Showing papers in "Public Health Reports in 1990"

Distance between homes and exercise facilities related to frequency of exercise among San Diego residents.

Abstract: Although personal determinants of exercise behavior have been studied extensively, few investigators have examined the influence of the physical environment on exercise habits. A random sample of 2,053 residents of San Diego, CA, were surveyed regarding exercise habits and other variables. A total of 385 exercise facilities in San Diego were classified into categories of either free or pay. After the addresses of respondents and facilities were located on a grid-map and coded, the density of exercise facilities around each respondent's home address was computed. Subjects who reported engaging in three or more exercise sessions per week reported a statistically greater density of pay facilities near their homes than did those who reported no exercise sessions, after controlling for age, education, and income. The finding suggests an association between proximity of exercise facilities and frequency of exercise.

The Vietnam Era Twin Registry: a resource for medical research.

Abstract: The Vietnam Era Twin Registry consists of 4,774 male-male twin pairs born between 1939 and 1957 with both brothers having served in the United States military during the Vietnam War. The registry was originally developed to provide the best control group for Vietnam-exposed servicemen to study the long-term health consequences of service in Vietnam. Recognizing the potential value of the registry for other areas of medical research, the Department of Veterans Affairs in 1988 opened the registry for use by both VA and non-VA investigators. The existence of centralized VA data bases for deaths and VA hospitalizations will strengthen future followup of the twins. This article describes the characteristics of the registry population and the process for accessing the registry.

Is there a hard-to-reach audience?

Abstract: The "hard-to-reach" label has been applied to many different audiences. Persons who have a low socioeconomic status (SES), members of ethnic minorities, and persons who have a low level of literacy often are tagged as "hard-to-reach." The authors identify reasons why these groups have been labelled "hard-to-reach," discuss preconceptions associated with the "hard-to-reach" label, propose alternative conceptualizations of these audiences, and present implications of such conceptualizations for health communication campaigns. Pejorative labels and preconceptions about various groups may lead to depicting these audiences as powerless, apathetic, and isolated. The authors discuss alternative conceptualizations, which highlight the strengths of different audience segments and encourage innovative approaches to the communication process. These alternative conceptualizations emphasize interactive communication, a view of society in which individuals are seen as members of equivalent--albeit different--cultures, and a shift of responsibility for health problems from individuals to social systems. Recommendations for incorporating these alternative concepts into health campaigns include formative research techniques that create a dialogue among participants, more sophisticated segmentation techniques to capture audience diversity, and new roles for mass media that are more interactive and responsive to individual needs.

Cognitive laboratory approach to designing questionnaires for surveys of the elderly.

Abstract: Data from surveys of the elderly are used by policy analysts to design health services programs. Consequently, the quality of survey data on elderly respondents has important implications for this growing segment of society: improving the quality of data should result in more cost effective programs for the elderly. However, studies suggest that the quality of responses from the elderly may be less than that for other respondents. Moreover, the increasing needs of policy analysts and health researchers for data have resulted in more complex survey questions that place a high cognitive burden on respondents. New methods for improving the design of these questionnaires are needed. This project investigated whether new techniques of questionnaire design, adapted from the theories and methods of cognitive psychology, could be effectively used in interviewing older respondents. The techniques used in this study, concurrent think-aloud interviews with followup probe questions, have been shown recently to be effective with younger respondents. Problems that elderly respondents have in comprehending survey questions, retrieving relevant information from memory, and using decision processes to estimate and provide answers were investigated. Questions on functional ability and social support were taken from the 1984 Supplement on Aging to the National Health Interview Survey. Analysis of respondents' think-aloud protocols and responses to probes suggest that the cognitive interview procedures were effective in identifying problems with the survey questions that would result in data of poorer quality and in suggesting the wording of questions that would be likely to result in answers of greater validity and reliability. Implications of these results for survey design and validation studies are discussed.

Broadening the perspective of pica: literature review.

Abstract: Pica is an eating disorder that is manifested by a craving for oral ingestion of a given substance that is unusual in kind and or quantity. It is a long-standing practice that has far reaching implications for prevention and treatment--implications for public health as well as clinical personnel who work in settings where they have the potential for influencing health knowledge, attitudes, and behaviors of their patients. Pica practices also challenge researchers and social scientists whose work encompass development and refinement of models related to nutritional deficiencies. The body of literature on pica is so fragmented that it is difficult to find a precise summary of the knowns and unknowns about the condition. There is little consistency in defining pica, classifying substances ingested, identifying key characteristics of practicers, recommending treatment, or in projecting outcomes. This review presents a framework for understanding pica as a general practice, summarizes divergent reported hypotheses and conclusions, and illustrates that there is a need for more comprehensive studies of prevalence and incidence and use of deductive as well as inductive research processes.

Pregnancy and medical cost outcomes of a self-help prenatal smoking cessation program in a HMO

Abstract: The results of a randomized clinical trial of a prenatal self-help smoking cessation program are reported in terms of the pregnancy and cost outcomes. The study population were the socioeconomically and ethnically diverse members of a large health maintenance organization (HMO) who reported that they were smoking at the time of their first prenatal visit. The intervention consisted predominantly of printed materials received through the mail. Compared with the usual care control group, women assigned to the self-help program were more likely to achieve cessation for the majority of their pregnancy (22.2 percent versus 8.6 percent), gave birth to infants weighing on average 57 grams more, and were 45 percent less likely to deliver a low birth weight infant. An economic evaluation of the self-help program was conducted from the perspective of the sponsoring HMO. Based upon the expenditures associated with the neonates' initial hospital episode, the intervention had a benefit-cost ratio of 2.8:1. These findings provide strong evidence to support widespread incorporation of smoking cessation interventions as a standard component of prenatal care.

Differentiating the barriers to adequate prenatal care in Missouri, 1987-88.

Abstract: Inadequate prenatal care has previously been identified as a significant risk factor for women who have low birth weight infants and infants who die during the neonatal period. Postpartum interviews with 1,484 primarily low-income women were conducted during 1987-88 in three areas of Missouri with the highest rates of inadequate prenatal care. The purpose of the study was to identify barriers to prenatal care and to determine which barriers differentiated between women receiving adequate and those receiving inadequate prenatal care. Women who received inadequate prenatal care were more likely to be black, unmarried, higher parity, and have less education than those who received adequate care. These women were also more likely to be poor, Medicaid-eligible, to have had an unwanted pregnancy, more stress and problems during pregnancy, and less social support. In the multivariate analysis, race and marital status lost their importance. The strongest predictor of inadequate prenatal care was women not knowing that they were pregnant in the first 4 months of pregnancy (adjusted odds ratio 9.28). To improve the rate of adequate prenatal care, society must address the issues of poverty and wantedness of pregnancy.

The family of HIV seroprevalence surveys: objectives, methods, and uses of sentinel surveillance for HIV in the United States.

Abstract: During 1987-89, the Centers for Disease Control (CDC), in collaboration with State and local health departments, other Federal agencies, blood collection agencies, and medical research institutions, implemented a national sentinel surveillance system for human immunodeficiency virus (HIV) infection. This ongoing surveillance system, known as the CDC family of HIV seroprevalence surveys, uses standardized survey and HIV serologic testing procedures in a group of sentinel populations from geographically diverse metropolitan areas, States, and Territories of the United States. As of September 1989, sentinel surveillance for HIV infection was being conducted in 41 States, Puerto Rico, and 39 metropolitan areas, including the District of Columbia. Information from this system complements AIDS surveillance data to assist health officials to direct resources and develop strategies for HIV prevention and health-care programs.

Gestational age reporting and preterm delivery.

Abstract: This study examines recent trends in the reporting completeness and quality of gestational age estimates derived from the date of the last normal menses (DLNM) as reported in South Carolina vital records from 1974 to 1985. Noteworthy improvements in the completeness of reporting emerged during this period with a decline from 31.1 percent missing information in 1974 to 6.6 percent missing in 1985. Completeness of reporting and strategies for imputing values for missing data were analyzed for their impact on the calculation of the percentage of preterm live births. The results indicate that the underreporting of gestational age can lead to marked underestimation of the preterm percentage in a population and to misinterpretation of trends in these percentages. Based on the results of this analysis, it is recommended that preterm percentages be based on cases with DLNM gestational age values between 20 and 50 weeks. Since cases with missing or implausible gestational age data have a greater risk of a poor pregnancy outcome, these findings emphasize the importance of identifying both the completeness of data reporting and the use of imputation and deletion strategies when employing population-based DLNM data to calculate gestational age related indicators.

Patterns of rates of mortality from narcotics and cocaine overdose in Texas, 1976-87.

Abstract: Drug overdose mortality data for narcotics and cocaine for Texas for 1976-87 reveal a cyclic pattern of narcotics mortality falling from 0.92 per 100,000 population in 1976 to a low of 0.13 in 1979, and rising to 0.62 in 1986. The data also show a sharp increase in cocaine mortality from 0.07 per 100,000 in 1983 to 0.38 in 1987. The data indicate that men consistently are at higher risk than women for overdose from both categories of drugs. Hispanics in the El Paso and San Antonio areas were found to have much higher risk of mortality from narcotics than expected, while blacks in the Houston and Dallas areas were at higher risk of cocaine mortality. The evidence suggests that narcotics and cocaine mortality is highest among the blue collar categories of the work force. The cyclical pattern of drug overdose mortality suggests the need for more examination of the historical interplay of public policies and social factors against the magnitude of the drug problems. The differences in mortality patterns by sex, ethnicity, and location indicate the need to develop policies and programs that address the unique characteristics of different at-risk populations. Language: en

A church-based cholesterol education program

Abstract: The leading cause of death among black people in the United States is coronary heart disease, accounting for about 25 percent of the deaths. The Task Force on Black and Minority Health formed by the Secretary of Health and Human Services in 1985 subsequently recommended increased efforts to reduce risk factors for coronary heart disease in the black population. A stated focus of the National Heart, Lung, and Blood Institute's National Cholesterol Education Program has been that of reaching minority groups. This report describes a pilot cholesterol education program conducted in black churches by trained members of those churches. Cholesterol screening, using a Reflotron, and other coronary heart disease risk factor screening was conducted in six churches with predominantly black members and at a neighborhood library. A total of 348 persons with cholesterol levels of 200 milligrams per deciliter (mg per dl) or higher were identified. At the time of screening, all were provided brief counseling on lowering their cholesterol and were given a copy of the screening results. Half of those identified, all members of one church, were invited to attend a 6-week nutrition education class of 1 hour each week about techniques to lower blood cholesterol. Information about cholesterol was also mailed to them. They were designated as the education group. Persons in the church were trained to teach the classes. A report of the screening results was sent to the personal physicians of the remaining 174 people in other churches who had cholesterol levels of 200 mg per dl or higher. This group served as a usual care comparison group.Six months after the initial screening, members of both groups were invited for followup screening.Among the 75 percent of the education group who returned for followup screening there was a 23.4 mg per dl (10 percent) decrease in the mean cholesterol level. Thirty-six percent of the usual care group returned for followup screening; their mean cholesterol level had decreased 38.7 mg per dl (16 percent).In this study, the support of churches provided access to large numbers of people. The mean serum cholesterol reductions occurring with both screening and referral and screening and education were statistically significant and large enough to be of clinical importance.The authors recommend that the approach taken in this study be investigated further by the National Cholesterol Education Program as a model for reaching the black population with coronary heart disease risk reduction programs.

Evaluation of the hospital discharge diagnoses index and the birth certificate as sources of information on birth defects.

Abstract: The hospital discharge diagnoses index (DI) for newborns and the birth certificate were evaluated as sources of information about birth defects by comparing them with the same births in the case registry of the California Birth Defects Monitoring Program (CBDMP). The CBDMP is an active surveillance system; the staff visit hospitals to identify children with birth defects diagnosed in the first year of life. The study population comprised 66,481 live births to residents of five counties in the San Francisco Bay area in 1983. Of these infants, 2,543 had at least one birth defect noted on the DI, and 1,623 were in the CBDMP registry; 1,020 with defects noted on the DI were also in the CBDMP registry. For this same population, 399 infants had one or more defects noted on the birth certificate; 304 of these were also in the CBDMP registry. Reporting of birth defects on the birth certificate was poor for every condition. Reporting on the DI was most reliable for oral clefts and chromosomal defects; for these defects, the DI omitted one-third of the cases but had identified only about 10 percent false-positive (that is, unverified) cases. Major central nervous system malformations were less well reported, with about one-third of them false-positive. For all other birth defects, the DI either omitted more than half of the cases, or more than half of the cases reported were false-positive cases. These findings raise questions about the validity of analytic studies of birth defects if the data are obtained only from the DI or the birth certificate.

Renal cancer and cigarette smoking in a 26-year followup of U.S. veterans.

Abstract: The cigarette smoking habits of a cohort of almost 250,000 U S veterans were analyzed for their relationship to renal cancer Information on smoking habits was collected in 1954 and in 1957 for nonrespondents to the first effort Of the veterans, 84 percent returned their questionnaires The cohort was followed for mortality until 1980, or 26 years The followup of these military veterans, mostly of World War I, revealed 719 deaths from renal cancer, making this the largest study of renal cancer and cigarette smoking to date Current smokers had a 47 percent increase in risk relative to nonsmokers The relative risk for renal cancer increased significantly with the number of cigarettes smoked per day, from 131 for 1-9, 137 for 10-20, 160 for 21-39, and 206 for 40 or more This analysis was unable to separate the risks of cigarette smoking for tumors of the renal parenchyma from those for tumors of the renal pelvis and ureter However, the results suggest that almost one-fifth of all renal cancer deaths are attributable to cigarette smoking

Comparing death certificate data with FBI crime reporting statistics on U.S. homicides.

Abstract: Both the National Center for Health Statistics (NCHS) Mortality System and the Federal Bureau of Investigation (FBI) Uniform Crime Reporting System measure the numbers and characteristics of homicide in the United States. There are important differences, however, in both the substance and the quality of the information that the two systems collect. The NCHS mortality system reported an average of 9 percent more homicides nationally than did the FBI crime reporting system during the 1976-82 period. Variations did occur in the average ratios of the frequencies of homicides reported by the two systems across age, race, and sex subgroups and geographic areas. The major source of the ascertainment difference between the NCHS and the FBI systems is thought to be incomplete voluntary reporting to the FBI by participating law enforcement agencies and lack of reporting by nonparticipating agencies. The proportions of homicides among corresponding demographic categories in the two systems is remarkably similar despite the difference in ascertainment. This congruence of the distributions of reported homicides supports the idea that inferences drawn from analysis of variables in one of these systems will be valid for the population reported on by the other system.

Cigarette smoking and cessation behaviors among urban blacks and whites.

Abstract: Smoking behaviors among blacks and whites were studied in a population-based sample of 2,626 residents of Minneapolis-St. Paul, MN. More blacks than whites were found to be smokers, before and after adjusting for age and education differences. More whites than blacks were former smokers, but the prevalence of those who had never smoked was comparable for whites and blacks. Among smokers, the mean number of cigarettes smoked per day was lower among blacks than whites, but more blacks were found to smoke cigarettes with high "tar" (dry particulate matter) and nicotine content. Men smokers were found to smoke more than women smokers, young people smoked more than older people, and those with a high school education or less smoked more than those with more than a high school education. Smoking cessation behavior consisted mostly of a variety of strategies that began with reducing cigarette consumption, followed by changing to lower tar brands, attempting to quit, and actually quitting. In general, a higher percentage of whites than blacks reported smoking cessation behaviors. A greater percentage of white than black women had tried cigarette brands lower in tar and nicotine within the previous year. Among men, a lower percentage of black than white smokers had tried quitting, and fewer black men planned to quit in the future. Blacks appeared to lag behind whites in their efforts to quit smoking. Smoking behavior continues to be problematic for both blacks and whites. Studies are needed to explain better the racial differences in smoking and smoking cessation behaviors, and to facilitate programs to encourage cessation.

Evaluating women's attitudes and perceptions in developing mammography promotion messages.

Abstract: Breast cancer is a leading cause of cancer deaths in women. Although mammography is recognized as the most effective early detection method for breast cancer, it remains underutilized. Communications theory and practice, with its emphasis on formative research, can provide a basis for developing strategies effective in changing mammography-related behaviors. Formative research, an important component of communications planning, can offer information useful in developing suitable messages and materials. The National Cancer Institute conducted small group discussions with white and black women, ages 40 to 75, to explore their attitudes, knowledge, and beliefs about mammography. Findings reinforced the results from quantitative surveys indicating that a perceived lack of their own need for the examination, lack of a physician referral, and procrastination were the main reasons that the women reported for not having mammograms. The discussions provided detailed information about the factors that can be used to guide development of messages and materials to promote mammography use. The results indicate that strategies for messages directed to either black or white women ages 40 years and older need to stress the same key message points. The points are that all women ages 40 and older are at risk for breast cancer; breast cancer can be treated successfully if it is detected early enough; mammography can detect breast cancer before a lump can be felt by a woman or her physician; women need to follow screening guidelines for age and frequency for screening; and mammography is a low-risk, quick, and painless procedure. Communication channels to reach women should include television, newspapers, magazines, and information available in physicians' offices.

Effects of the summer heat wave of 1988 on daily mortality in Allegheny County, PA.

Abstract: The authors studied total mortality in Allegheny County, PA, during the summer of 1988. A heat wave occurred in July of 1988, with daily maximum temperatures near or above 90 degrees Fahrenheit on 15 consecutive days. During that period there were a total of 694 deaths from all causes in the county, compared with an expected 587 deaths (P less than .01). All 107 excess deaths were of persons ages 65 or older, with the majority (78) occurring to persons older than age 75. Daily mortality was most closely correlated with average temperature from the previous day (R = .49, P less than .01), suggesting the cumulative effects of successive high daytime and night-time temperatures on susceptible persons. Evaluation of a possible effect on mortality of high ambient ozone levels detected in early July suggested that ozone did not contribute to excess mortality during the heat wave. Comparison of the 1988 heat wave with a less intense hot spell of 1973 indicated that excess mortality was less than would have been expected in 1988. The authors speculate that increased public awareness and the wider use of air conditioning over the years may have reduced the lethality of periods of extreme summer temperatures in urban areas. Further research is needed to evaluate this hypothesis completely. Public health officials should continue to monitor weather forecasts for predictions of extended periods of unusual heat and should warn the public to take suitable precautions during such periods.

The accuracy of liver cancer as the underlying cause of death on death certificates.

Abstract: Studies of liver cancer mortality are subject to confusion attributable to the changes in categories by which liver cancer is identified in successive revisions of the International Classification of Diseases. To determine the effects of these changes, diagnoses of 2,388 cases of primary liver cancer in the years 1973-80 were compared to the underlying causes of death recorded on the death certificates, using data from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. Results showed that only 53 percent of the deaths were attributed on death certificates to primary liver cancer. In a reverse comparison of 2,977 death certificates from the years 1973-85 with an underlying cause of death of primary liver cancer, 83 percent had been diagnosed as liver cancer. However, among the certificates that specified cancer of the liver, not specified as primary or secondary, as the cause of death, only 40 percent had been diagnosed originally as liver cancer. The mortality of liver cancer can be either underestimated or overestimated depending on which disease classification categories are used.

Updated forecasts of the costs of medical care for persons with AIDS, 1989-93.

Abstract: Data on the number of AIDS cases reported to the Centers for Disease Control (CDC) from January 1984 to June 1989 are used to predict the number of AIDS cases that will be diagnosed during the years 1989 through 1993. Using quadratic and linear models with the most recent data, it is projected that about 44,000 cases will be diagnosed in 1989, 56,000 in 1990, 70,000 in 1991, 87,000 in 1992, and 104,000 in 1993. These projections are lower than estimates derived using data from January 1984 to June 1988, and they are similar to estimates derived by the CDC. The lifetime medical care cost of treating a person with AIDS is estimated to be about $75,000 (all estimates are in 1988 dollars) assuming that the average length of survival is 15 months and that the intensity of care (that is, the cost of medical care per month) does not fall as longevity rises. This total, $75,000, reflects recent increases in the length of survival and the diffusion of costly drug therapies (for example, AZT and aerosol pentamidine). This study forecasts that the cumulative lifetime medical care costs of treating all people diagnosed with AIDS during a given year to be about $3.3 billion in 1989, $4.3 billion in 1990, $5.3 billion in 1991, $6.5 billion in 1992, and $7.8 billion in 1993.

A model program for providing health services for migrant farmworker mothers and children.

Abstract: A bilingual, multidisciplinary team of health professionals collaborated with a migrant health center in North Carolina to develop a model program to deliver primary health care services to migrant farmworker women and children. The program included case finding and outreach, coordination of maternal and child health services locally as well as interstate, and innovative health education programming. Data were collected on the health status of 359 pregnant migrant farmworker women and 560 children, ages birth to 5 years, the majority of Mexican descent, who received primary care services at the center. The mean age of the women was 23.1 years and their mean gravidity was 2.9. Dietary assessments showed that the protein intakes of most met or exceeded the U.S. Recommended Dietary Allowances, but their consumption of foods in the milk-dairy group and the fruit-vegetable group was below recommended standards. Low hematocrit was a common problem among the women (43 percent) and, to a lesser extent, among the children (26 percent). Among the infants and children, 18 percent were obese. Black American women had the highest proportion of low birth weight infants. The project emphasized coordinated services for migrant farmworker mothers and children, such as transportation services, language translation, followup, and advocacy. An outreach strategy involved case finding, home visits, and services by lay health advisors. By the third year of the project, there were increases in the average number of prenatal visits, the proportion of women entering prenatal care in their first trimester, and in the use of well-child services. The project demonstrated effective methods for delivering culturally appropriate health care services to migrant farmworkermothers and children using bilingual public health professionals.

National Health Interview Survey data on adult knowledge of AIDS in the United States.

Abstract: Information collected with the 1989 National Health Interview Survey of AIDS Knowledge and Attitudes from a nationally representative sample of 40,609 adults was examined to determine how knowledge about AIDS varied within demographic subgroups of the population. Most adults (83 percent) had seen or heard public service announcements about AIDS in the month prior to interview, and 51 percent had read an AIDS brochure in the past. Sixty-seven percent of adults responded correctly to at least 10 of 14 general AIDS knowledge questions. Knowledge levels were higher among those who were more educated and those who had seen or heard public service announcements or had read brochures. White adults responded correctly to these questions more often than their black counterparts; non-Hispanics responded correctly more often than Hispanics (for statistical purposes, the population is divided twice, in the first instance racially and in the second, ethnically--white and black, Hispanic and non-Hispanic). Even with relatively high information levels, misperceptions about casual transmission persisted, with one-third of adults answering more than half of the questions about casual transmission incorrectly. The same population groups that had less general AIDS knowledge had more misperceptions about transmission. More than 80 percent of adults recognized that use of condoms and a monogamous relationship between two uninfected persons were effective means of preventing the spread of the AIDS virus. Seventy-four percent of adults had heard of the HIV antibody test. The data demonstrate that while awareness about AIDS in general is high, certain population subgroups have more limited knowledge and more inappropriate concerns about AIDS, particularly those in certain racial-ethnic minorities and those less educated than the general population. Efforts must continue to develop culturally sensitive and easily understood educational programs and evaluation mechanisms for these programs

Training and service in public health practice, 1951-90--CDC's Epidemic Intelligence Service.

Abstract: The Epidemic Intelligence Service (EIS) was created at the Centers for Disease Control (CDC) in 1951 as a combined training and service program in the practice of applied epidemiology. Since 1951, more than 1,700 professional have served in this 2-year program of the Public Health Service. In the decade of the 1980s, EIS underwent dramatic changes in response to the increased breadth of the CDC mission and the rapid expansion of epidemiologic methods. Modifications in the experience of an EIS Officer have resulted from the increased need for more sophisticated analytic methods and the use of microcomputers, as well as CDC's expanded mission into chronic diseases, environmental health, occupational health, and injury control. Officers who have entered the EIS in the past decade tend to be older than their predecessors, tend to enter the program with more experience and training in epidemiology, and are more likely to stay in public health either at the Federal level or in State and local health departments. The EIS Program continues to be a critical source for men and women to respond to the need and demand for epidemiologic services both domestically and internationally.

A priority rating system for public health programs.

Abstract: When resources are limited, decisions must be made regarding which public health activities to undertake. A priority rating system, which incorporates various data sources, can be used to quantify disease problems or risk factors, or both. The model described in this paper ranks public health issues according to size, urgency, severity of the problem, economic loss, impact on others, effectiveness, propriety, economics, acceptability, legality of solutions, and availability of resources. As examples of how one State can use the model, rankings have been applied to the following health issues: acquired immunodeficiency syndrome, coronary heart disease, injuries from motor vehicle accidents, and cigarette smoking as a risk factor. In this exercise, smoking is the issue with the highest overall priority rating. The model is sensitive to the precision of the data used to develop the rankings and works best for health issues that are not undergoing rapid change. Cost-benefit and cost-effectiveness analyses can be incorporated into the model or used independently in the priority-setting process. Ideally, the model is used in a group setting with six to eight decision makers who represent the primary agency as well as external organizations. Using this method, health agencies, program directors, or community groups can identify the most critical issues or problems requiring intervention programs.

HIV seroprevalence surveys of childbearing women--objectives, methods, and uses of the data.

Abstract: A seroprevalence survey of human immunodeficiency virus (HIV) among childbearing women is being conducted in 43 States and Territories as one of the family of HIV seroprevalence surveys This blinded survey, in which serologic test results are not linked to identifiable persons, uses neonatal dried blood specimens on filter paper to test for maternal antibodies to HIV This survey provides relatively unbiased estimates of prevalence of HIV infection in the population of women delivering live children during given survey periods, by month or quarter of delivery, geographic area, and demographic subgroup This objective will be met while protecting the integrity and efficient conduct of neonatal screening programs and ensuring patient anonymity Information from this survey will be used to (a) assess the levels and trends of HIV infection in women and infants, (b) help develop and evaluate prevention programs, and (c) project the number of women and children who will develop HIV infection and the acquired immunodeficiency syndrome (AIDS) and will require health care and social services in the future

AIDS-related knowledge, attitudes, and precautionary behaviors among emergency medical professionals.

Abstract: AIDS-related knowledge, attitudes, and precautionary behaviors were assessed among a random sample of Michigan-licensed emergency medical service (EMS) professionals between June and August 1988. Of 2,000 mailed questionnaires, 1,020 were returned (51 percent response), and 997 of the returned questionnaires were used in the final analysis. Survey results indicated that most respondents were able to correctly identify the transmission routes of the human immunodeficiency virus (HIV), but many respondents had misconceptions about nonviable routes, the incidence of HIV infection among health care workers, and some aspects of the natural history of HIV. More than half of the respondents (56.6 percent) believed that their chances of becoming infected with HIV were "somewhat high" or "very high," although the number of documented HIV seroconversions due to occupational HIV exposures in health care settings is low. Although only six respondents (0.6 percent) reported that they had refused treatment to patients known or suspected to be infected with HIV, 25 percent felt that EMS professionals should be allowed to refuse treatment under such circumstances. Potential exposures to HIV were assessed through respondents' reports of three activities in the 6 months prior to the survey. For each activity, use of universal precautions recommended by the Centers for Disease Control was also assessed. In general, few respondents reported the consistent use of precautions. While the majority of those attempting resuscitations (86.9 percent) reported that they always use a protective device, only 36.7 percent of those treating bleeding patients reported that they always wear gloves, and only 21.9 percent of those using needles reported that they do not recap them after use.

Situational and financial barriers to prenatal care in a sample of low-income, inner-city women

Abstract: The relationship between the use of prenatal care and factors that may impede access to care was examined in a sample of low-income, inner-city women. Situational and financial barriers to care were not important correlates of utilization. In unadjusted analyses, only insurance status and employment status were associated with utilization. Of the sociodemographic characteristics studied, only parity was strongly associated with the use of prenatal care. When the apparent associations between utilization and insurance status and utilization and employment were analyzed controlling for parity, the estimated strength and statistical significance of these relationships diminished considerably. Multiparous women who were more likely than primiparous women to be underutilizers were also more likely to be on medical assistance and to be unemployed. These findings suggest that situational and financial barriers are not important correlates of utilization for low-income, adult women living in urban areas where there are accessible clinic facilities and public transportation. Efforts to identify and surmount other kinds of barriers may prove to be a more effective approach to prenatal outreach for women in these circumstances.

Opportunities for improving the nation's health through collaboration with the mass media.

Abstract: Understanding the mass media is a prerequisite to gaining the cooperation of those who control access to media time and space to improve the coverage of health issues about which the public needs, and often wants, to know. To address the complexities of the mass media and how they influence the public's health, a group of Public Health Service agencies, foundations, and research institutions collaborated to review recent changes in the mass media and public health sectors and to recommend steps for increased interaction. These included broadening strategies to include paid advertising, media advocacy, and other tactics beyond public service campaigns; increasing awareness within the public health sector of the media's perspective on health; working collaboratively with media professionals and organizations, including the minority media; and developing guidelines for public-private sector partnerships. These recommendations, and factors affecting the roles of the media and public health communities in informing the public about health, are described in this paper. A complete discussion of these recommendations and related issues can be found in "Mass Media and Health," edited by Caroline McNeil and Elaine Bratic Arkin, a forthcoming publication of the Office of Disease Prevention and Health Promotion, Public Health Service.

Efficacy of an intervention to promote use of hearing protection devices by firefighters.

Abstract: Numerous cases of hearing loss consistent with noise-induced damage were noted among firefighters in the city of Columbia, MO. A survey of firefighting vehicles in operation showed that the firefighters were exposed to excessive noise levels and put at risk for noise-induced hearing loss (NIHL). Audiologic evaluation showed that 36 percent of the firefighters had moderate or severe hearing loss (a threshold of 40 decibels (dB) or more at 3,000, 4,000, or 6,000 hertz (Hz) in either ear). An educational program on NIHL was then carried out to increase the use of hearing protection devices (HPDs) by firefighters, followed by an evaluation of the intervention. The educational intervention successfully increased knowledge of NIHL, positive attitudes toward HPDs, and resulted in more frequent use of HPDs. After the intervention, 85 percent of firefighters regularly used HPDs compared with 20 percent before the intervention. Recommendations are made for fire departments to reduce the risk of NIHL. Language: en