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.

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).