Sex of first child and breast cancer survival in young women.

Two studies have reported that young women with breast cancer face increased risk of early mortality if their first child was male rather than female. An immunological mechanism has been suggested. We sought to confirm these results in a larger, historical cohort study of 223 parous women who were aged <45 years at breast cancer diagnosis during 1983-1987. Subjects were identified through the Maine Cancer Registry. Follow-up data were obtained from hospitals, physicians, and death certificates. Reproductive history data were obtained from the next of kin of the deceased women, birth certificates, physicians, hospitals, and lastly, subjects. With a 7-year follow-up, multivariate modeling found a lower mortality risk in women with a male first child (hazard ratio [HR] 0.51, 95% confidence interval [CI] 0.32-0.81, log-rank comparison). The survival advantage remained for at least 13 years in women with a male firstborn. Thus, previous studies were not confirmed. Mortality risk in young women with breast cancer is not increased by having borne a male first child rather than a female first child.

Self-reported health and prior health behaviors of newly admitted correctional inmates.

OBJECTIVES: This study obtained comprehensive health information from newly admitted correctional inmates. METHODS: Interviews were conducted with 1198 inmates on day 3 of their incarceration. RESULTS: Interviewers found a high prevalence of chronic medical and mental health issues, limited access to health care, high rates of infections and sexually transmitted diseases, substantial substance abuse, other unhealthy behaviors and violence, and a strong desire for help with health-related problems. CONCLUSIONS: The data document the need to apply the public health approach to correctional health care, including detection and early treatment of disease, education and prevention to facilitate health and behavior change, and continuity of care into the community.

Factors associated with repeat mammography in a New York State public health screening program.

Screening mammography is the most effective method for early detection of breast cancer, but repeat mammography rates are not optimal in most populations. Since 1988, New York State has supported a program of breast cancer screening for underserved, uninsured, or underinsured women. The present study was designed to identify sociodemographic and clinical factors associated with failure to return for repeat mammography screening after a negative initial mammogram. Of women initially screened between 1988 and 1991 (N = 9,485), 27 percent obtained repeat mammograms by 1993. The final logistic regression model contained program site, race and ethnicity, family income, and time since last mammogram.

A multi-city community based smoking research intervention project in the african-american populatio.

OBJECTIVE: To carry out a community-based research approach to determine the most effective educational interventions to reduce smoking among African-American smokers. The intervention included preparation of the community, planning and developing a model of change, and developing a community-based intervention. The study population consisted of 2,544 randomly selected adult African-American smokers residing in four sites in the northeastern and southeastern parts of the United States. The research design provided a comparison of active intervention sites with passive control sites as well as low income and moderate income areas. MAJOR OUTCOME MEASURES: Point prevalence of non-smoking at the time of interview; Period prevalence of non-smoking at the time of interview; Period prevalence of quit attempts in the prior six months; Number of smoke-free days in the prior six months; Number of cigarettes smoked daily at the time of interview. RESULTS: Based upon a survey eighteen months after baseline data was collected, all four measures of cigarette smoking behavior showed a strong statistically significant reduction of personal smoking behavior among those receiving active interventions versus the passive group. On the basis of process variable analysis, direct contact with the project staff in the prior six months was significantly higher in the active intervention areas. There was only a small non-significant increase in personal smoking behavior in moderate income groups as opposed to low income groups. CONCLUSION: An analysis of process variables strongly suggests that, within this African-American Community, "hands on" or "face to face" approaches along with mass media, mailings, and other less personal approaches were more effective in reducing personal smoking behavior than media, mailings, and other impersonal approaches alone addressed to large audiences.

Hair lead levels related to children's classroom attention-deficit behavior.

The goal of this study was to evaluate the relationship between hair lead levels of children and their attention-deficit behaviors in the classroom. Scalp hair specimens were obtained from 277 first-grade pupils, teachers completed the abbreviated Boston Teacher's Rating Scale for rating classroom attention-deficit behavior, and parents completed a short questionnaire. The children's hair lead concentrations ranged from less than 1 to 11.3 ppm (microg/g). The striking dose-response relationship between levels of lead and negative teacher ratings remained significant after controlling for age, ethnicity, gender, and socioeconomic status. An even stronger relationship existed between physician-diagnosed attention-deficit hyperactivity disorder and hair lead in the same children. There was no apparent 'safe' threshold for lead. Scalp hair should be considered a useful clinical and epidemiologic approach for the measurement of chronic low-level lead exposure in children.

An evaluation of the hypothesis that females are more susceptible than males to lead-induced haematological alterations.

1. A retrospective epidemiological study was conducted to assess the hypothesis that sex differences exist with respect to selected lead-induced red blood cell parameters. The study utilized data previously collected in the Boston Childhood Lead Poisoning Prevention Program. 2. This study revealed no statistically significant difference between males and females (n = 1548) aged 1-6 years for blood FEP levels when blood lead levels were similar. 3. These findings are in contrast with previously published research with human adults, which has suggested that adult females display significantly greater FEP values at identical blood level values as similarly aged men.

Degree of public support for household hazardous waste control alternatives.

This paper reports information from Massachusetts on attitudes of householders toward alternative approaches and economic solutions to household hazardous waste (HHW) generation and disposal. Residents appear to be aware of the nature of the HHW problem and clearly support action to address the problem. The majority support a law fining householders for the improper disposal of HHW, endorse paying a sales tax on domestic hazardous products to finance safe disposal, and appear willing to drive up to five miles to dispose of HHW twice yearly.

Household hazardous waste in Massachusetts.

Household wastes, when disposed of improperly, are hazardous to health. This paper reports a random digit dial telephone survey of Massachusetts households concerning household hazardous waste (HHW) disposal with a 54% response. Of the automotive oil disposed of by 33% of survey households, 57% was deposited in the ground, sewer, or landfill. Annually by household oil disposal in Massachusetts is estimated to be 8.8 million quarts. Four percent of hazardous waste generated in Massachusetts is from households. Improper disposal makes it a major environmental contaminant. More households (41.5%) in smaller communities disposed of oil compared with 26% of households in larger communities. Paint and pesticides were disposed of by 10% of the households, but were dumped on the ground sewer or landfills more than 90% of the time.

The Massachusetts Blood Pressure Study, Part 1. Elevated levels of sodium in drinking water and blood pressure levels in children.

Continuing epidemiologic studies at the University of Massachusetts have examined the hypothesis that elevated levels of sodium (Na) in drinking water contribute to elevations of blood pressure (BP). Comparing tenth graders from a town with 107 mg Na/L in the drinking water to those from a town with 8 mg Na/L revealed statistically significant and medically important higher BP distributions among the high Na town students relative to their low Na town peers for both systolic and diastolic BP in both boys and girls. The differences were upheld when potentially confounding factors, including dietary Na intake and other water factors occurring differentially in the two water supplies, were controlled in the analysis. A replication study among third graders in the same communities showed similar results.

The Massachusetts Blood Pressure Study, Part 2. Modestly elevated levels of sodium in drinking water and blood pressure levels in high school students.

The blood pressure (BP) of tenth grade students from a town with 42 mg Na/L in drinking water was compared to that of comparable tenth grade students in a geographically contiguous community with 6 mg Na/L. No statistically significant difference occurred in mean BP between the two communities for males and females for diastolic BP and male systolic BP. However, the low sodium community females displayed a significantly higher BP (p less than 0.05) of 1.6 mmHg. Analysis of covariance for potentially confounding variables did not significantly alter the initial findings. In summary, an average of 36 mg Na/L higher Na levels in the drinking water was not associated with an increase in BP levels in tenth grade students.

The Massachusetts Blood Pressure Study, Part 3. Experimental reduction of sodium in drinking water: effects on blood pressure.

An experimental bottled water study assessed the effect on blood pressure of lowering Na concentration in the water of some of the high sodium community fourth graders. For three months, trios of children matched by sex, school, and baseline BP each used different water for all cooking and drinking purposes, with BP monitored bi-weekly. Pupils were randomly allocated to the three water conditions: high sodium water bottled from their own community distribution system, low sodium water bottled from the distribution system of the comparison community with sodium added to the level of the high sodium community water and low sodium water bottled from the distribution system of the low sodium community but with no sodium added. The results indicate that BP levels among the girls but not boys on the low sodium water exhibited marked decreases in BP over the test period when compared to the other two groups.

The Massachusetts Blood Pressure Study, Part 4. Modest sodium supplementation and blood pressure change in boarding school girls.

Based upon the results of the earlier work, a sodium supplement study was designed and carried out at a private boarding school. Two hundred and sixteen 9th-12th grade girls were randomly assigned to one of three groups while continuing to eat their regular meals at the dining commons. All participating students took two capsules, under supervision, both mid-morning and subsequent to the evening meal. One group received placebos at both times, one group received 2 G of salt in the morning and a placebo in the evening, and the final group received a placebo in the morning and 2 G of salt in the evening. One week of baseline data and eight weeks of follow-up data were collected twice weekly for BP, pulse, 24-hour urine specimen, and stress of daily events. Repeated measures analysis of variance failed to detect a significant difference in change in systolic and diastolic BP between groups. Extensive analysis of other variables did not uncover any negative confounding or interaction. Drop out rates were very low and compliance rates very high. The urinalysis clearly demonstrated that the Na excretion in the two supplement groups was similar and significantly elevated over the placebo group, thus documenting the high Na supplement compliance rates.

Uses of the case-control and cohort epidemiological approaches in pediatric practice and research.

Increasing reliance is being placed on the use of quantitative epidemiological methods in the conduct and evaluation of pediatric research. The basic design features of two common types of observational studies, the case-control study and the cohort study, are reviewed. Advantages and disadvantages of these two study designs are discussed with emphasis on aspects such as the selection of comparison groups, avoiding selection and recall bias, gathering exposure information, controlling for potentially confounding factors, and methods of analysis. Appreciation of the salient features of these study design approaches should aid the clinician/researcher in the conduct of research endeavors as well as in critically reviewing the medical literature.

Woodstoves, formaldehyde, and respiratory disease.

Telephone interviews were completed in Western Massachusetts in April 1983 for 399 households (91.5 per cent) in a random sample of households with elementary school children. Woodstoves were used in 64.7 per cent of the homes, but such use was not associated with acute respiratory illness. However, formaldehyde exposure was significantly related, with a risk ratio of 2.4 (95 per cent confidence interval 1.7-3.4). New construction/remodeling and new upholstered furniture had additive effects. Neither woodstove use nor formaldehyde exposure were significantly associated with asthma, chronic bronchitis, or allergies.

An epidemiologic study of gypsy moth rash.

In 1981, outbreaks of itchy skin rashes were reported accompanying the heavy infestation of gypsy moths (GM) in the Northeastern United States. The rash problem was widespread and a considerable public annoyance. In the spring of 1982, during the period of greatest contact with the caterpillars, a telephone survey was carried out in a highly infested community (HI) and a minimally infested community (LO). Information was collected from 1,000 persons, representing more than 90 per cent of those selected for study. The one-week risk of rash was 10.4 per cent in the HI area and 1.6 per cent in the LO area, for a risk ratio (RR) of 6.5. The occurrence of rash was strongly related to a history of having had a rash in the previous year or having had a caterpillar crawl on the affected area. The combination of both factors additively increased the risk of rash. Hay fever and hanging the wash outside were other related variables. History of allergies other than hay fever since childhood and the use of insecticides were unrelated to rash occurrence.

Health effects among newborns after prenatal exposure to ClO2-disinfected drinking water.

Because chlorination of potable surface waters may be associated with increased risk of carcinogenicity, substitute methods for the routine disinfection of public water supplies are being explored. As part of this search, it is especially important that the potential health effects of each alternative method should be considered. Chemical treatment of drinking water by chlorine dioxide (ClO2) is a likely alternative mode of disinfection. Two common by-products of the ClO2 disinfection of surface water are chlorate and chlorite. These oxidants may have negative health effects on certain high risk groups. Newborns, in particular, would seem to be at increased risk to red cell damage from oxidant stress. The historical record study being reported here compares the morbidity and mortality experience of newborns in two similar communities, one of which used chlorination and the other which used high levels of chlorine dioxide for potable water disinfection. A statistically significant positive association was found between exposure of the mother to ClO2-treated water during pregnancy and prematurity of the newborn as assessed by the attending physician and by a greater weight loss after birth. The rates of jaundice, birth defects and fetal and neonatal mortality did not differ significantly between communities. Because of the limitations of the study design, the findings reported here should be considered suggestive rather than definitive.

Drinking water sodium and blood pressure in children: a second look.

A previous study by the current authors demonstrated a statistically significant and clinically important elevation of 3-5 mmHg in mean systolic and diastolic blood pressure in high school sophomores in a community with 108 mg/L of sodium in the water supply when compared to their peers in an appropriately matched community with 8 mg/L of sodium. The current investigation, employing identical techniques but studying third graders in the same two communities, showed similar results. This second look considered dietary intake and urinary excretion of sodium. Since the difference in 24-hour dietary sodium consumption was 300 milligrams between the communities, an intake of one liter of high sodium tap water represented approximately 25 per cent of the difference in total sodium intake between the two communities. These studies suggest that sodium consumption in both drinking water and diet may be contributing to the different blood pressure distributions among the normotensive children in the two communities.

The influence of elevated levels of sodium in drinking water on elementary and high school students in Massachusetts.

Continuing epidemiologic studies at the University of Massachusetts have examined the hypothesis that elevated levels of sodium (Na) in drinking water contribute to elevations of blood pressure (BP). Comparing tenth graders from a town with 107 mg Na/L in the drinking water to those from a town with 8 mg Na/L, revealed statistically significant and medically important higher BP distributions among the high Na town students relative to their low Na town peers for both systolic and diastolic BP in both boys and girls. The differences were upheld when potentially confounding factors, including dietary Na intake and other water factors occurring differentially in the two water supplies, were controlled in the analysis. A replication study among third graders in the same communities showed similar results. Most recently, an experimental bottled water study assessed the effect on blood pressure of lowering Na concentration in the water of some of the high sodium community fourth graders. For three months trios of children matched by sex, school, and baseline BP each used different water for all cooking and drinking purposes, with BP monitored bi-weekly. Pupils were randomly allocated to the three water conditions: 1) high sodium water bottled from their own community distribution system, 2) low sodium water bottled from the distribution system of the comparison community with sodium added to the level of the high sodium community water and 3) low sodium water bottled from the distribution system of the low sodium community but with no sodium added. Preliminary results indicate the BP levels of the girls on the low sodium water exhibited marked decreases in BP over the test period when compared to the other two groups.

Elimination of "lead time" bias in assessing the effect of early breast cancer diagnosis.

The relationship between diagnosis of breast cancer in the localized stage of disease and improved prognosis for 234 female breast cancer patients aged 55 years and older was examined. Cause of death was used as an indicator of prognosis because, unlike measures of survival, it is unaffected by "lead time" bias. A three- to fourfold increase in the risk of death from breast cancer was observed among women diagnosed in the advanced stages of breast cancer relative to those diagnosed in the localized stage. The results indicate that diagnosis in the localized stage of breast cancer was associated with an improved prognosis, and that "lead time" bias cannot explain the observed association between stage at diagnosis and prognosis for female breast cancer patients aged 55 years and older.