An update on blood lead levels in pediatric patients of a neighborhood health center and an analysis of sources of exposure. H.T. Blumenthal and R. Mayfield. Journal of the National Medical Association 87 (February 1995): 99-104.
A decline in occupied housing units and in soil lead levels may help reduce children's exposure to environmental lead.
In 1976, researchers determined the blood lead levels of children in a predominantly black neighborhood in St. Louis, MO, and conducted followup studies every year until 1993. In the areas studied, the total population declined by 13.1 percent between 1976 and 1993, while the number of children younger than 5 years of age increased by almost 8 percent. Over this period, the number of occupied housing units declined by 11 percent, unoccupied housing increased by 39 percent, and total housing declined by 14 percent. Soil lead levels were four times higher in 1978 than in 1990. Between 1976 and 1993, the mean blood lead level among children in the study group decreased from 34.2 g/dL to 9.3 g/dL, or below 10 g/dL-the level proven to cause adverse health effects. [Editor's note: 9.3 g/dL is more than two times the national mean blood lead level of 3.6 g/dL for 1-5-year-olds.]
Environmental health and African Americans: challenges and opportunities. B. Walker, Jr., N.J. Goodwin, and R.C. Warren. Journal of the National Medical Association 87 (February 1995): 123-29.
African Americans experience greater exposure to environmental hazards than other population groups. Realizing that disease among African Americans may have an environmental basis may be important in improving their health.
Sixty percent of African Americans (15 million) live near abandoned toxic waste sites, and cleanup programs for these sites take 20 percent longer to be placed on the national priority action list. African Americans live with higher air pollution and are exposed to carcinogenic and other toxic agents. These environmental risks are associated with increased morbidity and mortality, as well as developmental delays in children. African Americans also have a harder time preventing environmentally provoked diseases because they are more likely than other groups to be poor, to lack health insurance, and to have to travel further to obtain medical care. The authors make the following suggestions for meeting the challenges to improving African Americans' health: initiate a comprehensive national birth defects monitoring and research program and a clearinghouse on birth defects research; improve environmental data with regard to releases of toxic substances, accidental spills, and toxic waste disposal; revise policy and regulatory programs to reduce the risk of pesticide exposure in infants and children; and provide medical students with a fuller understanding of the environmental causes of disease.
The Minnesota Prenatal Care Coordination Project: successes and obstacles. C. Skovholt, B. Lia-Hoagberg, S. Mullett, et al. Public Health Reports 109 (November/December 1994): 774-81.
Prenatal care providers will improve practices and collaboration as a result of personalized education and support.
The Minnesota Department of Human Services began the Minnesota Prenatal Care Initiative (MPCI) in 1988 to improve and expand prenatal care services for Medicaid-enrolled women at high risk for poor birth outcomes. The Minnesota Prenatal Care Coordination Project presented education and technical support for providers as they implemented MPCI. Project participants took part in 12 regional workshops throughout the State, had one-to-one contacts with nurse consultants, and received newsletters and a guidebook. As a result of the Prenatal Care Coordination Project, the numbers of Medicaid-enrolled women who received risk assessment and enhanced services were doubled, and provider participation increased by one-third. Greater collaboration among community providers and improved communication between State and local health care agencies also resulted. Low physician attendance, resistance to changes in practice, dissatisfaction with the enhanced services package and level of reimbursement, and problems with implementation protocols were obstacles to the implementation of the program.
Effect of distance and travel time on rural women's compliance with screening mammography: an UPRNet study. N.E. Kreher, J.M. Hickner, M.T. Ruffin, et al. The Journal of Family Practice 40 (February 1995): 143-47.
Women living in rural areas and receiving mammograms are not affected by distance, travel time, or transportation barriers.
Between March 15 and June 1, 1993, women over 40 years old and living in rural northern Michigan were given a questionnaire about mammography when they visited one of 12 family practices in the Upper Peninsula Research Network (UPRNet). The questionnaire asked about demographics, knowledge of and attitudes toward mammograms, and geographic barriers to receiving mammograms. A total of 416 women made up the study group. Women were classified as "current" if they had had a mammogram in the previous two years for those aged 40 to 49, and for the previous year for women aged 50 years and older. Eighty-eight percent of respondents had had at least one mammogram. Women classified as "current" had higher educational levels, health insurance, and a higher household income. Most of the women did not consider lack of transportation or distance to travel as barriers to obtaining a mammogram. However, only 67 percent of the "not current" group believed a woman needed a mammogram every 1 to 2 years, whereas 91 percent of the "current" group reported believing a woman needed a mammogram every 1 to 2 years.
Lack of HIV transmission in the practice of a dentist with AIDS. H.W. Jaffe, J.M. McCurdy, M.L. Kalish, et al. Annals of Internal Medicine 121 (December 1, 1994): 855-59.
In a study of the practice of a dentist with acquired immunodeficiency syndrome (AIDS), no evidence was found of either dentist-to-patient or patient-to-patient transmission of human immunodeficiency virus (HIV). The authors studied the practice of a Miami, Florida, dentist with AIDS to determine whether dentist-to-patient or patient-to-patient transmission of HIV had occurred. The dentist acknowledged that he had not followed recommended infection control procedures. Researchers interviewed the dentist's former employees and reviewed the medical records of the dentist and 6,474 of his former patients. Of these patients, 1,279 (19.8 percent) were known to have been tested for HIV infection, and 24 of those (1.9 percent) were HIV positive. Four other patients with HIV infection were identified through case-finding activities. These 28 HIV-positive patients were interviewed, and 19 acknowledged having engaged in drug use or in sexual behaviors that could have resulted in HIV infection. Analysis of genetic sequences from the dentist and 24 of the patients with HIV infection did not indicate that the virus strains were linked.
"It won't happen to me": perceived risk and concern about contracting AIDS. S.I. Mishra and S.A. Serxner. Health Values 18 (November/December 1994): 3-13.
Understanding why some people consider themselves to be at risk for contracting AIDS but are not concerned about this risk is important in targeting prevention efforts. Intervention programs should address understanding the notions of "risk" as well as reinforcing and facilitating preventive behaviors.
Between fall 1988 and spring 1991 in Orange County, California, researchers randomly interviewed 3,260 people (1,852 females and 1,408 males) 18 years and older to assess their levels of AIDS-related perceived risk and concern about contracting AIDS. Forty-five percent of males and 49.7 percent of females surveyed considered themselves to be at risk for contracting AIDS, and 36.5 percent of males and 34.6 percent of females were concerned about this risk. Nearly 57 percent of respondents aged 18 to 34 years perceived themselves at risk compared to 52.3 percent of those aged 35 to 49 years. The better educated respondents were more likely to perceive themselves at risk than those with lower levels of education. Unmarried Anglo males who know someone with AIDS were most likely to perceive themselves at risk but were least likely to be concerned about contracting AIDS.
Patient-perceived barriers to preventive health care among indigent, rural Appalachian patients. D.M. Elnicki, D.K. Morris, W.T. Shockcor. Archives of Internal Medicine 155 (February 27, 1995): 421-24.
Adequate education about preventive measures and removing barriers to these measures are important in helping indi-gent populations receive preventive care.
Researchers surveyed 188 new patients at a clinic for the indigent in rural Appalachia about their use of six preventive health measures: blood pressure screening, cholesterol level, current diphtheria-tetanus immunization, mammo-graphy, Pap smear, and physical examination. Sixteen percent of patients had not had blood pressure screening; 60 percent had not had cholesterol screening; 67 percent had not had diphtheria-tetanus immunizations; 69 percent had not had a mammogram; 22 percent had not had a Pap smear; and 32 percent had not had a physical examination. Eighty-five percent of patients were lacking at least one preventive measure. The most common reasons given for not having had these measures were lack of knowledge about prevention (51 percent) and cost (36 percent). Seventy-two percent of patients said that they would have these preventive measures performed if barriers were removed.
High prevalence of overweight and short stature among Head Start children in Massachusetts. J.L. Wiecha and V.A. Casey. Public Health Reports 109 (November/December 1994): 767-73.
Preschool children from low-income families are at risk for short stature and are at increasing risk for obesity.
Researchers consulted 1988-91 annual screening data from Massachusetts Head Start programs; data was available for an average of 2,664 children per year. The children's average age was between 36 and 59 months. Height and weight measurements were compared with National Center for Health Statistics reference populations. From 7.3 to 8.8 percent of children were below the fifth percentile of height for age each year, and from 1.2 to 3.3 percent were underweight. In each year overweight (weight for height above the 95th percentile) was most prevalent, ranging from 9.6 to 13.3 percent and demonstrating a statistically significant upward trend. The prevalence of overweight and short stature varied by race and ethnicity. A statistically significant upward trend in overweight was observed among Hispanic children. Children who were 48 months of age or older were more likely than younger children to be overweight.
Making the most of a teachable moment: a smokeless-tobacco cessation intervention in the dental office. V.J. Stevens, H. Severson, E. Lichtenstein, et al. American Journal of Public Health 85 (February 1995): 231-35.
Brief dental office interventions can be efficient in reducing the use of smokeless tobacco.
At a health maintenance organization in the Pacific Northwest, dentists, recep-tionists, and hygienists were given a 2-hour training session about how to deliver a smokeless tobacco intervention program. Male patients aged 15 years and older who reported current use of smoke-less tobacco became participants in the study. After the dental cleaning and ex-amination, patients watched a 9-minute videotape discussing the health consequences of smokeless tobacco use. Following the video, hygienists attempted to get patients to set a quit date; 43 per-cent of the participants set a quit date before leaving the dental office. The pre-intervention group (n=58) received only the questionnaire and dental examination, the intervention group (n=245) received the full intervention program, and the usual care (n=273) group received no program. Interviewers followed up with the subjects by mail or telephone 3 and 12 months after the intervention. At 3 months, 32.2 percent of the intervention group reported abstinence from smokeless tobacco. At 12 months, 33.5 percent of the intervention group reported having stopped using smokeless tobacco. In com-parison, only 19 percent of the preinter-vention group and 21.3 percent of the usual care group reported abstinence from smokeless tobacco at 3 months, and 20.7 percent of the preintervention group and 24.5 percent of the usual care group had stopped using smokeless tobacco at 12 months.
Lower legal blood alcohol limits for young drivers. R. Hingson, T. Heeren, and M. Winter. Public Health Reports 109 (November/December 1994): 738-44.
At least 375 nocturnal, fatal single vehicle crashes would be prevented annually if all States adopted .00 or .02 percent blood alcohol limits (BALs) for drivers aged 15 to 20.
To assess the impact of lower legal BALs for drivers aged 20 years and younger, researchers compared 12 States with 12 nearby States matched for legal drinking age and timing of changes in the law. Among drivers aged 15 to 20, fatal crashes involving a single vehicle at night are three times more likely than other fatal crashes to be alcohol-related. During the postlaw period, the proportion of these fatal crashes declined 16 percent among young drivers targeted by lower BAL laws, but rose 1 percent among drivers of the same age in comparison States where BALs were not changed. The proportion of fatal crashes that involved single vehicles at night declined 22 percent among drivers in States with .00 percent BALs, whereas it declined only 2 percent among drivers of the same age in comparison States. Among those drivers targeted by .02 percent BALs, the proportion of nocturnal, fatal crashes involving single vehicles declined 17 percent, but rose 4 percent in comparison States. In States with the lowered levels for young people, the proportion of fatal nocturnal single-vehicle crashes among adults declined 5 percent, while it declined 6 percent in the group of comparison States.
Abusive head trauma: the relationship of perpetrators to their victims. S.P. Starling, J.R. Holden, and C. Jenny. Pediatrics 95 (February 1995): 259-62.
Abusive head trauma, or shaken baby syndrome, is the most common cause of morbidity and mortality in physically abused infants, especially among boys. Male caretakers are potentially more dangerous than females, abusing infants twice as often as females.
Researchers reviewed the medical charts of 151 infants in Colorado who suffered abusive head trauma to determine the perpetrator of the abuse. Caretakers were classified by level of certainty: confession to the crime, con-victed of or charged with the crime, or strong suspicion by the staff. Victims ranged in age from 3 weeks to 24 months, with a median age of 5 months. More than 60 percent of the abused children were boys. Twenty-three percent of the children died as a result of the abuse, although death rates for the boys and girls did not vary significantly. Male caretakers were 2.2 times more likely to cause head trauma in infants than females, with fathers, stepfathers, and mothers' boyfriends committing 68.5 percent of the crimes. Fathers accounted for 37 percent of the abusers, followed by boyfriends at 20.5 percent. Female baby sitters represented 17.3 percent of the perpetrators, while mothers were responsible for only 12.6 percent of the cases. While men were more likely to abuse infants, men and women were equally likely to injure a child fatally.
Household chemical exposures: field testing a prevention brochure. C. Ng, E. Stone, and P.D. Blanc. Health Values 18 (November/December 1994): 24-31.
Public education may be an important strategy in preventing household chemical inhalation among ethnic minorities.
Researchers surveyed the potential outreach population for an educational brochure on household chemical hazards distributed by the San Francisco Bay Area Regional Poison Control Center. Forty persons each were interviewed in English, Cantonese, and Spanish; 89 percent of respondents were ethnic minorities. Respondents were asked to rate the potential hazard of household activities (mixing bleach and another cleaner together and spraying insect spray in a closed room) and the use of specific product types. Participants then read the pamphlet and were asked about the use of 13 other household chemical products. Before reading the pamphlet, 62 percent of those surveyed rated the potential hazard of bleach product mixing as dangerous, while 91 percent of participants rated closed-space spraying as dangerous. After reading the pamphlet, 78 and 94 percent of participants rated bleach product mixing and closed-space spraying as dangerous, respectively. Twenty-five percent of the persons interviewed reported past respiratory symptoms from product use, especially from bleach and insecticides.
Correlates of smoking, stress, and depression among women. S.L. Sheahan and M. Latimer. Health Values 19 (January/February 1995): 29-36.
Smoking among women is linked with stress and coping. Health care providers need to consider a woman's stress levels and socioeconomic status prior to initiating a smoking cessation program.
Researchers randomly surveyed 322 urban Kentucky women aged 18 to 55 to determine the prevalence of smoking; compare levels of stress, depression, and emotional support between smokers and nonsmokers; and determine the relationships among smoking, stress, and depression. Of these women, 208 were nonsmokers, 92 were smokers, and 33 were former smokers. Respondents were predominantly white (85 percent) and married (64 percent). The mean education and incomes were 13.67 years and $32,000, respectively. Smokers had significantly lower levels of education and income and were more likely to be single. Forty-seven percent of smokers reported that work stress greatly influenced their smoking behavior, and home stress was very influential for 29 percent of the smokers. Whereas depression did not significantly alter smoking behavior, smoking was a method of coping with stress for many smokers.
The association between leisure-time physical activity and dietary fat in American adults. E.J. Simoes, T. Byers, R.J. Coates, et al. American Journal of Public Health 85 (February 1995): 240-44.
Public health messages about either diet or physical activity also should include the other because Americans who have the fattiest diets also exercise the least.
Researchers analyzed data from the 1990 Behavioral Risk Factor Surveillance System for information on physical activity and fat intake. The study sample consisted of 29,672 white adults. Participants had been asked about their diets, their leisure-time physical activity level, and demographic information. Researchers found that physical activity decreased with age and smoking, increased with education and alcohol consumption, and decreased with a higher fat intake. Those respondents who were younger, were less well educated, smoked, and had not had their cholesterol screened had the highest fat intake. Conversely, the more physical activity a person performed, the lower his fat intake.
National Primary Care Conference. Orlando, FL. Sponsored by the Nurse Practitioner Associates for Continuing Education; (617)861-0270. April 18-21, 1995.
17th Annual Conference of the Association for Death Education and Counseling. Miami, FL. (203)586-7503. April 26-30, 1995.
10th Annual Commitment to Wellness Conference. Canton, OH. Sponsored by Health and Wellness Concepts, Inc.; Virginia Neutzling, (216)492-6739. April 28, 1995.
American Occupational Health Conference. Las Vegas, NV. Sponsored by the American College of Occupational and Environmental Medicine; (708)228-6850. April 29-May 5, 1995.
35th Annual Meeting of the American Society for Clinical Nutrition. San Diego, CA. Lisa Routzahn, (301)530-7110. May 3-5, 1995.
Violence in America Rx: An Ounce of Prevention. Washington, DC. Sponsored by Physicians for a Violence-Free Society; (214)590-8807. May 4-7, 1995.
Children Deserve Better 2000. Lake Buena Vista, FL. Sponsored by the Center for Substance Abuse Prevention, Ounce of Prevention Fund of Florida and Consortium of Comprehensive Addiction Programs; Carolyn Moore, (813)570-3014. May 6-9, 1995.
1995 Annual Meeting of the American Pediatric Society. San Diego, CA. (703)556-9222. May 7-11, 1995.
18th Annual National Conference of the National Rural Health Association. Atlanta, GA. (816)756-3140. May 17-20, 1995.
148th Annual Meeting of the American Psychiatric Association. Miami, FL. Gus Cervini, (202)682-6142. May 20-25, 1995.
American College Health Association Annual Meeting. Chicago, IL. (410)859-1500. May 23-27, 1995.
Primary Health Care for the Older Woman: Update 1995. San Francisco, CA. Sponsored by the University of California San Francisco/Mount Zion Center on Aging; Mary Henderson, (415)750-4170. June 3, 1995.