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Showing papers in "Journal of Health Care for the Poor and Underserved in 1992"


Journal ArticleDOI
TL;DR: The model shows a significant direct association between primary care and favorable mortality outcomes, though the same does not hold true for variables such as hospital beds or physician specialists.
Abstract: Many researchers criticize clinical medicine for its failure to improve mortality rates. But in their critiques, few distinguish primary care from expensive, high-technology specialized care. This research is concerned with the empirical relationship between the availability of health services resources (i.e., primary care, specialty care, hospital beds) and certain "life chances," as measured by overall and disease-specific mortality rates, and life expectancy. The model shows a significant direct association between primary care and favorable mortality outcomes, though the same does not hold true for variables such as hospital beds or physician specialists. There should be greater emphasis on prevention-oriented primary care as a mechanism for health improvement and cost control.

126 citations


Journal ArticleDOI
TL;DR: A recent study compared a group of drug-exposed and unexposed 18-month-old toddlers from low-income families, found that the drug-Exposed children exhibited notably less affect, were more apt to scatter or batter their toys, wereMore nervous in handling toys, and were less attached to their caregivers.
Abstract: SUBSTANCE ABUSE DURING pregnancy has been recognized asa major national health problem for both women and children. Medical complications including anemia, cardiac disease, cellulitis, edema, hepatitis, phlebitis, and pneumonia, are seen in 40 to 50 percent of drug-dependent pregnant women, while drug exposure in utero is now known to be a primary source of developmental delays, birth defects, and fetal death.1 Major effects on the fetus can include overwhelming infection, chorioamnionitis, premature rupture of the membranes, poor fetal growth, mental retardation, and low-birthweight with associated complications.2 In addition, infants born to drug-abusing parents are at heightened risk for physical abuse and neglect, learning disabilities, lowered IQ, and behavioral problems. The longer-term emotional and behavioral effects of prenatal drug exposure are uncertain. However, a recent study by Dr. Judith Howard at UCLA, which compared a group of drug-exposed and unexposed 18-month-old toddlers from low-income families, found that the drug-exposed children exhibited notably less affect (pleasure, anger, distress), were more apt to scatter or batter their toys, were more nervous in handling toys, and were less attached to their caregivers. A number of substances have been implicated as sources of poor birth outcome. Since they were initially described in 19733, hundreds of cases of fetal alcohol syndrome (FAS) and fetal alcohol effects (FAE) have been documented in the medical literature. The long-term effects of FAS, including deficits in

53 citations


Journal ArticleDOI
TL;DR: In a sample of 581 homeless or drug-abusing minority women, the relationship of self-esteem, sense of coherence, and support availability to emotional distress, somatic complaints, and high-risk behavior were investigated.
Abstract: In a sample of 581 homeless or drug-abusing minority women, the relationship of self-esteem, sense of coherence, and support availability to emotional distress, somatic complaints, and high-risk behavior were investigated. Findings revealed that women who were high in self-esteem and stronger in sense of coherence reported significantly less emotional distress, and significantly fewer high-risk behaviors. In addition, women who were high in any of the three resources reported lower somatic complaints. Regression analysis revealed that coherence, self-esteem and support availability jointly accounted for 49% of the variance in emotional distress, 10% of the variance in high-risk activities, and 26% of the variance in somatic complaints. Implications for empowering women at risk for HIV infection are discussed.

29 citations


Journal ArticleDOI
TL;DR: A brief historical record of the ways African-American women have sought to control their fertility through the use of abortion and birth control is assembled and the activism of African- American women in the establishment of family planning clinics and in defense of abortion rights is examined.
Abstract: The history of African-American women's efforts to control their fertility is largely unknown. From slavery to the present, the growth rate of the African-American population has been cut in half. Demographers and historians frequently attribute this change to external factors such as poverty, disease, and coerced birth control, rather than the deliberate agency of African-American women. This essay assembles a brief historical record of the ways African-American women have sought to control their fertility through the use of abortion and birth control. It also examines the activism of African-American women in the establishment of family planning clinics and in defense of abortion rights.

26 citations


Journal ArticleDOI
TL;DR: How social, economic, and political structures have contributed to the spread of human immunodeficiency virus (HIV) and hampered efforts to fight the epidemic is highlighted.
Abstract: AT the 1991 AIDS Update Conference in San Francisco, Don Francis presented a plenary talk on prevention strategies entitled \"The virus or the people, whose side are we on?\"1 Similarly, in this paper, we highlight how social, economic, and political structures have contributed to the spread of human immunodeficiency virus (HIV) and hampered efforts to fight the epidemic. We also discuss the ways in which one of the most stigmatized groups of people in our society—drug injectors—have responded to the epidemic. It is easy for us, as the authors, to miss our step in a paper such as this over intentions. Americans are individualistic and moralistic, and thus judge social issues in terms of individual intentions and guilt. Hence, statements about social structures that impoverish or oppress people tend to be perceived as claims that the people who run dominant institutions want to be exploitative or oppressive. As a result, issues concerning socioeconomic structure get reduced to speculation about the personal guilt or innocence of the powerful. The other side of this individualistic interpretation is that those who are oppressed or exploited are seen as the causes of their own poverty or diseases.

20 citations


Journal ArticleDOI
TL;DR: Today's psychiatric nomenclature recognizes the compulsive, addictive quality of certain sexual behaviors, as opposed to the impaired state of otherwise "normal" sexual dysfunctions, with the dichotomy set forth in the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IIIR).
Abstract: Sexual addiction is a relatively new term describing ancientbehavior which seems to be increasing exponentially worldwide, perhaps as an indicator of the generalized violence in modern life. The chief characteristic of this group of human sexual behaviors is its compulsivity. Formerly labelled perversions and later hypersexuality, these out-of-control and clearly antisocial behaviors are now medically and legally classified as paraphilias (disorders characterized by recurrent intense sexual urges and fantasies involving suffering or humiliation of one's self or partner, a child or other nonconsenting partner, or involving nonhuman objects). For the purposes of this discussion, such compulsive sexual behaviors are termed "sexual addiction." What, then, do we mean by sexual dysfunctions? These behaviors are largely impaired states of so-called normal sexual functioning. I use the wellknown labels such as impotence, premature ejaculation, and anorgasmia (failure to experience orgasm in sexual intercourse), although recent medical and legal classifications describe either low sexual desire or inhibitions in psychophysiologic functioning. Somehow these impaired states were never labelled hyposexuality, perhaps to spare a patient further embarrassment. Today's psychiatric nomenclature recognizes the compulsive, addictive quality of certain sexual behaviors, as opposed to the impaired state of otherwise "normal" sexual dysfunctions, with the dichotomy set forth in the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IIIR):

20 citations


Journal ArticleDOI
TL;DR: Research shows that the dual disordered population has poor treatment compliance, is hospitalized more frequently than are psychiatric patients, and has poor outcome in both psychiatric and chemical dependency treatment.
Abstract: AgrA©A¢t DEAL of interest has recently developed in the area of dual diagnosis, which is defined here as a co-occurrence of mental disorder and substance-use disorder. Much of the focus on dual diagnosis has come from the public mental health system, which is confronted with increasing numbers of young chronically mentally ill patients who also have problems related to substance use. Research shows that the dual disordered population has poor treatment compliance, is hospitalized more frequently than are psychiatric patients, and has poor outcome in both psychiatric1 and chemical dependency treatment.2 A number of programs have been developed to address dual disordered patients. These include outpatient programs3, case-managed pro- grams4, and inpatient programs.5"8 There are relatively few outcome studies in the area, probably due to several factors: 1. dual diagnosis is a relatively new area of interest; 2. dual-diagnosis programs and clinics have developed only in the last few years;

20 citations


Journal ArticleDOI
TL;DR: Data obtained from 29 homeless pregnant women indicated that 38 percent of these women drank alcohol, 69 percent smoked cigarettes, seven percent smoked marijuana, and 10 percent used other illegal substances, suggesting a need to develop and implement programs of care targeted at this population.
Abstract: Substance use during pregnancy contributes significantly to complications for both the mother and the developing child. Women who smoke cigarettes, use illicit drugs, or drink alcoholic beverages are at greater risk for the development of premature labor, spontaneous abortions, miscarriages, and stillbirths. Drug-exposed infants are more likely to develop low birth-weight, impaired neurological development, congenital anomalies, and symptoms of withdrawal. These effects maybe worse in poor and underprivileged populations if the mother also has inadequate prenatal care, poor nutritional status, chronic illnesses, or additional coexisting complications of pregnancy. Research concerning the substance use of pregnant women is beginning to accumulate. However, no published studies investigate the health behaviors of homeless pregnant women relative to drugs. Data obtained from 29 homeless pregnant women indicated that 38 percent of these women drank alcohol, 69 percent smoked cigarettes, seven percent smoked marijuana, and 10 percent used other illegal substances. These findings suggest a need to develop and implement programs of care targeted at this population.

19 citations


Journal ArticleDOI
TL;DR: Analysis of the economic and social characteristics of uninsured and underinsured individuals and households in a Midwestern state indicates that in rural areas, underinsurance may be a greater problem than uninsurance, and that income-based health insurance is more effective than employer-provided plans in reaching all Americans.
Abstract: The Midwest is often overlooked in national studies of health insurance status. We analyzed the economic and social characteristics of uninsured and underinsured individuals and households in a Midwestern state using both bivariate and multivariate techniques. As in much of the country, economic factors, particularly income and employment, were most significant in accounting for insurance coverage. Unexpectedly, rural and urban residents were equally likely to lack insurance. Results indicate that in rural areas, underinsurance may be a greater problem than uninsurance, and that income-based health insurance is more effective than employer-provided plans in reaching all Americans.

16 citations


Journal ArticleDOI
TL;DR: The Commissioner of the Department of Mental Health and Mental Retardation has become aware of the prevalence of dual diagnosis, the complications it poses to effective treatment, the difficulties confronting clients in seeking treatment, and the substantial costs that patients with dual diagnosis contribute to the health care system.
Abstract: AYOUNG man, let's call him James, had a history of mental illness and alcohol abuse. A friend of mine, a recovering alcoholic, told me that his first encounter with James was at a local Alcoholics Anonymous (AA) group. James had been directed to AA by the psychiatrist at a community mental health center. When James shared with the AA group that he was taking medication for his mental illness, he was told that in order to recover from alcoholism he must abstain from any and all mood-altering drugs. Several meetings later, James said that his doctor insisted that he remain on his medication. For months, James struggled to reconcile his doctor's orders with the rules of AA. Then, suddenly, he no longer appeared at meetings. One day my friend was visiting the Middle Tennessee Mental Health Institute, and there was James, who was now a patient at the hospital. My friend wondered, "Did this young man wind up in a mental institution because the alcoholic support group didn'tknow how, or were unwilling, to deal with his mental illness, or was it because the mental health treatment people didn't know how or were unwilling to deal with his alcoholism?" The case of James raises the subject of dual diagnosis. Now be it understood that I claim no substantial expertise in dual diagnosis. I am an administrator, not a clinician. However, as the Commissioner of the Department of Mental Health and Mental Retardation, the subject of dual diagnosis gives me cause for concern. I have become aware of the prevalence of dual diagnosis, the complications it poses to effective treatment, the difficulties confronting clients in seeking treatment, and the substantial costs that patients with dual diagnosis contribute to the health care system.

12 citations


Journal ArticleDOI
TL;DR: New Mexico is a unique setting for the study of alcohol and other drug abuse treatment and has a vibrant tricultural heritage, with a mutual respect for ethnic and cultural diversity that is a model for the nation.
Abstract: New Mexico is a unique setting for the study of alcohol and other drug abuse treatment. Though the fifth largest state in land mass, New Mexico ranks 37th in population. Only two of our counties are considered urban by the U.S. Bureau of the Census, with 15 counties identified as rural, and the remaining 16 designated as \"frontier\" counties. New Mexico has a vibrant tricultural heritage, with a mutual respect for ethnic and cultural diversity that is a model for the nation. Thirty-eight percent of the state's population is Hispanic, the highest proportion in the nation. Nine percent of the population is Native American, the second highest proportion in the country. With its rural character and tricultural diversity, New Mexico faces many challenges. The state ranks 44th in per-capita income, with 21 percent of the population currently living below the poverty line. Over 30 percent of our

Journal ArticleDOI
TL;DR: The real issue in the McKiever case is not the merits of institutional versus community-based care, rather, it is how to deal with the mentally ill chemical abuser (MIC A).
Abstract: ON the morning of June 8,1991, Kevin McKiever*, a homeless mentally ill man, killed Alexis Welsh, a young woman who was routinely walking her dog on Manhattan's Upper West Side. McKiever was identified by the victim before she died, and he was observed by witnesses before, during, and after the crime. When apprehended by the police a short time later, however, he could not remember the episode. This terrible and senseless murder quickly came to symbolize the belief that the city had become unlivable. It also became a part of the ongoing debate about the viability of deinstitutionalized care for the mentally ill. Yet, an important fact was overlooked. McKiever was not merely mentally ill. He was also a substance abuser. The real issue in the McKiever case is not the merits of institutional versus community-based care. Rather, it is how to deal with the mentally ill chemical abuser (MIC A). Our seeming inability to meet the needs of the dually diagnosed has called into question the appropriateness of the services we do provide. As Michael Stone noted in New York Magazine:

Journal ArticleDOI
TL;DR: The existing clinical and scientific literature on drug abuse treatment often ignores the role of racial/ethnic, cultural, and other sociodemographic factors.
Abstract: Illicit drug abuse is A major public health problem in the United States, one that affects all segments of the population. The problem is exacerbated when it occurs among sociodemographic groups—racial /ethnic minorities, the poor, the homeless, and those living in rural areas—that tend to be underserved by the health care and drug abuse treatment systems in this country. The existing clinical and scientific literature on drug abuse treatment often ignores the role of racial/ethnic, cultural, and other sociodemographic factors. For example, a recent survey of 26 comprehensive books on alcoholism or substance abuse published between 1975 and 1989 found that 10 (38 percent) made no mention of racial factors.1 A recent exhaustive review of success rates in detoxification

Journal ArticleDOI
TL;DR: Themes of this conference points to the connection between mental health and substance abuse and the most comprehensive national data comes from the Epidemiologic Catchment Area Studies.
Abstract: THE THEME OF THIS CONFERENCE points to the connection between mental health and substance abuse. Anecdotally, of course, we have long known that there is a connection. Examples are all around us. Just this August, for example, a subway crashed in New York City. The result was that a number of people lost their lives and many more were injured. The transportation infrastructure suffered great damage, as well, and because of that, travel for many hundreds of thousands of people was disrupted for weeks. The police reported tentatively thatthemotorman'sblood alcohol level, when tested many hours after the accident, was double the legal limit. The motorman was said to have been severely depressed, despondent, and disoriented because of a lover's quarrel. Such direct correlations between mental health and drug abuse occur all the time, and frequently with serious consequences for society. And as physicians and health professionals, we have always known that when people are in drug treatment programs, their mental disorders become apparent. But what statistical documentation proves the linkages between mental health and drug abuse? The most comprehensive national data, in my judgment, comes from the Epidemiologic Catchment Area Studies that the National Institute of Mental

Journal ArticleDOI
TL;DR: The title and focus of this conference are recognition that lives affected by alcohol and other drug abuse can be changed through research and treatment, and the critical relationship of substance abuse—particularly, but not solely, injection drug abuse—to the spread of HIV infection and AIDS is an urgent and major immediate challenge.
Abstract: Every individual IN this country has the right to good emotional, mental, and physical health. One of the highest priorities of the National Institute on Drug Abuse (NIDA), as an agency of the U.S. Department of Health and Human Services, is to ensure that substance abuse and any health problem it may spawn or intensify is, if not prevented, certainly greatly lessened. The critical relationship of substance abuse—particularly, but not solely, injection drug abuse—to the spread of HIV infection and AIDS is an urgent and major immediate challenge to this goal. I am particularly pleased with the title and focus of this conference, because of the recognition that lives affected by alcohol and other drug abuse can be changed through research and treatment. When we speak of alcohol and other drug abuse, we are speaking of primary care, infant mortality, tuberculosis, hepatitis, and sexually transmitted diseases. Although NID A's mission involves research, our Agency is one whose projects and programs emphasize helping people, and we never lose sight of the fact that our research has meaning because its findings lead directly to more effective prevention and treatment approaches. As a research institute, NIDA supports and conducts most of our nation's research into the incidence and prevalence of drug abuse, its causes and


Journal ArticleDOI
TL;DR: Children whose parents are chemically dependent tend to be poor or at risk for poverty, because chemical dependence drains the family's financial resources, and there is a very high risk for chronic placement in foster care that leaves children psychosocially deprived.
Abstract: Parental chemical dependence can affect a child psychosocially in two ways: 1) the consequences of organic brain-related birth defects caused by the drug during the child's gestation, or 2) deficits in parental child-rearing skills, from their emotional absorption with the chemical(s) or their own chemically-related organic brain affects. Although chemically dependent parents can be found in all socioeconomic strata, children whose parents are chemically dependent tend to be poor or at risk for poverty, because chemical dependence drains the family's financial resources. Further, there is a very high risk for chronic placement in foster care that leaves children psychosocially deprived. These children tend to be underserved by the health care system because they are under-identified, and existing mechanisms for health care are generally very costly and ill-equipped to properly manage the magnitude of children who need services. Most children who are affected by parental chemical dependence are victims of alcohol use by one or both parents. While an accurate count of the incidence and prevalence of child victims of alcohol and other drugs is difficult to ascertain1, an estimated 12 to 50 million children are victims of parental alcohol dependence alone.2 If the second parent is present in the home, that

Journal ArticleDOI
TL;DR: The D.C. Department of Corrections is currently implementing a residential substance abuse treatment program, which provides intensive transitional treatment for repeat offenders with histories of chronic substance abuse.
Abstract: The D.C. Department of Corrections is currently implementing a residential substance abuse treatment program. This program provides intensive transitional treatment for repeat offenders with histories of chronic substance abuse. The Department's inmate population has a high rate of recidivism: 51 percent were previously incarcerated. Eighty-six percent of the population have a documented history of substance abuse. Violent crimes represent the highest percentage of offenses committed. At least 50 percent were unemployed at that time of their criminal offense. Additionally, the population is primarily urban, inner-city African-American males for whom, far too often, the repeated cycle of substance abuse, crime, and incarceration has become a pattern of life.*

Journal ArticleDOI
TL;DR: This study toured five urban public health care systems in different parts of the country to promote consideration of a new governance for Chicago and Cook County's complicated and uncoordinated care for the medically indigent.
Abstract: Policy-oriented investigations into public health care delivery have been limited, especially during the Reagan era of competition and profit-based health care, when the inner city was essentially forgotten. In this study, policymakers toured five urban public health care systems in different parts of the country to promote consideration of a new governance for Chicago and Cook County's complicated and uncoordinated care for the medically indigent. A comparison of patterns of governance revealed strengths and weaknesses of each model. Local leadership and the political will to evolve a system of care, with clear connections between the public and private sectors, account for each city's relative success in addressing mounting needs of inner-city populations.

Journal ArticleDOI
TL;DR: Kosten TR, Schottenfeld MD, Morgan C, et al.
Abstract: s of the Fifth World Congress of Biological Psychiatry, Horence, Italy, June, 1991. 37. Kosten TR, Schottenfeld MD, Morgan C, et al. Buprenorphine vs. methadone for opioid dependence. Committee on Problems of Drug Dependence 53rd Annual Meeting, Abstracts, 1991.

Journal ArticleDOI
TL;DR: The public health sector has a legitimate and important role in working together with the criminal justice, social service, and educational sectors to reduce the dramatic toll in injuries and deaths that violence and abusive behavior inflict on the authors' society.
Abstract: Homicide and violent behavior are nationally recognized, preventable public health problems that traditionally have been left to the criminal justice system. The public health sector has a legitimate and important role in working together with the criminal justice, social service, and educational sectors to reduce the dramatic toll in injuries and deaths that violence and abusive behavior inflict on our society.1

Journal ArticleDOI
TL;DR: This work would like to review key social and clinical trends as well as research activities that have heightened the authors' awareness of the extent and implications of comorbid substance abuse and mental disorders, and consider how this awareness can and should be harnessed to make future improvements.
Abstract: Over the past decade, the co-occurrence and interaction of alcohol and other drug use disorders with psychiatric illness have gained increasing prominence in scientific, clinical, and health policy circles. While attention to comorbidity of mental and addictive disorders bears directly on the quality of health care available to all Americans, I would suggest that it is particularly auspicious for medically underserved populations. This suggestion reflects my confidence that research-based knowledge guides clinical practice patterns as well as the continuing refinement of our country's health care policies. It also reflects my knowledge that the poor and underserved are least likely to be afforded the full advantages of today's health care system. I would like to review key social and clinical trends as well as research activities that have heightened our awareness of the extent and implications of comorbid substance abuse and mental disorders. Against that backdrop, I will consider how this awareness can and should be harnessed to make future

Journal ArticleDOI
TL;DR: Analysts consider 11 percent to be an underestimate for the District of Columbia and perhaps for other such urban areas as well.
Abstract: The 1988 National Household Survey on Drug Abuse indicated that 11 percent of women of childbearing age had used illicit drugs within the past 30 days.1 In a 1989 survey of 44 selected hospitals (with 36 reporting) by the Chicago-based National Association of Perinatal Addiction Research Education (ÑAPARE), an average of 11 percent of infants were prenatally exposed to drugs (range 0.4 percent to 27 percent).2 Analysts consider 11 percent to be an underestimate for the District of Columbia and perhaps for other such urban areas as well. Consider the following:

Journal ArticleDOI
TL;DR: Exposure to six percent alcohol for 12 weeks is not associated with overt gonadal or copulatory failure, although decrements in erectile ability, alterations in parameters of copulatory behavior, and a moderate degree of hypertension are observed.
Abstract: Alcohol use is commonly believed to induce sexual dysfunction. To examine the nature and degree of sexual dysfunction induced by chronic alcohol consumption, we studied the effects of a liquid diet containing six percent ethanol on the copulatory behavior of sexually vigorous male Long-Evans rats. Control rats were pair-fed an isocaloric liquid diet and an additional group received normal food ad libitum . The groups were formed so that no differences in intromission latency, ejaculation frequency (number of ejaculations in the 60 minutes following the first intromission) or body weight were evident. Liquid food was administered once a day. The rats receiving alcohol drank throughout the course of the day. In contrast, the isocaloric controls consumed most of the available food within hours of its availability. Average daily intake of liquid diet was variable from 67 to 97 ml/rat per day. Copulatory behavior tests were administered weekly, beginning four days after initiation of the diet. No decrements in motivational aspects of copulatory behavior were evident in tests from four to 74 days after initiation of the study. In tests from four to 60 days after the start of alcohol exposure, there were no significant differences in any parameters of copulatory behavior. However, in tests administered after 67 days of alcohol exposure, the alcohol-treated rats demonstrated alterations in performance aspects of copulation: there was an increase in the number of mounts without intromission (mount frequency); an increase in the number of intromissions preceding ejaculation (intromission frequency); a decrease in copulatory efficacy; and an increase in the postejaculatory interval. In tests 74 and 81 days after the start of alcohol exposure, similar increases in mount frequency and postejaculatory interval were observed. Further, we observed a decrease in intromission frequency (premature ejaculation) coupled with a more dramatic decrease in copulatory efficacy. To ascertain whether the decreased copulatory efficacy and increased mount frequency were due to erectile dysfunction, we administered an ex copula penile reflex test 78 to 79 days after starting the ethanol diet and observed a profound deficit in erectile function. In contrast to these indications of reduced copulatory ability, the number of ejaculations obtained during the one-hour test period was not significantly decreased in alcohol-treated rats. Indirect assessment of systolic blood pressure 79 to 80 days after initiation of dietary manipulation revealed a moderate degree of hypertension in the alcohol-exposed rats. Rats were sacrificed 84 days after initiating the study. Despite isocaloric intakes, the nonalcoholic rats weighed 121 percent of their pretreatment body weight, compared to 105 percent for alcoholic rats. Ad lib chow-fed rats weighed 142 percent of their prestudy body weights. Indices of gonadal function (testes and accessory organ weights) do not indicate gonadal failure. Hormonal and neurochemical analyses will be performed. These data indicate that exposure to six percent alcohol for 12 weeks is not associated with overt gonadal or copulatory failure, although decrements in erectile ability, alterations in parameters of copulatory behavior, and a moderate degree of hypertension are observed. (Supported by NIH GM 08037, HL 02482, GM 04564, and NSF HRD 9106096)

Journal ArticleDOI
TL;DR: In 1970, a chance remark of a Brooklyn junior-high school science student suggested to his teacher, a medical sociologist by training, a widespread and hitherto unreported magico-religious use of elemental mercury in the home, and the possible pathology resulting from it as discussed by the authors.
Abstract: The chance remark of a Brooklyn junior-high-school science student suggested to his teacher—a medical sociologist by training—a widespread and hitherto unreported magico-religious use of elemental mercury in the home. Interested and concerned, the teacher undertook a preliminary investigation into the nature and geographical distribution of such occult mercury use, and the possible pathology resulting from it. His investigation issued in "the first mention [in the literature] of widespread domestic exposure to mercury vapor." 1 With confirmation of a potentially serious public-health threat, a one-man campaign was begun to alert health authorities and medical scientists to problems posed by this novel form of domestic mercury pollution. The campaign involved calling, writing, and meeting with health and regulatory personnel and with members of the scientific press and the mass media. A detailed log of all contacts was kept. These activist efforts to rouse officialdom produced tangible results: actions by several federal regulatory agencies, numerous state and city health-department investigations, and a federally sponsored clinical research project. The campaign is ultimately the reason why several foreign health agencies have also launched, or are contemplating, similar investigations into the sale and use of mercury for occult purposes, and why there is now, in general, a greatly heightened awareness of the need to monitor and, if necessary, regulate the trade in elemental mercury.