This project explores the efficiency and effectiveness of case management as compared with the usual and customary services available to chronic mentally ill individuals in reducing readmissions to mental hospitals and improving the quality of life. A randomized pretest-posttest control group design was used to assign 417 individuals who had at least two discharges from a mental hospital to an experimental (E) group (N = 213) to receive case management services and a control (C) group (N = 204) who could receive any services but case management. After participation in the project for 12 months, 138 members of the E group and 126 members of the C group were reinterviewed. The E group received more services, cost more to maintain, and were admitted to mental hospitals more often, but concomitant improvement in quality of life indicators was not evident. Alternative explanations for the findings are discussed.
Population health is a relatively new term that has not yet been precisely defined. Is it a concept of health or a field of study of health determinants?
We propose that the definition be “the health outcomes of a group of individuals, including the distribution of such outcomes within the group,” and we argue that the field of population health includes health outcomes, patterns of health determinants, and policies and interventions that link these two.
We present a rationale for this definition and note its differentiation from public health, health promotion, and social epidemiology. We invite critiques and discussion that may lead to some consensus on this emerging concept.
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.
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 pre- and postlaw years.
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.
It all states adopted 0.08% legal blood alcohol limits, at least 500 to 600 fewer fatal crashes would occur annually.
This study examined the relation between smoking and suicide, controlling for various confounders.
More than 50,000 predominantly White, middle-aged and elderly male health professionals were followed up prospectively with biennial questionnaires from 1986 through 1994. The primary end point was suicide. Characteristics controlled for included age, marital status, body mass index, physical activity, alcohol intake, coffee consumption, and history of cancer.
Eighty-two members of the cohort committed suicide during the 8-year follow-up period. In age-adjusted analyses with never smokers as the comparison group, the relative risk of suicide was 1.4 (95% confidence interval [CI] = 0.8, 2.3) among former smokers, 2.6 (95% CI = 0.9, 7.5) for light smokers (< 15 cigarettes/day), and 4.5 (95% CI = 2.3, 8.8) among heavier smokers. After adjustment for potential confounders, the relative risks were 1.4 (95% CI = 0.9, 2.4), 2.5 (95% CI = 0.9, 7.3), and 4.3 (95% CI = 2.2, 8.5), respectively.
We found a positive, dose-related association between smoking and suicide among White men. Although inference about causality is not justified, our findings indicate that the smoking-suicide connection is not entirely due to the greater tendency among smokers to be unmarried, to be sedentary, to drink heavily, or to develop cancers.
As state and local governments increase restrictions on cigarette smoking, tobacco manufacturers have shifted to marketing alternative tobacco products. Tobacco control laws need to be updated to reflect this shifting marketplace. With the 2010 enactment of the Tobacco Modernization and Compliance Act, Minnesota addressed regulatory gaps and created a model law for other states. We have detailed the updated definitions of tobacco and tobacco products and identified ways that future laws could be strengthened. (Am J Public Health. Published online ahead of print December 12, 2013: e1-e3. doi:10.2105/AJPH.2013.301747).
Objectives:
We examined associations between macrolevel economic factors hypothesized to drive changes in distributions of weight and body mass index (BMI) in a representative sample of 200,796 men and women from 40 low- and middle-income countries.
Methods:
We used meta-regressions to describe ecological associations between macrolevel factors and mean BMIs across countries. Multilevel regression was used to assess the relation between macrolevel economic characteristics and individual odds of underweight and overweight relative to normal weight.
Results:
In multilevel analyses adjusting for individual-level characteristics, a 1-standard-deviation increase in trade liberalization was associated with 13% (95% confidence interval [CI] = 0.76, 0.99), 17% (95% CI = 0.71, 0.96), 13% (95% CI = 0.76, 1.00), and 14% (95% CI = 0.75, 0.99) lower odds of underweight relative to normal weight among rural men, rural women, urban men, and urban women, respectively. Economic development was consistently associated with higher odds of overweight relative to normal weight. Among rural men, a 1-standard-deviation increase in foreign direct investment was associated with 17% (95% CI = 1.02, 1.35) higher odds of overweight relative to normal weight.
Conclusions:
Macrolevel economic factors may be implicated in global shifts in epidemiological patterns of weight.
Objectives:
We examined the associations of job strain, an indicator of work-related stress, with overall unhealthy and healthy lifestyles.
Methods:
We conducted a meta-analysis of individual-level data from 11 European studies (cross-sectional data: n = 118,701; longitudinal data: n = 43,971). We analyzed job strain as a set of binary (job strain vs no job strain) and categorical (high job strain, active job, passive job, and low job strain) variables. Factors used to define healthy and unhealthy lifestyles were body mass index, smoking, alcohol intake, and leisure-time physical activity.
Results:
Individuals with job strain were more likely than those with no job strain to have 4 unhealthy lifestyle factors (odds ratio [OR] = 1.25; 95% confidence interval [CI] = 1.12, 1.39) and less likely to have 4 healthy lifestyle factors (OR = 0.89; 95% CI = 0.80, 0.99). The odds of adopting a healthy lifestyle during study follow-up were lower among individuals with high job strain than among those with low job strain (OR = 0.88; 95% CI = 0.81, 0.96).
Conclusions:
Work-related stress is associated with unhealthy lifestyles and the absence of stress is associated with healthy lifestyles, but longitudinal analyses suggest no straightforward cause-effect relationship between work-related stress and lifestyle.
We examined the association between workplace social capital and all-cause mortality in a large occupational cohort from Finland.
We linked responses of 28 043 participants to surveys in 2000 to 2002 and in 2004 to national mortality registers through 2009. We used repeated measurements of self- and coworker-assessed social capital. We carried out Cox proportional hazard and fixed-effects logistic regressions.
During the 5-year follow-up, 196 employees died. A 1-unit increase in the mean of repeat measurements of self-assessed workplace social capital (range 1-5) was associated with a 19% decrease in the risk of all-cause mortality (age- and gender-adjusted hazard ratio [HR] = 0.81; 95% confidence interval [CI] = 0.66, 0.99). The corresponding point estimate for the mean of coworker-assessed social capital was similar, although the association was less precisely estimated (age- and gender-adjusted HR = 0.77; 95% CI = 0.50, 1.20). In fixed-effects analysis, a 1-unit increase in self-assessed social capital across the 2 time points was associated with a lower mortality risk (odds ratio = 0.81; 95% CI = 0.55, 1.19).
Workplace social capital appears to be associated with lowered mortality in the working-aged population.
We investigated whether reported experience of racial discrimination in health care and in other domains was associated with cancer screening and negative health care experiences.
We used 2006/07 New Zealand Health Survey data (n = 12 488 adults). We used logistic regression to examine the relationship of reported experience of racial discrimination in health care (unfair treatment by a health professional) and in other domains (personal attack, unfair treatment in work and when gaining housing) to breast and cervical cancer screening and negative patient experiences adjusted for other variables.
Racial discrimination by a health professional was associated with lower odds of breast (odds ratio [OR] = 0.37; 95% confidence interval [CI] = 0.14, 0.996) and cervical cancer (OR = 0.51; 95% CI = 0.30, 0.87) screening among Maori women. Racial discrimination by a health professional (OR = 1.57; 95% CI = 1.15, 2.14) and racial discrimination more widely (OR = 1.55; 95% CI = 1.35, 1.79) were associated with negative patient experiences for all participants.
Experience of racial discrimination in both health care and other settings may influence health care use and experiences of care and is a potential pathway to poor health.
Data on 10,749 breech presentations were analyzed for the effect of delivery type on neonatal mortality. Most of the data are from developing countries, and most of the hospitals have higher mortality than is found in Europe or the United States. The simultaneous effect of type of hospital where the delivery occurred, type of breech, birthweight, and parity were examined. The benefit of cesarean delivery was greater for nulliparae than multiparae, greater for footlings than for frank or complete breeches, and greater for larger babies than smaller ones. This last finding probably reflects the quality of neonatal care in developing country hospitals rather than the value of cesarean section. Maternal mortality and morbidity was higher among women delivered abdominally than among those delivered vaginally.
This commentary provides a brief overview of American Indian and Alaskan populations in the United States and selected data issues. The focus of this commentary is an excerpt of recommendations related to Office of Management and Budget Directive 15 (racial categories) and American Indians and Alaska Natives. Of paramount concern is not only that all federal, state, and local agencies collect data on American Indians and Alaska Natives, but also that reports, findings, and peer-reviewed publications include data on American Indians and Alaska Natives. It is of no use to recruit American Indians and Alaska Natives into studies and projects if their race/ethnicity-specific data are not disseminated. Collapsing racial/ethnic categories, such as Asians, Native Hawaiians and Pacific Islanders, and American Indians and Alaska Natives, into a single racial category of "other" is of no benefit to public health policymakers, researchers, and tribal planners. Likewise, tribal affiliation should be collected whenever it is feasible to do so. Insufficient inclusion and inaccurate identification of American Indians and Alaska Natives in national surveys has also resulted in a dearth of baseline data in significant reports such as Healthy People 2010.
Depression prevalence was examined by race/ethnicity in a nationally representative sample. The Diagnostic Interview Schedule was administered to 8449 (response rate=96.1%) participants (aged 15-40 years). Prevalence of major depressive disorder was significantly higher in Whites than in African Americans and Mexican Americans; the opposite pattern was found for dysthymic disorder. Across racial/ethnic groups, poverty was a significant risk factor for major depressive disorder, but significant interactions occurred between race/ethnicity, gender, and education in relation to prevalence of dysthymic disorder.
Past studies have reported little about variability in mental disorders among lesbians, gay men, and bisexual individuals. We assessed the prevalence of psychiatric disorders in 388 lesbian, gay, and bisexual Black, Latino, and White individuals. Black lesbians, gay men, and bisexual individuals had lower prevalence of all disorders than did Latino and White individuals; younger cohorts had fewer mood disorders than did older cohorts; bisexual persons had more substance use disorders than did gay men and lesbians; and Latino respondents attempted suicide more often than did White respondents.
We undertook a meta-analysis of epidemiological studies investigating the relationship between occupational diesel exhaust exposure and lung cancer.
Thirty of 47 studies initially identified as potentially relevant met specified inclusion criteria. We extracted or calculated 39 independent estimates of relative risk and derived pooled estimates of risk for all studies and for numerous study subsets by using a random-effects model. We also examined interstudy heterogeneity by using linear metaregressions.
There was substantial heterogeneity in the pooled risk estimates for all studies combined and for most subsets. Several factors consistent with higher study quality, however, contributed to increased pooled estimates of risk and lower heterogeneity, including (1) adjustment for confounding by cigarette smoking and other covariates, (2) having a lower likelihood of selection bias, and (3) having increased study power.
This analysis provides quantitative support for prior qualitative reviews that have ascribed an etiologic role to occupational diesel exhaust exposure in lung cancer induction. Among study populations most likely to have had substantial exposure to diesel exhaust, the pooled smoking-adjusted relative risk was 1.47 (95% confidence interval = 1.29, 1.67).
Graduate students and postdoctoral fellows—including those at the Harvard School of Public Health (HSPH)—have somewhat limited opportunities outside of traditional coursework to learn holistically about public health.
Because this lack of familiarity could be a barrier to fruitful collaboration across disciplines, HSPH postdocs sought to address this challenge. In response, the Public Health 101 Nanocourse was developed to provide an overview of five core areas of public health (biostatistics, environmental health sciences, epidemiology, health policy and management, and social and behavioral sciences) in a two half-day course format.
We present our experiences with developing and launching this novel approach to acquainting wider multidisciplinary audiences with the field of public health.
This study examined the activities and influence of public health interest groups and coalitions on the national health care reform debates in the 103rd Congress.
Congressional staff and representatives of public health interest groups, coalitions, and government health agencies were interviewed. Content analysis of eight leading national health care reform bills was performed.
The public health community coalesced around public health in health care reform; nearly all the major interest groups and government health agencies joined two or more public health or prevention coalitions, and half joined three or more. The most effective influence on health care reform legislation was early, sustained personal contact with Congress members and their staffs, accompanied by succinct written materials summarizing key points. Media campaigns and grassroots mobilization were less effective. Seven of the eight leading health care reform bills included one or more of the priorities supported by public health advocates.
The public health community played an important role in increasing awareness and support for public health programs in the health care reform bills of the 103rd Congress.
Objectives:
We examined the impact of Arizona's "Supporting Our Law Enforcement and Safe Neighborhoods Act" (SB 1070, enacted July 29, 2010) on the utilization of preventive health care and public assistance among Mexican-origin families.
Methods:
Data came from 142 adolescent mothers and 137 mother figures who participated in a quasi-experimental, ongoing longitudinal study of the health and development of Mexican-origin adolescent mothers and their infants (4 waves; March 2007-December 2011). We used general estimating equations to determine whether utilization of preventive health care and public assistance differed before versus after SB 1070's enactment.
Results:
Adolescents reported declines in use of public assistance and were less likely to take their baby to the doctor; compared with older adolescents, younger adolescents were less likely to use preventive health care after SB 1070. Mother figures were less likely to use public assistance after SB 1070 if they were born in the United States and if their post-SB 1070 interview was closer to the law's enactment.
Conclusions:
Findings suggest that immigration policies such as SB 1070 may contribute to decreases in use of preventive health care and public assistance among high-risk populations.
Objectives:
We examined trends from 1998 to 2010 in bullying, bullying victimization, physical fighting, and weapon carrying and variations by gender, grade level, and race/ethnicity among US adolescents.
Methods:
The Health Behavior in School-Aged Children surveys of nationally representative samples of students in grades 6 through 10 were completed in 1998 (n = 15,686), 2002 (n = 14,818), 2006 (n = 9229), and 2010 (n = 10,926). We assessed frequency of bullying behaviors, physical fighting, and weapon carrying as well as weapon type and subtypes of bullying. We conducted logistic regression analyses, accounting for the complex sampling design, to identify trends and variations by demographic factors.
Results:
Bullying perpetration, bullying victimization, and physical fighting declined from 1998 to 2010. Weapon carrying increased for White students only. Declines in bullying perpetration and victimization were greater for boys than for girls. Declines in bullying perpetration and physical fighting were greater for middle-school students than for high-school students.
Conclusions:
Declines in most violent behaviors are encouraging; however, lack of decline in weapon carrying merits further attention.
We hypothesized that chronic stressors associated with an everyday social role (work) would interact with a traumatic macrosocial stressor (the terrorist attacks of September 11, 2001) in predicting mental health status (during the fall of 2001).
We used mail surveys returned as part of wave 3 of a workplace cohort study, both before and after September 11, 2001, to assess decision latitude, sexual harassment, generalized workplace abuse, psychological distress, and alcohol use. We also used regression analyses to assess the main effect of September 11 and interactions between September 11 and stressors, after control for baseline mental health.
The main effect of September 11 on elevated alcohol use was significant for women but not for men. For women, work stressors significantly interacted with experiencing the events of September 11 to affect alcohol use and anxiety outcomes.
Women experiencing chronic work stressors were most vulnerable to elevated psychological distress and alcohol use after September 11, 2001.
Twelve countries were compared with respect to occupational class differences in ischemic heart disease mortality in order to identify factors that are associated with smaller or larger mortality differences.
Data on mortality by occupational class among men aged 30 to 64 years were obtained from national longitudinal or cross-sectional studies for the 1980s. A common occupational class scheme was applied to most countries. Potential effects of the main data problems were evaluated quantitatively.
A north-south contrast existed within Europe. In England and Wales, Ireland, and Nordic countries, manual classes had higher mortality rates than nonmanual classes. In France, Switzerland, and Mediterranean countries, manual classes had mortality rates as low as, or lower than, those among nonmanual classes. Compared with Northern Europe, mortality differences in the United States were smaller (among men aged 30-44 years) or about as large (among men aged 45-64 years).
The results underline the highly variable nature of socioeconomic inequalities in ischemic heart disease mortality. These inequalities appear to be highly sensitive to social gradients in behavioral risk factors. These risk factor gradients are determined by cultural as well as socioeconomic developments.
We conducted a population-based telephone survey in an attempt to determine correlates of formal and informal help seeking after September 11, 2001.
Between October 15 and December 31, 2001, 1774 Connecticut Behavioral Risk Factor Surveillance System respondents were asked questions directly related to their experiences of September 11.
Multivariate logistic regression analyses showed that receipt of formal help was predicted by sleep problems, close association with a victim, reports of increased smoking or drinking, and receipt of informal help. Age, gender, reports of 1 or more problems, and formal help seeking predicted receipt of informal help.
Public health planning and bioterrorism preparedness should include programs addressing increased smoking and drinking, sleep problems, and bereavement in the wake of disasters.
We compared the evolution of perception of discrimination from 1998 to 2007 among recent Arab (Muslim and non-Muslim) and Haitian immigrants to Montreal; we also studied the association between perception of discrimination and psychological distress in 1998 and 2007.
We conducted this cross-sectional comparative research with 2 samples: one recruited in 1998 (n = 784) and the other in 2007 (n = 432). The samples were randomly extracted from the registry of the Ministry of Immigration and Cultural Communities of Quebec. Psychological distress was measured with the Hopkins Symptom Checklist-25.
The perception of discrimination increased from 1998 to 2007 among the Arab Muslim, Arab non-Muslim, and Haitian groups. Muslim Arabs experienced a significant increase in psychological distress associated with discrimination from 1998 to 2007.
These results confirm an increase in perception of discrimination and psychological distress among Arab Muslim recent immigrant communities after September 11, 2001, and highlight the importance this context may have for other immigrant groups.
We examined trust in the army and perceptions of emergency preparedness among residents living near the Anniston, Ala, and Richmond, Ky, US Army chemical weapons stockpile sites shortly after September 11, 2001.
Residents (n = 655) living near the 2 sites who participated in a cross-sectional population were relatively unprepared in the event of a chemical emergency. The events of September 11 gave rise to concerns regarding the security of stored chemical weapons and the sites’ vulnerability to terrorist attacks. Although residents expressed trust in the army to manage chemical weapons safely, only a few expressed a desire to actively participate in site decisions.
Compliance with procedures during emergencies could be seriously limited, putting residents in these sites at higher levels of risk of exposure to chemical hazards than nonresidents.
We assessed the prevalence of perceived abuse and discrimination among Arab American adults after September 11, 2001, and associations between abuse or discrimination and psychological distress, level of happiness, and health status.
We gathered data from a face-to-face survey administered in 2003 to a representative, population-based sample of Arab American adults residing in the greater Detroit area.
Overall, 25% of the respondents reported post-September 11 personal or familial abuse, and 15% reported that they personally had a bad experience related to their ethnicity, with higher rates among Muslims than Christians. After adjustment for socioeconomic and demographic factors, perceived post-September 11 abuse was associated with higher levels of psychological distress, lower levels of happiness, and worse health status. Personal bad experiences related to ethnicity were associated with increased psychological distress and reduced happiness. Perceptions of not being respected within US society and greater reported effects of September 11 with respect to personal security and safety were associated with higher levels of psychological distress.
Perceived post-September 11 abuse and discrimination were associated with increased psychological distress, reduced levels of happiness, and worse health status in our sample. Community-based, culturally sensitive partnerships should be established to assess and meet the health needs of Arab Americans.
This study examined the methodology of epidemiological studies that suggest use of topical sunscreen preparations is associated with increased risk of malignant melanoma.
We pooled data from observational studies using a general variance-based meta-analytic method that employed confidence intervals (previously described). The outcome of interest was a summary relative risk (RR) reflecting the risk of melanoma associated with sunscreen use versus nonuse. Sensitivity analyses were performed when necessary to explain any observed statistical heterogeneity.
Combining studies that used non-heterogeneous data yielded a summary RR of 1.01, indicating no association between sunscreen use and development of malignant melanoma.
The available epidemiological data do not support the existence of a relationship between topical sunscreen use and an increased risk of cutaneous malignant melanoma.
The isolation of Pseudomonas aeruginosa, serogroup 11, from the skin lesions of bathers and from public whirlpools during outbreaks of pool-associated rash illness raises the question of whether the association is an etiologic one and if so what accounts for it. We suggest that a particular environmental adaptation of some strains of Pseudomonas and certain virulence factors they possess may enhance their pathogenic potential.
I applied the capture-recapture method to estimate the World Trade Center tower population at the time of the September 11, 2001, terrorist attacks. Available lists helped identify 8965 survivors and 2152 confirmed casualties. The capture-recapture model suggested that an additional 4435 survivors were present, putting the total count of all present at 15,552 (95% confidence interval=15,216, 15,897). An accurate estimate represents the potential number at risk for trauma as a result of direct exposure to the events of the day.
Historically, the importance of public health has often been recognized during or as a result of major tragedy. The attacks that occurred in the United States in 2001 are no exception.
These events have raised awareness of our vulnerability and the need for emergency preparedness, the need for a flexible and sustainable public health infrastructure, and the importance of linkages between environmental exposures and health outcomes.
The authors encourage the public health community, along with policymakers, to develop a national environmental health tracking system that can improve our overall public health capacity and prepare us to investigate the critical issues of the day, whether they be emerging infectious diseases, terrorist attacks, or chronic illnesses.
The horrific terrorist attacks on the World Trade Center, the Pentagon, and 4 commercial airliners have seared unspeakable images into our memories. In the wake of the attacks, various sectors of our society—including public health professionals, academics, and community workers—have been reexamining their preparedness for future assaults. Now, more than ever, there is an urgent need to strengthen the US public health infrastructure.
Because of the recognized benefits of exclusive breastfeeding,1–7 the American Academy of Pediatrics and the World Health Organization strongly encourage exclusive breastfeeding for the first 6 months of life.7,8 Unfortunately, national goals for exclusive breastfeeding in the United States are not yet established, at least in part because of a lack of data.
The Third National Health and Nutrition Examination Survey (NHANES III) sample is nationally representative and particularly valuable in providing data on exclusive breastfeeding. We used NHANES III data to examine the prevalence of exclusive breastfeeding among US infants to obtain baseline data for program evaluation and public health policymaking.
This study examined the relationship of nicotine dependence with smoking cessation and major depression, using the Fagerstrom Test for Nicotine Dependence (FTND) and the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R).
In an epidemiologic study of young adults that used the FTND and the National Institute of Mental Health Diagnostic Interview Schedule, 238 daily smokers were assessed with respect to nicotine dependence. Cessation (abstinence for 1 year or more) was assessed 2 years later.
FTND-defined nicotine dependence predicted cessation, with non-dependent smokers 4 times more likely to quit. DSM-III-R-defined nicotine dependence also predicted cessation, but much more weakly. Number of cigarettes per day was the best predictor of cessation. FTND-defined dependence was unrelated to major depression, whereas DSM-III-R-defined dependence signaled a 3-fold risk for major depression. The association of DSM-III-R-defined nicotine dependence with major depression might be driven by the behavioral rather than the physiologic symptoms of dependence.
The more a measure of dependence is based exclusively on level of daily smoking, the greater is its ability to predict cessation. The number of DSM-III-R behavioral symptoms might be an indicator of severity of dependence or of personality traits, which in turn might be associated with major depression.
Music videos from five genres of music were analyzed for portrayals of tobacco and alcohol use and for portrayals of such behaviors in conjunction with sexuality.
Music videos (n = 518) were recorded during randomly selected days and times from four television networks. Four female and four male observers aged 17 to 24 years were trained to use a standardized content analysis instrument. All videos were observed by rotating two-person, male-female teams who were required to reach agreement on each behavior that was scored. Music genre and network differences in behaviors were analyzed with chi-squared tests.
A higher percentage (25.7%) of MTV videos than other network videos portrayed tobacco use. The percentage of videos showing alcohol use was similar on all four networks. In videos that portrayed tobacco and alcohol use, the lead performer was most often the one smoking or drinking and the use of alcohol was associated with a high degree of sexuality on all the videos.
These data indicate that even modest levels of viewing may result in substantial exposure to glamorized depictions of alcohol and tobacco use and alcohol use coupled with sexuality.
The purpose of this study was to describe and compare risky behaviors in HIV-infected youths and adults.
Records of HIV-infected outpatients were reviewed for the period January 1990 to February 1998. Youths (younger than 22 years at HIV diagnosis and younger than 25 years at study entry, n = 139) were compared with adults (22 years or older at HIV diagnosis or 25 years or older at study entry, n = 2880). Risky behaviors occurring after HIV diagnosis included unsafe sex and needle sharing.
Female and male youths were more than twice as likely as adults to engage in risky behavior (adjusted odds ratios of 2.6 and 2.3, respectively).
Both youths and adults continue to engage in risky behaviors after HIV diagnosis. Prospective studies are needed, along with targeted public health campaigns, for youths with HIV and for those at risk of infection.
Maternal alcoholism during pregnancy may result in severe prenatal growth deficiency. In this prospective study, the relationship of moderate maternal alcohol consumption to infant birth weight is explored. Subjects were 263 paying members of a health maintenance organization who delivered single live children. Their alcohol consumption before pregnancy, and in early and late pregnancy, was estimated. In order to control for smoking, which is strongly related to both infant birth weight and maternal alcohol use, the sample was selected so that similar proportions of smokers were represented in both light and heavier drinkers. Multiple linear regression was employed. A regression equation was computed for each of the three periods in which drinking was estimated. Independent variables entered into the equation were maternal age, height, parity, daily cigarettes, alcohol use in the period, and gestational age and sex of child. The regression of birth weight on these variables revealed a significant relationship (p less than or equal to .01) with alcohol consumption in two of the periods. Ingestion of an average of one ounce of absolute alcohol daily before pregnancy was associated with an average decrease in birth weight of 91 grams; the same amount ingested in late pregnancy was associated with a decrease of 160 grams. The associations were independent of the other variables entered into the equation, and in particular, of tobacco use.
This paper reports register data concerning somatic and psychiatric hospital care on 117 battered women who were identified in a surgical emergency department and offered a treatment program. Data were collected during a period of 10 years before to 5 years after the battering in question. It was concluded that the battered woman seeks hospital care much more than the average woman of the same age. It is, however, not only traumatic injuries that bring her to the hospital, but also medical, gynecological, psychiatric, and unspecified disorders and suicide attempts. In this study it was hypothesized that this overuse of hospital care reflects the situation at home characterized by ongoing battering and other psychosocial problems. During the 5 years following the battering, the women did not show any signs of reducing their use of hospital care. It is alarming that this high use of medical care continues over years, and doctors should consider battering as one possible explanation for this phenomenon.
Biochemical determinations of plasma and salivary cotinine and thiocyanate were used to differentiate smokers from non-smokers and to follow daily smoking patterns in smokers. Results indicate that cotinine is better suited than thiocyanate to determine smoking status in large scale epidemiologic studies and to follow alterations in smoking behavior over periods of time. Salivary cotinine is a reliable alternative to plasma for validation of smoking status and for following changes in daily smoking patterns.
This study examined whether more highly educated women were at greater risk of dying of breast cancer during 1989 through 1993.
Breast cancer mortality rates were calculated through death certificates and Current Population Survey data.
Breast cancer mortality rates were highest among women with 12 and with 16 or more years of education. Non-Hispanic Black women had the highest mortality rates and Asian women the lowest. Positive relationships between mortality and education were found for Hispanic women as well as non-Hispanic Black and Asian women.
The previously seen positive relationship between breast cancer mortality and education was found among US women of color but not non-Hispanic White women.
