Active and passive smoking among asthmatic Missourians: implications for health education.

OBJECTIVES: To estimate the prevalence of smoking and exposure to secondhand smoke among asthmatic Missourians and to describe associated predisposing factors. METHOD: The Missouri County-level Behavioral Risk Factor Survey, conducted among 15,059 non-institutionalized Missourians aged 18 years or older using random-digit-dialed telephone interviews during 2002-2003, was used in this study. RESULTS: Current smoking (28.4%) and regular exposure to secondhand smoke (19.9%-36.4%, depending on the setting) were prevalent among asthmatic Missourians. Among asthmatics, those with college or technical school education were less likely to be current smokers compared to those with less than a high school education [odds ratio (OR)=0.25, 95% confidence interval (CI): 0.11, 0.57]; African Americans were less likely to be current smokers than white (OR=0.24, 95% CI: 0.07, 0.83); however, among asthmatic non-current smokers, African Americans were more likely to expose to secondhand smoke one or more days per week inside home than whites. Of the asthmatic current smokers who had visited a physician in the past 12 months, 30.0% were not advised by health care professionals to quit smoking. CONCLUSIONS: Asthma intervention programs should strengthen smoking cessation components and should educate health care professionals about the importance of advising asthmatic patients to quit smoking.

Cesarean section in term breech presentations: do rates of adverse neonatal outcomes differ by hospital birth volume?

AIM: To determine if risk of adverse neonatal outcomes among term breech infants delivered by cesarean section differs by volume of such births at the delivering hospital. METHODS: We conducted a population-based cohort study using Missouri linked birth and death certificate files. The study population included 10,106 singleton, term, normal birth weight infants in breech presentation delivered by cesarean section. Infants were linked to hospitals where delivered. These hospitals were divided into terciles (low, medium, and high volume) based on the median number of annual deliveries during 1993-1999. The primary outcome was presentation of at least one adverse neonatal outcome. Adjusted odds ratios and 95% confidence intervals (CI) were calculated using logistic regression analysis. RESULTS: The rate of any adverse outcome was 17.8, 15.0, and 5.9 cases per 1,000 deliveries at low-, medium-, and high-volume hospitals, respectively. All component adverse outcomes occurred more frequently in low- or medium-volume hospitals than in high-volume hospitals. Compared to breech infants delivered at high-volume hospitals, those delivered at low-volume and medium-volume hospitals were 2.7 (CI 1.6, 4.5) and 2.4 (CI 1.4, 4.1) times, respectively, more likely to experience an adverse outcome after adjusting for significant confounders. CONCLUSIONS: Prospective studies should explore the source of these risk differences.