Risk factors for pediatric tuberculosis infection and disease after household exposure to adult index cases in Alaska.

OBJECTIVES: To determine risk factors for pediatric tuberculosis infection and active tuberculosis. STUDY DESIGN: We examined medical records from multiple sources for all 282 children younger than 15 years in Alaska during the period 1987 to 1994 who were household contacts of an adult with culture-positive pulmonary tuberculosis. RESULTS: Infection developed in 25% of the children and progressed to active disease in 9.6%. Risk factors for pediatric infection included exposure to a parent who had active tuberculosis and exposure to any adult with active tuberculosis who had a cough, smear positivity, or a left upper lobe (LUL) chest lesion (odds ratios, 2.1 to 2.8). Among the 71 children in whom infection developed, Alaska Natives and younger children were more likely to progress to active tuberculosis, as were children exposed to a parent who had active tuberculosis and children exposed to any adult who had a LUL chest lesion (odds ratios, 1.5 to 12). CONCLUSIONS: Although all children with household exposure to adults with active tuberculosis have a high risk of contracting the infection and disease, specific risk factors can be identified and differ for infection and disease. Alaska Natives have an increased risk of progression to disease once infected.

Why a peer intervention program for Mexican-American women failed to modify the secular trend in cancer screening.

INTRODUCTION: We evaluated an intervention program for Mexican-American women to increase Pap smear and mammography screening. METHODS: The three-year intervention included the presentation of role models in the media and reinforcement by peer volunteers. We used a two-community (intervention and comparison) pre-post test design. Activities were targeted to a mainly Spanish-speaking, poverty-level, immigrant population. Pre- and postintervention screening rates were based on independent random samples of Mexican-American women 40 years and older. RESULTS: Women reported a 6% absolute increase in Pap smear use similar to the 7% increase in the comparison community. Both communities experienced large but similar increases in recent mammography use (17% and 19%). Adjusting for differences in demographic factors, intervention and comparison changes remained identical. CONCLUSIONS: Our peer intervention failed to accelerate the secular trend in cancer screening low-income Mexican-American women. Likely, promotional activities were too diffuse and the comparison community was contaminated with similar interventions. Strong social and market forces make it difficult to measure the effect of a specialized intervention on cancer screening rates.

Effect of social networks on cancer-screening behavior of older Mexican-American women.

BACKGROUND: Previous studies have determined that Hispanic women and, in particular, Mexican-American women have the lowest rates of cancer screening of any race and ethnic group in the United States. In the development of cancer control strategies for this population, little attention has been given to factors that encourage Mexican-American women to seek cancer preventive care. Recent studies suggest that social networks can have a positive influence on cancer-screening participation. PURPOSE: We determined the extent to which differences in social networks account for variations in breast and cervical cancer-screening practices among low-income Mexican-American women. METHODS: The data analyzed in this study were obtained from a baseline survey of knowledge, attitudes, and cancer-screening practices conducted prior to implementation of community interventions designed to improve Pap smear and mammography screening in low-income Mexican-American women 40 years old and older living along the U.S.-Mexican border in El Paso County, Texas. A random selection of 1300 households served as a sampling frame to identify Mexican-American women 40 years old and older for personal interviews. Of the 549 households identified as having at least one eligible female, 450 women completed the personal interviews that provided the data for this study. Personal interviews solicited information on age, income, marital status, place of birth, education, health insurance coverage, Pap smear- and mammogram-screening practices, and six questions relating to social network. A social network score was assigned to each woman by summation of the following six variables: number of confidants, number of close friends, number of close relatives, frequency of contact with these close friends or relatives per month, church membership, and church attendance. Women were grouped into three linear strata of social network (low, medium, high) based on tertiles of the scores. Cancer-screening history was also ascertained during the interview. RESULTS: The 2-year prevalence of Pap smear and mammography use increased with social network. For each gain in social network level (low, medium, high), adjusted for sociodemographic factors, the odds ratio for Pap smear use was 1.33 (95% confidence interval = 1.02-1.73); it was 1.40 (95% confidence interval = 1.02-1.93) for mammogram use. Of the six social network components, the number of close friends was the most important predictor of mammography (P = .002) and Pap smear (P = .025) screening. CONCLUSION: Social networks appear to be an important determinant of cancer-screening behavior among low-income, older Mexican-American women.

Data-based interventions for cancer control in Texas.

The percentage of excess mortality based on the ratio of the race-ethnic-sex-specific regional rate to the state rate was used to identify regions with differing risks of lung, breast, and cervical cancer. Mortality maps show wide variation in mortality risks for these cancers not only by race and ethnicity but also by geographic region. Cancer-staging information from the State Cancer Registry indicated that excess mortality for breast and cervical cancers in black and Mexican-American women results largely from the later detection of these cancers. Together with geographic mapping of data on cancer mortality, data on the prevalence of tobacco use and on the use of Papanicolaou's tests and mammograms can be used to select and direct interventions to specific regions and to the highest risk populations. Evaluation of routinely collected cancer data, particularly in state health departments, is a primary step in implementing programs to control and prevent cancer in Texas.

Primary liver cancer death and occupation in Texas.

A death certificate case-control study of primary liver cancer and occupation was conducted to determine if the high risk of liver cancer in Mexican-Americans can be explained by farmworker exposures to pesticides. The association of liver cancer with the petroleum and chemical industry and with other potentially high-risk occupations was also examined. For the years 1969 to 1980, 1,742 deaths from primary liver cancer were identified for Texas males. Controls were randomly selected from other causes of deaths among males excluding all neoplasms, liver and gallbladder diseases, infectious hepatitis, and alcoholism, and were frequency matched to cases by age, race, ethnicity, and year of death. Risk for farmworkers based on age, race, and ethnicity-adjusted odds ratios (ORs) was not excessive (OR = 1.4, 95% confidence limits [C.L.] 0.8-2.2) but was larger than the risk for farmers (OR = 1.0, 95% C.L. 0.8-1.2). Excess risk in the petroleum and chemical manufacturing industries was confined to oil refinery workers (OR = 2.0, 95% C.L. 1.1-3.5). Other occupations with twofold risk or greater were plumbers and pipefitters (OR = 2.0, 95% C.L. 1.0-3.8), butchers and meat cutters (OR = 2.6, 95% C.L. 1.1-6.6), textile workers (OR = 3.1, 95% C.L. 1.2-7.8), cooks (OR = 2.2, 95% C.L. 1.1-4.5), and longshoremen (OR = 2.2, 95% C.L. 0.6-7.4).