Rural v. urban aspects of cancer: first-year data from the Mississippi Central Cancer Registry.

This study investigated various aspects of cancer between rural and urban localities. The Mississippi State Department of Health Central Cancer Registry received reports of 9,685 new cancer cases in 1996 while there were 5,732 cancer deaths. Even though no difference was found between rural and urban age-adjusted cancer incidence (and mortality), for the vast majority of results, there was a significant difference between rural and urban residents for stage of disease at initial diagnosis. Results also show that the proportion of tumors unstaged at diagnosis is greater for rural compared to urban residents. While this study has limitations, findings suggest that rural residents in Mississippi and rural African American women in particular, have less access to, or utilization of, early cancer detection programs and/or quality medical care.

Drownings in Mississippi 1992-1994: frequencies and distribution.

This investigation was conducted to determine the mortality rate due to drownings in Mississippi from 1992-1994. Drownings were defined as unintentional deaths from asphyxia while submerged or within 24 hours of submersion. Death certificate data including ICD-9 codes related to drownings, were received from the Mississippi State Department of Health. Variables assessed included age, age category, sex, race, death month, death day, place of drowning, and risk factors. Although drownings occurred in ages from 0-91 years, the highest mortality rates were found in the 14-17 year old age category (1 1.9 deaths per 100,000). Asian and Native American populations had the highest drowning mortality rates (23.6 and 22.6 per 100,000) when analyzed by race. However, this may be primarily due to lower populations. Males drowned five times more frequently than women. This is felt to be related to increased exposure. More drownings occurred on Saturdays and Sundays; and in the months of July, June; May, April, September, and August consecutively. Results presented here identify correlates of drowning fatalities which will enable strategic targeting of prevention programs and resources.

Tri-ethnic alcohol use and religion, family, and gender.

Nine different behavioral responses to alcohol by over two hundred ninth-graders in Austin, Texas, were examined in a survey designed to identify the relationship between adolescents' alcohol use, religious affiliation, religiosity, and gender. The relationship between alcohol use and family adaptability was also examined. While religious affiliation was found to be mildly predictive of use, religiosity determined only specific behavior. Gender differences in alcohol use appeared to be narrowing. Family adaptability was the most predictive variable, showing a relationship with six of the nine kinds of alcohol behavior. Future studies of family influences on adolescents' alcohol behavior and alcohol use among females are recommended.

Ethnicity, gender, and Type A differences in resting heart rate and blood pressure among young children.

We analyzed results of the Matthews Youth Test for Health for Anglo-American, black, and Mexican-American 5- and 6-year-old children to address three questions: (1) Do these children differ in the prevalence of type A behavior pattern or its component scales? (2) Are blood pressures or heart rates related to ethnicity, gender, or type A behavior pattern? (3) Can possible confounding factors account for observed differences? We identified several differences related to traditional risk factors: (1) Mexican Americans had the lowest systolic blood pressure, (2) girls had higher diastolic blood pressures than boys, and (3) black and Mexican-American boys had lower heart rates. Our analysis also revealed a significant gender-ethnicity interaction. Anglo- and Mexican-American girls had lower impatience-aggression scores than any other group. We detected no interaction effects for competitiveness scores, nor was there any significant relationship between competitiveness and blood pressure. We did find relationships between type A behavior pattern and blood pressure; these relationships were strengthened by use of the impatience-aggression subscale. Use of covariates strengthened observed associations. We conclude that the effects of type A behavior pattern on cardiovascular disease may be mediated by conventional risk factors.

Utilization of curanderos by Mexican Americans: prevalence and predictors. Findings from HHANES 1982-84.

Data from the Southwest sample of the Hispanic Health and Nutrition Examination Survey (HHANES) were analyzed to examine whether the use of a curandero or other folk medicine practitioner hindered, enhanced, or did not affect the utilization of western health care services by Mexican Americans. Findings revealed that only 4.2 percent of the HHANES sample persons between the ages of 18-74 years reported consulting a curandero, herbalista, or other folk medicine practitioner within the 12 months prior to the survey. Income, self-perceived health status, the language of the interview, and dissatisfaction with modern medical care recently received independently predicted curandero utilization (adjusted OR 2.01 and 1.66, respectively). Low income and self-perceived health status were less strongly related to curandero utilization.

How do primary care residents manage patient non-adherence?

Managing patient non-adherence to prescribed regimens is a daunting challenge for the clinician. Although a variety of adherence management techniques have been proposed, we know little about what approaches are currently used in practice. This project studied adherence management techniques of 25 family medicine and internal medicine residents. We videotaped a 10 minute interview between the resident and a simulated patient with uncontrolled essential hypertension. We analyzed the videotapes using quantitative and qualitative methods and found the residents employed a variety of heterogeneous, unsystematic, and possibly ineffective compliance management techniques.

Lipids and lipoproteins in a triethnic sample of 5- or 6-year-old Type A or Type B children.

The Type A behavior pattern (TABP) has been proposed as a risk factor for coronary heart disease (CHD). Several studies have indicated an association between Type A behavior and serum cholesterol levels. If the effects of TABP are mediated by conventional CHD risk factors, evidence for a causal relationship between TABP and CHD would be strengthened if associations were detected among the young. This paper addresses the following: (1) Do levels of serum lipids and lipoproteins among young children vary by ethnicity, gender, or TABP? (2) Can obtained differences be accounted for by possible confounding factors, such as SES or body composition? ANCOVA revealed no significant ethnic, gender, or TABP effects for total serum cholesterol or HDLc. Analyses of LDLc and triglycerides disclosed significant main effects for gender and for ethnicity. A Competition subscale by ethnicity interaction was the only effect to approach statistical significance for TABP. The strongest findings were a replication of differences in lipid and lipoprotein risk factors by ethnicity.

Orchestrating the points of community intervention: enhancing the diffusion process.

Recent interest in community-based health education programs has emphasized the need to promote change in social systems, as well as individual behaviors. The problem is where and when to intervene to effect these multiple levels of change. Components of community programs have tended to be implemented simultaneously at only one or two points within a community. A potentially more effective approach would consider both where differing types of people can be reached, and the appropriate time to intervene at each point, to maximize the effective diffusion of information and behavior change across the community. The present article outlines eight points of community intervention including centers, institutions, major media, minor media, special events, formal social networks, informal social networks, and created social networks. A sequencing of intervention efforts at these points is proposed which is predicated on their role in regard to the need for preparation, public awareness, notification about planned events and implementation of the program. The proposed orchestration of the points for community program implementation capitalizes on the diffusion process and on the synergistic effects of multimodal education efforts.