Prevalence of elevated blood lead levels and risk factors among children living in Patna, Bihar, India 2020.

Childhood lead exposure remains a key health concern for officials worldwide, contributing some 600,000 new cases of intellectually disabled children annually. Most children affected by high exposure to lead live in low- and middle-income countries. The leaded gasoline phase out in India was completed in 2000. Yet, in 2020, an estimated 275 million children aged 0 to 9 years had blood lead levels (BLLs) ≥ 5 µg/dL known to adversely affect intelligence and behavior. Lead sources reported in India include spices, cookware, paint, traditional medicines and cosmetics, and lead-acid battery recycling and repair. However, their relative contribution has not been characterized. More than 200 lead pollution sites related to battery recycling and repair activities were identified in Bihar and Jharkhand, India. Ninety percent of the recycling sites had soil lead concentrations exceeding the US Environmental Protection Agency's standards. We compared blood and environmental lead levels in two groups of children in Patna, Bihar. Households in proximity to battery recycling operations (Proximal n = 67) versus households distal to these operations (Distal n = 68). The average age of children was 40 months; 46% were female. Overall, the geometric mean (GM) BLL was 11.6 µg/dL. GM BLLs of children in Proximal and Distal households were not significantly different (10.2 µg/dL vs. 13.1 µg/dL respectively; p≤0.07). About 87% children, 56 Proximal and 62 Distal had BLLs ≥5 µg/dl. Lead concentrations in environmental samples were significantly higher in Proximal households (soil mean 9.8 vs. 1.6 µg/ft2; dust mean 52.9 vs. 29.9 µg/ft2 p<0.001; Proximal vs. Distal respectively) whereas concentrations in all spices were higher in Distal households (mean 46.8 vs 134.5 ppm p<0.001; Proximal vs. Distal respectively), and turmeric (mean 59.4 vs. 216.9 ppm Proximal vs. Distal respectively). In multivariate analyses for all children lead in spices and turmeric and number of rooms in the house were significant while for the Proximal group only lead in spices remained in the model. The predictive value of these models was poor. For the Distal group, a model with lead concentration in spices, turmeric and soil and number of rooms in the house was a much better fit. Of the 34 water samples collected, 7 were above the Indian standard of 10 ppb for lead in drinking water (2 in the Proximal area, 5 in the Distal area). Children in Patna, Bihar, India are exposed to multiple sources of lead, with lead levels in house dust and loose, locally sourced spices the most likely to increase blood lead levels. A holistic approach to blood lead testing and source identification and remediation are necessary to prevent lead exposure.

Factors associated with local herb use during pregnancy and labor among women in Kigoma region, Tanzania, 2014-2016.

BACKGROUND: Despite research suggesting an association between certain herb use during pregnancy and delivery and postnatal complications, herbs are still commonly used among pregnant women in sub-Sahara Africa (SSA). This study examines the factors and characteristics of women using local herbs during pregnancy and/or labor, and the associations between local herb use and postnatal complications in Kigoma, Tanzania. METHODS: We analyzed data from the 2016 Kigoma Tanzania Reproductive Health Survey (RHS), a regionally representative, population-based survey of reproductive age women (15-49 years). We included information on each woman's most recent pregnancy resulting in a live birth during January 2014-September 2016. We calculated weighted prevalence estimates and used multivariable logistic regression to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for factors associated with use of local herbs during pregnancy and/or labor, as well as factors associated with postnatal complications. RESULTS: Of 3530 women, 10.9% (CI: 9.0-13.1) used local herbs during their last pregnancy and/or labor resulting in live birth. The most common reasons for taking local herbs included stomach pain (42.9%) and for the health of the child (25.5%). Adjusted odds of local herb use was higher for women reporting a home versus facility-based delivery (aOR: 1.6, CI: 1.1-2.2), having one versus three or more prior live births (aOR: 1.8, CI: 1.4-2.4), and having a household income in the lowest versus the highest wealth tercile (aOR: 1.4, CI: 1.1-1.9). Adjusted odds of postnatal complications were higher among women who used local herbs versus those who did not (aOR: 1.5, CI: 1.2-1.9), had four or more antenatal care visits versus fewer (aOR: 1.4, CI: 1.2-1.2), and were aged 25-34 (aOR: 1.1, CI: 1.0-1.3) and 35-49 (aOR: 1.3, CI: 1.0-1.6) versus < 25 years. CONCLUSIONS: About one in ten women in Kigoma used local herbs during their most recent pregnancy and/or labor and had a high risk of postnatal complications. Health providers may consider screening pregnant women for herb use during antenatal and delivery care as well as provide information about any known risks of complications from herb use.

Evaluation of the national tuberculosis surveillance program in Haiti.

OBJECTIVE: To assess the quality of tuberculosis (TB) surveillance in Haiti, including whether underreporting from facilities to the national level contributes to low national case registration. METHODS: We collected 2010 and 2012 TB case totals, reviewed laboratory registries, and abstracted individual TB case reports from 32 of 263 anti-tuberculosis treatment facilities randomly selected after stratification/weighting toward higher-volume facilities. We compared site results to national databases maintained by a non-governmental organization partner (International Child Care [ICC]) for 2010 and 2012, and the National TB Program (Programme National de Lutte contre la Tuberculose, PNLT) for 2012 only. RESULTS: Case registries were available at 30/32 facilities for 2010 and all 32 for 2012. Totals of 3711 (2010) and 4143 (2012) cases were reported at the facilities. Case totals per site were higher in site registries than in the national databases by 361 (9.7%) (ICC 2010), 28 (0.8%) (ICC 2012), and 31 (0.8%) cases (PNLT 2012). Of abstracted individual cases, respectively 11.8% and 6.8% were not recorded in national databases for 2010 (n = 323) and 2012 (n = 351). CONCLUSIONS: The evaluation demonstrated an improvement in reporting registered TB cases to the PNLT in Haiti between 2010 and 2012. Further improvement in case notification will require enhanced case detection and diagnosis.

Quantitative imaging of proteoglycan in cartilage using a gadolinium probe and microCT.

OBJECTIVE: Micro-computed tomography (microCT) imaging has the potential to allow the three-dimensional (3D) visualization of cartilage morphology. However, cartilage intensity on a microCT image is weak because cartilage does not strongly attenuate X-rays. This work was designed to demonstrate that exposure of cartilage to charged gadolinium compounds modifies the intensity to allow an improved visualization of cartilage morphology and the determination of proteoglycan content. DESIGN: Trypsin was used to deplete proteoglycan in bovine nasal cartilage disks. Disks were then exposed to Gd(3+), gadopentetate (Gd-DTPA(2-)), or gadoteridol (Gd-HP-DO3A), and imaged with microCT. The intensities of the disks were measured from the images and compared to the actual proteoglycan content determined with a dimethylmethylene blue assay. RESULTS: Treatment of naïve disks with 200 mM Gd(3+) for 24h at room temperature produced a 2.8-fold increase in intensity on microCT images. Similar treatment with 200 mM Gd-DTPA(2-) produced a 1.4-fold increase. After 2h of trypsin treatment at room temperature, the intensities of cartilage disks exposed to 20 0mM Gd(3+) decreased by 12%. Conversely, the intensities of trypsin-treated disks exposed to 200 mM Gd-DPTA(2-) increased by 15%. Trypsin treatment caused a 4% increase in the intensities of disks exposed to neutral Gd-HP-DO3A. The correlation between proteoglycan content and the microCT intensity of cartilage treated with Gd(3+) was very good (r(2)=0.81). CONCLUSIONS: Gadolinium and microCT allow an improved 3D visualization of cartilage and quantification of its proteoglycan content.

Role of coronary interventional procedures in improved postinfarction survival in the 1990s.

The contribution of increased use of same-admission percutaneous coronary interventional procedures to recent improvements in hospital survival of patients with acute myocardial infarction (AMI) remains unclear. Patients with International Classification of Diseases codes for AMI (code 410), who were admitted to the emergency coronary care unit and underwent an initial episode of treatment, were studied over the 9-year period 1990 to 1998 (n = 2,628). Three triennia between 1990 and 1998 were compared. Trends in risk, the use of procedures, and hospital outcomes were analyzed. Hospital mortality was 33% lower (p <0.02) in the third triennium (5.8%) than in the earlier 2 triennia (8.7%), equivalent to an absolute reduction of 29 hospital deaths/1,000 patients treated. The lower hospital mortality was not due to: (1) shorter hospital stays (reduction in mortality was primarily in the first 3 hospital days), (2) treatment of lower risk subjects (a risk score based on age, gender, and presence of diabetes increased between the first and third triennia), or (3) use of in-hospital interventional procedures (although the use of percutaneous coronary intervention more than doubled in the third triennium, most procedures were performed in patients with a 1% risk of hospital death). We conclude from this study that there has been a substantial improvement over a 9-year period in early case fatality after AMI, but that this cannot be attributed to the increased use of in-hospital coronary interventions, which were largely performed on low-risk patients.

Reduced feeding response to neuropeptide Y in senescent Fischer 344 rats.

The anorexia of aging syndrome in humans is characterized by spontaneous body weight loss reflecting diminished food intake. We reported previously that old rats undergoing a similar phenomenon of progressive weight loss (i.e., senescent rats) also display altered feeding behavior, including reduced meal size and duration. Here, we tested the hypothesis that blunted responsiveness to neuropeptide Y (NPY), a feeding stimulant, occurs concurrently with senescence-associated anorexia/hypophagia. Young (8 mo old, n = 9) and old (24-30 mo old, n = 11) male Fischer 344 rats received intracerebroventricular NPY or artificial cerbrospinal fluid injections. In response to a maximum effective NPY dose (10 microg), the net increase in size of the first meal after injection was similar in old weight-stable (presenescent) and young rats (10.85 +/- 1.73 and 12.63 +/- 2.52 g/kg body wt (0.67), respectively). In contrast, senescent rats that had spontaneously lost approximately 10% of body weight had significantly lower net increases at their first post-NPY meal (1.33 +/- 0.33 g/kg body wt (0.67)) than before they began losing weight. Thus altered feeding responses to NPY occur in aging rats concomitantly with spontaneous decrements in food intake and body weight near the end of life.

Measuring physical activity with the behavioral risk factor surveillance system.

PURPOSE AND METHODS: Because regular physical activity reduces the risk of premature death and disability, accurate methods of population-based measurement are important for public health surveillance efforts such as those based on the Behavioral Risk Factor Surveillance System (BRFSS). The present study: 1) briefly reviews and compares currently available methods to measure physical activity using BRFSS data, 2) describes physical activity patterns in the United States using these state-aggregated measures, and 3) provides suggestions on future directions for practitioners and researchers. Using a random-digit dialing, telephone survey, we collected data for noninstitutionalized adults aged 18 yr and older. We analyzed BRFSS data for 1996 from 50 states and the District of Columbia and Puerto Rico (N = 124,085). Based on recent literature and public health priorities, we developed eight different physical activity indices (one vigorous and seven moderate). These varied in their threshold for duration, kcal expenditure, and in frequency and intensity of activity. RESULTS: Using different algorithms, the population prevalence of moderate physical activity ranged from about 20% to 38%. Only 20% of adults met the Healthy People 2000 definition for regular, sustained activity (> or =30 min of moderate activity per day for at least 5 d x wk(-1)). CONCLUSIONS: Considerable progress is needed if the United States is to reach the current public health goal for regular physical activity. Standardized approaches to analyzing and collecting physical activity data are essential for public health surveillance, policy making, and communication to the public.

Tobacco use by youth: a surveillance report from the Global Youth Tobacco Survey project.

The Global Youth Tobacco Survey (GYTS) project was developed by the World Health Organization and the US Centers for Disease Control and Prevention to track tobacco use among youth in countries across the world, using a common methodology and core questionnaire. The GYTS is school based and employs a two-stage sample design to produce representative data on smoking among students aged 13-15 years. The first stage consists of a probabilistic selection of schools, and the second consists of a random selection of classes from the participating schools. All students in the selected classes are eligible for the survey. In 1999, the GYTS was conducted in 13 countries and is currently in progress in over 30 countries. This report describes data from 12 countries: Barbados, China, Costa Rica, Fiji, Jordan, Poland, the Russian Federation (Moscow), South Africa, Sri Lanka, Ukraine (Kiev), Venezuela, and Zimbabwe. The findings show that tobacco use in the surveyed age group ranged from a high of 33% to a low of 10%. While the majority of current smokers wanted to stop smoking, very few were able to attend a cessation programme. In most countries the majority of young people reported seeing advertisements for cigarettes in media outlets, but anti-tobacco advertising was rare. The majority of young people reported being taught in school about the dangers of smoking. Environmental tobacco smoke exposure was very high in all countries. These results show that the GYTS surveillance system is enhancing the capacity of countries to design, implement, and evaluate tobacco prevention and control programmes.

Perceived barriers to exercise and stage of exercise adoption in older women of different racial/ethnic groups.

The purpose of this study was to determine whether barriers to exercise differ among racial/ethnic groups at the same stage of exercise adoption and adjacent stages within racial/ethnic groups. Questions about stage of exercise adoption and perceived barriers to exercise were administered to a cross sectional sample of 745 African American, 660 Hispanic, 738 Native American/Native Alaskan, and 769 Caucasian U.S. women aged 40 years and older. Correlations between rankings of barriers among racial/ethnic groups within the same stage ranged from .43 to .89. For each racial/ethnic group, significant differences existed between adjacent stages in the percentage of women reporting barriers to interfere with exercise (p < .10). Barriers were not similar enough among racial/ethnic groups to recommend that the same barriers be addressed for all races/ethnicities.

Levels of physical activity and inactivity in children and adults in the United States: current evidence and research issues.

PURPOSE: The purpose was to describe current levels of physical activity and inactivity among adults and young people in the United States. METHODS: Estimates of participation in regular physical activity were derived from three national surveys for adults (National Health Interview Survey, National Health and Nutrition Examination Survey, and the Behavioral Risk Factor Surveillance System) and from the Youth Risk Behavior Survey for high school students. RESULTS: Overall, 63.8% of high school students surveyed on the 1997 YRBS reported participating in vigorous physical activity for at least 20 min on 3 or more days per week. Participation in vigorous activity was higher for boys (72.3%) than girls (53.5%), whites (66.8%) compared with blacks (53.9%) and Hispanics (60.4%), and decreased with advancing grade. Among adults, 27.7% meet recommended levels of either moderate or vigorous physical activity, whereas 29.2% report no regular physical activity outside of their work. Gender differences in participation in physical activity are less pronounced than in youth, and age-related patterns were complex. Whites are more active than blacks and Hispanics, and persons with higher family incomes and more education report being more physically active. There have been only minor changes in reported participation in leisure time physical activity over the past 15 yr. CONCLUSION: National estimates of physical activity appear to be reliable and valid for adults but may be less so for adolescents and are poor measures for children. Research is needed to determine the role that objective monitoring with accelerometers may play in surveillance. Reliable and valid measures of occupational, household, and transportation-related physical activity and sedentary behaviors are needed to better characterize the range of activity that is associated with health.

Neurochemical alterations during age-related anorexia.

Unexplained weight loss during the latter stages of aging is commonly preceded by a spontaneous diminution in food intake. Multiple etiologies of age-related anorexia in humans, ranging from social isolation to impaired gastrointestinal function, have been proposed. The observation of this phenomenon in older laboratory animals suggests that physiological changes play a significant causal role. A continually expanding body of information on the neurochemical control of food intake supports a contribution of altered neurochemistry to dysregulated feeding behavior. This review provides an update on the relationship between declining food intake during advanced age and physiological (specifically neurochemical) function. The complexity of the control of food intake as well as the variety of investigative methods used in this field of study render the identification of definitive causes difficult. Evidence presented here is evaluated and possible etiologic factors are suggested.

Physical activity patterns of Chippewa and Menominee Indians: the Inter-Tribal Heart Project.

INTRODUCTION: Leisure-time (LTPA), occupational, transportation, and household physical activity were evaluated among participants in the Inter-Tribal Heart Project (ITHP). METHODS: Age-stratified random samples of persons aged > or =25 years were drawn from three communities of Chippewa and Menominee Indians in Minnesota and Wisconsin. Participants (843 women and 501 men) completed an interviewer-administered questionnaire. Logistic regression analyses were performed to assess age-adjusted associations between no reported LTPA and potential correlates. RESULTS: During leisure time, 12% of women and 17% of men were active 7-12 months in the past year; 33% of women and 21% of men reported no LTPA. During a typical workday for employed persons, approximately 90% of both genders walked > or =20 minutes, for carrying/lifting moderate to heavy objects the median value for men was 1 hour and women 0 hours. The median value of weekly household activity for men was 3 hours compared to 10 hours for women. Little transportation activity was reported by either gender. Age, household income, smoking, and poor/fair self-perceived health were associated with leisure-time inactivity in women (p < 0.05). Age, poor/fair self-perceived health, and smoking were associated with leisure-time inactivity in men (p < 0.05). Walking was the most prevalent activity in the population. CONCLUSIONS: Prevalence of leisure-time inactivity is higher than the national health objective of 15%, however, ITHP participants obtain a substantial amount of occupational and household activity that may lower risks of chronic diseases. Health promotion efforts to increase LTPA may lead not only to reduced chronic disease risk, but to additional benefits of enjoyment and improved psychological well-being.

Meal patterns associated with the age-related decline in food intake in the Fischer 344 rat.

We previously reported that aging Fischer 344 (F344) rats display a spontaneous, rapid loss in body weight associated with decreased food intake near the end of life. Here, we describe the specific changes in feeding patterns underlying this reduced intake. Nine male F344 rats, aged 25 mo, were monitored continuously until 7 days after the onset of spontaneous rapid weight loss (i.e., senescence). Regardless of age at death (25.5-32.5 mo), all senescent rats demonstrated a similar pattern of decreased food intake. They ate significantly smaller meals (g/meal) of shorter duration during spontaneous rapid weight loss compared with their period of weight stability (presenescence). However, no differences occurred in the number of meals eaten per day. Rapid weight loss had no effect on the rats' selection of preferred diets. Serum levels of the hormone leptin were not higher in the senescent vs. age-matched presenescent rats, nor was the incidence of common disease different in senescent animals. Moreover, the area of the pituitary-hypothalamus interface, measured to identify possible hypothalamic compression, was similar in the senescent rats and an age-matched, presenescent control group despite significantly greater pituitary size in the former. Our data show that simultaneous with rapid spontaneous weight loss, aging rats demonstrate significant changes in feeding patterns suggestive of earlier satiation. These feeding alterations do not result from loss of ability to select for palatable food, elevated serum leptin levels, specific pathology, or hypothalamic compression.

Pharmacological evaluation of 1-(carboxymethyl)-3,5-diphenyl-2-methylbenzene, a novel arylacetic acid with potential anti-inflammatory properties.

OBJECTIVE AND DESIGN: 1-(Carboxymethyl)-3,5-diphenyl-2-methylbenzene (CDB), a novel arylacetic acid, was evaluated in vivo for its ability to inhibit acute and chronic inflammation as well as acute pain. MATERIALS AND METHODS: The effects of CDB were evaluated using the following assays: 1) acute inflammation induced by the injection of carrageenan, bradykinin and serotonin into the subplantar region of the hind paw of rats; 2) chronic inflammation produced by the injection of Mycobacterium butyricum into the base of the tail of rats; 3) acute pain induced by the i.p. injection of phenyl-p-quinone into mice resulting in the production of writhes; 4) cyclooxygenase (COX) activity, including COX-1 and COX-2, evaluated using whole blood; and 5) activity of peptidylglycine alpha-monooxygenase (PAM) isolated from Xenopus laevis skin. RESULTS: CDB (10 to 100mg/kg s.c.) produced a dose-dependent inhibition of carrageenan edema (ED50 of 41 mg/ kg at 3 h) which continued for up to 12 h. Using a therapeutic dosing regimen, this compound inhibited hind paw inflammation (>70%) and arthogram scores in rats with adjuvant-induced arthritis. This compound also possessed significant analgesic activity in mice (70% inhibition with 50mg/kg). CDB, however, lacked inhibitory activity on bradykinin and serotonin-induced edema. In addition, CDB significantly inhibited COX-I activity (IC50 approximately = 17 microM) while having only a weak inhibitory activity on both COX-2 and PAM activity. CONCLUSIONS: CDB is an effective anti-inflammatory/analgesic agent whose mechanism of action appears to be associated with inhibition of COX-1 activity.

Radial keratotomy learning curve using the American technique.

PURPOSE: To delineate the learning curve for a beginning refractive surgeon using the centrifugal (American) technique. SETTING: Naval Medical Center, San Diego, California, USA. METHODS: The first 100 radial keratotomy (RK) cases (51 patients) of one surgeon, divided into five sequential groups of 20, were retrospectively reviewed. All patients had RK using the American technique. Emmetropia was the goal in all patients. Groups were compared with respect to preoperative refractive status, age, sex, and outcome. Outcomes analysis included visual acuity, refractive error, complications, and enhancement rates. Data were reviewed preoperatively and 1 and 3 months postoperatively. RESULTS: All five groups were age and sex matched. There was no difference in preoperative refractive error among the five groups. Sequential improvement in early postoperative refractive error from a mean of -1.73 diopters (D) +/- 1.00 (SD) (first 20) to 0.45 +/- 0.55 D (last 20) (P < .001) and decreased enhancement rates from 50% (first 20) to 0% (last 20) (P = .002) were statistically significant. Visual acuity at 1 month was 20/40 or better in 47% of patients in Group 1 (first 20), whereas all patients in Group 5 (last 20) had an acuity better than 20/40 (P < .001). There was no significant difference in complication rates among the five groups. CONCLUSION: The results of RK using the American technique can improve significantly with surgeon experience. Enhancement rates decreased with experience, and there was no difference in complication rates during the learning period of one surgeon.

Topographic detection of photorefractive keratectomy.

PURPOSE: This study aimed to evaluate the sensitivity and specificity of subjective review of corneal topography to detect patients who have undergone photorefractive keratectomy (PRK). METHODS: Topographic maps from 3 different devices were obtained from 19 patients with postoperative PRK and 9 control subjects with emmetropia and 10 control subjects with myopia. Each image was printed in an absolute and relative scale (total of 228 maps) and graded for overall shape and pattern. Fifteen masked reviewers independently rated each map as either postoperative PRK or not. RESULTS: The overall sensitivity (ability to detect PRK) and specificity rates (ability to exclude control subjects) by reviewers were 65% and 93%, respectively. Sensitivity was influenced independently by the scale (relative, 68%; absolute, 62%; P < 0.01), experience of reviewer (experienced, 77%; inexperienced, 53%; P < 0.001), and device (Alcon, 67 +/- 29.9; Eyesys, 75 +/- 29.4%; and Tomey, 54 +/- 31.7%; P < 0.001). Low levels of preoperative myopia were consistently more difficult to detect than higher levels (low myopia -1.50 to -2.99 diopters [D] sensitivity: 53 +/- 34.5%; medium level -3.00 to -4.49 D: 67 +/- 28.9%; and high level -4.50 to -6.00 D: 77 +/- 21.1%; P < 0.0001). Differences in specificity between experienced and inexperienced reviewers were obtained when maps had a homogeneous topographic pattern (97 +/- 5.6% and 85 +/- 13.7%, respectively; P < 0.05). Several control topography patterns (e.g., homogeneous, focal, and keyhole) were disproportionately more difficult to correctly identify on the Eyesys device. CONCLUSIONS: Topographic experience is a significant factor influencing the correct identification of PRK. Techniques also can be used to enhance detection, such as the use of different devices and scales. However, if subjective review of topography is used as the only method of detection, many patients with PRK will not be identified properly. In addition, the most prevalent preoperative myopic category in the general population (myopia < -3.00 D) also is the most difficult to detect after treatment. This reduces the usefulness of topography as a screening tool. Other techniques are needed to improve the detection of patients with postoperative PRK.

Secular trends in ischemic heart disease mortality in California versus the United States, 1980 to 1991.

We compare the recent trends in ischemic heart disease mortality in California and the United States. Because California was among the first states to have declines in ischemic heart disease mortality, an examination of these recent trends may provide important clues for upcoming national trends. Age-adjusted and -specific ischemic heart disease mortality rates were calculated by sex for persons aged 35 and older during the years 1980 to 1991. Log-linear regression modeling was used to estimate the average annual percentage change in mortality. Between 1980 and 1991, the annual age-adjusted ischemic heart disease mortality declined less in California than in the United States for both women (1.9% versus 3.1%) and men (3.1% versus 3.5%). In California, it increased slightly between 1986 and 1990 for the oldest women and men. The slower rates of decline in mortality of this disease in California compared with the United States and the rising rates among the most elderly Californians suggest that careful attention should be paid to these trends in death rates of and risk factors for this disease in California.

Social class and race disparities in premature stroke mortality among men in North Carolina.

The purpose of this work was to examine the association between social class and premature stroke mortality among blacks and whites. For black men and white men in North Carolina, aged 35-54 years, mortality data from vital statistics files and population data from Census Public Use Microdata Sample files were matched according to social class for the years 1984-1993. Four categories of social class were defined based upon a two-dimensional classification scheme of occupations. For each category of social class, race-specific age-adjusted stroke mortality rates were calculated, and race-specific prevalences of income, wealth, education, unemployment, and disability were estimated. Women were excluded because comparable information on social class was not available from the mortality and population data sources. For both black men and white men, the highest rates of premature stroke mortality were observed among the lowest social classes. The rate ratios (RR) between the lowest and highest social class were 2.8 for black men and 2.3 for white men. Within each social class, black men had substantially higher rates of premature stroke mortality than white men (black-to-white RR ranged from 4.0 to 4.9). Among both black men and white men, the highest social class consistently had the most favorable levels of income, wealth, education, and employment. The inverse association between social class and stroke mortality for both black men and white men supports the need for stroke prevention efforts that address the structural inequalities in economic and social conditions.

Trends in mortality and health behaviors: status of white and African-American women.

A substantial proportion of mortality in the United States can be attributed to three major behaviors: using tobacco, maintaining an unhealthy diet, and being physically inactive. Using data from the South Carolina mortality files and Behavioral Risk Factor Surveillance System we were able to document state trends in mortality, cigarette smoking, physical inactivity, and unhealthy dietary practices. We found that, in spite of the declines in heart disease and stroke mortality noted nationally and in the state, the risk factor profiles for most women in South Carolina did not improve. This analysis further suggests that physical inactivity and dietary issues (excess caloric intake, low fruit and vegetable consumption) would be good choices for lifestyle interventions among women in South Carolina, not only because they ultimately affect mortality, but also because they exert interim effects on morbidity, including physical functioning and independence.