Showing papers in "Public Health Reports in 1987"

Overview of the National Infant Mortality Surveillance (NIMS) project--design, methods, results.

Abstract: The recent slowdown in the decline of infant mortality in the United States and the continued high risk of death among black infants (twice that of white infants) prompted a consortium of Public Health Service agencies to collaborate with all States in the development of a national data base from linked birth and infant death certificates. This National Infant Mortality Surveillance (NIMS) project for the 1980 U.S. birth cohort provides neonatal, postneonatal, and infant mortality risks for blacks, whites, and all races in 12 categories of birth weights. (Note: Neonatal mortality risk = number of deaths to infants less than 28 days of life per 1,000 live births; postneonatal mortality risk = number of deaths to infants 28 days to less than 1 year of life per 1,000 neonatal survivors; and infant mortality risk = number of deaths to infants less than 1 year of life per 1,000 live births.) Separate tabulations were requested for infants born in single and multiple deliveries. For single-delivery births, tabulations included birth weight, age at death, race of infant, and each of these characteristics: infant's live-birth order, sex, gestation, type of delivery, and cause of death; and mother's age, education, prenatal care history, and number of prior fetal losses at 20 weeks' or more gestation. An estimated 95 percent of eligible deaths were included in the NIMS tabulations. The analyses focus on three components of infant mortality: birth weight distribution of live births, neonatal mortality, and postneonatal mortality. The most important predictor for infant survival was birth weight, with an exponential improvement in survival by increasing birth weight to its optimum level. The nearly twofold higher risk of infant mortality among blacks was related to a higher prevalence of low birth weights and to higher mortality risks in the neonatal period for infants weighing 3,000 grams or more, and in the postneonatal period for all infants, regardless of birth weight. Regardless of other infant or maternal risk factors, the black-white gap persisted for infants weighing 2,500 grams or more.

Reliability of self-reported sexual behavior risk factors for HIV infection in homosexual men.

Abstract: This study was undertaken to determine the reliability of self-reported sexual behavior using the test and retest technique when used with self-reported sexual behavior. The subjects were 116 asymptomatic homosexual men who participated in another study (an examination of behavioral and demographic determinants of HIV antibody status). The subjects were asked to complete two questionnaires. The first contained demographic and sexual behavior questions. The second, administered an average of 6 weeks later, used a subset of the questions in the first questionnaire. The reliability of the test-retest procedure was measured by the Kappa statistic, which assesses the proportion of agreement between two data items, accounting for the amount of agreement expected by chance. The highest degree of reliability as measured by Kappa was found with demographic information, smoking history, and sexual orientation. Self-reported sexual behaviors for the previous 6 months generally had the next highest degree of reliability as measured by Kappa. Questions examining change over the previous 5 years had the lowest reliability. Behavior changes during the time between questionnaires, subjectivity of the answer categories, and social desirability of the answers are three factors that may result in a lack of reliability in this self-reported sexual behavior questionnaire. This raises methodological concerns about the measurement of behavioral risk factors for AIDS and the ability to assess meaningfully subjective reports of behavioral change.

Alcohol as a risk factor for injuries or death due to fires and burns: review of the literature.

Abstract: The findings in 32 studies on alcohol and injuries and deaths attributed to fires and burns were analyzed in detail. The studies, all in English, were published between 1947 and 1986. Most of them were descriptive and reported on the percent of the victims who were exposed to alcohol. Eight of the nine best descriptive studies indicated that alcohol exposure was more likely among those who died in fires ignited by cigarettes than those attributable to other causes. It can be concluded that there is substantial, although not definitive, evidence that alcohol plays a role in the etiology of fire and burn injuries and deaths.

Estimates of the direct and indirect costs of acquired immunodeficiency syndrome in the United States, 1985, 1986, and 1991.

Abstract: This study presents three estimates--ranging from low to high--of the direct and indirect costs of the AIDS epidemic in the United States in 1985, 1986, and 1991, based on prevalence estimates provided by the Centers for Disease Control (CDC). According to what the authors consider their best estimates, personal medical care costs of AIDS in current dollars will rise from $630 million in 1985 to $1.1 billion in 1986 to $8.5 billion in 1991. Nonpersonal costs (for research, screening, education, and general support services) are estimated to rise from $319 million in 1985 to $542 million in 1986 to $2.3 billion in 1991. Indirect costs attributable to loss of productivity resulting from morbidity and premature mortality are estimated to rise from $3.9 billion in 1985 to $7.0 billion in 1986 to $55.6 billion in 1991. While estimated personal medical care costs of AIDS represent only 0.2 percent in 1985 and 0.3 percent in 1986 of estimated total personal health care expenditures for the U.S. population, they represent 1.4 percent of estimated personal health care expenditures in 1991. Similarly, while estimated indirect costs of AIDS represent 1.2 percent in 1985 and 2.1 percent in 1986 of the estimated indirect costs of all illness, they are estimated to rise to almost 12 percent in 1991. Estimates of personal medical care costs were based on data from various sources around the United States concerning average number of hospitalizations per year, average length of hospital stay, average charge per hospital day, and average outpatient charges of persons with AIDS. For estimating the indirect costs the human capital method was used, and it was assumed that average wages and labor force participation rates of persons with AIDS were the same as those for the general population by age and sex.

Knowledge and attitudes of AIDS health care providers before and after education programs.

Abstract: Analysis of the responses of 1,247 health care providers to questionnaires immediately before and after educational programs on acquired immunodeficiency syndrome (AIDS) revealed significant (P less than .05) improvements in accuracy of knowledge about 7 of 15 modes of transmission and 7 of 11 means of infection control. Sizeable percentages, however, continued to believe after the programs that AIDS could be transmitted by casual contact, such as sharing coffee cups. Provider attitudes about caring for persons with AIDS shifted in the direction desired (P less than .001) on six of nine questions. After programs, 92 percent believed that they had sufficient knowledge to protect themselves from getting AIDS, and 79 percent felt professionally competent to care for a person with AIDS. Both before and after programs, providers who established regulations for the care of persons with AIDS and outpatient care providers had the most accurate knowledge and felt most comfortable with persons with AIDS, while inpatient care providers had the least accurate knowledge and felt least comfortable. A 1-month followup of 159 providers revealed that postprogram changes in knowledge and attitudes were largely retained. Results point to the need for education at all levels of the health care system, to a persistent gap in knowledge and attitudes between those persons who establish regulations and those who carry them out, and to the possibility of creating significant changes through education.

Cigarette advertising and black-white differences in brand preference.

Abstract: Anecdotal evidence indicates that the cigarette industry is targeting the sale of specific brands, notably menthol cigarettes, to black consumers. This paper presents data on the types of cigarettes smoked by white and black smokers. The cigarette brand preferences of two populations of smokers were examined. The first comprised 70 white and 365 black adult smokers seen at the Deaconness Family Medicine Center located in Buffalo, NY. The second population included 1,070 white and 92 black smokers who called a Stop Smoking Hotline in Buffalo. The results showed that, in both populations, blacks were twice as likely to smoke mentholated cigarettes compared with whites. In an attempt to evaluate the targeting of cigarette ads to black smokers as a possible explanation for black-white differences in brand preferences, cigarette ads appearing in magazines targeted to predominantly white or black readers were compared. Cigarette ads appearing in seven magazines were reviewed, four directed to predominantly white readers (Newsweek, Time, People, Mademoiselle) and three with wide circulation among black audiences (Jet, Ebony, Essence). The results showed that the magazines targeted to black readers contained significantly more cigarette ads and more ads for menthol brand cigarettes than magazines similar in content but targeted to white readers. The observation that a higher percentage of blacks smoke menthol cigarettes than do whites is consistent with the findings regarding differences in the type of cigarette ads appearing in magazines intended for black or white readers. However, it is not possible to determine from this study whether cigarette advertising is the cause of the differences in preference of cigarette brands between white and black smokers. Future research focusing on understanding the reasons for cigarette brand preferences may provide ideas for anti smoking campaigns aimed at specific target groups.

Young maternal age and infant mortality: the role of low birth weight.

Abstract: In 1980 there were 562330 babies born in the US to teenage mothers (19 years of age or younger). The offspring of teenage mothers have long been known to be at increased risk of infant mortality largely because of their high prevalence of low birth weight (less than 2500 grams). We used data from the National Infant Mortality Surveillance (NIMS) project to examine the effect of young maternal age and low birth weight on infant mortality among infants born in 1980 to US residents. This analysis was restricted to single-delivery babies who were either black or white were born to mothers aged 10-29 years and who were born in 1 of the 48 States or the District of Columbia. Included were 2527813 births and 28499 deaths (data from Maine and Texas were excuded for technical reasons). Direct standardization was used to calculate the relative risks adjusted for birth weight of neonatal mortality and postneonatal mortality by race and maternal age. There was a strong association between young maternal age and high infant mortality and between young maternal age and a high prevalence of low birth weight. Neonatal mortality declined steadily with increasing maternal age. After adjusting for birth weight the race-specific relative risks for babies born to mothers less than 16 years of age were still elevated from 11 to 40% compared with babies born to mothers 25-29 years of age. Otherwise all the relative risks were nearly equal to 1. By contrast most of the association between young maternal age and postneonatal mortality persisted after birth weight adjustment in all maternal age groups. These results suggest that the prevention of neonatal mortality and to a lesser extent postneonatal mortality among babies born to teenagers depends on preventing low birth weight. The prevention of postneonatal mortality may depend more on other factors such as assisting teenagers with better parenting. Finally although there may be few biological reasons to postpone childbearing teenage childbearing continues to place the mother and her baby at a social disadvantage. (authors)

Effects of a health promotion advertising campaign on sales of ready-to-eat cereals.

Abstract: The objective of this study was to determine how the sales of various segments of the high fiber and nonhigh fiber, ready-to-eat (RTE) cereal market were influenced by a health message advertising campaign about the possible benefits of a high fiber, low fat diet for preventing some types of cancer. The fiber statements in the media campaign were endorsed by the National Cancer Institute (NCI). The campaign was undertaken by the Kellogg Company to promote its line of high fiber cereal products, including Kellogg's All-Bran. The data base consisted of computerized purchase data from 209 Giant Food, Inc., supermarkets in the Baltimore, MD, and Washington, DC, metropolitan areas. All the RTE cereal products in the stores were classified according to their fiber content and competitive market positions compared with Kellogg high fiber cereals. Estimates of market share for the various classes of RTE cereal products were obtained weekly for each store during a period of 64 weeks, beginning 16 weeks before the start of the campaign. Shifts in market share between high fiber and nonhigh fiber cereal classifications indicate substantial increases in consumer purchases of Kellogg high fiber cereals, particularly All-Bran, beginning with the start of the Kellogg advertising campaign. Growth in market share of high fiber cereals continued during the entire 48-week evaluation period, with much of the later growth in non-Kellogg high fiber cereals. Growth in sales of high fiber cereals was mainly at the expense of low fiber cereals such as granola-type products. The implications of these results for the competitive and educational effectiveness of commercially sponsored health and diet messages are discussed.

The Indian burden of illness and future health interventions.

Abstract: This article describes the burden of illness of Indians eligible for services from the Indian Health Service (IHS) and discusses strategies for reducing morbidity and mortality related to those conditions. To improve health to an extent that parallels the IHS's past achievements, the illnesses that now are prevelant among Indians require changes in personal and community behavior rather than intensified medical services. Analysis of these conditions leads to the conclusion that much of the existing burden of illness can be reduced or eliminated. IHS is responding to this challenge by continuing to ensure Indians' access to comprehensive health care services, by increasing educational efforts aimed at prevention, and by enlisting the support of other government and private organizations in activities that have as their purpose treating diseases if intervention will lessen morbidity and mortality (such as diabetes and hypertension) and encouraging of dietary changes, cessation of smoking, exercise, reduction in alcohol consumption, and other healthy behavior.

The HIV antibody test: why gay and bisexual men want or do not want to know their results.

Abstract: Beginning in the latter part of 1985, 2,047 gay and bisexual men who were enrolled in the Pitt Men's Study, the Pittsburgh cohort of the Multicenter AIDS Cohort Study (MACS), were invited by mail to learn the results of their antibody test for HIV infection--human immunodeficiency virus infection. Participants were asked to complete and return a questionnaire designed to assess the factors influencing their (a) decision about learning the results, (b) recent sexual behavior, (c) knowledge about acquired immunodeficiency syndrome (AIDS), and (d) attitudes toward AIDS risk reduction. Of those men, 1,251 (61 percent) accepted the invitation, 188 (9 percent) declined, and 608 (30 percent) failed to respond. Fifty-four percent of the cohort subsequently learned their results. There were no significant differences in demographic, behavioral, and attitudinal characteristics or HIV seroprevalence between the men who accepted and those who declined. However, significant demographic differences were noted between the men who responded to the invitation versus those who did not; the latter group was composed of a greater proportion of men who were younger, nonwhite, and less educated. The most frequently cited reason (90 percent) why men wanted their test results was to determine if they had been infected with HIV. Of those who declined, 30 percent cited concerns about the psychological impact of learning about a positive result as being the most important factor for their decision. The two most frequently selected reasons for declining were the belief that the test is not predictive of the development of AIDS (48 percent) and concern about the worry that a positive result would produce (48 percent). These findings are discussed in the context of a nationwide, voluntary HIV screening program for gay and bisexual men.

The impact of the addition of naloxone on the use and abuse of pentazocine.

Abstract: An epidemic of abuse with "T's and blues" began in the late 1970's in which pentazocine-Talwin tablets ("T")--and the antihistamine tripelennamine (known as blues) were crushed, dissolved together, filtered, and injected intravenously. The resulting high was reported to be similar to that of heroin. In 1981, the manufacturer and the Food and Drug Administration met to discuss a possible solution. As a result, 0.5 mg of naloxone hydrochloride, a narcotic antagonist that is pharmacologically inactive at that dose orally but active if administered parenterally, was added to the tablet formulation. The reformulated product, Talwin Nx, was approved for marketing in late 1982 and introduced in the second quarter of 1983. Distribution of Talwin tablets in the United States was discontinued. The Drug Abuse Warning Network (DAWN) of the National Institute of Drug Abuse and IMS America's National Prescription Audit were used to review the use and abuse patterns of pentazocine before and after the naloxone intervention. The number of prescriptions dispensed quarterly for pentazocine products remained fairly stable from 1981 through the first quarter of 1983 and increased after the introduction of Talwin Nx. In contrast, DAWN emergency room and medical examiner mentions decreased after the product reformulation. The rates of both emergency room and medical examiner mentions per million prescriptions were substantially lower in the 2 years following the introduction of Talwin Nx (decreases of 70 percent by emergency rooms and 71 percent by medical examiners), indicating that the product reformulation successfully reduced pentazocine abuse.

Acquired immunodeficiency syndrome and black Americans: special psychosocial issues.

Abstract: Approximately 25% of persons diagnosed with AIDS in the US have been black. This paper examines 3 areas of concern when focusing on AIDS in the black population: differences from whites in patterns of transmission of the infection cultural factors that may affect health education efforts and ethnically relevant issues in the provision of medical care to black persons with AIDS. Recognition of these differences is important in developing appropriate AIDS-related services for the black population. 1st the epidemiologic pattern of infection in the black population differs from whites. Although they represent only 12% of the American population blacks make up nearly 1/4 of reported AIDS cases. Currently it is estimated that between 1.0 and 1.4% of the black population may be infected with the human T-lymphotropic virus/lymphadenopathy associated virus (HTLV-I I/LAV) a rate estimated to be 3 times that of whites (which is 0.3 to 0.5%). In addition epidemiological patterns of viral transmission in the black community suggest a greater incursion into the heterosexual population. Black homosexual and bisexual men account for 46.3% of all cases in blacks IV drug users account for 35.4%; among whites these figures are 88.9% and 5.2% respectively. 2nd educational interventions designed to slow the rate of infection need to be sensitive to cultural and behavioral differences between blacks and whites who are at increased risk for AIDS. These include possible differences in perceptions of being at risk and actual risk behavior. The black gay community insists that methods of educational outreach and intervention have been ineffective in reaching black gay and bisexual men. 3rd in caring for black AIDS patients there are psychological sociocultural and medical care issues that are relevant. Health professionals can be helpful if they dispense culturally relevant advice; patient-physician relationship is critical to the quality of care received. Recommendations for research and health education efforts in the black community are presented. (authors modified)

Differences in neonatal and postneonatal mortality by race, birth weight, and gestational age.

Abstract: In recent decades, neonatal and postneonatal mortality rates have declined overall in the United States. Yet, the mortality rates for black infants continue to be approximately twice those for white infants. With the use of data from 45 of the 53 vital statistics reporting areas that participated in the 1980 National Infant Mortality Surveillance project, we extended previous State analyses to describe differences, nationally, in neonatal and postneonatal mortality risks for black and white infants according to gestational age and birth weight. After restricting our analysis to single-delivery infants with known and plausible combinations of gestational age of 26 or more weeks and birth weights of 500 grams (g) or more, the neonatal mortality risk (NMR)--that is, the number of deaths to infants less than 28 days of life per 1,000 live births--for black infants was 1.6 times higher than the NMR for whites. This difference was largely explained by two findings: First, although the NMR was lower for black than for white infants with gestational ages of less than 38 weeks and birth weights less than 3,000 g, that advantage was heavily outweighed by the higher percentage of such births among blacks, accounting for roughly two-thirds of the overall difference in NMR between blacks and whites. Second, most of the remaining difference in NMR was accounted for by higher NMRs among black infants with gestational ages of 38 or more weeks and birth weights of 3,000 g or more. A comparison of the lowest mortality risk for any combination of birth weight and gestational age showed that the black NMR was 1.89 times higher than the white NMR. The postneonatal mortality risk (PNMR)--PNMR equals the number of deaths to infants 28 days to less than 1 year of life per 1,000 neonatal survivors--for black infants was 2.09 times the PNMR for white infants. Black infants had higher PNMRs than white infants for nearly all combinations of birth weight and gestational age. Higher PNMRs among infants with gestational ages of 38 or more weeks and birth weights of 2,500 g or more accounted for 43 percent of the difference in PNMR between black infants and white infants. Eliminating the U.S. black-white infant mortality disparity will require not only reducing the higher frequency of prematurity and low birth weight among black infants, but also improving the survival during both the neonatal and postneonatal periods of term black infants with normal birth weights.

Birth weight-specific infant mortality, United States, 1960 and 1980.

Abstract: National statistics on the risk of infant mortality by birth weight were collected most recently in 1980 and 1960. (Infant mortality risk is the number of deaths of infants under 1 year of age per 1,000 live births.) In this 20-year period, the infant mortality risk (IMR) for single-delivery infants declined 53 percent, from 23.3 deaths per 1,000 live births to 11.0; 91 percent of this decline was due to lower IMRs within birth weight categories, and 9 percent was due to reduced frequency of low birth weight. The greatest reduction in neonatal mortality (under 28 days)--73 percent--occurred among infants of 1,500-1,999 grams (g) birth weight, whereas the greatest reductions in postneonatal mortality (28 days to under 1 year)--51 percent to 54 percent--occurred among infants of 3,500 g or more birth weight. Trends in IMR for black and white infants were similar, and the twofold gap between the races in IMR persisted from 1960 to 1980. For whites, reductions in the frequency of low birth weights contributed to the decline in the IMR. For blacks, the percentage of infants with birth weights of less than 1,500 g increased, and the total reduction in the IMR was attributable to lower birth weight-specific mortality risks. In some regions of the United States, failure to observe an increase in birth weight for blacks may be a reporting artifact, reflecting improved reporting of births of very small black infants in 1980. Examination of changes in perinatal mortality risks (from 20 weeks gestation to less than 28 days of life) did not suggest that infant mortality trends were substantially affected by changes in the distinction between fetal and neonatal deaths over the 20-year period. Reducing the number of low birth weight infants remains the greatest potential for future reductions in infant mortality.

The control of hypertension in persons with diabetes: a public health approach.

Abstract: Coexistent diabetes and hypertension affect an estimated 2.5 million persons in the United States. Hypertension occurs approximately twice as frequently in persons with diabetes as without and contributes to most of the chronic complications of diabetes, including coronary artery disease, stroke, lower extremity amputations, renal failure and, perhaps, to diabetic retinopathy and blindness. The proportions of complications in the diabetic population attributable to hypertension range from 35 to 75 percent. Hypertension in the diabetic population increases with age and is particularly associated with obesity and nephropathy. Limited data suggest the control of hypertension in the diabetic population may be better than in the general population, perhaps due to greater contact that persons with diabetes have with the health care system. Yet, in approximately half, hypertension is not controlled. Control strategies for hypertension in the diabetic population must take into account the higher frequency of hypertension, increased risks for adverse sequelae from the coexistent conditions, more complicated clinical management, and the greater contact with the health care system experienced by persons with diabetes. Community programs to improve hypertension control in the diabetic population may target a subset of the diabetic population and should tailor strategies to meet the needs of the target population. Hypertension control in the diabetic population must be addressed at multiple levels in the health care system, including improved detection, evaluation, and treatment of hypertension; improved adherence to antihypertensive therapy and long-term followup; provision of quality professional education and patient education and support; and systematic health care monitoring and program evaluation. Hypertension control should be emphasized in all comprehensive diabetes control programs.The treatment and control of hypertension may significantly reduce morbidity and mortality in the diabetic population.

1985 NHIS findings: nutrition knowledge and baseline data for the weight-loss objectives

Abstract: A nutrition objective for the nation is that, by 1990, 50 percent of the overweight population should have adopted weight regimens, balancing diet and physical activity More than half of the overweight respondents in the 1985 National Health Interview Survey were trying to lose weight, and almost half of this group reported both increasing their physical activity and decreasing their intake of calories Dietary restriction without exercise was the next most common weight-loss regimen, suggesting that educational efforts should emphasize the need to increase physical activity as part of appropriate weight-loss regimens Attempts to lose weight were reported frequently among those of normal and lean weight as well as among those who were overweight, especially among women and the better educated About one-fifth of already lean young women reported attempting weight loss, an indication that some inappropriate dieting is probably occurring, suggesting the need for caution in public health promotion of weight loss Another 1990 objective is that 90 percent of adults should understand that eating fewer calories or increasing activity, or both, is essential to lose weight More than 70 percent of adults in this survey were able to identify these as the two best ways to reduce weight, with greater proportions of the younger adults and the more highly educated being knowledgeable The survey also provided data for an objective that targets some nutrition education and counseling as part of all routine health contacts with health professionals by 1990 Twenty-nine percent of all women and 22 percent of all men reported that eating proper foods was discussed sometimes or often in routine contacts

Review of death certificates to assess completeness of AIDS case reporting.

Abstract: To assess the level of reporting of acquired immunodeficiency syndrome (AIDS) cases, the authors reviewed death certificates for periods of 3 months during July through December 1985 in each of four cities: Washington, DC, New York City, Boston, and Chicago. Since reporting began in 1981, these cities have reported 38 percent of all AIDS cases in the United States. Death certificates were selected and matched to the AIDS surveillance registries in each city, and medical records of those not on the AIDS registry were reviewed to determine if AIDS had been diagnosed. The estimated completeness of AIDS case reporting to AIDS surveillance systems was high in all four cities (ranging from 83 percent to 100 percent). The unreported cases were similar to reported cases with respect to sex, race, risk factor, and specific diagnosis. Of the causes of death examined, AIDS, Pneumocystis carinii pneumonia, and Kaposi's sarcoma were predictive of AIDS as defined by the CDC case definition. However, 77 of 588 deaths (13 percent) attributed to 1 of these 3 causes occurred in cases that were presumptively AIDS but did not meet the diagnostic requirements to be classified as AIDS for reporting purposes. A review of death certificates provides an easy and rapid means of evaluating surveillance efforts and can be a useful adjunct to other methods of surveillance for AIDS.

Maternal exposure to neighborhood carbon monoxide and risk of low infant birth weight.

Abstract: This case-control study investigated the potential association between ambient levels of carbon monoxide in a pregnant woman's neighborhood of residence and her chance of delivering a low birth weight infant. Low birth weight infants and normal birth weight infants were contrasted with respect to ambient levels of CO during the 3 months prior to delivery in the neighborhoods where their mothers lived at birth. After adjustment for the confounding effects of maternal race and education, there was no association between higher CO exposure and higher odds of low birth weight. These data do not support a strong association between maternal exposure to neighborhood CO during pregnancy and odds of delivering a low birth weight infant. Further investigation of the effects of CO exposure on birth weight, with direct measurement of total CO exposure, is needed.

Periodontal effects and dental caries associated with smokeless tobacco use.

Abstract: The prevalence of smokeless tobacco use has been increasing in the United States with concomitant social, medical, legal, and regulatory ramifications. This paper examines the association between the use of smokeless tobacco and the occurrence of periodontal disease and dental caries. Existing literature consists primarily of case reports and cross-sectional studies among teenagers. The limited evidence suggests an association between smokeless tobacco use and gingival recession. There is insufficient evidence to support any associations between smokeless tobacco use and gingivitis, periodontitis, or dental caries. Methods to improve future epidemiologic research to examine possible associations between smokeless tobacco use and periodontal effects or dental caries are discussed.

Birth weight-specific causes of infant mortality, United States, 1980.

Abstract: To describe underlying causes of infant death by birth weight, we used data from the 1980 National Infant Mortality Surveillance project and aggregated International Classification of Diseases codes into seven categories: perinatal conditions, infections, congenital anomalies, injuries, sudden infant death syndrome (SIDS), other known causes, and nonspecific or unknown causes. Compared with heavier infants, infants with birth weights of 500-2,499 grams (g) are at increased risk of both neonatal and postneonatal death for virtually all causes. Sixty-two percent of neonatal deaths (under 28 days of life) were attributed to "conditions arising in the perinatal period," as defined using codes from the International Classification of Diseases. Prematurity-low birth weight and respiratory distress syndrome (RDS) were the leading causes of such deaths among infants with birth weights of 500-2,499 g, while birth trauma-hypoxia-asphyxia and other perinatal respiratory conditions were the leading causes among heavier infants. For all birth weight groups, congenital anomalies were the second leading cause, representing 27 percent of neonatal deaths. Although perinatal conditions caused nearly one-third of postneonatal deaths (28 days to under 1 year of life) among infants with birth weights of 500-1,499 g, for the other birth weight groups these conditions were much less important; predominant causes of postneonatal death were sudden infant death syndrome (SIDS), congenital anomalies, infections, and injuries. Black infants had a roughly twofold higher risk of neonatal and postneonatal death than did white infants for all causes except congenital anomalies, which occurred with almost equal frequency in blacks and whites. However, for infants with birth weights of 500-2,499 g, blacks had lower risks of neonatal death from RDS and congenital anomalies. Between 1960 (the latest year for which national birth weight-specific mortality statistics had been available) and 1980, SIDS emerged as a major diagnostic rubric. Otherwise, except for infections and congenital anomalies among infants with birth weights of 500-1,499 g, all causes of death declined in frequency among all birth weight groups.

Characteristics of drug abusers that discriminate needle-sharers.

Abstract: To identify variables that discriminate needle-sharing among drug abusers, 224 male drug abusers were studied. They had been admitted to a 30-day inpatient drug treatment program over a 19-month period (September 1983 through March 1985). The variables examined were divided into three categories: demographic (age, race, education), personality (Minnesota Multiphasic Personality Inventory [MMPI] scores and MMPI deviant scores), and drug use patterns (drug of choice, use of single or multiple [mixed] drugs, severity of drug use, and place of use). Three variables were identified that discriminated needle-sharers from other drug abusers. Compared with other drug abusers, needle-sharers used more multiple drugs, were more likely to use a "shooting gallery," and had more problems related to drug use. No demographic or personality variables discriminated needle-sharers from nonsharers. The data suggested that needle-sharing is widespread in the drug culture. Needle-sharing was not confined to a particular racial group, educational level, or personality type. These findings can be used to structure education programs about acquired immunodeficiency syndrome (AIDS) for drug abusers. Drug treatment programs appear to provide an important opportunity to educate drug abusers about AIDS and related health issues associated with needle-sharing.

A television format for national health promotion: Finland's "Keys to Health".

Abstract: A series of televised risk reduction and health promotion programs have been broadcast in Finland since 1978. The five series of programs were the product of a cooperative effort by Finland's television channel 2 and the North Karelia Project. The series has featured a group of volunteers who are at high risk of diseases because of their unhealthful habits and two health educators who counsel the studio group and the viewers to make changes in health behaviors. The "Keys to Health 84-85" was the fifth of the series and consisted of 15 parts, 35 minutes viewing time each. Results of the evaluation surveys, which are presented briefly, indicate that viewing rates were high. Of the countrywide sample, 27 percent of men and 35 percent of women reported that they had viewed at least three parts of the series. Reported changes in behaviors were substantial among the viewers who had seen several parts of the series and were meaningful, overall, for the entire population. Of the countrywide sample, 7.1 percent of smoking viewers reported an attempt to stop smoking--this number was 3.6 percent of all smokers. The percentages of weight loss among viewers and the total population sample were 3.9 for men and 2.1 for women. The reported reductions in fat consumption were 27.2 percent for men and 15.0 percent for women. The reported effects in the demonstration area of North Karelia were even higher, mainly because of higher viewing rates.

Toward the 1990 objectives for smoking: measuring the progress with 1985 NHIS data.

Abstract: The Health Promotion and Disease Prevention component of the 1985 National Health Interview Survey allowed us to measure the progress made toward achieving the 1990 objectives for the nation concerning cigarette smoking. The first smoking-related objective, namely, to reduce to below 25 percent the proportion of the U.S. population who smoke, has not been achieved. Today 31 percent of the population smoke. More than 85 percent are aware of the special risk of developing and worsening chronic obstructive lung disease, chronic bronchitis, and emphysema among smokers. More than 90 percent are aware that smoking is a major cause of lung cancer; however, awareness of the risk of laryngeal, esophageal, bladder, and other kinds of cancer from smoking is not so great. More than 85 percent are aware that cigarette smoking is one of the major risk factors for heart disease. In general, then, the 1990 objectives concerning the population's knowledge of the health consequences of cigarette smoking have been met.

Occupational health and safety risks and potential health consequences perceived by U.S. workers, 1985.

Abstract: Data from the Health Promotion and Disease Prevention Questionnaire, part of the 1985 National Health Interview Survey, were used to report workers' perceptions of occupational risk in their present jobs. This information will be used to monitor progress between 1985 and 1990 toward achieving broad goals in health promotion and disease prevention. The proportions of currently employed persons who perceived exposure to health-endangering substances, work conditions, or risks of injuries were reported for age, race, sex, and occupation groups. Occupational groups were further characterized by the proportion of men and women who reported specific exposures (such as exposure to chemicals or to loud noise) and specific health consequences of exposure (such as risk of developing cancer or hearing impairment). Greater proportions of men than women reported perceived risk from exposure to health-endangering substances, work conditions, and injuries in their present job. Also, a greater proportion of workers perceived risk of injury in their present job than other occupational risk categories. The greatest proportions of perceived exposure to occupational risk were reported by farm operators and managers, police and firefighters, and by workers in forestry and fishing occupations. Among workers reporting perceived exposures, chemicals, noise, and risk of injuries from vehicles were cited by the greatest proportion of workers, as were such health consequences as lung and respiratory problems and hearing impairment. Data from this study may be used to target employment groups for health promotion or education and to develop indepth studies of specific occupational groups to reduce or prevent risk at the worksite.

Age- and sex-related blood cell values in healthy black Americans.

Abstract: Hemoglobin, mean corpuscular volume, erythrocyte count, and leukocyte count were measured, and hematocrit, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration were computed electronically for 7,739 healthy black persons. The study population comprised 3,393 males and 4,346 females 1-84 years of age, all from the Washington, DC, metropolitan area. Persons with sickle cell disease and elevated hemoglobin F were excluded from analysis, but those with traits for hemoglobin S, C, and thalassemia were not. Mean and percentile values are presented in tabular form. Hemoglobin, hematocrit, and mean corpuscular volumes were lower than those reported in surveys of white populations. Beginning with the 11-15-year age groups, black males had higher red cell values than black females. After age 30, mean hemoglobin levels for men gradually declined, while those in women rose, so that the sex difference diminished after 60 years of age. Leukocyte counts were higher in young children and in women, compared with men ages 21-50 years. After 60 years of age, the sex difference disappeared. Further large surveys that exclude data on persons with iron deficiency are needed in black populations.

The role of the university.

Abstract: The role of the university, and particularly the health sciences university, in promoting positive health for women is twofold. First, the dissemination of existing knowledge raises awareness of special health needs and identifies gaps in the present research and literature base. Second, universities must project future needs of women in a rapidly changing society where such things as space travel may become commonplace. Reduction of the risk of debilitating disease and promotion of positive attitudes will enhance the quality of life for women. A logotherapeutic approach to choosing one's own attitudes toward life's challenges promotes successful coping in a dynamic society.

Effects of community characteristics on young physicians' decisions regarding rural practice.

Abstract: The supply of physicians has increased rapidly during the past decade. To examine the impact of this expanding supply on the geographic distribution of physicians in rural areas, we examined the location patterns of 1974-78 medical school graduates practicing in 1983 in rural areas. Of 2,112 rural counties, 58 percent gained at least one 1974-78 graduate; 31 percent of the least populous rural counties gained physicians; and 92 percent of most populous counties gained physicians. When Health Manpower Shortage Areas were examined separately, it was found that only 45 percent of the HMSAs that consisted of an entire county gained a young physician compared with 61 percent of non-HMSA counties. Characteristics of counties that gained a young physician were compared with characteristics of counties that did not attract a young physician. Results of the multivariate analysis indicated that the probability that a county would attract a young physician is positively related to population, the supply of physicians, the proportion of white collar employment, and the presence of a college. Higher levels of farm population are associated with a lower probability that a county would attract a young physician. These findings suggest that diffusion of young physicians into rural areas is occurring as the supply of physicians increases. However, young physicians are attracted to communities with particular characteristics. Those counties with fewer attractive characteristics may continue to have difficulty gaining physicians to serve their communities.

Birth weight-specific infant mortality due to congenital anomalies, 1960 and 1980.

Abstract: The impact of mortality due to congenital anomalies in single-delivery births was compared in 1960 and 1980 birth cohorts; data were used from the 1960 National Center for Health Statistics national linkage of birth and death certificates and the 1980 National Infant Mortality Surveillance project. In 1960 there were 14,714 deaths due to congenital anomalies, compared with 8,674 in 1980, a 41 percent reduction. The infant mortality risk (IMR) due to congenital anomalies fell 31 percent. This is in contrast with the observed 54 percent decline in IMR due to all causes. This reduction in mortality due to congenital anomalies occurred for both whites and blacks in the postneonatal period and for whites only in the neonatal period. Changes ranged from a 1.8 percent increase for the black neonatal mortality risk to a 46.6 percent decrease for the white postneonatal mortality risk. In spite of these relative reductions, the absolute percentage of all infant deaths due to congenital anomalies had increased from 15.8 percent in 1960 to 24.1 percent in 1980. Two categories, cardiovascular and central nervous system anomalies, accounted for 72 percent of infant deaths due to congenital anomalies in 1960 and for 59 percent in 1980; cardiovascular anomalies accounted for 48 percent of all deaths due to congenital anomalies in 1960 and 40 percent in 1980. Infant mortality risks in the United States showed a 2:1 black to white ratio in both 1960 and 1980. However, for infant mortality due to congenital anomalies, the black and white mortality risks were approximately equal in both 1960 and 1980. For infants with birth weights of 500-2,499 g, the risk of neonatal mortality for blacks was less than half the risk for whites.

Premenstrual symptoms: another look.

Abstract: A collection of over 200 symptoms has been labeled premenstrual syndrome. Common belief is that most women experience a marked increase in symptoms premenses. Cyclic variations in the prevalence of commonly cited perimenstrual symptoms were estimated from daily symptom recording. A community-based, multiethnic sample of 345 women recorded symptom severity from "not present" to "extreme" for 90 days. Maximum total reported symptom score occurred during menses, not during premenses. When individual symptoms are considered, the prevalence of those rated as moderate to extreme during menses is less than 15 percent. A method for identifying symptom severity patterns throughout the menstrual cycle is described. Six symptom severity patterns were identified. Only 13 percent of the women exhibited a pattern of increased symptom severity in the premenses. Another 13 percent had a pattern of decreased symptom severity in the premenses.

AIDS in minority populations in the United States.

Abstract: Among ethnic minorities in the United States, blacks and Hispanics, who compose 12 percent and 7 percent of the U.S. population, respectively, constitute 24 percent and 14 percent of the cases of AIDS. Seventy-eight percent of all children with AIDS are black or Hispanic, as are 71 percent of all women with AIDS. In the black and Hispanic communities, intravenous (IV) drug abuse is associated with much of the AIDS transmission, and parenterally acquired infections are spread secondarily by sexual and perinatal transmission. Almost two-thirds of black and Hispanic persons with AIDS in the United States reside in New York, New Jersey, or Florida. Important differences in the understanding of AIDS and human immunodeficiency virus infection and control measures in minority communities must be considered in devising information and intervention programs for those communities. Programs intended specifically for minorities, especially greatly intensified prevention and treatment of IV drugs abuse, are needed to supplement programs aimed at the U.S. population in general. Combatting AIDS offers black and Hispanic populations an opportunity to greatly reduce IV drug abuse, other sexually transmitted diseases, and teenage pregnancy.