The role of epidemiology in informing United States childhood immunization policy and practice.

One of the ten greatest public health achievements is childhood vaccination because of its impact on controlling and eliminating vaccine-preventable diseases (VPDs). Evidence-based immunization policies and practices are responsible for this success and are supported by epidemiology that has generated scientific evidence for informing policy and practice. The purpose of this report is to highlight the role of epidemiology in the development of immunization policy and successful intervention in public health practice that has resulted in a measurable public health impact: the control and elimination of VPDs in the United States. Examples in which epidemiology informed immunization policy were collected from a literature review and consultation with experts who have been working in this field for the past 30 years. Epidemiologic examples (e.g., thimerosal-containing vaccines and the alleged association between the measles, mumps, and rubella (MMR) vaccine and autism) are presented to describe challenges that epidemiologists have addressed. Finally, we describe ongoing challenges to the nation's ability to sustain high vaccination coverage, particularly with concerns about vaccine safety and effectiveness, increasing use of religious and philosophical belief exemptions to vaccination, and vaccine hesitancy. Learning from past and current experiences may help epidemiologists anticipate and address current and future challenges to respond to emerging infectious diseases, such as COVID-19, with new vaccines and enhance the public health impact of immunization programs for years to come.

Indomethacin use for the management of patent ductus arteriosus in preterms: a web-based survey of practice attitudes among neonatal fellowship program directors in the United States.

The objective of this study was to determine whether neonatal-perinatal fellowship programs (NFTPs) in the United States vary in indomethacin use for the management of patent ductus arteriosus (PDA) in < or =28 week gestational age infants at birth. A 53-item web-based survey was sent to 84 NFTP directors who received prenotification, followed 2 weeks later by a reminder letter. A total of 56 NFTP directors responded (67% maximum response rate). Wide variation exists in the maximum number of indomethacin courses used to close ductus, use of indomethacin for reopened PDA beyond 14 days, ductal closure definition, contraindications before consideration of indomethacin, interventions for contraindications, and reported ductal closer rate after each indomethacin course. Indomethacin therapy for symptomatic PDA and short course of indomethacin are common practices. Indomethacin use for the management of PDA in premature infants varies among NFTP directors. Practice attitudes may explain variations in ductal closure and ligation rates. Because practice variations may have implications for long-term outcome of vulnerable premature infants, studies relevant to the management of PDA in premature infants are needed.

Depressive symptoms as a risk factor for osteoporosis and fractures in older Mexican American women.

INTRODUCTION AND HYPOTHESIS: Despite higher rates of depression, lower hormone replacement therapy (HRT) use, and inadequate knowledge of factors associated with osteoporosis, Mexican Americans have been understudied with regards to the association between depression, osteoporosis, and fractures. We hypothesized that depression increases the risk for osteoporosis and fractures among older Mexican American women. METHODS: Seven years of prospective data (1993-2001) from the Hispanic Established Populations for Epidemiologic Studies of the Elderly were analyzed for 1,350 women in the Southwest United States who had complete data for at least the first follow-up interview. RESULTS: Respondents (mean age:75) were generally poorly educated, had low income, and reported poor or fair health. High levels of depressive symptoms were reported by 31%, while new diagnosis of osteoporosis and new fractures were reported by 18 and 13%, respectively. Logistic regression analyses showed that predictors of newly diagnosed osteoporosis included age, high school (HS) education, ever having been an alcoholic, early menopause, hormone replacement therapy, and high levels of depressive symptoms. Factors predictive of new fractures included age, HS education, diabetes, early menopause, and high levels of depressive symptoms. CONCLUSIONS: Depressive symptoms were associated with increased risk of osteoporosis and new fractures, even after controlling for other predictive factors.

Acculturation and leisure-time physical inactivity in Mexican American adults: results from NHANES III, 1988-1994.

OBJECTIVES: This study examined the relationship between acculturation and leisure-time physical inactivity among Mexican American adults. METHODS: Using data from the Third National Health and Nutrition Examination Survey, we estimated the prevalence of physical inactivity according to place of birth and language used at home. RESULTS: Spanish-speaking Mexican Americans had a higher prevalence of physical inactivity during leisure time than those who spoke mostly English, independent of place of birth. CONCLUSIONS: Acculturation seems to be positively associated with participation in leisure-time physical activity.

Health data issues for Hispanics: implications for public health research.

The limited availability of Hispanic health data has hampered the development of targeted public health policies. Hispanics represent 11.5 percent of the population and are projected to become the largest minority group in the United States by the year 2010. This paper explores current issues in Hispanic health data collection, examines methodological concerns, and presents recommendations for future Hispanic public health data collection. Data are derived from statistical reports of the U.S. Bureau of the Census, National Center for Health Statistics, Bureau of Labor Statistics, and other empirical studies. Recommendations include: collecting both race and ethnic-specific data by Hispanic subgroup, designing appropriate data collection instruments and approaches, and selecting referent groups for comparison purposes. The authors conclude that the renewed national focus on health disparities among underserved populations requires an increased commitment to adequately identify Hispanic subgroups.

Race/ethnicity, social class and their relation to physical inactivity during leisure time: results from the Third National Health and Nutrition Examination Survey, 1988-1994.

BACKGROUND: Physical inactivity is more prevalent among racial and ethnic minorities than among Caucasians. It is not known if differences in participation in leisure time physical activity are due to differences in social class. Thus, this paper provides estimates of the prevalence of physical inactivity during leisure time and its relationship to race/ethnicity and social class. METHODS: This was a national representative cross-sectional survey with an in-person interview and medical examination. Between 1988 and 1994, 18,885 adults aged 20 or older responded to the household adult and family questionnaires as part of the Third National Health and Nutrition Examination Survey . Mexican-Americans and African-Americans were over-sampled to produce reliable estimates for these groups. Multiple assessment of social class included education, family income, occupation, poverty status, employment status, and marital status. RESULTS: The age-adjusted prevalence (per 100) of adults reporting leisure time inactivity is lower among Caucasians (18%) than among African-Americans (35%) and Mexican-Americans (40%). African-American and Mexican-American men and women reported higher prevalence of leisure time inactivity than their Caucasian counterparts across almost every variable, including education, family income, occupation, employment, poverty and marital status. CONCLUSIONS: Current indicators of social class do not seem to explain the higher prevalence of physical inactivity during leisure time among African-American and Mexican-American. More research is needed to examine the effect of other constructs of social class such as acculturation, safety, social support and environmental barriers in promoting successful interventions to increase physical activity in these populations.

Health status by social class and/or minority status: implications for environmental equity research.

Much of the epidemiologic research in the United States has been based only on the categories of age, sex and race; thus, race has often been used in health statistics as a surrogate for social and economic disadvantage. Few multivariate analyses distinguish effects of components of social class (such as economic level) from the relative, joint, and independent effects of sociocultural identifiers such as race or ethnicity. This paper reviews studies of social class and minority status differentials in health, with a particular emphasis on health status outcomes which are known or suspected to be related to environmental quality and conditions which increase susceptibility to environmental pollutants. Sociodemographic data are presented for the U.S. population, including blacks, Asian American/Pacific Islanders, American Indian/Alaska Natives, and Hispanics. Four areas of health status data are addressed: mortality, health of women of reproductive age, infant and child health, and adult morbidity. Conceptual and methodological issues surrounding various measures of position in the system of social strata are discussed, including the multidimensionality of social class, in the context of the importance of these issues to public health research. Whenever possible, multivariate studies that consider the role of socioeconomic status in explaining racial/ethnic disparities are discussed.

Reported asthma among Puerto Rican, Mexican-American, and Cuban children, 1982 through 1984.

Data from the Hispanic Health and Nutrition Examination Survey (HHANES) (1982 through 1984) and the National Health and Nutrition Examination Survey (NHANES) II (1976 through 1980) were used to examine reported physician-diagnosed asthma among 6-month-old through 11-year-old children. The highest prevalence of active asthma was reported for Puerto Ricans: 11.2% compared with 3.3% for non-Hispanic Whites, 5.9% for non-Hispanic Blacks, 2.7% for Mexican Americans, and 5.2% for Cubans. Health services utilization and severity do not appear to explain the differences between Puerto Ricans and Mexican Americans. Educational programs on asthma should consider focusing on Puerto Ricans.

Alanine aminotransferase levels in Hispanics.

To prevent posttransfusion viral hepatitis, screening of potential blood donors includes the measurement of serum alanine aminotransferase (ALT) levels. The current use of single system-wide ALT cutoffs to determine acceptability of a blood unit or donor may not be appropriate, since male and Hispanic blood donors have much higher rejection rates than other donors, based solely on ALT level. Serum ALT measurements from the Hispanic Health and Nutrition Examination Survey were used to confirm these ALT elevations within general population samples of Mexican Americans, Cubans, and Puerto Ricans. Until specific tests are available to detect all hepatitis viral infections, testing blood donors for ALT levels will likely continue. Health personnel should be cautious in their interpretation of "elevated" ALT levels in these Hispanic populations.

Clinical chemistry profile data for Hispanics, 1982-84.

This report presents descriptive data for clinical chemistry profiles by age and sex. This information is from the Hispanic Health and Nutrition Examination Survey, a sample survey of selected groups of civilian noninstitutionalized Hispanic persons residing in the United States. The survey was conducted during 1982-84.

Selected pesticide residues and metabolites in urine from a survey of the U.S. general population.

Residues of toxic chemicals in human tissues and fluids can be important indicators of exposure. Urine collected from a subsample of the second National Health and Nutrition Examination Survey was analyzed for organochlorine, organophosphorus, and chlorophenoxy pesticides or their metabolites. Urine concentration was also measured. The most frequently occurring residue in urine was pentachlorophenol (PCP), found in quantifiable concentrations in 71.6% of the general population with an estimated geometric mean level of 6.3 ng/ml. Percent quantifiable levels of PCP were found to be highest among males. Quantifiable concentrations of 3,5,6-trichloro-2-pyridinol (5.8%), 2,4,5-trichlorophenol (3.4%), para-nitrophenol (2.4%), dicamba (1.4%), malathion dicarboxylic acid (0.5%), malathion alpha-monocarboxylic acid (1.1%), and 2,4-D (0.3%) were found, but at much lower frequencies. No quantifiable levels of 2,4,5-T or silvex were found. Preliminary analyses showed an apparent relationship between residue concentration and two measures of urine concentration (osmolality and creatinine). A large segment of the general population of the United States experienced exposure to certain pesticides, including some considered biodegradable, during the years 1976-1980.

Blood lead levels of 4-11-year-old Mexican American, Puerto Rican, and Cuban children.

Data from the Hispanic Health and Nutrition Examination Survey were used to estimate arithmetic mean blood lead and percent with elevated blood lead [25 micrograms per deciliter (micrograms per dl) or greater] for 4-11-year-old Mexican American, Puerto Rican, and Cuban children. The sample size was 1,390 for Mexican American children, 397 for Puerto Rican children, and 114 for Cuban children. Puerto Rican children had the highest mean blood lead levels (11.5 micrograms per dl), followed by Mexican American children (10.4 micrograms per dl) and Cuban children (8.6 micrograms per dl, P less than .05). Puerto Rican children had the highest percent with elevated blood lead (2.7 percent); 1.6 percent of Mexican American children had elevated blood lead; less than 1 percent (0.9 percent) of the Cuban children had elevated blood lead (P less than .05). Mexican American girls had a lower mean blood lead level than did boys: 9.7 micrograms per dl versus 11.0 micrograms per dl (P less than .05). For both Puerto Rican and Mexican American children, younger age indicated a higher risk of having elevated blood lead levels. Mexican American children who lived in poverty had higher mean blood lead levels than did Mexican American children who did not live in poverty--11.6 micrograms per dl versus 9.6 micrograms per dl (P less than .05). Despite advances in primary prevention of lead toxicity in children during the past 10 years, many Hispanic children are at risk of lead toxicity. Approximately 19,000 Mexican American 4-11-year-old children living in the Southwest and approximately 8,000 Puerto Rican children living in the New York City area had elevated blood lead levels (greater than or equal to 25 micrograms per dl) during 1982-84.