Increasing U.S. asthma mortality rates: who is really dying?

Asthma mortality rates have been increasing since 1979, but rates of change among different demographic subgroups have not been examined in detail. This analysis identifies the demographic subgroups that are most responsible for the increase in asthma mortality rates in the United States between 1979 and 1996. The analysis is limited to those death certificates that specified asthma as the underlying cause of death. Blacks, females, and people aged 65 and older had the largest increases in age-adjusted asthma mortality rates between 1979 and 1996. When all three demographic variables are considered simultaneously, black females aged 65 years and older had the highest crude asthma mortality rates in 1996 and the largest increase in rates since 1979. However, white females aged 65 years and older contributed the most to the increase in age-adjusted rates between 1979 and 1996 because of their relatively larger population size. Overall, the increase in asthma mortality rates between 1979 and 1996 was due primarily to increased mortality rates in the population subgroup aged 65 years and older Even though the rapid increase in asthma mortality rates in those aged 65 years and older shows evidence of a slight reversal after 1989, efforts to develop strategies to reduce overall mortality from asthma should concentrate on middle-aged and elderly women.

Health effects related to environmental tobacco smoke exposure in children in the United States: data from the Third National Health and Nutrition Examination Survey.

OBJECTIVE: To determine the effects of prenatal and postnatal smoke exposure on the respiratory health of children in the United States. DESIGN: Nationally representative cross-sectional survey, including questionnaire information, measurements of serum cotinine (a metabolite of nicotine), and pulmonary function measurement, of 5400 US children. SETTING AND PARTICIPANTS: Children aged 4 to 16 years in the Third National Health and Nutrition Examination Survey, October 25, 1988, to October 15, 1994. METHODS: We stratified the study participants into tertiles, on the basis of serum cotinine levels, and used logistic and linear regression modeling, adjusting for known covariates, to determine the effect of high environmental tobacco smoke (ETS) exposure (on the basis of a high cotinine level) on outcomes such as the prevalence of current asthma, the prevalence of frequent wheezing, school absence, and lung function. For children aged 4 to 11 years, we also determined the effect of prenatal maternal smoking on these outcomes. RESULTS: We observed effects of ETS exposure in all age groups, although the effects varied between age groups. Among all children significant effects associated with high cotinine levels were for wheezing apart from cold in the past year (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.1-2.8); 6 or more days of school absence in the past year (OR, 2.0; 95% CI, 1.4-2.8); and lung function decrements in the forced expiratory volume in 1 second (mean change, -1.8%; 95% CI, -3.2% to -0.4%) and the maximal midexpiratory flow (mean change, -5.9%; 95% CI, -8.1% to -3.4%). Although current and ever asthma were not significantly associated with high cotinine levels in the overall group (OR, 1.5; 95% CI, 0.8-2.7, and OR, 1.3; 95% CI, 0.8-2.2, respectively), they were increased significantly among 4- to 6-year-old children (OR, 5.3; 95% CI, 2.2-12.7, and OR, 2.3; 95% CI, 1.1-5.1, respectively). CONCLUSIONS: We investigated recent ETS exposures as important predictors of respiratory health outcomes in children 4 years and older. Environmental tobacco smoke exposure affects children of all ages, although the exact effects may vary between age groups.

Effects of tobacco use on the health of Indiana citizens.

In Indiana, the lung cancer mortality rate is almost equal to the incidence rate. The mortality rate from lung cancer in men is almost four times higher than for any other cancer. In women, the mortality rate is 20% higher than the mortality rate for breast cancer. In Indiana, black men have the highest death and incidence rates, followed by white men, black women, then white women. There are no early warning signs for lung cancer; there is no recommended screening mechanism; there is no uniformly effective treatment. Unlike most cancers, the primary cause of lung cancer is a well known behavioral factor: smoking. Smoking prevalence is higher in Indiana than in the United States for both men and women.

Married-couple families with step, adopted, and biological children.

National estimates of the numbers of families with step, adopted, and biological children have not previously been developed. In this work, parent types for children in married-couple families were indirectly identified by using marriage and birth dates. Families were then classified by the types of children present. A large majority (79 percent) had only biological children; however, a significant minority (16 percent) had at least one stepchild and 4 percent had at least one adopted child. This analysis provides national estimates of the numbers and characteristics of married-couple families with step, adopted, and biological children.

Continuing medical education with a personalized monthly newsletter.

The periodic newsletter is an approach to continuing medical education whose value is difficult to measure. A six-page monthly newsletter covering cancer and ambulatory medicine topics has been developed in two departments of a university medical center to meet perceived educational needs of new regional primary care practitioners and to maintain a helping relationship between university based and practicing physicians. The newsletter is sent free of charge to requesting clinicians. Each issue of the newsletter is introduced by a personalized letter signed individually by the editor. A reader survey was conducted to evaluate the interest of recipients and the content, usefulness, and format of the newsletter. A usable response rate of 76% was achieved. The evaluation documented that most readers found the publication useful in their practices, remembered receiving issues specifically, kept issues themselves after circulation to colleagues, and read the cover letter. Compared with conference or formal journal instructional methods of continuing medical education, a newsletter may consistently reach a larger audience at a fraction of the cost.