Women's Health

Cancer Coverage and Tobacco Advertising in African-American Women's Popular Magazines.
L. Hoffman-Goetz, et al. Journal of Community Health 22 (August 1997): 261-69.
Tobacco-related cancers are entirely preventable and contribute to the significant cancer burden of African-American women. Covering such cancers in magazines targeting these women presents an opportunity to promote preventive health behavior.

Tobacco ads and articles on cancer, cardiovascular disease, and general health were examined in three major magazines targeted to African-American women-Ebony, Essence, and Jet. Of 649 general health articles, 84 discussed cancer in general; only 9 covered tobacco-related cancers. The number of tobacco ads reached nearly 1,500 during the January 1987-December 1994 period studied, with the number per year declining over time and varying significantly by magazine.

In 1992, lung cancer surpassed breast cancer as the leading cause of cancer mortality among African-American women, but none of the three magazines published an article on lung cancer after that year. In those articles focusing on lung cancer, tobacco rarely was discussed as the major contributing cause.

Journal of Women's Health 6
(August 1997)
Women's Beliefs and Decisions About Hormone Replacement Therapy. K.M. Newton, et al. 459-65.
With a better understanding of the beliefs and decisions that influence women's choice to use hormone replacement therapy (HRT), providers can develop more effective strategies for helping women make informed choices about HRT.

A study of women's beliefs about HRT was conducted at Group Health Cooperative of Puget Sound, a health maintenance organization providing medical care to more than 370,000 people in western Washington. The study design featured random sampling of 1,520 women, oversampling in minority populations, and as many as 26 attempts to reach the sample. Of the 1,345 women reached, 1,120 (80.3 percent response rate) agreed to participate and completed the telephone interview. The final sample included 1,082 women who were classified as perimenopausal (very irregular or infrequent periods) and menopausal/postmenopausal, as well as current HRT users, past users, or never users.

Current and past users mentioned most frequently these reasons for their use of HRT: menopause-related symptoms (48.7 percent), osteoporosis prevention (32.6 percent), and physician advice (29.6 percent). Cardiovascular disease prevention was mentioned by 15.6 percent of current and 5.3 percent of past users. Of past HRT users, 53.8 percent reported stopping on their own, with the balance doing so on their physician's advice. The most frequently cited reasons for never using HRT were not needing hormones (49.9 percent) and viewing menopause as a natural event for which medications were unnecessary (17.9 percent). Fear of cancer (12.9 percent) and other side effects (12.9 percent), as well as physician advice (13.3 percent), were other reasons given for not initiating HRT.

Many women appear unaware or unconvinced of the potential role of HRT in cardiovascular disease prevention and misinformed about its role in osteoporosis prevention. Women need information from multiple sources-repeated counseling by health care providers as well as printed materials-to assess the risks and benefits of HRT, to make informed decisions, and then to reassess their earlier decisions.

Perceptions of Menopausal Stage and Patterns of Hormone Replacement Therapy Use. L.A. Bastian, et al. 467-75.
HRT use is associated with a woman's perception of her menopausal stage. To help women make informed decisions about HRT, health professionals should increase women's knowledge base about reproductive aging.

As part of ongoing data collection in the University of North Carolina Alumni Heart Study, women were asked about their menopausal stage and HRT use. Data were analyzed from mail questionnaires completed by 1,101 women aged 45-51. Menopausal stage was self-identified and not verified with hormone levels or medical record reviews. The women identified their menopausal stage as not near menopause (stage 1) (30 percent), may be close to menopause but not sure (stage 2) (38 percent), have begun menopause (stage 3) (19 percent), and have been through menopause (stage 4) (13 percent). No respondents in stage 1 were using HRT; 8 percent in stage 2, 52 percent in stage 3, and 76 percent in stage 4 were using HRT. Significant independent predictors of HRT use included menopausal stage, having had a hysterectomy, having had a pelvic exam in the past year, being married, and not participating regularly in physical exercise.

Nutrition

Population Nutrient Intake Approaches Dietary Recommendations: 1991 to 1995 Framingham Nutrition Studies. B.E. Millen, et al. Journal of the American Dietetic Association 97 (July 1997): 742-49.
Preventive nutrition messages should target the differing dietary patterns of men and women by focusing on specific nutrients, such as increasing folacin for women and complex carbohydrates for men.

A cross-sectional analysis was conducted of nutrient intake estimated from 3-day food records for 2,520 adults (1,375 women and 1,145 men) surveyed in the Framingham Offspring-Spouse Study between 1991 and 1995. Study objectives were to estimate population nutrient intake levels and to assess adherence to current dietary recommendations.

Between 1991 and 1995, high proportions of Framingham men and women (70 percent or more) achieved nutrient intake levels compatible with national preventive nutrition recommendations. Large proportions of adults did not meet the guidelines for some key nutrients. Statistically significant gender differences were noted, with more women than men meeting recommendations for carbohydrate, total and saturated fat, cholesterol, vitamin A, beta carotene, and sodium. More men than women met the guidelines for monounsaturated fat, dietary fiber, vitamin B-12, folacin, and calcium.

Food Intakes of U.S. Children and Adolescents Compared With Recommendations. K.A. Munoz, et al. Pediatrics 100 (September 1997): 328-29.
Many youth are not meeting the national Food Guide Pyramid recommendations for food group intake and need nutrition education and intervention. Adolescent females, minorities, and children from low-income households especially need dietary modification.

This study examined the food intake of 3,307 youth aged 2 to 19 years according to demographic characteristics, patterns of intake, and nutrient profiles associated with each pattern. Children did not meet recommendations, especially for fruit, grain, and dairy. Their intake of total fat, discretionary fat, and added sugars constituted 40 percent of total energy intake, well above recommendations for fat and sugars. Sixteen percent of youth did not meet any recommendations; 1 percent met all recommendations. Not meeting any intake recommendations resulted in intakes well below the recommended dietary allowances for some nutrients. Differences were noted for gender, race/ethnicity, and poverty level. Also, children's intake patterns differed from those observed among adults.

Educational and Community-Based Programs

Health Education & Behavior 24 (August 1997)

Recruitment and Training Issues From Selected Lay Health Advisor Programs Among African Americans: A 20-Year Perspective. E.J. Jackson and C.P. Parks. 418-31.
Lay health advisors (LHA's) are highly valuable in the helping and networking processes of their communities and benefit from clearly defined recruitment and training geared toward their roles. Appropriate training of LHA's fosters cooperative relationships with health professionals, enhances the potential to mobilize community resources, and offers new services and programs to the community.

The Community Health Education Program (CHEP) served as a guide for exploring the evolution of recruitment and training procedures in LHA programs for African Americans. CHEP represents one of the first fully documented LHA programs in the United States implemented in two predominantly African-American communities and based on the natural helper concept. The most effective CHEP recruitment methods were area organizations, program coordinators, people in key positions and occupations, and previously trained LHA's. Initial training was based on extensive planning and cooperation with program staff, community residents, and agency representatives after which the LHA's assumed a role in planning trainings that addressed their specific needs and interests.

The authors reviewed 87 LHA programs implemented among American Americans from the 1960's to 1994, focusing on recruitment and training procedures. Community-level recruitment techniques were identified as effective, suggesting that greater attention should be paid to the recruitment process for African-American LHA's. Four training issues merged-the dearth of information on specific training protocols used by African-American LHA programs, the large percentage of programs that pay for LHA services, thus professionalizing many LHA's; inconsistency in training methods and requirements; and possible mismatch between program goals, topics covered, and the natural helping role of LHA's. In sum, many of the training procedures reviewed by the authors fell short in their ability to assist LHA's in their community roles.

The Latino Health Advocacy Program: A Collaborative Lay Health Advisor Approach. E.A. Baker, et al. 495-509.
When community members take an active role in the initiation, design, implementation, and evaluation of local health care programs, they are more likely to use the programs.

The Latino Health Advocacy Program, a pilot program based in Worcester, MA, featured these components: forming linkages with health and human service agencies, working one-on-one with clients, and conducting community outreach. Through written summaries of interviews and meetings, community outreach forms, intake forms, and handwritten and tape-recorded progress notes, the program was evaluated as useful in increasing community access to and improving use of services. Because of the program's holistic approach, LHA's were able to address the underlying causes of problems, not just the symptoms. In addition, community health fairs helped LHA's share health information and information about resources. Finally, the agency linkages helped LHA's eliminate barriers to services.

Occupational Safety and Health

Occupational Fatalities Among Older Workers in the United States: 1980-1991. S.M. Kisner and S.G. Pratt. Journal of Occupational and Environmental Medicine 39 (August 1997): 715-21.
From 1992 to 2005 the number of workers aged 55 years and older is projected to grow 38 percent, increasing the importance of identifying job-related risks of injury and death and developing preventive work practices. Specifically, prevention efforts should focus on older workers in agricultural settings, as well as those at increased risk of workplace falls or violence.

Death certificates for persons 16 years of age or older with an "external" cause of death and a positive response to the "Injury at Work" item were examined from 52 U.S. vital statistics reporting units (the 50 States, New York City, and the District of Columbia). For the 12-year period, 1980 through 1991, there were 5,218 fatalities among full- and part-time workers aged 65 years and older. Older workers (aged 65 and older) had a fatality rate 2.6 times higher than that of younger workers (aged 16-64). The four leading causes of death for older workers were machinery-related incidents (28 percent), motor vehicle-related incidents (18 percent), homicide (13 percent), and falls (13 percent). Compared with younger workers, older women were at increased risk for fatal falls and homicide, and older men for fatalities caused by machines. The highest work-related industry division fatality rates were mining (62.7 per 100,000 workers), agriculture/forestry/fishing (52.6), construction (40.2), and transportation/communications/public utilities (33.2).

Oral Health

Journal of the American Dental Association 128 (July 1997)

Fluoride concentrations of infant foods. J.R. Heilman, et al. 857-63.
To prevent dental fluorosis, a tooth discoloration caused by excessive fluorine, caregivers should monitor an infant's total fluoride intake, especially infant foods containing chicken.

The researchers analyzed 206 ready-to-eat infant foods and 32 dry infant cereals manufactured by two different companies. Fluoride concentrations varied greatly, with foods containing chicken having the highest concentrations. Fluoride levels depended largely on the processing locations because of the different types of water used (fluoridated or nonfluoridated). Researchers noted that the fluoride level of the water used to reconstitute dry cereal is generally a more important determinant of fluoride intake than the fluoride level of the cereal itself.

The high fluoride content of infant foods containing chicken may be due to the mechanical deboning process. Foods containing fruits and vegetables are, in contrast, much lower in fluoride, but specific fluoride levels also depend on the water source used during processing.

Assessing the Cariogenic Potential of Some Infant Formulas, Milk, and Sugar Solutions. W.H. Bowen, et al. 865-71.
Dental practitioners and other health professionals should discourage the use of sugar in baby bottles and provide information on which formulas are least likely to induce caries when continuous bottle feeding is unavoidable.

Two separate rat studies were completed 1 year apart to test a total of 10 formulas. The rats were desalivated to match better the low-saliva condition of a baby sleeping with a bottle in its mouth. The control groups received sucrose or plain water by stomach tube; the remaining groups received a variety of infant formulas. Common in the two experiments were 5 percent sucrose and Gerber Baby Formula with Soy (Gerber). After the 17-day investigations, the rats' lower jaws were removed and tested. The researchers classified the tested formulas by ranking their cariogenic potential: negligible to low (milk, ProSobee, Carnation Follow-Up, Lactofree, Nutramigen, and Isomil); modest to moderate (Nursoy, Enfamil, and Gerber Baby Formula with Soy); and moderate to high (Similac Low-Iron Infant Formula and Gerber Baby Formula Low-Iron). The highest caries scores were observed in the rats that ingested the sucrose water. Of all the fluids examined, plain milk was by far the least cariogenic.

Maternal and Infant Health

Predictors of Injury Mortality in Early Childhood. S.J. Scholer, et al. Pediatrics 100 (September 1997): 342-47.
By focusing on maternal characteristics, health professionals can prevent serious injuries and deaths among high-risk children age 1 through 4 years. In particular, managed care organizations that serve high-risk populations, including low-income Medicaid mothers, are attractive settings for injury prevention programs.

Injuries are the leading cause of death for children of these ages. Recent data suggest that mortality rates for some injuries may be increasing.

In a study of 803 child deaths from injury, these maternal characteristics were associated, strongly and independently, with increased risk of mortality from injury: low education, young age, and increased number of children. The study did not identify potentially important environmental and behavioral factors associated with injury risk, such as use of child vehicle restraints or parental supervision. Researchers suggested that the maternal characteristics might serve as convenient surrogates for such factors, stating, for example, that the strong association between injury mortality and number of other children probably reflects the effects of supervision.

Heart Disease and Stroke

Prevention of Heart Failure by Antihypertensive Drug Treatment in Older Persons With Isolated Systolic Hypertension. J.B. Kostis, et al. Journal of the American Medical Association 278 (July 16, 1997): 212-16.
The stepped-care drug treatment can exert a strong protective effect in preventing heart failure in older persons with isolated systolic hypertension (ISO).

A double-blind, randomized, placebo-controlled, multicenter clinical trial tested the efficacy of diuretic-based stepped-care antihypertensive drug treatment on the occurrence of heart failure in older persons with ISO. The Systolic Hypertension in the Elderly Program studied 4,736 persons aged 60 and older with systolic blood pressure (SBP) between 160 and 219 mm Hg and diastolic blood pressure below 90 mm Hg. The step 1 drug was chlorthalidone or matching placebo; the step 2 drug was atenolol or matching placebo. In the active step-care therapy group, participants experienced fatal or nonfatal heart failure (HF) less frequently than the placebo group. A lower rate of HF was noted with active treatment in these risk categories: men, older participants, and persons with higher baseline SBP. Among patients with prior myocardial infarction, researchers observed an 80 percent risk reduction.

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