpbhl:1996:86:6:886-887_3 Template-Type: ReDIF-Article 1.0 Title: What proportion of multiple births are due to ovulation induction? A register-based study in Italy Journal: American Journal of Public Health Author-Name: Corchia, C. Author-Name: Mastroiacovo, P. Author-Name: Lanni, R. Author-Name: Mannazzu, R. Author-Name: Currò, V. Author-Name: Fabris, C. Year: 1996 Volume: 86 Issue: 6 Pages: 851-854 Abstract: Objectives. This study evaluated the increase in risk of multiple births associated with ovulation induction and calculated the proportion of multiple births attributable to this treatment. Methods. Cases were 350 multiple births and controls were 737 single births enrolled from April 1993 to March 1994 in the Mercurio Project, an investigation of reproductive outcomes in Italy. Results. Ovulation induction was used in 45 case births (12.9%) and 24 control births (3.3%); the adjusted odds ratio was 4.1 (95% confidence interval [CI] = 2.4, 6.9). The odds ratio for triplet or higher order births was 72.2 (95% CI = 25.7, 202.8). When unlike-sexed multiple births were considered, the odds ratio increased for twin births, but not for triplet or higher births. The highest odds ratios were found when ovulation induction was used with assisted reproduction. The proportion of multiple births attributable to ovulation induction was 9.7% overall, 5.4% for twin births, and 69.8% for triplet or higher births. Conclusions. Ovulation induction increases the risk of multiple births and has been responsible for the rise in the rate of triplet or higher order births in Italy in the last decade. Its indiscriminate and improper use should be avoided. Handle: RePEc:aph:ajpbhl:1996:86:6:851-854_7 Template-Type: ReDIF-Article 1.0 Title: The risk of prematurity and small-for-gestational-age birth in Mexico City: The effects of working conditions and antenatal leave Journal: American Journal of Public Health Author-Name: Cerón-Mireles, P. Author-Name: Harlow, S.D. Author-Name: Sánchez-Carrillo, C.I. Year: 1996 Volume: 86 Issue: 6 Pages: 825-831 Abstract: Objectives. This study examined the effect of working conditions, occupational stress, and antenatal leave on risk of small-for-gestational- age and premature births in Mexico City. Methods. Over a 3-month period, 2663 (96.2%) of 2767 women who gave birth at three major hospitals and worked at least 3 months during pregnancy were interviewed shortly after delivery. After the exclusion of multiple gestations and birth defects, 261 (10.0%) small-for-gestational-age and 288 (11.0%) preterm births were identified. Results. For small-for-gestational-age births, working more than 50 hours a week (odds ratio [OR] = 1.59), standing more than 7 hours a day (OR = 1.40), and no antenatal leave (OR = 1.55) were associated with an increased risk. Women with no antenatal leave were also much more likely to give birth prematurely (OR = 3.04). Conclusions. In this study, arduous working conditions and lack of antenatal leave benefits were found to increase the risk of poor birth outcome in Mexican women. Enforcement of existing antennal leave laws and provision of comparable benefits for the uninsured may reduce the incidence of small-for-gestational-age births and prematurity. Handle: RePEc:aph:ajpbhl:1996:86:6:825-831_7 Template-Type: ReDIF-Article 1.0 Title: The association between cesarean delivery and breast-feeding outcomes among Mexican women Journal: American Journal of Public Health Author-Name: Pérez-Escamilla, R. Author-Name: Maulén-Radovan, I. Author-Name: Dewey, K.G. Year: 1996 Volume: 86 Issue: 6 Pages: 832-836 Abstract: Objectives. This study examined the impact of cesarean section delivery on the initiation and duration of breast-feeding in the 1987 Mexican Demographic and Health Survey. Methods. The subsample (n = 2517) was restricted to women whose delivery of their last-born children (aged 5 years and younger) was attended by a physician. Multivariate logistic regression was used to examine the association between cesarean section and the likelihood of either not initiating breast-feeding or doing so for less than 1 month. Among women who breast-fed for 1 month or more, multivariate survival analysis was used to examine the relationship between cesarean section and breast-feeding duration. Results. Cesarean section was a risk factor for not initiating breast-feeding (odds ratio [OR] = 0.64, 95% confidence interval [CI] = 0.50, 0.82) and for breast-feeding for less than 1 month (OR = 0.58, 95% CI = 0.37, 0.91) but was unrelated to breast-feeding duration among women who breast- fed for 1 month or more (OR = 0.97, 95% CI = 0.86, 1.11). Conclusions. It is desirable to provide additional breast-feeding support during the early postpartum period to women who deliver via cesarean sections. Handle: RePEc:aph:ajpbhl:1996:86:6:832-836_9 Template-Type: ReDIF-Article 1.0 Title: Prenatal hospitalization and compliance with guidelines for prenatal care Journal: American Journal of Public Health Author-Name: Haas, J.S. Author-Name: Berman, S. Author-Name: Goldberg, A.B. Author-Name: Lee, L.W.K. Author-Name: Cook, E.F. Year: 1996 Volume: 86 Issue: 6 Pages: 815-819 Abstract: Objectives. This study examined the relationship between compliance with the US Public Health Service guidelines for prenatal care and the rate of prenatal hospitalization. Methods. For all women admitted to a Boston referral center during January and February 1993 with a pregnancy of at least 18 weeks gestation (n = 1400), a proportional hazards model was used to examine factors associated with prenatal hospitalization. Results. Prenatal hospitalization occurred during 248 (17.7%) pregnancies. The median length of stay for all prenatal admissions was 4 days; the median total charge was $5667. Prior medical and obstetrical problems were strongly associated with prenatal hospitalization. After adjustment for age, race, and medical and obstetrical complications, women who received less than 70% of the prenatal care recommended were significantly more likely to be hospitalized [relative risk [RR] = 2.14, 95% confidence interval [CI] = 1.50, 3.06). Conclusions. Prenatal hospitalization is a common, costly complication of pregnancy. Because of its association with compliance with the Public Health Service guidelines for the content of prenatal care, prenatal hospitalization may be a sentinel indicator of inadequate prenatal care amenable to intervention. Handle: RePEc:aph:ajpbhl:1996:86:6:815-819_0 Template-Type: ReDIF-Article 1.0 Title: Aiding troubled employees: The prevalence, cost, and characteristics of employee assistance programs in the United States Journal: American Journal of Public Health Author-Name: Hartwell, T.D. Author-Name: Steele, P. Author-Name: French, M.T. Author-Name: Potter, F.J. Author-Name: Rodman, N.F. Author-Name: Zarkin, G.A. Year: 1996 Volume: 86 Issue: 6 Pages: 804-808 Abstract: Objectives. Employee assistance programs (EAPs) are job-based programs designed to identify and assist troubled employees. This study determines the prevalence, cost, and characteristics of these programs in the United States by worksite size, industry, and census region. Methods. A stratified national probability sample of more than 6400 private, nonagricultural US worksites with 50 or more full-time employees was contacted with a computer-assisted telephone interviewing protocol. More than 3200 worksites responded and were eligible, with a response rate of 90%. Results. Approximately 33% of all private, nonagricultural worksites with 50 or more full-time employees currently offer EAP services to their employees, an 8.9% increase over 1985. These programs are more likely to be found in larger worksites and in the communications/utilities/transportation industries. The most popular model is an external provider, and the median annual cost per eligible employee for internal and external programs was $21.83 and $18.09, respectively. Conclusions. EAPs are becoming a more prevalent point of access to health care for workers with personal problems such as substance abuse, family problems, or emotional distress. Handle: RePEc:aph:ajpbhl:1996:86:6:804-808_0 Template-Type: ReDIF-Article 1.0 Title: DDE and insufficient breast milk [2] Journal: American Journal of Public Health Author-Name: Lutter, C. Author-Name: Perez-Escamilla, R. Author-Name: Gladen, B.C. Author-Name: Rogan, W.J. Year: 1996 Volume: 86 Issue: 6 Pages: 887-888 Handle: RePEc:aph:ajpbhl:1996:86:6:887-888_3 Template-Type: ReDIF-Article 1.0 Title: Preventing diabetic foot disease: Lessons from the medicare therapeutic shoe demonstration Journal: American Journal of Public Health Author-Name: Wooldridge, J. Author-Name: Bergeron, J. Author-Name: Thornton, C. Year: 1996 Volume: 86 Issue: 7 Pages: 935-938 Abstract: Objectives. Every year about 38 000 elderly people with diabetes have a lower extremity amputation. Therapeutic shoes are prescribed by clinicians specializing in foot care to prevent foot ulcerations and amputations among at-risk patients with diabetes. Medicare ran a 3-year demonstration of a therapeutic-shoe benefit for beneficiaries with diabetes. Medicare added the benefit nationwide in May 1993. Methods. This paper describes the benefit and its implementation in the demonstration based on demonstration records, a patient survey, and discussions with clinicians and shoe suppliers before and during the demonstration. Results. During the demonstration, far fewer beneficiaries applied for the therapeutic shoes than were eligible for them. The paper discusses reasons for the low beneficiary application rate and the associated low participation rate among physicians treating patients with diabetes. Conclusions. The benefit is unlikely to be used any more in the national program than in the demonstration unless physicians are educated in the role therapeutic shoes can play in diabetic foot disease, they prescribe the shoes for their patients, and they increase their patients' awareness of the shoes' value. Handle: RePEc:aph:ajpbhl:1996:86:7:935-938_5 Template-Type: ReDIF-Article 1.0 Title: Pregnancy outcomes of US-born and foreign-born Japanese Americans Journal: American Journal of Public Health Author-Name: Alexander, G.R. Author-Name: Mor, J.M. Author-Name: Kogan, M.D. Author-Name: Leland, N.L. Author-Name: Kieffer, E. Year: 1996 Volume: 86 Issue: 6 Pages: 820-824 Abstract: Objectives. This study investigated the birth outcomes of Japanese Americans, focusing on the role of the mother's place of birth. Methods. Single live births to US-resident Japanese American mothers (n = 37 941) were selected from the 1983 through 1987 US linked live birth-infant death files. Results. US-born mothers were more likely than foreign-born mothers to be less than 18 years old and not married, to start prenatal care early, and to more adequately use prenatal care. Infants of foreign-born Japanese Americans had a slightly lower risk of low birthweight. No significant differences were found between nativity groups for very low birthweight or neonatal, postneonatal, and infant mortality. The mortality rates of infants of US- born (6.2) and foreign-born (5.4) Japanese American women were below the US Year 2000 objective but still exceeded Japan's 1990 rate (4.6). However, low- birthweight percentages of the US-born group (5.7%) and the foreign-born group (5.0%) were similar to that of Japan (5.5%). Conclusions. The infants of foreign-born Japanese-American women exhibited modestly better low- birthweight percentages than those of US-born Japanese Americans. This finding supports theories of the healthy immigrant. Handle: RePEc:aph:ajpbhl:1996:86:6:820-824_3 Template-Type: ReDIF-Article 1.0 Title: Liability for managed care decisions: The Employee Retirement Income Security Act (ERISA) and the uneven playing field Journal: American Journal of Public Health Author-Name: Mariner, W.K. Year: 1996 Volume: 86 Issue: 6 Pages: 863-869 Abstract: As managed care organizations expand their programs of quality assurance and physician evaluation, more medical malpractice lawsuits may be brought against managed care organizations on the ground that, like hospitals, they are legally responsible for negligent corporate acts that injure patients. However, the federal Employee Retirement Income Security Act (ERISA) shields managed care organizations from liability when they are part of an employee group health plan governed by ERISA. Unlike patients with other types of insurance, patients in ERISA health plans do not have a malpractice remedy for a managed care organization's negligence. A few federal appeals churls recently recognized that ERISA plans can be vicariously liable for their physicians' medical malpractice, but only if the physician is the plan's employee or agent. Yet ERISA still prohibits negligence claims against ERISA health plans for injuries resulting from denial of plan benefits, failure to use qualified physicians, utilization review, or improper plan administration. Current managed care operations do not neatly distinguish between administering benefits and controlling quality of care. Neither should the law. ERISA should be amended to provide employees with the same remedies that patients in non-ERISA plans enjoy. Handle: RePEc:aph:ajpbhl:1996:86:6:863-869_1 Template-Type: ReDIF-Article 1.0 Title: Hospitalizations for injury in New Zealand: Prior injury as a risk factor for assaultive injury Journal: American Journal of Public Health Author-Name: Dowd, M.D. Author-Name: Langley, J. Author-Name: Koepsell, T. Author-Name: Soderberg, R. Author-Name: Rivara, F.P. Year: 1996 Volume: 86 Issue: 7 Pages: 929-934 Abstract: Objectives. This study sought to determine the degree to which injury hospitalization, especially for assaultive injury, is a risk for subsequent hospitalization due to assault. Methods. A New Zealand hospitalization database was used to perform a retrospective cohort study. Exposure was defined as an injury hospitalization, stratified into assaultive and nonassaultive mechanisms. Hospitalizations for an assault during a 12-month follow-up period were measured. Results. Individuals with a prior nonassaultive injury were 3.2 times more likely to be admitted for an assault than those with no injury admission (95% confidence interval [CI] = 2.7, 3.9). The relative risk associated with a prior assault was 39.5 (95% CI = 35.8, 43.5), and the subsequent admission rate did not vary significantly by sex, race, or marital or employment status. Among those readmitted for an assault, 70% were readmitted within 30 days of the initial hospitalization. Conclusions: Prior injury is a risk for serious assault, and the risk is even greater if the injury is due to assault. Risk of readmission for assault is largely independent of demographic factors and greatest within 30 days of the initial assault. Handle: RePEc:aph:ajpbhl:1996:86:7:929-934_8 Template-Type: ReDIF-Article 1.0 Title: Risk factors for self-reported uterine fibroids: A case-control study Journal: American Journal of Public Health Author-Name: Samadi, A.R. Author-Name: Lee, N.C. Author-Name: Dana Flanders, W. Author-Name: Boring III, J.R. Author-Name: Parris, E.B. Year: 1996 Volume: 86 Issue: 6 Pages: 858-862 Abstract: To identify risk factors for uterine fibroids, a case-control design was used to analyze data from control subjects enrolled in the Cancer and Steroid Hormone Study. Case patients were 201 women who reported a history of uterine fibroids, and control subjects were 1503 women without fibroids, individually matched by age to case patients. Reporting of fibroids was more frequent among premenopausal women, women who had frequent Papanicolaou (Pap) smears, women who used oral contraceptives and had infrequent Pap smears, and women with higher education. Reporting of fibroids was less frequent among women with a lower body mass index who were current or long-time smokers. Handle: RePEc:aph:ajpbhl:1996:86:6:858-862_0 Template-Type: ReDIF-Article 1.0 Title: Persons with dual diagnoses of substance abuse and major mental illness: Their excess costs of psychiatric care Journal: American Journal of Public Health Author-Name: Dickey, B. Author-Name: Azeni, H. Year: 1996 Volume: 86 Issue: 7 Pages: 973-977 Abstract: Objectives. This study examined the costs of psychiatric treatment for seriously mentally ill people with comorbid substance abuse as compared with mentally ill people not abusing substances. Methods. Three different sources of data were used to construct client-level files to compare the patterns of care and expenditures of 16395 psychiatrically disabled Medicaid beneficiaries with and without substance abuse: Massachusetts Medicaid paid claims; Department of Mental Health state hospital inpatient record files; and community support service client tracking files. Results. Psychiatrically disabled substance abusers had psychiatric treatment costs that were almost 60% higher than those of nonabusers. Most of the cost difference was the result of more acute psychiatric inpatient treatment. Conclusions. Although the public health and financial costs of high rates of comorbidity are obvious, the solutions to these problems are not. Numerous bureaucratic and social obstacles must be overcome before programs for those with dual diagnoses can be tested for clinical effectiveness. Handle: RePEc:aph:ajpbhl:1996:86:7:973-977_0 Template-Type: ReDIF-Article 1.0 Title: A cross-national trial of brief interventions with heavy drinkers Journal: American Journal of Public Health Author-Name: Babor, T.F. Year: 1996 Volume: 86 Issue: 7 Pages: 948-955 Abstract: Objectives. The relative effects of simple advice and brief counseling were evaluated with heavy drinkers identified in primary care and other health settings in eight countries. Methods. Subjects (1260 men, 299 women) with no prior history of alcohol dependence were selected if they consumed alcohol with sufficient frequency or intensity to be considered at risk of alcohol-related problems. Subjects were randomly assigned to a control group, a simple advice group, or a group receiving brief counseling. Seventy-five percent of subjects were evaluated 9 months later. Results. Male patients exposed to the interventions reported approximately 17% lower average daily alcohol consumption than those in the control group. Reductions in the intensity of drinking were approximately 10%. For women, significant reductions were observed in both the control and the intervention groups. Five minutes of simple advice were as effective as 20 minutes of brief counseling. Conclusions. Brief interventions are consistently robust across health care settings and sociocultural groups and can make a significant contribution to the secondary prevention of alcohol-related problems if they are widely used in primary care. Handle: RePEc:aph:ajpbhl:1996:86:7:948-955_4 Template-Type: ReDIF-Article 1.0 Title: The CDC's proposed revision of polio immunization policy: Is it wise? [3] Journal: American Journal of Public Health Author-Name: Judelsohn, R. Year: 1996 Volume: 86 Issue: 6 Pages: 890 Handle: RePEc:aph:ajpbhl:1996:86:6:890_0 Template-Type: ReDIF-Article 1.0 Title: Can physical activity minimize weight gain in women after smoking cessation? Journal: American Journal of Public Health Author-Name: Kawachi, I. Author-Name: Troisi, R.J. Author-Name: Rotnitzky, A.G. Author-Name: Coakley, E.H. Author-Name: Colditz, G.A. Year: 1996 Volume: 86 Issue: 7 Pages: 999-1004 Abstract: Objectives. The purpose of this study was to examine prospectively whether exercise can modify weight gain after smoking cessation in women. Methods. Data were analyzed from a 2-year follow-up period (1986-1988) in the Nurses' Health Study, an ongoing cohort of 121 700 US women aged 40 to 75 in 1986. Results. The average weight gain over 2 years was 3.0 kg in the 1474 women who stopped smoking, and 0.6 kg among the 7832 women who continued smoking. Among women smoking 1 to 24 cigarettes per day, those who quit without changing their levels of exercise gained an average of 2.3 kg more (95% confidence interval [CI] = 1.9, 2.6) than women who continued smoking. Women who quit and increased exercise by between 8 to 16 MET-hours (the work metabolic rate divided by the resting metabolic rate) per week gained 1.8 kg (95% CI = 1.0, 2.5), and the excess weight gain was only 1.3 kg (95% CI = 0.7, 1.9) in women who increased exercise by more than 16 MET-hours per week. Conclusions. Smoking cessation is associated with a net excess weight gain of about 2.4 kg in middle-aged women. However, this weight gain is minimized if smoking cessation is accompanied by a moderate increase in the level of physical activity. Handle: RePEc:aph:ajpbhl:1996:86:7:999-1004_3 Template-Type: ReDIF-Article 1.0 Title: Decreasing premature Norplant removals among low-income recipients Journal: American Journal of Public Health Author-Name: Radecki, S. Author-Name: McEwen, E. Year: 1996 Volume: 86 Issue: 6 Pages: 881-882 Handle: RePEc:aph:ajpbhl:1996:86:6:881-882_3 Template-Type: ReDIF-Article 1.0 Title: The regionalization of perinatal care in Wales and Washington State Journal: American Journal of Public Health Author-Name: Rosenblatt, R.A. Author-Name: Macfarlane, A. Author-Name: Dawson, A.J. Author-Name: Cartlidge, P.H.T. Author-Name: Larson, E.H. Author-Name: Hart, L.G. Year: 1996 Volume: 86 Issue: 7 Pages: 1011-1015 Abstract: Objectives. The purpose of this study was to compare perinatal regionalization and neonatal mortality in Wales and Washington State. Methods. The 28 hospitals in Wales and the 80 hospitals in Washington State that offered maternity services and the 218 326 births that occurred in these hospitals in 1989 and 1990 were studied. Surveys were used to identify the neonatal technology and the referral policies of each hospital, and linked data from birth and death certificates were used to examine birthweight- specific neonatal mortality rates for all babies born in these hospitals. Results. Welsh district general hospitals (broadly equivalent to Level II perinatal centers in the United States) have more sophisticated neonatal technology than their Washington State counterparts and appear less likely to refer small or preterm babies to regional or subregional centers. Neonatal mortality rates were quite similar in the two settings. Conclusions. Perinatal care in Wales appears to be less regionalized than in a similar region in the United States. The relative lack of perinatal regionalization in Wales may contribute to duplication and underutilization of expensive neonatal technologies. National health care systems do not, in and of themselves, lead to optimal regionalization of services. Handle: RePEc:aph:ajpbhl:1996:86:7:1011-1015_6 Template-Type: ReDIF-Article 1.0 Title: Adverse pregnancy outcomes: Differences between US- and foreign-born women in major US racial and ethnic groups Journal: American Journal of Public Health Author-Name: Singh, G.K. Author-Name: Stella, M.Yu. Year: 1996 Volume: 86 Issue: 6 Pages: 837-843 Abstract: Objectives. This study examined whether there were significant differentials between US-born and foreign-born women in risks of infant mortality, low birthweight, and preterm birth and whether these differentials, if they existed, varied across major US racial/ethnic groups. Methods. Multivariate logistic regression was applied to national linked birth/infant death records for 1985 through 1987 to estimate overall and ethnic-specific maternal nativity effects on pregnancy outcomes. Results. Substantial maternal nativity differences in risks of infant mortality and low birthweight were found, with the magnitude of the nativity effect varying significantly across racial/ethnic groups. Overall, foreign-born status was associated with 7% and 20% lower risks of low birthweight and infant mortality, respectively. However, the reduced risk of adverse pregnancy outcome associated with immigrant status tended to be substantially larger for Blacks, Cubans, Mexicans, and Chinese than for other ethnic groups. Conclusions. Maternal nativity status, along with ethnicity, may serve as an important axis of differentiation in birth outcome studies. Further research needs to be conducted to assess the effects of behavioral, cultural, and psychosocial factors in explaining the nativity differentials observed here. Handle: RePEc:aph:ajpbhl:1996:86:6:837-843_0 Template-Type: ReDIF-Article 1.0 Title: Recovery from alcohol problems with and without treatment: Prevalence in two population surveys Journal: American Journal of Public Health Author-Name: Sobell, L.C. Author-Name: Cunningham, J.A. Author-Name: Sobell, M.B. Year: 1996 Volume: 86 Issue: 7 Pages: 966-972 Abstract: Objectives. The purpose of this study was to determine the prevalence of recovery from alcohol problems with and without treatment, including whether such recoveries involved abstinence or moderate drinking. Methods. Data from two surveys of randomly selected adults in the general population were analyzed. Random-digit dialing was used to conduct telephone interviews with 11634 and 1034 respondents. Respondents 20 years of age or older were categorized on the basis of drinking status and history. Results. Both surveys found that most individuals (77.5% and 77.7%) who had recovered from an alcohol problem for 1 year or more did so without help or treatment. A sizable percentage (38% and 63%) also reported drinking moderately after resolving their problem. Conclusions. These two surveys are among the first to report prevalence rates for recovery from alcohol problems for treated and untreated individuals and for moderation and abstinence outcomes. Handle: RePEc:aph:ajpbhl:1996:86:7:966-972_8 Template-Type: ReDIF-Article 1.0 Title: Risk factors for hazardous substance releases that result in injuries and evacuations: Data from 9 states Journal: American Journal of Public Health Author-Name: Irene Hall, H. Author-Name: Haugh, G.S. Author-Name: Price-Green, P.A. Author-Name: Ramana Dhara, V. Author-Name: Kaye, W.E. Year: 1996 Volume: 86 Issue: 6 Pages: 855-857 Abstract: This study was undertaken to determine risk factors associated with hazardous substance releases (at fixed facilities or during transport) that have public health consequences. Data from nine states with surveillance systems for such releases and their consequences were analyzed. Risk factors were determined for releases resulting in (1) injuries or (2) evacuations. Both outcomes were more likely to occur as a result or facility releases (odds ratio [OR] = 1.89, 95% confidence interval [CI] = 1.44, 2.47, for injuries; OR = 3.29, 95% CI = 2.28, 4.74, for evacuations). Releases of ammonia, chlorine, and acids resulted in injuries and evacuations more frequently than releases of other substances. Handle: RePEc:aph:ajpbhl:1996:86:6:855-857_6 Template-Type: ReDIF-Article 1.0 Title: Are smokers with alcohol disorders less likely to quit? Journal: American Journal of Public Health Author-Name: Breslau, N. Author-Name: Peterson, E. Author-Name: Schultz, L. Author-Name: Andreski, P. Author-Name: Chilcoat, H. Year: 1996 Volume: 86 Issue: 7 Pages: 985-990 Abstract: Objectives. This study examined the likelihood of smoking cessation in smokers with a prior history of alcoholism. Methods. Data came from an epidemiologic study of 1007 young adults, randomly selected from those insured in a large health maintenance organization (HMO) in southeast Michigan. Cox proportional hazards models with time-dependent covariates were used to estimate the hazards ratios of quitting in smokers with current and past alcoholism, with smokers with no history of alcoholism as a reference. Sex, race, and education were controlled. Results. Smokers with active alcoholism in the preceding year were 60% less likely to quit than were smokers with no history of alcoholism. In contrast, smokers whose alcoholism had remitted were at least as likely to quit as smokers with no history of alcoholism. Compared with persistent alcoholism, remission of alcoholism was associated with more than a threefold increase in the likelihood of subsequent smoking cessation. Conclusions. The findings suggest that discontinuation of alcoholism might increase the potential for successful smoking cessation. Handle: RePEc:aph:ajpbhl:1996:86:7:985-990_3 Template-Type: ReDIF-Article 1.0 Title: Reducing alcohol-impaired driving in Massachusetts: The saving lives program Journal: American Journal of Public Health Author-Name: Hingson, R. Author-Name: McGovern, T. Author-Name: Howland, J. Author-Name: Heeren, T. Author-Name: Winter, M. Author-Name: Zakocs, R. Year: 1996 Volume: 86 Issue: 6 Pages: 791-797 Abstract: Objectives. The purpose of this study was to assess whether a community program begun in March 1988 that organized multiple city departments and private citizens could reduce alcohol-impaired driving, related driving risks, and traffic deaths and injuries. Methods. Trends in fatal crashes and injuries per 100 crashes were compared in Saving Lives Program cities and the rest of Massachusetts from March 1984 through February 1993. In annual roadside surveys conducted at randomly selected locations, safety belt use among occupants of 54 577 vehicles and travel speeds of 118 442 vehicles were observed. Four statewide telephone surveys (n = 15 188) monitored self- reported driving after drinking. Results. In program cities relative to the rest of Massachusetts during the 5 program years in comparison with the previous 5 years, fatal crashes declined 25%, from 178 to 120, and fatal crashes involving alcohol decreased 42%, from 69 to 36. Visible injuries per 100 crashes declined 5%, from 21.1 to 16.6. The proportions of vehicles observed speeding and teenagers who drove after drinking were cut in half. Conclusions. Interventions organized by multiple city departments and private citizens can reduce driving after drinking, related driving risks, and traffic deaths and injuries. Handle: RePEc:aph:ajpbhl:1996:86:6:791-797_3 Template-Type: ReDIF-Article 1.0 Title: Age-related changes in total and high-density-lipoprotein cholesterol in elderly Dutch men Journal: American Journal of Public Health Author-Name: Weijenberg, M.P. Author-Name: Feskens, E.J.M. Author-Name: Kromhout, D. Year: 1996 Volume: 86 Issue: 6 Pages: 798-803 Abstract: Objectives. This study investigated changes in total and high-density- lipoprotein cholesterol (HDL) concentrations with age and time in elderly men. Methods. A cohort of men born between 1900 and 1920 from the Dutch town of Zutphen was examined in 1977 and 1978 (n = 571), 1985 (n = 885), 1990 (n = 555), and 1993 (n = 345). Linear regression analysis and random-effects models were used to assess cross-sectional and longitudinal age- and time- related changes in cholesterol concentrations. Results. In both cross- sectional and longitudinal analyses, total cholesterol decreased by 0.04 mmol/L a year with age. The longitudinal change was observed in the entire population as well as in men who participated in all four examinations (n = 135) and in a subgroup of men who were free of common chronic diseases, were not on cholesterol-lowering medication or a prescribed diet, and rated themselves as being 'healthy' (n = 64). HDL cholesterol did not change significantly with age neither on a cross-sectional nor on a longitudinal basis. Conclusions. Among elderly men, total cholesterol diminishes with age both on a cross-sectional and on a longitudinal basis; HDL cholesterol does not vary with age in anyway. Handle: RePEc:aph:ajpbhl:1996:86:6:798-803_1 Template-Type: ReDIF-Article 1.0 Title: Alcohol consumption among the elderly in a general population, Erie County, New York Journal: American Journal of Public Health Author-Name: Mirand, A.L. Author-Name: Welte, J.W. Year: 1996 Volume: 86 Issue: 7 Pages: 978-984 Abstract: Objectives. Relatively few studies of drinking among the elderly have been completed despite the growing proportional representation of the elderly in the US population. This study sought to estimate the prevalence of and to observe whether active or health-oriented lifestyles are associated with heavy drinking among the elderly. Methods. Random-digit dialing telephone interviews were conducted with 2325 Erie County, New York, general population residents aged 60 years or older. Results. The prevalence of heavy drinking was 6%. Adjusted analyses showed positive associations between heavy drinking and being male, having suburban residency, and currently using cigarettes. Negative relationships were observed between heavy drinking and socioeconomic status, rural residency, and degree of health orientation. Age and level of active lifestyle were not significant contributors to the model. Conclusions. Of the studied variables, health orientation offers the greatest opportunity to address heavy drinking among the elderly. Handle: RePEc:aph:ajpbhl:1996:86:7:978-984_6 Template-Type: ReDIF-Article 1.0 Title: The cost of prematurity: A case-control study of twins vs singletons Journal: American Journal of Public Health Author-Name: Luke, B. Author-Name: Bigger, H.R. Author-Name: Leurgans, S. Author-Name: Sietsema, D. Year: 1996 Volume: 86 Issue: 6 Pages: 809-814 Abstract: Objectives. This study evaluated the extent to which morbidity and costs at birth were associated with plurality, gestational age, and birthweight with a sample of twins from a large urban hospital. Methods. Each twin infant was matched to two singleton infants (control [ctrl]-singletons) for payor status and race, and to one singleton infant (gestation [ga]-singleton) for payor status, race, and gestational age; after exclusion of infants who were transferred, the study population included 111 twins, 242 ctrl-singletons, and 106 ga-singletons. Data were stratified by five gestational categories and compared across study groups. Outcomes included birthweight, neonatal diagnoses, infant length of stay, infant costs per day, and total infant and total birth costs. Results. Total birth costs ranged from $280 146 at 25 to 27 weeks to $9803 at 39 to 42 weeks, decreasing with advancing gestation to means of $88 891 (twins), $43 041 (ga-singletons), and $9326 (ctrl- singletons). Twins did not differ from either group of singletons in prematurity-related diagnoses, length of stay, or costs until after 34 weeks' gestation. Conclusions. In this sample, prematurity, not plurality, was the predominant cost factor at birth. Compared with singletons, twins experienced increased morbidity and associated costs after 38 weeks' gestation. Handle: RePEc:aph:ajpbhl:1996:86:6:809-814_8 Template-Type: ReDIF-Article 1.0 Title: Project Northland: Outcomes of a communitywide alcohol use prevention program during early adolescence Journal: American Journal of Public Health Author-Name: Perry, C.L. Author-Name: Williams, C.L. Author-Name: Veblen-Mortenson, S. Author-Name: Toomey, T.L. Author-Name: Komro, K.A. Author-Name: Anstine, P.S. Author-Name: McGovern, P.G. Author-Name: Finnegan, J.R. Author-Name: Forster, J.L. Author-Name: Wagenaar, A.C. Author-Name: Wolfson, M. Year: 1996 Volume: 86 Issue: 7 Pages: 956-965 Abstract: Objectives. Project Northland is an efficacy trial with the goal of preventing or reducing alcohol use among young adolescents by using a multilevel, communitywide approach. Methods. Conducted in 24 school districts and adjacent communities in northeastern Minnesota since 1991, the intervention targets the class of 1998 (sixth-grade students in 1991) and has been implemented for 3 school years (1991 to 1994). The intervention consists of social-behavioral curricula in schools, peer leadership, parental involvement/education, and communitywide task force activities. Annual surveys of the class of 1998 measure alcohol use, tobacco use, and psychosocial factors. Results. At the end of 3 years, students in the intervention school districts report less onset and prevalence of alcohol use than students in the reference districts. The differences were particularly notable among those who were nonusers at baseline. Conclusions. The results of Project Northland suggest that multilevel, targeted prevention programs for young adolescents are effective in reducing alcohol use. Handle: RePEc:aph:ajpbhl:1996:86:7:956-965_2 Template-Type: ReDIF-Article 1.0 Title: Work site-based cancer prevention: Primary results from the working well trial Journal: American Journal of Public Health Author-Name: Sorensen, G. Author-Name: Thompson, B. Author-Name: Glanz, K. Author-Name: Feng, Z. Author-Name: Kinne, S. Author-Name: DiClemente, C. Author-Name: Emmons, K. Author-Name: Heimendinger, J. Author-Name: Probart, C. Author-Name: Lichtenstein, E. Year: 1996 Volume: 86 Issue: 7 Pages: 939-947 Abstract: Objectives. This paper presents the behavioral results of the Working Well Trial, the largest US work site cancer prevention and control trial to date. Methods. The Working Well Trial used a randomized, matched-pair evaluation design, with the work site as the unit of assignment and analysis. The study was conducted in 111 work sites (n = 28 000 workers). The effects of the intervention were evaluated by comparing changes in intervention and control work sites, as measured in cross-sectional surveys at baseline and follow-up. The 2-year intervention targeted both individuals and the work- site environment. Results. There occurred a net reduction in the percentage of energy obtained from fat consumption of 0.37 percentage points (P = .033), a net increase in fiber densities of 0.13 g/1000 kcal (P = .056), and an average increase in fruit and vegetable intake of 0.18 servings per day (P = .0001). Changes in tobacco use were in the desired direction but were not significant. Conclusions. Significant but small differences were observed for nutrition. Positive trends, but no significant results, were observed in trial-wide smoking outcomes. The observed net differences were small owing to the substantial secular changes in target behaviors. Handle: RePEc:aph:ajpbhl:1996:86:7:939-947_6 Template-Type: ReDIF-Article 1.0 Title: Socioeconomic status and weight control practices among 20- to 45-year- old women Journal: American Journal of Public Health Author-Name: Jeffery, R.W. Author-Name: French, S.A. Year: 1996 Volume: 86 Issue: 7 Pages: 1005-1010 Abstract: Objectives. This study examined the relationship between socioeconomic status (SES) and weight control practices in women. Methods. SES, defined by family income, was examined in an economically diverse sample of 998 women in relation to dieting practices by means of multivariate regression analyses controlling for age, ethnicity, smoking, and body mass index. Results. SES was positively associated with healthy, but not unhealthy, weight control practices; inversely related to energy and fat intake; and positively associated with weight concern and perceived social support for healthy eating and exercise. SES gradients were particularly striking at the low end of the income distribution (i.e., family income ≤ $10 000 per year). The SES gradient in body mass index persisted in analyses controlling for attitudes and behaviors. Conclusions. Economic deprivation may contribute to high rates of obesity among lower SES women. The reasons for this require further research. Handle: RePEc:aph:ajpbhl:1996:86:7:1005-1010_6 Template-Type: ReDIF-Article 1.0 Title: Nonconsensual participation in genetic studies. Journal: American Journal of Public Health Author-Name: Lippman, A. Year: 1996 Volume: 86 Issue: 7 Pages: 1030 Handle: RePEc:aph:ajpbhl:1996:86:7:1030_4 Template-Type: ReDIF-Article 1.0 Title: Violence and substance use among North Carolina pregnant women Journal: American Journal of Public Health Author-Name: Martin, S.L. Author-Name: English, K.T. Author-Name: Clark, K.A. Author-Name: Cilenti, D. Author-Name: Kupper, L.L. Year: 1996 Volume: 86 Issue: 7 Pages: 991-998 Abstract: Objectives. Prenatal patients were studied to examine the proportion of women who had been violence victims, women's patterns of substance use (cigarettes, alcohol, and illegal drugs) before and during pregnancy, and relationships between violence and substance use. Methods. More than 2000 prenatal patients in North Carolina were screened for violence and substance use. Relationships between violence and patterns of substance use before and during pregnancy were examined, as well as women's continuation of substance use during pregnancy as a function of violence and sociodemographic factors. Results. Twenty-six percent of the women had been violence victims during their lives. Before pregnancy, 62% of the women had used one or more substances; during pregnancy, 31% had used one or more substances. Both before and during pregnancy, violence victims were significantly more likely to use multiple substances than nonvictims. Continuation of substance use during pregnancy was significantly more likely among violence victims than nonvictims. Conclusions. Care providers should screen women for violence as well as for substance use and should ensure that women are provided with appropriate interventions. Handle: RePEc:aph:ajpbhl:1996:86:7:991-998_1 Template-Type: ReDIF-Article 1.0 Title: Directive counseling on long-acting contraception Journal: American Journal of Public Health Author-Name: Moskowitz, E. Author-Name: Jennings, B. Year: 1996 Volume: 86 Issue: 6 Pages: 787-790 Abstract: National rates of unintended births are a major public health concern. The availability of highly effective long-acting contraceptives has prompted some public officials to promote the coercive use of these methods to reduce such problems as intergenerational poverty and child abuse. Broad-brush public policies that require long-term contraceptive use are unethical. However, persuasion to use these methods can be appropriate. One place for exerting ethically justified influence is in family planning counseling. The dominant nondirective counseling model, which excludes the possibility of vigorous persuasion, is overly rigid. Family planning professionals should develop practice protocols that permit and guide the exercise of directive counseling to use long-acting contraception. Handle: RePEc:aph:ajpbhl:1996:86:6:787-790_6 Template-Type: ReDIF-Article 1.0 Title: De Madres a Madres: an access model for primary care. Journal: American Journal of Public Health Author-Name: McFarlane, J. Year: 1996 Volume: 86 Issue: 6 Pages: 879-880 Handle: RePEc:aph:ajpbhl:1996:86:6:879-880_5 Template-Type: ReDIF-Article 1.0 Title: Local research and legal advocacy for the medically indigent in Orange County, California. Journal: American Journal of Public Health Author-Name: Rimsha, N. Author-Name: Waitzkin, H. Author-Name: Peña, I. Author-Name: Meeker, J. Author-Name: Eastman, S. Author-Name: Wylie, S. Year: 1996 Volume: 86 Issue: 6 Pages: 883-885 Handle: RePEc:aph:ajpbhl:1996:86:6:883-885_1 Template-Type: ReDIF-Article 1.0 Title: Florida goes statewide with alcohol health warning signs. Journal: American Journal of Public Health Author-Name: Cleary, D. Year: 1996 Volume: 86 Issue: 6 Pages: 882-883 Handle: RePEc:aph:ajpbhl:1996:86:6:882-883_5 Template-Type: ReDIF-Article 1.0 Title: Improving access to prenatal care in Vermont. Journal: American Journal of Public Health Author-Name: Carney, J.K. Author-Name: Berry, P. Author-Name: Thompson, E.B. Author-Name: Brozicevic, M.M. Year: 1996 Volume: 86 Issue: 6 Pages: 880-881 Handle: RePEc:aph:ajpbhl:1996:86:6:880-881_3 Template-Type: ReDIF-Article 1.0 Title: The surveillance of birth defects: The usefulness of the revised US Standard Birth Certificate Journal: American Journal of Public Health Author-Name: Watkins, M.L. Author-Name: Edmonds, L. Author-Name: McClearn, A. Author-Name: Mullins, L. Author-Name: Mulinare, J. Author-Name: Khoury, M. Year: 1996 Volume: 86 Issue: 5 Pages: 731-734 Abstract: To assess the sensitivity and positive predictive value of birth defects reported on the 1989 revision of the US Standard Birth Certificate, a population of 76 862 Atlanta-area births during 1989 and 1990 was used as the basis for comparing 771 birth certificates that reported birth defects with 2428 live-born infant records in a birth defects registry that uses multiple sources of case ascertainment. Only 14% of birth defects in the registry records were reported on birth certificates. After the analysis was restricted to defects recognizable at birth, the sensitivity and positive predictive value of the birth certificates were 28% and 77%, respectively. Birth certificates underestimate birth defect rates and should be used cautiously for birth defect surveillance and epidemiological studies. Handle: RePEc:aph:ajpbhl:1996:86:5:731-734_8 Template-Type: ReDIF-Article 1.0 Title: Comment: Toward a coordinated system for the surveillance of environmental health hazards Journal: American Journal of Public Health Author-Name: Hertz-Picciotto, I. Year: 1996 Volume: 86 Issue: 5 Pages: 638-641 Abstract: The rapid increases in the numbers and quantities of chemicals released into the environment have been accompanied by a lack of adequate prerelease testing for adverse health outcomes. Environmental health surveillance is used both to track changes in exposures that are known to have adverse health effects and to identify previously unrecognized hazards. Surveillance data can directly aid in the design of interventions to reduce the level of hazardous agents in the environment or the opportunities for human contact with them. Components of an ideal environmental health surveillance system are discussed. For well-recognized hazards, databases related to exposure alone are adequate. However, for uncovering previously unrecognized associations, linkage between exposure and outcome databases that are collected or aggregated at the same geographic scale and for regions of relatively homogeneous exposures are needed. Handle: RePEc:aph:ajpbhl:1996:86:5:638-641_0 Template-Type: ReDIF-Article 1.0 Title: Choosing a future for epidemiology: II. From black box to Chinese boxes and eco-epidemiology Journal: American Journal of Public Health Author-Name: Susser, M. Author-Name: Susser, E. Year: 1996 Volume: 86 Issue: 5 Pages: 674-677 Abstract: Part I of this paper traced the evolution of modern epidemiology in terms of three eras, each with its dominant paradigm, culminating in the present era of chronic disease epidemiology with its paradigm, the black box. This paper sees the close of the present era and foresees a new era of eco- epidemiology in which the deployment of a different paradigm will be crucial. Here a paradigm is advocated for the emergent era. Encompassing many levels of organization-molecular and societal as well as individual-this paradigm, termed Chinese boxes, aims to integrate more than a single level in design, analysis, and interpretation. Such a paradigm could sustain and refine a public health-oriented epidemiology. But preventing a decline of creative epidemiology in this new era will require more than a cogent scientific paradigm. Attention will have to be paid to the social processes that foster a cohesive and humane discipline. Handle: RePEc:aph:ajpbhl:1996:86:5:674-677_7 Template-Type: ReDIF-Article 1.0 Title: Trends in US urban black infant mortality, by degree of residential segregation Journal: American Journal of Public Health Author-Name: Polednak, A.P. Year: 1996 Volume: 86 Issue: 5 Pages: 723-726 Abstract: Trends in Black infant mortality rates from 1982 through 1991 in large US metropolitan statistical areas were examined. In some least-segregated areas, the total Black infant mortality rate reached a low of 13 per 1000 live births in 1985; it increased sharply after 1985 in the West but not in the South. The explanation for these trends is unknown, but variation in regional trends in Black postneonatal infant mortality rates suggested that social and medical-care differences among Blacks should be examined. A high Black infant mortality rate for a group of most-segregated metropolitan statistical areas persisted and contributed to the rising Black-White ratio of rates. Handle: RePEc:aph:ajpbhl:1996:86:5:723-726_0 Template-Type: ReDIF-Article 1.0 Title: Choosing a future for epidemiology: I. Eras and paradigms Journal: American Journal of Public Health Author-Name: Susser, M. Author-Name: Susser, E. Year: 1996 Volume: 86 Issue: 5 Pages: 668-673 Abstract: To inform choices about the future of epidemiology, the present condition of epidemiology is examined, in terms of its evolution through three eras, each demarcated by its own paradigm: (1) the era of sanitary statistics with its paradigm, miasma; (2) the era of infectious disease epidemiology with its paradigm, the germ theory; and (3) the era of chronic disease epidemiology with its paradigm, the black box. The historical context in which these eras arose is briefly described. In each era, the public health was at the center of the concerns of the founders and early protagonists of the prevailing paradigm. Around this intellectual development we weave a further theme. We argue that in the present era, the public health has become less central a concern. At the same time, in epidemiology today the dominant black box paradigm is of declining utility and is likely soon to be superseded. Handle: RePEc:aph:ajpbhl:1996:86:5:668-673_9 Template-Type: ReDIF-Article 1.0 Title: Adjusting for multiple testing when reporting research results: The Bonferroni vs Holm methods Journal: American Journal of Public Health Author-Name: Aickin, M. Author-Name: Gensler, H. Year: 1996 Volume: 86 Issue: 5 Pages: 726-728 Abstract: Public health researchers are sometimes required to make adjustments for multiple testing in reporting their results, which reduces the apparent significance of effects and thus reduces statistical power. The Bonferroni procedure is the most widely recommended way of doing this, but another procedure, that of Holm, is uniformly better. Researchers may have neglected Holm's procedure because it has been framed in terms of hypothesis test rejection rather than in terms of P values. An adjustment to P values based on Holm's method is presented in order to promote the method's use in public health research. Handle: RePEc:aph:ajpbhl:1996:86:5:726-728_4 Template-Type: ReDIF-Article 1.0 Title: The expanded racial and ethnic codes in the Medicare data files: Their completeness of coverage and accuracy Journal: American Journal of Public Health Author-Name: Lauderdale, D.S. Author-Name: Goldberg, J. Year: 1996 Volume: 86 Issue: 5 Pages: 712-716 Abstract: Objectives. This paper evaluates the new race/ethnicity codes for Asian Americans, Hispanics, and Native Americans that have recently been added to the Medicare enrollment database. Methods. The race/ethnicity code revisions made by the Health Care Financing Administration are described and evaluated by (1) comparing the numbers of persons identified as Asian Americans, Hispanics, and Native Americans with corresponding population census projections and (2) determining whether Medicare enrollees born in Asian and Hispanic countries are assigned Asian and Hispanic codes. Results. Among persons 65 years of age and older, approximately 24% of Hispanics, 17% of Native Americans, and 56% of Asian Americans are identifiable by the new codes. From 18% to 29% of enrollees 65 years old or older born in Mexico, Puerto Rico, and Cuba are coded as Hispanic, and from 14% to 73% of enrollees born in nine Asian countries are classified as Asian American. Classification is not random but is related to timing of migration and to country of origin. Conclusions. Researchers should resist the temptation to base analyses on the revised Health Care Financing Administration race/ethnicity codes, since coverage is incomplete and biased. Handle: RePEc:aph:ajpbhl:1996:86:5:712-716_4 Template-Type: ReDIF-Article 1.0 Title: Clinical and prophylactic trials with assured new treatment for those at greater risk: I. A design proposal Journal: American Journal of Public Health Author-Name: Finkelstein, M.O. Author-Name: Levin, B. Author-Name: Robbins, H. Year: 1996 Volume: 86 Issue: 5 Pages: 691-695 Abstract: Objectives. The accepted sine qua non for estimating the difference in efficacy between a new and a standard treatment is a randomized controlled clinical trial. Yet in some situations it is either practically or ethically impossible to conduct such a trial. For example, patients who are desperately ill may decline to participate when they learn they may not receive the new treatment, especially when that treatment is readily available outside the experimental protocol. Likewise, in a prophylactic trial of a promising vaccine, recruitment of persons at greater risk may falter or fail. Our objective is to demonstrate that a rigorous comparison of treatments may still be attainable. Methods. The features of a controlled clinical or prophylactic trial are reviewed from the perspectives of Food and Drug Administration regulations, ethical considerations, and practical problems. Results. An explicit risk-based allocation method of design and analysis is proposed, one guaranteeing that all subjects at greater risk will receive the new treatment. Conclusions. Under certain conditions, a risk-based allocation trial can furnish consistent estimates of both standard and experimental treatment effects for those at greater risk while avoiding certain difficulties caused by randomized treatment allocation. Handle: RePEc:aph:ajpbhl:1996:86:5:691-695_0 Template-Type: ReDIF-Article 1.0 Title: Tracking community sentinel events: Breast cancer mortality and neighborhood risk for advanced-stage tumors in Denver Journal: American Journal of Public Health Author-Name: Andres, T.L. Author-Name: Baron, A.E. Author-Name: Wright, R.A. Author-Name: Marine, W.M. Year: 1996 Volume: 86 Issue: 5 Pages: 717-722 Abstract: Objectives. The incidence of related sentinel events-breast cancer mortality and neighborhood-specific morbidity for advanced stage at diagnosis-were calculated for women likely to use a community health center in Denver, Colo. Methods. For the center's service area, neighborhoods (n = 37) were defined by program use. Mortality rates and proportional hazards regression models were estimated for 4189 breast cancer cases recorded between 1979 and 1990. Neighborhood-specific standard morbidity ratios of advanced-stage tumors were based on age-specific rates applied to the entire community. Results. Service area residents were more likely to present with advanced tumors (odds ratio [OR] = 1.4; 95% [CI] = 1.2, 1.5). After adjustment, advanced-stage disease and socioeconomic-demographic status, but not race-ethnicity, contributed significantly to survival. Two neighborhoods (6.5% of the population at risk) with standard morbidity ratios of 2.1 (95% CI = 1.3, 3.4) and 1.7 (95% CI = 1.2, 2.5) accounted for 42% of the excess cases of advanced-stage tumors between 1986 and 1990. Conclusions. Neighborhood variation in advanced-stage cancer can serve as the basis for efforts to improve access to breast cancer screening. Handle: RePEc:aph:ajpbhl:1996:86:5:717-722_1 Template-Type: ReDIF-Article 1.0 Title: Tuberculosis surveillance in the United States: Case definitions used by state health departments Journal: American Journal of Public Health Author-Name: McCombs, S.B. Author-Name: Onorato, I.M. Author-Name: McCray, E. Author-Name: Castro, K.G. Year: 1996 Volume: 86 Issue: 5 Pages: 728-731 Abstract: Health departments in all 53 reporting areas in the United States were asked to submit the case definition they used for tuberculosis surveillance. Sixteen areas used the 1990 case definition; two areas sent 1977 guidelines; and 34 areas sent other definitions. Case reports sent to the Centers for Disease Control and Prevention (CDC) in 1992 were analyzed; 4% of cases did not meet the 1990 definition. Tuberculosis case reporting criteria are not uniformly applied in the United States. CDC, in collaboration with state and local health officials, is evaluating the current definition and will implement uniform national criteria for tuberculosis surveillance. Handle: RePEc:aph:ajpbhl:1996:86:5:728-731_9 Template-Type: ReDIF-Article 1.0 Title: Reporting vaccine-associated paralytic poliomyelitis: Concordance between the CDC and the National Vaccine Injury Compensation Program Journal: American Journal of Public Health Author-Name: Weibel, R.E. Author-Name: Benor, D.E. Year: 1996 Volume: 86 Issue: 5 Pages: 734-737 Abstract: This paper compares cases of paralytic poliomyelitis reported to the systems operated by the National Vaccine Injury Compensation Program and the Centers for Disease Control and Prevention (CDC) for reporting of adverse events associated with vaccination. Of the 118 cases of vaccine-associated paralytic poliomyelitis determined by either system, 18 were reported initially only to the compensation program, 50 only to the CDC, and 50 to both. The annual incidence of vaccine-associated paralytic poliomyelitis determined from data from both systems varied from 6 to 13 cases (mean = 9.1) a year, with an increase of 1.4 cases a year when initial reports only to the compensation program are included. Thus, the compensation program provides important supplemental incidence data. Handle: RePEc:aph:ajpbhl:1996:86:5:734-737_1 Template-Type: ReDIF-Article 1.0 Title: Surveillance in environmental public health: Issues, systems, and sources Journal: American Journal of Public Health Author-Name: Thacker, S.B. Author-Name: Stroup, D.F. Author-Name: Parrish, G. Author-Name: Anderson, H.A. Year: 1996 Volume: 86 Issue: 5 Pages: 633-638 Abstract: This article describes environmental public health surveillance and proposes a framework to enhance its practice in the United States. Special issues for surveillance in environmental public health are examined, and examples of existing systems useful for environmental public health practice are provided. Current and projected surveillance needs, as well as potential sources of data, are examined. The proposed framework for conducting environmental public health surveillance involves data from three points in the process by which an agent in the environment produces an adverse outcome in a host: hazards, exposures, and outcomes. Environmental health practitioners should build on efforts in other fields (e.g., infectious diseases and occupational health) to establish priorities in the surveillance of health conditions associated with exposure to environmental toxicants. For specific surveillance programs, existing data systems, as well as data gaps, should be identified. Coordinated surveillance systems can facilitate public health efforts to prevent and control disease, injury, and disability related to the interaction between people and their environment. Handle: RePEc:aph:ajpbhl:1996:86:5:633-638_1 Template-Type: ReDIF-Article 1.0 Title: The estimated prevalence and incidence of HIV in 96 large US metropolitan areas Journal: American Journal of Public Health Author-Name: Holmberg, S.D. Year: 1996 Volume: 86 Issue: 5 Pages: 642-654 Abstract: Objectives. This study sought to estimate the size and direction of the human immunodeficiency virus (HIV) epidemic in US metropolitan statistical areas (MSAs) with populations greater than 500 000. Methods. A 'components model' from review of more than 350 documents, several large datasets, and information from 220 public health personnel was used. Data review focused on injection drug users, men who have sex with men, and high-risk heterosexual men and women. Results. In the 96 MSAs, there are, broadly, an estimated 1.5 million injection drug users, 1.7 million gay and bisexual men, and 2.1 million at-risk heterosexuals, and, among them, an estimated 565 000 prevalent and 38 000 incident HIV infections. This implies about 700 000 prevalent and 41 000 new HIV infections yearly in the United States. Roughly half of all estimated new infections are occurring among injection drug users, most of them in northeastern cities, Miami, and San Juan. Gay and bisexual men still represent most prevalent HIV infections, although incidence-except in young and minority gay men-is much lower now than it was a decade ago. Relatively high prevalences of HIV in at-risk heterosexual persons in several cities indicate the potential for an increase in transmission among them. Conclusions. This review and synthesis outline the comparative epidemiology of HIV in major US cities and identify populations for interventions. Handle: RePEc:aph:ajpbhl:1996:86:5:642-654_9 Template-Type: ReDIF-Article 1.0 Title: Traditional epidemiology, modern epidemiology, and public health Journal: American Journal of Public Health Author-Name: Pearce, N. Year: 1996 Volume: 86 Issue: 5 Pages: 678-683 Abstract: There have been significant developments in epidemiologic methodology during the past century, including changes in basic concepts, methods of data analysis, and methods of exposure measurement. However, the rise of modem epidemiology has been a mixed blessing, and the new paradigm has major shortcomings, both in public health and in scientific terms. The changes in the paradigm have not been neutral but have rather helped change-and have reflected changes in-the way in which epidemiologists think about health and disease. The key issue has been the shift in the level of analysis from the population to the individual. Epidemiology has largely ceased to function as part of a multidisciplinary approach to understanding the causation of disease in populations and has become a set of generic methods for measuring associations of exposure and disease in individuals. This reductionist approach focuses on the individual, blames the victim, and produces interventions that can be harmful. We seem to be using more and more advanced technology to study more and more trivial issues, while the major causes of disease are ignored. Epidemiology must reintegrate itself into public health and must rediscover the population perspective. Handle: RePEc:aph:ajpbhl:1996:86:5:678-683_2 Template-Type: ReDIF-Article 1.0 Title: The risk of suicide among wounded Vietnam veterans Journal: American Journal of Public Health Author-Name: Bullman, T.A. Author-Name: Kang, M.K. Year: 1996 Volume: 86 Issue: 5 Pages: 662-667 Abstract: Objectives. This study was undertaken to determine whether an association exists between combat trauma and risk of postservice suicide among Vietnam veterans. Methods. Risk of suicide for 34 534 veterans who were wounded in Vietnam was evaluated for severity of wound and number of times wounded. Results. There was a trend of increasing risk of suicide with increased occurrence of combat trauma, the highest relative risk (1.82, 95% confidence interval [CI] = 1.12, 2.96) being observed for those veterans who were wounded more than once and hospitalized for a wound. In comparison with the US male general population, veterans hospitalized because of a combat wound or wounded more than once had a significantly increased risk of suicide (standardized mortality ratios [SMRs] of 1.22 [95% CI = 1.00, 1.46] and 1.58 [95% CI = 1.06, 2.26], respectively). Those wounded more than once and hospitalized had the highest increased risk of suicide (SMR = 1.73, 95% CI = 1.10, 2.60). Conclusions. This study suggests that, among wounded Vietnam veterans, there is an increased risk for suicide associated with increased occurrence of combat trauma. Handle: RePEc:aph:ajpbhl:1996:86:5:662-667_7 Template-Type: ReDIF-Article 1.0 Title: Viral infections in short-term injection drug users: The prevalence of the hepatitis C, hepatitis B, human immunodeficiency, and human T-lymphotropic viruses Journal: American Journal of Public Health Author-Name: Garfein, R.S. Author-Name: Vlahov, D. Author-Name: Galai, N. Author-Name: Doherty, M.C. Author-Name: Nelson, K.E. Year: 1996 Volume: 86 Issue: 5 Pages: 655-661 Abstract: Objectives. The purpose of this study was to estimate the prevalence and correlates of four blood-borne viral infections among illicit drug injectors with up to 6 years of injecting experience. Methods. We analyzed data from 716 volunteers recruited in 1988 and 1989. Test results for hepatitis C virus (HCV), hepatitis B virus (HBV), human immunodeficiency virus, type 1 (HIV), and human T-lymphotropic virus types I and II (HTLV) were examined across six sequential cohorts defined by duration of drug injection. Results. Overall, seroprevalence of HCV, HBV, HIV, and HTLV was 76.9%, 65.7%, 20.5% and 1.8%, respectively, and 64.7%, 49.8%, 13.9%, and 0.5%, respectively, among those who had injected for 1 year or less. Among the newest initiates, HCV and HBV were associated with injecting variables, and HIV was associated with sexual variables. Conclusions. The high rates of HCV, HBV, and HIV infections among short-term injectors emphasizes the need to target both parenteral and sexual risk reduction interventions early. Renewed efforts at primary prevention of substance abuse are indicated. Handle: RePEc:aph:ajpbhl:1996:86:5:655-661_9 Template-Type: ReDIF-Article 1.0 Title: Genetic screening for reproductive planning: Methodological and conceptual issues in policy analysis Journal: American Journal of Public Health Author-Name: Asch, D.A. Author-Name: Hershey, J.C. Author-Name: Pauly, M.V. Author-Name: Patton, J.P. Author-Name: Kathtyn Jedrziewski, M. Author-Name: Mennuti, M.T. Year: 1996 Volume: 86 Issue: 5 Pages: 684-690 Abstract: Objectives. This paper explores several critical assumptions and methodological issues arising in cost-effectiveness analyses of genetic screening strategies in the reproductive setting. Methods. Seven issues that arose in the development of a decision analysis of alternative strategies for cystic fibrosis carrier screening are discussed. Each of these issues required a choice in technique. Results. The presentations of these analyses frequently mask underlying assumptions and methodological choices. Often there is no best choice. In the case of genetic screening in the reproductive setting, these underlying issues often touch on deeply felt human values. Conclusions. Space limitations for published papers often preclude explaining such choices in detail; yet these decisions determine the way the results should be interpreted. Those who develop these analyses need to make sure that the implications of important assumptions are understood by the clinicians who will use them. At the same time, clinicians need to enhance their understanding of what these models truly mean and how they address underlying clinical, ethical, and economic issues. Handle: RePEc:aph:ajpbhl:1996:86:5:684-690_1 Template-Type: ReDIF-Article 1.0 Title: Differences in the misreporting of chronic conditions, by level of education: The effect on inequalities in prevalence rates Journal: American Journal of Public Health Author-Name: Mackenbach, J.P. Author-Name: Looman, C.W.N. Author-Name: Van Der Meer, J.B.W. Year: 1996 Volume: 86 Issue: 5 Pages: 706-711 Abstract: Objectives. Many studies of socioeconomic inequalities in the prevalence of chronic conditions rely on self-reports. For chronic nonspecific lung disease, heart disease, and diabetes mellitus, we studied the effects of misreporting on variations in prevalence rates by respondents' level of education. Method. In 1991, a health interview survey was conducted in the southeastern Netherlands with 2867 respondents. Respondents' answers were compared with validated diagnostic questionnaires in the same survey and the diagnoses given by the respondents' general practitioners. Results. Misreporting of chronic lung disease, heart disease, and diabetes may be extensive. Depending on the condition and the reference data used, the confirmation fractions ranged between .61 and .96 and the detection fractions between .13 and .93. Misreporting varied by level of education, and although various patterns were observed, the dominant pattern was that of more underreporting among less educated persons. The effects on prevalence rates were to underestimate differences by level of education to a sometimes considerable degree. Conclusions. Misreporting of chronic conditions differs by respondents' level of education. Health interview survey data underestimate socioeconomic inequalities in the prevalence of chronic conditions. Handle: RePEc:aph:ajpbhl:1996:86:5:706-711_3 Template-Type: ReDIF-Article 1.0 Title: Trends and differentials in adolescent and young adult mortality in the United States, 1950 through 1993 Journal: American Journal of Public Health Author-Name: Singh, G.K. Author-Name: Yu, S.M. Year: 1996 Volume: 86 Issue: 4 Pages: 560-564 Abstract: Using data from the National Vital Statistics System and the National Longitudinal Mortality Study, this study examined mortality trends and differentials from 1950 through 1993 among US adolescents and young adults according to sex, race/ethnicity, education, family income, marital status, and cause of death. No appreciable reduction in youth mortality has occurred, especially among men. Declines in youth mortality from accidents have been nearly offset by increases in death rates from homicide, suicide, and firearm injuries. American Indians, Blacks, males, and those with least education and income were at increased risk of both overall and injury-specific youth mortality. Handle: RePEc:aph:ajpbhl:1996:86:4:560-564_4 Template-Type: ReDIF-Article 1.0 Title: Socioeconomic differentials in mortality risk among men screened for the multiple risk factor intervention trial: I. White men Journal: American Journal of Public Health Author-Name: Smith, G.D. Author-Name: Neaton, J.D. Author-Name: Wentworth, D. Author-Name: Stamler, R. Author-Name: Stamler, J. Year: 1996 Volume: 86 Issue: 4 Pages: 486-496 Abstract: Objectives. This study examined socioeconomic differentials in risk of death from a number of specific causes in a large cohort of White men in the United States. Methods. For 300 685 White men screened for the Multiple Risk Factor Intervention Trial between 1973 and 1975, data were collected on median income of White households in the zip code of residence, age, cigarette smoking, blood pressure, serum cholesterol, previous myocardial infarction, and drug treatment for diabetes. The 31 737 deaths that occurred over the 16-year follow-up period were grouped into specific causes and related to median White family income. Results. There was an inverse association between age-adjusted all-cause mortality and median family income. There was no attenuation of this association over the follow-up period, and the association was similar for the 22 clinical centers carrying out the screening. The gradient was seen for many-but not all-of the specific causes of death. Other risk factors accounted for some of the association between income and coronary heart disease and smoking-related cancers. Conclusions. Socioeconomic position, as measured by median family income of area of residence, is an important determinant of mortality risk in White men. Handle: RePEc:aph:ajpbhl:1996:86:4:486-496_2 Template-Type: ReDIF-Article 1.0 Title: Morbidity and mortality among US adolescents: An overview of data and trends Journal: American Journal of Public Health Author-Name: Wayne Sells, C. Author-Name: Blum, R.Wm. Year: 1996 Volume: 86 Issue: 4 Pages: 513-519 Abstract: Objectives. This article reviews the health status of adolescents in the United States 1979 through 1994. Methods. An extensive array of data from federal agencies, private organizations, and published literature was reviewed, analyzed, and cross-validated. Results. Significant shifts in mortality and morbidity among America's youth have occurred over the past decade. Adolescents have recorded significant reductions in motor vehicle deaths: alcohol, cigarette, and illicit substance use; and gonorrhea and syphilis. Overall, mortality in the second decade of life has declined by 13%. However, reductions in unintentional injuries have been largely offset by increases in teenage homicide, while worsening poverty as well as risk taking behaviors continue to influence the morbidities of teenagers adversely. Violence, suicide, and teenage pregnancy continue to be overwhelming problems for young people. Conclusions. After years of downward spiral in the health of America's youth, there have been significant improvements in morbidity and mortality. These findings refute the myth that frothing can be done. Handle: RePEc:aph:ajpbhl:1996:86:4:513-519_6 Template-Type: ReDIF-Article 1.0 Title: Health status before and mortality after hip fracture Journal: American Journal of Public Health Author-Name: Katelaris, A.G. Author-Name: Cumming, R.G. Year: 1996 Volume: 86 Issue: 4 Pages: 557-560 Abstract: A cohort study was done to determine the direct impact of hip fracture on mortality in older people. Survival was compared between 211 hip fracture patients from a defined area and 201 non-hip fracture control subjects randomly selected from the same area. The mortality rate 1 year after hip fracture was 21.7% 1-year mortality in the comparison group was 4.7%. The crude hazard ratio for hip fracture and mortality was 4.0 (95% confidence interval [CI] = 2.2, 7.4); adjusting for multiple health related variables reduced it to 3.3 (95% CI = 1.7, 6.5). This finding suggests that the observed excess mortality after hip fracture is not explained by poor prefracture health status. Handle: RePEc:aph:ajpbhl:1996:86:4:557-560_1 Template-Type: ReDIF-Article 1.0 Title: Medical care employment in the United States, 1968 to 1993: The importance of health sector jobs for African Americans and women Journal: American Journal of Public Health Author-Name: Himmelstein, D.U. Author-Name: Lewontin, J.P. Author-Name: Woolhandler, S. Year: 1996 Volume: 86 Issue: 4 Pages: 525-528 Abstract: Objectives. The purpose of this study was to elucidate the social and economic impact of health sector employment. Methods. US medical care employment was analyzed for each year between 1968 and 1993, with data from the March Current Population Survey. Results. Between 1968 and 1993, medical care employment grew from 4.32 million to 11.40 million persons, accounting for 5.7% of all jobs in 1968 and 8.4% in 1993. Today, one seventh of employed women work in medical care: they hold 78% of medical care jobs. One fifth of all employed African-American women work in medical care. African Americans hold 15.5% of jobs in the health sector: they hold 24.1% of the jobs in nursing homes, 15.9% of the jobs in hospitals, but only 5.6% of the jobs in practitioners' offices. Hispanics constitute 6.4% of medical care employees. Real wages rose 25% to 50% between 1968 and 1993 for most health occupations. Wages of registered nurses rose 86%; physicians' incomes rose 22%. Wages of nursing home workers were far lower than those of comparable hospital workers, and the gap has widened. In 1993, 11.1% of all medical care workers lacked health insurance and 597 000 lived in poverty. Conclusions. Hospital cuts and the continuing neglect of long-term care exacerbate unemployment and poverty among women and African Americans. Handle: RePEc:aph:ajpbhl:1996:86:4:525-528_4 Template-Type: ReDIF-Article 1.0 Title: The ages of fathers in California adolescent births, 1993 Journal: American Journal of Public Health Author-Name: Males, M. Author-Name: Chew, K.S.Y. Year: 1996 Volume: 86 Issue: 4 Pages: 565-568 Abstract: Officials, media coverage, and prevention programs have assumed that fathers of infants born to US school-age (10-18 years old) mothers are school-age peers. This study analyzes fathers' ages in 46 500 California births to school age mothers in 1993, for which 85% of the fathers' ages were stated and whose distribution is similar to that of less complete national samples. Adult, postschool men father two thirds of the infants born to school-age mothers and average 4.2 years older than the senior-high mothers and 6.7 years older than the junior-high mothers. The extensive involvement of adult males in both school-age motherhood and its precursors represents a significant, undiscussed factor deserving greater attention. Handle: RePEc:aph:ajpbhl:1996:86:4:565-568_8 Template-Type: ReDIF-Article 1.0 Title: Cutaneous melanoma mortality among the socioeconomically disadvantaged in Massachusetts Journal: American Journal of Public Health Author-Name: Geller, A.C. Author-Name: Miller, D.R. Author-Name: Lew, R.A. Author-Name: Clapp, R.W. Author-Name: Wenneker, M.B. Author-Name: Koh, H.K. Year: 1996 Volume: 86 Issue: 4 Pages: 538-543 Abstract: Objectives. To identify groups for melanoma prevention and early detection programs, this study explored the hypothesis that survival with cutaneous melanoma is disproportionately lower for persons of lower socioeconomic status. Methods. Massachusetts Cancer Registry and Registry of Vital Records and Statistics data (1982 through 1987) on 3288 incident cases and 1023 deaths from cutaneous melanoma were analyzed. Mortality/incidence ratios were calculated and compared, predictors of late stage disease were examined with logistic regression analysis, and a proportional hazards regression analysis that used death registration as the outcome measure for incident cases was performed. Results. Lower socioeconomic status was associated with a higher mortality/incidence ratio after adjustment for age and sex. For education, the mortality/incidence ratio was 0.37 in the lower group vs 0.25 in the higher group (rate ratio = 1.48, 95% confidence interval [CI] = 1.08, 2.03). Late stage disease was independently associated with lower income (rate ratio for lowest vs highest tertile = 1.64, 95% CI = 1.20, 2.25), and melanoma mortality among case patients was associated with lower education (rate ratio = 1.52, 95% CI = 1.09, 2.13). Conclusions. Melanoma patients of lower socioeconomic status may be more likely to die from their melanoma than patients of higher socioeconomic status. Low-SES communities may be appropriate intervention targets. Handle: RePEc:aph:ajpbhl:1996:86:4:538-543_2 Template-Type: ReDIF-Article 1.0 Title: Iron deficiency in Massachusetts communities: Socioeconomic and demographic risk factors among children Journal: American Journal of Public Health Author-Name: Sargent, J.D. Author-Name: Stukel, T.A. Author-Name: Dalton, M.A. Author-Name: Freeman, J.L. Author-Name: Brown, M.J. Year: 1996 Volume: 86 Issue: 4 Pages: 544-550 Abstract: Objectives. This study examined the association between community rates of iron deficiency in children and sociodemographic characteristics of Massachusetts communities. Methods. Between April 1990 and March 1991, 238 273 Massachusetts children 6 through 59 months of age were screened; iron deficiency was defined as an erythrocyte protoporphyrin concentration of 0.62 μmol/L or higher and a blood lead level of less than 1.2 μmol/L. Sociodemographic data were obtained from the 1990 US Census. Results. Five percent of communities had iron deficiency rates greater than 13.9 per 100 children screened. Iron deficiency rate was positively associated with proportion of Southeast Asians (odds ratio [OR] = 1.10, 95% confidence interval [CI] = 1.08, 1.12), proportion of Hispanics (OR = 1.008, 95% CI = 1.002, 1.013), and high school incompletion (OR = 1.028, 95% CI = 1,020, 1.035). Similarly, an examination of three Massachusetts cities indicated that the iron deficiency rate was higher for children with Southeast Asian (relative risk [RR] = 3.6, 95% CI = 3.3, 3.8) and Hispanic (RR = 1.6, 95% CI = 1.5, 1.8) surnames than for all other children. Conclusions. Wide variation exists in iron deficiency rates for children in Massachusetts communities. Community iron deficiency was associated with low socioeconomic status and high proportions of Southeast Asians and Hispanics. Handle: RePEc:aph:ajpbhl:1996:86:4:544-550_6 Template-Type: ReDIF-Article 1.0 Title: The contribution of diabetes to early deaths from ischemic heart disease: US gender and racial comparisons Journal: American Journal of Public Health Author-Name: Will, J.C. Author-Name: Casper, M. Year: 1996 Volume: 86 Issue: 4 Pages: 576-579 Abstract: We evaluated the contribution of diabetes mellitus to premature ischemic heart disease mortality among US race- and gender-specific groups in 1986. Among persons aged 45 to 64 years, we examined ischemic heart disease death rates (corrected for underreporting of diabetes on death certificates) by diabetes status and calculated the population attributable risk due to diabetes for each group. Diabetes increased the ischemic heart disease death rate by 9 to 10 times for women but by only 2 to 3 times for men. Racial differences in ischemic heart disease mortality attributable to diabetes were greater for women (Blacks = 39%; Whites = 27%) than for men (Blacks = 19%; Whites = 14%). These discrepancies in the contribution of diabetes to ischemic heart disease mortality warrant further study. Handle: RePEc:aph:ajpbhl:1996:86:4:576-579_4 Template-Type: ReDIF-Article 1.0 Title: The growth in the US uninsured population: Trends in Hispanic subgroups, 1977 to 1992 Journal: American Journal of Public Health Author-Name: Berk, M.L. Author-Name: Albers, L.A. Author-Name: Schur, C.L. Year: 1996 Volume: 86 Issue: 4 Pages: 572-576 Abstract: This paper presents trends in the growth in the US uninsured population, using cross-sectional national estimates from 1977, 1987, 1989, and 1992 and focusing specifically on coverage problems experienced by Hispanic Americans. An examination of the composition of uninsured persons added between 1977 and 1992 shows that almost 40% of the difference is accounted for by persons of Hispanic origin, with those of Mexican origin alone constituting 27%. In addition, the annual average rate of growth in the uninsured Hispanic population between 1977 and 1992 was 9.7%, compared with only 2.3% for the uninsured non-Hispanic population. Handle: RePEc:aph:ajpbhl:1996:86:4:572-576_4 Template-Type: ReDIF-Article 1.0 Title: Socioeconomic differentials in mortality risk among men screened for the multiple risk factor intervention trial: II. Black men Journal: American Journal of Public Health Author-Name: Smith, G.D. Author-Name: Wentworth, D. Author-Name: Neaton, J.D. Author-Name: Stamler, R. Author-Name: Stamler, J. Year: 1996 Volume: 86 Issue: 4 Pages: 497-504 Abstract: Objectives. This study examined socioeconomic differentials in risk of death from a number of causes in a large cohort of Black men in the United States. Methods. For 20 224 Black men screened for the Multiple Risk Factor Intervention Trial between 1073 and 1975, data were collected on median family income of Black households in zip code of residence, age, cigarette smoking, blood pressure, serum cholesterol, previous heart attack, and drug treatment for diabetes. The 2937 deaths that occurred over the 16-year follow-up period were grouped into specific causes and related to median Black family income. Results. There was an inverse association between age- adjusted all-cause mortality and median family income. There was no attenuation of this association over the follow-up period, and the association was similar for the 22 clinical centers carrying out the screening. The gradient was seen for most of the specific causes of death, although the strength of the association varied. Median income was markedly lower for the Black men screened than for the White men, but the relationship between income and all-cause mortality was similar. Conclusions. Socioeconomic position is an important determinant of mortality risk for Black men. Even though Blacks lived in areas with substantially lower median family income than Whites, the association of income with mortality was similar for Blacks and Whites. Handle: RePEc:aph:ajpbhl:1996:86:4:497-504_0 Template-Type: ReDIF-Article 1.0 Title: Surgery for colorectal cancer: Race-related differences in rates and survival among medicare beneficiaries Journal: American Journal of Public Health Author-Name: Cooper, G.S. Author-Name: Yuan, Z. Author-Name: Landefeld, C.S. Author-Name: Rimm, A.A. Year: 1996 Volume: 86 Issue: 4 Pages: 582-586 Abstract: This study examined surgery for colorectal cancer among Medicare beneficiaries 65 years of age or older with an initial diagnosis in 1987 (n = 81 579). Black patients were less likely than Whites to undergo surgical resection (68% vs 78%), even after age, comorbidity, and location and extent of tumor were controlled for. Among those who underwent resection, Black patients were more likely to die (a 2-year mortality rate of 40.0% vs 33.5% in White patients); this disparity also remained after confounders had been controlled. The disparities were similar in teaching and nonteaching hospitals and in private and public hospitals. These data may indicate racially based differences among Medicare beneficiaries in access to and quality of care for colorectal cancer. Handle: RePEc:aph:ajpbhl:1996:86:4:582-586_4 Template-Type: ReDIF-Article 1.0 Title: Physician use in Ontario and the United States: The impact of socioeconomic status and health status Journal: American Journal of Public Health Author-Name: Katz, S.J. Author-Name: Hofer, T.P. Author-Name: Manning, W.G. Year: 1996 Volume: 86 Issue: 4 Pages: 520-524 Abstract: Objectives. This study compared physician use in Ontario and the midwestern and northeastern United States for persons of different socioeconomic status and health status. The distribution of health problems associated with the most recent physician visit also was compared. Methods. The design of the study was cross sectional; data derived from the 1990 Ontario Health Survey and the 1990 US National Health Interview Survey were used in analyses. Results. Overall, persons in Ontario averaged 19% more visits than US residents, but differences varied markedly across income and health status. At each level of health status, low-income Canadians had 25% to 33% more visits than their US counterparts. However, among higher income persons, those in excellent or very good health had 22% more visits than Americans, while those in good, fair, or poor health had 10% fewer visits than Americans. Higher visit rates in Ontario were not associated with a greater prevalence of low-priority visits. Conclusions. Under the Canadian single-payer system, medical care in Ontario has been redistributed to low- income persons and the elderly. Compared with the United States, there has been a lower intensity of medical care for the sick higher income population. Handle: RePEc:aph:ajpbhl:1996:86:4:520-524_3 Template-Type: ReDIF-Article 1.0 Title: Childhood lead poisoning through Kohl Journal: American Journal of Public Health Author-Name: Mojdehi, G.M. Author-Name: Gurtner, J. Year: 1996 Volume: 86 Issue: 4 Pages: 587-588 Handle: RePEc:aph:ajpbhl:1996:86:4:587-588_7 Template-Type: ReDIF-Article 1.0 Title: Sexual assault history and eating disorder symptoms among White, Hispanic, and African-American women and men Journal: American Journal of Public Health Author-Name: Laws, A. Author-Name: Golding, J.M. Year: 1996 Volume: 86 Issue: 4 Pages: 579-582 Abstract: Data from two Epidemiologic Catchment Area Program sites (Los Angeles and North Carolina) were analyzed to examine relations of sexual assault history to eating disorder symptoms. In regression analyses controlling for age, gender, ethnicity, income, socioeconomic status, and study site, persons with sexual assault history (n = 514) were more likely than those not assaulted (n = 5511) to report thinking they were too fat (odds ratio [OR] = 1.6); losing ≥ 15 lb (OR = 1.86); weight loss to 85% of normal (OR = 2.08); one or more anorexia symptoms (OR = 1.81); and sudden weight change (OR = 2.32). Ethnicity and income modified the relations. The data support an association of sexual assault history with eating disorder symptoms. Handle: RePEc:aph:ajpbhl:1996:86:4:579-582_9 Template-Type: ReDIF-Article 1.0 Title: US childhood mortality, 1950 through 1993: Trends and socioeconomic differentials Journal: American Journal of Public Health Author-Name: Singh, G.K. Author-Name: Yu, S.M. Year: 1996 Volume: 86 Issue: 4 Pages: 505-512 Abstract: Objectives. This study examined trends and differentials in US childhood mortality from 1950 through 1993 according to sex, race/ethnicity, education, family income, and cause of death. Methods. Log-linear, multiple regression, and Cox proportional hazards regression models were applied to the data from the National Vital Statistics System, the National Longitudinal Mortality Study, and the Area Resource File. Results. Substantial declines in US childhood mortality have occurred in the past 4 decades, primarily due to decreases in mortality from unintentional injuries, cancer, pneumonia and influenza, and congenital anomalies. The overall declining trend, however, has been dampened by a twofold to threefold increase in the suicide and homicide rates among children since 1968. Male, Black, American Indian, Hawaiian, and Puerto Rican children and those in the lower socioeconomic strata were at an increased risk of death. Conclusions. Increasing trends in mortality from violence, firearm injuries, and human immunodeficiency virus/acquired immunodeficiency syndrome pose a major obstacle to continued declines in US childhood mortality. Reducing socioeconomic disparities and improving access to and rise of health care may bring about further declines in overall and injury-related childhood mortality. Handle: RePEc:aph:ajpbhl:1996:86:4:505-512_1 Template-Type: ReDIF-Article 1.0 Title: Changes in multiple sexual partnerships, HIV testing, and condom use among US heterosexuals 18 to 49 years of age, 1990 and 1992 Journal: American Journal of Public Health Author-Name: Choi, K.-H. Author-Name: Catania, J.A. Year: 1996 Volume: 86 Issue: 4 Pages: 554-556 Abstract: We compared data from two independent, representative samples of the US population to determine whether heterosexual adults 18 to 49 years of age modified their human immunodeficiency virus (HIV) risk behaviors between 1990/91 and 1992. We found little change in multiple sexual partnerships, having a risky sexual partner, and HIV test seeking in the heterosexual population. Overall, consistent condom use significantly increased from 11% in 1990/91 to 20% in 1992, but this increase was limited to selected demographic groups. These results suggest a continuing need for HIV education among heterosexual adults. Handle: RePEc:aph:ajpbhl:1996:86:4:554-556_2 Template-Type: ReDIF-Article 1.0 Title: Will uninsured people volunteer for voluntary health insurance? Experience from Washington State Journal: American Journal of Public Health Author-Name: Diehr, P. Author-Name: Madden, C.W. Author-Name: Cheadle, A. Author-Name: Martin, D.P. Author-Name: Patrick, D.L. Author-Name: Skillman, S. Year: 1996 Volume: 86 Issue: 4 Pages: 529-532 Abstract: Objectives. In national and local discussions of health care reform, there is disagreement about whether a national health insurance plan should be mandatory or voluntary. This study describes characteristics of low-income people who were more likely or less likely to be covered by a voluntary plan. Methods. Survey data were available from an evaluation of Washington State's Basic Health Plan, which offered subsidized health insurance to low-income residents. For those subjects who were eligible and uninsured at baseline, those who joined were compared with those who did not join on a variety of demographic and health related characteristics. Results. There were substantial differences between those who did and did not join the Basic Health Plan. Those who did not enroll were generally less well-off, with less education, lower income, and worse health. Many had never had health insurance. Conclusions. If health care reform results in a voluntary plan, additional measures may be needed to ensure that less advantaged citizens have adequate access to health care. Handle: RePEc:aph:ajpbhl:1996:86:4:529-532_8 Template-Type: ReDIF-Article 1.0 Title: The transcontinental transmission of tuberculosis: A molecular epidemiological assessment Journal: American Journal of Public Health Author-Name: Casper, C. Author-Name: Singh, S.P. Author-Name: Rane, S. Author-Name: Daley, C.L. Author-Name: Schecter, G.S. Author-Name: Riley, L.W. Author-Name: Kreiswirth, B.N. Author-Name: Small, P.M. Year: 1996 Volume: 86 Issue: 4 Pages: 551-553 Abstract: Many tuberculosis control activities are based on principles learned from studies of tuberculosis transmission. To date, these have largely been limited to outbreak investigations in confined geographic regions. In this report conventional and computerized DNA fingerprint-based approaches were integrated to demonstrate that the most widely prevalent strain of Mycobacterium tuberculosis Item New York City was cultured from only 1 of 755 patients in San Francisco, Calif. who was a traveling salesman. Large-scale molecular epidemiologic studies may provide a better understanding of the dynamics of tuberculosis transmission between geographic regions and suggest rational measures to interrupt such transmission. Handle: RePEc:aph:ajpbhl:1996:86:4:551-553_4 Template-Type: ReDIF-Article 1.0 Title: Carrying and using weapons: A survey of minority junior high school students in New York City Journal: American Journal of Public Health Author-Name: Vaughan, R.D. Author-Name: McCarthy, J.F. Author-Name: Armstrong, B. Author-Name: Walter, H.J. Author-Name: Waterman, P.D. Author-Name: Tiezzi, L. Year: 1996 Volume: 86 Issue: 4 Pages: 568-572 Abstract: To explore weapon carrying among young, inner-city adolescents, a survey was administered in fall 1993 to 2005 predominantly Hispanic students (mean age = 12.8 years) in three New York City junior high schools. The survey revealed that 21% of students reported personally carrying a weapon; guns and knives were the weapons most commonly carried. Most of those who carried guns reported that they bought them. Forty-two percent indicated that they had a family member or close friend who had been shot. Boys and older students were more likely to report carrying weapons. Preventive efforts may need to begin before or on entry into junior high school rather than high school. Handle: RePEc:aph:ajpbhl:1996:86:4:568-572_9 Template-Type: ReDIF-Article 1.0 Title: The public health response to Los Angeles' 1994 earthquake. Journal: American Journal of Public Health Author-Name: Carr, S.J. Author-Name: Leahy, S.M. Author-Name: London, S. Author-Name: Sidhu, S. Author-Name: Vogt, J. Year: 1996 Volume: 86 Issue: 4 Pages: 589-590 Handle: RePEc:aph:ajpbhl:1996:86:4:589-590_2 Template-Type: ReDIF-Article 1.0 Title: 1995 Presidential Address. Public health: vision and reality. Journal: American Journal of Public Health Author-Name: Evans CA, Year: 1996 Volume: 86 Issue: 4 Pages: 476-479 Handle: RePEc:aph:ajpbhl:1996:86:4:476-479_2 Template-Type: ReDIF-Article 1.0 Title: Older women helping older women: Employing senior workers in community research. Journal: American Journal of Public Health Author-Name: Tyrrell, M. Author-Name: Margolis, K. Author-Name: Sandberg, L. Author-Name: Slater, J. Author-Name: Lurie, N. Year: 1996 Volume: 86 Issue: 4 Pages: 588-589 Handle: RePEc:aph:ajpbhl:1996:86:4:588-589_3 Template-Type: ReDIF-Article 1.0 Title: A health education program for migrant children. Journal: American Journal of Public Health Author-Name: Marier, A.E. Year: 1996 Volume: 86 Issue: 4 Pages: 590-591 Handle: RePEc:aph:ajpbhl:1996:86:4:590-591_2 Template-Type: ReDIF-Article 1.0 Title: The Armed Forces Institute of Pathology: an underutilized repository of case material. Journal: American Journal of Public Health Author-Name: Peterson, M.R. Year: 1996 Volume: 86 Issue: 4 Pages: 592 Handle: RePEc:aph:ajpbhl:1996:86:4:592_2 Template-Type: ReDIF-Article 1.0 Title: Long-term psychosocial work environment and cardiovascular mortality among Swedish men Journal: American Journal of Public Health Author-Name: Johnson, J.V. Author-Name: Stewart, W. Author-Name: Hall, E.M. Author-Name: Fredlund, P. Author-Name: Theorell, T. Year: 1996 Volume: 86 Issue: 3 Pages: 324-331 Abstract: Objectives. This study examined the effect of cumulative exposure to work organization-psychological demands, work control, and social support-on prospectively measured cardiovascular disease mortality risk. Methods. The source population was a national sample of 12517 subjects selected from the Swedish male population by statistics Sweden in annual surveys between 1977 and 1981. Over a 14-year follow-up period, 521 deaths from cardiovascular disease were identified. A nested case-control design was used. Work environment exposure scores were assigned to cases and controls by linking lifetime job histories with a job exposure matrix. Results. Conditional logistic regression analysis was used in examining cardiovascular mortality risk in relation to work exposure after adjustment for age, year last employed, smoking, exercise, education, social class, nationality, and physical job demands. In the final multi-variable analysis, workers with low work control had a relative risk of 1.83 (95% confidence interval [CI] = 1.19, 2.82) for cardiovascular mortality. Workers with combined exposure to low control and low support had a relative risk of 2.62 (95% CI = 1.22, 5.61). Conclusions. These results indicate that long-term exposure to low work control is a risk factor for cardiovascular disease mortality. Handle: RePEc:aph:ajpbhl:1996:86:3:324-331_0 Template-Type: ReDIF-Article 1.0 Title: Home injuries among adults in Stavanger, Norway Journal: American Journal of Public Health Author-Name: Kopjar, B. Author-Name: Wickizer, T.M. Year: 1996 Volume: 86 Issue: 3 Pages: 400-404 Abstract: Norwegian injury register data were analyzed to examine unintentional home injuries among persons aged 25 to 64 years residing in Stavanger, Norway, during 1992. A total of 782 persons received medical treatment for injury during 1992 (15.4 per 1000 population). The incidence was similar for males and females (15.8 and 14.9 per 1000 population); however, the exposure- specific injury rate was significantly higher for males (6.0 vs 4.1 per 1 million person-hours). This difference was entirely due to the much higher injury rate among males aged 25 to 44 years. The estimated first-year cost (direct and indirect) per injury was $2700. Home injuries among adults appear to be an overlooked public health problem that warrants increased attention. Handle: RePEc:aph:ajpbhl:1996:86:3:400-404_1 Template-Type: ReDIF-Article 1.0 Title: Access to war weapons and injury prevention activities among children in Croatia Journal: American Journal of Public Health Author-Name: Kopjar, B. Author-Name: Wiik, J. Author-Name: Wickizer, T.M. Author-Name: Bulajic-Kopjar, M. Author-Name: Mujkic-Klaric, A. Year: 1996 Volume: 86 Issue: 3 Pages: 397-400 Abstract: To investigate the exposure of children in Croatia to war weapons, we surveyed random samples of children (n = 986) aged 11 to 16 years and of parents (1469) of children aged 7 to 16 years in April 1994 in four war- affected districts in Croatia. The children's survey indicated that 57% of the boys and 36% of the girls had access to weapons at home, at some other place, or at both. Eighteen percent of the boys and 5% of the girls reported playing with weapons. The parents' survey showed that 68% of the households possessed weapons, with 19% of the children having access to weapons at home. Influenced by preliminary findings of these surveys, the Croatian government modified its national campaign (one partially supported by international aid) to prevent war-related injuries among children. This study demonstrates the feasibility of scientific evaluation of humanitarian aid programs. Handle: RePEc:aph:ajpbhl:1996:86:3:397-400_3 Template-Type: ReDIF-Article 1.0 Title: Psychosocial work environment and sickness absence among British civil servants: The Whitehall II study Journal: American Journal of Public Health Author-Name: North, F.M. Author-Name: Syme, S.L. Author-Name: Feeney, A. Author-Name: Shipley, M. Author-Name: Marmot, M. Year: 1996 Volume: 86 Issue: 3 Pages: 332-340 Abstract: Objectives. This study sought to examine the association between the psychosocial work environment and subsequent rates of sickness absence. Methods. The analyses were based on a cohort of male and female British civil servants (n = 9072). Rates of short spells (≤7 days) and long spells (>7 days) of sickness absence were calculated for different aspects of the psychosocial work environment, as measured by self-reports and personnel managers' ratings (external assessments). Results. Low levels of work demands, control, and support were associated with higher rates of short and long spells of absence in men and, to a lesser extent, in women. The differences were similar for the self-reports and external assessments. After adjustment for grade of employment, the differences were diminished but generally remained significant for short spells. The combination of high demands and low control was only associated with higher rates of short spells in the lower grades. Conclusions. The psychosocial work environment predicts rates of sickness absence. Increased levels of control and support at work could have beneficial effects in terms of both improving the health and well- being of employees and increasing productivity. Handle: RePEc:aph:ajpbhl:1996:86:3:332-340_7 Template-Type: ReDIF-Article 1.0 Title: Cigarette smoking and its risk factors among elementary school students in Beijing Journal: American Journal of Public Health Author-Name: Zhu, B.-P. Author-Name: Liu, M. Author-Name: Shelton, D. Author-Name: Liu, S. Author-Name: Giovino, G.A. Year: 1996 Volume: 86 Issue: 3 Pages: 368-375 Abstract: Objectives. This study investigated patterns of and risk factors for smoking among elementary school children in Beijing, China. Methods. In 1988, anonymous questionnaires were administered to a multistage stratified cluster sample of 16 996 students, aged mostly 10 to 12, in 479 fourth- to sixth- grade classes from 122 Beijing elementary schools. Results. Approximately 28% of boys and 3% of girls had smoked cigarettes. The most frequently cited reasons for smoking initiation were 'to imitate others' behavior' and 'to see what it was like.' Girls were more likely to get cigarettes from home than to purchase their own. Having close friends who smoked and being encouraged by close friends to smoke were strong risk factors for smoking. Smoking was also associated with lower parental socioeconomic status; having parents, siblings, or teachers who smoked; buying cigarettes for parents; performing poorly in school; and not believing that smoking is harmful to health. Conclusions. Gender differences in smoking prevalence among adolescents in China are larger than those among US teenagers, whereas the proximal risk factors for smoking are similar. Major efforts are needed to monitor and prevent smoking initiation among Chinese adolescents, particularly girls. Handle: RePEc:aph:ajpbhl:1996:86:3:368-375_4 Template-Type: ReDIF-Article 1.0 Title: Separation between HIV-positive women and their children: The French prospective study, 1986 through 1993 Journal: American Journal of Public Health Author-Name: Blanche, S. Author-Name: Mayaux, M.-J. Author-Name: Veber, F. Author-Name: Landreau, A. Author-Name: Courpotin, C. Author-Name: Vilmer, E. Author-Name: Ciraru-Vigneron, N. Author-Name: Floch, C. Author-Name: Tricoire, J. Author-Name: Noseda, G. Author-Name: Jean-Marc, J. Author-Name: Rouzioux, C. Year: 1996 Volume: 86 Issue: 3 Pages: 376-381 Abstract: Objectives. We studied the risk and circumstances of separation (due to either maternal death or drug use) between women infected by human immunodeficiency virus (HIV) type 1 and their children. Methods. This analysis was based on the French Prospective Study of Infants born to HIV- Seropositive Women (1986 through 1993). Data recorded at each follow-up visit included the mother's effective presence with the child and the child's care after separation. Results. A child's cumulative risk of long-term or permanent separation from his or her mother was 37% at 60 months. Maternal drug use was associated with an added risk during the child's first years (adjusted relative risk [RR] = 3.4, 95% confidence interval [CI] = 2.3, 5.0). The risk among drug users was even higher when the mother used injection drugs during pregnancy (adjusted RR = 2.9, 95% CI = 1.9, 4.3). Risk of early separation related to drug use tended to diminish since survey initiation. After separation, 57% of the children were placed through child welfare services and 43% were cared for by relatives. Conclusions. In the French Prospective Study, 2% to 3% of HIV-infected children were separated each year from their mothers as a result of the mother's death from acquired immunodeficiency syndrome (AIDS). Separations related to drug use have decreased over the years, and the family is becoming the most frequent carer after separation. Handle: RePEc:aph:ajpbhl:1996:86:3:376-381_2 Template-Type: ReDIF-Article 1.0 Title: Intrauterine growth retardation and premature delivery: The influence of maternal smoking and psychosocial factors Journal: American Journal of Public Health Author-Name: Nordentoft, M. Author-Name: Lou, H.C. Author-Name: Hansen, D. Author-Name: Nim, J. Author-Name: Pryds, O. Author-Name: Rubin, P. Author-Name: Hemmingsen, R. Year: 1996 Volume: 86 Issue: 3 Pages: 347-354 Abstract: Objectives. This study investigated the influence of psychosocial stress, maternal schooling, social support, psychological well-being, alcohol, and smoking on intrauterine growth retardation and premature delivery. Methods. At a Copenhagen university hospital, 2432 pregnant women completed a questionnaire on general health, psychosocial stressors, and sociodemographic characteristics. Results. In 212 cases (8.7%) the women delivered prematurely. Preterm delivery was associated with psychosocial stress (adjusted odds ratio [OR] = 1.14 for each 1-point increase on the psychosocial stressor 5-point scale and 1.92 for the whole scale) and poor school education (adjusted OR = 2.62 for 7-9 years of schooling, 1.91 for 10 years, and 1.0 for 11-13 years). In 152 cases (6.3%), infants had a birthweight below the 10th percentile. Intrauterine growth retardation was associated with smoking, daily drinking, school education, and social network variables. In a multiple logistic regression model, intrauterine growth retardation was associated with smoking habits (adjusted OR = 2.40 for 0-9 cigarettes daily, 2.68 for 10-15 daily, and 2.88 for more than 15 daily). Conclusions. Psychosocial stressors and limited duration of schooling appeared to influence preterm delivery. Smoking habits influenced intrauterine growth retardation. Handle: RePEc:aph:ajpbhl:1996:86:3:347-354_9 Template-Type: ReDIF-Article 1.0 Title: The first year of hyperinflation in the former Soviet Union: Nutritional deprivation among elderly pensioners, 1992 Journal: American Journal of Public Health Author-Name: Rush, D. Author-Name: Welch, K. Year: 1996 Volume: 86 Issue: 3 Pages: 361-367 Abstract: Objectives. Hyperinflation began in early 1992 in the former Soviet Union. This paper describes factors associated with nutritional status that year among elderly pensioners. Methods. Approximately 300 pensioners were selected randomly in each of eight cities. Surveys of diet, weight, health status, and social and economic conditions were done between June and December 1992. This paper reports on 2281 completed questionnaires. Results. Half the pensioners reported that they had lost 5 or more kilograms in the prior 6 months; 57% did not have enough money to buy food, and 39% needed medicines they could not afford. Forty percent consumed less than a half kilogram of meat, 50% consumed less than a half kilogram of fruit, a third consumed less than a liter of milk, and a third consumed less than 2 kg of bread per week. Weight loss was strongly associated with not having enough money to buy food, an inability to afford medication, and consumption of fewer than three meals a day. Concurrent with these conditions, there was a large increase in mortality in Russia. Conclusions. The results of these surveys suggest that many elderly pensioners were experiencing severe nutritional deprivation in the latter half of 1992. Handle: RePEc:aph:ajpbhl:1996:86:3:361-367_3 Template-Type: ReDIF-Article 1.0 Title: Long-term back problems and physical work exposures in the 1990 Ontario health survey Journal: American Journal of Public Health Author-Name: Liira, J.P. Author-Name: Shannon, H.S. Author-Name: Chambers, L.W. Author-Name: Haines, T.A. Year: 1996 Volume: 86 Issue: 3 Pages: 382-387 Abstract: Objectives. This study sought to provide data on the relationship of work exposures to long-term back problems in a population survey. Methods. The Ontario Health Survey in 1990 used a representative population sample of the province. It included data on long-term back problems, occupational activity, and physical work exposures. The current study examined relationships between these variables. Results. The prevalence of long-term back problems was 7.8% in working-age adults. It generally increased with age. Long-term back problems were more prevalent in blue-collar occupations and among those not working, as well as among people with less formal education, smokers, and those overweight. Physical work exposures-awkward working position, working with vibrating vehicles or equipment, and bending and lifting-were all associated with a greater risk of back problems. The number of simultaneous physical exposures was monotonically related to increased risk. Conclusions. Within the limitations of the data and assuming the relationship to be causal, about one quarter of the excess back pain morbidity in the working population could be explained by physical work exposures. Handle: RePEc:aph:ajpbhl:1996:86:3:382-387_8 Template-Type: ReDIF-Article 1.0 Title: Acculturation and low-birthweight infants among Latino women: A reanalysis of HHANES data with structural equation models Journal: American Journal of Public Health Author-Name: Cobas, J.A. Author-Name: Balcazar, H. Author-Name: Benin, M.B. Author-Name: Keith, V.M. Author-Name: Chong, Y. Year: 1996 Volume: 86 Issue: 3 Pages: 394-396 Abstract: Previous studies have demonstrated that acculturation is associated with negative birth outcomes among mothers in numerous immigrant populations, including Latinas. This study used structural equation models to reanalyze data employed in the 1989 Scribner and Dwyer study on the effect of acculturation (measured through the Cuellar scale) on mothers' low- birthweight status. Data revealed that language components dominate the effects of acculturation on low-birthweight status. Acculturation appears to affect low-birthweight status indirectly through smoking and dietary intake but not through parity. Acculturation has a persistent direct effect on low- birthweight status, suggesting that other intervening variables are operant. Handle: RePEc:aph:ajpbhl:1996:86:3:394-396_1 Template-Type: ReDIF-Article 1.0 Title: The nutritional status of the elderly in Russia, 1992 through 1994 Journal: American Journal of Public Health Author-Name: Popkin, B.M. Author-Name: Zohoori, N. Author-Name: Baturin, A. Year: 1996 Volume: 86 Issue: 3 Pages: 355-360 Abstract: Objectives. The purpose of this study was to ascertain how economic reform has affected nutritional well-being of the elderly in the Russian Federation. Methods. A sample of more than 2932 Russians 60 years of age and older was selected from a nationally representative survey of Russian households. A 24- hour dietary recall and data on weight, height, and socioeconomic status were collected during 1992 and 1993 and from a separate nationally representative sample of 1955 persons in the same age group in 1994. Results. Russia's elderly did not experience major declines in economic or nutritional well- being during the first 2 years of the reform period. Dietary composition shifted slightly toward reduced fat consumption. A small proportion of individuals showed signs of underweight. Of those who were underweight in 1992, none had lost more than 3 kg of weight by 1993. Among those 70 years of age and older, none who were underweight had lost any appreciable weight, although half lost small amounts. Conclusions. Many more underweight elderly people increased than reduced their weight. Mean weight increased among all body mass index groups over the year reported here. However, economic conditions in December 1994 raise concerns. Handle: RePEc:aph:ajpbhl:1996:86:3:355-360_4 Template-Type: ReDIF-Article 1.0 Title: The current state of health care in the former Soviet Union: Implications for health care policy and reform Journal: American Journal of Public Health Author-Name: Barr, D.A. Author-Name: Field, M.G. Year: 1996 Volume: 86 Issue: 3 Pages: 307-312 Abstract: Objectives. Given the many profound health care problems facing Russia and the other former Soviet republics, there are a number of fundamental policy questions that deserve close attention as part of the reform process. Methods. Summary data regarding Soviet health care issues were drawn from government agency reports, scholarly books and journals, recent press reports, and the authors' personal research. Results. Smoking, alcohol, accidents, poor sanitation, inadequate nutrition, and extensive environmental pollution contribute to illness and premature mortality in Russia and the other newly independent states. Hospitals and clinics are poorly maintained and equipped; most physicians are poorly trained and inadequately paid; and there is essentially no system of quality management. While efforts at reform, which emphasize shifting to a system of 'insurance medicine,' have been largely unsuccessful, they have raised several important policy issues that warrant extensive research and discussion. Conclusions. Without considering the implications and consequences of alternative policy directions, Russia and the other states face the very real possibility of developing health care systems that improve the overall level of care but also incorporate limited access and escalating costs. Russian health care reform leaders can learn from the health care successes in the West and avoid repeating our mistakes. Handle: RePEc:aph:ajpbhl:1996:86:3:307-312_1 Template-Type: ReDIF-Article 1.0 Title: Does religious observance promote health? Mortality in secular vs religious Kibbutzim in Israel Journal: American Journal of Public Health Author-Name: Kark, J.D. Author-Name: Shemi, G. Author-Name: Friedlander, Y. Author-Name: Martin, O. Author-Name: Manor, O. Author-Name: Blondheim, S.H. Year: 1996 Volume: 86 Issue: 3 Pages: 341-346 Abstract: Objectives. This study assessed the association of Jewish religious observance with mortality by comparing religious and secular kibbutzim. These collectives are highly similar in social structure and economic function and are cohesive and supportive communities. Methods. In a 16-year (1970 through 1985) historical prospective study of mortality in 11 religious and 11 matched secular kibbutzim in Israel, 268 deaths occurred among 3900 men and women 35 years of age and older during 41 347 person-years of observation. Results. Mortality was considerably higher in secular kibbutzim. Cox proportional hazards analysis was used to adjust for age and the matched design: rate ratios were 1.67 (95% confidence interval [CI] = 1.17, 2.39) for men, 2.67 (95% CI = 1.55, 4.60) for women, and 1.93 (95% CI = 1.44, 2.59) overall. Kaplan-Meier survival analysis of birth cohorts confirmed the association. The lower mortality in religious kibbutzim was consistent for all major causes of death. Conclusions. Belonging to a religious collective was associated with a strong protective effect not attributable to confounding by sociodemographic factors. Elucidation of mechanisms mediating this effect may provide etiologic insights and leads for intervention. Handle: RePEc:aph:ajpbhl:1996:86:3:341-346_9 Template-Type: ReDIF-Article 1.0 Title: Addressing the epidemiologic transition in the former Soviet Union: Strategies for health system and public health reform in Russia Journal: American Journal of Public Health Author-Name: Tulchinsky, T.H. Author-Name: Varavikova, E.A. Year: 1996 Volume: 86 Issue: 3 Pages: 313-320 Abstract: Objectives. This paper reviews Russia's health crisis, financing, and organization and public health reform needs. Methods. The structure, policy, supply of services, and health status indicators of Russia's health system are examined. Results. Longevity is declining; mortality rates from cardiovascular diseases and trauma are high and rising; maternal and infant mortality are high. Vaccine-preventable diseases have reappeared in epidemic form. Nutrition status is problematic. Conclusions. The crisis relates to Russia's economic transition, but it also goes deep into the former Soviet health system. The epidemiologic transition from a predominance of infectious to noninfectious diseases was addressed by increasing the quantity of services. The health system lacked mechanisms for epidemiologic or economic analysis and accountability to the public. Policy and funding favored hospitals over ambulatory care and individual routine checkups over community-oriented preventive approaches. Reform since 1991 has centered on national health insurance and decentralized management of services. A national health strategy to address fundamental public health problems is recommended. Handle: RePEc:aph:ajpbhl:1996:86:3:313-320_7 Template-Type: ReDIF-Article 1.0 Title: Switching Swiss enrollees from indemnity health insurance to managed care: The effect on health status and satisfaction with care Journal: American Journal of Public Health Author-Name: Perneger, T.V. Author-Name: Etter, J.-F. Author-Name: Rougemont, A. Year: 1996 Volume: 86 Issue: 3 Pages: 388-393 Abstract: Objectives. In 1992, most members of a Swiss indemnity health insurance plan were automatically transferred into a newly created managed care organization. This study examined whether this semivoluntary change affected enrollees' health status and satisfaction with care. Methods. Three groups of enrollees were compared: 332 plan members who accepted the switch (managed care joiners); 186 plan members who opted to maintain indemnity coverage (nonjoiners); and 296 persons continuously enrolled in another indemnity plan (indemnity plan members). Health status, health-related behaviors, and satisfaction with care received in the previous year were surveyed at baseline and 1 year later. Results. Health status remained unchanged in all three groups. Smoking prevalence decreased among managed care joiners but remained constant in the other groups. Satisfaction with insurance coverage increased between baseline and follow-up in managed care joiners, but decreased in nonjoiners and indemnity plan members. The latter groups had higher satisfaction with health care, particularly with continuity of care. Conclusions. A semivoluntary switch from indemnity health insurance to managed care reduced satisfaction with health care but increased satisfaction with insurance coverage. There were no changes in self-perceived health status. Handle: RePEc:aph:ajpbhl:1996:86:3:388-393_4 Template-Type: ReDIF-Article 1.0 Title: The Department of Defense's Women's Health Research Programs. Journal: American Journal of Public Health Author-Name: Suitor, C.W. Author-Name: Klein, L. Year: 1996 Volume: 86 Issue: 3 Pages: 405 Handle: RePEc:aph:ajpbhl:1996:86:3:405_2 Template-Type: ReDIF-Article 1.0 Title: How long will today's new adolescent smoker be addicted to cigarettes? Journal: American Journal of Public Health Author-Name: Pierce, J.P. Author-Name: Gilpin, E. Year: 1996 Volume: 86 Issue: 2 Pages: 253-256 Abstract: This study estimated the expected smoking duration for young smokers who have started recently. Data from National Health Interview Surveys were combined to model the ages at which smoking prevalence will decline to various percentages of the peak smoking prevalence for each successive birth cohort. Smoking-cessation ages were then estimated for the males and females born from 1975 through 1979. The median cessation age for those in this cohort who start smoking as adolescents is expected to be 33 years for males and 37 years for females. Thus, 50% of these adolescent males may smoke for at least 16 years and 50% of these adolescent females may smoke for at least 20 years, based on a median age of initiation of 16 to 17 years. Despite the decline in the median age of US smokers who quit, these data predict that smoking will be a long-term addiction for many adolescents who start now. Handle: RePEc:aph:ajpbhl:1996:86:2:253-256_7 Template-Type: ReDIF-Article 1.0 Title: Preconceptional and prenatal multivitamin-mineral supplement use in the 1988 National Maternal and Infant Health Survey Journal: American Journal of Public Health Author-Name: Stella, M.Yu. Author-Name: Keppel, K.G. Author-Name: Singh, G.K. Author-Name: Kessel, W. Year: 1996 Volume: 86 Issue: 2 Pages: 240-242 Abstract: This paper examines the prevalence of multivitamin-mineral supplement use before and during pregnancy, as well as predictors of nonuse, in 9953 women who delivered live infants in the 1988 National Maternal and Infant Health Survey. Ninety-seven percent of the women were advised to take multivitamin- mineral supplements in prenatal care. Sixty-seven percent of Black mothers took supplements during pregnancy, as compared with 84% of White mothers. Multivariate analysis revealed that Black mothers; mothers who are less educated, younger, unmarried, and non-smokers; and mothers who participate in Women, Infants, and Children programs are at elevated risk for nonuse. These data help identify groups in need of supplementation guidance. Handle: RePEc:aph:ajpbhl:1996:86:2:240-242_7 Template-Type: ReDIF-Article 1.0 Title: An education program for parents of children with asthma: Differences in attendance between smoking and nonsmoking parents Journal: American Journal of Public Health Author-Name: Fish, L. Author-Name: Wilson, S.R. Author-Name: Latini, D.M. Author-Name: Starr, N.J. Year: 1996 Volume: 86 Issue: 2 Pages: 246-248 Abstract: We studied smoking status in relation to parental attendance at an asthma education program for child patients of a health maintenance organization. Nonattendance rates were 24%, 42%, and 78% in non-smoking, one-smoker, and two-or-more-smoker families, respectively, and 33% overall. Only the number of smokers (odds ratio [OR] = 3.1; 95% confidence interval [CI] = 1.8, 5.3) and perceived adverse impact of asthma on the family (OR = 0.4; 95% CI = 0.2, 0.9) were retained in a multivariate model that correctly classified 73% of families; demographic characteristics, frequency of asthma symptoms, and health care use were rejected. There was a tendency for smoking parents to deny that their child had asthma (17% among families with two or more smokers; 9% among nonsmoking families). Asthma education programs may fail to involve parents who smoke. Handle: RePEc:aph:ajpbhl:1996:86:2:246-248_2 Template-Type: ReDIF-Article 1.0 Title: The Washington Heights-Inwood Healthy Heart Program: A 6-year report from a disadvantaged urban setting Journal: American Journal of Public Health Author-Name: Shea, S. Author-Name: Basch, C.E. Author-Name: Wechsler, H. Author-Name: Lantigua, R. Year: 1996 Volume: 86 Issue: 2 Pages: 166-171 Abstract: Objectives. This report summarizes 6 years of experience in a large community-based cardiovascular disease prevention program in a predominately minority, urban setting. Methods. The program seeks to reduce cardiovascular disease risk factors in an area of approximately 240 000 people in New York, NY; this population includes many Latino immigrants of low educational attainment and socioeconomic status. All program materials were in Spanish and English and at a low literacy level. Results. Major elements that achieved high levels of reach and support were a marketing campaign promoting low-fat milk, exercise clubs, and a Spanish-language smoking cessation video. Program elements that did not meet expectations or were abandoned were school-based smoking prevention initiatives, cholesterol screening, and efforts to involve local physicians. At the end of 6 years, the program was transferred to a local community organization. Conclusions. Conclusions are that it is feasible to implement a complex cardiovascular disease prevention program in a socially disadvantaged urban community; that additional evaluation research is needed; that such programs can be transferred from an academic center to a community organization; and that such programs are unlikely to be sustained effectively without external resources. Handle: RePEc:aph:ajpbhl:1996:86:2:166-171_1 Template-Type: ReDIF-Article 1.0 Title: Is smoking associated with depression and anxiety in teenagers? Journal: American Journal of Public Health Author-Name: Patton, G.C. Author-Name: Hibbert, M. Author-Name: Rosier, M.J. Author-Name: Carlin, J.B. Author-Name: Caust, J. Author-Name: Bowes, G. Year: 1996 Volume: 86 Issue: 2 Pages: 225-230 Abstract: Objectives. An association of smoking with depression and anxiety has been documented in adult smokers. This study examines this association in a representative group of teenage smokers. Methods. A two-stage cluster sample of secondary school students in Victoria, Australia, were surveyed by using a computerized questionnaire, which included a 7-day retrospective diary for tobacco use and a structured psychiatric interview. Results. Subjects reporting high levels of depression and anxiety were twice as likely to be smokers after the potential confounders of year level, sex, alcohol use, and parental smoking were controlled for. Regular smokers were almost twice as likely as occasional smokers to report high levels of depression and anxiety. In a stratified analysis, an association between regular smoking and psychiatric morbidity was found in girls of all ages but for boys only in the youngest group. Conclusions. The cross-sectional association is consistent with the use of smoking by teenage girls as self-medication for depression and anxiety. Therefore, future health promotional campaigns might consider strategies that attend to perceived psychological benefits of smoking. Handle: RePEc:aph:ajpbhl:1996:86:2:225-230_3 Template-Type: ReDIF-Article 1.0 Title: Maternal smoking during pregnancy and the risk of congenital urinary tract anomalies Journal: American Journal of Public Health Author-Name: Li, D.-K. Author-Name: Mueller, B.A. Author-Name: Hickok, D.E. Author-Name: Daling, J.R. Author-Name: Fantel, A.G. Author-Name: Checkoway, H. Author-Name: Weiss, N.S. Year: 1996 Volume: 86 Issue: 2 Pages: 249-253 Abstract: To study maternal smoking during pregnancy and the risk of congenital urinary tract anomalies, we interviewed mothers of 118 affected infants born to residents of western Washington State during 1990 and 1991 and mothers of 369 control infants randomly selected from those without birth defects delivered during those years in five hospitals in King County, Washington. Maternal smoking was associated with an increased risk of congenital urinary tract anomalies in offspring (adjusted odds ratio [OR] = 2.3; 95% confidence interval [CI] = 1.2, 4.5). This risk was higher among light smokers (1-1000 cigarettes during the pregnancy) (OR = 3.7; 95% CI = 1.7, 8.6) than among heavy smokers (OR = 1.4; 95% CI = 0.6, 3.3). Our results corroborate previous findings and support the hypothesis of a causal relation. Handle: RePEc:aph:ajpbhl:1996:86:2:249-253_4 Template-Type: ReDIF-Article 1.0 Title: Temporal variation in drinking water turbidity and diagnosed gastroenteritis in Milwaukee Journal: American Journal of Public Health Author-Name: Morris, R.D. Author-Name: Naumova, E.N. Author-Name: Levin, R. Author-Name: Munasinghe, R.L. Year: 1996 Volume: 86 Issue: 2 Pages: 237-239 Abstract: Daily counts of diagnosed gastroenteritis (gastrointestinal events) in Milwaukee County, Wisconsin, from January 1992 through April 1993 were compared with reported daily turbidity the two drinking water treatment plants serving the county. Turbidity in both plants was associated with an increased number of gastrointestinal events even after exclusion of a major documented outbreak of cryptosporidiosis. During the 434-day period prior to the outbreak, an increase in turbidity of 0.5 nephelometric turbidity units at one of the plants was associated with relative risks for gastrointestinal events of 2.35 among children (95% confidence interval [CI] = 1.34, 4.12) and 1.17 among adults (95% CI = 0.91, 1.52). Handle: RePEc:aph:ajpbhl:1996:86:2:237-239_6 Template-Type: ReDIF-Article 1.0 Title: Smoking prevalence in US birth cohorts: The influence of gender and education Journal: American Journal of Public Health Author-Name: Escobedo, L.G. Author-Name: Peddicord, J.P. Year: 1996 Volume: 86 Issue: 2 Pages: 231-236 Abstract: Objectives. To assess long-term trends in cigarette smoking according to the combined influence of sex and education, this study examined smoking prevalence in successive US birth cohorts. Methods. Data from nationally representative surveys were examined to assess smoking prevalence for six successive 10-year birth cohorts stratified by race or ethnicity, sex, and educational attainment. Results. Substantial declines in smoking prevalence were found among men who had a high school education or more, regardless of race or ethnicity, and slight declines among women of the same educational background were revealed. However, little change was found in smoking prevalence among men of all race/ethnic groups with less than a high school education, and large increases were found among women with the same years of schooling, especially if they were White or African American. Conclusions. These data suggest that persons of low educational attainment have yet to benefit from policies and education about the health consequences of cigarette smoking. Handle: RePEc:aph:ajpbhl:1996:86:2:231-236_3 Template-Type: ReDIF-Article 1.0 Title: Smoking cessation in young adults: Age at initiation of cigarette smoking and other suspected influences Journal: American Journal of Public Health Author-Name: Breslau, N. Author-Name: Peterson, E.L. Year: 1996 Volume: 86 Issue: 2 Pages: 214-220 Abstract: Objectives. Previous research has suggested that early smoking initiation predicts longer duration of smoking, heavier daily consumption, and increased chances of nicotine dependence. This report set out to estimate the relationship between smoking cessation and age of initiation, as well as nicotine dependence, sex, race, and education. Methods. A sample of 1007 young adults was randomly selected from a large health maintenance organization in southeast Michigan. Hazard ratios of quitting associated with age at smoking initiation were estimated among 414 persons who smoked daily for 1 month or more. Results. With potential confounders controlled for, the likelihood of cessation was significantly higher in smokers who initiated smoking after age 13. The hazard ratio for quitting associated with smoking initiation at ages 14 to 16 was 1.6 and with initiation at or after age 17 was 2.0, compared with initiation at or before 13 years of age. Factors that decreased the likelihood of cessation were nicotine dependence and low education. Conclusions. Public policy to discourage early smoking, if it succeeds in delaying the initiation of smoking, might contribute to the reduction of smoking-related mortality and morbidity by increasing the potential for quitting. Handle: RePEc:aph:ajpbhl:1996:86:2:214-220_9 Template-Type: ReDIF-Article 1.0 Title: The prevalence of self-reported peptic ulcer in the United States Journal: American Journal of Public Health Author-Name: Sonnenberg, A. Author-Name: Everhart, J.E. Year: 1996 Volume: 86 Issue: 2 Pages: 200-205 Abstract: Objectives. The purpose of this study was to draw a current picture of the sociodemographic characteristics of peptic ulcer in the United States. Methods. During the National Health Interview Survey of 1989, a special questionnaire on digestive diseases was administered to 41 457 randomly selected individuals. Data were retrieved from public use tapes provided by the National Center for Health Statistics. Odds ratios were calculated by logistic regression after adjustment for sample weights in the survey. Results. Of adult US residents, 10% reported having physician-diagnosed ulcer disease, and one third of these individuals reported having an ulcer in the past year. Old age, short education, low family income, being a veteran, and smoking acted as significant and independent risk factors. Gastric and duodenal ulcer occurred in both sexes equally often. Duodenal ulcer was more common in Whites than non-Whites, while gastric ulcer was more common in non- Whites. Conclusions. The age-related rise and socioeconomic gradients of peptic ulcer represent the historic scars of previous infection rates with Helicobacter pylori. The racial variations reflect different ages at the time of first infection; younger and older age at the acquisition of H. pylori appear to be associated with gastric and duodenal ulcer, respectively. Handle: RePEc:aph:ajpbhl:1996:86:2:200-205_4 Template-Type: ReDIF-Article 1.0 Title: Preventing cardiovascular disease through community-based risk reduction: The Bootheel Heart Health Project Journal: American Journal of Public Health Author-Name: Brownson, R.C. Author-Name: Smith, C.A. Author-Name: Pratt, M. Author-Name: Mack, N.E. Author-Name: Jackson-Thompson, J. Author-Name: Dean, C.G. Author-Name: Dabney, S. Author-Name: Wilkerson, J.C. Year: 1996 Volume: 86 Issue: 2 Pages: 206-213 Abstract: Objectives. The purpose of this study was to determine whether a community-based risk reduction project affected behavioral risk factors for cardiovascular disease. Methods. Community-based activities (e.g., exercise groups, healthy cooking demonstrations, blood pressure and cholesterol screenings, and cardiovascular disease education) were conducted in six southeastern Missouri counties. Evaluation involved population-based, cross- sectional samples of adult residents of the state and the intervention region. Weighted prevalence estimates were calculated for self-reported physical inactivity, cigarette smoking, consumption of fruits and vegetables, overweight, and cholesterol screening. Results. Physical inactivity decreased within the intervention region, that is, in communities where heart health coalitions were developed and among respondents who were aware of these coalitions. In addition, the prevalence rates for reports of cholesterol screening within the past 2 years were higher for respondents in areas with coalitions and among persons who were aware of the coalitions. Conclusions. Even with modest resources, community-based interventions show promise in reducing self-reported risk for cardiovascular disease within a relatively brief period. Handle: RePEc:aph:ajpbhl:1996:86:2:206-213_9 Template-Type: ReDIF-Article 1.0 Title: Occupational exposure to chrysotile asbestos and cancer risk: A review of the amphibole hypothesis Journal: American Journal of Public Health Author-Name: Stayner, L.T. Author-Name: Danhovic, D.A. Author-Name: Lemen, R.A. Year: 1996 Volume: 86 Issue: 2 Pages: 179-186 Abstract: Objectives. This article examines the credibility and policy implications of the 'amphibole hypothesis,' which postulates that (1) the mesotheliomas observed among workers exposed to chrysotile asbestos may be explained by confounding exposures to amphiboles, and (2) chrysotile may have lower carcinogenic potency than amphiboles. Methods. A critical review was conducted of the lung burden, epidemiologic, toxicologic, and mechanistic studies that provide the basis for the amphibole hypothesis. Results. Mechanistic and lung burden studies do not provide convincing evidence for the amphibole hypothesis. Toxicologic and epidemiologic studies provide strong evidence that chrysotile is associated with an increased risk of lung cancer and mesothelioma. Chrysotile may be less potent than some amphiboles for inducing mesotheliomas, but there is little evidence to indicate lower lung cancer risk. Conclusions. Given the evidence of a significant lung cancer risk, the lack of conclusive evidence for the amphibole hypothesis, and the fact that workers are generally exposed to a mixture of fibers, we conclude that it is prudent to treat chrysotile with virtually the same level of concern as the amphibole forms of asbestos. Handle: RePEc:aph:ajpbhl:1996:86:2:179-186_4 Template-Type: ReDIF-Article 1.0 Title: The elimination of selected chronic diseases in a population: The compression and expansion of morbidity Journal: American Journal of Public Health Author-Name: Nusselder, W.J. Author-Name: Van Velden, K.D. Author-Name: Van Sonsbeek, J.L.A. Author-Name: Lenior, M.E. Author-Name: Van Den Bos, G.A.M. Year: 1996 Volume: 86 Issue: 2 Pages: 187-194 Abstract: Objectives. This study evaluates the effect of eliminating a specific disease on the mortality, long-term disability, and overall health status of a population. Primarily, it examines whether elimination leads to a compression of morbidity. Methods. The Sullivan method was used to calculate disability-free life expectancy. Cause-deleted disability prevalence was estimated with a multiple logistic regression model that used data from the Dutch National Survey of General Practice. Cause-deleted probabilities of dying were derived with the cause-elimination life-table technique, assuming independence among competing causes of death. Results. Eliminating disabling nonfatal diseases such as arthritis/back complaints results in a decline in life expectancy with disability-that is, an absolute compression of morbidity. Eliminating highly fatal diseases such as cancer leads to an increase in the number of years and the proportion of life with disability- that is, a relative expansion of morbidity. Conclusions. While eliminating fatal diseases leads to an increase in disability-free life expectancy, life expectancy with disability may increase as well. This represents an increasing burden to society. On the other hand, eliminating nonfatal disabling diseases leads to absolute compression of morbidity. Handle: RePEc:aph:ajpbhl:1996:86:2:187-194_7 Template-Type: ReDIF-Article 1.0 Title: The validity of hospital administrative data in monitoring variations in breast cancer surgery Journal: American Journal of Public Health Author-Name: Kahn, L.H. Author-Name: Blustein, J. Author-Name: Arons, R.R. Author-Name: Yee, R. Author-Name: Shea, S. Year: 1996 Volume: 86 Issue: 2 Pages: 243-245 Abstract: To assess the validity of using hospital administrative data to measure variations in surgery for early-stage breast cancer, ICD-9-CM coded information was compared with corresponding tumor registry data for 1293 breast cancer patients undergoing lumpectomy or mastectomy at a tertiary referral center from January 1989 to October 1993. Relative to 'gold standard' tumor registry data, the administrative data proved 83.4% sensitive and 80.4% specific in identifying women with localized disease who would be potential candidates for lumpectomy. The proportion of women with localized disease undergoing lumpectomy in groups defined by race and insurance status was nearly identical, whichever data were used. Administrative data, which is often readily and publicly available, may be useful in studying variations in breast cancer treatment in key demographic groups. Handle: RePEc:aph:ajpbhl:1996:86:2:243-245_8 Template-Type: ReDIF-Article 1.0 Title: Chronic gynecological conditions reported by US women: Findings from the National Health Interview Survey, 1984 to 1992 Journal: American Journal of Public Health Author-Name: Kjerulff, K.H. Author-Name: Erickson, B.A. Author-Name: Langenberg, P.W. Year: 1996 Volume: 86 Issue: 2 Pages: 195-199 Abstract: Objectives. This study sought to describe prevalence rates of chronic gynecological conditions and correlates of these conditions in a representative sample of US women. Methods. National Health Interview Survey data from 1984 through 1992 for women aged 18 to 50 were used. Results. The estimated annual prevalence rate for the reported presence of one or more gynecological conditions was 97.1 per 1000 women. Menstrual disorders were most common, with an annual prevalence rate of 53.0 per 1000 women. Adnexal conditions and fibroids were the next most common conditions, with rates per 1000 women of 16.6 and 9.2, respectively. Prolapse, endometriosis, and fibroids were the conditions most likely to lead to hysterectomy within the year prior to the interview. More than three quarters (77.1%) of women with gynecological conditions had talked with a doctor in the previous year concerning their condition, and 28.8% reported spending 1 or more days in bed in the previous year because of their condition. Conclusions. Nearly a tenth of American women aged 18 to 50 report having one or more chronic gynecological conditions annually, the most common being disorders of menstruation. Handle: RePEc:aph:ajpbhl:1996:86:2:195-199_5 Template-Type: ReDIF-Article 1.0 Title: The injection of crack cocaine among Chicago drug users Journal: American Journal of Public Health Author-Name: Johnson, W.A. Author-Name: Ouellet, L.J. Year: 1996 Volume: 86 Issue: 2 Pages: 266 Handle: RePEc:aph:ajpbhl:1996:86:2:266_5 Template-Type: ReDIF-Article 1.0 Title: Temporarily detained: Tuberculous alcoholics in Seattle, 1949 through 1960 Journal: American Journal of Public Health Author-Name: Lerner, B.H. Year: 1996 Volume: 86 Issue: 2 Pages: 257-265 Abstract: Repeatedly noncompliant tuberculosis patients (who are often homeless or substance users) are once again being forcibly detained. Health officials intend that confinement be used only when 'less restrictive alternatives' have failed. Past programs of detention can inform current efforts. In 1949, Seattle's Firland Sanatorium established a locked ward. Although initially intended only for active public health threats, the ward was eventually used to maintain order among Firland's alcoholic patients. That is, the staff detained alcoholics-regardless of their infectivity or compliance with medications-for breaking sanatorium rules. In this manner, maintaining institutional order became a legitimate reason for invoking public health powers. Although new detention regulations strive to protect patients' civil liberties, attention must also be paid to the day-to-day implementation of coercive measures. When public health language is used to justify administrative or institutional requirements, disadvantaged patients may be stigmatized. Handle: RePEc:aph:ajpbhl:1996:86:2:257-265_9 Template-Type: ReDIF-Article 1.0 Title: Who administers? Who cares? Medical administrative and clinical employment in the United States and Canada Journal: American Journal of Public Health Author-Name: Himmelstein, D.U. Author-Name: Lewontin, J.P. Author-Name: Woolhandler, S. Year: 1996 Volume: 86 Issue: 2 Pages: 172-178 Abstract: Objectives. We compared US and Canadian health administration costs using national medical care employment data for both countries. Methods. Data from census surveys on hospital, nursing home, and outpatient employment in the United States (1968 to 1993) and Canada (1971 and 1986) were analyzed. Results. Between 1968 and 1993, US medical care employment grew from 3.976 to 10.308 million full-time equivalents. Administration grew from 0.719 to 2.792 million full-time equivalents, or from 18.1% to 27.1% of the total employment. In 1986, the United States deployed 33 666 health care full-time equivalent personnel per million population, and Canada deployed 31 529. The US excess was all administrative; Canada employed more clinical personnel, especially registered nurses. Between 1971 and 1986, hospital employment per capita grew 29% in the United States (mostly because of administrative growth) and fell 14% in Canada. In 1986, Canadian hospitals still employed more clinical staff per million. Outpatient employment was larger and grew faster in the United States. Per capita nursing home employment was substantially higher in Canada. Conclusions. If US hospitals and outpatient facilities adopted Canada's staffing patterns, 1 407 000 fewer managers and clerks would be necessary. Despite lower medical spending, Canadians receive slightly more nursing and other clinical care than Americans, as measured by labor inputs. Handle: RePEc:aph:ajpbhl:1996:86:2:172-178_6 Template-Type: ReDIF-Article 1.0 Title: Burn-related physical impairments and disabilities in Ghanaian children: Prevalence and risk factors Journal: American Journal of Public Health Author-Name: Forjuoh, S.N. Author-Name: Guyer, B. Author-Name: Ireys, H.T. Year: 1996 Volume: 86 Issue: 1 Pages: 81-83 Abstract: The prevalence and risk factors for childhood burn-related physical impairments and disabilities in Ghana were determined with data from mothers of burned children. Of 650 identified bums, 113 (17.4%) resulted in physical impairments; 5 (1%) resulted in physical disabilities. After multivariate adjustment, the odds of developing burn-related physical impairments were increased by bums with protracted healing (odds ratio [OR] = 5.80), burns to the head/neck (OR = 3.44), burns involving skin removal (OR = 3.04), and wound infection (OR = 2.03) and decreased by first aid (OR = 0.51) and maternal education (OR = 0.54). Education on the proper care of bums may prevent burn-related physical impairments. The results also underscore the link between maternal education and child morbidity. Handle: RePEc:aph:ajpbhl:1996:86:1:81-83_5 Template-Type: ReDIF-Article 1.0 Title: Total hip arthroplasty: Use and select complications in the US Medicare population Journal: American Journal of Public Health Author-Name: Baron, J.A. Author-Name: Barrett, J. Author-Name: Katz, J.N. Author-Name: Liang, M.H. Year: 1996 Volume: 86 Issue: 1 Pages: 70-72 Abstract: Use and outcomes of primary total hip arthroplasty among US Medicare recipients more than 65 years of age were investigated by means of physician and hospital claims for a 5% random sample during 1986 through 1989. Cases involving hip fracture or evidence of existing orthopedic devices in the hip were omitted. Use rates were higher for women than for men and were substantially lower for Blacks than Whites. Major complications (death, further hip surgery, infection, pulmonary embolism) were uncommon. These data document the frequent use of total hip arthroplasty, and confirm the rarity of serious adverse outcomes. Further studies should investigate the lower use of total hip arthroplasty among Blacks. Handle: RePEc:aph:ajpbhl:1996:86:1:70-72_2 Template-Type: ReDIF-Article 1.0 Title: Accidents and acts of God: A history of the terms Journal: American Journal of Public Health Author-Name: Loimer, H. Author-Name: Guamieri, M. Year: 1996 Volume: 86 Issue: 1 Pages: 101-107 Abstract: Despite criticism from safety professionals, scientists continue to use the word accident, meaning an unexpected, unintended injury or event. Some argue for its use based on tradition, but 'traditional' arguments appear to be invalid given our examination of the history of the word and its companion phrase act of God in statistics, law, and religion. People who were interested in public health recognized in the 1600s that unintended injuries were neither random nor unexpected. Legal scholars in the 1800s saw the word was useless for technical purposes. The word does not appear in the Bible until the mid-1900s, and then only in a paraphrased edition. Others have maintained that the meaning of accident is well understood, even though it has not been perfectly defined. We maintain that without a clear definition, people substitute an image, which may be distorted or damaging. Handle: RePEc:aph:ajpbhl:1996:86:1:101-107_9 Template-Type: ReDIF-Article 1.0 Title: Workers' compensation recipients with carpal tunnel syndrome: The validity of self-reported health measures Journal: American Journal of Public Health Author-Name: Katz, J.N. Author-Name: Punnett, L. Author-Name: Simmons, B.P. Author-Name: Fossel, A.H. Author-Name: Mooney, N. Author-Name: Keller, R.B. Year: 1996 Volume: 86 Issue: 1 Pages: 52-56 Abstract: Objectives. This study compared the reliability, validity, and responsiveness of self-reported measures of health-related quality of life in recipients and non-recipients of workers' compensation who have carpal tunnel syndrome. Methods. Patients with carpal tunnel syndrome completed questionnaires at study enrollment and 6 months later; scales measuring symptom severity, functional status, and satisfaction were included. The scales' internal consistency, validity, and responsiveness were assessed. Results. The internal consistencies for each scale were high (Cronbach's alpha .88 to .96) and virtually identical in recipients and nonrecipients of workers' compensation. The correlations between self-reported and objectively measured grip strength were .32 in recipients and .30 in nonrecipients; these correlations were not influenced by whether workers' compensation recipients were out of work. Correlations between changes in scale scores and three indicators of perceived improvement were higher in recipients (.48 to .69) than in nonrecipients (.19 to .41). Conclusions. The reliability, validity, and responsiveness of these measures were comparable in nonrecipients and recipients of workers' compensation; these data support the use of self- report measures in studies of workers. Handle: RePEc:aph:ajpbhl:1996:86:1:52-56_0 Template-Type: ReDIF-Article 1.0 Title: Reducing death on the road: The effects of minimum safety standards, publicized crash tests, seat belts, and alcohol Journal: American Journal of Public Health Author-Name: Robertson, L.S. Year: 1996 Volume: 86 Issue: 1 Pages: 31-34 Abstract: Objectives. Two phases of attempts to improve passenger car crashworthiness have occurred: minimum safety standards and publicized crash tests. This study evaluated these attempts, as well as changes in seat belt and alcohol use, in terms of their effect on occupant death and fatal crash rates. Methods. Data on passenger car occupant fatalities and total involvement in fatal crashes, for 1975 through 1991, were obtained from the Fatal Accident Reporting System. Rates per mile were calculated through published sources on vehicle use by vehicle age. Regression estimates of effects of regulation, publicized crash tests, seat belt use, and alcohol involvement were obtained. Results. Substantial reductions in fatalities occurred in the vehicle model years from the late 1960s through most of the 1970s, when federal standards were applied. Some additional increments in reduced death rates, attributable to additional improved vehicle crashworthiness, occurred during the period of publicized crash tests. Increased seat belt use and reduced alcohol use also contributed significantly to reduced deaths. Conclusions. Minimum safety standards, crashworthiness improvements, seat belt use laws, and reduced alcohol use each contributed to a large reduction in passenger car occupant deaths. Handle: RePEc:aph:ajpbhl:1996:86:1:31-34_2 Template-Type: ReDIF-Article 1.0 Title: Occupational injury mortality rates in the United States: Changes from 1980 to 1989 Journal: American Journal of Public Health Author-Name: Stout, N.A. Author-Name: Jenkins, E.L. Author-Name: Pizatella, T.J. Year: 1996 Volume: 86 Issue: 1 Pages: 73-77 Abstract: Changes in occupational injury mortality rates over the 1980s were examined through analysis of the National Traumatic Occupational Fatalities surveillance system. The US occupational injury mortality rate decreased 37% over the decade, with decreases seen in nearly every demographic and employment sector. Greater declines were among men, Blacks, and younger workers, as well as among agricultural, trade, and service workers. Electrocutions, machine-related incidents, and homicides showed the greatest decreases. Changes in occupational mortality rates by demography, industry, and cause of death indicate the areas in which the most progress has been made and those that are prime targets for prevention efforts. Handle: RePEc:aph:ajpbhl:1996:86:1:73-77_9 Template-Type: ReDIF-Article 1.0 Title: The loss of independence in activities of daily living: The role of low normal cognitive function in elderly nuns Journal: American Journal of Public Health Author-Name: Greiner, P.A. Author-Name: Snowdon, D.A. Author-Name: Schmitt, F.A. Year: 1996 Volume: 86 Issue: 1 Pages: 62-66 Abstract: Objectives. This study investigated the role of low normal cognitive function in the subsequent loss of independence in activities of daily living. Methods. Of the 678 elderly nuns who completed cognitive and physical function assessments in 1992/93, 575 were reassessed in 1993/94. Mini-Mental State Examination scores were divided into three categories and related to loss of independence in six activities of daily living. Results. Participants with low normal cognitive function at first assessment had twice the risk of losing independence in three activities of daily living by second assessment relative to those with high normal cognitive function. This relationship was largely due to a progression from low normal cognitive function at first assessment to impaired cognitive function at second assessment and was associated with an elevated risk of losing independence in the six activities. Conclusions. Progression from low normal to impaired cognitive function was associated with loss of independence in activities of daily living. Thus, low normal cognitive function could be viewed as an early warning of impending cognitive impairment and loss of physical function. Handle: RePEc:aph:ajpbhl:1996:86:1:62-66_6 Template-Type: ReDIF-Article 1.0 Title: Why are most drowning victims men? Sex differences in aquatic skills and behaviors Journal: American Journal of Public Health Author-Name: Howland, J. Author-Name: Hingson, R. Author-Name: Mangione, T.W. Author-Name: Bell, N. Author-Name: Bak, S. Year: 1996 Volume: 86 Issue: 1 Pages: 93-96 Abstract: Men have higher drowning rates than women for most age groups. Data from a 1991 national household survey (n = 3042) on aquatic activities were used to examine hypotheses about differential drowning rates by sex. Men and women were compared by (1) exposure to aquatic environments; (2) frequency of aquatic activities involving, or potentially involving, submersion; (3) swimming training and ability; (4) aquatic risk-taking behaviors; and (5) alcohol use on or near the water. Men had elevated risks for exposure, risk taking and alcohol use. It was concluded that several factors contribute to their relatively high drowning rates, including a possible interaction between overestimation of abilities and heavy alcohol use. Handle: RePEc:aph:ajpbhl:1996:86:1:93-96_0 Template-Type: ReDIF-Article 1.0 Title: Patterns in US medical expenditures and utilization for injury, 1987 Journal: American Journal of Public Health Author-Name: Miller, T.R. Author-Name: Lestina, D.C. Year: 1996 Volume: 86 Issue: 1 Pages: 89-93 Abstract: This article is based on data released in 1991/93 from the 1987 National Medical Expenditure Survey. Medical spending and utilization patterns are analyzed for 13 major categories of injury. Medical spending on injury in 1987 was $64.7 billion in 1993 dollars. Nonhospitalized medically treated injuries averaged $571 in medical spending on injuries during 1987 is 10% lower than the incidence-based estimates of lifetime medical spending resulting from injuries in 1985. Handle: RePEc:aph:ajpbhl:1996:86:1:89-93_1 Template-Type: ReDIF-Article 1.0 Title: Activity level and risk of overweight in male health professionals Journal: American Journal of Public Health Author-Name: Ching, P.L.Y.H. Author-Name: Willett, W.C. Author-Name: Rimm, E.B. Author-Name: Colditz, G.A. Author-Name: Gortmaker, S.L. Author-Name: Stampfer, M.J. Year: 1996 Volume: 86 Issue: 1 Pages: 25-30 Abstract: Objectives. This study undertook to examine relationships between nonsedentary activity level, time spent watching television (TV)/videocassette recorder (VCR), and risk of overweight among men. Methods. Men participating in the Health Professionals Follow-Up Study were mailed surveys. Cross-sectional analyses examined the prevalence and odds of being overweight; prospective analyses determined cumulative incidence rates and relative risks of becoming overweight over 2 years of follow-up. Results. Cross-sectionally, odds of being overweight were 50% (95% confidence interval [CI] = 45%, 55%) lower for men in the highest quintile of nonsedentary activity level when compared with men in the lowest quintile. Among men watching 41 or more hours of TV/VCR per week, the odds of being overweight were 4.06 (95% CI = 2.67, 6.17) times greater than those for men watching no more than 1 hour per week. Prospectively, higher levels of nonsedentary activity and lower levels of TV/VCR viewing were independently associated with lower relative risks for becoming overweight between survey years. Conclusions. Both a lack of nonsedentary activity and time spent watching TV/VCR contribute to the development of overweight in men. Sedentary and nonsedentary activities represent separate domains, each with independent risks for overweight. Handle: RePEc:aph:ajpbhl:1996:86:1:25-30_6 Template-Type: ReDIF-Article 1.0 Title: Injuries among inner-city minority women: A population-based longitudinal study Journal: American Journal of Public Health Author-Name: Grisso, J.A. Author-Name: Schwarz, D.F. Author-Name: Miles, C.G. Author-Name: Holmes, J.H. Year: 1996 Volume: 86 Issue: 1 Pages: 67-70 Abstract: Active emergency department-based surveillance was conducted to determine the incidence of fatal and nonfatal injuries in an urban, female African American population from 1987 through 1990. Nearly 40% of the women studied sustained one or more injuries that required emergency care or resulted in death. By 1989, violence had surpassed falls as the leading cause of injuries; the rate increased by 55% over the study period. Injury rates were highest among young women for nearly every major cause of injury. The rate of death due to injuries was also highest among young women, for whom violence was the leading cause of death. In summary, injuries to women in this inner- city minority community were extremely common and increased significantly from 1987 to 1990. Injuries in young inner-city minority women should be considered a priority health problem in the United States. Handle: RePEc:aph:ajpbhl:1996:86:1:67-70_1 Template-Type: ReDIF-Article 1.0 Title: The effect of walking on lower body disability among older Blacks and Whites Journal: American Journal of Public Health Author-Name: Clark, D.O. Year: 1996 Volume: 86 Issue: 1 Pages: 57-61 Abstract: Objectives. This study investigated the association between regular physical activity and risk of or increase in lower body disability in older, community-dwelling Blacks and Whites. Method. The present study used the 1984 to 1990 Longitudinal Study on Aging, which included 413 Black and 3428 White self-respondents 70 years of age or older. Discrete-time hazard models provided estimates of the effects of self-reported walking frequency and regular exercise on lower body disability among Black and White self- respondents. Results. Whites who reported walking 4 to 7 days per week at baseline vs those who reported never walking 1 mile (1.6 km) or more experienced a one-third lower risk of increased disability. Blacks who reported walking 4 to 7 days per week experienced a two-thirds lower risk. Walking 4 to 7 days per week reduced the risk of disability onset by 50% to 80% on all five disability items within the Black sample and by 50% on two items within the White sample. Conclusions. Among older Blacks, walking 4 to 7 days per week had a greater protective effect against lower body decline than any of the other factors, including age and chronic conditions. Handle: RePEc:aph:ajpbhl:1996:86:1:57-61_6 Template-Type: ReDIF-Article 1.0 Title: Capodanno Senza Danno: The effects of an intervention program on fireworks injuries in Naples Journal: American Journal of Public Health Author-Name: D'Argenio, P. Author-Name: Cafaro, L. Author-Name: Santonastasi, F. Author-Name: Taggz, F. Author-Name: Binkin, N. Year: 1996 Volume: 86 Issue: 1 Pages: 84-86 Abstract: To study the effects of a comprehensive, multifaceted intervention program to reduce fireworks-related injuries during the Italian New Year's holiday season, active surveillance was conducted in the 18 public emergency rooms of Naples, Italy, before and after implementation of the program. Preintervention data collected between December 24, 1992, and January 6, 1993, were compared with data collected during the same period in 1993-1994. The number of injuries decreased by 48%, from 353 to 183, with the greatest declines seen among 10- to 12-year-olds. The broad-based intervention implemented during the 1993-1994 holiday season appears to have substantially reduced the number of injuries. Handle: RePEc:aph:ajpbhl:1996:86:1:84-86_3 Template-Type: ReDIF-Article 1.0 Title: Homicide risk among immigrants in California, 1970 through 1992 Journal: American Journal of Public Health Author-Name: Sorenson, S.B. Author-Name: Shen, H. Year: 1996 Volume: 86 Issue: 1 Pages: 97-100 Abstract: According to the death certificates of the 65 510 California residents who died of homicide from 1970 through 1992, foreign-born persons are overrepresented in the homicides of California residents. Analysis of homicide data for 15- to 34-year-olds (n = 38 774), who account for a majority of all victims, indicated that immigrant-to-nonimmigrant risk patterns differed by ethnicity and across time. During the 23-year study period, foreign-born White. Hispanics, and Asians and other were at significantly higher risk and foreign-born Blacks were at a statistically similar risk of homicide compared with their US-born counterparts (risk ratio = 2,12, 1.24, 1.72, and 0.60, respectively). Handle: RePEc:aph:ajpbhl:1996:86:1:97-100_6 Template-Type: ReDIF-Article 1.0 Title: Violence and injury in marital arguments: Risk patterns and gender differences Journal: American Journal of Public Health Author-Name: Sorenson, S.B. Author-Name: Upchurch, D.M. Author-Name: Shen, H. Year: 1996 Volume: 86 Issue: 1 Pages: 35-40 Abstract: Objectives. Community-based research on violence against women typically focuses on marital arguments rather than on resulting injuries. This study investigated patterns of victimization, violence perpetration, and injury in marital arguments. Methods. Data from the National Survey on Families and Households and binomial and multinomial logit models were used to analyze characteristics of those who experienced physical violence, as well as to determine who was the perpetrator and who was the victim. Results. Men and women reported similar behaviors during verbal arguments. Young persons, urban dwellers, the less educated, those with low incomes, and Blacks were more likely to report that there had been physical violence in their marriages in the past year. Ethnicity, income, education, and number and age of children at home were not associated consistently with injury of the wife, the husband, or both. Conclusions. Persons who report physical violence in their marriage are very similar to those who are at increased risk of interpersonal violence in general. The co-occurrence of street and other nonfamily violence with spousal violence may be a fruitful area for future research. Handle: RePEc:aph:ajpbhl:1996:86:1:35-40_6 Template-Type: ReDIF-Article 1.0 Title: The effects of a 4-year program promoting bicycle helmet use among children in Quebec Journal: American Journal of Public Health Author-Name: Farley, C. Author-Name: Haddad, S. Author-Name: Brown, B. Year: 1996 Volume: 86 Issue: 1 Pages: 46-51 Abstract: Objectives. This study assessed the effectiveness of a 4-year program of bicycle helmet promotion that targeted elementary school children in one region of Quebec. The program revolved primarily around persuasive communication and community organization, combining standard educational activities and activities to facilitate helmet acquisition and use. Methods. Helmet use was compared between more than 8000 young cyclists in municipalities exposed or not exposed to the program. Factors influencing helmet use were controlled through the use of multivariate analyses. Results. Helmet use increased from 1.3% before program implementation to 33% in 1993. The program was clearly effective in most cycling circumstances and for various groups of children. However, the benefits of the program were unequally distributed; the program was one third as effective in poorer municipalities as in 'average-rich' ones. Conclusions. This community-based program that combined various types of activities appeared to be effective. New intervention models are needed to ensure an equitable distribution of benefits. Handle: RePEc:aph:ajpbhl:1996:86:1:46-51_5 Template-Type: ReDIF-Article 1.0 Title: Assessment of a severe-weather warning system and disaster preparedness, Calhoun County, Alabama, 1994 Journal: American Journal of Public Health Author-Name: Liu, S. Author-Name: Quenemoen, L.E. Author-Name: Malilay, J. Author-Name: Noji, E. Author-Name: Sinks, T. Author-Name: Mendlein, J. Year: 1996 Volume: 86 Issue: 1 Pages: 87-89 Abstract: Tornado preparedness, warning system effectiveness, and shelter-seeking behavior were examined in two Alabama areas after tornado warnings. In the area without sirens, only 28.9% of 194 respondents heard a tornado warning; of these, 73.2% first received the warning from radios or television. In the area with sirens, 88.1% of 193 respondents heard a warning, and 61.8% first received the warning from a siren. Knowledge of warnings, access to shelter, and education were key predictors for seeking shelter. Our findings indicate that installing sirens, providing access to shelter, and teaching appropriate responses to warnings are important elements of an effective disaster prevention system. Handle: RePEc:aph:ajpbhl:1996:86:1:87-89_8 Template-Type: ReDIF-Article 1.0 Title: Smokers' knowledge and understanding of advertised tar numbers: Health policy implications Journal: American Journal of Public Health Author-Name: Cohen, J.B. Year: 1996 Volume: 86 Issue: 1 Pages: 18-24 Abstract: Objectives. This article examines health policy implications of providing smokers with numerical tar yield information in cigarette advertising. Methods. Results of a national probability telephone survey regarding smokers' knowledge and understanding of numerical tar yields and deliveries are reported. Results. Few smokers knew the tar level of their own cigarettes (the exception being smokers of 1- to 5-mg tar cigarettes), and a majority could not correctly judge the relative tar levels of cigarettes. Smokers were unsure whether switching to lower-tar cigarettes would reduce their personal health risks. Many smokers relied on absolute numbers in making trade-offs between number of cigarettes smoked and their tar levels, thus confusing machine-rated tar yields with actual amounts ingested. Conclusions. The wisdom of the present method of providing tar and nicotine numbers in ads and recommendations for modifying the test protocol are now under discussion. This research indicates that these tar numbers and their implications are poorly understood. The paper recommends revisions in tar ratings to make them more useful and a required statement on cigarette packages to more explicitly relate tar levels to major health risks. Handle: RePEc:aph:ajpbhl:1996:86:1:18-24_2 Template-Type: ReDIF-Article 1.0 Title: Motorcycle helmet use and injury outcome and hospitalization costs from crashes in Washington State Journal: American Journal of Public Health Author-Name: Rowland, J. Author-Name: Rivara, F. Author-Name: Salzberg, P. Author-Name: Soderberg, R. Author-Name: Maier, R. Author-Name: Koepsell, T. Year: 1996 Volume: 86 Issue: 1 Pages: 41-45 Abstract: Objectives. The incidence, type, severity, and costs of crash-related injuries requiring hospitalization or resulting in death were compared for helmeted and unhelmeted motorcyclists. Methods. This was a retrospective cohort study of injured motorcyclists in Washington State in 1989. Motorcycle crash data were linked to statewide hospitalization and death data. Results. The 2090 crashes included in this study resulted in 409 hospitalizations (20%) and 59 fatalities (2.8%). Although unhelmeted motorcyclists were only slightly more likely to be hospitalized overall, they were more severely injured, nearly three times more likely to have been head injured, and nearly four times more likely to have been severely or critically head injured than helmeted riders. Unhelmeted riders were also more likely to he readmitted to a hospital for follow-up treatment and to die from their injuries. The average hospital stay for unhelmeted motorcyclists was longer and cost more per case; the cost of hospitalization for unhelmeted motorcyclists was 60% more overall ($3.5 vs $2.2 million). Conclusions. Helmet use is strongly associated with reduced probability and severity of injury, reduced economic impact, and a reduction in motorcyclist deaths. Handle: RePEc:aph:ajpbhl:1996:86:1:41-45_5 Template-Type: ReDIF-Article 1.0 Title: Mercury use in espiritismo: A survey of botanicas Journal: American Journal of Public Health Author-Name: Zayas, L.H. Author-Name: Ozuah, P.O. Year: 1996 Volume: 86 Issue: 1 Pages: 111-112 Handle: RePEc:aph:ajpbhl:1996:86:1:111-112_3 Template-Type: ReDIF-Article 1.0 Title: The hazards of epidemiology, continued. Journal: American Journal of Public Health Author-Name: Staines, A. Year: 1996 Volume: 86 Issue: 2 Pages: 267 Handle: RePEc:aph:ajpbhl:1996:86:2:267_1 Template-Type: ReDIF-Article 1.0 Title: A call for the destruction of smallpox virus stores. Journal: American Journal of Public Health Author-Name: Donohoe, M.T. Year: 1996 Volume: 86 Issue: 2 Pages: 268 Handle: RePEc:aph:ajpbhl:1996:86:2:268_6 Template-Type: ReDIF-Article 1.0 Title: Erratum: The costs and effects of a nutritional education program following work-site cholesterol screening (American Journal of Public Health (1995) 85 (650-655)) Journal: American Journal of Public Health Author-Name: Byers, T. Author-Name: Mullis, R. Author-Name: Anderson, J. Year: 1996 Volume: 86 Issue: 6 Pages: 790 Handle: RePEc:aph:ajpbhl:1996:86:6:790_9 Template-Type: ReDIF-Article 1.0 Title: Native Hawaiian mortality, 1980 and 1990. Journal: American Journal of Public Health Author-Name: Braun, K.L. Author-Name: Look, M.A. Author-Name: Yang, H. Author-Name: Onaka, A.T. Author-Name: Horiuchi, B.Y. Year: 1996 Volume: 86 Issue: 6 Pages: 888-889 DOI: 10.2105/AJPH.86.6.888 File-URL: http://hdl.handle.net/10.2105/AJPH.86.6.888 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.6.888_2 Template-Type: ReDIF-Article 1.0 Title: The promise of risk-based allocation trials in assessing new treatments. Journal: American Journal of Public Health Author-Name: Mosteller, F. Year: 1996 Volume: 86 Issue: 5 Pages: 622-623 DOI: 10.2105/AJPH.86.5.622 File-URL: http://hdl.handle.net/10.2105/AJPH.86.5.622 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.5.622_7 Template-Type: ReDIF-Article 1.0 Title: Estimating the prevalence of women with breast implants. Journal: American Journal of Public Health Author-Name: Bright, R.A. Author-Name: Moore Jr., R.M. Year: 1996 Volume: 86 Issue: 6 Pages: 891-892 DOI: 10.2105/AJPH.86.6.891 File-URL: http://hdl.handle.net/10.2105/AJPH.86.6.891 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.6.891_5 Template-Type: ReDIF-Article 1.0 Title: Maine students' musculoskeletal injuries attributed to harvesting blueberries. Journal: American Journal of Public Health Author-Name: Millard, P.S. Author-Name: Shannon, S.C. Author-Name: Carvette, B. Author-Name: Tanaka, S. Author-Name: Halperin, W.E. Year: 1996 Volume: 86 Issue: 12 Pages: 1821-1822 DOI: 10.2105/AJPH.86.12.1821-a File-URL: http://hdl.handle.net/10.2105/AJPH.86.12.1821-a Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.12.1821-a_8 Template-Type: ReDIF-Article 1.0 Title: Disasters, the environment, and public health: Improving our response Journal: American Journal of Public Health Author-Name: Logue, J.N. Year: 1996 Volume: 86 Issue: 9 Pages: 1207-1210 DOI: 10.2105/AJPH.86.9.1207 File-URL: http://hdl.handle.net/10.2105/AJPH.86.9.1207 Abstract: Natural and human-made disasters continue to adversely affect all areas of the world in both predictable and unpredictable ways. To highlight the importance of natural disasters, the United Nations declared the 1990s the International Decade for Natural Disaster Reduction. This paper considers the public health response to disasters. It highlights environmental health issues and approaches since disasters are extreme environmental events, and it reviews developments relating to capacity building, training, and collaboration. Although progress is noted, a comprehensive federal or academic approach is not evident in the United States and the proper linkage to environmental health is lacking. With the International Decade now half over, public health professionals and others involved with disaster management should reflect on progress made to date and goals for the future. Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.9.1207_2 Template-Type: ReDIF-Article 1.0 Title: Erratum: Surveillance in environmental public health: Issues, systems, and sources (American Journal of Public Health (1996) 86 (633-638)) Journal: American Journal of Public Health Author-Name: Thacker, S.B. Author-Name: Stroup, D.F. Author-Name: Parrish, R.G. Author-Name: Anderson, H.A. Year: 1996 Volume: 86 Issue: 11 Pages: 1526 Handle: RePEc:aph:ajpbhl:1996:86:11:1526_6 Template-Type: ReDIF-Article 1.0 Title: Intensive follow-up of control subjects: is it necessary? Journal: American Journal of Public Health Author-Name: Alderman, B.W. Year: 1996 Volume: 86 Issue: 5 Pages: 744-745 DOI: 10.2105/AJPH.86.5.744 File-URL: http://hdl.handle.net/10.2105/AJPH.86.5.744 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.5.744_0 Template-Type: ReDIF-Article 1.0 Title: Why foodborne disease surveillance is critical to the safety of our food supply. Journal: American Journal of Public Health Author-Name: Hedberg, C.W. Author-Name: Hirschhorn, N. Year: 1996 Volume: 86 Issue: 8 Pages: 1076-1077 DOI: 10.2105/AJPH.86.8_Pt_1.1076 File-URL: http://hdl.handle.net/10.2105/AJPH.86.8_Pt_1.1076 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.8_Pt_1.1076_0 Template-Type: ReDIF-Article 1.0 Title: Blood lead levels, scientific misconduct and the Needleman case. 3. A reply from Scarr and Ernhart. Journal: American Journal of Public Health Author-Name: Scarr, S. Author-Name: Ernhart, C.B. Year: 1996 Volume: 86 Issue: 1 Pages: 113-115 Handle: RePEc:aph:ajpbhl:1996:86:1:113-115_9 Template-Type: ReDIF-Article 1.0 Title: Intrauterine infection and why preterm prevention programs have failed. Journal: American Journal of Public Health Author-Name: Goldenberg, R.L. Author-Name: Andrews, W.W. Year: 1996 Volume: 86 Issue: 6 Pages: 781-783 DOI: 10.2105/AJPH.86.6.781 File-URL: http://hdl.handle.net/10.2105/AJPH.86.6.781 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.6.781_7 Template-Type: ReDIF-Article 1.0 Title: Who are these "nonsmokers"? Journal: American Journal of Public Health Author-Name: Hughes, J.R. Year: 1996 Volume: 86 Issue: 5 Pages: 745-746 DOI: 10.2105/AJPH.86.5.745 File-URL: http://hdl.handle.net/10.2105/AJPH.86.5.745 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.5.745_5 Template-Type: ReDIF-Article 1.0 Title: Parents' understanding of the CDC's vaccine information material. Journal: American Journal of Public Health Author-Name: Esernio-Jenssen, D. Author-Name: Turow, V. Year: 1996 Volume: 86 Issue: 11 Pages: 1648-1649 DOI: 10.2105/AJPH.86.11.1648 File-URL: http://hdl.handle.net/10.2105/AJPH.86.11.1648 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.11.1648_6 Template-Type: ReDIF-Article 1.0 Title: Some principles in study design for preventing HIV transmission: rigor or reality. Journal: American Journal of Public Health Author-Name: Susser, M. Year: 1996 Volume: 86 Issue: 12 Pages: 1713-1716 DOI: 10.2105/AJPH.86.12.1713 File-URL: http://hdl.handle.net/10.2105/AJPH.86.12.1713 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.12.1713_3 Template-Type: ReDIF-Article 1.0 Title: Erratum: Trends in the treatment of alcohol problems in the US general population, 1979 through 1990 (American Journal of Public Health (1995) 85 (55-60)) Journal: American Journal of Public Health Author-Name: Weisner, C. Author-Name: Greenfield, T. Author-Name: Room, R. Year: 1996 Volume: 86 Issue: 3 Pages: 331 Handle: RePEc:aph:ajpbhl:1996:86:3:331_4 Template-Type: ReDIF-Article 1.0 Title: Australia implements voluntary folate fortification. Journal: American Journal of Public Health Author-Name: Adams, T. Author-Name: Jeffreson, S. Year: 1996 Volume: 86 Issue: 4 Pages: 593-594 DOI: 10.2105/AJPH.86.4.593 File-URL: http://hdl.handle.net/10.2105/AJPH.86.4.593 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.4.593_4 Template-Type: ReDIF-Article 1.0 Title: Topics for our times: can we learn from the care of persons with mental illness in developing countries? Journal: American Journal of Public Health Author-Name: Susser, E. Author-Name: Collins, P. Author-Name: Schanzer, B. Author-Name: Varma, V.K. Author-Name: Gittelman, M. Year: 1996 Volume: 86 Issue: 7 Pages: 926-928 DOI: 10.2105/AJPH.86.7.926 File-URL: http://hdl.handle.net/10.2105/AJPH.86.7.926 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.7.926_5 Template-Type: ReDIF-Article 1.0 Title: Daily movement, adiposity, and blood glucose among older adults of middle to lower socioeconomic status. Journal: American Journal of Public Health Author-Name: Pescatello, L.S. Author-Name: Murphy, D. Author-Name: DiPietro, L. Year: 1996 Volume: 86 Issue: 4 Pages: 592-593 DOI: 10.2105/AJPH.86.4.592-a File-URL: http://hdl.handle.net/10.2105/AJPH.86.4.592-a Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.4.592-a_1 Template-Type: ReDIF-Article 1.0 Title: The implications of CDC's research on organizational downsizing. Journal: American Journal of Public Health Author-Name: Wallace, D. Year: 1996 Volume: 86 Issue: 2 Pages: 268-269 DOI: 10.2105/AJPH.86.2.268-a File-URL: http://hdl.handle.net/10.2105/AJPH.86.2.268-a Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.2.268-a_1 Template-Type: ReDIF-Article 1.0 Title: Inappropriately timed immunizations: types, causes, and their relationship to record keeping Journal: American Journal of Public Health Author-Name: Hamlin, J.S. Author-Name: Wood, D. Author-Name: Pereyra, M. Author-Name: Grabowsky, M. Year: 1996 Volume: 86 Issue: 12 Pages: 1812-1814 DOI: 10.2105/AJPH.86.12.1812 File-URL: http://hdl.handle.net/10.2105/AJPH.86.12.1812 Abstract: Objective. This study examined inappropriately timed immunizations and their relationship to record keeping practices in Los Angeles Public health centers. Methods. Records of children's visits were reviewed at four public health centers maintaining separate records. Results. One third of all children seen at both immunization-only and well child clinics were given inappro-priately timed immunizations. Almost half of the immunizations were not transferred between sets of records. Children seen in both clinics were more than twice as likely to receive at least one inappropriately timed immunzation as those seen only at the well child clinic. Conclusion. Keeping separate immunization records at separate clinics leads to inappropriately timed immunization. Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.12.1812_3 Template-Type: ReDIF-Article 1.0 Title: Trends in overweight among US adults from 1987 to 1993: A multistate telephone survey Journal: American Journal of Public Health Author-Name: Galuska, D.A. Author-Name: Serdula, M. Author-Name: Pamuk, E. Author-Name: Siegel, P.Z. Author-Name: Byers, T. Year: 1996 Volume: 86 Issue: 12 Pages: 1729-1735 DOI: 10.2105/AJPH.86.12.1729 File-URL: http://hdl.handle.net/10.2105/AJPH.86.12.1729 Abstract: Objectives. Using data from the Behavioral Risk Factor Surveillance System, this study describes trends in the prevalence of overweight between 1987 and 1993. Methods. Data were examined from 33 states participating in an ongoing telephone survey of health behaviors of adults (n = 387 704). Self-reported weights and heights were used to calculate sex-specific prevalence estimates of overweight for each year from 1987 to 1993. Time trends were evaluated with the use of linear regression. Results. Between 1987 and 1993, the age-adjusted prevalence of over-weight increased by 0.9% per year for both sexes (from 21.9% to 26.7% among men and from 20.6% to 25.4% among women). The increasing linear trend was observed in all subgroups of the population but was most notable for Black men (1.5% per year) and men living in the Northeast (1.4% per year). Secular changes in smoking and leisure-time physical activity did not entirely account for the increase in over-weight. Conclusions. The prevalence of overweight among American adults increased by 5% between 1987 and 1993. Efforts are needed to explore the causes of this adverse trend and to find effective strategies to prevent obesity. Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.12.1729_7 Template-Type: ReDIF-Article 1.0 Title: Clarifying the issues in tuberculosis control. Journal: American Journal of Public Health Author-Name: Frieden, T.R. Year: 1996 Volume: 86 Issue: 2 Pages: 267-268 DOI: 10.2105/AJPH.86.2.267-b File-URL: http://hdl.handle.net/10.2105/AJPH.86.2.267-b Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.2.267-b_4 Template-Type: ReDIF-Article 1.0 Title: Revealing and reversing tobacco industry strategies. Journal: American Journal of Public Health Author-Name: Fielding, J.E. Year: 1996 Volume: 86 Issue: 8 Pages: 1073-1075 DOI: 10.2105/AJPH.86.8_Pt_1.1073 File-URL: http://hdl.handle.net/10.2105/AJPH.86.8_Pt_1.1073 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.8_Pt_1.1073_3 Template-Type: ReDIF-Article 1.0 Title: Tuberculosis control in resource-poor settings with high rates of HIV infection. Journal: American Journal of Public Health Author-Name: De Cock, K.M. Year: 1996 Volume: 86 Issue: 8 Pages: 1071-1073 DOI: 10.2105/AJPH.86.8_Pt_1.1071 File-URL: http://hdl.handle.net/10.2105/AJPH.86.8_Pt_1.1071 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.8_Pt_1.1071_8 Template-Type: ReDIF-Article 1.0 Title: Public health history and advocacy in the money-driven 1990s. Journal: American Journal of Public Health Author-Name: Stevens, R. Year: 1996 Volume: 86 Issue: 11 Pages: 1522-1523 DOI: 10.2105/AJPH.86.11.1522 File-URL: http://hdl.handle.net/10.2105/AJPH.86.11.1522 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.11.1522_7 Template-Type: ReDIF-Article 1.0 Title: An adolescent tobacco-use prevention trial in orthodontic offices Journal: American Journal of Public Health Author-Name: Hovell, M.F. Author-Name: Slymen, D.J. Author-Name: Jones, J.A. Author-Name: Richard Hofstetter, C. Author-Name: Burkham-Kreitner, S. Author-Name: Conway, T.L. Author-Name: Rubin, B. Author-Name: Noel, D. Year: 1996 Volume: 86 Issue: 12 Pages: 1760-1766 DOI: 10.2105/AJPH.86.12.1760 File-URL: http://hdl.handle.net/10.2105/AJPH.86.12.1760 Abstract: Objectives, This; study? examined the effect of an orthodontist-delivered tobacco-use prevention; program for adolescents. Methods. Southern: California orthodontic offices were randomly assigned to experimental (n = 77) and control (n = 77) groups. Randomly selected: adolescents were interviewed at baseline and 2 years later: (in = 15 644). Experimental offices received tobacco prevention training, anti-tobacco materials, and 50 cents for each anti-tobacco "prescription" written. Results. The 30-day tobacco use 2-year incidence rates for the control and experimental groups were 12.6% and 12.0%, respectively incidence rates for using tobacco-more than 100 times were 7.6% and 6.8% Diffierences between the groups did not reach significance. Mean prescription compliance was 64.4%. A multivariate logistic model, showed a significant dose response: patients who received more pescriptions had lower incidence rates than those who received few or none (10% vs 14%). Conclusions. Training, payment, and Support did not ensure clinician compliance with prevention services. The dose effect suggests that replication under conditions that would ensure clinician compliance and statistical power would more thoroughly test clinicians' ability to prevent tobacco use. Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.12.1760_9 Template-Type: ReDIF-Article 1.0 Title: The long-term effects of a cardiovascular disease prevention trial: The stanford five-city project Journal: American Journal of Public Health Author-Name: Winkleby, M.A. Author-Name: Taylor, B. Author-Name: Jatulis, D. Author-Name: Fortmann, S.P. Year: 1996 Volume: 86 Issue: 12 Pages: 1773-1779 DOI: 10.2105/AJPH.86.12.1773 File-URL: http://hdl.handle.net/10.2105/AJPH.86.12.1773 Abstract: Objectives. This study examined long-term effects of a health-education intervention trial to reduce the risk of cardiovascular disease. Methods. Surveys were conducted in California in two treatment and two control cities at baseline (1979/1980), after the 6-year intervention (1985/1986), and 3 years later at follow-up (1989/1990). Net treatment/control differences in risk-factor change were assessed for women and men 25 to 74 years of age. Results. Blood pressure improvements observed in all cities from baseline to the end of the intervention were maintained during the follow-up in treatment but not control cities. Cholesterol levels continued to decline in all cities during follow-up. Smoking rates leveled out or increased slightly in treatment cities and continued to decline in control cities but did not yield significant net differences. Both coronary heart disease and all-cause mortality risk scores were maintained or continued to improve in treatment cities while leveling out or rebounding in control cities. Conclusions. These findings suggest that community-based cardiovascular disease prevention trials can have sustained effects. However, the modest net differences in risk factors suggest the need for new designs and interventions that will accelerate posi tive risk-factor change. Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.12.1773_7 Template-Type: ReDIF-Article 1.0 Title: Comment: genetics and public health. Journal: American Journal of Public Health Author-Name: Omenn, G.S. Year: 1996 Volume: 86 Issue: 12 Pages: 1701-1704 DOI: 10.2105/AJPH.86.12.1701-a File-URL: http://hdl.handle.net/10.2105/AJPH.86.12.1701-a Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.12.1701-a_5 Template-Type: ReDIF-Article 1.0 Title: Beyond mortality--residential placement and quality of life among children with mental retardation. Journal: American Journal of Public Health Author-Name: Durkin, M.S. Year: 1996 Volume: 86 Issue: 10 Pages: 1359-1361 DOI: 10.2105/AJPH.86.10.1359 File-URL: http://hdl.handle.net/10.2105/AJPH.86.10.1359 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.10.1359_6 Template-Type: ReDIF-Article 1.0 Title: Understanding and treating obesity. Journal: American Journal of Public Health Author-Name: Winick, M. Year: 1996 Volume: 86 Issue: 7 Pages: 925-926 DOI: 10.2105/AJPH.86.7.925 File-URL: http://hdl.handle.net/10.2105/AJPH.86.7.925 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.7.925_6 Template-Type: ReDIF-Article 1.0 Title: Tuberculosis and HIV among mentally ill men in a New York City shelter. Journal: American Journal of Public Health Author-Name: Saez, H. Author-Name: Valencia, E. Author-Name: Conover, S. Author-Name: Susser, E. Year: 1996 Volume: 86 Issue: 9 Pages: 1318-1319 DOI: 10.2105/AJPH.86.9.1318 File-URL: http://hdl.handle.net/10.2105/AJPH.86.9.1318 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.9.1318_9 Template-Type: ReDIF-Article 1.0 Title: The psychosocial work environment and heart disease. Journal: American Journal of Public Health Author-Name: Fine, L.J. Year: 1996 Volume: 86 Issue: 3 Pages: 301-303 DOI: 10.2105/AJPH.86.3.301 File-URL: http://hdl.handle.net/10.2105/AJPH.86.3.301 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.3.301_1 Template-Type: ReDIF-Article 1.0 Title: Erratum: Who administers? Who cares? Medical administrative and clinical employment in the United States and Canada (American Journal of Public Health (1996) 86 (172-178)) Journal: American Journal of Public Health Author-Name: Himmelstein, D.U. Author-Name: Lewontin, J.P. Author-Name: Woolhandler, S. Year: 1996 Volume: 86 Issue: 6 Pages: 790 Handle: RePEc:aph:ajpbhl:1996:86:6:790_8 Template-Type: ReDIF-Article 1.0 Title: The population "wolf" and demographic entrapment in Rwanda. Journal: American Journal of Public Health Author-Name: King, M. Year: 1996 Volume: 86 Issue: 7 Pages: 1030-1031 DOI: 10.2105/AJPH.86.7.1030-b File-URL: http://hdl.handle.net/10.2105/AJPH.86.7.1030-b Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.7.1030-b_9 Template-Type: ReDIF-Article 1.0 Title: Comment: Deteriorating health in Russia--a place for community-based approaches. Journal: American Journal of Public Health Author-Name: Wyon, J.B. Year: 1996 Volume: 86 Issue: 3 Pages: 321-323 DOI: 10.2105/AJPH.86.3.321 File-URL: http://hdl.handle.net/10.2105/AJPH.86.3.321 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.3.321_4 Template-Type: ReDIF-Article 1.0 Title: Monitoring vendor compliance with tobacco sales laws: payment vs no payment approaches. Journal: American Journal of Public Health Author-Name: Cummings, K.M. Author-Name: Saunders-Martin, T. Author-Name: Clarke, H. Author-Name: Perla, J. Year: 1996 Volume: 86 Issue: 5 Pages: 750-751 DOI: 10.2105/AJPH.86.5.750-a File-URL: http://hdl.handle.net/10.2105/AJPH.86.5.750-a Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.5.750-a_5 Template-Type: ReDIF-Article 1.0 Title: Topics for our times: public health on the line--abortion and beyond. Journal: American Journal of Public Health Author-Name: Chavkin, W. Year: 1996 Volume: 86 Issue: 9 Pages: 1204-1206 DOI: 10.2105/AJPH.86.9.1204 File-URL: http://hdl.handle.net/10.2105/AJPH.86.9.1204 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.9.1204_7 Template-Type: ReDIF-Article 1.0 Title: Blood lead levels, scientific misconduct, and the Needleman case. 1. A reply from the lead industry. Journal: American Journal of Public Health Author-Name: Smith, J.F. Year: 1996 Volume: 86 Issue: 1 Pages: 112-115 Handle: RePEc:aph:ajpbhl:1996:86:1:112-115_0 Template-Type: ReDIF-Article 1.0 Title: Erratum: Psychosocial work environment and sickness absence among British civil servants: The Whitehall II study (American Journal of Public Health (1996) 86 (332-340)) Journal: American Journal of Public Health Author-Name: North, F.M. Author-Name: Syme, S.L. Author-Name: Feeney, A. Author-Name: Shipley, M. Author-Name: Marmot, M. Year: 1996 Volume: 86 Issue: 8 Pages: 1093 Handle: RePEc:aph:ajpbhl:1996:86:8:1093_0 Template-Type: ReDIF-Article 1.0 Title: Nonfatal injuries among US children. Journal: American Journal of Public Health Author-Name: Kim, H.J. Author-Name: Graves, M. Year: 1996 Volume: 86 Issue: 6 Pages: 892-893 DOI: 10.2105/AJPH.86.6.892-a File-URL: http://hdl.handle.net/10.2105/AJPH.86.6.892-a Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.6.892-a_7 Template-Type: ReDIF-Article 1.0 Title: Reducing delays in the laboratory diagnosis of tuberculosis. Journal: American Journal of Public Health Author-Name: Krishnan, S. Author-Name: Koehler, J.E. Author-Name: Benjamin, R. Author-Name: Reingold, A.L. Year: 1996 Volume: 86 Issue: 8 Pages: 1171-1172 DOI: 10.2105/AJPH.86.8_Pt_1.1171 File-URL: http://hdl.handle.net/10.2105/AJPH.86.8_Pt_1.1171 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.8_Pt_1.1171_4 Template-Type: ReDIF-Article 1.0 Title: Promoting abstinence among relapsed chronic smokers: The effect of telephone support Journal: American Journal of Public Health Author-Name: Lando, H.A. Author-Name: Pirie, P.L. Author-Name: Roski, J. Author-Name: McGovem, P.G. Author-Name: Schmid, L.A. Year: 1996 Volume: 86 Issue: 12 Pages: 1786-1790 DOI: 10.2105/AJPH.86.12.1786 File-URL: http://hdl.handle.net/10.2105/AJPH.86.12.1786 Abstract: Objectives, The present study used telephone support both to sustain abstinence and to encourage renewed - quit attemps in smokers who had completed an intensive smoking cessation clinic. Methods. Subjects weres hardcore smokers (n = 1083) who had attended a multisession cessation clinic. They were then assigned randomly to receive telephone support (intervention calls 3, 9, and 21 months after - the targeted cessation clinic quit date) or no further intervention. Results. In the interventíon condition, subjects who relapsed were significantly more likely to resume abstinence (that is, to 10 recycle) than those in the comparison condition at follow-up (6 months: 17.8% vs 11.3%: 24-months: 25.7% vs 18.2%). Telephone support was not effective in preventing relapse, and overall differences in abstinence outcome were not significant. Conclusions, The major hypothesis of the current study - that tetephone support would enhance the resumption of abstinence - received partial support. However, there was no evidence either or an overall treatment effect or of an effect in preventing relapse. Telephone out-reach may be more effective in the context of be self-help or other less intensive interventions. Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.12.1786_4 Template-Type: ReDIF-Article 1.0 Title: Youth access to tobacco: The effects of age, gender, vending machine locks, and "it's the law" programs Journal: American Journal of Public Health Author-Name: Difranza, J.R. Author-Name: Savageau, J.A. Author-Name: Aisquith, B.F. Year: 1996 Volume: 86 Issue: 2 Pages: 221-224 DOI: 10.2105/AJPH.86.2.221 File-URL: http://hdl.handle.net/10.2105/AJPH.86.2.221 Abstract: Objectives, This study evaluated the influence of age, gender, vending machine lockout devices, and tobacco industry-sponsored voluntary compliance programs ("It's the Law" programs) on underage youths abil-ity to purchase tobacco. Methods. Twelve youths made 480 attempts to purchase tobacco in Massachusetts from over-the-counter retailers and vending machines with and without remote control lockout devices. Half the vendors were participating in It's the Law programs. Results. In communities with no requirements for lockout devices, illegai sales were far more likely from vending machines than from over-the-counter sources (odds ratio [OR] = 5.9, 95% confidence interval [CI] = 3.3, 10.3). Locks on vending machines made them equivalent to over-the-counter sources in terms of illegal sales to youths. Vendors participating in It's the Law programs were as likely to make illegal sales as nonparticipants (OR = 0.87, 95% CI = 0.57, 1.35). Girls and youths 16 years of age and older were more successful at purchasing tobacco. Conclusions. The It's the Law programs are ineffective in preventing illegal sales. While locks made vending machines equivalent to over-the-counter sources in their compliance with the law, they are not a substitute for law enforcements. Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.2.221_7 Template-Type: ReDIF-Article 1.0 Title: Sexual identity vs sexual behavior. Journal: American Journal of Public Health Author-Name: Rankow, E.J. Year: 1996 Volume: 86 Issue: 12 Pages: 1822-1823 DOI: 10.2105/AJPH.86.12.1822 File-URL: http://hdl.handle.net/10.2105/AJPH.86.12.1822 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.12.1822_7 Template-Type: ReDIF-Article 1.0 Title: Assessing mothers' attitudes about the physician's role in child health promotion Journal: American Journal of Public Health Author-Name: Cheng, T.L. Author-Name: Savageau, J.A. Author-Name: Bigelow, C. Author-Name: Charney, E. Author-Name: Kumar, S. Author-Name: DeWitt, T.G. Year: 1996 Volume: 86 Issue: 12 Pages: 1809-1812 DOI: 10.2105/AJPH.86.12.1809 File-URL: http://hdl.handle.net/10.2105/AJPH.86.12.1809 Abstract: Objectives. This study assessed maternal attitudes about the physician's role in child health promotion. Methods. Home interviews were conducted with 200 Massashusetts mothers (with one child age 2 to 3 years) enrolled in a health maintenance organization. Results, Mothers chose growth and nutrition, physical development, and illness as the most important topics and felt that providers have the ability to prevent problems and to help. Psychosocial and safety issues were less important, although mothers felt suscepitible to these issues and believed they greatly affected children's health, Conclusions. On all issues, mothers believed physicians were more effective in helping families after, not before problems arose. The Health Belief Model provided insight into attitudes and possible interventions. attitudes and possible interventions. Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.12.1809_4 Template-Type: ReDIF-Article 1.0 Title: The important contribution of community mental health workers. Journal: American Journal of Public Health Author-Name: Ozarin, L.D. Year: 1996 Volume: 86 Issue: 9 Pages: 1319-1320 DOI: 10.2105/AJPH.86.9.1319-a File-URL: http://hdl.handle.net/10.2105/AJPH.86.9.1319-a Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.9.1319-a_7 Template-Type: ReDIF-Article 1.0 Title: Understanding sociodemographic differences in health--the role of fundamental social causes. Journal: American Journal of Public Health Author-Name: Link, B.G. Author-Name: Phelan, J.C. Year: 1996 Volume: 86 Issue: 4 Pages: 471-473 DOI: 10.2105/AJPH.86.4.471 File-URL: http://hdl.handle.net/10.2105/AJPH.86.4.471 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.4.471_5 Template-Type: ReDIF-Article 1.0 Title: The cost-effectiveness of HIV prevention targeting: How much more bang for the buck? Journal: American Journal of Public Health Author-Name: Kahn, J.G. Year: 1996 Volume: 86 Issue: 12 Pages: 1709-1712 DOI: 10.2105/AJPH.86.12.1709 File-URL: http://hdl.handle.net/10.2105/AJPH.86.12.1709 Abstract: Background. Although the targeting of human immunodeficiency virus (HIV) prevention to high-risk populations has been widely discussed, its benefits have not been quantified. Methods. This analysis of cost-effectiveness combines an HIV epidemic model, target population scenarios, and data on the cost and impact of prevention. Results. The number of HIV infections averted in 5 years with $1 million in annual prevention spending ranges from 164 in high-risk populations to 0.4 in very-low-risk populations. Fortyfold to two-hundredfold differences in prevention costs could equalize HIV infections averted. Conclusions. Targeting appears to provide substantial benefit and should be considered in allocation decisions about prevention. Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.12.1709_3 Template-Type: ReDIF-Article 1.0 Title: The late-stage diagnosis of colorectal cancer: Demographic and socioeconomic factors Journal: American Journal of Public Health Author-Name: Mandelblatt, J. Author-Name: Andrews, H. Author-Name: Kao, R. Author-Name: Wallace, R. Author-Name: Kerner, J. Year: 1996 Volume: 86 Issue: 12 Pages: 1794-1797 DOI: 10.2105/AJPH.86.12.1794 File-URL: http://hdl.handle.net/10.2105/AJPH.86.12.1794 Abstract: Objectives, This study described factors related to colorectal cancer stage at diagnosis. Methods. Logistic regression analyses were used on data from the New York State Tumor Registry and US Census area level social class indicators. Results. After the effects of other predictors were controlled for, the odds of late-stage Cancer increased as age decreased; women and African Americans were signif-cantly more likely to have late stage than men and whites; and individu-al living in areas of low socioeconomic status (SES) were significantly more likely to be diagnosed at late stage than those living in higher SES areas. Stratified analyses showed that living in a low SES area was the most important determinant of stage for all age, race, gender, and source-of-care groups. Conclusions. While al populations would benefit form the systematic use of screening, socioeconomically disadvantaged groups may also benefit form targeted screening. Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.12.1794_7 Template-Type: ReDIF-Article 1.0 Title: Topics for our times: from Cairo to Beijing-women's agenda for equality. Journal: American Journal of Public Health Author-Name: Rodriguez-Trias, H. Year: 1996 Volume: 86 Issue: 3 Pages: 305-306 DOI: 10.2105/AJPH.86.3.305 File-URL: http://hdl.handle.net/10.2105/AJPH.86.3.305 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.3.305_8 Template-Type: ReDIF-Article 1.0 Title: A contract on American's children. Journal: American Journal of Public Health Author-Name: Miller, C.A. Year: 1996 Volume: 86 Issue: 4 Pages: 473-474 DOI: 10.2105/AJPH.86.4.473 File-URL: http://hdl.handle.net/10.2105/AJPH.86.4.473 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.4.473_7 Template-Type: ReDIF-Article 1.0 Title: Paradox as paradigm--the health outcomes of Mexican Americans. Journal: American Journal of Public Health Author-Name: Scribner, R. Year: 1996 Volume: 86 Issue: 3 Pages: 303-305 DOI: 10.2105/AJPH.86.3.303 File-URL: http://hdl.handle.net/10.2105/AJPH.86.3.303 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.3.303_4 Template-Type: ReDIF-Article 1.0 Title: The need for adolescent health education and training among health professionals. Journal: American Journal of Public Health Author-Name: Gordon, T.E. Year: 1996 Volume: 86 Issue: 6 Pages: 889-890 DOI: 10.2105/AJPH.86.6.889 File-URL: http://hdl.handle.net/10.2105/AJPH.86.6.889 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.6.889_8 Template-Type: ReDIF-Article 1.0 Title: The pleasures and perils of prophetic advocacy: Henry E. Sigerist and the politics of medical reform. Journal: American Journal of Public Health Author-Name: Fee, E. Year: 1996 Volume: 86 Issue: 11 Pages: 1637-1647 DOI: 10.2105/AJPH.86.11.1637 File-URL: http://hdl.handle.net/10.2105/AJPH.86.11.1637 Abstract: Henry E. Sigerist, an internationally renowned medical historian, played a surprisingly important and visible role in American medical politics in the 1930s and 1940s. Born in Paris of Swiss parents, he was professor in Leipzig, Germany, before coming to the United States in 1932 as professor of the history of medicine at Johns Hopkins University. Once in America. Sigerist became deeply involved in medical politics and the campaign for national health insurance. He argued that individualized medical practice was outdated and should gradually be superseded by state-run and state-financed health services. National health insurance was but one step in this historical progression. Sigerist thus lent the weight of history itself to the cause of medical care reform. The charming and erudite Sigerist was welcomed by the leaders of academic medicine in America. Soon, he emerged as a spokesman of the left wing of the medical profession, an effective and popular speaker and an impassioned advocate of socialized medicine. This paper traces Sigerist's political ideas and activities, and his contributions toward medical care reform in the United States. Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.11.1637_0 Template-Type: ReDIF-Article 1.0 Title: Social class and asthma--distinguishing between the disease and the diagnosis. Journal: American Journal of Public Health Author-Name: Gergen, P. Year: 1996 Volume: 86 Issue: 10 Pages: 1361-1362 DOI: 10.2105/AJPH.86.10.1361 File-URL: http://hdl.handle.net/10.2105/AJPH.86.10.1361 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.10.1361_9 Template-Type: ReDIF-Article 1.0 Title: Preventing tobacco use--the youth access trap. Journal: American Journal of Public Health Author-Name: Glantz, S.A. Year: 1996 Volume: 86 Issue: 2 Pages: 156-158 DOI: 10.2105/AJPH.86.2.156 File-URL: http://hdl.handle.net/10.2105/AJPH.86.2.156 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.2.156_3 Template-Type: ReDIF-Article 1.0 Title: Self-rated health among hispanic vs non-hispanic white adults: The San Luis Valley health and aging study Journal: American Journal of Public Health Author-Name: Shetterly, S.M. Author-Name: Baxter, J. Author-Name: Mason, L.D. Author-Name: Hamman, R.F. Year: 1996 Volume: 86 Issue: 12 Pages: 1798-1801 DOI: 10.2105/AJPH.86.12.1798 File-URL: http://hdl.handle.net/10.2105/AJPH.86.12.1798 Abstract: Objectives. This study investigated whether objective health indicators explained lower self-rated health among Hispanics compared with non-Hispanic whites. It also considered socioeconimic and cultural explanations. Methods. Health ratings of 429 Hispanics and 583 non-Hispanic W White age 20 throgh 74 were analyzed with logistic regression. Results. Illness indicators were found to be strongly correlated with self-rated health in both ethnic groups, but after such markers were controlled for, Hispanics remained 3.6 times more likely to report fair or poor health (95% confidence interval - 2.4, 5.3). adjustment for socioeconomic factors accounted for a portion of Hispanics' lower health rating, but the strongest explanatory factor was acculaturation. Conclusions. Because of cultural and economic influences on definitions of health, ethnic differences in self-assessed healths mays not accurately reflected patterns resulting from objeetive health measurements. Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.12.1798_7 Template-Type: ReDIF-Article 1.0 Title: Erratum: The first year of hyperinflation in the former Soviet Union: Nutritional deprivation among elderly pensioners, 1992 (American Journal of Public Health (1996) 86 (361-367)) Journal: American Journal of Public Health Author-Name: Rush, D. Author-Name: Welch, K. Year: 1996 Volume: 86 Issue: 6 Pages: 790 Handle: RePEc:aph:ajpbhl:1996:86:6:790_6 Template-Type: ReDIF-Article 1.0 Title: State health agencies' role in a more balanced and sophisticated tobacco control program. Journal: American Journal of Public Health Author-Name: Lumpkin, J.R. Author-Name: Rice, J.R. Year: 1996 Volume: 86 Issue: 10 Pages: 1482-1483 DOI: 10.2105/AJPH.86.10.1482-a File-URL: http://hdl.handle.net/10.2105/AJPH.86.10.1482-a Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.10.1482-a_2 Template-Type: ReDIF-Article 1.0 Title: Compliance with antihypertensive therapy among elderly medicaid enrollees: The roles of age, gender, and race Journal: American Journal of Public Health Author-Name: Monane, M. Author-Name: Bohn, R.L. Author-Name: Gurwitz, J.H. Author-Name: Glynn, R.J. Author-Name: Levin, R. Author-Name: Avorn, J. Year: 1996 Volume: 86 Issue: 12 Pages: 1805-1808 DOI: 10.2105/AJPH.86.12.1805 File-URL: http://hdl.handle.net/10.2105/AJPH.86.12.1805 Abstract: Objectives. This study measured compliance and related demographic factors in a retrospective cohort of 4068 elderly outpatients newly starting antihypertensive therapy from 1982 through 1988. Methods. Logistic regression modeling of data from the New Jersey Medicaid program was used. Results. These patients filled antihypertensive prescriptions covering an average of only 179 days in the 365-day follow-up period (49%). Good compliance (≥ 80%) was associated with advanced age (odds ratio [OR] = 2.12, for patients 85 or older) and White race (OR = 0.55 for Blacks). There was no relationship between compliance and gender. Conclusions. Despite the efficacy of antihypertensive therapy in preventing cardiovascular morbidity, such high rates of noncompliance may contribute to suboptimal patient outcomes. Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.12.1805_8 Template-Type: ReDIF-Article 1.0 Title: Preventing injuries from violence towards women. Journal: American Journal of Public Health Author-Name: Davidson, L.L. Year: 1996 Volume: 86 Issue: 1 Pages: 12-14 DOI: 10.2105/AJPH.86.1.12 File-URL: http://hdl.handle.net/10.2105/AJPH.86.1.12 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.1.12_9 Template-Type: ReDIF-Article 1.0 Title: Capture-recapture estimates of cancer incidence, adjusting for geographic effects: an alternative perspective. Journal: American Journal of Public Health Author-Name: Hook, E.B. Year: 1996 Volume: 86 Issue: 5 Pages: 746-747 DOI: 10.2105/AJPH.86.5.746 File-URL: http://hdl.handle.net/10.2105/AJPH.86.5.746 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.5.746_2 Template-Type: ReDIF-Article 1.0 Title: Comment: recent twists and turns in American Indian health care. Journal: American Journal of Public Health Author-Name: Jorgensen, J.G. Year: 1996 Volume: 86 Issue: 10 Pages: 1362-1364 DOI: 10.2105/AJPH.86.10.1362 File-URL: http://hdl.handle.net/10.2105/AJPH.86.10.1362 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.10.1362_2 Template-Type: ReDIF-Article 1.0 Title: Healthy behaviors among women in the United States and Ontario: The effect on use of preventive care Journal: American Journal of Public Health Author-Name: Hofer, T.P. Author-Name: Katz, S.J. Year: 1996 Volume: 86 Issue: 12 Pages: 1755-1759 DOI: 10.2105/AJPH.86.12.1755 File-URL: http://hdl.handle.net/10.2105/AJPH.86.12.1755 Abstract: Objectives. This study examined how several healthy behaviors among women in Ontario and the United States explained (1) the use of preventive health services, (2) differences in use between socioeconomic groups, and (3) differences in use between the two health systems. Methods. 1990 data on women from the Ontario Health Survey (n = 22 985) and the US National Health Interview Survey (n = 19 092) were analyzed. A woman who avoided smoking and obesity, used seatbelts, and regularly engaged in aerobic exercise was defined as having a healthy lifestyle. Women were considered screened if they reported a mammogram or a breast exam within the previous year or a Pap smear within 2 years. Results. A healthy lifestyle was more common in the United States than Canada among more highly educated groups (odds ratio [OR] = 1.40; 95% confidence interval [CI] = 1.22, 1.60 for college educated) but less common in the United States for those with less than a high school education (OR = 0.52; 95% CI = 0.40, 0.67). Each additional unhealthy behavior decreased the odds of having undergone a mammogram in the previous year by 20%. However, adjusting for the number of unhealthy behaviors did not substantially change the relationship between socioeconomic status and use of preventive services. Conclusions. The number of healthy behaviors is an important measure of demand for preventive health services. This measure varies across country and socioeconomic group. Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.12.1755_4 Template-Type: ReDIF-Article 1.0 Title: New directions for community intervention studies. Journal: American Journal of Public Health Author-Name: Feinleib, M. Year: 1996 Volume: 86 Issue: 12 Pages: 1696-1698 DOI: 10.2105/AJPH.86.12.1696 File-URL: http://hdl.handle.net/10.2105/AJPH.86.12.1696 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.12.1696_9 Template-Type: ReDIF-Article 1.0 Title: Drug use and behavior change. Journal: American Journal of Public Health Author-Name: Osborn, J.E. Year: 1996 Volume: 86 Issue: 12 Pages: 1698-1699 DOI: 10.2105/AJPH.86.12.1698 File-URL: http://hdl.handle.net/10.2105/AJPH.86.12.1698 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.12.1698_4 Template-Type: ReDIF-Article 1.0 Title: The history and politics of US health care policy for American Indians and Alaskan Natives Journal: American Journal of Public Health Author-Name: Kunitz, S.J. Year: 1996 Volume: 86 Issue: 10 Pages: 1464-1473 DOI: 10.2105/AJPH.86.10.1464 File-URL: http://hdl.handle.net/10.2105/AJPH.86.10.1464 Abstract: This paper traces the development of the US federal government's program to provide personal and public health services to American Indians and Alaska Natives since the 1940s. Minimal services had been provided since the mid 19th century through the Bureau of Indian Affairs of the Department of the Interior. As a result of attempts by western congressmen to weaken and destroy the bureau during the 1940s, responsibility for health services was placed with the US Public Health Service. The transfer thus created the only US national health program for civilians, providing virtually the full range of personal and public health services to a defined population at relatively low cost. Policy changes since the 1970s have led to an emphasis on self-determination that did not exist during the 1950s and 1960s. Programs administered by tribal governments tend to be more expensive than those provided by the Indian Health Service, but appropriations have not risen to meet the rising costs, nor are the appropriated funds distributed equitably among Indian Health Service regions. The result is likely to be an unequal deterioration in accessibility and aualitv of care. Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.10.1464_1 Template-Type: ReDIF-Article 1.0 Title: Our view of adolescent sexuality--a focus on risk behavior without the developmental context. Journal: American Journal of Public Health Author-Name: Ehrhardt, A.A. Year: 1996 Volume: 86 Issue: 11 Pages: 1523-1525 DOI: 10.2105/AJPH.86.11.1523 File-URL: http://hdl.handle.net/10.2105/AJPH.86.11.1523 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.11.1523_7 Template-Type: ReDIF-Article 1.0 Title: Erratum: What is the matter with the medical profession? (American Journal of Public Health (1996) 86 (108-109)) Journal: American Journal of Public Health Author-Name: Warbasse, J.P. Year: 1996 Volume: 86 Issue: 3 Pages: 331 Handle: RePEc:aph:ajpbhl:1996:86:3:331_1 Template-Type: ReDIF-Article 1.0 Title: Erratum: The effect of ordinances requiring smoke-free restaurants on restaurant sales (American Journal of Public Health (1994) 84 (1081-1085)) Journal: American Journal of Public Health Author-Name: Glantz, S.A. Author-Name: Smith, L.R.A. Year: 1996 Volume: 86 Issue: 6 Pages: 790 Handle: RePEc:aph:ajpbhl:1996:86:6:790_7 Template-Type: ReDIF-Article 1.0 Title: Public hospitals and health care reform: choices and challenges. Journal: American Journal of Public Health Author-Name: Andrulis, D.P. Author-Name: Acuff, K.L. Author-Name: Weiss, K.B. Author-Name: Anderson, R.J. Year: 1996 Volume: 86 Issue: 2 Pages: 162-165 DOI: 10.2105/AJPH.86.2.162 File-URL: http://hdl.handle.net/10.2105/AJPH.86.2.162 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.2.162_1 Template-Type: ReDIF-Article 1.0 Title: The dominant role of driver behavior in traffic safety. Journal: American Journal of Public Health Author-Name: Evans, L. Year: 1996 Volume: 86 Issue: 6 Pages: 784-786 DOI: 10.2105/AJPH.86.6.784 File-URL: http://hdl.handle.net/10.2105/AJPH.86.6.784 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.6.784_0 Template-Type: ReDIF-Article 1.0 Title: Firearm injuries among Virginia juvenile drug traffickers, 1992 through 1994. Journal: American Journal of Public Health Author-Name: McLaughlin, C.R. Author-Name: Reiner, S.M. Author-Name: Smith, B.W. Author-Name: Waite, D.E. Author-Name: Reams, P.N. Author-Name: Joost, T.F. Author-Name: Gervin, A.S. Year: 1996 Volume: 86 Issue: 5 Pages: 751-752 DOI: 10.2105/AJPH.86.5.751 File-URL: http://hdl.handle.net/10.2105/AJPH.86.5.751 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.5.751_9 Template-Type: ReDIF-Article 1.0 Title: Trends in restraint prevalence in US nursing homes, 1990 through 1994. Journal: American Journal of Public Health Author-Name: Schoeneman, K. Author-Name: Graber, D.R. Year: 1996 Volume: 86 Issue: 10 Pages: 1480-1481 DOI: 10.2105/AJPH.86.10.1480 File-URL: http://hdl.handle.net/10.2105/AJPH.86.10.1480 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.10.1480_7 Template-Type: ReDIF-Article 1.0 Title: Rape is a major public health issue. Journal: American Journal of Public Health Author-Name: Schafran, L.H. Year: 1996 Volume: 86 Issue: 1 Pages: 15-17 DOI: 10.2105/AJPH.86.1.15 File-URL: http://hdl.handle.net/10.2105/AJPH.86.1.15 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.1.15_2 Template-Type: ReDIF-Article 1.0 Title: Topics for our times: Don't inhale - Reflections on garbage! Journal: American Journal of Public Health Author-Name: Rosner, D. Year: 1996 Volume: 86 Issue: 2 Pages: 159-161 DOI: 10.2105/AJPH.86.2.159 File-URL: http://hdl.handle.net/10.2105/AJPH.86.2.159 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.2.159_7 Template-Type: ReDIF-Article 1.0 Title: Eras, paradigms, and the future of epidemiology. Journal: American Journal of Public Health Author-Name: Winkelstein Jr., W. Year: 1996 Volume: 86 Issue: 5 Pages: 621-622 DOI: 10.2105/AJPH.86.5.621 File-URL: http://hdl.handle.net/10.2105/AJPH.86.5.621 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.5.621_3 Template-Type: ReDIF-Article 1.0 Title: What is the matter with the medical profession? 1912. Journal: American Journal of Public Health Author-Name: Warbasse, J.P. Year: 1996 Volume: 86 Issue: 1 Pages: 108-110 DOI: 10.2105/AJPH.86.1.108-a File-URL: http://hdl.handle.net/10.2105/AJPH.86.1.108-a Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.1.108-a_0 Template-Type: ReDIF-Article 1.0 Title: Reduce drunk driving for everyone's sake. Journal: American Journal of Public Health Author-Name: Jacobsen, P. Year: 1996 Volume: 86 Issue: 6 Pages: 890-891 DOI: 10.2105/AJPH.86.6.890-a File-URL: http://hdl.handle.net/10.2105/AJPH.86.6.890-a Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.6.890-a_3 Template-Type: ReDIF-Article 1.0 Title: Editorial: Community solutions to community problems - Preventing adolescent alcohol use Journal: American Journal of Public Health Author-Name: Wechsler, H. Author-Name: Weitzman, E.R. Year: 1996 Volume: 86 Issue: 7 Pages: 923-925 Handle: RePEc:aph:ajpbhl:1996:86:7:923-925_1 Template-Type: ReDIF-Article 1.0 Title: Emerging objectives and methods in epidemiology. Journal: American Journal of Public Health Author-Name: Koopman, J.S. Year: 1996 Volume: 86 Issue: 5 Pages: 630-632 DOI: 10.2105/AJPH.86.5.630 File-URL: http://hdl.handle.net/10.2105/AJPH.86.5.630 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.5.630_4 Template-Type: ReDIF-Article 1.0 Title: Toward a holistic approach to public health surveillance. Journal: American Journal of Public Health Author-Name: Levy, B.S. Year: 1996 Volume: 86 Issue: 5 Pages: 624-625 DOI: 10.2105/AJPH.86.5.624 File-URL: http://hdl.handle.net/10.2105/AJPH.86.5.624 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.5.624_9 Template-Type: ReDIF-Article 1.0 Title: Social inequalities in health--do they diminish with age? Journal: American Journal of Public Health Author-Name: Jefferys, M. Year: 1996 Volume: 86 Issue: 4 Pages: 474-475 DOI: 10.2105/AJPH.86.4.474 File-URL: http://hdl.handle.net/10.2105/AJPH.86.4.474 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.4.474_1 Template-Type: ReDIF-Article 1.0 Title: The Department of Energy's Comprehensive Epidemiologic Data Resource: a public-use database on radiation exposure. Journal: American Journal of Public Health Author-Name: Stockwell, H.G. Author-Name: Brooks, B.G. Author-Name: Holmes, H.H. Author-Name: Durst, M.J. Author-Name: Shim, Y.K. Author-Name: Heinig, P.E. Year: 1996 Volume: 86 Issue: 5 Pages: 747-748 DOI: 10.2105/AJPH.86.5.747 File-URL: http://hdl.handle.net/10.2105/AJPH.86.5.747 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.5.747_0 Template-Type: ReDIF-Article 1.0 Title: Annotation: Patients on the auction block Journal: American Journal of Public Health Author-Name: Woolhandler, S. Author-Name: Himmelstein, D.U. Year: 1996 Volume: 86 Issue: 12 Pages: 1699-1700 DOI: 10.2105/AJPH.86.12.1699 File-URL: http://hdl.handle.net/10.2105/AJPH.86.12.1699 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.12.1699_0 Template-Type: ReDIF-Article 1.0 Title: Erratum: Annotation: Uncertainties in the estimation of HIV prevalence and incidence in the United States (American Journal of Public Health (1996) 86 (627-628)) Journal: American Journal of Public Health Author-Name: Samuel, M.C. Author-Name: Osmond, D.E. Year: 1996 Volume: 86 Issue: 8 Pages: 1093 Handle: RePEc:aph:ajpbhl:1996:86:8:1093_3 Template-Type: ReDIF-Article 1.0 Title: Lowering infant mortality in western Europe: national health service vs social security systems. Journal: American Journal of Public Health Author-Name: Grubaugh, S.G. Author-Name: Santerre, R.E. Year: 1996 Volume: 86 Issue: 12 Pages: 1823-1824 DOI: 10.2105/AJPH.86.12.1823-a File-URL: http://hdl.handle.net/10.2105/AJPH.86.12.1823-a Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.12.1823-a_1 Template-Type: ReDIF-Article 1.0 Title: The persistence of a high maternal mortality rate in the Ivory Coast. Journal: American Journal of Public Health Author-Name: Thonneau, P. Author-Name: Djanhan, Y. Author-Name: Tran, M. Author-Name: Welfens-Ekra, C. Author-Name: Bohoussou, M. Author-Name: Papiernik, E. Year: 1996 Volume: 86 Issue: 10 Pages: 1478-1479 DOI: 10.2105/AJPH.86.10.1478 File-URL: http://hdl.handle.net/10.2105/AJPH.86.10.1478 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.10.1478_3 Template-Type: ReDIF-Article 1.0 Title: The influence of socioeconomic position on health--and vice versa. Journal: American Journal of Public Health Author-Name: Morris, N.M. Year: 1996 Volume: 86 Issue: 11 Pages: 1649-1650 DOI: 10.2105/AJPH.86.11.1649-a File-URL: http://hdl.handle.net/10.2105/AJPH.86.11.1649-a Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.11.1649-a_1 Template-Type: ReDIF-Article 1.0 Title: The high cost of injuries in the United States. Journal: American Journal of Public Health Author-Name: Rice, D.P. Author-Name: Max, W. Year: 1996 Volume: 86 Issue: 1 Pages: 14-15 DOI: 10.2105/AJPH.86.1.14 File-URL: http://hdl.handle.net/10.2105/AJPH.86.1.14 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.1.14_1 Template-Type: ReDIF-Article 1.0 Title: Evaluating population folate exposure through a complete frequency distribution. Journal: American Journal of Public Health Author-Name: Koehler, K.M. Author-Name: Pareo-Tubbeh, S.L. Author-Name: Baumgartner, R.N. Author-Name: Romero, L.J. Author-Name: Garry, P.J. Year: 1996 Volume: 86 Issue: 3 Pages: 406-407 DOI: 10.2105/AJPH.86.3.406 File-URL: http://hdl.handle.net/10.2105/AJPH.86.3.406 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.3.406_1 Template-Type: ReDIF-Article 1.0 Title: Great expectations, or do we ask too much from community-level interventions? Journal: American Journal of Public Health Author-Name: Fishbein, M. Year: 1996 Volume: 86 Issue: 8 Pages: 1075-1076 DOI: 10.2105/AJPH.86.8_Pt_1.1075 File-URL: http://hdl.handle.net/10.2105/AJPH.86.8_Pt_1.1075 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.8_Pt_1.1075_6 Template-Type: ReDIF-Article 1.0 Title: The health insurance status of US latino women: A profile from the 1982-1984 HHANES Journal: American Journal of Public Health Author-Name: De La Torre, A. Author-Name: Friis, R. Author-Name: Hunter, H.R. Author-Name: Garcia, L. Year: 1996 Volume: 86 Issue: 4 Pages: 533-537 DOI: 10.2105/AJPH.86.4.533 File-URL: http://hdl.handle.net/10.2105/AJPH.86.4.533 Abstract: Objectives. This research studied the correlates of health insurance status among three major subpopulations (Mexican, Puerto Rican, and Cuban) of adult (ages of 20 to 64) Latino women. Methods. Data from the Hispanic Health and Nutrition Examination Survey (HHANES), 1982-1984, were examined to determine the percentages of health insurance coverage among the sample populations and to assess the relationship between access to coverage and selected sociodemographic, employment/income, ancestry, and acculturation variables. Results. Variations in health insurance coverage existed by Latina subpopulation. While Puerto Rican women had the highest percentage of any health insurance coverage. Mexican-origin women (particularly those 50 to 64 years old) had the lowest. For all three Latina groups, health insurance coverage was greater among those who reported a family income above the poverty level than among those whose income fell below the poverty level; employment location, acculturation variables, and ancestry were also related to coverage. Conclusions. Eligibility requirements, particularly for Mexican- and Cuban-origin women, need to be streamlined, and innovative health insurance programs need to be developed to increase access of Latinas to health insurance. Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.4.533_4 Template-Type: ReDIF-Article 1.0 Title: CDC's first 50 years: lessons learned and relearned. Journal: American Journal of Public Health Author-Name: Satcher, D. Year: 1996 Volume: 86 Issue: 12 Pages: 1705-1708 DOI: 10.2105/AJPH.86.12.1705 File-URL: http://hdl.handle.net/10.2105/AJPH.86.12.1705 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.12.1705_6 Template-Type: ReDIF-Article 1.0 Title: Public health and primary care: a framework for proposed linkages. Journal: American Journal of Public Health Author-Name: Starfield, B. Year: 1996 Volume: 86 Issue: 10 Pages: 1365-1369 DOI: 10.2105/AJPH.86.10.1365 File-URL: http://hdl.handle.net/10.2105/AJPH.86.10.1365 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.10.1365_5 Template-Type: ReDIF-Article 1.0 Title: Current research on chronic pain and suicide. Journal: American Journal of Public Health Author-Name: Fishbain, D.A. Year: 1996 Volume: 86 Issue: 9 Pages: 1320-1321 DOI: 10.2105/AJPH.86.9.1320 File-URL: http://hdl.handle.net/10.2105/AJPH.86.9.1320 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.9.1320_6 Template-Type: ReDIF-Article 1.0 Title: Family planning, sexually transmitted diseases, and the prevention of AIDS--divided we fail? Journal: American Journal of Public Health Author-Name: Stein, Z. Year: 1996 Volume: 86 Issue: 6 Pages: 783-784 DOI: 10.2105/AJPH.86.6.783 File-URL: http://hdl.handle.net/10.2105/AJPH.86.6.783 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.6.783_4 Template-Type: ReDIF-Article 1.0 Title: A graphical method for pooling epidemiological studies. Journal: American Journal of Public Health Author-Name: Chappell, W.R. Author-Name: Gratt, L.B. Year: 1996 Volume: 86 Issue: 5 Pages: 748-750 DOI: 10.2105/AJPH.86.5.748 File-URL: http://hdl.handle.net/10.2105/AJPH.86.5.748 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.5.748_7 Template-Type: ReDIF-Article 1.0 Title: Is a rational, national drug policy possible? Journal: American Journal of Public Health Author-Name: Kilwein, J.H. Year: 1996 Volume: 86 Issue: 1 Pages: 115 Handle: RePEc:aph:ajpbhl:1996:86:1:115_5 Template-Type: ReDIF-Article 1.0 Title: Needle exchange programs and the law--time for a change. Journal: American Journal of Public Health Author-Name: Glantz, L.H. Author-Name: Mariner, W.K. Year: 1996 Volume: 86 Issue: 8 Pages: 1077-1078 DOI: 10.2105/AJPH.86.8_Pt_1.1077 File-URL: http://hdl.handle.net/10.2105/AJPH.86.8_Pt_1.1077 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.8_Pt_1.1077_8 Template-Type: ReDIF-Article 1.0 Title: The scope of the data available in the AMA's Physician Masterfile. Journal: American Journal of Public Health Author-Name: Kenward, K. Year: 1996 Volume: 86 Issue: 10 Pages: 1481-1482 DOI: 10.2105/AJPH.86.10.1481 File-URL: http://hdl.handle.net/10.2105/AJPH.86.10.1481 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.10.1481_4 Template-Type: ReDIF-Article 1.0 Title: Determining the Nutritional Status of the Elderly in post-cold war Russia. Journal: American Journal of Public Health Author-Name: Toole, M.J. Author-Name: Serdula, M. Year: 1996 Volume: 86 Issue: 3 Pages: 299-301 DOI: 10.2105/AJPH.86.3.299 File-URL: http://hdl.handle.net/10.2105/AJPH.86.3.299 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.3.299_0 Template-Type: ReDIF-Article 1.0 Title: Annotation: the use of educational attainment as an indicator of socioeconomic position. Journal: American Journal of Public Health Author-Name: Hadden, W.C. Year: 1996 Volume: 86 Issue: 11 Pages: 1525-1526 DOI: 10.2105/AJPH.86.11.1525 File-URL: http://hdl.handle.net/10.2105/AJPH.86.11.1525 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.11.1525_2 Template-Type: ReDIF-Article 1.0 Title: Can conflict resolution training increase aggressive behavior in young adolescents? Journal: American Journal of Public Health Author-Name: Colyer, E. Author-Name: Thompkins, T. Author-Name: Durkin, M. Author-Name: Barlow, B. Year: 1996 Volume: 86 Issue: 7 Pages: 1028-1029 DOI: 10.2105/AJPH.86.7.1028 File-URL: http://hdl.handle.net/10.2105/AJPH.86.7.1028 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.7.1028_3 Template-Type: ReDIF-Article 1.0 Title: The future of epidemiology: a humanist response. Journal: American Journal of Public Health Author-Name: Lawson, J. Author-Name: Floyd, J. Year: 1996 Volume: 86 Issue: 7 Pages: 1029-1030 DOI: 10.2105/AJPH.86.7.1029 File-URL: http://hdl.handle.net/10.2105/AJPH.86.7.1029 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.7.1029_0 Template-Type: ReDIF-Article 1.0 Title: Erratum: Choosing a future for epidemiology: I. Cras and paradigms (American Journal of Public Health (1996) 86 (668-673)) Journal: American Journal of Public Health Author-Name: Susser, M. Author-Name: Susser, E. Year: 1996 Volume: 86 Issue: 8 Pages: 1093 Handle: RePEc:aph:ajpbhl:1996:86:8:1093_2 Template-Type: ReDIF-Article 1.0 Title: Cuban epidemic neuropathy, 1991 to 1994: History repeats itself a century after the "Amblyopia of the Blockade" Journal: American Journal of Public Health Author-Name: Ordúñez-García, P.O. Author-Name: Javier Nieto, F. Author-Name: Espinosa-Brito, A.D. Author-Name: Caballero, B. Year: 1996 Volume: 86 Issue: 5 Pages: 738-743 DOI: 10.2105/AJPH.86.5.738 File-URL: http://hdl.handle.net/10.2105/AJPH.86.5.738 Abstract: The 1991 to 1994 epidemic of neuropathy in Cuba has been one of the more devastating in recent history, affecting more than 50 000 people throughout the entire country with clinical manifestations of optic and peripheral neuropathy. Although the causes are not entirely clear, it seems that a combination of acute nutritional deficiency and the toxic effects of tobacco and possibly other unidentified toxic substances is involved. The epidemic coincided with the acute worsening of the economic situation on the island following political changes in Eastern European countries and a tightening of the US economic embargo. This paper reviews reports of a strikingly similar epidemic known as the "Amblyopia of the Blockade," which occurred in the Cuba almost a century ago when the island was undergoing a US naval blockade during the Cuban-Spanish-American war. It discusses the parallelism with the recent epidemic as well as the implications of this historical evidence to clarify further the ultimate causes of these epidemics. Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.5.738_7 Template-Type: ReDIF-Article 1.0 Title: Editorial: From alcohol and breast cancer to beef and BSE - Improving our communication of risk Journal: American Journal of Public Health Author-Name: Marmot, M. Year: 1996 Volume: 86 Issue: 7 Pages: 921-923 Handle: RePEc:aph:ajpbhl:1996:86:7:921-923_0 Template-Type: ReDIF-Article 1.0 Title: Are uninsured trauma patients treated differently? Journal: American Journal of Public Health Author-Name: Millham, F.H. Author-Name: Segui-Gomez, M. Year: 1996 Volume: 86 Issue: 3 Pages: 407-408 DOI: 10.2105/AJPH.86.3.407 File-URL: http://hdl.handle.net/10.2105/AJPH.86.3.407 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.3.407_1 Template-Type: ReDIF-Article 1.0 Title: Improving HIV/AIDS prevention in prisons is good public health policy. Journal: American Journal of Public Health Author-Name: Gaiter, J. Author-Name: Doll, L.S. Year: 1996 Volume: 86 Issue: 9 Pages: 1201-1203 DOI: 10.2105/AJPH.86.9.1201 File-URL: http://hdl.handle.net/10.2105/AJPH.86.9.1201 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.9.1201_3 Template-Type: ReDIF-Article 1.0 Title: Estimating the indirect cost of illness: An assessment of the forgone earnings approach Journal: American Journal of Public Health Author-Name: Glied, S. Year: 1996 Volume: 86 Issue: 12 Pages: 1723-1728 DOI: 10.2105/AJPH.86.12.1723 File-URL: http://hdl.handle.net/10.2105/AJPH.86.12.1723 Abstract: Objectives. This study attempted to assess (1) the accuracy of estimates of the indirect cost of illness and death computed with the human capital (forgone earnings) method and (2) the sensitivity of these estimates to key assumptions and parameters. Methods. The study used data from the annual Current Population Surveys of 1964 through 1988 to compare the earnings experience of cohorts of White men aged 18 through 65 with predictions made with the human capital method. The study then assessed the sources and magnitude of the observed differences. Results. Predictions of forgone earnings can be as much as 18% greater or 20% smaller than actual earnings, under identical assumptions, depending on the data used. While in most cases errors are quite small, alternative, equally plausible estimates of forgone earnings may differ by as much as 50%. Estimates differed mainly because of (1) the cross section chosen to make the predictions and (2) assumptions about future earnings growth. However, other factors, such as cohort size, also contributed to variation. Conclusions. Researchers and policymakers should be very careful in making and interpreting estimates of the indirect cost of illness and death. Handle: RePEc:aph:ajpbhl:10.2105/AJPH.86.12.1723_7 Template-Type: ReDIF-Article 1.0 Title: Fluoride exposure and childhood osteosarcoma: A case-control study Journal: American Journal of Public Health Author-Name: Gelberg, K.H. Author-Name: Fitzgerald, E.F. Author-Name: Hwang, S.-A. Author-Name: Dubrow, R. Year: 1995 Volume: 85 Issue: 12 Pages: 1678-1683 Abstract: Objectives. This study tests the hypothesis that fluoride exposure in a nonoccupational setting is a risk factor for childhood osteosarcoma. Methods. A population-based case-control study was conducted among residents of New York State, excluding New York City. Case subjects (n = 130) were diagnosed with osteosarcoma between 1978 and 1988, at age 24 years or younger. Control subjects were matched to case subjects on year of birth and sex. Exposure information was obtained by a telephone interview with the subject, parent, or both. Results. Based on the parents' responses, total lifetime fluoride exposure was not significantly associated with osteosarcoma among all subjects combined or among females. However, a significant protective trend was observed among males. Protective trends were observed for fluoridated toothpaste, fluoride tablets, and dental fluoride treatments among all subjects and among males. Based on the subjects' responses, no significant associations between fluoride exposure and osteosarcoma were observed. Conclusions. Fluoride exposure does not increase the risk of osteosarcoma and may be protective in males. The protective effect may not be directly due to fluoride exposure but to other factors associated with good dental hygiene. There is also biologic plausibility for a protective effect. Handle: RePEc:aph:ajpbhl:1995:85:12:1678-1683_8 Template-Type: ReDIF-Article 1.0 Title: The reporting sensitivities of two passive surveillance systems for vaccine adverse events Journal: American Journal of Public Health Author-Name: Rosenthal, S. Author-Name: Chen, R. Year: 1995 Volume: 85 Issue: 12 Pages: 1706-1709 Abstract: To evaluate reporting sensitivities for vaccine adverse events, reporting rates were estimated, by dividing the number of events reported to the Monitoring System for Adverse Events Following Immunization and the Vaccine Adverse Event Reporting System in a given period by the number of doses administered or distributed during the same period. Reporting sensitivity was calculated as the ratio of the rates at which events were reported to each passive surveillance system (numerator) and occurred in controlled studies (denominator). Reporting sensitivities were generally better in the public sector than in the private sector. The significant underreporting of known outcomes, together with the nonspecific nature of most adverse event reports, highlights the limitations of passive surveillance systems in assessing the incidence of vaccine adverse events. Handle: RePEc:aph:ajpbhl:1995:85:12:1706-1709_0 Template-Type: ReDIF-Article 1.0 Title: The availability of low-fat milk in an inner-city Latino community: Implications for nutrition education Journal: American Journal of Public Health Author-Name: Wechsler, H. Author-Name: Basch, C.E. Author-Name: Zybert, P. Author-Name: Lantigua, R. Author-Name: Shea, S. Year: 1995 Volume: 85 Issue: 12 Pages: 1690-1692 Abstract: Substitution of low-fat for whole milk is an important strategy for reducing saturated fat consumption, but intake of whole milk remains high among Latinos. To assess whether this is related to the unavailability of low-fat milk, we surveyed 251 grocery stores (bodegas) and 25 supermarkets in a predominantly low-income, urban Latino community. Low-fat milk was available in 73% of bodegas and 96% of supermarkets, but it constituted only 15% of total milk volume in bodegas and 37% of that volume in supermarkets. Since lack of availability was not a major obstacle to increasing low-fat milk consumption, public health nutrition campaigns should focus on increasing consumer demand. Handle: RePEc:aph:ajpbhl:1995:85:12:1690-1692_3 Template-Type: ReDIF-Article 1.0 Title: The defeat of health care reform: Misplaced mistrust in government Journal: American Journal of Public Health Author-Name: Feingold, E. Year: 1995 Volume: 85 Issue: 12 Pages: 1619-1622 Handle: RePEc:aph:ajpbhl:1995:85:12:1619-1622_8 Template-Type: ReDIF-Article 1.0 Title: Aerobic fitness, blood lipids, and body fat in children Journal: American Journal of Public Health Author-Name: Hager, R.L. Author-Name: Tucker, L.A. Author-Name: Seljaas, G.T. Year: 1995 Volume: 85 Issue: 12 Pages: 1702-1706 Abstract: This study examined the association between aerobic fitness and serum cholesterol and the effects of controlling for gender, body composition, abdominal fat, and dietary saturated fat in 262 children. The 1-mile run was used to estimate fitness. Skinfolds were used in assessing body fat. Fit children had lower total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels and higher high-density lipoprotein cholesterol levels than unfit children, except after adjustment for body fat and/or abdominal fat. Unfit children appear to be at an increased risk of unhealthy levels of serum cholesterol due primarily to increased levels of body fat. Handle: RePEc:aph:ajpbhl:1995:85:12:1702-1706_1 Template-Type: ReDIF-Article 1.0 Title: The tracking of nutrient intake in young children: The Framingham Children's Study Journal: American Journal of Public Health Author-Name: Singer, M.R. Author-Name: Moore, L.L. Author-Name: Garrahie, E.J. Author-Name: Ellison, R.C. Year: 1995 Volume: 85 Issue: 12 Pages: 1673-1677 Abstract: Objectives. This study compared the nutrient intake of children at 3 through 4 years of age with that in subsequent years to determine whether nutrient intake tracked over time. Methods. Intakes of 10 nutrients were estimated by means of multiple days of food diaries collected over a span of up to 6 years of follow-up for 95 children in the Framingham Children's Study. All diaries collected during each of three age periods (age 3 through 4, age 5 through 6, and age 7 through 8) were averaged. Nutrient density intakes at each age period were compared. Results. Nutrient-specific correlations ranged from .37 to .63 between nutrient density intakes at age 3-4 and age 5-6. Correlations between intakes at age 3-4 and age 7-8 ranged from .35 to .62. Consistency of classification was strong; 35.7% to 57.1% of children in the highest quintile of intake at age 3-4 remained in that quintile at age 5-6, and 57.1% to 85.7% remained in the top two quintiles. At age 7-8, 40.0% to 66.7% of those with the highest intake at baseline were still in the top quintile, and 60.0% to 93.3% remained in the top two quintiles. Results were similar in the lowest quintile of intake. Extreme misclassification was rare. Conclusions. This study suggests that tracking of nutrient intake begins as young as 3-4 years of age. Handle: RePEc:aph:ajpbhl:1995:85:12:1673-1677_9 Template-Type: ReDIF-Article 1.0 Title: New York city's 1993 child immunization day: Planning, costs, and results Journal: American Journal of Public Health Author-Name: Fairbrother, G. Author-Name: DuMont, K.A. Year: 1995 Volume: 85 Issue: 12 Pages: 1662-1665 Abstract: Objectives. This study evaluates New York City's Child Immunization Day (1993), with emphasis on the cost and effects of a mass campaign and the use of strategies from developing nations in an inner-city context. Methods. The methodology was designed to (1) document the planning and implementation process. (2) analyze the number and characteristics of children in the target group, and (3) estimate costs. Results. Neither the social mobilization nor the political will that characterize successful campaigns in developing nations occurred in New York City's campaign. Despite substantial time and effort from both private and public agencies, turnout for the event was low. In total, 2647 families and 5237 children were assessed for health care and insurance needs, 2940 children were immunized at a cost of about $279 per immunized child, and 7236 vaccines were administered. Conclusions. The differences between inner cities and developing nations have a hearing on strategies used in planning and implementing mass campaigns. New strategies need to be forged from a blending of these contexts to create effective campaigns in industrialized inner cities. Handle: RePEc:aph:ajpbhl:1995:85:12:1662-1665_5 Template-Type: ReDIF-Article 1.0 Title: Moderate prenatal alcohol exposure and psychomotor development at preschool age Journal: American Journal of Public Health Author-Name: Larroque, B. Author-Name: Kaminski, M. Author-Name: Dehaene, P. Author-Name: Subtil, D. Author-Name: Delfosse, M.-J. Author-Name: Querleu, D. Year: 1995 Volume: 85 Issue: 12 Pages: 1654-1661 Abstract: Objectives. This study investigated the effect of moderate prenatal alcohol exposure on psychomotor development of preschool-age children in a longitudinal study. Methods. Pregnant women were interviewed about their alcohol consumption at their first visit to the maternity hospital in Roubaix, France. Alcohol consumption before pregnancy and during the first trimester was assessed with a structured questionnaire. The psychomotor development of 155 children of these women was assessed with the McCarthy scales of children's abilities when the children were about 4 1/2 years old. Results. Consumption of 1.5 oz of absolute alcohol (approximately three drinks) or more per day during pregnancy was significantly related to a decrease of 7 points in the mean score on the general cognitive index of the McCarthy scales, after gender, birth order, maternal education, score for family stimulation, family status, maternal employment, child's age at examination, and examiner were controlled for. Conclusions. This study showed that moderate to heavy alcohol consumption during pregnancy, at levels well below those associated with fetal alcohol syndrome, has effects on children's psychomotor development. Handle: RePEc:aph:ajpbhl:1995:85:12:1654-1661_9 Template-Type: ReDIF-Article 1.0 Title: A model for estimating the impact of changes in children's vaccines Journal: American Journal of Public Health Author-Name: Simpson, K.N. Author-Name: Biddle, A.K. Author-Name: Rabinovich, N.R. Year: 1995 Volume: 85 Issue: 12 Pages: 1666-1672 Abstract: Objectives. To assist in strategic planning for the improvement of vaccines and vaccine programs, an economic model was developed and tested that estimates the potential impact of vaccine innovations on health outcomes and costs associated with vaccination and illness. Methods. A multistep, iterative process of data extraction/integration was used to develop the model and the scenarios. Parameter replication, sensitivity analysis, and expert review were used to validate the model. Results. The greatest impact on the improvement of health is expected to result from the production of less reactogenic vaccines that require fewer inoculations for immunity. The greatest economic impact is predicted from improvements that decrease the number of inoculations required. Conclusions. Scenario analysis may be useful for integrating health outcomes and economic data into decision making. For childhood infections, this analysis indicates that large cost savings can be achieved in the future if we can improve vaccine efficacy so that the number of required inoculations is reduced. Such an improvement represents a large potential 'payback' for the United States and might benefit other countries. Handle: RePEc:aph:ajpbhl:1995:85:12:1666-1672_7 Template-Type: ReDIF-Article 1.0 Title: Psychosocial factors in maternal phenylketonuria: Women's adherence to medical recommendations Journal: American Journal of Public Health Author-Name: Waisbren, S.E. Author-Name: Hamilton, B.D. Author-Name: St. James, P.J. Author-Name: Shiloh, S. Author-Name: Levy, H.L. Year: 1995 Volume: 85 Issue: 12 Pages: 1636-1641 Abstract: Objectives. This study identified factors predicting adherence to medical recommendations in maternal phenylketonuria, which can result in severe fetal damage. Methods. Sixty-nine women with phenylketonuria, 68 of their acquaintances, and 69 women with diabetes mellitus were interviewed annually for 5 years. A model in which each stage in the maternal phenylketonuria life cycle represented a treatment-related goal provided a means to assess adherence. Results. At the stages of prevention of unplanned pregnancy, treatment initiation, and diet continuation throughout pregnancy, attitudes and social support were associated with adherence to medical recommendations. No specific variables were associated with outcome at reproductive decision making, but women with phenylketonuria were more likely to delay making a decision, resulting in unplanned and, hence, untreated or late-treated pregnancy. Conclusions. Women with phenylketonuria differed from their acquaintances and diabetic women in many respects, suggesting that special programs are needed. Greater emphasis on reproductive decision making is especially needed. Interventions that focus on improving social support networks and attitudes about treatment may increase adherence to recommendations. Handle: RePEc:aph:ajpbhl:1995:85:12:1636-1641_4 Template-Type: ReDIF-Article 1.0 Title: The diversion of mentally ill persons from jails to community-based services: A profile of programs Journal: American Journal of Public Health Author-Name: Steadman, H.J. Author-Name: Morris, S.M. Author-Name: Dennis, D.L. Year: 1995 Volume: 85 Issue: 12 Pages: 1630-1635 Abstract: Objetives. A major proposal for appropriately treating persons with mental illnesses who have been arrested is to divert them from jail to community- based mental health programs. However, there are few available definitions, guidelines, and principles for developing effective diversion programs. The goal of this research was to determine the number and kinds of jail diversion programs that exist, how they are set up, and which types of programs are effective. Methods. On the basis of information gathered during a national mail survey (n = 1263) and follow-up telephone survey of 115 responding jails, 18 sites were selected for on-site interviews based on perceived effectiveness and presence of a formal diversion program. Results. Data are presented from a national sample of jail diversion programs (n = 18). Key factors for developing diversion programs and descriptors of effective programs are presented. Conclusions. It is clear that controlled, longitudinal studies of these programs' effectiveness, using client-based and organizational outcome measures, are badly needed. Handle: RePEc:aph:ajpbhl:1995:85:12:1630-1635_5 Template-Type: ReDIF-Article 1.0 Title: Victimization prevention programs for children: A follow-up Journal: American Journal of Public Health Author-Name: Finkelhor, D. Author-Name: Asdigian, N. Author-Name: Dziuba-Leatherman, J. Year: 1995 Volume: 85 Issue: 12 Pages: 1684-1689 Abstract: Objective. This study examined whether victimization prevention instruction in school has any impact on children's behavior in situations of real victimization threat. Methods. Telephone interviews were conducted in 1992 with a nationally representative sample of youths aged 10 to 16 and their caretakers, and the experience of 1457 of these children was followed up more than a year later. Results. Exposure to a more comprehensive prevention program was not associated with reduced incidence of victimization, injury, or upset. However, some of the exposure conditions were associated with an increased likelihood that the children would disclose victimizations, an increased likelihood that they would see themselves as having successfully protected themselves, and a decreased likelihood that they would blame themselves for the episode. Exposed children acquired some knowledge about sexual abuse and, when actually confronted by a threat, an ability to do the things they had been taught. A nonsignificant trend was also noted toward increased injury for exposed children during sexual assaults. Conclusion. These mixed findings suggest that prevention educators need to plan programs based on realistic goals for what can be accomplished. Handle: RePEc:aph:ajpbhl:1995:85:12:1684-1689_6 Template-Type: ReDIF-Article 1.0 Title: US adults' fruit and vegetable intakes, 1989 to 1991: A revised baseline for the healthy People 2000 objective Journal: American Journal of Public Health Author-Name: Krebs-Smith, S.M. Author-Name: Cook, D.A. Author-Name: Subar, A.F. Author-Name: Cleveland, L. Author-Name: Friday, J. Year: 1995 Volume: 85 Issue: 12 Pages: 1623-1629 Abstract: Objectives. This study provides revised baseline data for the Healthy People 2000 objective related to fruit and vegetable intakes, accounting for fruits and vegetables from all sources and measuring servings in a manner consistent with current dietary guidance. Methods. Dietary data from 8181 adults in the US Department of Agriculture's 1989-1991 Continuing Surveys of Food Intakes by Individuals were examined. All foods were disaggregated into their component ingredients; all fruit and vegetable ingredients were assigned specific weights to correspond to a serving as defined by current dietary guidance materials; and the number of servings was tallied. Results. While mean intakes of fruits and vegetables-4.3 servings per day-were not far from the Year 2000 objective, only 32% of American adults' intakes met the objective. When more stringent standards were set either to compensate for higher calorie levels or to achieve the balance between fruits and vegetables suggested in current guidance, only 24% and 12%, respectively, met the recommendations. Conclusions. These results suggest a need to develop strategies for overcoming barriers to eating fruits and vegetables. Handle: RePEc:aph:ajpbhl:1995:85:12:1623-1629_7 Template-Type: ReDIF-Article 1.0 Title: Tobacco information in two grade school newsweeklies: A content analysis Journal: American Journal of Public Health Author-Name: Balbach, E.D. Author-Name: Glantz, S.A. Year: 1995 Volume: 85 Issue: 12 Pages: 1650-1653 Abstract: Objectives. This study compared tobacco-related articles from two elementary school publications, Weekly Reader and Scholastic News, published in 1989 through 1994. Methods. Articles for grades 4 through 6 were evaluated, and the publications were compared with each other. Also, issues of Weekly Reader published after acquisition by K-III, which is owned by the finn that formerly owned RJR Tobacco, were compared with the earlier ones. Results. Weekly Reader was less likely than Scholastic News to mention short- term consequences of smoking (32% vs 64%) or to give a clear 'no-use' message (35% vs 79%). Weekly Reader was more likely to give the tobacco industry position (68% vs 32%). Post-K-III issues of Weekly Reader were less likely to provide a clear no-use message than earlier ones (62% vs 24%). Conclusions. Health professionals need to monitor the health information carried in these publications, which reach between 1 and 2 million students per grade level each week. Although neither publication had perfect tobacco coverage, Scholastic News was significantly better than Weekly Reader. Handle: RePEc:aph:ajpbhl:1995:85:12:1650-1653_4 Template-Type: ReDIF-Article 1.0 Title: Teaching and reinforcing hygienic practices in child care centers. Journal: American Journal of Public Health Author-Name: Esernio-Jenssen, D. Year: 1995 Volume: 85 Issue: 12 Pages: 1710 Handle: RePEc:aph:ajpbhl:1995:85:12:1710_9 Template-Type: ReDIF-Article 1.0 Title: Inhaled and oral corticosteroids: Their effects on bone mineral density in older adults Journal: American Journal of Public Health Author-Name: Marystone, J.F. Author-Name: Barrett-Connor, E.L. Author-Name: Morton, D.J. Year: 1995 Volume: 85 Issue: 12 Pages: 1693-1695 Abstract: Use of oral and inhaled corticosteroids and bone mineral density were examined cross-sectionally in 1673 community-dwelling white subjects aged 56 to 91 years. Bone mineral densities at the ultradistal and midshaft radii, hip, and lumbar spine were compared in users of inhaled (n = 34) and oral (n = 44) corticosteroids and nonusers. Women who used oral corticosteroids had significantly lower bone mineral densities at the midshaft radius, hip, and spine than never users. Women who used inhaled corticosteroids had bone mineral densities at the ultradistal radius, hip, and spine that were intermediate between those of oral corticosteroid users and those of never users. Bone mineral density did not vary significantly according to corticosteroid use in men. Handle: RePEc:aph:ajpbhl:1995:85:12:1693-1695_9 Template-Type: ReDIF-Article 1.0 Title: Changes in perinatal cocaine use in an inner-city hospital, 1988 to 1992 Journal: American Journal of Public Health Author-Name: McCalla, S. Author-Name: Feldman, J. Author-Name: Webbeh, H. Author-Name: Ahmadi, R. Author-Name: Minkoff, H.L. Year: 1995 Volume: 85 Issue: 12 Pages: 1695-1697 Abstract: Temporal trends in perinatal drug use among parturients at an inner-city hospital were assessed in a cohort study of 1300 parturients in 1991 through 1992 and 1111 parturients in 1988 through 1989. Toxicology results were coupled to data sheets containing demographic and obstetrical information. A decrease was noted between 1988 and 1992 in the prevalence of cocaine metabolites, independent of the utilization of prenatal services. An increase in marijuana use and no change in opiate use were seen. When adjusted for ethnicity and receipt of care, a 50% decline in the odds ratio (OR) of cocaine use was noted between 1988 and 1992 (OR = 0.55; 95% confidence interval = 0.39, 0.79). Handle: RePEc:aph:ajpbhl:1995:85:12:1695-1697_1 Template-Type: ReDIF-Article 1.0 Title: Correlates of high-density lipoprotein cholesterol in Black girls and White girls: The NHLBI growth and health study Journal: American Journal of Public Health Author-Name: Simon, J.A. Author-Name: Morrison, J.A. Author-Name: Similo, S.L. Author-Name: McMahon, R.P. Author-Name: Schreiber, G.B. Year: 1995 Volume: 85 Issue: 12 Pages: 1698-1702 Abstract: To determine the correlates of serum high-density lipoprotein cholesterol (HDL-C) in 9- and 10-year-old girls, data were examined from 624 Black girls and 773 White girls. Black girls had, on average, 3.6 mg/dL higher levels than White girls. Each 10-mm increase in sum of skinfolds was associated with a decrease of 1.4 mg/dL; each unit increase in the tricep/suprailiac skin- told ratio was associated with an increase of 2 mg/dL; and each 10% increase in polyunsaturated fat intake was associated with an increase of 3.4 mg/dL. The associations of sedentary/activity and sexual maturation with HDL were mediated by differences in adiposity. Interventions to decrease adiposity may be important for the primary prevention of heart disease in women. Handle: RePEc:aph:ajpbhl:1995:85:12:1698-1702_9 Template-Type: ReDIF-Article 1.0 Title: Childhood risk factors for homelessness among homeless adults Journal: American Journal of Public Health Author-Name: Koegel, P. Author-Name: Melamid, E. Author-Name: Burnam, M.A. Year: 1995 Volume: 85 Issue: 12 Pages: 1642-1649 Abstract: Objectives. This effort used data from the Course of Homelessness study and comparative secondary data on the general population to identify negative childhood and family background experiences that may increase risk for adult homelessness. Methods. Frequencies of negative childhood experiences were examined among a probability sample of 1563 homeless adults. Differences in risk for such experiences were calculated by sex, age cohort, and racial/ethnicity status. Where possible, rates of negative childhood experiences among the homeless were compared with the general population. Results. Substantial numbers of this sample experienced multiple problems as children across several domains: poverty, residential instability, and family problems. Women and Whites disproportionately reported experiences suggestive of personal or family problems; non-Whites disproportionately reported experiences suggestive of poverty. Homeless adults were at increased risk of childhood out-of-home placement, tenure in public housing, and homelessness, but not at greater risk for physical abuse. Women appeared to be at greater risk for sexual abuse. Conclusions. The problems that homeless individuals experience as adults have very clear analogs in their childhoods. Vulnerability to homelessness stems from factors unevenly distributed across age, sex, and race/ethnicity groups. Handle: RePEc:aph:ajpbhl:1995:85:12:1642-1649_8 Template-Type: ReDIF-Article 1.0 Title: HIV seroprevalence and risk behaviors among lesbians and bisexual women in San Francisco and Berkeley, California Journal: American Journal of Public Health Author-Name: Lemp, G.F. Author-Name: Jones, M. Author-Name: Kellogg, T.A. Author-Name: Nieri, G.N. Author-Name: Anderson, L. Author-Name: Withum, D. Author-Name: Katz, M. Year: 1995 Volume: 85 Issue: 11 Pages: 1549-1552 Abstract: Few data are available on human immunodeficiency virus (HIV) infection and risk behaviors among lesbians and bisexual women. A total of 498 lesbians and bisexual women was sampled from public venues in San Francisco and Berkeley, Calif, during 1993. The overall HIV seroprevalence was 1.2%. Ten percent of participants reported injecting drugs since 1978. Forty percent of the participants reported unprotected vaginal or anal sex with men during the past 3 years, including unprotected sex with gay and bisexual men and male injection drug users. The high rates of injection drug use and unsafe sexual behaviors suggest that lesbians and bisexual women frequenting public venues in San Francisco and Berkeley are at risk for HIV infection. Handle: RePEc:aph:ajpbhl:1995:85:11:1549-1552_8 Template-Type: ReDIF-Article 1.0 Title: Folic acid fortification for the prevention of neural tube defects: consensus needed on potential adverse effects. Journal: American Journal of Public Health Author-Name: Pérez-Escamilla, R. Year: 1995 Volume: 85 Issue: 11 Pages: 1587-1588 Handle: RePEc:aph:ajpbhl:1995:85:11:1587-1588_0 Template-Type: ReDIF-Article 1.0 Title: Casual sex and HIV transmission. Journal: American Journal of Public Health Author-Name: Vermund, S.H. Year: 1995 Volume: 85 Issue: 11 Pages: 1488-1489 Handle: RePEc:aph:ajpbhl:1995:85:11:1488-1489_2 Template-Type: ReDIF-Article 1.0 Title: The availability of disposable syringes in Russia. Journal: American Journal of Public Health Author-Name: Hartsock, P.I. Year: 1995 Volume: 85 Issue: 11 Pages: 1586 Handle: RePEc:aph:ajpbhl:1995:85:11:1586_2 Template-Type: ReDIF-Article 1.0 Title: Annotation: needle exchange programs--do they work? Journal: American Journal of Public Health Author-Name: Coutinho, R.A. Year: 1995 Volume: 85 Issue: 11 Pages: 1490-1491 Handle: RePEc:aph:ajpbhl:1995:85:11:1490-1491_9 Template-Type: ReDIF-Article 1.0 Title: HIV risk factors and behaviors among men in a Milwaukee homeless shelter. Journal: American Journal of Public Health Author-Name: Kelly, J.A. Author-Name: Heckman, T.G. Author-Name: Helfrich, S.E. Author-Name: Mence, R.L. Author-Name: Adair Jr., V. Author-Name: Broyles Jr., L.A. Year: 1995 Volume: 85 Issue: 11 Pages: 1585 Handle: RePEc:aph:ajpbhl:1995:85:11:1585_1 Template-Type: ReDIF-Article 1.0 Title: More on women and the prevention of HIV infection. Journal: American Journal of Public Health Author-Name: Stein, Z.A. Year: 1995 Volume: 85 Issue: 11 Pages: 1485-1488 Handle: RePEc:aph:ajpbhl:1995:85:11:1485-1488_5 Template-Type: ReDIF-Article 1.0 Title: Encouraging mammography use among underserved women through a celebration of breast health. Journal: American Journal of Public Health Author-Name: Englisbe, B.H. Author-Name: Jimpson, G.E. Author-Name: Harper, G.R. Author-Name: Cohen, M. Year: 1995 Volume: 85 Issue: 10 Pages: 1446-1447 Handle: RePEc:aph:ajpbhl:1995:85:10:1446-1447_0 Template-Type: ReDIF-Article 1.0 Title: Integrating indicators into a public health quality improvement system. Journal: American Journal of Public Health Author-Name: Speake, D.L. Author-Name: Mason, K.P. Author-Name: Broadway, T.M. Author-Name: Sylvester, M. Author-Name: Morrison, S.P. Year: 1995 Volume: 85 Issue: 10 Pages: 1448-1449 Handle: RePEc:aph:ajpbhl:1995:85:10:1448-1449_7 Template-Type: ReDIF-Article 1.0 Title: A short-term consumer agenda for health care reform. Journal: American Journal of Public Health Author-Name: Karpatkin, R.H. Author-Name: Shearer, G.E. Year: 1995 Volume: 85 Issue: 10 Pages: 1352-1355 Handle: RePEc:aph:ajpbhl:1995:85:10:1352-1355_1 Template-Type: ReDIF-Article 1.0 Title: A communitywide needle/syringe disposal program. Journal: American Journal of Public Health Author-Name: Toews, D.W. Year: 1995 Volume: 85 Issue: 10 Pages: 1447-1448 Handle: RePEc:aph:ajpbhl:1995:85:10:1447-1448_8 Template-Type: ReDIF-Article 1.0 Title: Containing state health care expenditures--the competition vs regulation debate. Journal: American Journal of Public Health Author-Name: Glied, S. Author-Name: Sparer, M. Author-Name: Brown, L. Year: 1995 Volume: 85 Issue: 10 Pages: 1347-1349 Handle: RePEc:aph:ajpbhl:1995:85:10:1347-1349_0 Template-Type: ReDIF-Article 1.0 Title: Prevalence, promotion, and person: the 3 Ps of firearm use. Journal: American Journal of Public Health Author-Name: Farquhar, J.W. Year: 1995 Volume: 85 Issue: 10 Pages: 1453 Handle: RePEc:aph:ajpbhl:1995:85:10:1453_8 Template-Type: ReDIF-Article 1.0 Title: Promoting healthy eating: Contra Costa County's food policy. Journal: American Journal of Public Health Author-Name: Cortes, F. Author-Name: Steeples, M. Author-Name: Stone, M. Year: 1995 Volume: 85 Issue: 10 Pages: 1449-1450 Handle: RePEc:aph:ajpbhl:1995:85:10:1449-1450_4 Template-Type: ReDIF-Article 1.0 Title: The origins of health standards for quartz exposure. Journal: American Journal of Public Health Author-Name: Ayer, H.E. Year: 1995 Volume: 85 Issue: 10 Pages: 1453-1454 Handle: RePEc:aph:ajpbhl:1995:85:10:1453-1454_5 Template-Type: ReDIF-Article 1.0 Title: Health systems' effects on health status--financing vs the organization of services. Journal: American Journal of Public Health Author-Name: Starfield, B. Year: 1995 Volume: 85 Issue: 10 Pages: 1350-1351 Handle: RePEc:aph:ajpbhl:1995:85:10:1350-1351_4 Template-Type: ReDIF-Article 1.0 Title: Back pain and risk of suicide among Finnish farmers. Journal: American Journal of Public Health Author-Name: Penttinen, J. Year: 1995 Volume: 85 Issue: 10 Pages: 1452-1453 Handle: RePEc:aph:ajpbhl:1995:85:10:1452-1453_5 Template-Type: ReDIF-Article 1.0 Title: The inexcusable persistence of silicosis. Journal: American Journal of Public Health Author-Name: Wagner, G.R. Year: 1995 Volume: 85 Issue: 10 Pages: 1346-1347 Handle: RePEc:aph:ajpbhl:1995:85:10:1346-1347_7 Template-Type: ReDIF-Article 1.0 Title: Beyond population statistics. Journal: American Journal of Public Health Author-Name: Silver, G. Year: 1995 Volume: 85 Issue: 10 Pages: 1345-1346 Handle: RePEc:aph:ajpbhl:1995:85:10:1345-1346_1 Template-Type: ReDIF-Article 1.0 Title: Smoking cessation counseling during routine public prenatal care. Journal: American Journal of Public Health Author-Name: Haddow, J.E. Author-Name: Palomaki, G.E. Author-Name: Sepulveda, D. Year: 1995 Volume: 85 Issue: 10 Pages: 1451-1452 Handle: RePEc:aph:ajpbhl:1995:85:10:1451-1452_3 Template-Type: ReDIF-Article 1.0 Title: The use of existing databases in morbidity and mortality studies. Journal: American Journal of Public Health Author-Name: Kuller, L.H. Year: 1995 Volume: 85 Issue: 9 Pages: 1198-1200 Handle: RePEc:aph:ajpbhl:1995:85:9:1198-1200_1 Template-Type: ReDIF-Article 1.0 Title: Public health methods--attributable risk as a link between causality and public health action. Journal: American Journal of Public Health Author-Name: Northridge, M.E. Year: 1995 Volume: 85 Issue: 9 Pages: 1202-1204 Handle: RePEc:aph:ajpbhl:1995:85:9:1202-1204_2 Template-Type: ReDIF-Article 1.0 Title: Genetic prophecy and genetic privacy--can we prevent the dream from becoming a nightmare? Journal: American Journal of Public Health Author-Name: Annas, G.J. Year: 1995 Volume: 85 Issue: 9 Pages: 1196-1197 Handle: RePEc:aph:ajpbhl:1995:85:9:1196-1197_1 Template-Type: ReDIF-Article 1.0 Title: Evaluating the performance of local health agencies. 2. The 10 public health practices vs the 10 public health services: a clarification. Journal: American Journal of Public Health Author-Name: Turnock, B.J. Author-Name: Handler, A. Year: 1995 Volume: 85 Issue: 9 Pages: 1295-1296 Handle: RePEc:aph:ajpbhl:1995:85:9:1295-1296_6 Template-Type: ReDIF-Article 1.0 Title: Motivating physicians to provide smoking cessation treatment. Journal: American Journal of Public Health Author-Name: Hughes, J.R. Year: 1995 Volume: 85 Issue: 9 Pages: 1297 Handle: RePEc:aph:ajpbhl:1995:85:9:1297_8 Template-Type: ReDIF-Article 1.0 Title: Two techniques for evaluating the accuracy of record linkages. Journal: American Journal of Public Health Author-Name: Griffin, G.W. Author-Name: Gaudino, J.A. Author-Name: Rochat, R. Year: 1995 Volume: 85 Issue: 9 Pages: 1294-1295 Handle: RePEc:aph:ajpbhl:1995:85:9:1294-1295_4 Template-Type: ReDIF-Article 1.0 Title: Do HIV testing and counseling increase risk behavior? Journal: American Journal of Public Health Author-Name: Chamot, E. Author-Name: Laborde, D.J. Author-Name: Rice, J.C. Year: 1995 Volume: 85 Issue: 9 Pages: 1297-1298 Handle: RePEc:aph:ajpbhl:1995:85:9:1297-1298_8 Template-Type: ReDIF-Article 1.0 Title: Policy as intervention: environmental and policy approaches to the prevention of cardiovascular disease. Journal: American Journal of Public Health Author-Name: Schmid, T.L. Author-Name: Pratt, M. Author-Name: Howze, E. Year: 1995 Volume: 85 Issue: 9 Pages: 1207-1211 Abstract: This paper describes the evolution of efforts to prevent cardiovascular disease, from individual health education approaches to broader community education efforts and, finally, to comprehensive and integrated programs addressing environmental, policy, and individual behavior change. Policies are divided into two areas: legislation/regulation and organizational policy. Environmental strategies are measures that alter or control the physical or social environment. Dimensions along which these strategies might be implemented are provided. Policy and environmental approaches can be justified on economic, strategic, and theoretical grounds. Experiences from other fields and other countries provide a framework for conceptualizing cardiovascular disease prevention approaches. Handle: RePEc:aph:ajpbhl:1995:85:9:1207-1211_2 Template-Type: ReDIF-Article 1.0 Title: Listeriosis in Minnesota, January 1986 through May 1988. Journal: American Journal of Public Health Author-Name: Hedberg, K. Author-Name: Osterholm, M.T. Author-Name: Gabriel, L.L. Author-Name: Hedberg, C.W. Author-Name: MacDonald, K.L. Year: 1995 Volume: 85 Issue: 9 Pages: 1293-1294 Handle: RePEc:aph:ajpbhl:1995:85:9:1293-1294_7 Template-Type: ReDIF-Article 1.0 Title: Assessing exposure to carcinogens in drinking water. Journal: American Journal of Public Health Author-Name: Levallois, P. Author-Name: Ayotte, P. Year: 1995 Volume: 85 Issue: 9 Pages: 1298-1300 Handle: RePEc:aph:ajpbhl:1995:85:9:1298-1300_8 Template-Type: ReDIF-Article 1.0 Title: Social inequality and death as illustrated in late-medieval death dances. Journal: American Journal of Public Health Author-Name: Mackenbach, J.P. Year: 1995 Volume: 85 Issue: 9 Pages: 1285-1292 Abstract: Late-medieval murals and books of the then-popular "dances of death" usually represented the living according to their social standing. These works of art thus provide an interesting opportunity to study the relationship between social inequality and death as it was perceived by the works' commissioners or executers. The social hierarchy in these dances of death is mostly based on the scheme of the three orders of the feudal society; variations relate to the inclusion of female characters, new occupations, and non-Christian characters. Many dances of death contain severe judgments on highplaced persons and thus seem to be expressions of a desire for greater social equality. However, a more thorough analysis reveals that the equality of all before death that these dances of death proclaimed held nothing for the poor but only threatened the rich. Because of a lack of reliable data, it is not yet completely clear whether during the late Middle Ages all were indeed equally at risk for premature mortality. Available evidence, however, suggests that the clergy and nobility actually had a higher life expectancy than people placed lower in the social hierarchy. Despite modern changes in the perception of, and knowledge about, social inequality and mortality, these dances of death still capture the imagination, and they suggest that the phenomenon of socioeconomic inequalities in mortality could be used more to emphasize contemporary moral messages on social inequality. Handle: RePEc:aph:ajpbhl:1995:85:9:1285-1292_9 Template-Type: ReDIF-Article 1.0 Title: Evaluating the performance of local health agencies. 1. Agencies' weaknesses in the practice of evaluation. Journal: American Journal of Public Health Author-Name: Jung, B.C. Year: 1995 Volume: 85 Issue: 9 Pages: 1295-1297 Handle: RePEc:aph:ajpbhl:1995:85:9:1295-1297_5 Template-Type: ReDIF-Article 1.0 Title: The effects of vitamin A supplementation on the morbidity of children born to HIV-infected women Journal: American Journal of Public Health Author-Name: Coutsoudis, A. Author-Name: Bobat, R.A. Author-Name: Coovadia, H.M. Author-Name: Kuhn, L. Author-Name: Tsai, W.-Y. Author-Name: Stein, Z.A. Year: 1995 Volume: 85 Issue: 8 Pages: 1076-1081 Abstract: Objective. The effects of vitamin A supplementation on morbidity of children born to human immunodeficiency virus (HIV)-infected women were evaluated in a population where vitamin A deficiency is not endemic. Methods. A randomized, placebo-controlled trial of vitamin A supplementation was carried out in 118 offspring of HIV-infected women in Durban, South Africa. Those assigned to receive a supplement were given 50 000 IU of vitamin A at 1 and 3 months of age; 100 000 IU at 6 and 9 months; and 200 000 IU at 12 and 15 months. Morbidity in the past month was then recalled at each follow-up visit. Analysis was based on 806 child-months. Results. Among all children, the supplemented group had lower overall morbidity than the placebo group (OR = 0.69; 95% confidence interval [CI] = 0.48, 0.99). Among the 85 children of known HIV status (2.8 infected, 57 uninfected), morbidity associated with diarrhea was significantly reduced in the supplemented infected children (OR = 0.51; 95% CI = 0.27, 0.99), whereas no effect of supplementation on diarrheal morbidity was noted among the uninfected children. Conclusion. In a population not generally vitamin A deficient, vitamin A supplementation for children of HIV-infected women appeared to be beneficial, reducing morbidity. The benefit was observed particularly for diarrhea among HIV-infected children. Handle: RePEc:aph:ajpbhl:1995:85:8:1076-1081_8 Template-Type: ReDIF-Article 1.0 Title: Retaining cocaine-abusing women in a therapeutic community: The effect of a child live-in program Journal: American Journal of Public Health Author-Name: Hughes, P.H. Author-Name: Coletti, S.D. Author-Name: Neri, R.L. Author-Name: Urmann, C.F. Author-Name: Stahl, S. Author-Name: Sicilian, D.M. Author-Name: Anthony, J.C. Year: 1995 Volume: 85 Issue: 8 Pages: 1149-1152 Abstract: A clinical trial examined whether retention of cocaine-abusing women in a therapeutic community can be improved by permitting their children to live with them during treatment. Fifty-three women were randomly assigned to either the standard community condition (n = 22), in which children were placed with the best available caretaker, or the demonstration condition (n = 31), in which one or two of the children lived with their mother in the community. Survival analysis distributions indicated that demonstration women remained in treatment significantly longer than standard treatment women. (Mean length of stay was 300.4 days vs 101.9 days, respectively.) Handle: RePEc:aph:ajpbhl:1995:85:8:1149-1152_1 Template-Type: ReDIF-Article 1.0 Title: Paternal smoking and low birthweight: the routes of exposure. Journal: American Journal of Public Health Author-Name: Olshan, A.F. Author-Name: Savitz, D.A. Year: 1995 Volume: 85 Issue: 8 Pages: 1169-1170 Handle: RePEc:aph:ajpbhl:1995:85:8:1169-1170_8 Template-Type: ReDIF-Article 1.0 Title: Trauma-related care among the uninsured in Massachusetts. Journal: American Journal of Public Health Author-Name: Dulisse, B. Year: 1995 Volume: 85 Issue: 8 Pages: 1164-1165 Handle: RePEc:aph:ajpbhl:1995:85:8:1164-1165_2 Template-Type: ReDIF-Article 1.0 Title: Measuring and reducing exposure to the pollutants in house dust. Journal: American Journal of Public Health Author-Name: Lewis, R.G. Author-Name: Roberts, J.W. Author-Name: Chuang, J.C. Author-Name: Camann, D.E. Author-Name: Ruby, M.G. Year: 1995 Volume: 85 Issue: 8 Pages: 1168 Handle: RePEc:aph:ajpbhl:1995:85:8:1168_0 Template-Type: ReDIF-Article 1.0 Title: The federal budget and women's health. Journal: American Journal of Public Health Author-Name: Davis, K. Year: 1995 Volume: 85 Issue: 8 Pages: 1051-1053 Handle: RePEc:aph:ajpbhl:1995:85:8:1051-1053_6 Template-Type: ReDIF-Article 1.0 Title: Community health workers: integral members of the health care work force. Journal: American Journal of Public Health Author-Name: Witmer, A. Author-Name: Seifer, S.D. Author-Name: Finocchio, L. Author-Name: Leslie, J. Author-Name: O'Neil, E.H. Year: 1995 Volume: 85 Issue: 8 Pages: 1055-1058 Abstract: As the US health care system strives to function efficiently, encourage preventive and primary care, improve quality, and overcome nonfinancial barriers to care, the potential exists for community health workers to further these goals. Community health workers can increase access to care and facilitate appropriate use of health resources by providing outreach and cultural linkages between communities and delivery systems; reduce costs by providing health education, screening, detection, and basic emergency care; and improve quality by contributing to patient-provider communication, continuity of care, and consumer protection. Information sharing, program support, program evaluation, and continuing education are needed to expand the use of community health workers and better integrate them into the health care delivery system. Handle: RePEc:aph:ajpbhl:1995:85:8:1055-1058_1 Template-Type: ReDIF-Article 1.0 Title: The evolving epidemiology of syphilis. Journal: American Journal of Public Health Author-Name: Kilmarx, P.H. Author-Name: St Louis, M.E. Year: 1995 Volume: 85 Issue: 8 Pages: 1053-1054 Handle: RePEc:aph:ajpbhl:1995:85:8:1053-1054_5 Template-Type: ReDIF-Article 1.0 Title: The nursing profession and physicians in authority roles. Journal: American Journal of Public Health Author-Name: Gebbie, K.M. Year: 1995 Volume: 85 Issue: 8 Pages: 1166-1168 Handle: RePEc:aph:ajpbhl:1995:85:8:1166-1168_5 Template-Type: ReDIF-Article 1.0 Title: Monitoring community health workers' performance through lot quality-assurance sampling. Journal: American Journal of Public Health Author-Name: Valadez, J.J. Author-Name: Weld, L. Author-Name: Vargas, W.V. Year: 1995 Volume: 85 Issue: 8 Pages: 1165-1166 Handle: RePEc:aph:ajpbhl:1995:85:8:1165-1166_9 Template-Type: ReDIF-Article 1.0 Title: Reducing smoking among psychiatric inpatients: a survey of psychiatrists. Journal: American Journal of Public Health Author-Name: Landow, L. Author-Name: Szetela, B. Author-Name: Know, M.A. Year: 1995 Volume: 85 Issue: 8 Pages: 1169 Handle: RePEc:aph:ajpbhl:1995:85:8:1169_0 Template-Type: ReDIF-Article 1.0 Title: The rise of the modern addict. Journal: American Journal of Public Health Author-Name: Jonnes, J. Year: 1995 Volume: 85 Issue: 8 Pages: 1157-1162 Abstract: In the mid-19th century, most American addicts were genteel women hooked on opiates through medical treatment. Within a few decades, a new group of addicts emerged--pleasure users who patronized opium dens. As local laws closed dens, the pleasure users--most often poor young men in northern cities--began experimenting with cocaine and heroin, causing an alarmed government to launch an escalating campaign to root out the new deviant subculture. Various treatment efforts were instituted, from short-lived clinics to federal narcotics farms. This drug use epidemic peaked in the 1920s and was essentially quelled by World War II. This paper briefly discusses differences between early British and US policies and the contemporary implications of this early drug use epidemic. Handle: RePEc:aph:ajpbhl:1995:85:8:1157-1162_6 Template-Type: ReDIF-Article 1.0 Title: War injuries among children in Karlovac District, Croatia. Journal: American Journal of Public Health Author-Name: Kopjar, B. Author-Name: Wiik, J. Author-Name: Zunic, J. Author-Name: Koepsell, T. Author-Name: Scheidt, P. Author-Name: Wickizer, T. Year: 1995 Volume: 85 Issue: 8 Pages: 1163-1164 Handle: RePEc:aph:ajpbhl:1995:85:8:1163-1164_0 Template-Type: ReDIF-Article 1.0 Title: Promoting tobacco control policies in Northwest Indian tribes Journal: American Journal of Public Health Author-Name: Lichtenstein, E. Author-Name: Glasgow, R.E. Author-Name: Lopez, K. Author-Name: Hall, R. Author-Name: McRae, S.G. Author-Name: Meyers, G.B. Year: 1995 Volume: 85 Issue: 7 Pages: 991-994 Abstract: A culturally sensitive consultative process to facilitate adoption by tribal councils of more effective tobacco control policies was developed and evaluated. Thirty-nine Northwest Indian tribes were randomized to early intervention or late intervention conditions. Early intervention tribes received a policy workbook and consultation by means of meetings and telephone calls. Late intervention tribes were assessed but received no assistance or encouragement regarding tobacco use policies. The stringency of the policies was assessed via telephone at baseline and after intervention. At postintervention, there were consistent, and generally statistically significant, differences in adoption of more stringent and comprehensive smoking policies for early intervention tribes compared with late intervention tribes. The intervention could be used in other Indian setting. Handle: RePEc:aph:ajpbhl:1995:85:7:991-994_9 Template-Type: ReDIF-Article 1.0 Title: Educating preschoolers about sun safety Journal: American Journal of Public Health Author-Name: Loescher, L.J. Author-Name: Emerson, J. Author-Name: Taylor, A. Author-Name: Christensen, D.H. Author-Name: McKinney, M. Year: 1995 Volume: 85 Issue: 7 Pages: 939-943 Abstract: Objectives. This feasibility study examined whether a sun safety curriculum designed for and administered to preschoolers affects their cognition (knowledge, comprehension, application) regarding san safety. Methods. Twelve classes of 4- to 5-year-olds were recruited from local preschools and randomly assigned to an intervention group or a control group. The intervention group received an investigator-developed sun safety curriculum; the control group did not. Children in both groups were tested at the beginning of the study about their cognition related to sun safety. They then received posttests 2 and 7 weeks following the pretest. Results. The curriculum had a significant effect on the knowledge (P = .01) and comprehension (P = .006) components of cognition. The application component of cognition was not significantly changed by the curriculum. Conclusions. A structured curriculum was found to be an efficacious means of enhancing knowledge and comprehension of sun safety in preschool children. At the preoperational developmental stage, however, children may not be able to apply such knowledge and comprehension. Handle: RePEc:aph:ajpbhl:1995:85:7:939-943_3 Template-Type: ReDIF-Article 1.0 Title: Access to paid in-home assistance among disabled elderly people: Do Latinos differ from non-Latino Whites? Journal: American Journal of Public Health Author-Name: Wallace, S.P. Author-Name: Levy-Storms, L. Author-Name: Ferguson, L.R. Year: 1995 Volume: 85 Issue: 7 Pages: 970-975 Abstract: Objectives. The purpose of this study was to compare the national prevalences and predictors of paid in-home functional assistance among disabled Latino and non-Latino elderly people who receive such assistance. Methods. Data were derived from the 1988 wave of the National Center for Health Statistics Longitudinal Study on Aging and the 1988 Commonwealth Fund Commission Survey of Elderly Hispanics. Logistic regression was used to model paid care use and to calculate estimated probabilities of such use. Results. Among Latino and non-Latino Whites 74 years of age and older who received functional assistance, similar proportions used paid assistance. Predictors of paid care coincided with established models for non-Latino Whites only. Disabled Latinos had a lower estimated probability of using paid assistance when they were highly disabled and socially isolated but had a higher estimated probability when their children lived nearby. Conclusions. The effects of disability and social support differ among non-Latino White and Latino elderly people. Latino elderly people with high anticipated needs obtain less paid assistance than similar non-Latino Whites. In addition to a reduction in financial barriers, improving access to long-term care services requires addressing this diversity in service use patterns. Handle: RePEc:aph:ajpbhl:1995:85:7:970-975_5 Template-Type: ReDIF-Article 1.0 Title: Postexposure rabies prophylaxis. 1. Experience with a computerized algorithm. Journal: American Journal of Public Health Author-Name: Dato, V.M. Author-Name: Sorhage, F.E. Author-Name: Spitalny, K.C. Year: 1995 Volume: 85 Issue: 7 Pages: 1020-1021 Handle: RePEc:aph:ajpbhl:1995:85:7:1020-1021_6 Template-Type: ReDIF-Article 1.0 Title: Neonatal technology, perinatal survival, social consequences, and the perinatal paradox. Journal: American Journal of Public Health Author-Name: Kliegman, R.M. Year: 1995 Volume: 85 Issue: 7 Pages: 909-913 Abstract: Exogenous surfactant therapy for premature infants with respiratory distress syndrome has had a significant impact on infant mortality and on some complications of prematurity. Yet the total number of low-birthweight infants has not declined, resulting in a high-risk population who would require surfactant therapy and long-term child care. Surviving low-birthweight infants (despite surfactant therapy) remain at risk for the consequences of premature birth, such as neurosensory impairment, cerebral palsy, and chronic lung disease. In addition, because of the close association between poverty and low birthweight, surviving premature infants are at increased risk for the new morbidities such as violence, homelessness, child abuse and neglect, and addictive drug use. A goal should be to reduce the risk of being born with a low birthweight, rather than having to treat the consequences of premature gestation. Despite the marvelous advances that permit us to treat respiratory distress syndrome, the continuing high low-birthweight rate places a significant strain on our health care system. The goal should be redirected to identifying large population-based efforts to reduce the number of low-birthweight infants. Handle: RePEc:aph:ajpbhl:1995:85:7:909-913_6 Template-Type: ReDIF-Article 1.0 Title: The perinatal paradox. Journal: American Journal of Public Health Author-Name: Leviton, A. Year: 1995 Volume: 85 Issue: 7 Pages: 906-907 Handle: RePEc:aph:ajpbhl:1995:85:7:906-907_4 Template-Type: ReDIF-Article 1.0 Title: Does passive smoking affect the incidence of nasal allergies? Journal: American Journal of Public Health Author-Name: Tsunoda, K. Author-Name: Ohta, Y. Author-Name: Shinogami, M. Author-Name: Soda, Y. Year: 1995 Volume: 85 Issue: 7 Pages: 1019-1020 Handle: RePEc:aph:ajpbhl:1995:85:7:1019-1020_7 Template-Type: ReDIF-Article 1.0 Title: Social determinants of health--socioeconomic status, social class, and ethnicity. Journal: American Journal of Public Health Author-Name: Blane, D. Year: 1995 Volume: 85 Issue: 7 Pages: 903-905 Handle: RePEc:aph:ajpbhl:1995:85:7:903-905_9 Template-Type: ReDIF-Article 1.0 Title: Ethnicity, socioeconomic status, and the 50-year US infant mortality record. Journal: American Journal of Public Health Author-Name: Oechsli, F.W. Year: 1995 Volume: 85 Issue: 7 Pages: 905-906 Handle: RePEc:aph:ajpbhl:1995:85:7:905-906_0 Template-Type: ReDIF-Article 1.0 Title: Postexposure rabies prophylaxis. 2. Expanding the treatment model. Journal: American Journal of Public Health Author-Name: Llorens, S.A. Author-Name: Neuhauser, D. Year: 1995 Volume: 85 Issue: 7 Pages: 1020-1021 Handle: RePEc:aph:ajpbhl:1995:85:7:1020-1021_9 Template-Type: ReDIF-Article 1.0 Title: Reform without change? Look beyond the curriculum. Journal: American Journal of Public Health Author-Name: Bloom, S.W. Year: 1995 Volume: 85 Issue: 7 Pages: 907-908 Handle: RePEc:aph:ajpbhl:1995:85:7:907-908_7 Template-Type: ReDIF-Article 1.0 Title: Comment: epidemiology and the liberal arts--toward a new paradigm? Journal: American Journal of Public Health Author-Name: Oppenheimer, G.M. Year: 1995 Volume: 85 Issue: 7 Pages: 918-920 Handle: RePEc:aph:ajpbhl:1995:85:7:918-920_8 Template-Type: ReDIF-Article 1.0 Title: The prevalence of patient disclosure of HIV infection to doctors. Journal: American Journal of Public Health Author-Name: Marks, G. Author-Name: Mason, H.R. Author-Name: Simoni, J.M. Year: 1995 Volume: 85 Issue: 7 Pages: 1018-1019 Handle: RePEc:aph:ajpbhl:1995:85:7:1018-1019_5 Template-Type: ReDIF-Article 1.0 Title: Video-based sexually transmitted disease patient education: Its impact on condom acquisition Journal: American Journal of Public Health Author-Name: O'Donnell, L.N. Author-Name: San Doval, A. Author-Name: Duran, R. Author-Name: O'Donnell, C. Year: 1995 Volume: 85 Issue: 6 Pages: 817-822 Abstract: Objectives. This study assessed the impact of video-based educational interventions on condom acquisition among men and women seeking services at a large sexually transmitted disease clinic in the South Bronx, New York. Methods. During 1992, 3348 African American and Hispanic patients were enrolled in a clinical trial of video-based interventions designed to promote safer sex behaviors, including increased condom use. Patients were assigned to one of three groups: control, video, or video plus interactive group discussion. Subjects were given a coupon to redeem for free condoms at a pharmacy several blocks from the clinic. Rates of condom acquisition were assessed by level of intervention. Results. In comparison with a control group, subjects who viewed videos were significantly more likely to redeem coupons for condoms (21.2% redemption rate vs 27.6%). However, participation in interactive sessions after video viewing augmented the positive effects of video viewing alone (27.6% redemption rate vs 36.9%). Gender and ethnicity were significantly associated with outcomes. Conclusions. The condom acquisition rate almost doubled with the use of culturally appropriate, video-based interventions. Designed to present minimal disruption to clinical services, these interventions can be implemented in clinics servicing at- risk men and women. Handle: RePEc:aph:ajpbhl:1995:85:6:817-822_6 Template-Type: ReDIF-Article 1.0 Title: The Pawtucket Heart Health Program: Community changes in cardiovascular risk factors and projected disease risk Journal: American Journal of Public Health Author-Name: Carleton, R.A. Author-Name: Lasater, T.M. Author-Name: Assaf, A.R. Author-Name: Feldman, H.A. Author-Name: McKinlay, S. Author-Name: Gans, K. Author-Name: Derby, C. Author-Name: Barbour, M. Author-Name: Hume, A. Author-Name: Lapane, K. Author-Name: Eaton, C. Author-Name: Parker, D. Author-Name: McKenney, J. Author-Name: McPhillips, J. Year: 1995 Volume: 85 Issue: 6 Pages: 777-785 Abstract: Objectives: Whether community-wide education changed cardiovascular risk factors and disease risk in Pawtucket, RI, relative to a comparison community was assessed. Methods. Random-sample, cross-section al surveys were done of people aged 18 through 64 years at baseline, during, and after education. Baseline cohorts were reexamined. Pawtucket citizens of all ages participated in multilevel education, screening, and counseling programs. Results. The downward trend in smoking was slightly greater in the comparison city. Small, insignificant differences favored Pawtucket in blood cholesterol and blood pressure. In the cross-sectional surveys, body mass index increased significantly in the comparison community; a similar change was not seen in cohort surveys. Projected cardiovascular disease rates were significantly (16%) less in Pawtucket during the education program. This difference lessened to 8% posteducation. Conclusions. The hypothesis that projected cardiovascular disease risk can be altered by community-based education gains limited support from these data. Achieving cardiovascular risk reduction at the community level was feasible, but maintaining statistically significant differences between cities was not. Accelerating risk factor changes will likely require a sustained community effort with reinforcement from state, regional, and national policies and programs. Handle: RePEc:aph:ajpbhl:1995:85:6:777-785_0 Template-Type: ReDIF-Article 1.0 Title: Routine hepatitis B vaccination in a clinic for sexually transmitted diseases Journal: American Journal of Public Health Author-Name: Weinstock, H.S. Author-Name: Bolan, G. Author-Name: Moran, J.S. Author-Name: Peterman, T.A. Author-Name: Polish, L. Author-Name: Reingold, A.L. Year: 1995 Volume: 85 Issue: 6 Pages: 846-849 Abstract: Patients were assigned to one of two vaccine schedules to assess the feasibility of vaccinating a sexually transmitted disease clinic population against hepatitis B virus. Of 1386 patients entering an inner-city clinic between June and July 1990, 611 (44%) accepted a first dose of vaccine. Twenty-one percent of all susceptible patients received at least two doses of vaccine. Annualizing these finding shows that an ongoing program could prevent 636 hepatitis B virus infections per year. Although a significant proportion of sexually transmitted disease clinic patients can be successfully vaccinated, strategies for preventing hepatitis B virus infections in this high-risk population must consider patient behavior as well as vaccine efficacy. Handle: RePEc:aph:ajpbhl:1995:85:6:846-849_2 Template-Type: ReDIF-Article 1.0 Title: Breast and cervical cancer screening in a low-income managed care sample: The efficacy of physician letters and phone calls Journal: American Journal of Public Health Author-Name: Lantz, P.M. Author-Name: Stencil, D. Author-Name: Lippert, M.T. Author-Name: Beversdorf, S. Author-Name: Jaros, L. Author-Name: Remington, P.L. Year: 1995 Volume: 85 Issue: 6 Pages: 834-836 Abstract: A randomized trial was conducted to evaluate the combined impact of a physician reminder letter and a telephone contact on the use of Pap tests and mammograms in a low-income managed care program. Women 40 to 79 years of age who were past due for cancer screening were randomly assigned to an intervention or control group. Medical claims were reviewed after 6 months to determine intervention effectiveness. The odds of receiving all needed cancer screening tests during follow-up were four times higher in the intervention group. Women who reported having to take time off from work to see a doctor had lower odds of getting screened. Handle: RePEc:aph:ajpbhl:1995:85:6:834-836_2 Template-Type: ReDIF-Article 1.0 Title: A preventive child health program: The effect of telephone and home visits by public health nurses Journal: American Journal of Public Health Author-Name: Oda, D.S. Author-Name: Heilbron, D.C. Author-Name: Taylor, H.J. Year: 1995 Volume: 85 Issue: 6 Pages: 854-855 Abstract: A randomized trial was conducted to determine if a public health nursing intervention consisting of telephone contacts or home visits affected the receipt of preventive health services by children eligible for the Early Periodic Screening, Diagnosis, and Treatment program. Each nursing intervention was applied using a protocol, and outcome data for 1654 case subjects were obtained from state-paid provider claims. However, the trial revealed no statistically significant differences between the study groups, nor was ethnicity a significant factor. Methodological and study context issues were identified that may have affected the results, the generalization of which is limited by the strict selection of cases. Handle: RePEc:aph:ajpbhl:1995:85:6:854-855_1 Template-Type: ReDIF-Article 1.0 Title: HIV, sexually transmitted disease, and tuberculosis testing at community sites in upstate New York. Journal: American Journal of Public Health Author-Name: Chaffee, B.H. Author-Name: Moehring, S. Author-Name: Pruden, S. Year: 1995 Volume: 85 Issue: 6 Pages: 867-868 Handle: RePEc:aph:ajpbhl:1995:85:6:867-868_2 Template-Type: ReDIF-Article 1.0 Title: Smaller increases in life expectancy for blacks and whites between the 1970s and 1980s. Journal: American Journal of Public Health Author-Name: Wallace, D. Year: 1995 Volume: 85 Issue: 6 Pages: 875-876 Handle: RePEc:aph:ajpbhl:1995:85:6:875-876_7 Template-Type: ReDIF-Article 1.0 Title: Failures of cervical cancer screening. Journal: American Journal of Public Health Author-Name: Miller, A.B. Year: 1995 Volume: 85 Issue: 6 Pages: 761-762 Handle: RePEc:aph:ajpbhl:1995:85:6:761-762_3 Template-Type: ReDIF-Article 1.0 Title: Use of the community-oriented primary care model for a special-needs population: a clinic for adults with Down syndrome. Journal: American Journal of Public Health Author-Name: Chicoine, B. Author-Name: McGuire, D. Author-Name: Hebein, S. Author-Name: Gilly, D. Year: 1995 Volume: 85 Issue: 6 Pages: 869-870 Handle: RePEc:aph:ajpbhl:1995:85:6:869-870_1 Template-Type: ReDIF-Article 1.0 Title: Surveillance for pesticide-related illness--lessons from California. Journal: American Journal of Public Health Author-Name: Ordin, D.C. Author-Name: Fine, L.J. Year: 1995 Volume: 85 Issue: 6 Pages: 762-763 Handle: RePEc:aph:ajpbhl:1995:85:6:762-763_7 Template-Type: ReDIF-Article 1.0 Title: A personal role in health care reform. Journal: American Journal of Public Health Author-Name: Koop, C.E. Year: 1995 Volume: 85 Issue: 6 Pages: 759-760 Handle: RePEc:aph:ajpbhl:1995:85:6:759-760_5 Template-Type: ReDIF-Article 1.0 Title: Pelvic inflammatory disease among patients in a public health practice: profile and outcomes. Journal: American Journal of Public Health Author-Name: Rice, R.J. Author-Name: Coston, W.A. Author-Name: Bhoomkar, A. Author-Name: Tambe, P.B. Author-Name: Schmid, D.S. Author-Name: Knapp, J.S. Year: 1995 Volume: 85 Issue: 6 Pages: 874-875 Handle: RePEc:aph:ajpbhl:1995:85:6:874-875_9 Template-Type: ReDIF-Article 1.0 Title: Annotation: a community-focused strategy for the control of day-care center shigellosis. Journal: American Journal of Public Health Author-Name: Gangaros, E.J. Year: 1995 Volume: 85 Issue: 6 Pages: 763-764 Handle: RePEc:aph:ajpbhl:1995:85:6:763-764_1 Template-Type: ReDIF-Article 1.0 Title: The effectiveness of DARE and other drug use prevention programs. Journal: American Journal of Public Health Author-Name: Gorman, D.M. Year: 1995 Volume: 85 Issue: 6 Pages: 873-874 Handle: RePEc:aph:ajpbhl:1995:85:6:873-874_6 Template-Type: ReDIF-Article 1.0 Title: Bridging the Gap: addressing alcohol and drug addiction from a community health perspective. Journal: American Journal of Public Health Author-Name: Turner, N.H. Year: 1995 Volume: 85 Issue: 6 Pages: 870-871 Handle: RePEc:aph:ajpbhl:1995:85:6:870-871_0 Template-Type: ReDIF-Article 1.0 Title: Deaths from firearms among children and adolescents in New Mexico. Journal: American Journal of Public Health Author-Name: Knight-Bohnhoff, K. Author-Name: Burkybile, D. Year: 1995 Volume: 85 Issue: 6 Pages: 872 Handle: RePEc:aph:ajpbhl:1995:85:6:872_8 Template-Type: ReDIF-Article 1.0 Title: The Houston Advance DATAR Follow-Up project: private investigator techniques for public health. Journal: American Journal of Public Health Author-Name: Johnson, J. Author-Name: Williams, M.L. Author-Name: Chatham, L. Year: 1995 Volume: 85 Issue: 6 Pages: 868-869 Handle: RePEc:aph:ajpbhl:1995:85:6:868-869_4 Template-Type: ReDIF-Article 1.0 Title: An outbreak of hypervitaminosis D associated with the overfortification of milk from a home-delivery dairy Journal: American Journal of Public Health Author-Name: Blank, S. Author-Name: Scanlon, K.S. Author-Name: Sinks, T.H. Author-Name: Lett, S. Author-Name: Falk, H. Year: 1995 Volume: 85 Issue: 5 Pages: 656-659 Abstract: Objectives. The purpose of the study was to identify cases of hypervitaminosis D caused by the inadvertent overfortification of milk from a home-delivery dairy and to identify risk factors for this illness. Methods. Hospital discharge, laboratory, and state health department data were used to define, identify, and describe cases of hypervitaminosis D diagnosed in the exposed communities between January 1, 1985, and June 30, 1991. To identify disease risk factors, community-based sex- and age-matched controls were used in a case-control study. Results. Of the 56 case patients identified, at least 41 were hospitalized; 2 died. The study included 33 case patients and 93 control subjects. Nineteen of the 33 case patients had been customers of the implicated dairy. Risk of illness rose with increasing consumption of the dairy's milk and was also associated with vitamin D supplement use, sunburn susceptibility, and cancer history. Accounting for these factors did not alter the association between drinking the dairy's milk and developing hypervitaminosis D. Conclusions. Overfortification of milk with vitamin D can lead to hypervitaminosis D manifested by severe illness and death. The episode highlights the need for monitoring the fortification process and enforcing the upper limit for vitamin D addition to milk. Handle: RePEc:aph:ajpbhl:1995:85:5:656-659_9 Template-Type: ReDIF-Article 1.0 Title: Frequent dieting among adolescents: Psychosocial and health behavior correlates Journal: American Journal of Public Health Author-Name: French, S.A. Author-Name: Story, M. Author-Name: Downes, B. Author-Name: Resnick, M.D. Author-Name: Blum, R.W. Year: 1995 Volume: 85 Issue: 5 Pages: 695-701 Abstract: Objectives. The present study examined correlates of frequent dieting in 33 393 adolescents. It was hypothesized that frequent dieting would be correlated with negative psychosocial and health behavior outcomes. Methods. A comprehensive, school-based health behavior survey was administered in 1987 to public school students in grades 7 through 12 in Minnesota. Students self- reported dieting behavior; substance use; suicidal, sexual, and delinquent behavior; family and peer concerns, sick days; and abuse history. Differences on psychosocial and health behavior risk factors by dieting frequency and by purging status were assessed with multivariate logistic regression, with body mass index and demographic variables controlled. Results. Dieting frequency was associated with history of binge eating (females: odds ratio [OR] = 1.46, males: OR = 1.53); poor body image (females: OR = 0.56, males: OR = 0.63); lower connectedness to others (females: OR = 0.79); greater alcohol use (females: OR = 1.17); and greater tobacco use (females: OR = 1.08). Purging status was independently associated with negative risk factors in both males and females. Conclusions. These findings suggest that frequent dieting efforts in adolescents should not be viewed in isolation, but rather in the broader context of health and risk-taking behaviors. Handle: RePEc:aph:ajpbhl:1995:85:5:695-701_3 Template-Type: ReDIF-Article 1.0 Title: Annotation: cause and noncause--nutritional epidemiology and public health nutrition. Journal: American Journal of Public Health Author-Name: Stein, A.D. Year: 1995 Volume: 85 Issue: 5 Pages: 618-620 Handle: RePEc:aph:ajpbhl:1995:85:5:618-620_1 Template-Type: ReDIF-Article 1.0 Title: Politics and public health research: HIV prevention policy in the schools. Journal: American Journal of Public Health Author-Name: Mélèse-d'Hospital, I. Author-Name: Colman, S.S. Year: 1995 Volume: 85 Issue: 5 Pages: 738 Handle: RePEc:aph:ajpbhl:1995:85:5:738_5 Template-Type: ReDIF-Article 1.0 Title: Topics for our times: life in a refugee camp--lessons from Cambodia and site 2. Journal: American Journal of Public Health Author-Name: Kanter, A.S. Year: 1995 Volume: 85 Issue: 5 Pages: 620-621 Handle: RePEc:aph:ajpbhl:1995:85:5:620-621_4 Template-Type: ReDIF-Article 1.0 Title: Cytomegalovirus infection as a cause of hearing loss among children. Journal: American Journal of Public Health Author-Name: Fowler, K.B. Author-Name: Pass, R.F. Year: 1995 Volume: 85 Issue: 5 Pages: 734-735 Handle: RePEc:aph:ajpbhl:1995:85:5:734-735_3 Template-Type: ReDIF-Article 1.0 Title: The new paradigm of public health nutrition. Journal: American Journal of Public Health Author-Name: Scrimshaw, N.S. Year: 1995 Volume: 85 Issue: 5 Pages: 622-624 Handle: RePEc:aph:ajpbhl:1995:85:5:622-624_1 Template-Type: ReDIF-Article 1.0 Title: The standardization of statewide hospitalized injury morbidity reports. Journal: American Journal of Public Health Author-Name: Forjuoh, S.N. Author-Name: Weiss, H.B. Author-Name: Coben, J.H. Author-Name: Garrison, H.G. Year: 1995 Volume: 85 Issue: 5 Pages: 732-733 Handle: RePEc:aph:ajpbhl:1995:85:5:732-733_7 Template-Type: ReDIF-Article 1.0 Title: Lady beetles and public health research: geographic and population scales. Journal: American Journal of Public Health Author-Name: Wallace, D. Year: 1995 Volume: 85 Issue: 5 Pages: 735-736 Handle: RePEc:aph:ajpbhl:1995:85:5:735-736_4 Template-Type: ReDIF-Article 1.0 Title: Annotation: the National Academy of Sciences-National Research Council Twin Registry. Journal: American Journal of Public Health Author-Name: Page, W.F. Year: 1995 Volume: 85 Issue: 5 Pages: 617-618 Handle: RePEc:aph:ajpbhl:1995:85:5:617-618_0 Template-Type: ReDIF-Article 1.0 Title: The hazards of epidemiology. Journal: American Journal of Public Health Author-Name: Holland, W.W. Year: 1995 Volume: 85 Issue: 5 Pages: 616-617 Handle: RePEc:aph:ajpbhl:1995:85:5:616-617_8 Template-Type: ReDIF-Article 1.0 Title: DDE and shortened duration of lactation in a northern Mexican town Journal: American Journal of Public Health Author-Name: Gladen, B.C. Author-Name: Rogan, W.J. Year: 1995 Volume: 85 Issue: 4 Pages: 504-508 Abstract: Objectives. Worldwide declines in the duration of lactation are cause for public health concern. Higher levels of dichlorodiphenyl dichloroethene (DDE) have been associated with shorter durations of lactation in the United States. This study examined whether this relationship would hold in an agricultural town in northern Mexico. Methods. Two hundred twenty-nine women were followed every 2 months from childbirth until weaning or until the child reached 18 months of age. DDE was measured in breast milk samples taken at birth, and women were followed to see how long they lactated. Results. Median duration was 7.5 months in the lowest DDE group and 3 months in the highest. The effect was confined to those who had lactated previously, and it persisted after statistical adjustment for other factors. These results are not due to overtly sick children being weaned earlier. Previous lactation lowers DDE levels, which produces an artifactual association, but simulations using best estimates show that an effect as large as that found here would arise through this mechanism only 6% of the time. Conclusions. DDE may affect women's ability to lactate. This exposure may be contributing to lactation failure throughout the world. Handle: RePEc:aph:ajpbhl:1995:85:4:504-508_7 Template-Type: ReDIF-Article 1.0 Title: Agent Orange and the Vietnamese: The persistence of elevated dioxin levels in human tissues Journal: American Journal of Public Health Author-Name: Schecter, A. Author-Name: Le Cao Dai Author-Name: Thuy, L.T.B. Author-Name: Hoang Trong Quynh Author-Name: Dinh Quang Minh Author-Name: Hoang Dinh Cau Author-Name: Pham Hoang Phiet Author-Name: Phuong, N.T.N. Author-Name: Constable, J.D. Author-Name: Baughman, R. Author-Name: Papke, O. Author-Name: Ryan, J.J. Author-Name: Furst, P. Author-Name: Raisanen, S. Year: 1995 Volume: 85 Issue: 4 Pages: 516-522 Abstract: Objectives. The largest known dioxin contamination occurred between 1962 and 1970, when 12 million gallons of Agent Orange, a defoliant mixture contaminated with a form of the most toxic dioxin, were sprayed over southern and central Vietnam. Studies were performed to determine if elevated dioxin levels persist in Vietnamese living in the south of Vietnam. Methods. With gas chromatography and mass spectroscopy, human milk, adipose tissue, and blood from Vietnamese living in sprayed and unsprayed areas were analyzed, some individually and some pooled, for dioxins and the closely related dibenzofurans. Results. One hundred sixty dioxin analyses of tissue from 3243 persons were performed. Elevated 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) levels as high as 1832 ppt were found in milk lipid collected from southern Vietnam in 1970, and levels up to 103 ppt were found in adipose tissue in the 1980s. Pooled blood collected from southern Vietnam in 1991/92 also showed elevated TCDD up to 33 ppt, whereas tissue from northern Vietnam (where Agent Orange was not used) revealed TCDD levels at or below 2.9 ppt. Conclusions. Although most Agent Orange studies have focused on American veterans, many Vietnamese had greater exposure. Because health consequences of dioxin contamination are more likely to be found in Vietnamese living in Vietnam than in any other populations, Vietnam provides a unique setting for dioxin studies. Handle: RePEc:aph:ajpbhl:1995:85:4:516-522_8 Template-Type: ReDIF-Article 1.0 Title: School-to-Work Opportunities Act. Journal: American Journal of Public Health Author-Name: Davis, L. Author-Name: Pollack, S.H. Year: 1995 Volume: 85 Issue: 4 Pages: 590-591 Handle: RePEc:aph:ajpbhl:1995:85:4:590-591_9 Template-Type: ReDIF-Article 1.0 Title: Beyond state regulation of child care: a venture into a public-private partnership in Nebraska. Journal: American Journal of Public Health Author-Name: Bergwell, E. Author-Name: Ford, M.J. Year: 1995 Volume: 85 Issue: 4 Pages: 585-586 Handle: RePEc:aph:ajpbhl:1995:85:4:585-586_1 Template-Type: ReDIF-Article 1.0 Title: Epidemiologic data in risk assessment--imperfect but valuable. Journal: American Journal of Public Health Author-Name: Shore, R.E. Year: 1995 Volume: 85 Issue: 4 Pages: 474-476 Handle: RePEc:aph:ajpbhl:1995:85:4:474-476_7 Template-Type: ReDIF-Article 1.0 Title: The quality of proxy-respondent data in NCHS surveys. 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: Hendershot, G.E. Year: 1995 Volume: 85 Issue: 4 Pages: 591-592 Handle: RePEc:aph:ajpbhl:1995:85:4:591-592_4 Template-Type: ReDIF-Article 1.0 Title: Comment: integrating epidemiologic data into risk assessment. Journal: American Journal of Public Health Author-Name: Wartenberg, D. Author-Name: Simon, R. Year: 1995 Volume: 85 Issue: 4 Pages: 491-493 Handle: RePEc:aph:ajpbhl:1995:85:4:491-493_9 Template-Type: ReDIF-Article 1.0 Title: Pediatric HIV infection in Elista, Russia: interventional strategies. Journal: American Journal of Public Health Author-Name: Mintz, M. Author-Name: Boland, M. Author-Name: O'Hara, M.J. Author-Name: Barros, J. Author-Name: Hansen, C. Author-Name: Denny, T.N. Author-Name: Scolpino, A. Author-Name: Maha-Elkins, M. Author-Name: Sandzhieva, D. Author-Name: Esenova, V. Year: 1995 Volume: 85 Issue: 4 Pages: 586-588 Handle: RePEc:aph:ajpbhl:1995:85:4:586-588_0 Template-Type: ReDIF-Article 1.0 Title: The role of gender relations in HIV prevention research for women. Journal: American Journal of Public Health Author-Name: Wingood, G.M. Author-Name: DiClemente, R.J. Year: 1995 Volume: 85 Issue: 4 Pages: 592 Handle: RePEc:aph:ajpbhl:1995:85:4:592_4 Template-Type: ReDIF-Article 1.0 Title: The need to restore the public health base for environmental control. Journal: American Journal of Public Health Author-Name: Goldstein, B.D. Year: 1995 Volume: 85 Issue: 4 Pages: 481-483 Abstract: Restoration of the public health base for local, national, and international efforts aimed at protection against adverse health consequences of environmental degradation should be of prime concern for today and the future. Wherever possible, whether it be a mission statement for a cabinet-level EPA or the training and composition of the environmental health work force, we must reinvigorate the public health mission of our environmental protection activities. This cannot be accomplished without recognition by the public health community that environmental health is a central public health concern. As we move toward facing the initially more subtle, but eventually more consequential, global environmental health challenges, it will become even more important for the public health profession to respond. Handle: RePEc:aph:ajpbhl:1995:85:4:481-483_8 Template-Type: ReDIF-Article 1.0 Title: Politics and practice: Introducing Norplant into a school-based health center in Baltimore Journal: American Journal of Public Health Author-Name: Beilenson, P.L. Author-Name: Miola, E.S. Author-Name: Farmer, M. Year: 1995 Volume: 85 Issue: 3 Pages: 309-311 Abstract: As one element of Baltimore's effort to combat its high rate of teenage pregnancy, the Baltimore City Health Department added the implantable contraceptive Norplant to the array of services offered at one of its school- based health centers in early 1993. The initial findings with the adolescents who received this contraceptive at the school were favorable, particularly regarding condom use, parental involvement and patient acceptance of the contraceptive. This new policy garnered a significant amount of attention, both nationally and locally. It attempts to address problems that have complicated etiologies as well as diverse clinical, social, and ethical ramifications, all complicated by political realities. The Norplant experience offers useful lessons regarding controversial health initiatives that address problems facing public health practitioners today. Handle: RePEc:aph:ajpbhl:1995:85:3:309-311_9 Template-Type: ReDIF-Article 1.0 Title: Community intervention trial for smoking cessation (COMMIT): I. Cohort results from a four-year community intervention Journal: American Journal of Public Health Author-Name: Glynn, T.J. Author-Name: Shopland, D.R. Author-Name: Manley, M. Author-Name: Lynn, W.R. Author-Name: Freedman, L.S. Author-Name: Green, S.B. Author-Name: Corle, D.K. Author-Name: Graubard, B. Author-Name: Baker, S. Author-Name: Mills, S.L. Author-Name: Chapelsky, D.A. Author-Name: Gail, M. Author-Name: Mark, S. Author-Name: Bettinghaus, E. Author-Name: Orlandi, M.A. Author-Name: McAlister, A. Author-Name: Royce, J. Author-Name: Lewit, E. Author-Name: Dalton, L.T. Year: 1995 Volume: 85 Issue: 2 Pages: 183-192 Abstract: Objectives. The primary hypothesis of COMMIT (Community Intervention Trial for Smoking Cessation) was that a community-level, multi-channel, 4-year intervention would increase quit rates among cigarette smokers, with heavy smokers (≥25 cigarettes per day) of priority. Methods. One community within each of 11 matched community pairs (10 in the United States, 1 in Canada) was randomly assigned to intervention. Endpoint cohorts totaling 10 019 heavy smokers and 10328 light-to-moderate smokers were followed by telephone. Results. The mean heavy smoker quit rate (i.e., the fraction of cohort members who had achieved and maintained cessation at the end of the trial) was 0.180 for intervention communities versus 0.187 for comparison communities, a nonsignificant difference (one-sided P = .68 by permutation test; 90% test-based confidence interval (CI) for the difference = -0.031, 0.019). For light-to-moderate smokers, corresponding quit rates were 0.306 and 0.275; this difference was significant (P = .004; 90% CI = 0.014, 0.047). Smokers in intervention communities had greater perceived exposure to smoking control activities, which correlated with outcome only for light-to-moderate smokers. Conditions. The impact of this community-based intervention on light-to-moderate smokers, although modest, has public health importance. This intervention did not increase quit rates of heavy smokers; reaching them may require new clinical programs and policy changes. Handle: RePEc:aph:ajpbhl:1995:85:2:183-192_1 Template-Type: ReDIF-Article 1.0 Title: Community intervention trial for smoking cessation (COMMIT): II. Changes in adult cigarette smoking prevalence Journal: American Journal of Public Health Author-Name: Glynn, T.J. Author-Name: Shopland, D.R. Author-Name: Manley, M. Author-Name: Lynn, W.R. Author-Name: Freedman, L.S. Author-Name: Green, S.B. Author-Name: Corle, D.K. Author-Name: Graubard, B. Author-Name: Baker, S. Author-Name: Mills, S.L. Author-Name: Chapelsky, D.A. Author-Name: Gail, M. Author-Name: Mark, S. Author-Name: Bettinghaus, E. Author-Name: Orlandi, M.A. Author-Name: McAlister, A. Author-Name: Royce, J. Author-Name: Lewit, E. Author-Name: Dalton, L.T. Year: 1995 Volume: 85 Issue: 2 Pages: 193-200 Abstract: Objectives. COMMIT (Community Intervention Trial for Smoking Cessation) investigated whether a community-level multichannel intervention would decrease the prevalence of adult cigarette smoking and increase quitting with heavy smokers (≥25 cigarettes per day) receiving the highest priority. Methods. One community within each of 11 matched community pairs (10 in the United States, 1 in Canada) was randomly assigned to intervention. Baseline (1988) and final (1993) telephone surveys sampled households to determine prevalence of smoking behavior. Results. Among the target population aged 25 to 64 years, there was no intervention effect on heavy smoking prevalence, which decreased by 2.9 percentage points in both intervention and comparison communities. Overall smoking prevalence decreased by 3.5 in intervention communities vs 3.2 in comparison communities, a difference not statistically significant, while the mean quit ratios were 0.198 versus 0.185, respectively, a difference of 0.013 (90% test-based confidence interval = - 0.003, 0.028). Conditions. Results are consistent with the cohort analysis reported separately, although the more powerful cohort design showed a statistically significant intervention effect upon light-to-moderate smokers. This community-based intervention did not have a significant impact on smoking prevalence beyond the favorable secular trends. In future efforts, additional strategies should be incorporated and rigorously evaluated. Handle: RePEc:aph:ajpbhl:1995:85:2:193-200_2 Template-Type: ReDIF-Article 1.0 Title: Integrating smoking cessation into routine public prenatal care: The smoking cessation in pregnancy project Journal: American Journal of Public Health Author-Name: Kendrick, J.S. Author-Name: Zahniser, S.C. Author-Name: Miller, N. Author-Name: Salas, N. Author-Name: Stine, J. Author-Name: Gargiullo, P.M. Author-Name: Floyd, R.L. Author-Name: Spierto, F.W. Author-Name: Sexton, M. Author-Name: Metzger, R.W. Author-Name: Stockbauer, J.W. Author-Name: Hannon, W.H. Author-Name: Dalmat, M.E. Year: 1995 Volume: 85 Issue: 2 Pages: 217-222 Abstract: Objectives. In 1986, the state health departments of Colorado, Maryland, and Missouri conducted a federally-funded demonstration project to increase smoking cessation among pregnant women receiving prenatal care and services from the Women, Infants, and Children (WIC) program in public clinics. Methods. Low-intensity interventions were designed to be integrated into routine prenatal care. Clinics were randomly assigned to intervention or control status; pregnant smokers tilled out questionnaires and gave urine specimens at enrollment, in the eighth month of pregnancy, and postpartum. Urine cotinine concentrations were determined at CDC by enzyme-linked immunosorbent assay and were used to verify self-reported smoking status. Results. At the eighth month of pregnancy, self-reported quitting was higher for intervention clinics than control clinics in all three states. However, the cotinine-verified quit rates were not significantly different. Conclusions. Biochemical verification of self-reported quitting is essential to the evaluation of smoking cessation interventions. Achieving changes in smoking behavior in pregnant women with low-intensity interventions is difficult. Handle: RePEc:aph:ajpbhl:1995:85:2:217-222_3 Template-Type: ReDIF-Article 1.0 Title: Take heart: Results from the initial phase of a work-site wellness program Journal: American Journal of Public Health Author-Name: Glasgow, R.E. Author-Name: Terborg, J.R. Author-Name: Hollis, J.F. Author-Name: Severson, H.H. Author-Name: Boles, S.M. Year: 1995 Volume: 85 Issue: 2 Pages: 209-216 Abstract: Objectives. The purpose of this study was to evaluate the short-term effects of a low-intensity work-site heart disease risk reduction program using a matched pair design with work site as the unit of analysis. Methods. Twenty-six heterogeneous work sites with between 125 and 750 employees were matched on key organization characteristics and then randomly assigned to early or delayed intervention conditions. Early intervention consisted of an 18-month multifaceted program that featured an employee steering committee and a menu approach to conducting key intervention activities tailored to each site. Results. Cross-sectional and cohort analyses produced consistent results. At the conclusion of the intervention, early and delayed intervention conditions did not differ on changes in stocking rates, dietary intake, or cholesterol levels. There was considerable variability in outcomes among work sites within each condition. Conclusions. Despite documented implementation of key intervention activities and organization-level changes in terms of perceived support for health promotion, this intervention did not produce short-term improvements beyond secular trends observed in control work sites. Research is needed to understand determinants of variability between work sites. Handle: RePEc:aph:ajpbhl:1995:85:2:209-216_4 Template-Type: ReDIF-Article 1.0 Title: Making the most of a teachable moment: A smokeless-tobacco cessation intervention in the dental office Journal: American Journal of Public Health Author-Name: Stevens, V.J. Author-Name: Severson, H. Author-Name: Lichtenstein, E. Author-Name: Little, S.J. Author-Name: Leben, J. Year: 1995 Volume: 85 Issue: 2 Pages: 231-235 Abstract: Objectives. Primary care medical clinics are good settings for smoking interventions. This study extends this strategy with a smokeless tobacco intervention delivered by dentists and dental hygienists in the course of routine dental care. Methods. Male users of moist snuff and chewing tobacco (n = 518) were identified by questionnaire in clinic waiting rooms and then randomly assigned to either usual care or intervention. The intervention included a routine oral examination with special attention to the part of the mouth in which tobacco was kept and an explanation of the health risks of using smokeless tobacco. After receiving unequivocal advice to stop using tobacco, each patient viewed a 9-minute videotape, received a self-help manual, and was briefly counseled by the dental hygienist. Results. Long- term success was defined as no smokeless tobacco use at both 3- and 12-month follow-ups, with those lust to follow-up counted as smokeless tobacco users. The intervention increased the proportion of patients who quit by about one half (12.5% vs 18.4%, P < .05). Conclusions. These results demonstrate the efficacy of a brief dental office intervention for the general population of smokeless tobacco users. Handle: RePEc:aph:ajpbhl:1995:85:2:231-235_6 Template-Type: ReDIF-Article 1.0 Title: Beaver Dam Eye Study questioned. Journal: American Journal of Public Health Author-Name: Gray, J.E. Year: 1995 Volume: 85 Issue: 3 Pages: 414-415 Handle: RePEc:aph:ajpbhl:1995:85:3:414-415_0 Template-Type: ReDIF-Article 1.0 Title: Does intensive perinatal care improve the outcome of extreme prematurity? Addressing the methodologic issues. Journal: American Journal of Public Health Author-Name: Tyson, J.E. Year: 1995 Volume: 85 Issue: 3 Pages: 300-302 Handle: RePEc:aph:ajpbhl:1995:85:3:300-302_5 Template-Type: ReDIF-Article 1.0 Title: Clausewitz vs Sun Tzu--the art of health reform. Journal: American Journal of Public Health Author-Name: Silver, G.A. Year: 1995 Volume: 85 Issue: 3 Pages: 307-308 Handle: RePEc:aph:ajpbhl:1995:85:3:307-308_7 Template-Type: ReDIF-Article 1.0 Title: Health care reform: the more it changes... Journal: American Journal of Public Health Author-Name: Silver, G.A. Year: 1995 Volume: 85 Issue: 3 Pages: 415 Handle: RePEc:aph:ajpbhl:1995:85:3:415_8 Template-Type: ReDIF-Article 1.0 Title: Trans fatty acid and coronary disease: the debate continues. 2. Confounding and selection bias in the data. Journal: American Journal of Public Health Author-Name: Shapiro, S. Year: 1995 Volume: 85 Issue: 3 Pages: 410-412 Handle: RePEc:aph:ajpbhl:1995:85:3:410-412_9 Template-Type: ReDIF-Article 1.0 Title: The accuracy of siblings' family history reports of thyroid and other cancers. Journal: American Journal of Public Health Author-Name: Gierlowski, T.C. Author-Name: Ron, E. Author-Name: Schneider, A.B. Year: 1995 Volume: 85 Issue: 3 Pages: 408-409 Handle: RePEc:aph:ajpbhl:1995:85:3:408-409_9 Template-Type: ReDIF-Article 1.0 Title: Can we "cure" mild mental retardation among individuals in the lower socioeconomic stratum? Journal: American Journal of Public Health Author-Name: Zigler, E. Year: 1995 Volume: 85 Issue: 3 Pages: 302-304 Handle: RePEc:aph:ajpbhl:1995:85:3:302-304_5 Template-Type: ReDIF-Article 1.0 Title: Physicians' attitudes and decision making regarding the withdrawal of life support. Journal: American Journal of Public Health Author-Name: Levin, B.W. Year: 1995 Volume: 85 Issue: 3 Pages: 306-307 Handle: RePEc:aph:ajpbhl:1995:85:3:306-307_4 Template-Type: ReDIF-Article 1.0 Title: Violence and personal responsibility. Journal: American Journal of Public Health Author-Name: Cather, P. Year: 1995 Volume: 85 Issue: 3 Pages: 413-414 Handle: RePEc:aph:ajpbhl:1995:85:3:413-414_0 Template-Type: ReDIF-Article 1.0 Title: Trans fatty acid and coronary disease: the debate continues. 1. The use of population attributable risk. Journal: American Journal of Public Health Author-Name: Leviton, A. Year: 1995 Volume: 85 Issue: 3 Pages: 410-413 Handle: RePEc:aph:ajpbhl:1995:85:3:410-413_3 Template-Type: ReDIF-Article 1.0 Title: The sociodemographic correlates of mental retardation. Journal: American Journal of Public Health Author-Name: Satcher, D. Year: 1995 Volume: 85 Issue: 3 Pages: 304-306 Handle: RePEc:aph:ajpbhl:1995:85:3:304-306_2 Template-Type: ReDIF-Article 1.0 Title: Trans fatty acid and coronary disease: the debate continues. 3. What should we tell consumers? Journal: American Journal of Public Health Author-Name: Gans, K.M. Author-Name: Lapane, K. Year: 1995 Volume: 85 Issue: 3 Pages: 411-412 Handle: RePEc:aph:ajpbhl:1995:85:3:411-412_1 Template-Type: ReDIF-Article 1.0 Title: A collaborative regional model for obstetrical care in New York State. Journal: American Journal of Public Health Author-Name: Yang-Lewis, P. Year: 1995 Volume: 85 Issue: 2 Pages: 264-265 Handle: RePEc:aph:ajpbhl:1995:85:2:264-265_0 Template-Type: ReDIF-Article 1.0 Title: What does a decline in child pedestrian injury rates mean? Journal: American Journal of Public Health Author-Name: Roberts, I. Year: 1995 Volume: 85 Issue: 2 Pages: 268-269 Handle: RePEc:aph:ajpbhl:1995:85:2:268-269_3 Template-Type: ReDIF-Article 1.0 Title: The limits of thresholds: silica and the politics of science, 1935 to 1990. Journal: American Journal of Public Health Author-Name: Markowitz, G. Author-Name: Rosner, D. Year: 1995 Volume: 85 Issue: 2 Pages: 253-262 Abstract: Since the 1930s threshold limit values have been presented as an objectively established measure of US industrial safety. However, there have been important questions raised regarding the adequacy of these thresholds for protecting workers from silicosis. This paper explores the historical debates over silica threshold limit values and the intense political negotiation that accompanied their establishment. In the 1930s and early 1940s, a coalition of business, public health, insurance, and political interests formed in response to a widely perceived "silicosis crisis." Part of the resulting program aimed at containing the crisis was the establishment of threshold limit values. Yet silicosis cases continued to be documented. By the 1960s these cases had become the basis for a number of revisions to the thresholds. In the 1970s, following a National Institute for Occupational Safety and Health recommendation to lower the threshold limit value for silica and to eliminate sand as an abrasive in blasting, industry fought attempts to make the existing values more stringent. This paper traces the process by which threshold limit values became part of a compromise between the health of workers and the economic interests of industry. Handle: RePEc:aph:ajpbhl:1995:85:2:253-262_1 Template-Type: ReDIF-Article 1.0 Title: The results of the COMMIT trial. Community Intervention Trial for Smoking Cessation. Journal: American Journal of Public Health Author-Name: Fisher Jr., E.B. Year: 1995 Volume: 85 Issue: 2 Pages: 159-160 Handle: RePEc:aph:ajpbhl:1995:85:2:159-160_2 Template-Type: ReDIF-Article 1.0 Title: The tribulations of trials--intervention in communities. Journal: American Journal of Public Health Author-Name: Susser, M. Year: 1995 Volume: 85 Issue: 2 Pages: 156-158 Handle: RePEc:aph:ajpbhl:1995:85:2:156-158_2 Template-Type: ReDIF-Article 1.0 Title: Emerging diseases and ecosystem instability: new threats to public health. Journal: American Journal of Public Health Author-Name: Epstein, P.R. Year: 1995 Volume: 85 Issue: 2 Pages: 168-172 Abstract: Ecologists have begun to describe an environmental distress syndrome, whereby widespread loss of top predators and harsh environmental conditions are encouraging the selection of opportunistic pests and pathogens across a wide taxonomic range of plants and animals. Environmental change and pollutants stress individuals and populations, and this may be reflected in the global resurgence of infectious disease as these stresses cascade through the community assemblages of species. In 1993, the sudden appearance of a virulent, rodent-borne hantavirus in the arid US Southwest accompanied anomalous weather patterns, and a novel Vibrio cholerae variant (O139 Bengal) emerged in Asia where marine ecosystems are experiencing a pandemic of coastal algal blooms, apparently harboring and amplifying the agent. This paper suggests a framework for integrating the surveillance of health outcomes and key reservoir and vector species, with ecological and climatic monitoring. Handle: RePEc:aph:ajpbhl:1995:85:2:168-172_0 Template-Type: ReDIF-Article 1.0 Title: Community incorporation of quit and win contests in Bloomington, Minnesota. Journal: American Journal of Public Health Author-Name: Lando, H.A. Author-Name: Pirie, P.L. Author-Name: Dusich, K.H. Author-Name: Elsen, C. Author-Name: Bernards, J. Year: 1995 Volume: 85 Issue: 2 Pages: 263-264 Handle: RePEc:aph:ajpbhl:1995:85:2:263-264_0 Template-Type: ReDIF-Article 1.0 Title: Annotation: protection of the public interest, allegations of scientific misconduct, and the Needleman case. Journal: American Journal of Public Health Author-Name: Silbergeld, E.K. Year: 1995 Volume: 85 Issue: 2 Pages: 165-166 Handle: RePEc:aph:ajpbhl:1995:85:2:165-166_6 Template-Type: ReDIF-Article 1.0 Title: Annotation: confounding in epidemiologic research. Journal: American Journal of Public Health Author-Name: Buring, J.E. Author-Name: Lee, I.M. Year: 1995 Volume: 85 Issue: 2 Pages: 164-165 Handle: RePEc:aph:ajpbhl:1995:85:2:164-165_5 Template-Type: ReDIF-Article 1.0 Title: Day care, infant feeding, and ear infections. Journal: American Journal of Public Health Author-Name: Visness, C.M. Author-Name: Kennedy, K.I. Author-Name: Labbok, M. Year: 1995 Volume: 85 Issue: 2 Pages: 267-268 Handle: RePEc:aph:ajpbhl:1995:85:2:267-268_6 Template-Type: ReDIF-Article 1.0 Title: Annotation: accounting for the effects of both group- and individual-level variables in community-level studies. Journal: American Journal of Public Health Author-Name: Levin, B. Year: 1995 Volume: 85 Issue: 2 Pages: 163-164 Handle: RePEc:aph:ajpbhl:1995:85:2:163-164_6 Template-Type: ReDIF-Article 1.0 Title: Smoking cessation treatment and the good doctor club. Journal: American Journal of Public Health Author-Name: Fiore, M.C. Author-Name: Baker, T.B. Year: 1995 Volume: 85 Issue: 2 Pages: 161-163 Handle: RePEc:aph:ajpbhl:1995:85:2:161-163_1 Template-Type: ReDIF-Article 1.0 Title: The perceived needs of child care center directors in preventing injuries and infectious diseases. Journal: American Journal of Public Health Author-Name: Sacks, J.J. Author-Name: Addiss, D.G. Year: 1995 Volume: 85 Issue: 2 Pages: 266-267 Handle: RePEc:aph:ajpbhl:1995:85:2:266-267_5 Template-Type: ReDIF-Article 1.0 Title: Form of day care and respiratory infections among Finnish children Journal: American Journal of Public Health Author-Name: Louhiala, P.J. Author-Name: Jaakkola, N. Author-Name: Ruotsalainen, R. Author-Name: Jaakkola, J.J.K. Year: 1995 Volume: 85 Issue: 8 Pages: 1109-1112 Abstract: The relationship between respiratory infectious diseases and form of day care was assessed in a retrospective cohort study of 2568 randomly selected children aged 1 through 7 years in Espoo, Finland. Day-care center children had an increased risk for the common cold, acute otitis media, and pneumonia. The risk concentrated in 1-year-old children, for whom the adjusted relative risks (incidence density ratios) for the common gold, otitis media, and pneumonia were 1.69 (95% confidence interval [CI] = 1.43, 2.01), 1.99 (95% CI = 1.57, 2.52), and 9.69 (95% CI = 2.31, 40.55), respectively. Among 1-year- old children, the proportion of infections attributable to care at day-care centers were 41% (95% CI = 30, 50) for colds, 50% (95% CI = 36, 60) for otitis media, and 85% (95% CI = 57, 98) for pneumonia. The results provide evidence that care in day-care centers is a determinant of acute respiratory infections in children under 2, whereas family day care does not essentially increase risk. Handle: RePEc:aph:ajpbhl:1995:85:8:1109-1112_0 Template-Type: ReDIF-Article 1.0 Title: Women at a sexually transmitted disease clinic who reported same-sex contact: Their HIV seroprevalence and risk behaviors Journal: American Journal of Public Health Author-Name: Bevier, P.J. Author-Name: Chiasson, M.A. Author-Name: Heffeman, R.T. Author-Name: Castro, K.G. Year: 1995 Volume: 85 Issue: 10 Pages: 1366-1371 Abstract: Objectives. This study compares characteristics, behaviors, and human immunodeficiency virus (HIV) infection in women who reported same-sex contact and women who had sex only with men. Methods. Participants were patients attending a New York City sexually transmitted disease clinic. Structured questionnaires were administered by interviewers. Results. Overall, 9% (135/1518) of women reported same-sex contact; among these, 93% also reported contact with men. Women reporting same-sex contact were more likely than exclusively heterosexual women to be HIV seropositive (17% vs 11%; odds ratio [OR] = 1.7, 95% confidence interval [CI]=1.0, 2.6), to exchange sex for money/drugs (48% vs 12%, OR = 6.7, 95% CI = 4.6, 9.8), to inject drugs (31% vs 7%, OR = 6.3, 95% CI = 4.1, 9.5), and to use crack cocaine (37% vs 15%, OR = 3.3, 95% CI = 2.2, 4.8). HIV in women reporting same-sex contact was associated with history of syphilis (OR = 8.8), sex for crack (OR = 5.7), and injection drug use (OR = 4.5). Conclusions. In this study, women who reported same-sex contact were predominantly bisexual. They had more HIV risk behaviors and were more often HIV seropositive than women who had sex only with men. Among these bisexual women, heterosexual contact and injection drug use were the most likely sources of HIV. There was no evidence of female-to- female transmission. Handle: RePEc:aph:ajpbhl:1995:85:10:1366-1371_0 Template-Type: ReDIF-Article 1.0 Title: Sociodemographic and psychosocial factors in childhood as predictors of adult mortality Journal: American Journal of Public Health Author-Name: Schwartz, J.E. Author-Name: Friedman, H.S. Author-Name: Tucker, J.S. Author-Name: Tomlinson-Keasey, C. Author-Name: Wingard, D.L. Author-Name: Criqui, M.H. Year: 1995 Volume: 85 Issue: 9 Pages: 1237-1245 Abstract: Objectives. Childhood sociodemographic, psychosocial, and environmental factors are often assumed to affect adult health and longevity. These relationships were prospectively tested by using the 7-decade Terman Life Cycle Study of Children With High Ability (n = 1285). Methods. Parental socioeconomic status, childhood health, objective childhood stressors (e.g., death or divorce of parents), and childhood personality were considered as potential predictors in hazard regression analyses of longevity through 1991. Results. Parental divorce during childhood predicted decreased longevity, with sex controlled. Other potential social predictors failed to show significant associations with longevity. Three dimensions of childhood personality-conscientiousness, lack of cheerfulness, and permanency of mood (males only)-predicted increased longevity. The effects of parental divorce and childhood personality were largely independent and did not account for any of the gender difference in mortality. Conclusions. A small number of childhood factors significantly predicted mortality across the life span in this sample. Further research should focus on how these psychosocial factors influence longevity. Handle: RePEc:aph:ajpbhl:1995:85:9:1237-1245_5 Template-Type: ReDIF-Article 1.0 Title: Silicosis among gold miners: Exposure-response analyses and risk assessment Journal: American Journal of Public Health Author-Name: Steenland, K. Author-Name: Brown, D. Year: 1995 Volume: 85 Issue: 10 Pages: 1372-1377 Abstract: Objectives. This study sought to estimate the risk of silicosis by cumulative exposure-years in a cohort of miners exposed to silica, as well as the lifetime risk of silicosis under the current Occupational Safety and Health Administration (OSHA) standard (0.09 mg/m3). Methods. In a cohort study of 3330 gold miners who worked at least 1 year underground from 1940 to 1965 (average 9 years) and were exposed to a median silica level of 0.05 mg/m3 (0.15 mg/m3 for those hired before 1930), 170 cases of silicosis were determined from either death certificates or two cross-sectional radiographic surveys. Results. The risk of silicosis was less than 1% with a cumulative exposure under 0.5 mg/m3-years, increasing to 68% to 84% for the highest cumulative exposure category of more than 4 mg/m3-years. Cumulative exposure was the best predictor of disease, followed by duration of exposure and average exposure. After adjustment for competing risks of death, a 45-year exposure under the current OSHA standard would lead to a lifetime risk of silicosis of 35% to 47%. Conclusions. Almost 2 million US workers are currently exposed to silica. Our results add to a small but increasing body of literature that suggests that the current OSHA silica exposure level is unacceptably high. Handle: RePEc:aph:ajpbhl:1995:85:10:1372-1377_0 Template-Type: ReDIF-Article 1.0 Title: Health and social characteristics and children's cognitive functioning: Results from a national cohort Journal: American Journal of Public Health Author-Name: Kramer, R.A. Author-Name: Allen, L. Author-Name: Gergen, P.J. Year: 1995 Volume: 85 Issue: 3 Pages: 312-318 Abstract: Objectives. The purpose of this study was to examine the associations between cognitive functioning in children and sociodemographic, family, and health characteristics. Methods: Data from phase 1 of the third National Health and Nutrition Examination Survey were used to evaluate performance on standardized cognitive tests in a representative sample of 2531 children 6 to 16 years of age. Multivariate analyses were used to assess independent associations between covariates and test performance. Results. Lower income, minority status, and lower education of an adult reference person (one of the persons in the household who owned or rented the home) were independently associated with poorer performance on all cognitive subtests. To a lesser degree, general health status, history of birth complications, and sex also were independent predictors of performance for some of the subtests. Conclusions.These findings illustrate disparities in cognitive functioning across sociodemographic and health characteristics of children in the US population. They suggest the need for public health policies to take a multifaceted approach to optimizing childhood environments in order to overcome the effects of socioeconomic and minority status. Handle: RePEc:aph:ajpbhl:1995:85:3:312-318_4 Template-Type: ReDIF-Article 1.0 Title: A matter of opinion about hysterectomies: Experts' and practicing community gynecologists' ratings of appropriateness Journal: American Journal of Public Health Author-Name: Bickell, N.A. Author-Name: Earp, J. Author-Name: Evans, A.T. Author-Name: Bernstein, S.J. Year: 1995 Volume: 85 Issue: 8 Pages: 1125-1128 Abstract: The degree to which national expert panel survey rating of the appropriateness of hysterectomy differed from those of a random sample of practicing community gynecologists was determined. Community gynecologists rated hysterectomy as more appropriate on six of eight cervical dysplasia scenarios. Experts agreed among themselves on 19 of 32 indications (intraclass correlation coefficient = 0.66); community gynecologists agreed on 12 of 32 indications (intraclass correlation coefficient = 0.50). Although few differences of opinion existed between experts and community gynecologists, for common clinical scenarios there was a large variation of opinion about the appropriateness of hysterectomy within each group. For areas of clinical uncertainty in which experts' opinions are used in guideline development, additional measures such as process of care, quality of life, and patient preference should be included in discussions about guidelines. Handle: RePEc:aph:ajpbhl:1995:85:8:1125-1128_7 Template-Type: ReDIF-Article 1.0 Title: Spermicide acceptability among patients at a sexually transmitted disease clinic in Zambia Journal: American Journal of Public Health Author-Name: Hira, S.K. Author-Name: Spruyt, A.B. Author-Name: Feldblum, P.J. Author-Name: Sunkutu, M.R. Author-Name: Glover, L.H. Author-Name: Steiner, M.J. Year: 1995 Volume: 85 Issue: 8 Pages: 1098-1103 Abstract: Objective. This study assessed the acceptability of three nonoxynol-9 spermicides among persons attending a sexually transmitted disease clinic in Lusaka, Zambia. Methods. Spermicidal foam, suppositories, and foaming tablets were evaluated. Women (n = 114) and men (n = 150) attending an sexually transmitted disease clinic were enrolled. After each participant used two products, each for 2 weeks, consistency of use and acceptability were evaluated. Results. At admission, most women (74%) and men (58%) were not using any family planning method. Moreover, most women (85%) and men (98%) had at least one sexually transmitted disease or genital infection. During the study, the proportion of coital episodes protected by spermicide use was high, yet loss to follow-up and discontinuation were also substantial. Discontinuation was frequently unrelated to acceptability. Women and men rated all three products positively along several acceptability parameters. Foam was the least desirable delivery system due to excess messiness. Conclusions. The results of this study suggest that it is feasible to distribute spermicides to women and men at increased risk for sexually transmitted disease and that the products will be used. Further research should be done among different populations and include other spermicidal delivery mechanisms. Handle: RePEc:aph:ajpbhl:1995:85:8:1098-1103_3 Template-Type: ReDIF-Article 1.0 Title: The practice of prophylactic mastectomy: A survey of Maryland surgeons Journal: American Journal of Public Health Author-Name: Houn, F. Author-Name: Helzlsouer, K.J. Author-Name: Friedman, N.B. Author-Name: Stefanek, M.E. Year: 1995 Volume: 85 Issue: 6 Pages: 801-805 Abstract: Objectives. Bilateral prophylactic mastectomy is a drastic breast cancer preventive option for which indications are not standardized and efficacy has not been proven. To estimate the magnitude of this controversial practice, surgeons were surveyed on their recommendations about and performance of prophylactic mastectomy. Methods. A cross-sectional survey was sent to general surgeons (n = 522), plastic surgeons (n = 80), and gynecologists (n = 801) licensed to practice in Maryland in 1992. Proportions responding were 41.9%, 66.3%, and 54.9%, respectively. In addition, there were 30 respondents who identified 'other' as their specialty. The respondents were asked about the role of bilateral prophylactic mastectomy and the number of times they had recommended performed it in a year. Results. Seven hundred forty-two surgeons responded (51.8%). More plastic surgeons (84.6%) than general surgeons (47.0%) and gynecologists (38.3%) agreed that bilateral prophylactic mastectomy has a role in the care of high-risk women. Eighty-one percent of plastic surgeons had recommended the procedure, compared with 38.8% of general surgeons and 17.7% of gynecologists. Conclusions. Indications and practice patterns reveal heterogeneity of medical opinion and practice of prophylactic mastectomy. This study raises the need for better evaluation of the efficacy and appropriateness of prophylactic mastectomy. Handle: RePEc:aph:ajpbhl:1995:85:6:801-805_0 Template-Type: ReDIF-Article 1.0 Title: The changing epidemiology of invasive bacterial infections in Massachusetts children, 1984 through 1991 Journal: American Journal of Public Health Author-Name: Loughlin, A.M. Author-Name: Marchant, C.D. Author-Name: Lett, S.M. Year: 1995 Volume: 85 Issue: 3 Pages: 392-394 Abstract: Coincident with the licensure of Haemophilus influenzae b conjugate vaccines from 1987 to 1990, the incidence of meningitis and other invasive infections caused by H influenzae type b declined in Massachusetts children by 87% and 91%, respectively. By 1991, Neisseria meningitidis had replaced H influenzae b as the leading cause of bacterial meningitis, accounting for 57% of cases. During the period 1984 through 1991, serogroup C displaced serogroup B as the most common cause of N meningitidis disease. Streptococcus pneumoniae caused 92% of nonmeningitis invasive disease, with serogroups 14, 6, 19, 18, 4, 2.3, and 9 causing 94.5% of infections. These finding have implications for the development of additional polysaccharide-protein conjugate vaccines for the prevention of childhood infections. Handle: RePEc:aph:ajpbhl:1995:85:3:392-394_0 Template-Type: ReDIF-Article 1.0 Title: Topics for our times: Justice Blackmun and legal abortion - A besieged legacy to women's reproductive health Journal: American Journal of Public Health Author-Name: Cates Jr., W. Author-Name: Grimes, D.A. Author-Name: Hogue, L.L. Year: 1995 Volume: 85 Issue: 9 Pages: 1204-1206 Handle: RePEc:aph:ajpbhl:1995:85:9:1204-1206_3 Template-Type: ReDIF-Article 1.0 Title: Prison health: the breaking point. Journal: American Journal of Public Health Author-Name: Berkman, A. Year: 1995 Volume: 85 Issue: 12 Pages: 1616-1618 DOI: 10.2105/AJPH.85.12.1616 File-URL: http://hdl.handle.net/10.2105/AJPH.85.12.1616 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.85.12.1616_1 Template-Type: ReDIF-Article 1.0 Title: HIV risk-related behaviors among injection drug users in Rome: Differences between 1990 and 1992 Journal: American Journal of Public Health Author-Name: Davoli, M. Author-Name: Perucci, C.A. Author-Name: Abeni, D.D. Author-Name: Arca, M. Author-Name: Brancato, G. Author-Name: Forastiere, F. Author-Name: Montiroli, P.M. Author-Name: Zampieri, F. Year: 1995 Volume: 85 Issue: 6 Pages: 829-832 Abstract: Temporal differences in human immunodeficiency virus (HIV) risk-related behaviors among injection drug users in Rome, Italy, were analyzed in 487 drug users recruited in 1990 and 450 recruited in 1992. Sharing of syringes decreased among self-reported HIV-positive drug users between 1990 and 1992, but there was no change in their sexual behavior. Fewer HIV-seronegative drug users reported passing on used syringes in 1992 than in 1990; however, there was no change in the percentage of seronegative subjects using previously used syringes, and a reduction in condom use with primary partners. There still exists a great potential for transmission of HIV infection among injection drug users and from injection drug users to the general population. Handle: RePEc:aph:ajpbhl:1995:85:6:829-832_9 Template-Type: ReDIF-Article 1.0 Title: Radium-bearing pipe scale deposits: Implications for national waterborne radon sampling methods Journal: American Journal of Public Health Author-Name: Field, R.W. Author-Name: Fisher, E.L. Author-Name: Valentine, R.L. Author-Name: Kross, B.C. Year: 1995 Volume: 85 Issue: 4 Pages: 567-570 Abstract: A point-of-use waterborne ration-222 (222Rn) survey of a small Iowa town was performed to determine the cause of unnaturally high waterborne 222Rn concentrations in the municipality. The source of the elevated 222Rn concentrations was a newly discovered reservoir of waterborne 222Rn originating from distribution-system radium-226 (226Ra) adsorbed internal pipe scale deposits. Because the proposed national drinking water regulations for 222Rn require sampling at the origin of the distribution system rather than at the point of use, the proposed scheme for collection of water samples may not represent actual consumer waterborne 222Rn exposure in all cases. Handle: RePEc:aph:ajpbhl:1995:85:4:567-570_2 Template-Type: ReDIF-Article 1.0 Title: Alcohol consumption among adolescents and young adults: The Bogalusa Heart Study, 1981 to 1991 Journal: American Journal of Public Health Author-Name: Johnson, C.C. Author-Name: Myers, L. Author-Name: Webber, L.S. Author-Name: Hunter, S.M. Author-Name: Srinivasan, S.R. Author-Name: Berenson, G.S. Year: 1995 Volume: 85 Issue: 7 Pages: 979-982 Abstract: This report describes the alcohol consumption of adolescents and young adults who participated in the Bogalusa Heart Study, 1981 to 1991. Data were collected in three cross-sectional surveys of school-age children (11 to 19 years) and three surveys of young adults (18 to 32 years). White males had the highest proportion of drinkers and Black females had the lowest. By the end of the decade, adult White and Black male drinkers were about equal. Most individuals drank once or twice a week, but dally drinkers had the highest weekly alcohol intake. An association between alcohol and high-density lipoprotein cholesterol was found only in the latest survey and probably reflects the aging of the cohort. Handle: RePEc:aph:ajpbhl:1995:85:7:979-982_8 Template-Type: ReDIF-Article 1.0 Title: Admissions for injury at a rural hospital in Ghana: Implications for prevention in the developing world Journal: American Journal of Public Health Author-Name: Mock, C.N. Author-Name: Adzotor, E. Author-Name: Denno, D. Author-Name: Conklin, E. Author-Name: Rivara, F. Year: 1995 Volume: 85 Issue: 7 Pages: 927-931 Abstract: Objectives. Strategies for injury prevention have been extensively studied in developed nations but not in the developing world. This study sought to determine which mechanisms of injury were common in a rural developing area and which were important contributors to mortality and disability. Methods. All 614 patients admitted for injuries to a rural African hospital between 1987 and 1991 were analyzed retrospectively for mechanism of injury and outcome, as assessed by mortality and long-term functional status. Results. The leading mechanisms of injury were transport related (29%) and burns (16%). Burns accounted for 61% of injuries in children under 5 years. Mortality was 7.3% in the series, with 2.4% of deaths owing to transport injuries. Disability developed in 103 (22%) of the 462 survivors available for assessment, with most disability resulting from transport injuries (26% of all disabilities), burns (13%), and agricultural injuries (14%). Conclusions. Among injured patients who presented for treatment in this rural developing area, the largest burden of mortality and disability was from burns and transport-related injuries. Population-based studies are needed to substantiate whether these should be priorities for injury prevention efforts. Handle: RePEc:aph:ajpbhl:1995:85:7:927-931_5 Template-Type: ReDIF-Article 1.0 Title: Use of smokeless tobacco in the World Series, 1986 through 1993. Journal: American Journal of Public Health Author-Name: Jones, R.B. Year: 1995 Volume: 85 Issue: 1 Pages: 117-118 Handle: RePEc:aph:ajpbhl:1995:85:1:117-118_1 Template-Type: ReDIF-Article 1.0 Title: Racial and ethnic differences in the use of invasive cardiac procedures among cardiac patients in Los Angeles county, 1986 through 1988 Journal: American Journal of Public Health Author-Name: Carlisle, D.M. Author-Name: Leake, B.D. Author-Name: Shapiro, M.F. Year: 1995 Volume: 85 Issue: 3 Pages: 352-356 Abstract: Objectives. The purpose of the study was to compare use of invasive cardiovascular procedures among Latino, Asian, African-American, and White patients. Methods. In a cross-sectional study of hospital discharge data, multiple logistic regression was used to model use of coronary artery angiography, bypass graft surgery, and angioplasty among adult Los Angeles County residents discharged from California hospitals between 1986 and 1988 with primary diagnoses consistent with possible ischemic heart disease. Results. After potential demographic, socioeconomic, and clinical confounders, including hospital procedure volume, were controlled, Latinos were less likely than Whites to undergo angiography (odds ratio [OR] = 0.90) and bypass graft surgery (OR = 0.87). African Americans were less likely to receive bypass graft surgery (OR = 0.62) and angioplasty (OR = 0.80). Asians were as likely as Whites to receive each procedure. The impact of adjustment for hospital procedure volume was greater for Latinos and Asians than for African Americans. Conclusions. Administrative data suggest that disparities in use of invasive cardiovascular procedures are not limited to African Americans. Hospital procedure volume appears to be an important factor related to such disparities. The causes of racial/ethnic differences in reported procedure rates remain unclear. Handle: RePEc:aph:ajpbhl:1995:85:3:352-356_1 Template-Type: ReDIF-Article 1.0 Title: Subclinical health effects in a population exposed to excess vitamin D in milk Journal: American Journal of Public Health Author-Name: Scanlon, K.S. Author-Name: Blank, S. Author-Name: Sinks, T. Author-Name: Lett, S. Author-Name: Mueller, P. Author-Name: Freedman, D.S. Author-Name: Serdula, M. Author-Name: Falk, H. Year: 1995 Volume: 85 Issue: 10 Pages: 1418-1422 Abstract: To evaluate subclinical health effects of excess vitamin D, a cross- sectional study was conducted of persons consuming milk from a dairy that had overfortified milk for at least 4 years. Milk consumption, sunlight exposure, medical symptoms, serum 25-hydroxyvitamin D (25[OH]D), serum and urinary calcium, and indicators of renal function were measured. Increased milk consumption was associated with increased serum 25(OH)D and urinary calcium. However, the prevalences of elevated serum 25(OH)D and calcium were no greater than expected, and data indicated normal renal function. It was concluded that most persons exposed to excess vitamin D exhibited no measurable adverse subclinical effects. Handle: RePEc:aph:ajpbhl:1995:85:10:1418-1422_0 Template-Type: ReDIF-Article 1.0 Title: The epidemiology of nonfatal injuries among US children and youth Journal: American Journal of Public Health Author-Name: Scheidt, P.C. Author-Name: Harel, Y. Author-Name: Trumble, A.C. Author-Name: Jones, D.H. Author-Name: Overpeck, M.D. Author-Name: Bijur, P.E. Year: 1995 Volume: 85 Issue: 7 Pages: 932-938 Abstract: Objectives. National data are not routinely available regarding the incidence of and associated risk factors for nonfatal injuries in children and youth. The Child Health Supplement to the 1988 National Health Interview Survey provided an opportunity to determine accurate national estimates of childhood injury morbidity by demographic factors, location, external cause, nature of injury, and other factors. Methods. The closest adult for 17 110 sampled children was asked whether the child had had an injury, accident, or poisoning during the preceding 12 months and about the cause, location, and consequences of the event. An analysis for potential underreporting from 12 months of recall provided adjustments of annual rates to those for a 1-month recall period. Results. On the basis of 2772 reported injuries, the national estimated annual rate for children 0 to 17 years of age was 27 per 100 children after adjustment to 1-month recall. Boys experienced significantly higher rates than girls (risk ratio [RR] = 1.52, 95% confidence interval [CI] = 1.37, 1.68), and adolescents experienced the highest overall rate (38 per 100 children) and proportion of serious injuries. Conclusions. Approximately one fourth of US children experience a medically attended injury each year, but the risks vary considerably depending on the characteristics of subgroups and the injury cause. Handle: RePEc:aph:ajpbhl:1995:85:7:932-938_5 Template-Type: ReDIF-Article 1.0 Title: Seven chronic conditions: Their impact on US adults' activity levels and use of medical services Journal: American Journal of Public Health Author-Name: Verbrugge, L.M. Author-Name: Patrick, D.L. Year: 1995 Volume: 85 Issue: 2 Pages: 173-182 Abstract: Objectives. This paper analyzes the impact of seven chronic conditions (three nonfatal: arthritis, visual impairment, hearing impairment; four fatal: ischemic heart disease, chronic obstructive pulmonary disease, diabetes mellitus, malignant neoplasms) on US adults aged 18 and older. Impact refers to how readily a condition prompts activity limitations, physician visits, and hospital stays. Methods. Data come from three national health surveys and vital statistics. For comparability, a single disease classification scheme was applied, and new rates were estimated. Frequency, impact, and prominence of the target conditions are studied via rates, ratios of rates, and ranks, respectively. Results. In young adulthood, the nonfatal conditions prompt limitations less readily than do the fatal ones, but by older ages, arthritis and visual impairment have a limiting impact equivalent to that of fatal conditions. Despite high prevalence and limitations, nonfatal conditions stand well below fatal conditions for health services use. Conclusions. Although statistics on frequency, impact, and prominence all indicate conditions' 'importance,' they give only weak dues about specific service needs of affected persons. The persistent finding that nonfatal conditions do not receive health services care commensurate with their prevalence and impact reflects long-standing imbalanced attention on fatal conditions in research and medical care. Handle: RePEc:aph:ajpbhl:1995:85:2:173-182_0 Template-Type: ReDIF-Article 1.0 Title: Magico-religious mercury use and cultural sensitivity Journal: American Journal of Public Health Author-Name: Wendroff, A.P. Year: 1995 Volume: 85 Issue: 3 Pages: 409-410 Handle: RePEc:aph:ajpbhl:1995:85:3:409-410_9 Template-Type: ReDIF-Article 1.0 Title: The association between alcohol and breast cancer: Popular press coverage of research Journal: American Journal of Public Health Author-Name: Houn, F. Author-Name: Bober, M.A. Author-Name: Huerta, E.E. Author-Name: Hursting, S.D. Author-Name: Lemon, S. Author-Name: Weed, D.L. Year: 1995 Volume: 85 Issue: 8 Pages: 1082-1086 Abstract: Objectives. This study was undertaken to examine popular press reports of the association between alcohol and breast cancer. Methods. Articles from scientific journals and stories from newspapers and magazines published from January 1, 1985, to July 1, 1992, were retrieved from six on-line databases. Lay press stories were analyzed to determine which medical articles were publicized and what information was reported. Results. Fifty-eight scientific articles on the relationship of alcohol and breast cancer were found, and 64 newspaper and 23 magazine stories were retrieved. The press cited 11 studies, 19% of those published during the study period. Three studies were featured in 77% of popular press stories. No scientific review articles were reported. Behavioral recommendations were given to the public in 63% of stories. Conclusions. The vast majority of scientific studies on alcohol and breast cancer were ignored in press reports. We encourage researchers and the popular press to give the public a broader understanding of public health issues. Handle: RePEc:aph:ajpbhl:1995:85:8:1082-1086_3 Template-Type: ReDIF-Article 1.0 Title: Community-based tuberculin screening in Montreal: A cost-outcome description Journal: American Journal of Public Health Author-Name: Adhikari, N. Author-Name: Menzies, R. Year: 1995 Volume: 85 Issue: 6 Pages: 786-790 Abstract: Objectives. This study describes the costs and outcomes of community- based tuberculin screening programs conducted between 1987 and 1991 in Montreal, Quebec, Canada. Methods. Follow-up information was abstracted from hospital records of all reactors detected in tuberculin screening of students in grades 6 and 10, of first-year health professional students, and of workers aged 18 to 25 in a number of workforces. Screening costs were estimated directly from survey records, and follow-up costs were estimated from the annual financial report of the Montreal Chest Hospital for 1989/90. Results. Of 7669 persons tested, 782 (10.2%) had positive results and 757 (9.9%) were referred to a clinic. Of those, 525 (6.8% of the original 7669) reported, 293 (3.8%) were prescribed therapy, and 154 (2.0%) were compliant. In Canadian dollars, screening cost $5.70 per person tested and $56 per tuberculin reactor detected, but follow-up of reactors accounted for 73% of the total program cost of $13455 to $18753 per case of tuberculosis prevented. Conclusions. Because of high rates of patient and provider noncompliance, a tuberculin screening program was much less cost-effective than anticipated. Screening costs must be targeted to the highest risk populations, and compliance with recommendations for preventive therapy must be maximized. Handle: RePEc:aph:ajpbhl:1995:85:6:786-790_7 Template-Type: ReDIF-Article 1.0 Title: Regulating controversial programs for unpopular people: Methadone maintenance and syringe exchange programs Journal: American Journal of Public Health Author-Name: Des Jarlais, D.C. Author-Name: Paone, D. Author-Name: Friedman, S.R. Author-Name: Peyser, N. Author-Name: Newman, R.G. Year: 1995 Volume: 85 Issue: 11 Pages: 1577-1584 Abstract: One third of all cases of the acquired immunodeficiency syndrome (AIDS) in the United States are associated with the injection of illicit drugs. There is mounting evidence for the effectiveness of syringe exchange programs in reducing human immunodeficiency virus (HIV) risk behavior and HIV transmission among injection drug users. Expansion of syringe exchange would require increased public funding and undoubtedly would include government regulation of syringe exchanges. An analogy is drawn with the present system of regulation of methadone maintenance treatment programs and possible regulation of syringe exchange programs. Specific recommendations are offered to reduce the likelihood of repeating the regulatory problems of methadone maintenance treatment in future regulation of syringe exchange programs. Handle: RePEc:aph:ajpbhl:1995:85:11:1577-1584_3 Template-Type: ReDIF-Article 1.0 Title: Adolescent parity and infant mortality, Minnesota, 1980 through 1988 Journal: American Journal of Public Health Author-Name: Hellerstedt, W.L. Author-Name: Pirie, P.L. Author-Name: Alexander, G.R. Year: 1995 Volume: 85 Issue: 8 Pages: 1139-1142 Abstract: The association of parity and infant mortality was studied using linked birth-death files for 46 985 infants born to 11- to 19-year-old Minnesota residents between 1980 and 1988. Compared with infants of primiparas, infants of multiparas were at twice the risk for infant and postneonatal death but at no increased risk for neonatal death. They were also at two to three times the risk for deaths due to accidents, infections, and sudden infant death syndrome. The higher sociodemographic disadvantage and poorer prenatal care of multiparas did not explain the excess infant mortality risk that was concentrated in causes of death that are potentially preventable through primary care and parent education. Handle: RePEc:aph:ajpbhl:1995:85:8:1139-1142_4 Template-Type: ReDIF-Article 1.0 Title: Tuberculosis screening among homeless persons with aids living in single- room-occupancy hotels Journal: American Journal of Public Health Author-Name: Layton, M.C. Author-Name: Cantwell, M.F. Author-Name: Dorsinville, G.J. Author-Name: Valway, S.E. Author-Name: Onorato, I.M. Author-Name: Frieden, T.R. Year: 1995 Volume: 85 Issue: 11 Pages: 1556-1559 Abstract: Congregate facilities for homeless persons with the acquired immunodeficiency syndrome (AIDS) are often endemic for tuberculosis. We evaluated tuberculosis screening methods at single-room-occupancy hotels housing persons with AIDS. Residents were screened by cross matching the New York City Tuberculosis Registry, interviewing for tuberculosis history, skin testing, and chest radiography. Cases were classified as either previously or newly diagnosed. Among the 106 participants, 16 (15%) previously diagnosed tuberculosis cases were identified. Participants' tuberculosis histories were identified by the questionnaire (100%) or by registry match (69%). Eight participants (50%) were noncompliant with therapy. These findings prompted the establishment of a directly observed therapy program on site. Handle: RePEc:aph:ajpbhl:1995:85:11:1556-1559_4 Template-Type: ReDIF-Article 1.0 Title: Reevaluating the evidence on pesticide safety Journal: American Journal of Public Health Author-Name: Bukowski, J.A. Author-Name: Meyer, L.W. Author-Name: Leiss, J.K. Author-Name: Savitz, D.A. Year: 1995 Volume: 85 Issue: 11 Pages: 1586-1587 Handle: RePEc:aph:ajpbhl:1995:85:11:1586-1587_8 Template-Type: ReDIF-Article 1.0 Title: Physician characteristics associated with decisions to withdraw life support Journal: American Journal of Public Health Author-Name: Christakis, N.A. Author-Name: Asch, D.A. Year: 1995 Volume: 85 Issue: 3 Pages: 367-372 Abstract: Objective. This study was undertaken to identify attributes of physicians associated with physicians' decisions to withdraw life support. Methods. Of the 862 Pennsylvania internists surveyed and asked to make decisions in response to hypothetical vignettes and to report their actual experience with the withdrawal of life support, 485 (56%) responded. The data were analyzed with regression models. Results. With other factors controlled, physicians were more willing to withdraw life support if they were young, practiced in a tertiary care setting, or spent more time in clinical practice; they were less willing if they were Catholic or Jewish. Physicians reported a higher frequency of actually withdrawing life support if they were young, had more contact with ICU patients, spent more time in clinical practice, or were specialists. Physicians with a greater willingness to withdraw were more likely to report having done so. Conclusions. Physicians' personal characteristics are associated with both their preferences and their practice in the withdrawal of life support, and a greater willingness to withdraw is associated with a higher frequency of withdrawal. The influence of physician characteristics demonstrates that patient preferences and clinical circumstances do not exclusively govern such ethical decisions. Handle: RePEc:aph:ajpbhl:1995:85:3:367-372_3 Template-Type: ReDIF-Article 1.0 Title: The need for innovation in immunization. Journal: American Journal of Public Health Author-Name: Edelson, P.J. Year: 1995 Volume: 85 Issue: 12 Pages: 1613-1614 DOI: 10.2105/AJPH.85.12.1613 File-URL: http://hdl.handle.net/10.2105/AJPH.85.12.1613 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.85.12.1613_2 Template-Type: ReDIF-Article 1.0 Title: Cancer screening by primary care physicians: A comparison of rates obtained from physician self-report, patient survey, and chart audit Journal: American Journal of Public Health Author-Name: Montano, D.E. Author-Name: Phillips, W.R. Year: 1995 Volume: 85 Issue: 6 Pages: 795-800 Abstract: Objectives. This study measured the cancer screening rates of family physicians and compared the measures obtained through physician self-reports, chart audits, and patient surveys. Methods. A cancer screening survey was sent to 50% of the members of the Washington Academy of Family Physicians, with 326 family physicians (74% response rate) completing the survey. Sixty physicians were recruited for the patient survey and chart audit phase, with a 90% participation rate. Patient surveys were conducted with about 350 patients per physician, and chart audits were conducted on a subset of about 50 patients per physician. Each physician's rate of providing each service was computed from the self-report, the patient survey, and the chart audit. Results. Physicians provided many of these services at rates different from those commonly recommended. Large discrepancies were found between the rates measured by different methods. Correlations between rates derived from chart audits and patient surveys were high; however, correlations between rates from physician self-report and either patient survey or chart audit were much lower for all services. Conclusions. Studies of physicians' provision of cancer prevention services should not rely on physician self-report, but should obtain the rates through patient surveys or chart audits. Handle: RePEc:aph:ajpbhl:1995:85:6:795-800_4 Template-Type: ReDIF-Article 1.0 Title: Body weight patterns among the Chinese: Results from the 1989 and 1991 China health and nutrition surveys Journal: American Journal of Public Health Author-Name: Popkin, B.M. Author-Name: Paeratakul, S. Author-Name: Ge, K. Author-Name: Fengying, Z. Year: 1995 Volume: 85 Issue: 5 Pages: 690-694 Abstract: Objectives. A longitudinal survey assessed the distribution of adult body weight among the Chinese population. Methods. Data from the 1989 and 1991 China Health and Nutrition Survey were used to study changes in the proportions of adults aged 20-45 years who were classified as underweight, normal weight, overweight, and severely overweight. Results. Them was a slight decline in the proportion of men and women classified as underweight, but among lower-income persons an increase occurred. The proportion of adults with normal body weight decreased, and the proportions of those classified as overweight and severely overweight increased during the same period. The observed increases in proportions of adults classified as overweight and severely overweight were largely confined to the urban residents and to those in the middle-and high-income groups. Conclusions. Results indicate increases in both obesity and undernutrition. Current efforts in China to develop a preventive health care policy emphasize the prevention of excess nutrient intakes and overnutrition and, hence, address the problem of the increase in obesity among well-to-do, mostly urban residents. However, the increase in undernutrition among low-income Chinese adults should not be overlooked and requires further research and serious policy consideration. Handle: RePEc:aph:ajpbhl:1995:85:5:690-694_7 Template-Type: ReDIF-Article 1.0 Title: Vaccination levels in Los Angeles Public Health Centers: The contribution of missed opportunities to vaccinate and other factors Journal: American Journal of Public Health Author-Name: Wood, D. Author-Name: Pereyra, M. Author-Name: Halfon, N. Author-Name: Hamlin, J. Author-Name: Grabowsky, M. Year: 1995 Volume: 85 Issue: 6 Pages: 850-853 Abstract: We abstracted 752 randomly selected records of 2-year-old children at 5 public health centers in Los Angeles. Only 27% of the children were up-to- date in their vaccinations by 2 years of age. Being up-to-date was strongly associated with the number of missed opportunities to vaccinate and number of well child visits. Missed opportunities to vaccinate occurred during 52% of all visits and were associated with minor illness diagnoses and inaccurate immunization status assessment by nurses. Frequent missed opportunities to vaccinate and inadequate numbers of well child visits may result in low immunization levels among children attending public health clinics. Handle: RePEc:aph:ajpbhl:1995:85:6:850-853_9 Template-Type: ReDIF-Article 1.0 Title: The risk of domestic violence and women with HIV infection: Implications for partner notification, public policy, and the law Journal: American Journal of Public Health Author-Name: Rothenberg, K.H. Author-Name: Paskey, S.J. Year: 1995 Volume: 85 Issue: 11 Pages: 1569-1576 Abstract: Partner notification has emerged as an important strategy in the fight against acquired immunodeficiency syndrome (AIDS), and states have now adopted a plethora of laws that encourage or mandate notification, often without the patient's consent. As human immunodeficiency virus (HIV) infection continues to spread among women, the future development of AIDS control strategies and public health laws must be shaped by concern for the safely and autonomy of patients who face a risk of domestic violence. Three distinct recommendations flow from this premise. First, all HIV-infected women should be assessed for the risk of domestic violence and offered appropriate interventions. Second, where a risk of abuse is indicated, partners should never be notified without the patient's consent. State laws that presently permit involuntary notification should be repealed or amended. Third, laws that punish a patient's refusal to notify partners should also be modified or repealed. Handle: RePEc:aph:ajpbhl:1995:85:11:1569-1576_3 Template-Type: ReDIF-Article 1.0 Title: Objectively measuring physical ability in elderly persons: The physical capacity evaluation Journal: American Journal of Public Health Author-Name: Daltroy, L.H. Author-Name: Phillips, C.B. Author-Name: Eaton, H.M. Author-Name: Larson, M.G. Author-Name: Partridge, A.J. Author-Name: Logigian, M. Author-Name: Liang, M.H. Year: 1995 Volume: 85 Issue: 4 Pages: 558-560 Abstract: The Physical Capacity Evaluation, a performance measure of functional capabilities comprised of 13 tasks simulating those used in activities of daily living, was tested on 289 community-dwelling elderly people and compared against a widely used self-report measure of function, the Health Assessment Questionnaire. Factor analysis identified one dominant component in each instrument, Internal consistency reliability (Cronbach's alpha) was .90 for both instruments. Global disability (Health Assessment Questionnaire) and function (Physical Capacity Evaluation) scores were correlated -,74. One- week retest reliabilities on 58 subjects were .94 for the Physical Capacity Evaluation and .95 for the Health Assessment Questionnaire. The Physical Capacity Evaluation is a valid and reliable measure of physical performance for use with elderly people. Handle: RePEc:aph:ajpbhl:1995:85:4:558-560_1 Template-Type: ReDIF-Article 1.0 Title: US mortality by economic, demographic, and social characteristics: The National Longitudinal Mortality Study Journal: American Journal of Public Health Author-Name: Sorlie, P.D. Author-Name: Backlund, E. Author-Name: Keller, J.B. Year: 1995 Volume: 85 Issue: 7 Pages: 949-956 Abstract: Objectives. A large US sample was used to estimate the effects of race, employment status, income, education, occupation, marital status, and household size on mortality. Methods. Approximately 530 000 persons 25 years of age or more were identified from selected Current Population Surveys between 1979 and 1985. These individuals were followed for mortality through use of the National Death Index for the years 1979 through 1989. Results. Higher mortality was found in Blacks than in Whites less than 65 years of age; in persons not in the labor force, with lower incomes, with less education, and in service and other lower level occupations; and in persons not married and living alone. With occasional exceptions, in specific sex and age groups, these relationships were reduced but remained strong and statistically significant when each variable was adjusted for all of the other characteristics. The relationships were generally weaker in individuals 65 years of age or more. Conclusions. Employment status, income, education, occupation, race, and marital status have substantial net associations with mortality. This study identified segments of the population in need of public health attention and demonstrated the importance of including these variables in morbidity and mortality studies. Handle: RePEc:aph:ajpbhl:1995:85:7:949-956_1 Template-Type: ReDIF-Article 1.0 Title: The migration of persons with AIDS: Data from 12 states, 1985 to 1992 Journal: American Journal of Public Health Author-Name: Buehler, J.W. Author-Name: Frey, R.L. Author-Name: Chu, S.Y. Year: 1995 Volume: 85 Issue: 11 Pages: 1552-1555 Abstract: This study measured the migration of persons with the acquired immunodeficiency virus (AIDS) between diagnosis and death using AIDS case and death reports from 12 states for 1985 to 1992. Of 49 805 persons with AIDS, 10.6% changed their place of residence, and half of these individuals who moved changed their state of residence. Migration had relatively little impact on the numbers of persons with AIDS in the largest metropolitan areas, which accounted for approximately 90% of AIDS diagnoses. Although only 3% of deaths occurred in residents of nonmetropolitan areas, the net effect of migration was a 24% increase in the number of persons with AIDS residing in such areas. Handle: RePEc:aph:ajpbhl:1995:85:11:1552-1555_9 Template-Type: ReDIF-Article 1.0 Title: Editorial: Failing to prevent unintended pregnancy is costly Journal: American Journal of Public Health Author-Name: Lee, P.R. Author-Name: Stewart, F.H. Year: 1995 Volume: 85 Issue: 4 Pages: 479-480 Handle: RePEc:aph:ajpbhl:1995:85:4:479-480_7 Template-Type: ReDIF-Article 1.0 Title: Predictors of dietary intake in a functionally dependent elderly population in the community Journal: American Journal of Public Health Author-Name: Payette, H. Author-Name: Gray-Donald, K. Author-Name: Cyr, R. Author-Name: Boutier, V. Year: 1995 Volume: 85 Issue: 5 Pages: 677-683 Abstract: Objectives. The aim of this study was to describe dietary intake and identify predictors of energy and protein intake in a group of high-risk elderly people. Methods. All elderly persons receiving publicly financed home care services in the area of Sherbrooke, Quebec, Canada, were eligible. Subjects (n = 145) 60 to 94 years of age from three home care programs were interviewed to measure sociodemographic, health, and food-related behavior variables. Three nonconsecutive 24-hour recalls were used to describe usual dietary intake. Independent predictors of energy and protein intake were derived from multiple regression analyses. Results. Very low mean energy intakes were observed in this functionally dependent population. More than 50% of the study subjects did not meet the recommended levels of daily protein intake (0.8 g/kg body weight). Significant independent determinants of intake were burden of disease, stress, poor appetite, and vision. Conclusions. Results suggest that community-living elderly people with loss of autonomy may have more nutritional problems than healthy elderly individuals. Surveillance of predictors of dietary intake may enable early detection and prevention of nutritional deficits. Handle: RePEc:aph:ajpbhl:1995:85:5:677-683_1 Template-Type: ReDIF-Article 1.0 Title: Alcohol and longevity. Journal: American Journal of Public Health Author-Name: Klatsky, A.L. Author-Name: Friedman, G.D. Year: 1995 Volume: 85 Issue: 1 Pages: 16-18 Abstract: The literature on the relationship between drinking alcohol and longevity is reviewed. The focus is on the advice that public health officials should give concerning alcohol drinking, given that although moderate alcohol consumption may well be beneficial, heavy drinking is not. Handle: RePEc:aph:ajpbhl:1995:85:1:16-18_5 Template-Type: ReDIF-Article 1.0 Title: Gender differences in smoking cessation after 3 years in the Lung Health Study Journal: American Journal of Public Health Author-Name: Bjornson, W. Author-Name: Rand, C. Author-Name: Connett, J.E. Author-Name: Lindgren, P. Author-Name: Nides, M. Author-Name: Pope, F. Author-Name: Buist, A.S. Author-Name: Hoppe-Ryan, C. Author-Name: O'Hara, P. Year: 1995 Volume: 85 Issue: 2 Pages: 223-230 Abstract: Objectives. An analysis of gender differences in smoking cessation was conducted among 3923 participants in the Special Intervention group of the Lung Health Study. This report focuses on gender differences in sustained quit rates at 12 and 36 months. Methods. Special Intervention participants were offered a 12-session, 12-week smoking cessation program using nicotine gum and were followed for 3 years. Self-reported smoking status was validated with carbon monoxide and salivary cotinine. Results. Men had higher sustained quit rates at 12 and 36 months; gender differences were found in baseline variables that also predicted sustained abstinence; and controlling for selected baseline variables reduced the association between gender and sustained abstinence. When other variables were controlled, gender predicted sustained abstinence at 36 months (odds ratio [OR] = 1.24, 95% confidence interval [CI] = 1.04, 1.48) but not 12 months (OR = 1.08, 95% CI = 0.92, 1.27), reflecting more late relapse among women. Conclusions. Demographics and smoking history were more important than gender per se in sustained smoking cessation in the Lung Health Study. Programs tailoring smoking cessation by gender need to include coping skills for problems associated with less education and social support and for improving persistence with quit attempts. Handle: RePEc:aph:ajpbhl:1995:85:2:223-230_9 Template-Type: ReDIF-Article 1.0 Title: Epidemiology, the humanities, and public health Journal: American Journal of Public Health Author-Name: Weed, D.L. Year: 1995 Volume: 85 Issue: 7 Pages: 914-918 Abstract: Epidemiologists may benefit from the disciplines of history, philosophy of science, ethics, literature, and art. Within these disciplines lie answers to the questions of who we are, what is right, how to think, and when to act. Studying and participating in the humanities may also help epidemiologists focus their professional concerns on the humanity their methods serve. A parallel phenomenon in the clinical sciences-medical humanities-provides support for the approach (and some lessons). Handle: RePEc:aph:ajpbhl:1995:85:7:914-918_2 Template-Type: ReDIF-Article 1.0 Title: Preventive services for the elderly: Would coverage affect utilization and costs under Medicare? Journal: American Journal of Public Health Author-Name: Burton, L.C. Author-Name: Steinwachs, D.M. Author-Name: German, P.S. Author-Name: Shapiro, S. Author-Name: Brant, L.J. Author-Name: Richards, T.M. Author-Name: Clark, R.D. Year: 1995 Volume: 85 Issue: 3 Pages: 387-391 Abstract: Objectives. This study was undertaken to determine whether adding a benefit for preventive services to older Medicare beneficiaries would affect utilization end costs under Medicare. Methods. The demonstration used an experimental design, enrolling 4195 older, community-dwelling Medicare recipients. Medicare claims data for the 2 years in which the preventive visits occurred were compared for the intervention (n = 2105) and control (n=2090) groups. Monthly allowable charges for Part A and Part B services and number of hospital discharges end ambulatory visits were compared. Results. There were no significant differences in the charges between the groups owing to the intervention, although total charges were somewhat lower for the intervention group even when the cost of the intervention was included. Charges for both groups rose significantly as would be expected for en aging population. A companion paper describes a modest health benefit. Conclusions. There appears to be a modest health benefit with no negative cost impact. This finding gives en early quantitative basis for the discussion of whether to extend Medicare benefits to include a general preventive visit from a primary care clinician. Handle: RePEc:aph:ajpbhl:1995:85:3:387-391_3 Template-Type: ReDIF-Article 1.0 Title: Current trends in tobacco use on prime-time fictional television. Journal: American Journal of Public Health Author-Name: Hazan, A.R. Author-Name: Glantz, S.A. Year: 1995 Volume: 85 Issue: 1 Pages: 116-117 Handle: RePEc:aph:ajpbhl:1995:85:1:116-117_1 Template-Type: ReDIF-Article 1.0 Title: Eighteen-month incidence of tooth loss among older adults in North Carolina Journal: American Journal of Public Health Author-Name: Hunt, R.J. Author-Name: Drake, C.W. Author-Name: Beck, J.D. Year: 1995 Volume: 85 Issue: 4 Pages: 561-563 Abstract: This study investigated tooth loss in North Carolina adults 65 years of age or older. A random sample of 335 Blacks and 284 Whites participated in dental examinations and interviews at baseline and again after 18 months. Blacks were more likely than Whites to lose at least one tooth (36% vs 19%), and they lost more teeth on average (1.0 vs 0.4). Several oral disease conditions and symptoms were related to tooth loss, but many other hypothesized factors were not. Risk models were inconclusive in the identification of factors related to risk of tooth loss. Handle: RePEc:aph:ajpbhl:1995:85:4:561-563_2 Template-Type: ReDIF-Article 1.0 Title: Accounting for cluster randomization: A review of primary prevention trials, 1990 through 1993 Journal: American Journal of Public Health Author-Name: Simpson, J.M. Author-Name: Klar, N. Author-Name: Donner, A. Year: 1995 Volume: 85 Issue: 10 Pages: 1378-1383 Abstract: Objectives. This methodological review aims to determine the extent to which design and analysis aspects of cluster randomization have been appropriately dealt with in reports of primary prevention trials. Methods. All reports of primary prevention trials using cluster randomization that were published from 1990 to 1993 in the American Journal of Public Health and Preventive Medicine were identified. Each article was examined to determine whether cluster randomization was taken into account in the design and statistical analysis. Results. Of the 21 articles, only 4 (19%) included sample size calculations or discussions of power that allowed for clustering, while 12 (57%) took clustering into account in the statistical analysis. Conclusions. Design and analysis issues associated with cluster randomization are not recognized widely enough. Reports of cluster randomized trials should include sample size calculations and statistical analyses that take clustering into account, estimates of design effects to help others planning trials, and a table showing the baseline distribution of important characteristics by intervention group, including the number of clusters and average cluster size for each group. Handle: RePEc:aph:ajpbhl:1995:85:10:1378-1383_5 Template-Type: ReDIF-Article 1.0 Title: The limitations of breast cancer screening for first-degree relatives of breast cancer patients Journal: American Journal of Public Health Author-Name: Neugut, A.I. Author-Name: Jacobson, J.S. Year: 1995 Volume: 85 Issue: 6 Pages: 832-834 Abstract: Bitter controversy surrounds the recommendation of mammographic breast- cancer screening for women aged 40 to 49 years of average risk. This paper considers the case for screening women in their 40s with higher risk, specifically women who have one or more first-degree relatives with breast cancer. A review of the literature and of current knowledge suggests that screening such women is more cost-effective, in the sense of having a higher yield per mammogram and better predictive value, than screening women of average risk in this age group. However, there is no evidence that screening is more efficacious in reducing mortality in this subgroup than in other women in their 40s. Handle: RePEc:aph:ajpbhl:1995:85:6:832-834_3 Template-Type: ReDIF-Article 1.0 Title: Health indicators and the organization of health care systems in Western Europe Journal: American Journal of Public Health Author-Name: Elola, J. Author-Name: Daponte, A. Author-Name: Navarro, V. Year: 1995 Volume: 85 Issue: 10 Pages: 1397-1401 Abstract: Objectives. This study investigated the association between health care systems and health indicators in developed countries. Methods. Cross-national comparisons were conducted with regression analysis between 17 Western European countries with two types of health care systems: national health services and social security systems. Results. Health care expenditures were inversely correlated to potential years of life lost to females and to infant mortality rates; they were positively correlated to life expectancy for females. Regression models predicted that countries with national health services systems would have lower infant mortality rates at similar levels of gross domestic product (GDP) and health care expenditures. Finally, increases in health care expenditures would decrease the ratio of observed to predicted infant mortality rates according to GDP; this decrease would be greater in countries with national health services than in those with social security systems. The model predicted this difference to be about 13% at average levels of health expenditures. Conclusions. National health services seem to he more efficient at producing lower infant mortality rates than social security systems in Western European countries. Handle: RePEc:aph:ajpbhl:1995:85:10:1397-1401_6 Template-Type: ReDIF-Article 1.0 Title: Women's receptivity to testing for a genetic susceptibility to breast cancer Journal: American Journal of Public Health Author-Name: Chaliki, H. Author-Name: Loader, S. Author-Name: Levenkron, J.C. Author-Name: Logan-Young, W. Author-Name: Hall, W.J. Author-Name: Rowley, P.T. Year: 1995 Volume: 85 Issue: 8 Pages: 1133-1135 Abstract: Four hundred eighty-four patients undergoing mammography and 498 patients visiting their obstetrician-gynecologist were asked whether they would take a breast cancer 1 (BRCA1) test to detect a genetic susceptibility to breast cancer. More than 90% in both groups said they would take the test. Women were more likely to accept if they were regularly having breast examinations by a physician, believed that mammography effectively detects early breast cancer, and believed that early breast cancer is curable. If shown to have inherited a susceptibility, many reported that they would be very anxious, would want the test repeated, would examine their breasts more often than monthly, and would want mammography more often than yearly. Many also reported that they would recommend testing to relatives. Handle: RePEc:aph:ajpbhl:1995:85:8:1133-1135_5 Template-Type: ReDIF-Article 1.0 Title: Reduced risk of hepatitis B and hepatitis C among injection drug users in the Tacoma syringe exchange program Journal: American Journal of Public Health Author-Name: Hagan, H. Author-Name: Des Jarlais, D.C. Author-Name: Friedman, S.R. Author-Name: Purchase, D. Author-Name: Alter, M.J. Year: 1995 Volume: 85 Issue: 11 Pages: 1531-1537 Abstract: Objectives. This case-control study examined the association between syringe exchange use and hepatitis B and C in injection drug users. Methods. Case patients included 28 injection drug users with acute hepatitis B and 20 with acute hepatitis C reported to the health department in a sentinel hepatitis surveillance county; control subjects were injection drug users with no markers of exposure to hepatitis B or C (n = 38 and 26, respectively) attending health department services during the same period. Data were abstracted from clinic records. Results. Seventy-five percent of case patients with hepatitis B and 26% of control subjects had never used the exchange; similar proportions were found for the hepatitis C case and control groups. After adjustment for demographic characteristics and duration of injecting drugs, nonuse of the exchange was associated with a sixfold greater risk of hepatitis B (odds ratio [OR] = 5.5; 95% confidence interval [CI] = 1.5, 20.4) and a sevenfold greater risk of hepatitis C (OR = 7.3; 95% CI = 1.6, 32.8). Conclusions. The results suggest that use of the exchange led to a significant reduction in hepatitis B and hepatitis C in the county and may have also prevented a substantial proportion of human immunodeficiency virus infections in injection drug users. Handle: RePEc:aph:ajpbhl:1995:85:11:1531-1537_7 Template-Type: ReDIF-Article 1.0 Title: Occupational hepatitis C virus infection in Italian health care workers Journal: American Journal of Public Health Author-Name: Puro, V. Author-Name: Petrosillo, N. Author-Name: Ippolito, G. Author-Name: Aloisi, M.S. Author-Name: Boumis, E. Author-Name: Rava, L. Year: 1995 Volume: 85 Issue: 9 Pages: 1272-1275 Abstract: The risk of exposed health care workers in 16 Italian hospitals becoming infected with hepatitis C virus was assessed through two serosurveys at a 1- year interval and at follow-up. Prevalence, which was 2.2%, was significantly associated with previous acute hepatitis, blood transfusions, housekeeping, and older age (> 46 years) but not with occupational risk factors. After 1 year, 2622 (87%) of the 3006 seronegative health care workers were retested, and 3 (0.1%), who did not acknowledge occupational or community risk factors, seroconverted. Additionally, 133 (97 needlesticks) out of 370 reported occupational exposures were to hepatitis C virus; one pricked nurse seroconverted (0.75%). Although the risk is not negligible, hepatitis C virus infection does not seem to be easily occupationally transmitted. Handle: RePEc:aph:ajpbhl:1995:85:9:1272-1275_5 Template-Type: ReDIF-Article 1.0 Title: State legislative strategies to improve the supply and distribution of generalist physicians, 1985 to 1992 Journal: American Journal of Public Health Author-Name: Rivo, M.L. Author-Name: Henderson, T.M. Author-Name: Jackson, D.M. Year: 1995 Volume: 85 Issue: 3 Pages: 405-407 Abstract: State laws enacted between 1985 and 1992 were reviewed to examine state involvement in influencing the supply and distribution of generalist physicians. Forty-seven states enacted 238 relevant laws during this period. In 1991 and 1992, 36 states enacted 98 laws, as compared with 1985 and 1986, when 8 states enacted 12 laws. Legislation addressed planning and oversight; financial incentives to institutions, students, and residents; and strategies to enhance the practice environment. A new strategy is to link funding to measurable outcomes, such as the career choices of a state medical school's graduates. Few states devoted resources to evaluate their efforts. Handle: RePEc:aph:ajpbhl:1995:85:3:405-407_0 Template-Type: ReDIF-Article 1.0 Title: Could you starve to death in England in 1839? The Chadwick-Farr controversy and the loss of the 'social' in public health Journal: American Journal of Public Health Author-Name: Hamlin, C. Year: 1995 Volume: 85 Issue: 6 Pages: 856-866 Abstract: The public health field has long been palled in two directions, either toward a narrower biomedical mission to control infectious disease or toward a broader mission to address the social and economic factors that adversely affect health and wellbeing. This paper explores as an instance of this tension an 1839 controversy between the statistician William Farr and the pioneering sanitary reformer Edwin Chadwick on the role of starvation as a cause of death. Farr thought hunger contributed significantly to many deaths; Chadwick wanted Farr to concentrate on the diseases from which people actually died. The paper then considers what the 'constitutional' disease theories, which underlay Farr's concerns, implied for public health using medical testimony on child labor in industrial revolution factories as an illustration. An exploration of this constitutional medicine may help provide a 'useable past' for modern public health workers interested in broadening the scope of public health. Handle: RePEc:aph:ajpbhl:1995:85:6:856-866_8 Template-Type: ReDIF-Article 1.0 Title: The impact of the 1987 federal regulations on the use of psychotropic drugs in Minnesota nursing homes Journal: American Journal of Public Health Author-Name: Garrard, J. Author-Name: Chen, V. Author-Name: Dowd, B. Year: 1995 Volume: 85 Issue: 6 Pages: 771-776 Abstract: Objectives. The purpose of this study was to examine prevalence rates of psychotropic drug use by elderly nursing home residents 3 years before and 1 year after implementation of the 1987 Omnibus Budget Reconciliation Act drug regulations throughout the United States on October 1, 1990. Methods. A cohort study was conducted of elderly nursing home residents, for each of 4 study years (approximately 33 000 residents per year), of all nursing homes (n = 372) in Minnesota certified by Medicare and Medicaid. Data included (1) health status assessment and psychotropic drug use; (2) nursing home and care characteristics; and (3) county geographic and population characteristics. Results. Annual rates of antipsychotic drug use declined by one third over the 4-year period (23%, 22%, 19%, and 15% from 3 years before enforcement of the regulations to 1 year afterward). All differences were statistically significant. Antianxiety use rates were 11%, 12%, 12%, and 12%, respectively, and antidepressant use rates were 14%, 15%, 16%, 16%, respectively, for the 4 years. The latter two classes of drugs were not affected directly by the regulations. Conclusions. Declines in the rates of antipsychotic drug use appear to be associated with anticipation of the regulations the year before and as the result of the regulations the year after the October 1990 implementation. A hypothesized meditation shift to benzodiazepine drugs was not observed. Handle: RePEc:aph:ajpbhl:1995:85:6:771-776_8 Template-Type: ReDIF-Article 1.0 Title: The natural history of substance use as a guide to setting drug policy. Journal: American Journal of Public Health Author-Name: Robins, L.N. Year: 1995 Volume: 85 Issue: 1 Pages: 12-13 Handle: RePEc:aph:ajpbhl:1995:85:1:12-13_6 Template-Type: ReDIF-Article 1.0 Title: Reducing cigarette consumption in California: Tobacco taxes vs an anti- smoking media campaign Journal: American Journal of Public Health Author-Name: Hu, T.-W. Author-Name: Sung, H.-Y. Author-Name: Keeler, T.E. Year: 1995 Volume: 85 Issue: 9 Pages: 1218-1222 Abstract: Objectives. The purpose of this study was to examine the relative effects of taxation vs an anti-smoking media campaign on cigarette consumption in California. Methods. Quarterly cigarette sales data reported by the California State Board of Equalization between 1980 and 1992 were used to estimate a time-series model, adjusted for seasonal variations and time trends. Results. The estimated results show that sales of cigarettes were reduced by 819 million packs from the third quarter of 1990 through the fourth quarter of 1992 owing to an additional 25-cent state tax increase, while the anti-smoking media campaign reduced the cigarette sales by 232 million packs during the same period. Conclusions. Both taxation and anti- smoking media campaigns are effective means of reducing cigarette consumption. The strength of those effects, however, is influenced by the magnitude of the taxes and the amount of media campaign expenditures. Handle: RePEc:aph:ajpbhl:1995:85:9:1218-1222_0 Template-Type: ReDIF-Article 1.0 Title: The effect of passenger load on unstable vehicles in fatal, untripped rollover crashes Journal: American Journal of Public Health Author-Name: Whitfield, R.A. Author-Name: Jones, I.S. Year: 1995 Volume: 85 Issue: 9 Pages: 1268-1271 Abstract: Consumers may be unaware of the risk of rollover crashes posed by passenger loads in vehicles with poor roll stability. This analysis demonstrates that certain sports utility vehicles and small pickup trucks have designs that are so unstable that the weight of the passengers in the vehicle affects its propensity to roll over. This effect occurs even though the weight of the loaded vehicle is less than the manufacturer's gross vehicle weight rating. The risk of a fatal, 'untripped' rollover crash in vehicles with low roll stability is increased as each passenger is added to the vehicle load. Handle: RePEc:aph:ajpbhl:1995:85:9:1268-1271_5 Template-Type: ReDIF-Article 1.0 Title: Access to neonatal intensive care for low-birthweight infants: The role of maternal characteristics Journal: American Journal of Public Health Author-Name: Bronstein, J.M. Author-Name: Capilouto, E. Author-Name: Carlo, W.A. Author-Name: Haywood, J.L. Author-Name: Goldenberg, R.L. Year: 1995 Volume: 85 Issue: 3 Pages: 357-361 Abstract: Objectives. This study assessed the impact of mother's race, insurance status, and use of prenatal care on very low birthweight infant delivery in or transfer to hospitals with neonatal intensive care units (ICUs). Methods. Multivariate analysis of Alabama vital statistics records between 1988 and 1990 for infants weighing 500 to 1499 g was conducted, comparing hospital of birth and maternal and infant transfer status, and controlling for infant birthweight and for maternal pregnancy history and demographic characteristics. Results. With other factors adjusted for, non-White mothers with early prenatal care were more likely than White mothers to deliver their very low birthweight infants in hospitals with neonatal ICUs without transfer. Among the mothers who presented first at hospitals without such facilities, those who had late prenatal care were less likely than those with early care to be transferred to hospitals with neonatal ICUs before delivery. Medicaid coverage increased the likelihood of antenatal transfer for White women. Likelihood of infant transfer was not associated with these maternal characteristics. Conclusions. Maternal race, prenatal care use, and insurance status may influence the likelihood that very low birthweight infants will have access to neonatal intensive care. Interventions to improve perinatal regionalization should address individual and system barriers to the timely referral of high-risk mothers. Handle: RePEc:aph:ajpbhl:1995:85:3:357-361_3 Template-Type: ReDIF-Article 1.0 Title: Obstetrical judgments of viability and perinatal survival of extremely low birthweight infants Journal: American Journal of Public Health Author-Name: Reuss, M.L. Author-Name: Gordon, H.R. Year: 1995 Volume: 85 Issue: 3 Pages: 362-366 Abstract: Objectives. The purpose of the study was to determine whether the obstetrical judgment of viability makes a difference to fetal and neonatal survival of extremely low birthweight infants (500-749 g). Methods. We assessed the effect of the antenatal judgment of viability in a group of 66 infants born weighing from 500 to 749 g. These infants were alive at maternal hospital admission and were subsequently live-born or stillborn between January 1, 1984, and December 31, 1985. We related the antepartum assessment of viability and other factors recorded in the medical record to fetal survival and to postneonatal survival to hospital discharge. Results. The obstetrical judgment of viability was strongly associated with outcome. After birthweight and gestational age were controlled, fetuses considered viable were 18 times more likely to survive (95% confidence interval = 2, 175) than those considered nonviable. Conclusions. The effects of obstetrical practices on perinatal mortality must be taken into consideration in estimating the survival potential of very small fetuses and in evaluating the relationship between survival and disability. Handle: RePEc:aph:ajpbhl:1995:85:3:362-366_6 Template-Type: ReDIF-Article 1.0 Title: Women dieters of normal weight: Their motives, goals, and risks Journal: American Journal of Public Health Author-Name: Biener, L. Author-Name: Heaton, A. Year: 1995 Volume: 85 Issue: 5 Pages: 714-717 Abstract: Using data from a national survey of weight loss practices; this study examined those dieters who were of normal weight. Forty-seven percent of White women, 25% of Black women, and 16% of men currently trying to lose weight had a body mass index under 25. Women's primary motive was health improvement. Among normal-weight female dieters, 12% of Whites and 27% of Blacks were using risky strategies. Dieters were less likely than nondieters to smoke and reported better nutritional practices; however, they were not more likely to exercise; and their maximum weight fluctuation was 50% greater. Additional research on the consequences of dieting among normal- weight individuals is of high priority. Handle: RePEc:aph:ajpbhl:1995:85:5:714-717_5 Template-Type: ReDIF-Article 1.0 Title: Changes in adult cigarette smoking in the Minnesota Heart Health Program Journal: American Journal of Public Health Author-Name: Lando, H.A. Author-Name: Pechacek, T.F. Author-Name: Pirie, P.L. Author-Name: Murray, D.M. Author-Name: Mittelmark, M.B. Author-Name: Lichtenstein, E. Author-Name: Nothwehr, F. Author-Name: Gray, C. Year: 1995 Volume: 85 Issue: 2 Pages: 201-208 Abstract: Objectives. The Minnesota Heart Health Program was a research and demonstration project designed to reduce risk factors for heart disease in whole communities. This paper describes smoking-specific interventions and outcomes. Methods. Three pairs of matched communities were included in the study. After baseline surveys, one community in each pair received a 5-year education program, while both cross-sectional and cohort surveys continued in all sites. Adult education programs for smoking cessation included Quit and Win contests, classes, self-help materials, telephone support, and home correspondence programs. Results. Encouraging short-term results were obtained for several adult education programs. Overall long-term outcomes were mixed, with evidence of an intervention effect only for women in cross- sectional survey data. Unexpectedly strong secular declines in smoking prevalence were observed in comparison communities. Conclusions. The findings suggest that community education may be unlikely to exceed dramatic secular reductions in smoking prevalence. The success of several key interventions and the incorporation of Minnesota Heart Health Program interventions by education communities are encouraging, however. Handle: RePEc:aph:ajpbhl:1995:85:2:201-208_4 Template-Type: ReDIF-Article 1.0 Title: Using ICD-9 codes to identify indications for primary and repeat cesarean sections: Agreement with clinical records Journal: American Journal of Public Health Author-Name: Henry, O.A. Author-Name: Gregory, K.D. Author-Name: Hobel, C.J. Author-Name: Platt, L.D. Year: 1995 Volume: 85 Issue: 8 Pages: 1143-1146 Abstract: Aggregate databases arc increasingly being used to evaluate appropriateness of care, and, for cesarean sections, Anderson and Lomas' International Classification of Diseases, 9th Revision (ICD-9), coding hierarchy is a widely used tool. The aim of this study was to assess the validity of the hierarchy and expand its applicability to repeat cesareans. Hospital records of 1885 singleton cesareans were reviewed. Clinical indications and ICD-9 hierarchical codes were concordant for 83% of primary and 86% of repeat cesareans; modification allowed elective repeat cesareans to be distinguished from indicated procedures. The Anderson and Lomas ICD-9 hierarchy is a valid tool for assessing indications for cesarean. The current modification improves its clinical utility and expands its application to repeat procedures. Handle: RePEc:aph:ajpbhl:1995:85:8:1143-1146_5 Template-Type: ReDIF-Article 1.0 Title: The association between leisure-time physical activity and dietary fat in American adults Journal: American Journal of Public Health Author-Name: Simoes, E.J. Author-Name: Byers, T. Author-Name: Coates, R.J. Author-Name: Serdula, M.K. Author-Name: Mokdad, A.H. Author-Name: Heath, G.W. Year: 1995 Volume: 85 Issue: 2 Pages: 240-244 Abstract: Relations between leisure-time physical activity and dietary fat were examined in a population-based probability sample of 29 672 adults in the 1990 Behavioral Risk Factor Surveillance System. Consumption of 13 high-fat food items and participation in physical activities were measured, and fat and activity scores were calculated. Dietary fat and physical activity were strongly and inversely associated. This association was independent of nine other demographic and behavioral risk factors. Etiologic researchers should consider that diet and physical activity can potentially confound each other, and creators of public health messages that target one behavior should consider including the other. Handle: RePEc:aph:ajpbhl:1995:85:2:240-244_5 Template-Type: ReDIF-Article 1.0 Title: Risk factors for HIV-1 seroconversion among injection drug users: A case- control study Journal: American Journal of Public Health Author-Name: Chitwood, D.D. Author-Name: Griffin, D.K. Author-Name: Comerford, M. Author-Name: Page, J.B. Author-Name: Trapido, E.J. Author-Name: Lai, S. Author-Name: McCoy, C.B. Year: 1995 Volume: 85 Issue: 11 Pages: 1538-1542 Abstract: Objectives. A nested case-control study was conducted in Miami, Fla, to determine risk factors associated with human immunodeficiency virus type 1 (HIV-1) seroconversion among injection drug users. Methods. The study identified 21 incident cases of HIV-1 infection and 76 unmatched controls from two longitudinal cohorts of injection drug users. One cohort consisted of individuals who originally had been recruited from treatment centers; a second cohort was recruited from the 'street.' Logistic regression analyses that adjusted for age, gender, and race were performed. Results. The final model determined that the primary independent risk factor that best explained the risk for seroconversion was sharing injection equipment in the year prior to conversion; a marginal risk factor was presence of sexually transmitted disease during this same period. Conclusions. Both an injection component and a sexual component play a role in seroconversion among injection drug users, although the injection component is much stronger. Handle: RePEc:aph:ajpbhl:1995:85:11:1538-1542_8 Template-Type: ReDIF-Article 1.0 Title: Risk factors for HIV and other sexually transmitted diseases and prevention practices among US heterosexual adults: Changes from 1990 to 1992 Journal: American Journal of Public Health Author-Name: Catania, J.A. Author-Name: Binson, D. Author-Name: Dolcini, M.M. Author-Name: Stall, R. Author-Name: Choi, K.-H. Author-Name: Pollack, L.M. Author-Name: Hudes, E.S. Author-Name: Canchola, J. Author-Name: Phillips, K. Author-Name: Moskowitz, J.T. Author-Name: Coates, T.J. Year: 1995 Volume: 85 Issue: 11 Pages: 1492-1499 Abstract: Objectives. The National AIDS Behavioral Survey (1990-1992) of heterosexual adults (18-49 years) measured human immunodeficiency virus (HIV) risk factors, condom use, and HIV antibody testing, with a focus on major 'high-risk' cities. Methods. A longitudinal survey was conducted. Results. There was little reduction in the overall prevalence of HIV risk factors in the national or high-risk cities cohorts over time. Despite this picture of stability, approximately 39% of the population at risk for HIV because of multiple sexual partners turns over annually. There was little change in HIV test-seeking or in consistent condom use with primary sexual partners. Although the majority of at-risk respondents used condoms sporadically or not at all (65%), a significant increase in condom use was found among those reporting multiple sexual partners in both waves, particularly among Black heterosexuals. Data from other surveys and condom sales nationally support the findings. Conclusions. There is a need for a series of surveys in this area to assess the reliability of the present findings and to monitor the general US population's response to prevention programs. Handle: RePEc:aph:ajpbhl:1995:85:11:1492-1499_9 Template-Type: ReDIF-Article 1.0 Title: Reducing the risk of HIV infection among South African sex workers: Socioeconomic and gender barriers Journal: American Journal of Public Health Author-Name: Karim, Q.A. Author-Name: Karim, S.S.A. Author-Name: Soldan, K. Author-Name: Zondi, M. Year: 1995 Volume: 85 Issue: 11 Pages: 1521-1525 Abstract: Objectives. The social context within which women engaged in sex work at a popular truck stop in South Africa are placed at risk of human immunodeficiency virus (HIV) infection and the factors that influence their ability to reduce their risk were assessed. Methods. Using qualitative and quantitative techniques, an elected sex worker from within the group collected all data. Results. Given the various pressing needs for basic survival, the risk of HIV infection is viewed as one more burden imposed on these women by their lack of social, legal, and economic power. Violence, or the threat thereof, plays an important role in their disempowerment. In the few instances in which sex workers were able to insist on condom use, it resulted in a decrease in earnings, loss of clients, and physical abuse. Conclusions. Recommendations to reduce the sex workers' risk for HIV infection include negotiation and communication skills to enable them to persuade their clients to use condoms; development of strategies through which they can maximally use their group strength to facilitate unified action; and accessibility of protective methods they can use and control, such as intravaginal microbicides. Handle: RePEc:aph:ajpbhl:1995:85:11:1521-1525_0 Template-Type: ReDIF-Article 1.0 Title: The administrative prevalence of mental retardation in 10-year-old children in metropolitan Atlanta, 1985 through 1987 Journal: American Journal of Public Health Author-Name: Murphy, C.C. Author-Name: Yeargin-Allsopp, M. Author-Name: Decoufle, P. Author-Name: Drews, C.D. Year: 1995 Volume: 85 Issue: 3 Pages: 319-323 Abstract: Objectives. In this study, data from the Metropolitan Atlanta Developmental Disabilities Study were used to determine the administrative prevalence (i.e., the number of children previously identified for service provision) of mental retardation among 10-year-old children during the years 1985 through 1987. Methods. Children with mental retardation (intelligence quotient [IQ] of 70 or lower) were identified by review of records from multiple sources, with the public schools as the primary source. Results. The overall administrative prevalence of mental retardation was 12.0 per 1000 children. The rate for mild mental retardation (IQ of 50 to 70) was 8.4 per 1000 and the rate for severe mental retardation (IQ lower than 50) was 3.6 per 1000. The prevalence was higher in Black children than in White children (prevalence odds ratio [POR] = 2.7) and in boys than in girls (POR = 1.4). Children with severe mental retardation had more coexisting disabilities than did children with mild mental retardation. Conclusions. The mental retardation prevalence rates reported here, especially the race-specific rates, may reflect social and demographic features unique to the metropolitan Atlanta area and therefore should be used with caution in making comparisons with other populations. Handle: RePEc:aph:ajpbhl:1995:85:3:319-323_5 Template-Type: ReDIF-Article 1.0 Title: A gender-specific measure of binge drinking among college students Journal: American Journal of Public Health Author-Name: Wechsler, H. Author-Name: Dowdall, G.W. Author-Name: Davenport, A. Author-Name: Rimm, E.B. Year: 1995 Volume: 85 Issue: 7 Pages: 982-985 Abstract: This study examined the relationship of volume of alcohol consumed to the occurrence of alcohol-related problems among male and female college students to develop a gender-specific measure of heavy episodic or binge drinking by college students for public health research. A self-administered survey was mailed to a national representative sample of students at 140 4-year colleges in 40 states and the District of Columbia. A total of 17592 college students completed the survey. Women who typically drink four drinks in a row were found to have roughly the same likelihood of experiencing drinking-related problems as men who typically drink five drinks in a row. Use of the same standard for both sexes underestimates binge drinking and the negative health risks for women. Handle: RePEc:aph:ajpbhl:1995:85:7:982-985_3 Template-Type: ReDIF-Article 1.0 Title: Environmental risk factors for Lyme disease identified with geographic information systems Journal: American Journal of Public Health Author-Name: Glass, G.E. Author-Name: Schwartz, B.S. Author-Name: Morgan III, J.M. Author-Name: Johnson, D.T. Author-Name: Noy, P.M. Author-Name: Israel, E. Year: 1995 Volume: 85 Issue: 7 Pages: 944-948 Abstract: Objectives. A geographic information system was used to identify and locate residential environmental risk factors for Lyme disease. Methods. Data were obtained for 53 environmental variables at the residences of Lyme disease case patients in Baltimore County from 1989 through 1990 and compared with data for randomly selected addresses. A risk model was generated combining the geographic information system with logistic regression analysis. The model was validated by comparing the distribution of cases in 1991 with another group of randomly selected addresses. Results. In crude analyses, 11 environmental variables were associated with Lyme disease. In adjusted analyses, residence in forested areas (odds ratio [OR] = 3.7, 95% confidence interval [CI] = 1.2, 11.8), on specific soils (OR = 2.1, 95% CI = 1.0, 4.4), and in two regions of the county (OR = 3.5, 95% CI = 1.6, 7.4) (OR = 2.8, 95% CI = 1.0, 7.7) was associated with elevated risk of getting Lyme disease. Residence in highly developed regions was protective (OR = 0.3, 95% CI = 0.1, 1.0). The risk of Lyme disease in 1991 increased with risk categories defined from the 1989 through 1990 data. Conclusions. Combining a geographic information system with epidemiologic methods can be used to rapidly identify risk factors of zoonotic disease over large areas. Handle: RePEc:aph:ajpbhl:1995:85:7:944-948_6 Template-Type: ReDIF-Article 1.0 Title: Dietary intake among Mexican-American women: Generational differences and a comparison with White non-Hispanic women Journal: American Journal of Public Health Author-Name: Guendelman, S. Author-Name: Abrams, B. Year: 1995 Volume: 85 Issue: 1 Pages: 20-25 Abstract: Objectives. Although Mexican Americans consume diets that may protect them against adverse health, dietary advantages may disappear with increased acculturation. This study examined whether the nutrient intake of second- generation Mexican-American women of childbearing age deteriorates compared with that of first-generation Mexican-American women and approximates that of White non-Hispanic women. Methods. Data on the absolute and relative intake of eight nutrients were obtained from a 24-hour recall and compared among 475 first-generation and 898 second-generation Mexican-American women, and among 2326 White non-Hispanic women. Results. Although first-generation Mexican- American women were of lower socioeconomic status than were second-generation or White non-Hispanic women, they had a higher average intake of protein; vitamins A, C, and folic acid; and calcium than the other two groups. Whereas the mean adequacy ratio of the eight nutrients studied was highest in first- generation Mexican women, it was lowest in their second-generation counterparts. Conclusions. First-generation Mexican women stand a markedly lower risk of eating a poor diet than second-generation Mexican women, whose nutrient intake resembles that of White non-Hispanic women. Handle: RePEc:aph:ajpbhl:1995:85:1:20-25_3 Template-Type: ReDIF-Article 1.0 Title: Risk factors for homelessness among women with schizophrenia Journal: American Journal of Public Health Author-Name: Caton, C.L.M. Author-Name: Shrout, P.E. Author-Name: Dominguez, B. Author-Name: Eagle, P.F. Author-Name: Opler, L.A. Author-Name: Cournos, F. Year: 1995 Volume: 85 Issue: 8 Pages: 1153-1156 Abstract: A study of risk factors for homelessness among the severely mentally ill was extended to include women, and a case-control study of 100 indigent women with schizophrenia meeting criteria for literal homelessness and 100 such women with no history of homelessness was conducted. Subjects were recruited from shelters, clinics, and inpatient psychiatric programs in New York City. Clinical interviewers used standardized research instruments to probe three domains of risk factors: severity of mental illness, family background, and prior mental health service use. Findings adjusted for ethnicity revealed that homeless women had higher rates of a concurrent diagnosis of alcohol abuse, drug abuse, and antisocial personality disorder. Homeless women also had less adequate family support. Handle: RePEc:aph:ajpbhl:1995:85:8:1153-1156_0 Template-Type: ReDIF-Article 1.0 Title: Epidemiology and quantitative risk assessment: A bridge from science to policy Journal: American Journal of Public Health Author-Name: Hertz-Picciotto, I. Author-Name: Wartenberg, D. Author-Name: Simon, R. Year: 1995 Volume: 85 Issue: 4 Pages: 484-493 Abstract: Quantitative risk assessment provides formalized scientific input to regulatory agencies that set occupational and environmental standards for potentially toxic exposures. Current practice relies heavily on statistical extrapolation from high-dose animal studies. Human data obviate the need for interspecies extrapolation and reduce the range of high-to-low dose extrapolation. This paper proposes a framework for classifying individual epidemiologic studies as to their adequacy for use in dose-response extrapolation. The framework considers five criteria: (1) a stable positive association with an adverse health outcome; (2) high overall study quality; (3) no substantial confounding; (4) quantitative exposure assessment for individuals; (5) evidence of a dose-response relationship. With these criteria, studies can he categorized as (1) suitable to serve as a basis for extrapolation; (2) inadequate to he the basis for direct extrapolation but appropriate to use for evaluating the plausibility of animal-derived risk estimates; or (3) useful only for hazard identification, not for dose- response assessment. Methods for using studies in the first two categories are briefly described. The emphasis is not on establishing rigid rules, but rather on ensuring a consistent, reliable process that makes optimum use of available data. Handle: RePEc:aph:ajpbhl:1995:85:4:484-493_8 Template-Type: ReDIF-Article 1.0 Title: World War II-veteran male twins who are discordant for alcohol consumption: 24-year mortality Journal: American Journal of Public Health Author-Name: Carmelli, D. Author-Name: Swan, G.E. Author-Name: Page, W.F. Author-Name: Christian, J.C. Year: 1995 Volume: 85 Issue: 1 Pages: 99-101 Abstract: The role of genetic and shared environmental influences in the association of alcohol with mortality was studied by using the National Academy of Sciences-National Research Council World War II - veteran male twin registry. An epidemiologic questionnaire administered from 1967 through 1969 permitted identification of twin pairs discordant for alcohol consumption. The subsequent 24 years of mortality follow-up yielded data on time and cause of death. Analyzing the first or only death in drinking-discordant pairs, we observed 27 deaths in abstainer twins and 14 deaths in their light- to moderate-drinker cotwins (relative risk [RR] = 1.93). Excess mortality in twin abstainers was also indicated for deaths from cardiovascular diseases (RR = 2.0) and other causes of death excluding cancers (RR = 3.2). The protective effect, however, of light to moderate drinking did not persist in twins who were smokers at baseline. Handle: RePEc:aph:ajpbhl:1995:85:1:99-101_3 Template-Type: ReDIF-Article 1.0 Title: Erratum: Breast and cervical cancer screening in a low-income managed care sample: The efficacy of physician letters and phone calls (American Journal of Public Health (1995) 85 (834-836)) Journal: American Journal of Public Health Author-Name: Lantz, P.M. Author-Name: Stencil, D. Author-Name: Lippert, M.T. Author-Name: Beversdorf, S. Author-Name: Jaros, L. Author-Name: Remington, P.L. Year: 1995 Volume: 85 Issue: 8 Pages: 1063 Handle: RePEc:aph:ajpbhl:1995:85:8:1063_8 Template-Type: ReDIF-Article 1.0 Title: The risk of assaultive violence and alcohol availability in Los Angeles county Journal: American Journal of Public Health Author-Name: Scribner, R.A. Author-Name: MacKinnon, D.P. Author-Name: Dwyer, J.H. Year: 1995 Volume: 85 Issue: 3 Pages: 335-340 Abstract: Objectives. Although there is considerable evidence that alcohol consumption facilitates assaultive violence, the extent to which alcohol outlets in a community influence assaultive violence remains controversial. Methods. To assess the geographic association between city-specific rates of assaultive violence and alcohol-outlet density, an ecologic analysis of the 74 larger cities in Los Angeles County was conducted for the 1990 reporting year. Results. Sociodemographic factors alone accounted for 70% (R2 = .70) of the variance in the rate of assaultive violence in a multiple regression model. Adding the variable for alcohol-outlet density to the model yielded a significant positive slope. The magnitude of this relation indicates that in a typical Los Angeles County city (50 000 residents, 100 outlets, 570 offenses per year), one outlet was associated with 3.4 additional assaultive violence offenses in 1990. Conclusions. These findings indicate that higher levels of alcohol-outlet density are geographically associated with higher rates of assaultive violence. This association is independent of measured confounders, including city-level measures of unemployment, ethnic/racial makeup, income, age structure, city size, household size, and female-headed households. Handle: RePEc:aph:ajpbhl:1995:85:3:335-340_1 Template-Type: ReDIF-Article 1.0 Title: The effect of US children's access to care on medical attention for injuries Journal: American Journal of Public Health Author-Name: Overpeck, M.D. Author-Name: Kotch, J.B. Year: 1995 Volume: 85 Issue: 3 Pages: 402-404 Abstract: This analysis examined the effect of access to care on nonfatal medically attended injury rates for US children in 1988. Rates of medically attended injury were about the same for children with health insurance and Medicaid, after adjustment for other characteristics. However, lack of medical care coverage (health insurance or Medicaid) had the effect of decreasing the rates of both total and serious medically attended injury compared with the rates for children with coverage. For children without coverage, as many as 30% of total injuries and 40% of serious injuries may not have been attended in 1988. Handle: RePEc:aph:ajpbhl:1995:85:3:402-404_7 Template-Type: ReDIF-Article 1.0 Title: Daylight saving time and motor vehicle crashes: The reduction in pedestrian and vehicle occupant fatalities Journal: American Journal of Public Health Author-Name: Ferguson, S.A. Author-Name: Preusser, D.F. Author-Name: Lund, A.K. Author-Name: Zador, P.L. Author-Name: Ulmer, R.G. Year: 1995 Volume: 85 Issue: 1 Pages: 92-96 Abstract: Fatal crashes were tabulated for 6-hour periods around sunrise and sunset, from 13 weeks before the fall change to standard time until 9 weeks after the spring change to daylight saving time. Fatal-crash occurrence was related to changes in daylight, whether these changes occurred abruptly with the fall and spring time changes or gradually with the changing seasons of the year. During daylight saving time, which shifts an hour of daylight to the busier evening traffic hours, there were fewer fatal crashes. An estimated 901 fewer fatal crashes (727 involving pedestrians, 174 involving vehicle occupants) might have occurred if daylight saving time had been retained year-round from 1987 through 1991. Handle: RePEc:aph:ajpbhl:1995:85:1:92-96_4 Template-Type: ReDIF-Article 1.0 Title: The feasibility and desirability of public health credentialing: A survey of public health leaders Journal: American Journal of Public Health Author-Name: Livingood Jr., W.C. Author-Name: Woodhouse, L.D. Author-Name: Godin, S.W. Year: 1995 Volume: 85 Issue: 6 Pages: 765-770 Abstract: Objectives. The goal of this study was to provide insight concerning the potential of credentialing public health workers through an exploratory examination of public health leaders' perceptions. Methods. Qualitative and quantitative procedures were used. Credentialing issues were identified through the literature and through open-ended interviews with leaden and experts. A 74-item Likert-type survey was used to quantify perceptions. Key informants and survey participants were identified through pertinent organizations. Results. The public health leaders leaned toward consensus on some benefits of and concerns about credentialing. There was no consensus related to a specific form of desired credentialing, although national certification was supported by a plurality. State licensing and an emphasis on the master's in public health (MPH) degree were opposed by large margins. Public health leadership survey results were similar to results of a survey of credentialing experts. Conclusions. The lack of consensus and the vehemence of some opposing positions indicate that movements toward credentialing should proceed cautiously. However, many of the response patterns indicate that the issue merits further exploration. Handle: RePEc:aph:ajpbhl:1995:85:6:765-770_3 Template-Type: ReDIF-Article 1.0 Title: Hormonal replacement therapy and morbidity and mortality in a prospective study of postmenopausal women Journal: American Journal of Public Health Author-Name: Folsom, A.R. Author-Name: Mink, P.J. Author-Name: Sellers, T.A. Author-Name: Hong, C.-P. Author-Name: Zheng, W. Author-Name: Potter, J.D. Year: 1995 Volume: 85 Issue: 8 Pages: 1128-1132 Abstract: We assessed the association of hormonal replacement therapy with mortality and incidence of multiple diseases in over 40 000 postmenopausal women followed for 6 years as part of the Iowa Women's Health Study. Compared with women who never used hormone replacement therapy, current users had multivariate adjusted relative risks (RR) as follows: total mortality (RR = 0.78; 95% confidence interval [CI] = 0.65, 0.94), coronary heart disease mortality (RR = 0.74; 95% CI = 0.48, 1.12), endometrial cancer incidence (RR = 4.3; 95% CI = 2.7, 6.9), breast cancer incidence (RR = 1.23; 95% CI = 0.99, 1.55), colon cancer incidence (RR = 0.72; 95% CI = 0.46, 1.12), and hip fracture incidence (RR = 0.53; 95% CI = 0.31, 0.91). Handle: RePEc:aph:ajpbhl:1995:85:8:1128-1132_1 Template-Type: ReDIF-Article 1.0 Title: Combatting iodine deficiency: The iodization of water in the Central African Republic [1] Journal: American Journal of Public Health Author-Name: Yazipo, D. Author-Name: Ngaindiro, L.F. Author-Name: Namboua, L. Author-Name: Ndoyo, J. Author-Name: Pichard, E. Author-Name: Barriere- Constantin, L. Author-Name: Bourdoux, P. Year: 1995 Volume: 85 Issue: 5 Pages: 732 Handle: RePEc:aph:ajpbhl:1995:85:5:732_9 Template-Type: ReDIF-Article 1.0 Title: HIV-1 seroconversion and risk behaviors among young men in the US army Journal: American Journal of Public Health Author-Name: Levin, L.I. Author-Name: Peterman, T.A. Author-Name: Renzullo, P.O. Author-Name: Lasley-Bibbs, V. Author-Name: Shu, X.-O. Author-Name: Brundage, J.F. Author-Name: McNeil, J.G. Year: 1995 Volume: 85 Issue: 11 Pages: 1500-1506 Abstract: Objectives. This study sought to examine risk factors associated with human immunodeficiency virus type 1 (HIV-1) seroconversion among active-duty men in the US Army. Methods. One hundred twenty-eight men with documented HIV-1 seroconversion between 1988 and 1991 were matched to control subjects on demographic variables. Risk factor information was collected for the seroconversion period. Results. Forty-nine case subjects and no control subjects reported same-gender sex; this includes 34 case subjects who also reported sex with women. Seventy case and 118 control subjects reported no risk factors other than heterosexual intercourse. Among heterosexuals, excess risk was noted for men who had sex with women in risk categories defined by the Centers for Disease Control and Prevention (odds ratio = 10.0; 95% confidence interval = 1.3, 78.1). Significant trends of increasing risk for seroconversion were found with increasing numbers of female partners, nonsteady partners, and partners with whom sex occurred on the first day of acquaintance. Conclusions. In this population, the major risk factor for HIV- 1 seroconversion was same-gender sex. Among heterosexuals, sex with anonymous or casual partners increased this risk. Intervention programs should emphasize the risk of indiscriminate partner selection in addition to 'safe sex' practices. Handle: RePEc:aph:ajpbhl:1995:85:11:1500-1506_6 Template-Type: ReDIF-Article 1.0 Title: The reliability of cigarette consumption reports by spousal proxies. Journal: American Journal of Public Health Author-Name: Chen, Y. Author-Name: Rennie, D.C. Author-Name: Dosman, J.A. Year: 1995 Volume: 85 Issue: 12 Pages: 1711-1712 DOI: 10.2105/AJPH.85.12.1711 File-URL: http://hdl.handle.net/10.2105/AJPH.85.12.1711 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.85.12.1711_4 Template-Type: ReDIF-Article 1.0 Title: Is public health credentialing necessary? Journal: American Journal of Public Health Author-Name: Carpenter, E.S. Year: 1995 Volume: 85 Issue: 12 Pages: 1712-1713 DOI: 10.2105/AJPH.85.12.1712 File-URL: http://hdl.handle.net/10.2105/AJPH.85.12.1712 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.85.12.1712_7 Template-Type: ReDIF-Article 1.0 Title: The estimated frequency of cosmetic breast augmentation among US women, 1963 through 1988 Journal: American Journal of Public Health Author-Name: Terry, M.B. Author-Name: Skovron, M.L. Author-Name: Garbers, S. Author-Name: Sonnenschein, E. Author-Name: Toniolo, P. Year: 1995 Volume: 85 Issue: 8 Pages: 1122-1124 Abstract: Estimates ranging from 1 to 2 million have been used to describe the number of women in the United States who have had cosmetic breast implants. Original data from a historical cohort study of women with breast augmentation were combined with simulation techniques to compute new estimates grounded on a more objective set of information and assumptions than previous attempts. It was estimated that the number of women who had cosmetic augmentation mammoplasty between 1963 and 1988 was 894 206 (range = 437 602 to 2 035 783). The number of women ever treated with cosmetic augmentation mammoplasty may be substantially smaller than previously reported. Handle: RePEc:aph:ajpbhl:1995:85:8:1122-1124_8 Template-Type: ReDIF-Article 1.0 Title: Tobacco industry smokers' rights publications: A content analysis Journal: American Journal of Public Health Author-Name: Cardador, M.T. Author-Name: Hazan, A.R. Author-Name: Glantz, S.A. Year: 1995 Volume: 85 Issue: 9 Pages: 1212-1217 Abstract: Objectives. This study was undertaken to identify the content of tobacco industry smokers' rights publications and to analyze their major themes. Methods. Fifty-eight issues of smokers' rights publications from 1987 to 1992 were selected at random and analyzed. The number of publications per year, number of mentions (sentences) in different thematic categories per year, and number of mentions per category per publication were examined. Results. The number of smokers' rights publications increased rapidly from 1987 to 1992. The number of mentions across all thematic categories increased over time, with the largest numbers appearing in 1990, 1991, and 1992. The category of Political and Social Action comprised the highest average number of mentions across years. Conclusions. These publications appear to be consistent with past and present tobacco industry strategies to counter tobacco control efforts and negative public perceptions by attempting to refute scientific evidence about the health impact of environmental tobacco smoke. Additionally, they serve the industry goals of encouraging smokers to take action to protect their rights, mobilizing public opinion, and delaying societal rejection of smoking and secondhand smoke and acceptance of smoking restrictions. Handle: RePEc:aph:ajpbhl:1995:85:9:1212-1217_5 Template-Type: ReDIF-Article 1.0 Title: Redefining the goals of national drug policy: Recommendations from a working group Journal: American Journal of Public Health Author-Name: Reuter, P. Author-Name: Caulkins, J.P. Year: 1995 Volume: 85 Issue: 8 Pages: 1059-1063 Abstract: This paper discusses what the goals of national drug policy have been and suggests an alternative set of goals. The past emphasis on use reduction is found wanting. Total harm related to drugs can be viewed as the product of use and harm per use. Thus, reducing use usually serves to reduce harm. However, in some cases, use reduction programs may increase harm per use so much that they increase overall harm even as they succeed in reducing use. Hence, use reduction goals can be usefully augmented with the explicit objective of reducing the total harm created by the production, distribution, consumption, and control of drugs. Numerous programmatic recommendations flow from this approach. Handle: RePEc:aph:ajpbhl:1995:85:8:1059-1063_0 Template-Type: ReDIF-Article 1.0 Title: Erratum: The logic in ecological: I. the logic of analysis (American Journal of Public Health (1994) 84 (825-829)) Journal: American Journal of Public Health Author-Name: Susser, M. Year: 1995 Volume: 85 Issue: 8 Pages: 1063 Handle: RePEc:aph:ajpbhl:1995:85:8:1063_9 Template-Type: ReDIF-Article 1.0 Title: Attitudes and practices Journal: American Journal of Public Health Author-Name: Rosenblatt, R.A. Author-Name: Mattis, R. Author-Name: Hart, L.G. Year: 1995 Volume: 85 Issue: 10 Pages: 1423-1425 Abstract: This study surveyed all family physicians, obstetrician-gynecologists, and general surgeons practicing in rural Idaho in 1994. Although most respondents provided a wide range of reproductive health services, less than 4% performed abortions, so most rural Idaho women wanting abortions must travel long distances for this procedure. Physicians report that they do not provide abortion services because of both their own moral objections and local community opposition to the procedure. Yet 26% of the respondents indicated interest in using RU-486 for abortions when it becomes available. This suggests that the development of acceptable medical abortifacients may improve access to this procedure even in very conservative rural areas. Handle: RePEc:aph:ajpbhl:1995:85:10:1423-1425_2 Template-Type: ReDIF-Article 1.0 Title: Adolescents' perceptions of their peers' health norms Journal: American Journal of Public Health Author-Name: Evans, N. Author-Name: Gilpin, E. Author-Name: Farkas, A.J. Author-Name: Shenassa, E. Author-Name: Pierce, J.P. Year: 1995 Volume: 85 Issue: 8 Pages: 1064-1069 Abstract: Objectives. The purpose of this study was to determine the relative importance adolescents place on preventive health behaviors. Methods. Data were from a survey of California adolescents (n = 5040). Respondents were asked how important it was to their peers to avoid drugs, marijuana, cigarettes, heavy drinking, and drinking and driving and to maintain seat belt use, fitness, weight control, and healthy eating habits. Results were compared with data from a similar national survey (n = 6126). Results. California teenagers perceived that their peers gave top priority to weight control: 85% of California teenagers believed that weight control was of high concern to girls in their age group. Avoiding drugs, not drinking and driving, and maintaining fitness ranked in the top five behaviors. The lowest ranked health behaviors were seat belt use, heavy drinking, and, last, eating healthily. In the national survey, healthy eating also ranked last. Although not identical in rank, teenage priorities for other health behaviors were consistent with the California results. Conclusion. Efforts are needed to bring adolescent health norms more into line with the objective risks of their health choices during this critical period of socialization. Handle: RePEc:aph:ajpbhl:1995:85:8:1064-1069_6 Template-Type: ReDIF-Article 1.0 Title: State health care expenditures under competition and regulation, 1980 through 1991 Journal: American Journal of Public Health Author-Name: Melnick, G.A. Author-Name: Zwanziger, J. Year: 1995 Volume: 85 Issue: 10 Pages: 1391-1396 Abstract: Objectives. This paper examines health expenditure growth under two alternative policy approaches: competition-based managed care and state government rate regulation. Methods. Data are presented on cumulative growth in real per capita health expenditures between 1980 and 1991 so as to compare California, a state with a pro-competitive policy, with the US average and with four states with established regulation programs. Results. Real per capita expenditures for hospital services in the United States grew 54% between 1980 and 1991, while in California the growth was half the national rate, or 27%. Real per capita expenditures for physician services and drug expenditures in the United States grew by 82% and 65%, respectively, while in California these expenditures increased only 58% and 41%, respectively. California's growth rate was below that of all four regulatory states for all measures of health care cost inflation. Conclusions. On the basis of these findings, a properly structured competitive approach could play a significant role in controlling health expenditures in the United States. Handle: RePEc:aph:ajpbhl:1995:85:10:1391-1396_2 Template-Type: ReDIF-Article 1.0 Title: The rapid implementation of a statewide emergency health information system during the 1993 Iowa flood Journal: American Journal of Public Health Author-Name: O'Carroll, P.W. Author-Name: Friede, A. Author-Name: Noji, E.K. Author-Name: Lillibridge, S.R. Author-Name: Fries, D.J. Author-Name: Atchison, C.G. Year: 1995 Volume: 85 Issue: 4 Pages: 564-567 Abstract: In the face of disastrous flooding, the Iowa Department of Public Health established the statewide Emergency Computer Communications Network to establish rapid electronic reporting of disaster-related health data, provide e-mail communications among all county health departments, monitor the long- range public health effects of the disaster, and institute a general purpose public health information system in Iowa. Based on software (CDC WONDER/PC) provided by the Centers for Disease Control and Prevention and using standard personal computers and moderns, this system has resulted in a 10- to 20-fold increase in surveillance efficiency at the health department, not including time saved by county network participants. It provides a critical disaster assessment capability to the health department but also facilitates the general practice of public health. Handle: RePEc:aph:ajpbhl:1995:85:4:564-567_0 Template-Type: ReDIF-Article 1.0 Title: Home hazards and falls in the elderly: The role of health and functional status Journal: American Journal of Public Health Author-Name: Northridge, M.E. Author-Name: Nevitt, M.C. Author-Name: Kelsey, J.L. Author-Name: Link, B. Year: 1995 Volume: 85 Issue: 4 Pages: 509-515 Abstract: Objectives. This study was undertaken to determine whether vigorous and frail older people who identify environmental hazards in their homes have an increased risk for falls. Methods. A 1-year prospective study was conducted among 266 female and 59 male community-dwelling volunteers aged 60 to 93 years who had fallen at least once during the previous year. Composite measures of home safety and of frailty were derived using principal components analysis. Participants were divided into vigorous and frail groups, and associations between baseline home safety measures and falls at home over the follow-up year were compared between the two groups. Results. Frail individuals were more than twice as likely as vigorous individuals to fall during follow-up (rate ratio [RR] = 2.24; 95% confidence interval [CI] = 1.54, 3.27). In the study group as a whole, falls were not strongly associated with the presence of home hazards. However, when compared with vigorous older persons living with fewer home hazards, vigorous older persons living with more home hazards were more likely to fall. The increased risk for falls among vigorous elderly was limited to falls where home hazards were present. By contrast, living with more home hazards was not associated with increased likelihood of falls among frail older persons. Conclusions. While frail older persons experience higher overall fall rates, vigorous older persons should not be overlooked in fall prevention projects. Handle: RePEc:aph:ajpbhl:1995:85:4:509-515_6 Template-Type: ReDIF-Article 1.0 Title: Editorial: The timing of high-dose vitamin A supplementation to children Journal: American Journal of Public Health Author-Name: Underwood, B.A. Year: 1995 Volume: 85 Issue: 9 Pages: 1200-1201 Handle: RePEc:aph:ajpbhl:1995:85:9:1200-1201_6 Template-Type: ReDIF-Article 1.0 Title: Reducing postneonatal mortality in West Virginia: A statewide intervention program targeting risk identified at and after birth Journal: American Journal of Public Health Author-Name: Myerberg, D.Z. Author-Name: Carpenter, R.G. Author-Name: Myerberg, C.F. Author-Name: Britton, C.M. Author-Name: Bailey, C.W. Author-Name: Fink, B.E. Year: 1995 Volume: 85 Issue: 5 Pages: 631-637 Abstract: Objectives. Excessive postneonatal mortality in West Virginia has been associated with inadequate health care. This paper describes two interventions aimed at those infants at greatest risk of dying. Methods. Two systems of risk-related intervention were simultaneously introduced and funded statewide from 1985 through 1987. Risk status was determined by a multifactorial score at birth or clinical risk factors later. At-risk infants were linked with physicians who provided specified care plans. All infants were followed for 1 year for mortality. Results. Of 4570 infants with a high Sheffield Birth Score, 45%, together with 1003 infants with clinical risk factors, received specified care plans. High-risk infants constituted 7.6% of total resident birth. Odds ratios for overall postneonatal mortality and sudden infant death syndrome in high-birth-score infants compared with low- birth-score fonts were 6.2 (95% confidence interval [CI] = 4.2, 9.3) and 11.2 (95% CI = 5.4, 23.2), respectively. The relative risks of postneonatal mortality were similarly significant for infants with most clinical risk factors. During the program there was a 21.4% reduction in the trend of yearly standardized mortality ratios, which differed markedly from the trend in surrounding states. The data suggest 33 lives were saved at a cost of $36 363 per infant. Conclusion. Ensuring affordable, available, accessible, and accept able care for a small group of at-risk infants was associated with a dramatic drop in overall postneonatal mortality in West Virginia. Handle: RePEc:aph:ajpbhl:1995:85:5:631-637_7 Template-Type: ReDIF-Article 1.0 Title: The relationship between physicians' qualifications and experience and the adequacy of prenatal care and low birthweight Journal: American Journal of Public Health Author-Name: Haas, J.S. Author-Name: Orav, E.J. Author-Name: Goldman, L. Year: 1995 Volume: 85 Issue: 8 Pages: 1087-1091 Abstract: Objectives. The purpose of this study was to examine the relationship between physicians' qualifications and experience and rates of completion of the recommended number of prenatal visits and delivery of a low-birthweight infant. Methods. All deliveries performed by a permanently licensed physician in Massachusetts in 1990 (n = 80 537) were examined. Qualification was measured by board certification. Experience was measured by both volume of deliveries and duration of practice. Results. Women cared for by a non- board-certified physician were less likely to receive the recommended number of prenatal visits (odds ratio [OR] = 0.67, 95% confidence interval [CI] = 0.54, 0.85) and were more likely to have a low-birthweight infant (OR = 1.20, 95% CI = 1.00, 1.42). Physicians with a smaller volume of deliveries or a shorter duration of practice were more likely to deliver a low-birthweight infant. Conclusions. The data show an association of board certification with rates of the recommended number of prenatal visits and low birthweight. In addition, volume and duration of practice were significantly associated with low birthweight. Further research should examine whether these associations are related to differences in patient referral or to physicians' judgment and efficiency in provision of prenatal care. Handle: RePEc:aph:ajpbhl:1995:85:8:1087-1091_9 Template-Type: ReDIF-Article 1.0 Title: Workplace assaults on minority health and mental health care workers in Los Angeles Journal: American Journal of Public Health Author-Name: Sullivan, C. Author-Name: Yuan, C. Year: 1995 Volume: 85 Issue: 7 Pages: 1011-1014 Abstract: Workplace violence is becoming increasingly recognized as a serious problem in health care settings. All 628 workers' compensation assaults claimed by minority Los Angeles County health care workers from 1986 through 1990 were abstracted. Population-at-risk data from county personnel computer tapes provided denominators by age, sex, race, job classification, and type of facility. Rates varied by type of facility (rate ratio = 38 for psychiatric hospitals vs public health facilities) and varied by job, with inpatient nursing attendants having the highest rate for caregivers. Most assaults were committed by patients (86%), followed by coworkers (8%). The average cost of an assault ($4879) was relatively low but related to the costlier problem of work-related emotional illness. Handle: RePEc:aph:ajpbhl:1995:85:7:1011-1014_0 Template-Type: ReDIF-Article 1.0 Title: The surveillance of work-related pesticide illness: An application of the Sentinel Event Notification System for Occupational Risks (SENSOR) Journal: American Journal of Public Health Author-Name: Maizlish, N. Author-Name: Rudolph, L. Author-Name: Dervin, K. Year: 1995 Volume: 85 Issue: 6 Pages: 806-811+762 Abstract: Objectives. In response to limitations in state-based occupational disease surveillance, the California Department of Health Services developed a model for surveillance of acute, work-related pesticide illness. The objectives were to enhance case reporting and link case reports to preventive interventions. Methods. Elements from surveillance of communicable diseases and sentinel health events were used to integrate a model into the preexisting system in one agricultural county. Results. Between 1988 and 1991, 45 Fresno County health care providers reported 230 suspected cases, of which 217 from 80 work sites met reporting guidelines. Risk factors were profiled from interviews of 81 prioritized case patients and 36 employers. Fifteen work sites were visited and 117 recommendations were made, of which 6% were identified in enforcement inspections. Pest management experts consulted with growers on reducing future pesticide use. Conclusions. Risk factors for pesticide illness were prevalent. Agricultural inspectors did not detect routine and serious hazards. Integrated pest management should be expanded and linked to occupational health. Agricultural enforcement personnel should be oriented and trained in occupational safety and health. Handle: RePEc:aph:ajpbhl:1995:85:6:806-811+762_3 Template-Type: ReDIF-Article 1.0 Title: Ocular and dermatologic health effects of ultraviolet radiation exposure from the ozone hole in Southern Chile Journal: American Journal of Public Health Author-Name: Schein, O.D. Author-Name: Vicencio, C. Author-Name: Munoz, B. Author-Name: Gelatt, K.N. Author-Name: Duncan, D.D. Author-Name: Nethercott, J. Author-Name: Honeyman, J. Author-Name: Koren, H.S. Author-Name: West, S. Year: 1995 Volume: 85 Issue: 4 Pages: 546-550 Abstract: Objectives. This study sought to investigate numerous reports emanating from Punta Arenas, Chile (population 110 000, latitude 53°S), that associated acute ocular and dermatologic disease in humans and animals with excess ultraviolet-B (UV-B) exposure in the setting of the thinning of the ozone column. Methods. Ophthalmologic and dermatologic records in Punta Arenas were systematically reviewed to enumerate sentinel diagnoses potentially associated with UV-B exposure, ocular examinations on representative animal populations were performed, and the ambient UV-B exposure in the region during the time of maximal thinning was estimated. Results. No increase in patient visits or conditions attributable to UV-B exposure was seen for periods of known ozone depletion compared with control periods. Although ambient UV-B exposure was 1.6 to 2.3 times the habitual exposure on individual days, this excess exposure conferred only a 1% increase in annual exposure on the region. Conclusion. This study does not support existing lay reports of ocular and dermatologic disease in humans and animals that had been associated with the ozone hole over southern Chile. Handle: RePEc:aph:ajpbhl:1995:85:4:546-550_4 Template-Type: ReDIF-Article 1.0 Title: The natural history of drug use from adolescence to the mid-thirties in a general population sample Journal: American Journal of Public Health Author-Name: Chen, K. Author-Name: Kandel, D.B. Year: 1995 Volume: 85 Issue: 1 Pages: 41-47 Abstract: Objectives. This study sought to describe patterns of initiation, persistence, and cessation in drug use in individuals from their late 20s to their mid-30s, within a broad perspective that spans 19 years from adolescence to adulthood. Methods. A fourth wave of personal interviews was conducted at ages 34-35 with a cohort of men and women (n = 1160) representative of adolescents formerly enrolled in Now York State public secondary high schools. A school survey was administered at ages 15-16, and personal interviews with participants and school absentees were conducted at ages 24-25 and 28-29. Retrospective continuous histories of 12 drug classes were obtained at each follow-up. Results. There was no initiation into alcohol and cigarettes and hardly any initiation into illicit drugs after age 29, the age at which most use ceased. The largest proportion of new users was observed for prescribed psychoactives. Periods of highest use since adolescence based on relative and absolute criteria were delineated. Among daily users, the proportions of heavy users declined for alcohol and marijuana but not for cigarettes. Conclusions. Cigarettes are the most persistent of any drug used. Drug-focused interventions must target adolescents and young adults. Handle: RePEc:aph:ajpbhl:1995:85:1:41-47_5 Template-Type: ReDIF-Article 1.0 Title: Rationing health care and the need for credible scarcity: Why Americans can't say no Journal: American Journal of Public Health Author-Name: Mariner, W.K. Year: 1995 Volume: 85 Issue: 10 Pages: 1439-1445 Abstract: With adequate cost containment unlikely in the foreseeable future, health care use will have to be curtailed, ideally with open and explicit criteria for equitably allocating resources or rationing. Yet, consensus on any such criteria appears remote because Americans cannot say no to health care. Americans may refuse to accept rationing for two reasons. The absence of any global limitation on health care resources may encourage patients to believe that health care resources are not scarce and do not need to be rationed. A belief in vitalism-that everyone is morally entitled to unlimited longevity and good health-may discourage setting limits on one's own care. Together, these characteristics may foster the belief that denials of health care services, especially by health insurers, are arbitrary or unfair refusals to pay for existing resources and not a necessary method of rationing scarce resources. If this hypothesis is true, Americans are unlikely to achieve consensus on any equitable allocation of health care unless they face an actual shortage (credible scarcity) of health care resources that makes it necessary to ration care. Handle: RePEc:aph:ajpbhl:1995:85:10:1439-1445_6 Template-Type: ReDIF-Article 1.0 Title: Public health and medicine. Journal: American Journal of Public Health Author-Name: Lewis, C.E. Year: 1995 Volume: 85 Issue: 1 Pages: 120 Handle: RePEc:aph:ajpbhl:1995:85:1:120_7 Template-Type: ReDIF-Article 1.0 Title: Home pesticide use and childhood cancer: A case-control study Journal: American Journal of Public Health Author-Name: Leiss, J.K. Author-Name: Savitz, D.A. Year: 1995 Volume: 85 Issue: 2 Pages: 249-252 Abstract: The association between childhood cancer and home pesticide use was examined in a case-control study of children under 15 years of age. Parents of 252 children diagnosed with cancer in the Denver area between 1976 and 1983 and of 222 control subjects were interviewed regarding use of home pest extermination, yard treatment, and pest strips. The strongest associations were found for yard treatments and soft tissue sarcomas (odds ratios [ORs] around 4.0) and for use of pest strips and leukemias (ORs between 1.7 and 3.0). These results suggest that use of home pesticides may be associated with some types of childhood cancer. Handle: RePEc:aph:ajpbhl:1995:85:2:249-252_9 Template-Type: ReDIF-Article 1.0 Title: Water chlorination and lipo- and apolipoproteins: The relationship in elderly white women of Western Pennsylvania Journal: American Journal of Public Health Author-Name: Riley, T.J. Author-Name: Cauley, J.A. Author-Name: Murphy, P.A. Year: 1995 Volume: 85 Issue: 4 Pages: 570-573 Abstract: The relationship between consumption of chlorinated drinking water in the home water supply and serum lipids was examined in 2070 elderly White women. Private springs, cisterns, and wells were considered nonchlorinated and public water sources, chlorinated. Mean serum lipids and lipoproteins were similar in the chlorinated and nonchlorinated groups. Stratification by years of exposure revealed little difference in lipid concentrations. Lifestyle factors-for example, smoking and alcohol consumption-differed by years of exposure. Hence, previous reports of an association between chlorinated drinking water and serum cholesterol levels my reflect inadequate control of other factors differentially distributed across chlorinated exposure groups. Handle: RePEc:aph:ajpbhl:1995:85:4:570-573_0 Template-Type: ReDIF-Article 1.0 Title: Chronic obstructive pulmonary disease in lifelong nonsmokers: Results from NHANES Journal: American Journal of Public Health Author-Name: Whittemore, A.S. Author-Name: Perlin, S.A. Author-Name: DiCiccio, Y. Year: 1995 Volume: 85 Issue: 5 Pages: 702-706 Abstract: The prevalence of chronic obstructive pulmonary disease was evaluated in 12 980 lifelong nonsmoking adults who participated in one of three National US Health and Nutrition Examination Surveys. Also evaluated were the relationships between chronic obstructive pulmonary disease and age, sex, ethnicity, education, income, and certain environmental and occupational factors. Overall, 4% of men and 5% of women reported physician-diagnosed chronic obstructive pulmonary disease. Prevalence increased with age and with decreasing household income, was higher in Whites than in non-Whites, and was particularly high in Hispanic women. Further research is needed to explain the excess risk for chronic obstructive pulmonary disease in economically disadvantaged nonsmokers, and to assess the role of environmental tobacco smoke in nonsmokers' risk for the disease. Handle: RePEc:aph:ajpbhl:1995:85:5:702-706_8 Template-Type: ReDIF-Article 1.0 Title: Harm reduction--a framework for incorporating science into drug policy. Journal: American Journal of Public Health Author-Name: Des Jarlais, D.C. Year: 1995 Volume: 85 Issue: 1 Pages: 10-12 Handle: RePEc:aph:ajpbhl:1995:85:1:10-12_7 Template-Type: ReDIF-Article 1.0 Title: Unintentional carbon monoxide poisoning in Colorado, 1986 through 1991 Journal: American Journal of Public Health Author-Name: Cook, M. Author-Name: Simon, P.A. Author-Name: Hoffman, R.E. Year: 1995 Volume: 85 Issue: 7 Pages: 988-990 Abstract: Unintentional carbon monoxide poisonings were identified through death certificates, by hyperbaric chambers, and by laboratories required to report carboxyhemoglobin levels greater than 12%. From 1986 to 1991, 981 cases were reported, including 174 deaths. Deaths most often resulted from fire-related carbon monoxide intoxication (36.2%), followed by motor vehicle exhaust (34.5%), and furnaces (10.3%). Among nonfatal cases, furnaces were the leading source of carbon monoxide exposure (44.3%), followed by motor vehicle exhaust (22.8%). The importance of furnaces and other home heating devices in carbon monoxide intoxication may be underappreciated if only mortality data are examined. Surveillance of carbon monoxide-related morbidity is a useful adjunct to mortality surveillance in guiding prevention efforts. Handle: RePEc:aph:ajpbhl:1995:85:7:988-990_1 Template-Type: ReDIF-Article 1.0 Title: Facial wrinkling in men and women, by smoking status Journal: American Journal of Public Health Author-Name: Ernster, V.L. Author-Name: Grady, D. Author-Name: Miike, R. Author-Name: Black, D. Author-Name: Selby, J. Author-Name: Kerlikowske, K. Year: 1995 Volume: 85 Issue: 1 Pages: 78-82 Abstract: Objectives. This study examined the association of smoking status and pack-years of smoking with facial wrinkling in men and women. Methods. We conducted a cross-sectional study of 299 never smokers, 551 former smokers and 286 current smokers, aged 30 through 69 years, drawn from a health maintenance organization. Smoking all pack-years of smoking and potential confounding variables were assessed by questionnaire. Facial wrinkle category, a dichotomous variable, and fatal wrinkle score, a computed continuous variable, were assessed by blinded standardized visual assessment. Wrinkling was so uncommon among 30- 39-year-old subjects that analyses were restricted to subjects aged 40 and over (227 never smokers, 456 former smokers, and 228 current smokers). Results. With age, average sun exposure, and body mass index controlled, the estimated relative risk of moderate/severe wrinkling for current smokers compared to never smokers was 2.3 (95% confidence interval [CI] = 1.2, 4.2) among men and 3.1 (95% CI = 1.6, 5.9) among women. Pack-years was positively associated with facial wrinkle score in women aged 40 through 69 years and in men aged 40 through 59 years. In both groups the increased risk of wrinkling was equivalent to about 1.4 years of aging. Conclusion. Our results support earlier findings that risk of facial wrinkling is greater in cigarette smokers than in never smokers. Handle: RePEc:aph:ajpbhl:1995:85:1:78-82_0 Template-Type: ReDIF-Article 1.0 Title: The costs and effects of a nutritional education program following work- site cholesterol screening Journal: American Journal of Public Health Author-Name: Byers, T. Author-Name: Mullis, R. Author-Name: Anderson, J. Author-Name: Dusenbury, L. Author-Name: Gorski, R. Author-Name: Kimber, C. Author-Name: Krueger, K. Author-Name: Kuester, S. Author-Name: Mokdad, A. Author-Name: Perry, G. Author-Name: Smith, C.A. Year: 1995 Volume: 85 Issue: 5 Pages: 650-655 Abstract: Objectives. The purpose of this study was to assess the costs and impact of a nutrition education program following a cholesterol screening. Methods. Forty work-sites were randomly assigned to one of two educational interventions: a 'usual' intervention of 5 minutes of counseling, or a 'special' intervention of 2 hours of behaviorally based education on dietary changes to lower serum cholesterol. Costs were monitored, and cholesterol levels were retested 6 and 12 months later. Results. The total per-person cost for screening and the educational intervention was about $50. Cholesterol levels differed little between the two intervention groups 6 months after screening, but after 12 months those in the special intervention worksites showed a 6.5% drop in cholesterol, whereas those at the usual intervention worksites showed a drop of only 3.0%. Hence a 3.5% cholesterol reduction was attributable to the special intervention. Conclusions. A behaviorally based nutrition education program following cholesterol screening can have a meaningful impact on longterm cholesterol levels at a low cost. Nutrition education in work-sites may therefore be a useful way to lower the risk of heart disease in communities. Handle: RePEc:aph:ajpbhl:1995:85:5:650-655_9 Template-Type: ReDIF-Article 1.0 Title: Empirically based guidelines for moderate drinking: 1-year results from three studies with problem drinkers Journal: American Journal of Public Health Author-Name: Sanchez-Craig, M. Author-Name: Wilkinson, A. Author-Name: Davila, R. Year: 1995 Volume: 85 Issue: 6 Pages: 823-828 Abstract: Objectives. The study was conducted to refine guidelines on moderate drinking for problem drinkers, persons whose alcohol use is hazardous or harmful. Information on levels of alcohol intake unlikely to cause problems is useful for health professionals, educators, and policymakers. Methods. Based on their reports of alcohol-related problems, participants in three studies assessing interventions to reduce heavy drinking (144 men, 91 women) were categorized as 'problem-free' or 'problem' drinkers at follow-up. Drinking measures were examined to identify patterns separating these outcome categories. Results. Analyses using 95% confidence intervals for means on drinking measures showed that guidelines should be sex-specific. Based on analyses of positive and negative predictive value, sensitivity, and specificity, it is recommended that men consume no more than 4 standard drinks in any day and 16 drinks in any week, and that women consume no more than 3 drinks in any day and 12 drinks in any week. Conclusions. These guidelines are consistent with those from several official bodies and should be useful for advising problem drinkers when moderation is a valid treatment goal. Their applicability to the general population is unevaluated. Handle: RePEc:aph:ajpbhl:1995:85:6:823-828_6 Template-Type: ReDIF-Article 1.0 Title: Fruit and vegetable intake among adults in 16 states: Results of a brief telephone survey Journal: American Journal of Public Health Author-Name: Serdula, M.K. Author-Name: Coates, R.J. Author-Name: Byers, T. Author-Name: Simoes, E. Author-Name: Mokdad, A.H. Author-Name: Subar, A.F. Year: 1995 Volume: 85 Issue: 2 Pages: 236-239 Abstract: A brief food frequency questionnaire was used to assess daily fruit and vegetable consumption among 23 699 adults in 16 US states sampled in a random-digit dialing telephone survey. Men consumed fewer servings per day (3.3) than did women (3.7). Only 20% of the population consumed the recommended 5 or more daily serving. Intakes varied somewhat by state and were lower among the young and the less educated. Efforts are needed to improve fruit and vegetable consumption among all Americans, especially younger adults and those with lower levels of education. Handle: RePEc:aph:ajpbhl:1995:85:2:236-239_2 Template-Type: ReDIF-Article 1.0 Title: Physician recommendations for dietary change: Their prevalence and impact in a population-based sample Journal: American Journal of Public Health Author-Name: Hunt, J.R. Author-Name: Kristal, A.R. Author-Name: White, E. Author-Name: Lynch, J.C. Author-Name: Fries, E. Year: 1995 Volume: 85 Issue: 5 Pages: 722-726 Abstract: A random-digit-dialing survey to examine the prevalence, content, and impact of physician dietary recommendations in a representative population- based sample of Washington State residents was administered to 1972 persons aged 18 years and older. Twenty percent of those surveyed received a physician's recommendation for dietary change in the previous year. The most common recommendations were to decrease intake of cholesterol, calories, and red meat and to increase intake of vegetables and fiber. Respondents receiving recommendations were more likely to report decreased use of high- fat foods and increased use of high-fiber foods and to be in the maintenance stage of dietary change. Results suggest that physicians can play a limited role in promoting dietary change. Handle: RePEc:aph:ajpbhl:1995:85:5:722-726_6 Template-Type: ReDIF-Article 1.0 Title: Trends in the treatment of alcohol problems in the US general population, 1979 through 1990 Journal: American Journal of Public Health Author-Name: Weisner, C. Author-Name: Greenfield, T. Author-Name: Room, R. Year: 1995 Volume: 85 Issue: 1 Pages: 55-60 Abstract: Objectives. The purpose of this study was to conduct a comprehensive analysis of alcohol-treatment service utilization trends in the general population during the 1980s. Methods. Three national surveys of the US household population (1979, 1984, and 1990) were used for trend analysis of treatment utilization. Trends in demographic characteristics of parsons with lifetime treatment rates and particular types of treatment were examined by means of logistic regression analysis, controlling for alcohol problem severity and other variables. Results. Substantial increases in the numbers reporting treatment were found. In all surveys, Alcoholics Anonymous was the treatment used most frequently and its use increased most, especially for women. Men were more likely than women (odds ratio [OR] = 2.01, 95% confidence interval [CI] = 1.20, 5.39) and unmarried persons were less likely than married parsons (OR = 0.47, 95% CI = 0.29, 0.77) to report treatment over time. Social consequences carded more predictive power than dependence symptoms. Conclusions. From a general population perspective, while overall treatment capacity has increased, the structural changes in the public/private balance of services have not positively affected the representation of women or other characteristics of the treatment population. Handle: RePEc:aph:ajpbhl:1995:85:1:55-60_6 Template-Type: ReDIF-Article 1.0 Title: Mortality rates among 15- to 44-year-old women in Boston: Looking beyond reproductive status Journal: American Journal of Public Health Author-Name: Katz, M.E. Author-Name: Holmes, M.D. Author-Name: Power, K.L. Author-Name: Wise, P.H. Year: 1995 Volume: 85 Issue: 8 Pages: 1135-1138 Abstract: Mortality rates were examined for Boston women, aged 15 to 44, from 1980 to 1989. There were 1234 deaths, with a rate of 787.8/100 000 for the decade. Leading causes were cancer, accidents, heart disease, homicide, suicide, and chronic liver disease. After age adjustment, African-American women in this age group were 2.3 times more likely to die than White women. Deaths at least partly attributable to smoking and alcohol amounted to 29.8% and 31.9%, respectively. Mortality was found to be related more directly to the general well-being of young women than to their reproductive status, and many deaths were preventable. African-American/White disparities were most likely linked to social factors. These findings suggest that health needs of reproductive- age women transcend reproductive health and require comprehensive interventions. Handle: RePEc:aph:ajpbhl:1995:85:8:1135-1138_2 Template-Type: ReDIF-Article 1.0 Title: Treating early-stage breast cancer: Hospital characteristics associated with breast-conserving surgery Journal: American Journal of Public Health Author-Name: Johantgen, M.E. Author-Name: Coffey, R.M. Author-Name: Harris, D.R. Author-Name: Levy, H. Author-Name: Clinton, J.J. Year: 1995 Volume: 85 Issue: 10 Pages: 1432-1434 Abstract: Despite growing acceptance of the fact that women with early-stage breast cancer have similar outcomes with lumpectomy plus radiation as with mastectomy, many studies have revealed the uneven adoption of such breast- conserving surgery. Discharge data from the Hospital Cost and Utilization Project, representing multiple payers, locations, and hospital types, demonstrate increasing trends in breast-conserving surgery as a proportion of breast cancer surgeries from 1981 to 1987. Women with axillary node involvement were less likely to have a lumpectomy, even though consensus recommendations do not preclude this form of treatment when local metastases are present. Non-White race, urban hospital location, and hospital teaching were associated with an increased likelihood of having breast-conserving surgery. Handle: RePEc:aph:ajpbhl:1995:85:10:1432-1434_9 Template-Type: ReDIF-Article 1.0 Title: Measuring chemical sensitivity prevalence: A questionnaire for population studies Journal: American Journal of Public Health Author-Name: Kipen, H.M. Author-Name: Hallman, W. Author-Name: Kelly-McNeil, K. Author-Name: Fiedler, N. Year: 1995 Volume: 85 Issue: 4 Pages: 574-577 Abstract: Because no information exists on the prevalence of chemical sensitivity syndromes such as multiple chemical sensitivities, a questionnaire for use in population studies was developed and tested to assess the presence or absence of chemical sensitivity. Seven hundred five individuals attending clinics answered a questionnaire asking whether each of 122 common substances caused symptoms. Results showed that patients with multiple chemical sensitivities and asthma had average total scores that were significantly different from each other and from those of each of the other diagnostic categories. Higher total scores were also reported by female patients. The instrument described here may facilitate meaningful prevalence studies of multiple chemical sensitivities. It will also allow study of chemically induced symptoms in other conditions such as asthma. Handle: RePEc:aph:ajpbhl:1995:85:4:574-577_3 Template-Type: ReDIF-Article 1.0 Title: Excess mortality among cigarette smokers: Changes in a 20-year interval Journal: American Journal of Public Health Author-Name: Thun, M.J. Author-Name: Day-Lally, C.A. Author-Name: Calle, E.E. Author-Name: Flanders, W.D. Author-Name: Heath Jr., C.W. Year: 1995 Volume: 85 Issue: 9 Pages: 1223-1230 Abstract: Objectives. This study was undertaken to examine changes in smoking- specific death rates from the 1960s to the 1980s. Methods. In two prospective studies, one from 1959 to 1965 and the other from 1982 to 1988, death rates from lung cancer, coronary heart disease, and other major smoking-related diseases were measured among more than 200 000 current smokers and 480 000 lifelong nonsmokers in each study. Results. From the first to the second study, lung cancer death rates (per 100 000) among current cigarette smokers increased from 26 to 155 in women and from 187 to 341 in men; the increase persisted after current daily cigarette consumption and years of smoking were controlled for. Rates among nonsmokers were stable. In contrast, coronary heart disease and stroke death rates decreased by more than 50% in both smokers and nonsmokers. The all-cause rate difference between smokers and nonsmokers doubled for women but was stable for men. Conclusions. Premature mortality (the difference in all-cause death rates between smokers and nonsmokers) doubled in women and continued unabated in men from the 1960s to the 1980s. Lung cancer surpassed coronary heart disease as the largest single contributor to smoking-attributable death among White middle-class smokers. Handle: RePEc:aph:ajpbhl:1995:85:9:1223-1230_1 Template-Type: ReDIF-Article 1.0 Title: The quality of psychiatric emergency evaluations and patient outcomes in county hospitals Journal: American Journal of Public Health Author-Name: Segal, S.P. Author-Name: Egley, L. Author-Name: Watson, M.A. Author-Name: Goldfinger, S.M. Year: 1995 Volume: 85 Issue: 10 Pages: 1429-1431 Abstract: Quality of care is widely assumed to be related to patient outcomes, but little is known about care in relation to outcomes in county general hospital psychiatric emergency services. It was hypothesized that conformity to professional standards (technical quality) and engagement of the patient (artful care) in psychiatric emergency services evaluations would contribute to improved patient functioning (Global Assessment Scale score) and appropriate disposition. A total of 583 cases in seven facilities were analyzed. Conformity to technical standards of care was associated with retention even after constraints, biases, and admission criteria had been taken into account. Conversely, artful care was associated with lower probability of retention and improved functioning. Handle: RePEc:aph:ajpbhl:1995:85:10:1429-1431_2 Template-Type: ReDIF-Article 1.0 Title: Chronic liver disease mortality in the United States, 1979 through 1989 Journal: American Journal of Public Health Author-Name: Hurwitz, E.S. Author-Name: Holman, R.C. Author-Name: Strine, T.W. Author-Name: Chorba, T.L. Year: 1995 Volume: 85 Issue: 9 Pages: 1256-1260 Abstract: Objectives. Rates and trends for chronic liver disease mortality in the United States were examined. Methods. National Center for Health Statistics data on underlying cause of death for chronic liver disease for the United States from 1979 through 1989 were analyzed. Four groups of diseases and conditions included under the International Classification of Diseases, 9th Revision, code for chronic liver disease were assessed separately. Results. From 1979 through 1989, there were 303 875 deaths from chronic liver disease; 48% were in the cirrhosis without alcohol group, 42% in the alcohol-related liver disease group, 8% in the liver disease without alcohol group, and 1.5% in the biliary cirrhosis group. Chronic liver disease death rates for Blacks were more than 1.5 times greater than those for Whites and for other races. Chronic liver disease mortality declined 22% overall among both sexes. The largest decreases were for liver disease without alcohol (42%) and cirrhosis without alcohol (25%), followed by alcohol-related liver disease (14%) and biliary cirrhosis (12%). Conclusion. Although declines in US chronic liver disease deaths have been attributed to declining alcohol consumption, these analyses suggest that greater declines have occurred in deaths not coded as alcohol related. Handle: RePEc:aph:ajpbhl:1995:85:9:1256-1260_0 Template-Type: ReDIF-Article 1.0 Title: Has the use of cervical, breast, and colorectal cancer screening increased in the United States? Journal: American Journal of Public Health Author-Name: Anderson, L.M. Author-Name: May, D.S. Year: 1995 Volume: 85 Issue: 6 Pages: 840-842 Abstract: This report describes trends in reported breast, cervical, and colorectal cancer screening within the US population from 1987 to 1992. Data from the 1987 and 1992 Cancer Control Supplements of the National Health Interview Survey were analyzed to determine use of Pap smears by women aged 18+; of mammography and clinical breast examination by women aged 50+; and of proctoscopy, digital rectal examination, and fecal occult blood testing among men and women aged 50+. Use of mammography doubled between 1987 and 1992 while Pap smear use changed very little. Use of the three colorectal cancer screening modalities increased but levels remained low. Usage trends were also assessed in relation to several sociodemographic factors. Disparities in screening reported in 1987 according to income and education persisted in 1992. Handle: RePEc:aph:ajpbhl:1995:85:6:840-842_0 Template-Type: ReDIF-Article 1.0 Title: Improving Americans' diet--setting public policy with limited knowledge. Journal: American Journal of Public Health Author-Name: Marshall, J.R. Year: 1995 Volume: 85 Issue: 12 Pages: 1609-1611 DOI: 10.2105/AJPH.85.12.1609 File-URL: http://hdl.handle.net/10.2105/AJPH.85.12.1609 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.85.12.1609_9 Template-Type: ReDIF-Article 1.0 Title: Gender differences in nutritional status and feeding patterns among infants in the Gaza strip Journal: American Journal of Public Health Author-Name: Schoenbaum, M. Author-Name: Tulchinsky, T.H. Author-Name: Abed, Y. Year: 1995 Volume: 85 Issue: 7 Pages: 965-969 Abstract: Objectives. This study examined gender variation in nutritional treatment and anthropometric status of infants in the Gaza Strip. Numerous studies have documented gender differences in health status in developing areas, generally finding boys to be at an advantage over girls. Social and economic characteristics in Gaza suggest that one might expect preferential treatment of boys there. Methods. The study used data on two samples of infants 0 to 18 months of age collected from five health centers in Gaza. A variety of different analytic methods were used to look for gender differences in feeding patterns, prevalence of malnutrition, and anthropometric status. Results. Although some differences in nutritional treatment and anthropometric outcome for infants of different socioeconomic status and between the earlier and later samples were found, no consistent gender differences were revealed. Conclusions. The findings are consistent with several different explanations. First, expectations of finding gender differences may have been unfounded. Alternatively, such differences may have existed previously but have been eliminated through successful public health intervention, rising levels of education, and economic development. Handle: RePEc:aph:ajpbhl:1995:85:7:965-969_1 Template-Type: ReDIF-Article 1.0 Title: Excess mortality in smokeless tobacco users not meaningful. Journal: American Journal of Public Health Author-Name: Rodu, B. Author-Name: Cole, P. Year: 1995 Volume: 85 Issue: 1 Pages: 118-119 Handle: RePEc:aph:ajpbhl:1995:85:1:118-119_3 Template-Type: ReDIF-Article 1.0 Title: Peer review of mammography interpretations in a breast cancer screening program Journal: American Journal of Public Health Author-Name: Feldman, J. Author-Name: Smith, R.A. Author-Name: Giusti, R. Author-Name: DeBuono, B. Author-Name: Fulton, J.P. Author-Name: Scott, H.D. Year: 1995 Volume: 85 Issue: 6 Pages: 837-839 Abstract: Mammograms from a statewide screening program were subjected to a blind review by a panel of expert mammographers. Ninety-five percent (173/182) of original normal mammograms and 53% (164/311) of original abnormal mammograms were reread as normal. In comparison with the expert panel, community radiologists were more likely to request a repeat mammogram in 6 months than to interpret a mammogram as normal or address their uncertainty with an immediate diagnostic workup. Handle: RePEc:aph:ajpbhl:1995:85:6:837-839_7 Template-Type: ReDIF-Article 1.0 Title: Hospitalizations for near drowning in California: Incidence and costs Journal: American Journal of Public Health Author-Name: Ellis, A.A. Author-Name: Trent, R.B. Year: 1995 Volume: 85 Issue: 8 Pages: 1115-1118 Abstract: California hospital discharge data for 1991 were examined to describe persons hospitalized for near drownings (i.e., a submersion incident for which the victim was admitted to a hospital). Among residents with near- drowning injuries, there were 865 discharges, regardless of outcome (rate = 2.8/100 000); 785 persons survived the hospitalization, and 80 (9%) did not. Swimming pools were the most common submersion site (62%). Highest rates per 100 000 were found among males (3.6), Blacks (3.6), and children 1 through 5 years old (18.4). Charges for the initial hospitalization (excluding physicians' fees) amounted to $11.4 million. The state government's share of these charges was $5.4 million, with Medi-Cal expected to pay $4.1 million. Blacks, males, Medi-Cal recipients, and young children are most at risk and should be targeted for prevention programs. Handle: RePEc:aph:ajpbhl:1995:85:8:1115-1118_1 Template-Type: ReDIF-Article 1.0 Title: Health policy approaches to measuring and valuing human life: Conceptual and ethical issues Journal: American Journal of Public Health Author-Name: Morrow, R.H. Author-Name: Bryant, J.H. Year: 1995 Volume: 85 Issue: 10 Pages: 1356-1360 Abstract: To achieve more cost-effective and equitable use of health resources, improved methods for defining disease burdens and for guiding resource allocations are needed by health care decision makers. Three approaches are discussed that use indicators that combine losses due to disability with losses due to premature mortality as a measure of disease burden. These indicators can also serve as outcome measures for health status in economic analyses. However, their use as tools for measuring and valuing human life raises important questions concerning the measurement of mortality and the multidimensions of morbidity; valuing of life, particularly regarding weighting productivity, dependency, age, and time-preference factors; and conflicts between equity and efficiency that arise in allocation decisions. Further refinement of these tools is needed to (1) incorporate national and local values into weighting; (2) elaborate methods for disaggregating calculations to assess local disease patterns and intervention packages; and (3) develop guidelines for estimating marginal effects and costs of interventions. Of utmost importance are methods that ensure equity while achieving reasonable efficiency. Handle: RePEc:aph:ajpbhl:1995:85:10:1356-1360_6 Template-Type: ReDIF-Article 1.0 Title: Trauma among Hispanic children: A population-based study in a regionalized system of trauma care Journal: American Journal of Public Health Author-Name: Matteucci, R.M. Author-Name: Holbrook, T.L. Author-Name: Hoyt, D.B. Author-Name: Molgaard, C. Year: 1995 Volume: 85 Issue: 7 Pages: 1005-1008 Abstract: We studied 1164 injured Hispanic and 2560 injured non-Hispanic White children newborn through 14 years triaged to the San Diego County Regionalized Trauma System from 1985 through 1990. Incidence rates did not differ by ethnic group. Hispanic children were more likely to be struck as pedestrians (odds ratio [OR] = 1.5) and less likely to be injured in falls (OR = 0.7) than non-Hispanic White children. For motor vehicle and pedal cycle injuries, Hispanic children were more likely not to have been restrained by seatbelts (OR = 4.0) or car seats (OR = 3.7). Handle: RePEc:aph:ajpbhl:1995:85:7:1005-1008_6 Template-Type: ReDIF-Article 1.0 Title: Pediatric mortality and hospital use in Canada and the United States, 1971 through 1987 Journal: American Journal of Public Health Author-Name: Hodge, M.J. Author-Name: Dougherty, G.E. Author-Name: Pless, I.B. Year: 1995 Volume: 85 Issue: 9 Pages: 1276-1279 Abstract: Since 1971 pediatric mortality rates have decreased markedly but differently in Canada and the United States. These trends were examined in light of changes in hospital use and health care financing. Annual mortality and hospital use rates for children aged 14 years and younger were calculated. Between 1971 and 1987, all-cause mortality in Canada fell from 165 to 74 per 100 000; the American rate fell from 172 to 96 per 100 000. American hospitalization rates remained essentially constant until 1983 and then fell by 27.5%, while Canadian hospitalization rates declined throughout. In 1987 Canadian children had higher hospitalization rates, while American children had higher mortality rates. These differences may be associated with differences in health financing; the adoption of US prospective payment systems was temporally coincident with sharp declines in hospitalization rates for American children. Handle: RePEc:aph:ajpbhl:1995:85:9:1276-1279_6 Template-Type: ReDIF-Article 1.0 Title: The location of residence as a basis for childhood lead poisoning screening programs Journal: American Journal of Public Health Author-Name: Bronson, M.A. Year: 1995 Volume: 85 Issue: 4 Pages: 589-590 Handle: RePEc:aph:ajpbhl:1995:85:4:589-590_2 Template-Type: ReDIF-Article 1.0 Title: Apolipoprotein E and Alzheimer's disease: The implications of progress in molecular medicine Journal: American Journal of Public Health Author-Name: Mayeux, R. Author-Name: Schupf, N. Year: 1995 Volume: 85 Issue: 9 Pages: 1280-1284 Abstract: We review the current status as well as the risks and benefits of a recently developed DNA test of risk for Alzheimer's disease: the apolipoprotein E genotype. While apolipoprotein E genotypes may indicate a degree of susceptibility, the gene is neither necessary nor sufficient to cause the disease; thus, many questions remain. Because risk prediction is not straightforward, practical issues related to the testing of complex diseases like Alzheimer's and to the ethical, legal, and social implications of genetic tests require careful consideration and unambiguous answers. The use of apolipoprotein E genotyping in patients with Alzheimer's disease should be limited to research centers, and additional studies are strongly recommended. Apolipoprotein E genotypes should not be available to third panics such as insurers or employers until genotypic risks are fully understood. National policies that encourage scientific investigation while maintaining individual privacy and limiting unnecessary access to genetic information should be immediately developed. Handle: RePEc:aph:ajpbhl:1995:85:9:1280-1284_8 Template-Type: ReDIF-Article 1.0 Title: Menthol vs nonmenthol cigarettes: Effects on smoking behavior Journal: American Journal of Public Health Author-Name: McCarthy, W.J. Author-Name: Caskey, N.H. Author-Name: Jarvik, M.E. Author-Name: Gross, T.M. Author-Name: Rosenblatt, M.R. Author-Name: Carpenter, C. Year: 1995 Volume: 85 Issue: 1 Pages: 67-72 Abstract: Objectives. The purpose of this study was to examine intraindividual differences in smoking behavior between smoking regular and mentholated cigarettes. Methods. Healthy male smokers (n = 29) smoked either a regular or a mentholated cigarette in two separate sessions 1 week apart. Commercial brands with comparable tar, nicotine, and CO content were used. Smoking behavior was constrained by fixed 15-second interpuff intervals, but puff volume and number of puffs were unconstrained. Results. When smoking the non- mentholated brand of cigarettes, participants smoked 22% more puffs and had 13% higher mean volumes per puff than they did when smoking the mentholated brand of cigarettes. The aggregate 39% excess exposure to cigarette smoke in the regular-cigarette condition was not accompanied by commensurate excesses in expired carbon monoxide or in physiological measures normally correlated with nicotine exposure. Conclusions. These findings parallel differences in physiological correlates of exposure to nicotine found in cross-sectional comparisons of African-American and White smokers and are consistent with the results of emerging laboratory investigations. Handle: RePEc:aph:ajpbhl:1995:85:1:67-72_7 Template-Type: ReDIF-Article 1.0 Title: The professional structure of Soviet medical care: The relationship between personal characteristics, medical education, and occupational setting for Estonian physicians Journal: American Journal of Public Health Author-Name: Barr, D.A. Year: 1995 Volume: 85 Issue: 3 Pages: 373-378 Abstract: Objectives. Using the Estonian example, this study provides data to describe the ways in which personal, educational, and occupational factors interacted to determine the professional structure of the Soviet health care system. Methods. The study analyzes data gathered from a survey of 20% of the physicians in Estonia. It measures the frequencies of pertinent personal and occupational factors, and uses multivariate analysis to explore relationships between these factors. Results. Most physicians in Estonia are women and work in urban settings. About half of the physicians work in hospitals, and one third work in large outpatient clinics called polyclinics. About one third work in primary care. Gender affects education, specialty, type of workplace, and administrative duties; nationality affects education and administrative duties. Conclusions. The Soviet system of health care derived its professional structure from a combination of personal and occupational factors. Those considering options for reform of the health care systems of the newly independent states that once constituted the Soviet Union should appreciate the nature of these structural forces. Handle: RePEc:aph:ajpbhl:1995:85:3:373-378_0 Template-Type: ReDIF-Article 1.0 Title: Trends in state agency oral health and public health expenditures, 1984 through 1989 Journal: American Journal of Public Health Author-Name: Lockwood, S.A. Author-Name: Malvitz, D.M. Year: 1995 Volume: 85 Issue: 9 Pages: 1266-1268 Abstract: This paper documents oral health and public health expenditures for fiscal years 1984, 1986, 1988, and 1989, as reported by state health agencies. During this period, reported national expenditures for public and oral health increased 68% and 46%, respectively; between successive fiscal years, fewer states (73%, 67%, 57%) reported increased oral health expenditures, while increasingly more states reported no categorical oral health expenditures. Block grant expenditures for oral health increased overall but decreased as a percentage of total oral health expenditures; 16 states reported no block grant expenditures for oral health in fiscal year 1989, perhaps reflecting either substantial state support, or marginal to nonexistent oral health programs in these states. Handle: RePEc:aph:ajpbhl:1995:85:9:1266-1268_1 Template-Type: ReDIF-Article 1.0 Title: Predicting body fatness: The body mass index vs estimation by bioelectrical impedance Journal: American Journal of Public Health Author-Name: Roubenoff, R. Author-Name: Dallal, G.E. Author-Name: Wilson, P.W.F. Year: 1995 Volume: 85 Issue: 5 Pages: 726-728 Abstract: The body mass index (weight in kilograms/height in square meters) is a common surrogate for fatness. With the advent of bioelectrical impedance analysis, more precise measurement of fatness in populations is now possible. We measured height, weight, and percentage that is fat by bioelectrical impedance analysis in 2032 adults, ages 31 to 92, participating in the Framingham studies. Body mass index was a poor predictor of fatness in women (R2 = 0.55) and men (R2 = 0.38), and was imprecise (standard error of estimate = 5 percentage points). The relationship between percentage fat and body mass index was quadratic in both sexes, and was altered by age in women (P < .0001) and, to a lesser extent, in men (P < .027). These data suggest that body mass index is an imprecise measurement of fatness compared with bioelectrical impedance. Handle: RePEc:aph:ajpbhl:1995:85:5:726-728_0 Template-Type: ReDIF-Article 1.0 Title: Patterns of alcohol use and the risk of drinking and driving among US high school students Journal: American Journal of Public Health Author-Name: Escobedo, L.G. Author-Name: Chorba, T.L. Author-Name: Waxweiler, R. Year: 1995 Volume: 85 Issue: 7 Pages: 976-978 Abstract: Approximately one third of deaths among persons aged 15 to 24 years are the result of motor vehicle-related crashes. Data from a national sample of US high school students were used to assess patterns of alcohol use among adolescents in relation to the risk of drinking and driving. Prevalence and odds ratios were calculated for drinking and driving associated with patterns of alcohol use. Drinking and driving increased with increasing frequency of alcohol use and binge drinking and when alcohol was used in addition to other drugs. Efforts to reduce drinking and driving among adolescents should address underage drinking that is frequent or heavy. Handle: RePEc:aph:ajpbhl:1995:85:7:976-978_6 Template-Type: ReDIF-Article 1.0 Title: The treatment of non-HIV-related conditions in newborns at risk for HIV: A survey of neonatologists Journal: American Journal of Public Health Author-Name: Levin, B.W. Author-Name: Krantz, D.H. Author-Name: Driscoll Jr., J.M. Author-Name: Fleischman, A.R. Year: 1995 Volume: 85 Issue: 11 Pages: 1507-1513 Abstract: Objectives. The purpose of this study was to examine attitudes of neonatologists about treatment of conditions unrelated to the human immunodeficiency virus (HIV) for critically ill newborns at risk for HIV. Methods. Questionnaires were mailed to the 1508 members of the Section on Perinatal Medicine of the American Academy of Pediatrics; 63% completed the survey (n = 951). The survey included structured questions about treatment for hypothetical cases and open-ended questions eliciting reasons for decisions. Results. Differences in recommendations for treatment by both maternal and infant HIV status were substantial and statistically reliable. For example, 98% of respondents recommended life-saying cardiac surgery for a neonate with no risk for HIV, but only 93% recommended such surgery for a child of an HIV-positive mother; only 50% recommended the same surgery for a newborn known to be infected. The corresponding figures for chronic dialysis were 91%, 61%, and 26%. Most expected diminished quality of life for both infected and uninfected children of HIV-positive mothers. Conclusions. Recommendations about life-sustaining treatment for non-HIV-related conditions varied by HIV status. These data on physician attitudes raise the possibility that infants labeled as HIV positive, whether infected or not, may suffer discrimination. Handle: RePEc:aph:ajpbhl:1995:85:11:1507-1513_4 Template-Type: ReDIF-Article 1.0 Title: Alberta's universal dental plan for the elderly: Differences in use over 6 years by two cohorts Journal: American Journal of Public Health Author-Name: Lewis, D.W. Author-Name: Thompson, G.W. Year: 1995 Volume: 85 Issue: 10 Pages: 1408-1411 Abstract: Objectives. Dental services use by two cohorts under the universal dental plan for the elderly in Alberta, Canada, was examined. Methods. Two birth cohorts 65 to 69 years old at entry who used the plan from 1978 to 1979 (n = 17 816) or from 1985 to 1986 (n = 27 474) were analyzed over 6 successive years for differences in dental services use and costs. Results. The 1985/86 cohort received 24% more visits per patient than the 1978/79 cohort. Their inflation-adjusted expenditures increased by 19% mainly as a result of increases in denturists' expenditures (33%) (dentists' expenditures increased just 4% because of lower plan fee increases). The 1985/86 cohort received relatively many more periodontal and fewer denture services. Annual attendance over 6 consecutive years was high, especially for the 1985/86 cohort and dentists' patients; 55% of the 1985/86 cohort who used dentists did so in 5 or all 6 years. Conclusions. Differences in plan expenditures per patient between the birth cohorts and dentists and denturists, along with the high continuity of care for dentists' patients, have important implications for planning and administering dental plans for the elderly. The large expenditure decreases for removable dentures and the large increases for periodontal services to the 1985/86 cohort are noteworthy. Handle: RePEc:aph:ajpbhl:1995:85:10:1408-1411_0 Template-Type: ReDIF-Article 1.0 Title: The economic value of contraception: A comparison of 15 methods Journal: American Journal of Public Health Author-Name: Trussell, J. Author-Name: Leveque, J.A. Author-Name: Koenig, J.D. Author-Name: London, R. Author-Name: Borden, S. Author-Name: Henneberry, J. Author-Name: LaGuardia, K.D. Author-Name: Stewart, F. Author-Name: Wilson, T.G. Author-Name: Wysocki, S. Author-Name: Strauss, M. Year: 1995 Volume: 85 Issue: 4 Pages: 494-503 Abstract: Objectives. The purpose of the study was to determine the clinical and economic impact of alternative contraceptive methods. Methods. Direct medical costs (method use, side effects, and unintended pregnancies) associated with 15 contraceptive methods were modeled from the perspectives of a private payer and a publicly funded program. Cost data were drawn from a national claims database and Medi-Cal. The main outcome measures included 1-year and 5-year costs and number of pregnancies avoided compared with use of no contraceptive method. Results. All 15 contraceptives were more effective and less costly than no method. Over 5 years, the copper-T IUD, vasectomy, the contraceptive implant, and the injectable contraceptive were the most cost- effective, saving $14 122, $13 899, $13 813, and $13 373, respectively, and preventing approximately the same number of pregnancies (4.2) per person. Because of their high failure rates, barrier methods, spermicides, withdrawal, and periodic abstinence were costly but still saved from $8933 to $12 239 over 5 years. Oral contraceptives fell between these groups, costing $1784 over 5 years, saving $12 879, and preventing 4.1 pregnancies. Conclusions. Contraceptives save health care resources by preventing unintended pregnancies. Up-front acquisition costs are inaccurate predictors of the total economic costs of competing contraceptive methods. Handle: RePEc:aph:ajpbhl:1995:85:4:494-503_9 Template-Type: ReDIF-Article 1.0 Title: Characteristics of repeat trauma patients, San Diego County Journal: American Journal of Public Health Author-Name: Hedges, B.E. Author-Name: Dimsdale, J.E. Author-Name: Hoyt, D.B. Author-Name: Berry, C. Author-Name: Leitz, K. Year: 1995 Volume: 85 Issue: 7 Pages: 1008-1010 Abstract: Data on 22 312 admissions to the San Diego County Trauma System were used to identify 185 trauma patients admitted repeatedly to trauma units. These patients were compared with the entire group of nonrepeating trauma patients admitted during the 80-month period of the study. In comparison with nonrepeaters, the repeaters were younger, were more often men, were more often Black, and were much more frequently victims of assault. Forty-eight percent of the repeaters were injured by the same general mechanism on both admissions. Handle: RePEc:aph:ajpbhl:1995:85:7:1008-1010_0 Template-Type: ReDIF-Article 1.0 Title: Health services access and use among older adults in north carolina: Urban vs rural residents Journal: American Journal of Public Health Author-Name: Blazer, D.G. Author-Name: Landerman, L.R. Author-Name: Fillenbaum, G. Author-Name: Horner, R. Year: 1995 Volume: 85 Issue: 10 Pages: 1384-1390 Abstract: Objectives. This study compared health service use and satisfaction with health care among older adults living in urban vs rural counties in North Carolina. Methods. A stratified random sample of 4162 residents of one urban and four rural counties of North Carolina was surveyed to determine urban/rural variation in inpatient and outpatient health service use, continuity of care and satisfaction with care, and barriers (transportation, cost) to care. Results. Inpatient and outpatient service use did not vary by residence in controlled analyses. Continuity of care was more frequent in rural counties. Transportation was not perceived as a barrier to health care more frequently in rural than in urban counties, but cost was a greater barrier to care among rural elderly people. Conclusions. In this sample, older persons living in rural counties within reasonable driving distance of urban counties with major medical centers used health services as frequently and were as satisfied with their health care as persons in urban counties. Cost of care, however, was a significant and persistent barrier among rural elderly people, despite Medicare coverage. Handle: RePEc:aph:ajpbhl:1995:85:10:1384-1390_8 Template-Type: ReDIF-Article 1.0 Title: Care denied: US residents who are unable to obtain needed medical services Journal: American Journal of Public Health Author-Name: Himmelstein, D.U. Author-Name: Woolhandler, S. Year: 1995 Volume: 85 Issue: 3 Pages: 341-344 Abstract: Objectives. This study analyzed data on US residents reporting that they were unable to obtain needed care. Inadequately immunized children and women inadequately screened for breast or cervical cancer were also examined. Methods. Data from the 1987 National Medical Expenditure Survey was analyzed. Results. A total of 6 375 000 (90% confidence interval [CI] = 6 039 000, 6 711 000) people could not get hospitalization, prescription medications, medical equipment/supplies, or emergency, pediatric, mental health, or home care. Although the uninsured were more likely to forego care unavailable, three quartets of those unable to obtain services were insured, and 46% (90% CI = 42.4%, 49.6%) had private coverage. Of those reporting the reason why they failed to obtain care, 65.1% (90% CI = 61.7%, 68.6%) listed high costs or lack of insurance, including 60.7% (90% CI = 57.1%, 64.3%) of the privately insured. More than a third of women had not had a breast examination in the previous 2 years, a fifth had not had a Pap smear within the previous 4 years, and half had never had a mammogram (ages 50-69 only). Of children 2 to 5 years old, 35.1% (90% CI = 31.5%, 35.7%) were inadequately immunized. Medicaid recipients had measures of access to care similar to those of the uninsured. Conclusions. Many US residents-most of whom have insurance-are unable to obtain needed care, usually because of high costs. Handle: RePEc:aph:ajpbhl:1995:85:3:341-344_9 Template-Type: ReDIF-Article 1.0 Title: Macronutrient intakes among adult Hispanics: A comparison of Mexican Americans, Cuban Americans, and mainland Puerto Ricans Journal: American Journal of Public Health Author-Name: Loria, C.M. Author-Name: Bush, T.L. Author-Name: Carroll, M.D. Author-Name: Looker, A.C. Author-Name: McDowell, M.A. Author-Name: Johnson, C.L. Author-Name: Sempos, C.T. Year: 1995 Volume: 85 Issue: 5 Pages: 684-689 Abstract: Objectives. The purpose of this study was to compare energy and macronutrient intakes between adult Mexican Americans, Cuban Americans, mainland Puerto Ricans, and non-Hispanics. Methods. Age-specific mean intakes were estimated based on 24-hour recalls from the Hispanic Health and Nutrition Examination Survey (HHANES) (1982 to 1984) and the Second National Health and Nutrition Examination Survey (NHANES II) (1976 to 1980) and were compared with the use of t tests. Results. Mexican Americans had higher total fat, saturated fat, and monounsaturated fat intakes than did Puerto Ricans and older Cuban Americans. Cuban Americans and Puerto Ricans had similar intakes, except for younger Cuban Americans, who had higher total and saturated fat and lower carbohydrate intakes. Cholesterol intakes among Mexican American men and 60- to 74-year-old women were higher than those among other Hispanic groups. Carbohydrate and protein intakes were higher among Hispanic groups compared with those among nonHispanics while total fat intakes were generally lower. Conclusions. Since macronutrient intakes differ between Hispanic groups, dietary research, recommendations, and interventions should be targeted to each group individually. Older Puerto Rican and Cuban American adults met population guidelines for reducing chronic disease risk for more macronutrients than any other group. Handle: RePEc:aph:ajpbhl:1995:85:5:684-689_7 Template-Type: ReDIF-Article 1.0 Title: Socioeconomic differences in sexually transmitted disease rates among Black and White adolescents, San Francisco, 1990 to 1992 Journal: American Journal of Public Health Author-Name: Ellen, J.M. Author-Name: Kohn, R.P. Author-Name: Bolan, G.A. Author-Name: Shiboski, S. Author-Name: Krieger, N. Year: 1995 Volume: 85 Issue: 11 Pages: 1546-1548 Abstract: This paper examines the effect of socioeconomic position on the differences in the 3-year rates (1990 to 1992) of reported cases of gonorrhea and chlamydia between Black and White adolescents, aged 12 to 20 years, residing in San Francisco. The crude relative risks for Blacks were 23.4 (95% confidence interval [CI] = 20.4, 27.8) for gonorrhea and 9.3 (95% CI = 8.3, 10.3) for chlamydia. Adjusting for poverty and occupational status, the relative risks were 28.7 (95% CI = 22.5, 36.1) for gonorrhea and 8.9 (95% CI = 7.4, 10.6) for chlamydia. This study demonstrates that factors other than poverty and occupational status account for the racial/ethnic differences in the rates of gonorrhea and chlamydia among adolescents in San Francisco. Handle: RePEc:aph:ajpbhl:1995:85:11:1546-1548_2 Template-Type: ReDIF-Article 1.0 Title: Vitamin A capsule supplementation in Malawi villages: Missed opportunities and possible interventions Journal: American Journal of Public Health Author-Name: Berger, R.A. Author-Name: Courtright, P. Author-Name: Barrows, J. Year: 1995 Volume: 85 Issue: 5 Pages: 718-719 Abstract: A population-based survey was used to assess childhood and maternal vitamin A capsule coverage in Malawi and to investigate missed opportunities for capsule distribution. Overall, 9.3% of children had received vitamin A supplementation in the previous 6 months. Missed opportunities for receiving vitamin A were high in younger children. Fifty-five percent of mothers were covered in 8 villages served by volunteers and 23% in the 58 villages without volunteers. Existing strategies need to be redesigned and new strategies defined. For instance, mothers could receive supplementation during infant BCG vaccination, and children could receive initial supplementation during measles vaccination. Village health volunteers could be used to target children over 2 years of age. Handle: RePEc:aph:ajpbhl:1995:85:5:718-719_1 Template-Type: ReDIF-Article 1.0 Title: Child morbidity and mortality following vitamin A supplementation in Ghana: Time since dosing, number of doses, and time of year Journal: American Journal of Public Health Author-Name: Ross, D.A. Author-Name: Kirkwood, B.R. Author-Name: Binka, F.N. Author-Name: Arthur, P. Author-Name: Dollimore, N. Author-Name: Morris, S.S. Author-Name: Shier, R.P. Author-Name: Gyapong, J.O. Author-Name: Smith, P.G. Year: 1995 Volume: 85 Issue: 9 Pages: 1246-1251 Abstract: Objectives. The impact of large, dose vitamin A supplementation given at intervals of 4 months on child mortality and morbidity was examined according to the time interval since dosing, number of doses received previously, and time of year. Methods. Two double-blind, randomized, placebo-controlled trials of large doses of vitamin A administered at intervals of 4 months were conducted in adjacent populations in northern Ghana. Results. While vitamin A supplementation significantly reduced the overall incidence of severe illnesses (especially diarrhea with dehydration), clinic attendances, hospital admissions, and mortality, there was no evidence that the impact of each dose of vitamin A was related to the number of doses the child had received previously. There was no evidence that the effectiveness of the supplement waned over the 3 to 5 months between doses. The impact on mortality did not differ significantly by the month in which the supplement had been given. Conclusions. In the study population, there was no evidence that an interval between doses of less than 4 months would have had a greater impact on severe morbidity or mortality, and the effectiveness of supplementation did not vary by time of year. Handle: RePEc:aph:ajpbhl:1995:85:9:1246-1251_8 Template-Type: ReDIF-Article 1.0 Title: Editorial: Agent Orange in Vietnam Journal: American Journal of Public Health Author-Name: Dwyer, J.H. Author-Name: Flesch-Janys, D. Year: 1995 Volume: 85 Issue: 4 Pages: 476-478 Handle: RePEc:aph:ajpbhl:1995:85:4:476-478_4 Template-Type: ReDIF-Article 1.0 Title: Vaccine use and the risk of outbreaks in a sample of nursing homes during an influenza epidemic Journal: American Journal of Public Health Author-Name: Arden, N. Author-Name: Monto, A.S. Author-Name: Ohmit, S.E. Year: 1995 Volume: 85 Issue: 3 Pages: 399-401 Abstract: This study was conducted in nursing homes in a seven-county area of lower Michigan. Seventy percent of the 83 nursing homes in the study area provided data on vaccine use. Significantly higher rates of vaccination were found in smaller vs larger nursing homes; a requirement of written informed consent lowered the frequency of vaccination among residents. Among a subset of 45 homes that collected weekly prospective illness data during the confirmed epidemic of influenza A(H3N2), 17 (38%) experienced an influenza outbreak. In bivariate analyses, both greater size of nursing home and lower frequency of vaccination were significant predictors of outbreak status, suggesting a role for indirect protection or herd immunity. Handle: RePEc:aph:ajpbhl:1995:85:3:399-401_9 Template-Type: ReDIF-Article 1.0 Title: Improving the E coding of hospitalizations for injury: Do hospital records contain adequate documentation? Journal: American Journal of Public Health Author-Name: Langlois, J.A. Author-Name: Buechner, J.S. Author-Name: O'Connor, E.A. Author-Name: Nacar, E.Q. Author-Name: Smith, G.S. Year: 1995 Volume: 85 Issue: 9 Pages: 1261-1265 Abstract: Objectives. Incomplete external cause of injury (E) coding limits the usefulness of hospital discharge data sets for injury surveillance and research. Hospital medical records were examined to determine whether they contained adequate cause of injury documentation to allow for more complete E coding of injury discharges. Methods. Medical records for a sample of discharges involving a principal diagnosis of injury from the Uniform Hospital Discharge Data Set for Rhode Island were selected. We assigned E codes to these discharges and compared our E codes with those of the discharge data set. Results. Documentation of cause of injury in the medical records was sufficient to allow assignment of a specific E code to 70% of the injuries for which no E codes or vague E codes were submitted on the Uniform Hospital Discharge Data Set. It was estimated that specific cause of injury documentation is available in the medical records of 80% of all injury discharges in Rhode Island; for approximately 90%, an E code describing at least the broad cause of injury could be assigned. Conclusions. Rates of E coding can be substantially increased by making better use of existing documentation in medical records. Handle: RePEc:aph:ajpbhl:1995:85:9:1261-1265_1 Template-Type: ReDIF-Article 1.0 Title: The epidemiology of vulvovaginal candidiasis among university students Journal: American Journal of Public Health Author-Name: Geiger, A.M. Author-Name: Foxman, B. Author-Name: Gillespie, B.W. Year: 1995 Volume: 85 Issue: 8 Pages: 1146-1148 Abstract: Vulvovaginal candidiasis affects approximately 20% of women annually, but it is not well characterized epidemiologically. Of 1027 respondents to two mailed cross-sectional surveys at a large university, 37.5% reported a prior clinical diagnosis of vulvovaginal candidiasis. The frequency of first diagnosis increased rapidly after age 17, with an estimated 54.7% of women experiencing the condition by age 25. In a proportional hazards model of age at first diagnosis, vulvovaginal candidiasis was associated with initiation of sexual activity (rate ratio [RR] = 2.9; 95% confidence interval [CI] = 2.2, 3.8), oral contraceptive use (RR = 1.7; CI = 1.4, 2.2), and White (RR = 3.1; CI = 1.7, 5.7) and Black (RR = 5.9; CI = 3.0, 11.5) race vs Asian. Handle: RePEc:aph:ajpbhl:1995:85:8:1146-1148_4 Template-Type: ReDIF-Article 1.0 Title: Syphilis and gonorrhea in Miami: Similar clustering, different trends Journal: American Journal of Public Health Author-Name: Hamers, F.F. 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: 1995 Volume: 85 Issue: 8 Pages: 1104-1108 Abstract: During the second half of the 1980s, Miami had a syphilis epidemic while gonorrhea rates decreased. To determine whether the direction of these trends truly differed within all population subgroups or whether they resulted from aggregating groups within which trends were similar, records from four sexually transmitted disease clinics from 1986 to 1990 and census data from 1990 were used to compare race-, sex-, age-, and zip code-specific groups. Syphilis and gonorrhea clustering was similar; 50% of cases occurred in the same zip codes, representing 10% of the population. In all groups, gonorrhea decreased (aggregate 48%) while syphilis first increased (aggregate 47%) and then decreased. Determining reasons for these different trends may facilitate controlling these diseases. Handle: RePEc:aph:ajpbhl:1995:85:8:1104-1108_6 Template-Type: ReDIF-Article 1.0 Title: Sociodemographic characteristics and sexual behavior of bisexual men in France: Implications for HIV prevention Journal: American Journal of Public Health Author-Name: Messiah, A. Author-Name: Mouret-Fourme, E. Author-Name: Spira, A. Author-Name: Bajos, N. Author-Name: Bejin, A. Author-Name: Beltzer, N. Author-Name: Bozon, M. Author-Name: Ducot, B. Author-Name: Durandeau, A. Author-Name: Ferrand, A. Author-Name: Giami, A. Author-Name: Gilloire, A. Author-Name: Giraud, M. Author-Name: Leridon, H. Author-Name: Ludwig, D. Author-Name: Messiah, A. Author-Name: Moatti, J.-P. Author-Name: Mounnier, L. Author-Name: Olomucki, H. Year: 1995 Volume: 85 Issue: 11 Pages: 1543-1546 Abstract: The French National Survey on Sexual Behavior was used to identify sociodemographic characteristics and sexual behavior of bisexually active men, as distinct from both homosexually and heterosexually active men. In regard to number of partners and frequency of unprotected vaginal sex, bisexuals were similar to multipartnered hcterosexuals. On sociodemographic criteria, they differed from both homosexuals and heterosexuals. Bisexual men reported fewer partners than homosexuals but seemed more likely to engage in risk behavior related to the acquired immunodeficiency syndrome (AIDS), and they were less likely to have ever had a human immunodeficiency virus (HIV) test. These results justify prevention efforts specially adapted for bisexuals. Handle: RePEc:aph:ajpbhl:1995:85:11:1543-1546_7 Template-Type: ReDIF-Article 1.0 Title: Sociocultural factors in the use of prenatal care by Hmong women, Minneapolis Journal: American Journal of Public Health Author-Name: Spring, M.A. Author-Name: Ross, P.J. Author-Name: Etkin, N.L. Author-Name: Deinard, A.S. Year: 1995 Volume: 85 Issue: 7 Pages: 1015-1017 Abstract: Understanding the sociocultural context of prenatal care underuse by an immigrant population can suggest programmatic changes that result in more effective health care delivery. Ethnographic survey interviews of female Hmong clinic patients conducted in 1987/88 revealed that they objected to biomedical procedures and to being attended by several doctors; the women also reported poor communication with staff as a problem. Clinic reforms implemented in 1989/90 included hiring a nurse-midwife, reducing the number of pelvic examinations, expanding hours of operation, creating a direct telephone line to Hmong interpreters, and producing a Hmong-language prenatal health care education videotape. Women interviewed in 1993 reported a more positive clinic experience. Handle: RePEc:aph:ajpbhl:1995:85:7:1015-1017_8 Template-Type: ReDIF-Article 1.0 Title: Estimating the costs of substance abuse to the Medicaid hospital care program Journal: American Journal of Public Health Author-Name: Fox, K. Author-Name: Merrill, J.C. Author-Name: Chang, H.-H. Author-Name: Califano Jr., J.A. Year: 1995 Volume: 85 Issue: 1 Pages: 48-54 Abstract: Objectives. The purpose of this study was to develop a model, using the epidemiologic tool of attributable risk, for estimating the cost of substance abuse to Medicaid. Methods. Based on prior sub-stance-use and morbidity research, population attributable risks for substance abuse-related diseases were calculated. (These risks measure the proportion of total disease cases attributable to smoking, drinking, and drug use.) The risks for each disease were applied to Medicaid hospital discharges and days on the 1991 National Hospital Discharge Survey that had these diseases as primary diagnoses. The cost of these substance abuse-related days were added to Medicaid hospital costs for direct treatment of Substance abuse. Results. More than 60 medical conditions involving 1100 diagnoses were identified, at least in part, as attributable to substance abuse. Factoring these substance abuse-related conditions into hospital costs, 1 out of 5 Medicaid hospital days, or 4 million days, were spent on substance abuse-related care in 1991. In 1994, this would account for almost $8 billion in Medicaid expenditures. Conclusions. The use of tobacco, alcohol, and drugs contributes significantly to hospital costs. To address rising costs, substance abuse treatment and prevention should be an integral part of any health care reform effort. Handle: RePEc:aph:ajpbhl:1995:85:1:48-54_7 Template-Type: ReDIF-Article 1.0 Title: Weight concerns and change in smoking behavior over two years in a working population Journal: American Journal of Public Health Author-Name: French, S.A. Author-Name: Jeffery, R.W. Author-Name: Klesges, L.M. Author-Name: Forster, J.L. Year: 1995 Volume: 85 Issue: 5 Pages: 720-722 Abstract: The hypothesis that weight concerns are related to less successful smoking cessation and greater relapse among ex-smokers was prospectively evaluated. A population-based sample of 4981 working women and men 17 to 71 years of age was surveyed at 32 work sites. Current and previous weight loss efforts and smoking behavior were self-reported at baseline and 2 years later. Dieting and weight concerns were unrelated to smoking cessation or relapse. However, female smokers who had previously participated in a formal weight control program were three times more likely to quit smoking than those without a history of participation 125% vs 11%; odds ratio = 3.25. 95% confidence interval = 1.86. 5.67). Weight concerns and dieting efforts do not appear to inhibit smoking cessation or increase relapse in adults. Handle: RePEc:aph:ajpbhl:1995:85:5:720-722_2 Template-Type: ReDIF-Article 1.0 Title: Evaluating food fortification options: General principles revisited with folic acid Journal: American Journal of Public Health Author-Name: Crane, N.T. Author-Name: Wilson, D.B. Author-Name: Cook, D.A. Author-Name: Lewis, C.J. Author-Name: Yetley, E.A. Author-Name: Rader, J.I. Year: 1995 Volume: 85 Issue: 5 Pages: 660-666 Abstract: Objectives. This article uses folic acid as an example to illustrate some of the complex issues and general principles that emerge when evaluating fortification of the food supply as one possible means to address a public health recommendation. Method. Distributions of current daily folate intakes from conventional foods and dietary supplements were estimated. Intakes that might result from fortification of cereal grain products and ready-to-eat cereals at various levels for eight age-gender groups were also estimated by using the US Department of Agriculture's 1987-1988 Nationwide Food Consumption Survey. Results. The results illustrate that fortification of the US food supply tends to increase folate intakes of consumers at the high end of the intake distribution curves in the general population to a greater extent than it affects consumers at the low end of the intake distribution curves in the target population. Conclusions. The effectiveness of food fortification options for a target population and the safety for the general population impose conflicting challenges that must be considered concurrently when making decisions about fortifying the US food supply. Handle: RePEc:aph:ajpbhl:1995:85:5:660-666_9 Template-Type: ReDIF-Article 1.0 Title: Farm-related fatalities among children in California, 1980 to 1989 Journal: American Journal of Public Health Author-Name: Schenker, M.B. Author-Name: Lopez, R. Author-Name: Wintemute, G. Year: 1995 Volume: 85 Issue: 1 Pages: 89-92 Abstract: To evaluate farm-related deaths among children in California and to identify specific risk factors, this study used death certificate tapes to identify 40 farm-related deaths among children under age 15 in California for 1980 to 1989. Mortality rates and odds ratios for cause-specific unintentional farm deaths were calculated. While California's farm-related mortality rate was lower than those in the midwestern states studied, the rate for Hispanic boys was 70% higher than that for non-Hispanics. The odds of death from machinery (81.3), animals (10.1), electricity (5.2), and nontraffic motor vehicles (3.4) were significantly greater than those in nonfarm locations; those from drowning were significantly lower (0.2). Specific factors associated with the lower California mortality rate need to be identified. Handle: RePEc:aph:ajpbhl:1995:85:1:89-92_0 Template-Type: ReDIF-Article 1.0 Title: Drug regulation and drug information--who should do what to whom? Journal: American Journal of Public Health Author-Name: Avorn, J. Year: 1995 Volume: 85 Issue: 1 Pages: 18-19 Handle: RePEc:aph:ajpbhl:1995:85:1:18-19_6 Template-Type: ReDIF-Article 1.0 Title: Condom use among female commercial sex workers in Nevada's legal brothels Journal: American Journal of Public Health Author-Name: Albert, A.E. Author-Name: Warner, D.L. Author-Name: Hatcher, R.A. Author-Name: Trussell, J. Author-Name: Bennett, C. Year: 1995 Volume: 85 Issue: 11 Pages: 1514-1520 Abstract: Objectives. The purpose of this study was to evaluate condom use and the incidence of breakage and slippage during vaginal intercourse among female prostitutes in legal Nevada brothels, where use of condoms is required by law. Methods. Forty-one licensed prostitutes in three brothels were enrolled in a prospective trial in August 1993. Used condoms were collected to verify reported breaks visually. Retrospective breakage and slippage rates were obtained in a standardized interview. Results. Condoms were used for every act of vaginal intercourse with a brothel client during the study period, as well as in the previous year. In the prospective study phase, condoms were used in 353 acts of vaginal intercourse with clients. No condoms broke, and none fell off the penis during intercourse. Only twice (0.6%) did condoms completely fall off during withdrawal. Twelve times (3.4%) during intercourse and 15 times (4.3 %) during withdrawal, condoms slipped down the penis but did not fall off. Conclusions. These findings, among the lowest breakage and slippage rates published, suggest that regular condom use may lead to condom mastery and the development of techniques to reduce the likelihood of breakage and slippage. Handle: RePEc:aph:ajpbhl:1995:85:11:1514-1520_0 Template-Type: ReDIF-Article 1.0 Title: Cancer mortality risk among military participants of a 1958 atmospheric nuclear weapons test Journal: American Journal of Public Health Author-Name: Watanabe, K.K. Author-Name: Kang, H.K. Author-Name: Dalager, N.A. Year: 1995 Volume: 85 Issue: 4 Pages: 523-527 Abstract: Objective. This study was undertaken to determine if Navy veterans who participated in an atmospheric nuclear test in 1958 were at increased risk of death from certain cancers. Methods. Cancer mortality risk of 8554 Navy veterans who participated in an atmospheric nuclear test in the Pacific was compared with that of 14 625 Navy veterans who did not participate in any test. Radiation dosage information was obtained from film badges for 88% of the test participants. Results. The median radiation dose for the test participants was 388 mrem (3.88 millisieverts [mSv]). Among participants who received the highest radiation dose (>1000 mrem, or 10 mSv), an increased mortality risk for all causes (relative risk [RR] = 1.23; 95% confidence interval [CI] = 1.04, 1.45), all cancers (RR = 1.42; 95% CI: = 1.03, 1.96), and liver cancer (RR = 6.42; 95% CI = 1.17, 35.3) was observed. The risk for cancer of the digestive organs was elevated among test participants (rate ratio = 1.47; 95% CI = 1.06, 2.04) but with no significant dose-response trend. Many of the cancers of a priori interest were not significantly elevated in the overall test participant group or in the group that received the highest radiation dose. Conclusions. Most of the cancers suspected of being radiogenic were not significantly elevated among the test participants. Nevertheless, increased risks for certain cancers cannot be ruled out at this time. Veterans who participated in the nuclear weapons tests should continue to be monitored. Handle: RePEc:aph:ajpbhl:1995:85:4:523-527_3 Template-Type: ReDIF-Article 1.0 Title: The effectiveness of alternative planned durations of residential drug abuse treatment Journal: American Journal of Public Health Author-Name: McCusker, J. Author-Name: Vickers-Lahti, M. Author-Name: Stoddard, A. Author-Name: Hindin, R. Author-Name: Bigelow, C. Author-Name: Zorn, M. Author-Name: Garfield, F. Author-Name: Frost, R. Author-Name: Love, C. Author-Name: Lewis, B. Year: 1995 Volume: 85 Issue: 10 Pages: 1426-1429 Abstract: Randomized controlled trials were conducted at two residential drug abuse treatment facilities to compare programs that differed in planned duration. One trial compared a 6-month and a 12-month therapeutic community program (n = 184), and the second compared a 3-month and a 6-month relapse prevention program (n = 444). Retention rates over comparable time periods differed minimally by planned treatment duration, and the longer programs had lower completion rates. There was no effect in either trial of planned treatment duration on changes in psychosocial variables between admission and exit or on rates or patterns of drug use at follow-up between 2 and 6 months after exit. Handle: RePEc:aph:ajpbhl:1995:85:10:1426-1429_6 Template-Type: ReDIF-Article 1.0 Title: What if Americans drank less? The potential effect on the prevalence of alcohol abuse and dependence Journal: American Journal of Public Health Author-Name: Archer, L. Author-Name: Grant, B.F. Author-Name: Dawson, D.A. Year: 1995 Volume: 85 Issue: 1 Pages: 61-66 Abstract: Objectives. Several advisory committees have recently recommended that alcohol consumption be limited to moderate levels. Moderate drinking has been defined generally as not more than two drinks per day for healthy men and not more than one drink per day for healthy, nonpregnant women. The impact of reducing alcohol consumption to within the recommended guidelines on the prevalence of two serious alcohol-related problems was examined by modeling the relationship between average daily ethanol intake and alcohol abuse and dependence. Methods. The recommended drinking guidelines, both in their existing form and modified by a measure of impairment, were applied to the observed distribution of consumption derived from a large representative survey of the US general population. Results. The results demonstrated that restricting drinking to the maximum allowable levels under the existing and the modified guidelines would reduce the prevalence of alcohol abuse and dependence by 14.2% and 47.1%, respectively, in the adult US general population. Conclusions. Implications of these findings are discussed in terms of the validity of the assumptions underlying the models and the nature and direction of future research that would form the basis of newly developed guidelines for safe drinking limits. Handle: RePEc:aph:ajpbhl:1995:85:1:61-66_4 Template-Type: ReDIF-Article 1.0 Title: Renal failure among male Hispanics in the United States Journal: American Journal of Public Health Author-Name: Chiapella, A.P. Author-Name: Feldman, H.I. Year: 1995 Volume: 85 Issue: 7 Pages: 1001-1004 Abstract: This study examined epidemiologic patterns and time trends among male patients with Hispanic surnames in the Medicare End-Stage Renal Disease Program and compared US Hispanics with non-Hispanic Blacks and Whites. Male Hispanics had substantially higher proportions of end-stage renal disease attributed to diabetes than did Blacks and Whites. There were notable regional differences among Hispanics. Between 1980 and 1990, the incidence of treated renal failure among Hispanics increased more than that among Blacks or Whites. The increasing number of Hispanics in the United States with end- stage renal disease emphasizes the importance of explicit health evaluations and prevention strategies for Hispanic populations. Handle: RePEc:aph:ajpbhl:1995:85:7:1001-1004_6 Template-Type: ReDIF-Article 1.0 Title: Should college students be vaccinated against meningococcal disease? A cost-benefit analysis Journal: American Journal of Public Health Author-Name: Jackson, L.A. Author-Name: Schuchat, A. Author-Name: Gorsky, R.D. Author-Name: Wenger, J.D. Year: 1995 Volume: 85 Issue: 6 Pages: 843-845 Abstract: Outbreaks and sporadic cases of meningococcal disease among college students have prompted consideration of a policy of routine vaccination for this group. Purchase and administration of the vaccine for routine vaccination would cost $56 million per year. Savings in medical care and indirect costs would not equal this amount unless the annual rate of disease among students is at least 6.5/100 000. The actual rate among students is unknown; however, surveillance data suggest it could not be more than 1.3/100 000. At rates near this estimate, the net cost of the program would be approximately $45 million annually. More cost-effective prevention strategies might be yielded by further studies to identify students at substantial risk of meningococcal disease, or by the development of a conjugate serogroup C vaccine that could be administered during infancy. Handle: RePEc:aph:ajpbhl:1995:85:6:843-845_6 Template-Type: ReDIF-Article 1.0 Title: Access to hospitals with high-technology cardiac services: How is race important? Journal: American Journal of Public Health Author-Name: Blustein, J. Author-Name: Weitzman, B.C. Year: 1995 Volume: 85 Issue: 3 Pages: 345-351 Abstract: Objectives. Relatively few hospitals in the United States offer high- technology cardiac services (cardiac catheterization, bypass surgery, or angioplasty). This study examined the association between race and admission to a hospital offering those services. Methods. Records of 11 410 patients admitted with acute myocardial infarction to hospitals in New York State in 1986 were analyzed. Results. Approximately one third of both White and Black patients presented to hospitals offering high-technology cardiac services. However, in a multivariate model adjusting for home-to-hospital distance, the White-to-Black odds ratio for likelihood of presentation to such a hospital was 1.68 (95% confidence interval = 1.42, 1.98). This discrepancy between the observed and 'distance-adjusted' probabilities reflected three phenomena: (1) patients presented to nearby hospitals; (2) Blacks were more likely to live near high-technology hospitals; and (3) there were racial differences in travel patterns. For example, when the nearest hospitals did not include a high-technology hospital, Whites were more likely than Blacks to travel beyond those nearest hospitals to a high-technology hospital. Conclusions. Whites and Blacks present equally to hospitals offering high-technology cardiac services at the time of acute myocardial infarction. However, there are important underlying racial differences in geographic proximity and tendencies to travel to those hospitals. Handle: RePEc:aph:ajpbhl:1995:85:3:345-351_2 Template-Type: ReDIF-Article 1.0 Title: The epidemiology of walking for exercise: Implications for promoting activity among sedentary groups Journal: American Journal of Public Health Author-Name: Siegel, P.Z. Author-Name: Brackbill, R.M. Author-Name: Heath, G.W. Year: 1995 Volume: 85 Issue: 5 Pages: 706-710 Abstract: The relative contribution of walking to overall leisure-time physical activity participation rates was studied among respondents from the 45 states that participated in the 1990 Behavioral Risk Factor Surveillance System (n = 81 557). The percentages of low income, unemployed, and obese persons who engaged in leisure-time physical activity (range = 51.1% to 57.7%) were substantialIy lower than the percentage among the total adult population (70.3%). In contrast, the prevalence of walking for exercise among these sedentary groups (range = 32.5% to 35.9%) was similar to that among the total population (35.6%). Walking appears to be an acceptable, accessible exercise activity, especially among population subgroups with a low prevalence of leisure-time physical activity. Handle: RePEc:aph:ajpbhl:1995:85:5:706-710_3 Template-Type: ReDIF-Article 1.0 Title: Research on the effects of prenatal alcohol exposure--a new direction. Journal: American Journal of Public Health Author-Name: Day, N.L. Year: 1995 Volume: 85 Issue: 12 Pages: 1614-1615 DOI: 10.2105/AJPH.85.12.1614 File-URL: http://hdl.handle.net/10.2105/AJPH.85.12.1614 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.85.12.1614_1 Template-Type: ReDIF-Article 1.0 Title: Estimating mortality in the Hispanic population of Connecticut, 1990 to 1991 Journal: American Journal of Public Health Author-Name: Polednak, A.P. Year: 1995 Volume: 85 Issue: 7 Pages: 998-1001 Abstract: Among all deaths to Connecticut residents (1990/91), 1260 were acceptable Spanish-surname matches (using father's surname for females), of which only 793 (62.9%) were identified as Hispanic origin on the death certificate. Certificates also identified 127 non-Spanish-surnamed Hispanics. With death rates for non-Hispanics used as the standard, the standardized mortality ratio for Hispanics based on the 920 (793 plus 127) deaths identified by the Hispanic-origin item was lower (by 33% in males and 36% in females) than that based on all 1387 (1260 plus 127) Hispanics. Spanish-surname matching should improve estimation of mortality rates in some Hispanic populations. Handle: RePEc:aph:ajpbhl:1995:85:7:998-1001_3 Template-Type: ReDIF-Article 1.0 Title: Tuberculosis knowledge among New York City injection drug users Journal: American Journal of Public Health Author-Name: Wolfe, H. Author-Name: Marmor, M. Author-Name: Maslansky, R. Author-Name: Nichols, S. Author-Name: Simberkoff, M. Author-Name: Jarlais, D.D. Author-Name: Moss, A. Year: 1995 Volume: 85 Issue: 7 Pages: 985-988 Abstract: Structured interviews measuring tuberculosis knowledge were administered to 494 New York City injection drug users, 31% of whom reported a history of having a reactire tuberculin skin test. Medical records review of a subsample confirmed the validity of self-reported data. Most respondents understood the mechanisms of tuberculosis transmission. Three fourths of the subjects did not fully understand the distinction between a reactive skin test and active tuberculosis, but those who reported a history of skin test reactivity were twice as likely to understand this distinction. Forty percent of subjects did not understand the importance of medication adherence. Misunderstanding, based on a recent lack of tuberculosis education, may contribute to the fear and confusion that interfere with efforts to control tuberculosis. Handle: RePEc:aph:ajpbhl:1995:85:7:985-988_2 Template-Type: ReDIF-Article 1.0 Title: Communitywide shigellosis: Control of an outbreak and risk factors in child day-care centers Journal: American Journal of Public Health Author-Name: Mohle-Boetani, J.C. Author-Name: Stapleton, M. Author-Name: Finger, R. Author-Name: Bean, N.H. Author-Name: Poundstone, J. Author-Name: Blake, P.A. Author-Name: Griffin, P.M. Year: 1995 Volume: 85 Issue: 6 Pages: 812-816+763 Abstract: Objectives. The study's objectives were to assess (1) control of a community outbreak of shigellosis through the promotion of handwashing, (2) risk factors in day-care centers, and (3) shigellosis attributable to attendance at a day-care center. Methods. In 1991, an outbreak of Shigella sonnei infections occurred in Lexington-Fayette County, Ky; 14 licensed child day-care centers were involved. Communitywide promotion of hand washing was instituted along with diarrhea surveillance. A case-control study compared day-care centers that had confirmed cases of shigellosis with centers that had none. A family transmission study determined those cases attributable to attendance at day-care centers. Results. The outbreak abated 3 weeks after the interventions' initiation. Day-care centers with outbreaks were more likely than those with no cases to have a food handler who changed diapers and to provide transportation for children from their homes to the center. These centers also had a higher toddler-to-toilet ratio than control centers (21 vs 12). In 58% of families with shigellosis, the first person with diarrhea during the outbreak was a child younger than 6 years; 92% of diarrheal illnesses among these children were attributable to day-care attendance. Conclusions. Community involvement in increasing hand washing most likely resulted in control of this shigellosis outbreak. Diarrhea prevention strategies in day-care centers could prevent substantial communitywide disease. Handle: RePEc:aph:ajpbhl:1995:85:6:812-816+763_6 Template-Type: ReDIF-Article 1.0 Title: Variation in the influence of selected sociodemographic risk factors for mental retardation Journal: American Journal of Public Health Author-Name: Drews, C.D. Author-Name: Yeargin-Allsopp, M. Author-Name: Decoufle, P. Author-Name: Murphy, C.C. Year: 1995 Volume: 85 Issue: 3 Pages: 329-334 Abstract: Objectives. This study explored the utility of subdividing mental retardation into groups based on the presence of other neurological conditions. Methods. Data were abstracted tiara birth certificates as part of a case-control study of mental retardation among 10-year-old children. The study sample included 458 case children and 563 control children selected from public schools. Case children were subdivided on the basis of intelligence quotient (IQ) score and the presence of other neurological conditions. Results. Other neurological conditions were more common with severe mental retardation than with mild mental retardation. Regardless of IQ level or the presence of other neurological conditions, boys were more likely than girls to have mental retardation. Older mothers were more likely than younger mothers to have a child with mental retardation accompanied by another neurological condition. High birth order, Black race, and low maternal education were associated with a higher prevalence of isolated mental retardation. Conclusions. These findings suggest that sociodemographic risk factors for mental retardation vary according to the presence of other neurological conditions and that subdivisions based on medical or physical criteria may be useful in epidemiologic studies of mental retardation. Handle: RePEc:aph:ajpbhl:1995:85:3:329-334_8 Template-Type: ReDIF-Article 1.0 Title: AIDS phobia, public health warnings, and lawsuits: Deterring harm or rewarding ignorance? Journal: American Journal of Public Health Author-Name: Mariner, W.K. Year: 1995 Volume: 85 Issue: 11 Pages: 1562-1568 Abstract: Courts in more than a dozen states have decided cases in which a person has claimed money damages for his or her fear of getting acquired immunodeficiency syndrome (AIDS). Although most courts have rejected such claims in the absence of actual exposure to the human immunodeficiency virus (HIV), their reasoning has varied slightly from state to state. This article argues that negligence law should not permit people who are HIV negative to recover damages for an unfounded fear of AIDS. Public health statements intended to educate the public about preventing HIV transmission may have encouraged some fear-of-AIDS lawsuits against health care practitioners. Although well intentioned, such statements have been used to justify inappropriate restrictions on medical practice and disclosure of a practitioner's HIV status. To avoid such misuse, such statements should be revised to make clear that the way in which procedures are performed, not who performs them, determines HIV transmission. Handle: RePEc:aph:ajpbhl:1995:85:11:1562-1568_9 Template-Type: ReDIF-Article 1.0 Title: Serial mass-media campaigns to promote physical activity: Reinforcing or redundant? Journal: American Journal of Public Health Author-Name: Owen, N. Author-Name: Bauman, A. Author-Name: Booth, M. Author-Name: Oldenburg, B. Author-Name: Magnus, P. Year: 1995 Volume: 85 Issue: 2 Pages: 244-248 Abstract: Changes associated with two serial, nationwide, mass-media-based campaigns to promote physical activity conducted by the National Heart Foundation of Australia in 1990 and 1991 were examined. Surveys conducted before and after each campaign found statistically significant differences in message awareness (46% vs 71% in 1990; 63% vs 74% in 1991). In 1990, there were significant increases in walking, particularly among older people, and in intentions to exercise. No such changes were apparent in 1991. In the case of these two campaigns, conducted 1 year apart, the second may have been redundant. Handle: RePEc:aph:ajpbhl:1995:85:2:244-248_5 Template-Type: ReDIF-Article 1.0 Title: Trends in cigarette smoking among US adolescents, 1974 through 1991 Journal: American Journal of Public Health Author-Name: Nelson, D.E. Author-Name: Giovino, G.A. Author-Name: Shopland, D.R. Author-Name: Mowery, P.D. Author-Name: Mills, S.L. Author-Name: Eriksen, M.P. Year: 1995 Volume: 85 Issue: 1 Pages: 34-40 Abstract: Objectives. The purpose of this study was to determine national trends in adolescent cigarette smoking prevalence. Methods. We conducted trend analyses based on 1974 through 1991 current smoking prevalence data among persons aged 12 through 19 years from the National Household Surveys on Drug Abuse, High School Seniors Surveys, and National Health Interview Surveys. Results. Overall smoking prevalence declined much more rapidly from 1974 through 1980 (1.9 percentage points annually among younger adolescents; the range among surveys of older adolescents was 0.2 to 2.0 percentage points annually) than from 1985 through 1991 (0 to 0.5 percentage points annually among all adolescents). Since 1980, smoking has generally declined at a slightly faster rate among older female adolescents than among male adolescents. Smoking among Black adolescents of all ages declined in nearly every survey population during each study period (range among surveys: 1974-1985 = 1.0 to 2.9 percentage points; 1985-1991 = 0.7 to 1.5 percentage points annually); for White adolescents, only minimal declines in smoking have occurred since 1985. Conclusions. Since 1974, major changes in adolescent smoking patterns have occurred, especially among Blacks. The overall slowing rate of decline in smoking prevalence since 1985 may indicate success of increased tobacco advertising and promotional activities targeted at adolescents or inadequate antitobacco education efforts. Handle: RePEc:aph:ajpbhl:1995:85:1:34-40_7 Template-Type: ReDIF-Article 1.0 Title: The role of psychological distress and personality in the incidence of sciatic pain among working men Journal: American Journal of Public Health Author-Name: Pietri-Taleb, F. Author-Name: Riihimaki, H. Author-Name: Viikari-Juntura, E. Author-Name: Lindstrom, K. Author-Name: Moneta, G.B. Year: 1995 Volume: 85 Issue: 4 Pages: 541-545 Abstract: Objectives. The role of personality characteristics and psychological distress in the incidence of sciatic pain was investigated in a 3-year prospective study. Methods. The study population consisted of 1149 Finnish men aged 25 through 49 years (387 machine operators, 336 carpenters, and 426 office workers) with no history of sciatic pain at the beginning of follow- up. The psychological distress and personality characteristics were assessed by the Middlesex Hospital Questionnaire and the Maudsley Personality Inventory. Results. The 3-year cumulative incidence rate for sciatic pain was 22% among the machine operators, 24% among the carpenters, and 14% among the office workers. The multivariate analysis of psychological factors, taking into account individual and occupational factors, showed that only hysteria was significantly associated with the incidence of sciatic pain among the blue-collar workers. Among the white-cellar workers, none of the psychological dimensions were associated with sciatic pain. Conclusions. These results are in accordance with previous relationships found between hysteria and low-back disorders. Further follow-up investigations are needed to elucidate the role of psychological factors in the occurrence of back problems. Handle: RePEc:aph:ajpbhl:1995:85:4:541-545_0 Template-Type: ReDIF-Article 1.0 Title: The antecedents of teen fatherhood: A retrospective case-control study of Great Britain youth Journal: American Journal of Public Health Author-Name: Dearden, K.A. Author-Name: Hale, C.B. Author-Name: Woolley, T. Year: 1995 Volume: 85 Issue: 4 Pages: 551-554 Abstract: Historically, researchers have focused on identifying risk factors for teen motherhood, largely ignoring teen fathers. This study uses the 1958 National Child Development Study of Great Britain to examine antecedents of teen fatherhood. Teen fathers were compared with later fathers and nonfathers by using epidemiological methods. Results indicate that boys who became fathers while in their teens were at increased risk for experiencing problems at home and at school and were more likely to demonstrate aggressive, truant, and law-breaking behaviors. Many of these risk factors were also evident among those who became fathers while in their early 20s. Handle: RePEc:aph:ajpbhl:1995:85:4:551-554_2 Template-Type: ReDIF-Article 1.0 Title: Company characteristics and workplace medical testing Journal: American Journal of Public Health Author-Name: Boden, L.I. Author-Name: Cabral, H. Year: 1995 Volume: 85 Issue: 8 Pages: 1070-1075 Abstract: Objectives. This study measures the relative impact of company economic characteristics and workplace hazards on the prevalence of several types of medical testing. It uses the results to assess likely public health impacts of testing. Methods. We used data on potential exposure to workplace hazards, medical testing, unionization, firm size, and turnover from the National Occupational Hazards Survey and the National Occupational Exposure Survey. Other sources provided industry-specific data on wages and turnover. Logistic regression analysis estimated the relationship of economic variables and workplace health risks to the prevalence of medical testing. Results. Economic variables were related to the prevalence of testing. However, consistent positive relationships were not found between health hazards and testing. Conclusions. Employers' testing decisions may not be beneficial to the health of workers and may shift the costs of illness to workers or other employers. Safer firms may provide too much medical testing, and firms that are less safe may provide too little. Handle: RePEc:aph:ajpbhl:1995:85:8:1070-1075_8 Template-Type: ReDIF-Article 1.0 Title: More on folic acid and neural tube defects Journal: American Journal of Public Health Author-Name: Werler, M.M. Author-Name: Mitchell, A.A. Year: 1995 Volume: 85 Issue: 2 Pages: 269 Handle: RePEc:aph:ajpbhl:1995:85:2:269_4 Template-Type: ReDIF-Article 1.0 Title: The key role of nurses in local health departments. Journal: American Journal of Public Health Author-Name: Suen, J.C. Author-Name: Christenson, G.M. Author-Name: Nicola, R.M. Year: 1995 Volume: 85 Issue: 1 Pages: 120-121 Handle: RePEc:aph:ajpbhl:1995:85:1:120-121_3 Template-Type: ReDIF-Article 1.0 Title: The impact of drug-related deaths on mortality among young adults in Madrid Journal: American Journal of Public Health Author-Name: De la Fuente, L. Author-Name: Barrio, G. Author-Name: Vicente, J. Author-Name: Bravo, M.J. Author-Name: Santacreu, J. Year: 1995 Volume: 85 Issue: 1 Pages: 102-105 Abstract: The trend from 1983 to 1990 of drug-related mortality (defined as the sum of deaths from acute drug reactions and the acquired immunodeficiency syndrome [AIDS] in drug users) among the population 15 to 39 years of age in Madrid, Spain, was studied and compared with mortality from all causes. All of the mortality rates increased from 1983 to 1990: all causes, from 101/100 000 to 148/100 000; acute drug reactions, from 3/100 000 to 15/100 000; and AIDS, from 0 to 20/100 000. Drug-related mortality represented 60% of the increase in the rate from all causes in males and 170% of the increase in females. The increases in drug-related mortality are likely to continue in the future. Handle: RePEc:aph:ajpbhl:1995:85:1:102-105_7 Template-Type: ReDIF-Article 1.0 Title: Does WIC participation improve breast-feeding practices? Journal: American Journal of Public Health Author-Name: Schwartz, J.B. Author-Name: Popkin, B.M. Author-Name: Tognetti, J. Author-Name: Zohoori, N. Year: 1995 Volume: 85 Issue: 5 Pages: 729-731 Abstract: The effects of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on breast-feeding behavior have been sometimes found inadequate. The determinants of breast-feeding initiation and duration among WIC participants and nonparticipants were modeled by using retrospective crosssectional data from the 1988 National Maternal and Infant Health Survey. This study corrects for self-selection bias as far as the data allow, in addition to controlling for parents' ages, education, race, and family income. Findings suggest that prenatal WIC participation, combined with breast-feeding advice, significantly increases the initiation of breastfeeding but does not affect duration. The exact nature of effective breastfeeding advice given prenatally at WIC clinics is unclear and warrants further research. Handle: RePEc:aph:ajpbhl:1995:85:5:729-731_1 Template-Type: ReDIF-Article 1.0 Title: Ambient air pollution and hospitalization for congestive heart failure among elderly people in seven large US cities Journal: American Journal of Public Health Author-Name: Morris, R.D. Author-Name: Naumova, E.N. Author-Name: Munasinghe, R.L. Year: 1995 Volume: 85 Issue: 10 Pages: 1361-1365 Abstract: Objectives. Preexisting data sets were used to investigate the association between hospital admissions for congestive heart failure and air pollutants. Methods. Medicare hospital admissions data, ambient air pollution monitoring data, and meteorological data were used to create daily values of hospital admissions for congestive heart failure, maximum hourly temperature, and maximum hourly levels of carbon monoxide, nitrogen dioxide, sulfur dioxide, and ozone. Data were compiled for each of seven cities (Chicago, Detroit, Houston, Los Angeles, Milwaukee, New York, and Philadelphia) for 1986 through 1989. Single-pollutant and multipollutant models with adjustments for temperature, seasonal effects, and weekly cycles were used in conducting negative binomial regression analyses. Results. Ambient carbon monoxide levels were positively associated with hospital admissions for congestive heart failure in the single-pollutant and multipollutant models for each of the seven cities. The relative risk of hospital admission for congestive heart failure associated with an increase of 10 ppm in carbon monoxide ranged from 1.10 in New York to 1.37 in Los Angeles. Conclusions. Hospital admissions for congestive heart failure exhibited a consistent association with daily variations in ambient carbon monoxide. This association was independent of season, temperature, and other major gaseous pollutants. Handle: RePEc:aph:ajpbhl:1995:85:10:1361-1365_0 Template-Type: ReDIF-Article 1.0 Title: Attitudes toward genetic testing for colon cancer risk Journal: American Journal of Public Health Author-Name: Smith, K.R. Author-Name: Croyle, R.T. Year: 1995 Volume: 85 Issue: 10 Pages: 1435-1438 Abstract: This study examined public interest regarding genetic testing for colon cancer susceptibility. Survey data were collected from 383 adults in Utah. Respondents were very (47.3%) or somewhat (36.6%) interested in taking this genetic test. Nearly 95 % reported that they would share their results with others. Individuals with higher income and with a perceived risk of getting colon cancer were the most interested in testing. Individuals without health insurance and widowed individuals were the least likely to share their test results. If respondents were told that they carried a gene for colon cancer, most would be concerned with how to reduce their risk of getting the disease. Handle: RePEc:aph:ajpbhl:1995:85:10:1435-1438_6 Template-Type: ReDIF-Article 1.0 Title: Infant mortality in the United States: Trends, differentials, and projections, 1950 through 2010 Journal: American Journal of Public Health Author-Name: Singh, G.K. Author-Name: Yu, S.M. Year: 1995 Volume: 85 Issue: 7 Pages: 957-964 Abstract: Objectives. This study examined long-term trends and differences in infant mortality in the United States from 1950 through 1991 according to race and ethnicity, education, family income, and cause of death. Forecasts are made through the year 2010. Methods. Log-linear regression models were applied to data from the National Vital Statistics System, National Linked Birth and Infant Death files, the National Maternal and Infant Health Survey, the National Natality Survey, and the National Infant Mortality Survey to model and forecast infant mortality. Results. Dramatic declines in the US infant mortality rate have occurred in the past 4 decades, largely as a result of declines in mortality from pneumonia and influenza, respiratory distress syndrome, prematurity and low birthweight, congenital anomalies, and accidents. Despite the overall reductions, however, substantial racial/ethnic, educational, and income differences in infant mortality still exist. Conclusions. The long-term downward trend in US infant mortality has not benefited Blacks and Whites equally. The Black/White disparity in infant mortality has not only persisted but increased over time and is not expected to diminish in the near future. Educational inequalities have also widened, and racial disparities have generally increased across all educational levels. Handle: RePEc:aph:ajpbhl:1995:85:7:957-964_2 Template-Type: ReDIF-Article 1.0 Title: Heroin use during methadone maintenance treatment: The importance of methadone dose and cocaine use Journal: American Journal of Public Health Author-Name: Hartel, D.M. Author-Name: Schoenbaum, E.E. Author-Name: Selwyn, P.A. Author-Name: Kline, J. Author-Name: Davenny, K. Author-Name: Klein, R.S. Author-Name: Friedland, G.H. Year: 1995 Volume: 85 Issue: 1 Pages: 83-88 Abstract: Objectives. The purpose of this study was to examine factors associated with heroin use during methadone maintenance treatment. Methods. Logistic regression statistical models were used to examine data obtained in a cross- sectional sample of 652 methadone patients. Results. Heroin use during the 3 months prior to interview was shown to be greatest among (1) patients maintained on methadone dosages of less than 70 mg/day (adjusted odds ratio [OR] = 2.1, 95% confidence interval [CI] = 1.3, 3.4) and (2) patients who used cocaine during treatment (adjusted OR = 5.9, 95% CI = 3.8, 9.1). These results were independent of treatment duration, treatment compliance, alcohol use, and socioeconomic factors. Cocaine users were more likely than nonusers of cocaine to use heroin at all methadone dosage levels. Conclusions. This study confirms and extends past research showing high-dose methadone maintenance to be important to heroin abstinence. Further investigation of the independent association between heroin use and cocaine use is needed. Handle: RePEc:aph:ajpbhl:1995:85:1:83-88_3 Template-Type: ReDIF-Article 1.0 Title: Female condom use among injection drug- and crack cocaine-using women [2] Journal: American Journal of Public Health Author-Name: Ashery, R.S. Author-Name: Carlson, R.G. Author-Name: Falck, R.S. Author-Name: Siegal, H.A. Author-Name: Wang, J. Year: 1995 Volume: 85 Issue: 5 Pages: 736-737 Handle: RePEc:aph:ajpbhl:1995:85:5:736-737_1 Template-Type: ReDIF-Article 1.0 Title: Random-digit dialing for control selection in childhood cancer studies: The geographic proximity and demographics within matched sets Journal: American Journal of Public Health Author-Name: Sakkinen, P.A. Author-Name: Severson, R.K. Author-Name: Ross, J.A. Author-Name: Robison, L.L. Year: 1995 Volume: 85 Issue: 4 Pages: 555-557 Abstract: The purpose of this analysis was to evaluate the degree of matching in 95 individually matched pairs from a case-control study of childhood leukemia that used random-digit dialing to select control subjects. Both geographic proximity (of each case subject to his or her matched control subject) and differences in socioeconomic status were evaluated. The median distance between matched pairs was 3.2 km. There were no significant differences in distance between matched pairs by urban/rural status and geographic location. For studies of childhood center drawn from pediatric referral centers, random-digit dialing appears to provide a suitable control group. Handle: RePEc:aph:ajpbhl:1995:85:4:555-557_6 Template-Type: ReDIF-Article 1.0 Title: Priorities for vaginal microbicide research [3] Journal: American Journal of Public Health Author-Name: Sokal, D.C. Author-Name: Hermonat, P.L. Year: 1995 Volume: 85 Issue: 5 Pages: 737-738 Handle: RePEc:aph:ajpbhl:1995:85:5:737-738_1 Template-Type: ReDIF-Article 1.0 Title: Revisiting 'The origins of compulsory drug prescriptions' Journal: American Journal of Public Health Author-Name: Marks, H.M. Year: 1995 Volume: 85 Issue: 1 Pages: 109-115 Abstract: It has been argued that today's prescription drug market originated in the arbitrary acts of the US Food and Drug Administration (FDA), which in 1938 issued regulations creating a class of drugs that could be sold by prescription only. On the basis of the FDA's administrative records, I argue that the 1938 regulations on prescription drug labeling were initiated by industry and then agreed to by the FDA; that contemporaries understood and accepted the reasons for restricting the use of certain drugs; and that the subsequent evolution of these regulations is best understood as an FDA effort to limit industry abuses of the prescription labeling system. This decade- long war of position ended when drug manufacturers persuaded the US Congress to enshrine their version of prescription labeling in law in a highly politicized struggle over government's role in the economy. Handle: RePEc:aph:ajpbhl:1995:85:1:109-115_4 Template-Type: ReDIF-Article 1.0 Title: Drug abuse treatment experience and HIV risk behaviors among active drug injectors in Ohio Journal: American Journal of Public Health Author-Name: Siegal, H.A. Author-Name: Carlson, R.G. Author-Name: Falck, R.S. Author-Name: Wang, J. Year: 1995 Volume: 85 Issue: 1 Pages: 105-108 Abstract: This study compares the sociodemographic characteristics and human immunodeficiency virus (HIV) risk behaviors of injection drug users who had received drug abuse treatment in the previous 5 years and those who had not received treatment. The National AIDS Demonstration Research Program database provided 2001 structured interviews, representing Cleveland, Columbus, Cincinnati, and Dayton, Ohio. About 43% of the subjects reported having received treatment in the previous 5 years. Length of involvement with drugs, more frequent injection, more legal problems, and higher levels of HIV risk behaviors were associated with a history of treatment. Incorporating HIV risk reduction education in drug abuse treatment is an urgent priority. Handle: RePEc:aph:ajpbhl:1995:85:1:105-108_1 Template-Type: ReDIF-Article 1.0 Title: Interdisciplinary centers for tobacco-related cancer research--a health policy issue. Journal: American Journal of Public Health Author-Name: Wynder, E.L. Year: 1995 Volume: 85 Issue: 1 Pages: 14-16 Handle: RePEc:aph:ajpbhl:1995:85:1:14-16_6 Template-Type: ReDIF-Article 1.0 Title: Mild mental retardation in Black and White children in metropolitan Atlanta: A case-control study Journal: American Journal of Public Health Author-Name: Yeargin-Allsopp, M. Author-Name: Drews, C.D. Author-Name: Decoufle, P. Author-Name: Murphy, C.C. Year: 1995 Volume: 85 Issue: 3 Pages: 324-328 Abstract: Objectives. This study assessed differences in the prevalence of mild mental retardation, defined as an intelligence quotient (IQ) from 50 to 70, between Black and White children. Methods. A case-control study design was used. Ten-year-old children with mental retardation were identified from multiple sources. Information on race, sex, maternal age, birth order, economic status, and maternal education was abstracted from birth certificates of 330 case children and 563 control children (public school students). Results. The crude Black-White odds ratio (OR) was 2.6, but it was reduced to 1.8 after the other five covariates were controlled. The disparity was largest among children whose mental retardation was first diagnosed when they were 8 to 10 years old (adjusted OR = 2.5). We found no significant difference in the occurrence of mild mental retardation between Black and White children diagnosed before and age of 6 years (adjusted OR = 1.2). Black children had a higher prevalence of mild mental retardation within all strata of the other five covariates. Conclusions. Five sociodemographic factors accounted for approximately half of the excess prevalence of mild mental retardation among Black children. Possible reasons for the residual difference are discussed. Handle: RePEc:aph:ajpbhl:1995:85:3:324-328_8 Template-Type: ReDIF-Article 1.0 Title: Pet ownership among persons with AIDS in three Florida counties Journal: American Journal of Public Health Author-Name: Conti, L. Author-Name: Lieb, S. Author-Name: Liberti, T. Author-Name: Wiley-Bayless, M. Author-Name: Hepburn, K. Author-Name: Diaz, T. Year: 1995 Volume: 85 Issue: 11 Pages: 1559-1561 Abstract: Interviews were conducted among 408 adults with acquired immunodeficiency syndrome at three local health departments to determine the proportion who owned pets, their perceived attachment to their pets, and the proportion who were informed about zoonoses. Nearly half (187, or 46%) were living with pets, most commonly dogs (64%), followed by cats (38%), fish (15%), birds (8%), reptiles (3%), and rodents (2%). Most pet owners (81%) reported an attachment to their pet. Only 10% were informed of zoonoses, albeit some incorrectly. Health care providers should recognize the high pet ownership rate among persons infected with human immunodeficiency virus and correctly inform their patients of strategies to sustain a low zoonotic disease incidence. Handle: RePEc:aph:ajpbhl:1995:85:11:1559-1561_2 Template-Type: ReDIF-Article 1.0 Title: Fecal contamination in child day care centers: Cloth vs paper diapers Journal: American Journal of Public Health Author-Name: Holaday, B. Author-Name: Waugh, G. Author-Name: Moukaddem, V.E. Author-Name: West, J. Author-Name: Harshman, S. Year: 1995 Volume: 85 Issue: 1 Pages: 30-33 Abstract: Objectives. Cloth diapers with front closure and all-in-one design were compared with paper diapers containing absorbent gel material for their influence on fecal contamination of the environment in licensed child day care centers. Methods. One infant room and two toddler rooms in each of four day care centers were monitored for the presence of fecal bacteria. Microbial samples were taken from the play/sleep area, the diaper-changing area, and the hands of the caregivers and the children. Sampling was done twice weekly for two 4-week periods. Each center used either cloth or paper diapers during the first period, changing to the other diaper type during the second period. Results. A total of 1722 samples were cultured, 881 during the first 4 weeks and 841 during the second 4 weeks. The frequency of isolation of fetal organisms ranged from a low of 12% of the total bacteria isolates at a center using cloth diapers, to highs of 46% and 45%, respectively, at a center using first paper and then cloth diapers. Sink faucets and the hands of the caregivers and the children were often contaminated. Conclusions. Analysis of the results of comparisons between cloth and paper diapers showed no significant difference in the frequency (F = .380, P < .535) or the intensity of fecal contamination in child day care centers. Handle: RePEc:aph:ajpbhl:1995:85:1:30-33_2 Template-Type: ReDIF-Article 1.0 Title: Associations of peptic ulcer and gastric cancer with other diseases in US veterans Journal: American Journal of Public Health Author-Name: Sonnenberg, A. Author-Name: Wasserman, I.H. Year: 1995 Volume: 85 Issue: 9 Pages: 1252-1255 Abstract: Objectives. The purpose of this study was to examine, through the database of the Department of Veterans Affairs, the joint occurrence of different diseases in individual patients. Methods. Patients with a diagnosis of gastric cancer, gastric ulcer, or duodenal ulcer were extracted from the 1987 through 1990 computer files. A random sample of patients from each annual file served as a control population. All previous discharges of each case or control patient between 1970 and 1990 were searched for the occurrence of hypertensive diseases or chronic diseases of the joints, lungs, pancreas, and liver. The relative frequencies of such diagnoses in case and control patients were compared by multivariate logistic regression. Results. Gastric ulcer and duodenal ulcer, but not gastric cancer, were significantly associated with chronic diseases of the joints, lungs, pancreas, and liver. None of the three diagnoses showed any significant association with hypertensive diseases. Conclusions. These relationships may reflect the influence of nonsteroidal anti-inflammatory drugs, smoking, and alcohol. They stress the importance of environmental risk factors other than Helicobacter pylori in terms of damage to the upper gastrointestinal mucosa. Handle: RePEc:aph:ajpbhl:1995:85:9:1252-1255_4 Template-Type: ReDIF-Article 1.0 Title: The classification of AIDS cases: Concordance between two AIDS surveillance systems in Italy Journal: American Journal of Public Health Author-Name: Serraino, D. Author-Name: Franceschi, S. Author-Name: Dal Maso, L. Author-Name: Lepri, A.C. Author-Name: Tirelli, U. Author-Name: Rezza, G. Year: 1995 Volume: 85 Issue: 8 Pages: 1112-1114 Abstract: This study assessed the concordance between the transmission classification of 725 acquired immunodeficiency syndrome (AIDS) cases by the Italian AIDS Registry (the national surveillance system) and the classification of the same cases by the Italian Cooperative Group on AIDS- Related Tumors. A high degree of concordance emerged for intravenous drug users in both sexes (κ = 0.88; 95% confidence interval [CI] = 0.84, 0.92), for homosexual men (κ = 0.83; 95% CI = 0.79, 0.87), and for persons infected through contaminated blood or blood derivatives (κ = 1.00). The concordance was lower among heterosexual men (κ = 0.51; 95% CI = 0.37, 0.65) and especially among men whose risk group was not determined (κ = 0.28; 95% CI = 0.12, 0.44). The discrepancies observed among heterosexual men indicate a need for continuing and accurate monitoring of AIDS reporting by transmission category. Handle: RePEc:aph:ajpbhl:1995:85:8:1112-1114_0 Template-Type: ReDIF-Article 1.0 Title: Characteristics associated with excessive weight gain after smoking cessation in men Journal: American Journal of Public Health Author-Name: Swan, G.E. Author-Name: Carmelli, D. Year: 1995 Volume: 85 Issue: 1 Pages: 73-77 Abstract: Objectives. Data from two surveys of the National Academy of Sciences- National Research Council Twin Registry, conducted 16 years apart, were used to determine characteristics of individuals that were predictive of excessive weight gain after smoking cessation. Methods. Over the follow-up, 2179 men quit smoking and averaged a weight gain of 3.5 kg. Quitters were grouped into four categories of weight change: lost weight, no change, gained weight, and excessive weight gain ('super-gainers'). Results. In comparison with quitters reporting no change in weight, super-gainers were younger, were of lower socioeconomic status, and differed on a number of health habits before quitting (all Ps < .05). At follow-up, super-gainers reported changes in health habits that were significantly different from those seen in quitters reporting stable weight (all Ps < .05). Pairwise concordance for weight change in 146 monozygotic and 111 dizygotic twin pairs in which both twins quit smoking was significantly greater in monozygotic than dizygotic pairs (P < .01). Conclusions. These results indicate that super-gainers differ in important ways from those who do not gain weight after smoking cessation and that these weight changes may be influenced by underlying genetic factors. Handle: RePEc:aph:ajpbhl:1995:85:1:73-77_7 Template-Type: ReDIF-Article 1.0 Title: Vasectomy in the United States, 1991 Journal: American Journal of Public Health Author-Name: Marquette, C.M. Author-Name: Koonin, L.M. Author-Name: Antarsh, L. Author-Name: Gargiullo, P.M. Author-Name: Smith, J.C. Year: 1995 Volume: 85 Issue: 5 Pages: 644-649 Abstract: Objectives. Recent conflicting findings on possible health risks related to vasectomy have underscored the need for reliable and representative estimates of numbers and rates of vasectomies in the United States. The purpose of this study was to estimate the annual US number, rate, and characteristics of vasectomies in 1991. Methods. A national survey of urology, general surgery, and family practice physician practices was conducted with probability sampling methods (n = 1685 physicians). Results. An estimated 493 487 (95% confidence interval = 450 480, 536 494) vasectomies were performed in 1991, for a rate of 10.3 procedures per 1000 men aged 25 through 49 yearn. Most vasectomies were performed by urologists, and most were done in physicians' offices with local anesthesia and ligation as the method of occlusion. The rate of vasectomies was highest in the Midwest. Conclusions. This survey provides the first national estimates of the number and rate of vasectomies in the United States, as well as the first estimates of occlusion method used. Results confirm previous findings that urologists perform most vasectomies and that most vasectomies are performed with local anesthesia. Recommendations include the monitoring of vasectomy numbers and rates as well as demographic studies of men obtaining vasectomies. Handle: RePEc:aph:ajpbhl:1995:85:5:644-649_3 Template-Type: ReDIF-Article 1.0 Title: The challenge of defining and counting generalist physicians: An analysis of physician masterfile data Journal: American Journal of Public Health Author-Name: Grumbach, K. Author-Name: Becker, S.H. Author-Name: Osborn, E.H.S. Author-Name: Bindman, A.B. Year: 1995 Volume: 85 Issue: 10 Pages: 1402-1407 Abstract: Objectives. The study reviewed methods for measuring the specialty distribution of the US physician workforce. It was hypothesized that current databases and measurement conventions overestimate the number of generalist physicians. Methods. A descriptive analysis of the American Medical Association (AMA) Physician Masterfile for California was done with different assumptions about the definition of generalists based on primary and secondary specialty information. Results. A rigorous definition of generalist physician that excludes physicians with secondary practices in specialist fields resulted in an estimate of generalist physicians 25% lower than the number estimated by conventional workforce evaluation methods. Physicians who reported practicing in both generalist and specialist fields were more likely to be older, to be international medical school graduates, and to be in solo or duo practice compared with physicians who listed only generalist or specialist fields. Conclusions. The actual number of generalist physicians in the United States may be less than previously believed. Although the exact magnitude of the 'hidden system' of specialists providing primary care is difficult to measure, at least a portion appear to already be counted as generalist physicians by current conventions. Handle: RePEc:aph:ajpbhl:1995:85:10:1402-1407_8 Template-Type: ReDIF-Article 1.0 Title: Editorial: Vitamin A supplementation and morbidity in children born to HIV-infected women Journal: American Journal of Public Health Author-Name: Martorell, R. Author-Name: Ramakrishnan, U. Year: 1995 Volume: 85 Issue: 8 Pages: 1049-1051 Handle: RePEc:aph:ajpbhl:1995:85:8:1049-1051_5 Template-Type: ReDIF-Article 1.0 Title: Correlates of college student binge drinking Journal: American Journal of Public Health Author-Name: Wechsler, H. Author-Name: Dowdall, G.W. Author-Name: Davenport, A. Author-Name: Castillo, S. Year: 1995 Volume: 85 Issue: 7 Pages: 921-926 Abstract: Objectives. This study examines the individual correlates of college student hinge drinking. Methods. Questionnaires were completed by a representative national sample (n = 17 592) of students on 140 campuses in 1993. Binge drinking was defined as five or more drinks per episode for men and as four or more drinks per episode for women. Results. Overall, 44% of the students (50% of the men and 39% of the women) hinged. While demographic factors such as sex and race were significantly related to hinge drinking, prior hinging in high school was crucial, suggesting that for many students, binge drinking begins fore college. The strongest predictors of college hinge drinking were residence in a fraternity or sorority, adoption of a party- centered lifestyle, and engagement in other risky behaviors. Conclusions. Interventions must be targeted at high school hinge drinking as well as at several characteristics of college life-most notably fraternity residence. Legal drinking age fails to predict binge drinking, raising questions about the effectiveness of the legal minimum drinking age of 21 in college alcohol policies. Handle: RePEc:aph:ajpbhl:1995:85:7:921-926_1 Template-Type: ReDIF-Article 1.0 Title: Compliance with the 1992 California motorcycle helmet use law Journal: American Journal of Public Health Author-Name: Kraus, J.F. Author-Name: Peek, C. Author-Name: Williams, A. Year: 1995 Volume: 85 Issue: 1 Pages: 96-99 Abstract: To evaluate helmet use in California before and after the introduction of an unrestricted helmet use law on January 1, 1992, observations of motorcycles and their riders were made at 60 locations in seven California counties, twice before and four times after the law was introduced. Helmet use increased from about 50% in 1991 to more than 99% throughout 1992. Compliance was achieved despite variations in helmet use by motorcycle design and road type. Seven percent of riders used nonstandard helmets after the law. With adequate enforcement, unrestricted helmet use laws can achieve almost 100% compliance and reduce the number of people riding motorcycles. Handle: RePEc:aph:ajpbhl:1995:85:1:96-99_1 Template-Type: ReDIF-Article 1.0 Title: Racial/ethnic differences in the likelihood of cesarean delivery, California Journal: American Journal of Public Health Author-Name: Braveman, P. Author-Name: Egerter, S. Author-Name: Edmonston, F. Author-Name: Verdon, M. Year: 1995 Volume: 85 Issue: 5 Pages: 625-630 Abstract: Objectives. The purpose of this study was to determine whether women's sociodemographic characteristics are independently associated with cesarean delivery. Methods. A retrospective review was conducted of hospital discharge data for singleton first births: in California in 1991. Results. After insurance and personal, community, medical, and hospital characteristics had been controlled, Blacks were 24% more likely to undergo cesarean delivery than Whites; only among low-birthweight and county hospital births were Blacks not at a significantly elevated risk. Among women who resided in substantially non-English-speaking communities, who delivered high- birthweight babies, or who gave birth at for-profit hospitals, cesarean delivery appeared to be more likely among non-Whites and was over 40% more likely among Blacks than among Whites. Conclusions. The findings cannot establish causation, but the significant racial/ethnic disparities in delivery mode, despite adjustment for social, economic, medical, and hospital factors, suggest inappropriate influences on clinical decision making that would not be addressed by changes in reimbursement. If practice variations among providers are involved, de facto racial differences in access to optimal care may be indicated. The role of provider and patient attitudes and expectations in the observed racial ethnic differentials should also be explored. Handle: RePEc:aph:ajpbhl:1995:85:5:625-630_7 Template-Type: ReDIF-Article 1.0 Title: Editorial: Out of the vortex - Neonatologists' treatment decisions for newborns at risk for HIV Journal: American Journal of Public Health Author-Name: Avery, G.B. Year: 1995 Volume: 85 Issue: 11 Pages: 1484-1485 Handle: RePEc:aph:ajpbhl:1995:85:11:1484-1485_9 Template-Type: ReDIF-Article 1.0 Title: Syphilis in the south: Rural rates surpass urban rates in North Carolina Journal: American Journal of Public Health Author-Name: Thomas, J.C. Author-Name: Kulik, A.L. Author-Name: Schoenbach, V.J. Year: 1995 Volume: 85 Issue: 8 Pages: 1119-1122 Abstract: We studied primary and secondary syphilis rates in North Carolina for 1985 through 1993 to elucidate demographic trends and the role of rurality in the state's high rates. Each of the state's 100 counties was classified by rural- urban character; and county-level rates, adjusted for gender, race, and age group, were compared. Syphilis rates rose dramatically during the 9-year period, with most of the increase occurring among woman, non-Whites, and rural counties. The rural rates recently surpassed urban rates, with the greatest increase experienced by non-White rural women. The exchange of sex for drugs and characteristics of rural poverty may be fueling these trends. Handle: RePEc:aph:ajpbhl:1995:85:8:1119-1122_2 Template-Type: ReDIF-Article 1.0 Title: Socioeconomic indicators and mortality from coronary heart disease and cancer: A 22-year follow-up of middle-aged men Journal: American Journal of Public Health Author-Name: Bucher, H.C. Author-Name: Ragland, D.R. Year: 1995 Volume: 85 Issue: 9 Pages: 1231-1236 Abstract: Objectives. Data from the Western Collaborative Group Study were used to determine the extent to which the inverse association between socioeconomic status (SES) and mortality can be explained by risk factors for major causes of mortality. Methods. The relation of education and income to subsequent mortality was studied in 3154 employed, middle-aged men over 22 years of follow-up. Results. Over the follow-up period, 584 (18.5%) men died, 214 (6.8%) from coronary heart disease and 70 (2.2%) from lung cancer. A significant inverse association with systolic blood pressure, serum cholesterol, and smoking was found only for education. Far education, adjustment for risk factors reduced the relative risk for coronary heart disease mortality from 1.80 (95% confidence interval = 1.33, 2.44) to 1.54 (1.13, 2.09), for lung cancer mortality from 1.60 (0.95, 2.70) to 1.38 (0.81, 2.34), and for all-cause mortality from 1.49 (1.09, 1.13) to 1.33 (1.12, 1.60). For income, adjustment for risk factors did not change relative risk for mortality from coronary heart disease (1.27 [0.97, 1.66]) and all causes (1.21 [1.03, 1.43]), but it did increase the relative risk for lung cancer mortality from 1.68 (1.05, 2.68) to 1.83 (1.13, 2.96). Conclusions. In middle-aged, employed men, the association between SES and mortality is partially but not completely accounted for by major risk factors for mortality. Handle: RePEc:aph:ajpbhl:1995:85:9:1231-1236_1 Template-Type: ReDIF-Article 1.0 Title: Go tell it on the mountain: Hilla Sheriff and public health in the South Carolina Piedmont, 1929 to 1940 Journal: American Journal of Public Health Author-Name: Hill, P.E. Year: 1995 Volume: 85 Issue: 4 Pages: 578-584 Abstract: As director of the South Carolina units of the American Women's Hospitals and as the state's first female county health official, Hilla Sheriff combined elements of the Progressive Era's social gospel; the New Deal notion that concerned, public-spirited officials could make a difference; and a nascent feminism that led her into the controversial fields of family planning and nutrition. Sheriff's responses to endemic pellagra, innovative maternal and child health campaigns, and contraceptive research for the Milbank Memorial Fund attracted national attention and spawned programs based on her models throughout the South. Her ability to tailor programs to diverse communities-mothers who bore double burdens as textile workers, isolated farm families, mountaineers, and African Americans denied access to most health care facilities in the Jim Crow South - serves as a timeless example for those committed to community medicine. Handle: RePEc:aph:ajpbhl:1995:85:4:578-584_5 Template-Type: ReDIF-Article 1.0 Title: Mortality among Navajo uranium miners Journal: American Journal of Public Health Author-Name: Roscoe, R.J. Author-Name: Deddens, J.A. Author-Name: Salvan, A. Author-Name: Schnorr, T.M. Year: 1995 Volume: 85 Issue: 4 Pages: 535-540 Abstract: Objectives. To update mortality risks for Navajo uranium miners, a retrospective cohort mortality study was conducted of 757 Navajos from the cohort of Colorado Plateau uranium miners. Methods. Vital status was followed from 1960 to 1990. Standardized mortality ratios were estimated, with combined New Mexico and Arizona non-White mortality rates used for comparison. Cox regression models were used to evaluate exposure-response relationships. Results. Elevated standardized mortality ratios were found for lung cancer (3.3), tuberculosis (2.6), and pneumoconioses and other respiratory, diseases (2.6). Lowered ratios were found for heart disease (0.6), circulatory disease (0.4), and liver cirrhosis (0.5). The estimated relative risk for a 5-year duration of exposure vs none was 3.7 for lung cancer, 2.1 for pneumoconioses and other respiratory diseases, and 2.0 for tuberculosis. The relative risk for long cancer was 6.9 for the midrange of cumulative exposure to redon progeny compared with the least exposed. Conclusions. Findings were consistent with those from previous studies. Twenty-three years after their last exposure to radon progeny, these light- smoking Navajo miners continue to face excess mortality risks from lung cancer and pneumoconioses and other respiratory diseases. Handle: RePEc:aph:ajpbhl:1995:85:4:535-540_2 Template-Type: ReDIF-Article 1.0 Title: Passive and active maternal smoking as measured by serum cotinine: The effect on birthweight Journal: American Journal of Public Health Author-Name: Eskenazi, B. Author-Name: Prehn, A.W. Author-Name: Christianson, R.E. Year: 1995 Volume: 85 Issue: 3 Pages: 395-398 Abstract: To determine how maternal exposure to environmental tobacco smoke affects birthweight, maternal sera obtained from 3529 pregnant women around 27 weeks gestation were analyzed for cotinine, a metabolite of nicotine. Based on cotinine levels, nonsmokers were divided into those exposed to environmental tobacco smoke (2-10 ng/mL) and those unexposed (<2 ng/mL), and smokers were divided into tertiles. Compared with unexposed nonsmokers' infants, infants of exposed nonsmokers averaged 45 g less (P = .28) after adjustment for confounders, and smokers' infants averaged 78, 191, and 233 g less for the first, second, and third cotinine tertiles, respectively. Birthweight decreased 1 g for every nanogram per milliliter of cotinine increase (P < .001). Handle: RePEc:aph:ajpbhl:1995:85:3:395-398_8 Template-Type: ReDIF-Article 1.0 Title: Quality of condom use as reported by female clients of a family planning clinic Journal: American Journal of Public Health Author-Name: Oakley, D. Author-Name: Bogue, E.-L. Year: 1995 Volume: 85 Issue: 11 Pages: 1526-1530 Abstract: Objectives. This study analyzed the prevalence and determinants of the quality of condom use after a woman's first visit to a family planning clinic. Methods. This report presents data from 360 female family planning clients who reported using condoms as their primary method of contraception for at least 1 sexually active month during the study's follow-up period after their first clinic visit. Results. Only 1% always engaged in all five use behaviors studied: using a condom for each sexual intercourse, putting the condom on before first entry, withdrawal after intercourse while there is still an erection, holding on to the condom's rim during withdrawal, and using foam. Multiple linear regression indicated that more effective condom use was reported by women who had not had an induced abortion, were not using condoms just bemuse they were starting oral contraceptive pill regimens, had more knowledge about birth control in general, had received a nursing intervention, and had more communication with their partner. Conclusions. Increasing attention needs to be devoted to understanding determinants of the specific actions that differentiate between more and less effective contraceptive use. Handle: RePEc:aph:ajpbhl:1995:85:11:1526-1530_7 Template-Type: ReDIF-Article 1.0 Title: Childhood lead poisoning in Massachusetts communities: Its association with sociodemographic and housing characteristics Journal: American Journal of Public Health Author-Name: Sargent, J.D. Author-Name: Brown, M.J. Author-Name: Freeman, J.L. Author-Name: Bailey, A. Author-Name: Goodman, D. Author-Name: Freeman Jr., D.H. Year: 1995 Volume: 85 Issue: 4 Pages: 528-534 Abstract: Objectives. The purpose of the study was to examine the relationship between communities' sociodemographic and housing characteristics and incidence of lead poisoning. Methods. This was a population-based correlational study of 238 275 Massachusetts children from birth through 4 years of age who were screened for lead poisoning in 1991-1992. A logistic regression model was developed with the community as the unit of analysis, the case identification rate for lead poisoning (newly identified children with venous blood lead ≥25 μg/dL per 1000 children) as the dependent variable, and Us census variables as independent variables. Results. A significant independent relationship with the community case identification rate of lead poisoning was found for seven variables: median per capita income, percentage of housing built before 1950, percentage of the population who were Black, percentage of children screened, and a 'poverty index.' Rates of iron deficiency and percentage of Hispanics were not associated with the case identification rate of lead poisoning. Conclusions. Massachusetts communities' incidence of lead poisoning is correlated with sociodemographic and housing characteristics. In states similar to Massachusetts and without screening data, this model may help target screening programs. Handle: RePEc:aph:ajpbhl:1995:85:4:528-534_8 Template-Type: ReDIF-Article 1.0 Title: Causes of death in Florida prisons: the dominance of AIDS. Journal: American Journal of Public Health Author-Name: Amankwaa, A.A. Year: 1995 Volume: 85 Issue: 12 Pages: 1710-1711 DOI: 10.2105/AJPH.85.12.1710-a File-URL: http://hdl.handle.net/10.2105/AJPH.85.12.1710-a Handle: RePEc:aph:ajpbhl:10.2105/AJPH.85.12.1710-a_3 Template-Type: ReDIF-Article 1.0 Title: Increasing Medicaid child health screenings: The effectiveness of mailed pamphlets, phone calls, and home visits Journal: American Journal of Public Health Author-Name: Selby-Harrington, M. Author-Name: Sorenson, J.R. Author-Name: Quade, D. Author-Name: Stearns, S.C. Author-Name: Tesh, A.S. Author-Name: Donat, P.L.N. Year: 1995 Volume: 85 Issue: 10 Pages: 1412-1417 Abstract: Objectives. A randomized controlled trial was conducted to test the effectiveness and cost-effectiveness of three outreach interventions to promote well-child screening for children on Medicaid. Methods. In rural North Carolina, a random sample of 2053 families with children due or overdue for screening was stratified according to the presence of a home phone. Families were randomly assigned to receive a mailed pamphlet and letter, a phone call, or a home visit outreach intervention, or the usual (control) method of informing at Medicaid intake. Results. All interventions produced more screenings than the control method, but increases were significant only for families with phones. Among families with phones, a home visit was the most effective intervention but a phone call was the most cost-effective. However, absolute rates of effectiveness were low, and incremental costs per effect were high. Conclusions. Pamphlets, phone calls, and home visits by nurses were minimally effective for increasing well-child screenings. Alternate outreach methods are needed, especially for families without phones. Handle: RePEc:aph:ajpbhl:1995:85:10:1412-1417_5 Template-Type: ReDIF-Article 1.0 Title: Mortality among injection drug users identified as "out of treatment". Journal: American Journal of Public Health Author-Name: McAnulty, J.M. Author-Name: Tesselaar, H. Author-Name: Fleming, D.W. Year: 1995 Volume: 85 Issue: 1 Pages: 119-120 Handle: RePEc:aph:ajpbhl:1995:85:1:119-120_6 Template-Type: ReDIF-Article 1.0 Title: Functional disability among elderly Blacks and Whites in two diverse areas: The New Haven and North Carolina EPESE Journal: American Journal of Public Health Author-Name: De Leon, C.F.M. Author-Name: Fillenbaum, G.G. Author-Name: Williams, C.S. Author-Name: Brock, D.B. Author-Name: Beckett, L.A. Author-Name: Berkman, L.F. Year: 1995 Volume: 85 Issue: 7 Pages: 994-998 Abstract: This study examines the prevalence of functional disability (limitation in at least one basic activity of daily living) among elderly Black and White community residents in the New Haven (n = 2812) and North Carolina (n = 4162) sites of the Established Populations for Epidemiologic Studies of the Elderly (EPESE). In New Haven, elderly Blacks, particularly women below age 75, had a higher prevalence of disability compared with Whites, which was partially attributable to a higher prevalence of chronic conditions. In North Carolina, Blacks had only a slightly higher risk of being disabled than Whites, and this was fully accounted for by differences in socioeconomic status. Black- White differences in the prevalence of functional disability reveal geographic variation. Handle: RePEc:aph:ajpbhl:1995:85:7:994-998_5 Template-Type: ReDIF-Article 1.0 Title: Violence by male partners against women during the childbearing year: A contextual analysis Journal: American Journal of Public Health Author-Name: O'Campo, P. Author-Name: Gielen, A.C. Author-Name: Faden, R.R. Author-Name: Xue, X. Author-Name: Kass, N. Author-Name: Wang, M.-C. Year: 1995 Volume: 85 Issue: 8 Pages: 1092-1097 Abstract: Objectives. Many contextual analyses that bridge the micro-level-macro- level gap in identifying risk factors for adverse outcomes have not used methods appropriate for multilevel data. The purpose of this paper is to illustrate the application of appropriate multi-level analytic methods and discuss their implications for public health. Methods. A previously published individual-level model of physical violence perpetrated by male partners during the childbearing year was reanalyzed to include variables describing the neighborhoods where the women resided. Logistic regression with estimation methods of the generalized estimating equation was used for the contextual analysis. To assess the advantages of the generalized estimating equation over conventional logistic regression, both were used for the two- level model. Results. The regression coefficients from the contextual model differed from the betas obtained in the individual-level model. Not only were neighborhood-level variables related to the risk of partner-perpetrated violence, but the presence of these macro-level variables in the models modified the relationships of the individual-level variables to the risk of violence. Conclusions. Two-level models that include individual- and community-level factors may be beneficial for purposes of explanation in public health research. Handle: RePEc:aph:ajpbhl:1995:85:8:1092-1097_9 Template-Type: ReDIF-Article 1.0 Title: Endometriosis and moderate alcohol use Journal: American Journal of Public Health Author-Name: Thylan, S. Author-Name: Grodstein, F. Author-Name: Goldman, M.B. Author-Name: Cramer, D.W. Year: 1995 Volume: 85 Issue: 7 Pages: 1021-1122 Handle: RePEc:aph:ajpbhl:1995:85:7:1021-1122_0 Template-Type: ReDIF-Article 1.0 Title: Folic acid fortification of grain: An economic analysis Journal: American Journal of Public Health Author-Name: Romano, P.S. Author-Name: Waitzman, N.J. Author-Name: Scheffler, R.M. Author-Name: Pi, R.D. Year: 1995 Volume: 85 Issue: 5 Pages: 667-676 Abstract: Objectives. The purpose of this study was to compare the economic costs and benefits of fortifying grain with folic acid to prevent neural tube defects. Methods. A cost-benefit analysis based on the US population, using the human capital approach to estimate the costs associated with preventable neural tube defects, was conducted. Results. Under a range of assumptions about discount rates, baseline folate intake, the effectiveness of folate in preventing neural tube defects, the threshold dose that minimizes risk, and the cost of surveillance, fortification would likely yield a net economic benefit. The best estimate of this benefit is $94 million with low-level (140 micrograms [mcg] per 100 g grain) fortification and $252 million with high- level (350 mcg/100 g) fortification. The benefit-to-cost ratio is estimated at 4.3:1 for low-level and 6.1:1 for high-level fortification. Conclusions. By averting costly birth defects, folic acid fortification of grain in the United States may yield a substantial economic benefit. We may have underestimated net benefits because of unmeasured costs of neural tube defects and unmeasured benefits of higher folate intake. We may have overestimated net benefits if the cost of neurologic sequelae related to delayed diagnosis of vitamin B12 deficiency exceeds our projection. Handle: RePEc:aph:ajpbhl:1995:85:5:667-676_7 Template-Type: ReDIF-Article 1.0 Title: Extended coverage for preventive services for the elderly: Response and results in a demonstration population Journal: American Journal of Public Health Author-Name: German, P.S. Author-Name: Burton, L.C. Author-Name: Shapiro, S. Author-Name: Steinwachs, D.M. Author-Name: Tsuji, I. Author-Name: Paglia, M.J. Author-Name: Damiano, A.M. Year: 1995 Volume: 85 Issue: 3 Pages: 379-386 Abstract: Objectives. This study was undertaken to test the acceptability of preventive services under Medicare waivers to a community-dwelling population aged 65 and over and to examine the effect of such services on health. Methods. Medicare beneficiaries and designated primary care providers were sampled, and beneficiaries were screened and surveyed. A total of 4195 individuals were then randomized into intervention or control groups. Those in the intervention group were offered free preventive visits (under waivers) to their physicians. A follow-up survey of the entire group was administered after completion of the intervention. Results. Sixty-three percent of the intervention group made a preventive clinical visit, and about half of them a counseling visit. For men, being married and having a solo practitioner were positively associated with accepting the intervention services, while for women, having had a mammogram, having a confidant, having a high school education, and having a female practitioner were so associated. The intervention group showed a greater health benefit than did the control group and had a significantly lower death rate: 8.3% vs 11.1%. Conclusions. Older individuals will respond to preventive programs, and such services will result in modest health gains. Handle: RePEc:aph:ajpbhl:1995:85:3:379-386_1 Template-Type: ReDIF-Article 1.0 Title: Jails and prisons--America's new mental hospitals. Journal: American Journal of Public Health Author-Name: Torrey, E.F. Year: 1995 Volume: 85 Issue: 12 Pages: 1611-1613 DOI: 10.2105/AJPH.85.12.1611 File-URL: http://hdl.handle.net/10.2105/AJPH.85.12.1611 Handle: RePEc:aph:ajpbhl:10.2105/AJPH.85.12.1611_8 Template-Type: ReDIF-Article 1.0 Title: The screening histories of women with invasive cervical cancer, Connecticut Journal: American Journal of Public Health Author-Name: Janerich, D.T. Author-Name: Hadjimichael, O. Author-Name: Schwartz, P.E. Author-Name: Lowell, D.M. Author-Name: Meigs, J.W. Author-Name: Merino, M.J. Author-Name: Flannery, J.T. Author-Name: Polednak, A.P. Year: 1995 Volume: 85 Issue: 6 Pages: 791-794+761 Abstract: Objectives. Each case of a continuous series of invasive cervical cancer cases was studied with a structured review procedure conducted by an expert panel to assess the reason that it was not detected before it became invasive. Methods. All cases of invasive cervical cancer diagnosed in a 5- year period among Connecticut residents were identified; a screening history and screening outcome were obtained for 72% (481 of 664). Results. Two hundred fifty women (51.9%) had suboptimal screening. One hundred thirty- seven women (28.5%) had never had a screening test, and their mean age was greater than that of the rest of the study population (64.5 years vs 46.5 years). Of the 344 women who had ever had a Pap test, 113 (32.8%) had their last Pap test 5 or more years before their diagnosis of invasive cancer; 52 (15.1%) were not followed up properly; 33 (9.6%) had their last smear misread as normal; and 118 (34.3%) developed cervical cancer within 3 years of their last Pap test. Conclusions. Physicians, nurses, and other care providers need to ensure that woman have timely and accurate screening with proper follow- up, make increased efforts to reach older women, and improve quality control of Pap smear readings. Handle: RePEc:aph:ajpbhl:1995:85:6:791-794+761_0 Template-Type: ReDIF-Article 1.0 Title: Return rates and outcomes from ethnicity-specific mental health programs in Los Angeles Journal: American Journal of Public Health Author-Name: Takeuchi, D.T. Author-Name: Sue, S. Author-Name: Yeh, M. Year: 1995 Volume: 85 Issue: 5 Pages: 638-643 Abstract: Objectives. The present study compared the return rate, length of treatment, and treatment outcome of ethnic minority adults who received services from ethnicity-specific or mainstream programs. Methods. The sample consisted of 1516 African Americans, 1888 Asian Americans, and 1306 Mexican Americans who used 1 of 36 predominantly White (mainstream) or 18 ethnicity- specific mental health centers in Los Angeles County over a 6-year period. Predictor variables included type of program (ethnicity specific vs mainstream), disorder, ethnic match (whether or not clients had a therapist of the same ethnicity), gender, age, and Medi-Cal eligibility. The criterion variables were return after one session, total number of sessions, and treatment outcome. Results. The study indicated that ethnic clients who attended ethnicity-specific programs had a higher return rate and stayed in the treatment longer than those using mainstream services. The data analyses were less clear cut when treatment outcome was examined. Conclusions. The findings support the notion that ethnicity-specific programs seem to increase the continued use of mental health services among ethnic minority groups. Handle: RePEc:aph:ajpbhl:1995:85:5:638-643_9 Template-Type: ReDIF-Article 1.0 Title: Young maternal age and congenital malformations: A population-based study Journal: American Journal of Public Health Author-Name: Croen, L.A. Author-Name: Shaw, G.M. Year: 1995 Volume: 85 Issue: 5 Pages: 710-713 Abstract: This study examined the prevalence of congenital malformations across the maternal age spectrum and identified specific malformation types that contributed to the overall prevalence among mothers under the age of 20 years. Data were derived from the California Birth Defects Monitoring Program for 1983 through 1988 live births. The distribution of prevalences of all nonchromosomal malformations was U-shaped across maternal age. Furthermore, several specific malformation types, representing nearly every organ system, were elevated among the infants of women under 20 years of age in comparison with those of women 25 to 29 years old. Handle: RePEc:aph:ajpbhl:1995:85:5:710-713_1 Template-Type: ReDIF-Article 1.0 Title: Editorial: Is carbon monoxide a risk factor for hospital admission for heart failure? Journal: American Journal of Public Health Author-Name: Schwartz, J. Year: 1995 Volume: 85 Issue: 10 Pages: 1343-1344 Handle: RePEc:aph:ajpbhl:1995:85:10:1343-1344_0 Template-Type: ReDIF-Article 1.0 Title: The relationship between structural and health services variables and state-level infant mortality in the United States Journal: American Journal of Public Health Author-Name: Bird, S.T. Author-Name: Bauman, K.E. Year: 1995 Volume: 85 Issue: 1 Pages: 26-29 Abstract: Objectives. This study compared the relative strength of the associations of a set of structural (social, economic, and political) variables and a set of health services variables with state-level infant, neonatal, and postneonatal mortality. It also examined whether health services mediate the relationships between structural variables and state-level infant, neonatal, and postneonatal mortality. Methods. With the state as the unit of analysis, data for all 50 states were analyzed by means of multiple regression. Results. Structural variables accounted for substantially more variance in infant, neonatal, and postneonatal mortality than health services variables, and health services variables were more strongly related to infant mortality than to neonatal or postneonatal mortality. When health services variables were controlled, the strengths of the associations between the structural variables and infant, neonatal, and postneonatal mortality were reduced but remained statistically significant. Conclusions. A substantial portion of the variance in state-level infant mortality is accounted for by states' structural characteristics, which are partially mediated by health services. Handle: RePEc:aph:ajpbhl:1995:85:1:26-29_5 Template-Type: ReDIF-Article 1.0 Title: Erratum: Predicting body fatness: The body mass index vs estimation by bioelectrical impedance (American Journal of Public Health (1995) 85 (726- 728)) Journal: American Journal of Public Health Author-Name: Roubenoff, R. Author-Name: Dallal, G.E. Author-Name: Wilson, P.W.F. Year: 1995 Volume: 85 Issue: 8 Pages: 1063 Handle: RePEc:aph:ajpbhl:1995:85:8:1063_0