Unlimited opportunities for environmental interventions with inner-city asthmatics.

The purpose of this study was to identify the asthmatics living in the Lower West Side (LWS) of Buffalo, New York, and then explore the relationship between urban asthmatic and nonasthmatic exposures to many common household aeroallergens. Eight hundred twenty-eight households were visited and 167 asthmatics and 161 nonasthmatics were identified for comparison. Specific self-reported household exposure prevalences were identified for environmental tobacco smoke, sources of molds, household pets, rats, cockroaches, and sources of dust. Sources of molds, pets, and cockroaches were more likely to be found in the homes of asthmatics compared to nonasthmatics (p < 0.05). Other aeroallergens studied, although highly prevalent, were not more likely to be found in either asthmatic or nonasthmatic homes.

Unmasking adverse birth outcomes among Hispanic subgroups.

The 1988 Upstate New York Live Birth Certificate was the first to record Hispanic ethnicity and country of origin. This registry was used to compare low birthweight and preterm delivery among non-Hispanic white, non-Hispanic black, and Hispanic infants. Risk of low birthweight and preterm delivery was assessed for Hispanics by country of origin. Unconditional backward elimination logistic regression analysis, controlling for confounders was used to assess risk of low birthweight and preterm delivery of Hispanic subgroups compared to non-Hispanic white and non-Hispanic black mothers. The data showed that non-Hispanic black mothers are at greatest risk of low birthweight and preterm delivery. Hispanics as a group have rates similar to non-Hispanic white mothers, although risk of preterm delivery and low birthweight differs among Hispanic ethnic subgroups. This study supports the need to assess Hispanic subgroups separately rather than as a single entity.

Patterns of dysphoria in a Puerto Rican urban community.

This study was undertaken to explore the prevalence of perceived dysphoria in a poor, urban, predominantly Puerto Rican community. A cross-sectional sample of 704 adult respondents were asked a single validated question, with a five-item Likert scale response, about their level of perceived dysphoria. Chi-squared analysis and Spearman's correlation coefficients were used to assess the association of level of dysphoria with social characteristics, barriers to health care, health status, and substance use. Linear regression modeling was used to control for confounding variables. Twenty percent of the respondents were dysphoric. Respondents with no health insurance or no source of health care were least likely to be dysphoric. Persons who perceived distance to the hospital and the doctor, and understanding language of the doctor and office staff as barriers to care were more likely to be dysphoric. Ethnicity was not correlated with level of perceived dysphoria; however, age, gender, and health status were found to be associated with level of dysphoria after controlling for other correlated variables. These results indicate that the psychological needs of communities need to be understood and interventions that are appropriate for the population need to be devised.

Missed opportunities for prevention: smoking cessation counseling and the competing demands of practice.

BACKGROUND: Smoking cessation advice is an effective intervention for the control of tobacco use. The objective of this study was to assess and describe the rates of smoking status assessment and smoking cessation advice provided by physicians during ambulatory office visits with respect to physician specialty, type of visit, and number of problems addressed at the visit. METHODS: We used a cross-sectional survey of patient visits to the offices of nonfederally employed, office-based physicians participating in the 1992 National Ambulatory Medical Care Survey (n = 1558). RESULTS: Physicians reported knowing the smoking status of their patients in 66% of outpatient visits. The rate of assessment was similar for generalists and specialists. Cardiologists and generalists, except for pediatricians, showed discernible rates of smoking cessation advice (medians ranging from 14% to 50%), whereas obstetrician/gynecologists and other specialists had negligible rates. For tobacco-related visits, generalists and specialists had comparable rates of cessation advice to identified smokers. For non-tobacco-related visits, generalists had higher rates than specialists (22% vs 10%; P < .001). CONCLUSIONS: Although a substantial majority of smokers are reportedly identified by physicians during ambulatory visits, a large number of identified smokers are not receiving smoking cessation counseling. Patients seen by generalists are more likely to receive smoking cessation advice. Physicians appear to prioritize smoking cessation advice based on diagnosis at the time of the visit.