An evaluation of Duke University's LIVE FOR LIFE health promotion program on changes in worker absenteeism.

The effect of an employer-sponsored health promotion program on worker absenteeism is examined over a 4-year period in a group of 4972 Duke University hourly employees. Program participants experienced an average of 4.6 fewer absentee hours in the third year of program availability than did nonparticipants, after controlling for baseline absenteeism, gender, race, education, and age. These results suggest that employer-sponsored health promotion initiatives can have a favorable influence on absenteeism.

Longitudinal changes in lung function and respiratory symptoms in progressive systemic sclerosis. Prospective study.

Most patients with progressive systemic sclerosis (PSS) exhibit lung involvement. However, the natural history of lung disease in PSS remains poorly defined. To evaluate lung function over time in PSS, a battery of lung function tests were prospectively performed serially between 1973 and 1982 in 61 patients with PSS. Functional indexes of restriction (vital capacity and total lung capacity) and diffusion impairment (diffusing capacity) showed greater-than-expected annual rates of change. Male subjects showed a trend toward faster declines in forced vital capacity, forced expired volume in one second, total lung capacity, and functional residual capacity and a more rapid increase in static recoil pressure at 90 percent of total lung capacity than did female subjects. Nonsmokers had greater rates of decline in total lung capacity and static lung compliance (but not in forced vital capacity or diffusing capacity) and a greater rate of increase in static recoil pressure than did current and former smokers. Level of lung function at initial study visit, age, race, and chlorambucil therapy had no significant effect on the annual rates of change in lung function, whereas longer duration of disease prior to study entry was associated with a slower annual decrease in lung volumes. Between the first and last visits (mean interval 3.1 years, maximum nine years), the frequency of abnormality in pulmonary function test results showed significant change only in the diffusing capacity (60 percent increasing to 82 percent) and static lung compliance (40 percent increasing to 54 percent), whereas the frequency of respiratory symptoms showed little change. These findings indicate an overall indolent progression of PSS-related lung disease, with substantial individual variability.

Respiratory symptoms and lung function in habitual heavy smokers of marijuana alone, smokers of marijuana and tobacco, smokers of tobacco alone, and nonsmokers.

To evaluate the possible pulmonary effects of habitual marijuana smoking with and without tobacco, we administered a detailed respiratory and drug use questionnaire and/or lung function tests to young, habitual, heavy smokers of marijuana alone (n = 144) or with tobacco (n = 135) and control subjects of similar age who smoked tobacco alone (n = 70) or were nonsmokers (n = 97). Mean amounts of marijuana and/or tobacco smoked were 49 to 57 joint-years marijuana (average daily number of joints times number of years smoked) and 16 to 22 pack-years of tobacco. Among the smokers of marijuana and/or tobacco, prevalence of chronic cough (18 to 24%), sputum production (20 to 26%), wheeze (25 to 37%) and greater than 1 prolonged acute bronchitic episode during the previous 3 yr (10 to 14%) was significantly higher than in the nonsmokers (p less than 0.05, chi square). No difference in prevalence of chronic cough, sputum production, or wheeze was noted between the marijuana and tobacco smokers, nor were there additive effects of marijuana and tobacco on symptom prevalence. We noted significant worsening effects of marijuana but not to tobacco on specific airway conductance and airway resistance (tests of mainly large airways function) in men and of tobacco but not of marijuana on carbon monoxide diffusing capacity and on closing volume, closing capacity, and the slope of Phase III of the single-breath nitrogen washout curve (tests reflecting mainly small airways function) (p less than 0.03, two-way ANCOVA). No adverse interactive effects of marijuana and tobacco on lung function were found.