Agreement between patient self-reports and medical records for Pap smear histories.

As part of a larger cervical cancer study, we tried to verify the Pap smear histories for 125 black women with cervical cancer. For 105 of the patients, we identified all possible providers for the five-year period before the calendar year of diagnosis. Agreement between the medical records and the patient reports was poor to fair (kappa = 0.34) for whether the patient had a Pap smear in the three-year period before diagnosis. Patients tended to report far more Pap smears than medical records confirmed. Important determinants of agreement were the number of Pap smears reported during the five-year period and the age of the patient. The older the patient and the more Pap smears reported, the larger the discrepancy between the medical record and her self-report. The medical records did not contain enough data for us to complete an investigation of the possible reasons for this disagreement. Our results suggest these implications: (1) clinicians should strongly consider performing Pap smears if they doubt a patient's screening history, and (2) Pap smear registries are required for reliable and efficient evaluations of cervical cancer control programs because neither the patient report nor medical records are adequate.

Facilitating use of analytic methods at a federal agency.

Identification and application of appropriate analytic methods are critical pieces of the foundation of science. Because of the increasingly complex issues federal agencies face and the increasing importance of addressing those issues with multi-disciplinary teams that offer knowledge and skills in many methods areas, it is important that agencies foster coordinated integration of analytic methods. This report discusses the Centers for Disease Control and Prevention's (CDC's) evolving needs regarding analytic methods and includes activities that CDC has undertaken to facilitate a coordinated approach to the use of the statistical sciences. We introduce a new framework for facilitating coordination in analytic methods as a hybrid model, blending attributes of centralized and decentralized resource models. This coordinating focus approach offers assets of timeliness, efficiency, and effectiveness, as well as fosters strengthened relationships among scientists and increased collaboration among scientific disciplines.

Spouse similarities in high blood pressure knowledge: implications for control of high blood pressure.

This study describes the general knowledge about high blood pressure of husbands and wives using data from all 1,260 white spouse pairs from the 1982 Connecticut Blood Pressure Survey and examines the relationship between high blood pressure knowledge and control of hypertension. We found the average level of knowledge to be high; about 70% of the items were answered correctly. The correlation between spouses' knowledge about high blood pressure was significantly high (r = .41). Multiple regression analysis was used to control for other variables that might influence the spousal correlation in knowledge. When controlling for education, age, socioeconomic status, and hypertension status of both spouses, the correlation between spouses' knowledge remained significant (r = .24). Respondents' knowledge and spouses' knowledge about high blood pressure were significantly related to high blood pressure control among hypertensive persons, particularly to being aware of hypertension and being in current treatment.

Waist-to-hip ratio in a biracial population: measurement, implications, and cautions for using guidelines to define high risk for cardiovascular disease.

Cutoff points for high waist-to-hip ratio (WHR) that may define high risk for cardiovascular disease have been suggested for men (0.95) and women (0.80). The WHRs of groups defined by age, race, and sex among 3,118 South Carolina adults were compared with these cutoff points. Measurement methodology, mean WHRs, and prevalence of elevated WHR in this biracial study population were compared with data from other populations. A review of anthropometric measurement methods used in recent epidemiologic studies indicates that a standard method for measuring waist and hip girth is required before comparisons of mean levels can be valid. The paucity of evidence that a high WHR is associated with cardiovascular disease mortality in black populations, and the high number of women who have an elevated WHR in this and other epidemiologic studies, support the following conclusion: Current WHR cutoff points, which are based on evidence from primarily white populations, may not be appropriate for women, older age groups, and some racial or ethnic groups in the United States.

Capacity building and resource needs of state health agencies to implement community-based cardiovascular disease programs.

State Health Agencies play a critical role in the Nation's efforts for health promotion and disease prevention. This role is especially critical in efforts to reduce the burden of CVD through community-based programs. Resources SHAs need to facilitate implementation of community-based CVD prevention programs fall into three general categories: (a) Adequate time to plan, carry out and evaluate, (b) Financial resources to support staff, community organization and demonstration programs, and (c) Personnel with requisite technical expertise, skills and technological resources. Six critical activities for building state-level CVD program capacity include: (1) Forming a statewide CVD oversight committee, (2) Developing a state CVD plan, (3) Developing quality assurance standards and guidelines, (4) Developing new paradigms of community assessment and evaluation, (5) Planning for institutionalization, and (6) Translation of research to application. SHA roles vary from direct service delivery to serving as a linking agent, transferring information and resources and coordinating efforts between agencies.

Psychosocial correlates of hemoglobin Alc in young adults with type I diabetes.

To determine whether psychosocial variables are related to long-term glycemic control; trait anxiety, depression, loneliness and life stress were assessed in 48 Type I diabetic patients. Hemoglobin A1c (HbA1c), an indicator of long-term glycemic utilization, was assayed from blood samples drawn shortly before the self-report instruments were administered. Of the psychosocial variables, anxiety was significantly related to current values of HbA1c. The association between anxiety and current HbA1c remained after statistically controlling for potentially confounding variables, including the previous value of HbA1c. Despite the stability of HbA1c values over time, anxiety scores were not significantly correlated with follow-up HbA1c. The implications of the significant relationships between psychological constructs and glycemic control are discussed.

Disease prevention and health promotion in urban areas: CDC's perspective.

The mission of the Centers for Disease Control and Prevention (CDC) is to prevent disease, injury, and premature death and to promote quality of life. This mission applies to all Americans, especially to the poor and underserved. As so many people who are impoverished live in America's urban areas, the CDC has a unique and specific interest in the health problems of our urban population. The CDC has established five priorities: (1) strengthen essential public health services, (2) enrich capacity to respond to urgent threats to health, (3) develop a nationwide prevention network and program, (4) promote women's health, and (5) invest in our nation's youth. Each of these priorities will contribute to improving the health of people living in urban areas. The CDC has recently undertaken numerous initiatives to address health promotion and disease prevention issues in the urban setting. Future directions for the CDC lie in better understanding the role of socioeconomic and cultural factors in promoting health and how resources within urban areas can be used to promote health. The CDC needs to explore potential relationships with various types of partners. Solving urban health problems requires actions from many federal agencies as well as from state and local organizations.

Identifying and defining the dimensions of community capacity to provide a basis for measurement.

Although community capacity is a central concern of community development experts, the concept requires clarification. Because of the potential importance of community capacity to health promotion, the Division of Chronic Disease Control and Community Intervention, Centers for Disease Control and Prevention (CDC), convened a symposium in December 1995 with the hope that a consensus might emerge regarding the dimensions that are integral to community capacity. This article describes the dimensions that the symposium participants suggested as central to the construct, including participation and leadership, skills, resources, social and interorganizational networks, sense of community, understanding of community history, community power, community values, and critical reflection. The dimensions are not exhaustive but may serve as a point of departure to extend and refine the construct and to operationalize ways to assess capacity in communities.

Behavior as a diagnostic aid in failure-to-thrive.

The presence of a defined set of behaviors was examined in 67 hospitalized infants, 3-24 months old; 17 with organic failure-to-thrive (OFTT), 17 with nonorganic failure-to-thrive (NOFTT), and 33 with no signs of failure-to-thrive. The usefulness of assessing these behaviors to distinguish nonorganic from organic failure-to-thrive infants was evaluated. The frequency of behaviors per infant as well as the intensity of behaviors was greater for NOFTT. The order of decreasing frequency of behaviors was similar in both OFTT and NOFTT infants. Four of the 7 most prevalent behaviors occurred significantly more frequently in NOFTT than OFTT infants. The presence of these behaviors does not rule in NOFTT or rule out OFTT. However, when a number of the behaviors are present, particularly if they occur in high intensity, and when no organic disease is found, a diagnosis of NOFTT is suggested. Response to appropriate treatment remains the most reliable confirmation of the diagnosis.

Care of the infant in a Pavlik harness.

Congenital hip dysplasias, a common orthopaedic problem in children, can be treated effectively if diagnosed early. One such valuable tool in treating this disorder is the Pavlik Harness. These authors describe their child's experience with the Pavlik Harness along with the personal needs of the child and family.

Marital correlates of blood pressure.

In 1982, 1,260 white spouse pairs, aged 18 years and over, were interviewed as part of the Connecticut Blood Pressure Survey. The present report is based on a systematic analysis of 1) the personal characteristics and behavior of the spouse, 2) the roles and responsibilities of the material partners, and 3) similarity between spouses on selected variables. Results indicated that a number of these marital variables were associated with either systolic or diastolic blood pressure in husbands and in wives. Some components of the marital situation were associated with lower blood pressure whereas others were associated with higher blood pressure. Effects of marriage on blood pressure were observed both for husband's and wife's blood pressures, although the effects varied by sex. Similarity in spouses' behaviors and characteristics were more frequently associated with blood pressure than the individual effects of these behaviors. Age difference, measured as husband older than wife, was associated with lower blood pressure in husband's but with higher blood pressure in wives. Spouse's educational level and occupational status were not significantly related to blood pressure. Responsibility for common household chores (e.g., cooking) was associated with higher blood pressure in wives but responsibility for the family's health care was associated with lower blood pressure in both spouses.

Occupational exposures and brain cancer mortality: a preliminary study of east Texas residents.

The relationship between various occupational exposures and brain cancer was investigated in a case-control study using mortality data from 202 males who died in East Texas from gliomas in 1969-1978 and 238 male controls randomly selected from all deaths in East Texas in 1969-1978. Using the occupational classification scheme of the U.S. Bureau of the Census, the risk for brain cancer was significantly increased for male workers employed in the transportation, communication, and utilities industries [odds ratio (OR) = 2.26, confidence intervals (CI) = 1.18-4.32]. Further examination of this finding showed that male workers employed in occupations associated with electricity or electromagnetic (EM) fields had an elevated risk for brain cancer (OR = 3.94, CI = 1.52-10.20). In addition, there was a linear relationship between the probability of exposure to EM fields and brain cancer. Significantly elevated risk for brain cancer was also found among male workers in the trucking industry.

Health promotion in the city: a structured review of the literature on interventions to prevent heart disease, substance abuse, violence and HIV infection in US metropolitan areas, 1980-1995.

To achieve its national public health goals, the US must improve the health of low-income urban populations. To contribute to this process, this study reviewed published reports of health promotion interventions designed to prevent heart disease, HIV infection, substance abuse, and violence in US cities. The study's objectives were to describe the target populations, settings, and program characteristics of these interventions and to assess the extent to which these programs followed accepted principles for health promotion. Investigators searched five computerized databases and references of selected articles for articles published in peer-reviewed journals between 1980 and 1995. Selected articles listed as a main goal primary prevention of one of four index conditions; were carried out within a US city; included sufficient information to characterize the intervention; and organized at least 25% of its activities within a community setting. In general, programs reached a diverse population of low-income city residents in a variety of settings, employed multiple strategies, and recognized at least some of the principles of effective health promotion. Most programs reported a systematic evaluation. However, many programs did not involve participants in planning, intervene to change underlying social causes, last more than a year, or tailor for the subpopulations they targeted, limiting their potential effectiveness. Few programs addressed the unique characteristics of urban communities.

Racial differences in cervical cancer mortality in Chicago.

Racial differences in cervical cancer mortality in Chicago were examined. Age-adjusted mortality in Blacks (10.0/100,000) was over twice the rate found in Whites (4.6/100,000). Age-specific rates also showed significant excess mortality among Blacks. After stratification by a group-level defined poverty indicator, the race differential in age-adjusted rates remained significant. The race differential in age-specific rates diminished in the group with more than 30% living below the national poverty level, in contrast to the group with 30% or fewer living below the national poverty level, in whom race differences were more marked. Methodological issues concerning hysterectomy prevalence, Hispanic ethnicity, and social class must be considered with respect to interpretation of these findings.

Blood pressure concordance between spouses.

In 1982, 4,474 noninstitutionalized residents of Connecticut who were 18 years or older were interviewed as part of the Connecticut High Blood Pressure Program. This cross-sectional study was undertaken to determine the prevalence of hypertension among the 2.1 million adults in the state. Spouse correlations for systolic and diastolic blood pressures were examined in 1,260 white spouse pairs. Upon demonstrating a significant correlation in blood pressure between spouses (r = 0.262 for systolic and 0.248 for diastolic, p less than 0.001), subsequent stepwise multiple regressions were used to determine which aspects of the shared marital environment might influence the spouse concordance. Variables related to each spouse as well as variables reflecting similarity between spouses were analyzed. When spouse concordance in blood pressure was examined controlling for age, obesity, dietary salt intake, socioeconomic status, income, education, occupation, smoking, and exercise of both spouses and similarities in these variables, the correlations between spouses' blood pressures remained significant.

Advocacy. Necessary to achieve cancer control goals.

As resources become increasingly scarce, oncology professionals and consumers of oncology services are increasingly engaging in advocacy efforts to achieve goals in cancer control. Effective advocacy includes both legislative and direct educational efforts.

Cancer incidence among American Indians and Alaska Natives, 1980 through 1987.

OBJECTIVES: This study uses Indian Health Service inpatient data to estimate cancer incidence among American Indians and Alaska Natives. METHODS: Hospital discharge data for 1980 through 1987 were used to identify cases of cancer for 21 sites in women and 18 sites in men. Estimates of incidence were directly standardized to data from the Surveillance, Epidemiology, and End Results Program for the same time frame. RESULTS: Cancers of the gallbladder, kidney, stomach, and cervix show generally high rates among many American Indian and Alaska Native communities, and cancers of the liver and nasopharynx are high in Alaska. Of the relatively common cancers in Whites, American Indians and Alaska Natives experience lower rates for cancers of the breast, uterus, ovaries, prostate, lung, colon, rectum, and urinary bladder and for leukemia and melanoma. Variation among geographic areas and among tribal groups is observed for many important cancer sites. CONCLUSIONS: This study demonstrates significant variations of cancer rates among American Indians and Alaska Natives, with important implications for Indian Health Service cancer control programs. The study also supports the potential use of hospital discharge data for estimating chronic disease among diverse American Indian and Alaska Native communities.