International comparison of medical students' perceptions of HIV infection and AIDS.

This analysis compared medical students' perceptions of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) in two cities in two countries with different cultural and educational backgrounds. A total of 292 first- and second-year medical students (45% sample) were surveyed from New Jersey Medical School and from Benin Medical School, Nigeria. Compared with the Benin students, the Newark medical students were significantly more knowledgeable and had more positive attitudes and behaviors regarding HIV infection and AIDS. Misperceptions regarding certain modes of transmission of HIV were significantly higher among the Benin students than the Newark students. Compared with the Benin students, the Newark students had more frequent sexual intercourse and used condoms more frequently, but the Benin students had more sex partners. Perception of personal risk and concern of contracting AIDS was significantly higher among the Newark students than the Benin students. These results indicate it is important that medical educators in medical schools convey accurate information to improve medical students' perception regarding HIV infection and AIDS.

PIP: The HIV- and AIDS-related perceptions of students from 2 medical schools in countries with divergent cultures--New Jersey Medical School (Newark, New Jersey, US) and Benin Medical School (Benin City, Nigeria)--were compared in a questionnaire-based survey. Random samples of 151 US and 141 Nigerian medical students were selected. In the Nigerian sample, 48% of respondents were women and 96% were Black; the US sample was 52% women and 15% African American. 38 questionnaire items assessed general knowledge of the transmission and epidemiology of HIV/AIDS, 15 measured attitudes, 18 related to beliefs, and 20 assessed behaviors. US medical students were significantly more knowledgeable than their Nigerian counterparts about HIV/AIDS. 26% of US and 51% of Nigerian students believed all infants born to HIV-positive mothers are infected. Significant proportions of Nigerian students thought HIV could be spread by kissing (12%), using the comb of an AIDS patient (14%), donating blood (34%), sharing bathroom facilities (11%), or by mosquito bites (16%). 13% of US and 29% of Nigerian students did not know that a healthy looking, asymptomatic HIV-infected person can transmit the virus. 24% of Nigerian and 18% of US medical students reported more than 1 sex partner in the year preceding the survey; only 11% and 30%, respectively, always used condoms, while 49% and 31%, respectively, never used this form of protection against HIV. Overall, Nigerian students showed significantly less concern than US students about HIV affecting them or their families and were less alarmed about the severity of the AIDS epidemic. It could not be determined whether this finding reflects cultural differences or deficiencies in the medical school curriculum. However, since misperceptions about HIV/AIDS may adversely affect the willingness of physicians to provide AIDS patients with high-quality care, the AIDS-related curriculum of medical schools should be reviewed.

Stressful life events and risk of symptomatic kidney stones.

BACKGROUND: It has been reported that a substantial proportion of cases of hypercalciuria and nephrolithiasis are idiopathic. Several studies suggested that stressful life events increase lithogenic urinary constituents (calcium, oxalate and uric acid). OBJECTIVE: To test the hypothesis that there is an association between stressful life events and symptomatic kidney stone. METHODS: A case-control study of 200 symptomatic kidney stone cases and 200 matched controls was designed to test the hypothesis. In this study, the stressors include those life events that the subjects perceived as highly stressful and inflicted upon them an intense emotional impact with apprehension and distress for at least one week in duration. RESULTS: Ten of eleven (91%) categories and 41 of 60 (68%) subcategories of stressful events occurred more frequently among cases than controls. Eighteen stressful events had odds ratios of 1.5 or greater. Of the seven significant (P < 0.05) variables that were entered into a multivariate logistic regression model, the following three remained statistically significant between cases and controls: annual family income (lower for cases); stressful morgage problems; and emotional life events. CONCLUSION: The overall prevalence rate of stressful life events was significantly (P < 0.00001) higher among cases than controls. The data support the hypothesis that there is an association between stressful life event(s) and symptomatic kidney stones.

Patterns of smoking among inner-city teenagers: smoking has a pediatric age of onset.

OBJECTIVES: (1) To test the hypothesis that the prevalence of smoking among African-American teenagers is lower than among whites and Hispanic inner-city senior high school students; (2) to assess the patterns of smoking among inner-city teenagers; and (3) to ascertain the relationship between smoking status and their knowledge, attitudes, beliefs, and behaviors. METHODS: All students attending inner-city senior high schools in two cities in New Jersey were included in the survey (n = 8,900). Response Rate was 85%; 89% of respondents were minority teenagers. RESULTS: The overall point prevalence rate of cigarette smoking was 9%. Almost all smoking began before the age of 16 years. The factors that significantly (p < .001) contributed to the initiation of cigarette smoking were: peer influence, self-initiation, and the influence of relatives' cigarette smoking. The factors that were stated to play a major role in progression to regular smoking were: perceptions that smoking relieves stress and feelings of induced pleasure while smoking. In addition, smokers were significantly (p < .0005) less knowledgeable about smoke-related diseases than exsmokers or nonsmokers. Over two-thirds of smokers and exsmokers believed that it is the physician's responsibility to advise patients to quit smoking and the majority of the current smokers contemplated quitting smoking. The data support the hypothesis that smoking prevalence among African-American teenagers is significantly lower than among white and Hispanic teenagers who attended the senior high school and resided in the inner city. CONCLUSION: These data suggest that multidimensional antismoking strategies are needed to address the smoking among predominately minority teenagers. This includes supportive messages from physicians, relatives, friends along with public policy to act as motivating factors to discourage early smoking.

Papanicolaou test status among inner-city adolescent girls.

BACKGROUND: The English medical literature for the past decade lacks any reports on Papanicolaou (Pap) test status among inner-city adolescent girls. Our objectives were (1) to assess the pattern of Pap test status among inner-city adolescent girls and (2) to ascertain the association of the Pap test status with their knowledge, beliefs, and behaviors. METHODS: All 3,980 inner-city senior high school adolescent female students in two cities in New Jersey were included in the survey. Response rate was 84%; 89% of respondents were minority adolescents. RESULTS: The factors that significantly increased the probability of obtaining a Pap smear were physician recommendation for Pap test, being knowledgeable of Pap test, awareness that other family members had obtained Pap tests, family income and parents' education levels. The age of initiation of first Pap test almost always was before 18 years of age; 13% of sexually active girls were smokers. The major barriers for never having had a Pap test were lack of physician's recommendation, ignorance about the Pap test, cost of the test, lack of information on how and where to obtain it, belief that they were not at risk for cancer, and embarrassment over requesting the test. CONCLUSION: Inner-city predominantly minority adolescent girls who have considerable sexual activity, multiple sex partners, initiation of intercourse at an early age, and smoking are at high risk for cervical cancer. It makes sense to initiate Pap screening for such high-risk adolescents. Individualized Pap test educational intervention programs adopted to the adolescents' barriers to undergoing Pap testing and physicians' recommendations for this preventive care are needed to encourage high-risk adolescent girls to undergo regular Pap tests and appropriate follow-up.

Health risk factors and health promoting behavior of medical, dental and nursing students.

The assumption of this study is: the preventive care beliefs and practices of health science students stand-out among the general public. To test this assumption, a survey of beliefs, behaviors and disease prevention practices of medical, dental, undergraduate and graduate nursing students in three health science schools was carried out in New Jersey. All students in these three schools were included in the study. A questionnaire which consisted of information on socio-demographic, life style patterns, health risk factors, and preventive cares was used. Results showed that 99% of the students knew their blood pressure, 10% were cigarette smokers and 3% were heavy drinkers. Approximately 68% of the students exercised regularly and 78% of them used seat belts. About 81 and 79% of the female students had regular clinical breast examinations (CBE) and pelvic examinations, respectively. It is worth noting that 10% of medical and dental students had driven an automobile under the influence of alcohol. About 77% of all students did not know their cholesterol levels, and 14% of dental students reported no concern about fat consumption. Only 38% of the female students reported monthly breast self examination (BSE). Over 27% of undergraduate nursing and 14% of all students never had a Papanicolaou (Pap) test. The main reasons for never having a Pap test, CBE, and pelvic examinations were: they did not think it was necessary and they believed that they were not at risk. The major reason for not performing BSE was forgetfulness.(ABSTRACT TRUNCATED AT 250 WORDS)

Health effects of a Superfund hazardous chemical waste disposal site.

A cross-sectional study of 358 households consisting of 1,454 persons was carried out to test the hypothesis that people who have resided in the vicinity of a Superfund hazardous chemical waste disposal site (SHCWDS) would have more health problems than those who lived at a greater distance from the SHCWDS. The SHCWDS is located in a rural community in southern New Jersey. Geohydrological surveys of the SHCWDS premise have found groundwater and soil contaminated with chemical substances. There was no significant difference in the prevalence of cancer, liver illnesses, and skin diseases between the exposed and comparison groups. However, a significantly higher prevalence of respiratory diseases (relative risk [RR] = 1.9, confidence interval [CI] = 1.1, 3.3) and seizures (RR = 4.3, CI 1.1, 13.9) occurred among the exposed group. The differences between the exposed and unexposed groups disappeared when cigarette smoking, the consumption of homegrown vegetables, or source of water supply were considered.

Health effects of hazardous chemical waste disposal sites in New Jersey and in the United States: a review.

The hazardous chemical waste disposal issue is a widespread problem. Large quantities of chemical wastes have been produced by the chemical industries in the past forty years. Estimates now number disposal sites in the United States at least 30,000. The public and scientists have grown increasingly concerned about the effects of these waste disposal sites not only on the environment, but also on the human body. In this article, we review the number of hazardous chemical waste disposal sites (HCWDS), their construction, difficulties in defining their contents, and the establishment of the Superfund Act. We then discuss various studies in the literature that have attempted to define adverse health effects of HCWDS, particularly those examining Love Canal and sites in New Jersey. In our conclusions, we note the difficulties in establishing direct causal links between HCWDS and dangerous health effects. We suggest that more epidemiological studies are needed, with improved methodology for gathering complete data and studying large samples. Both positive and negative findings of epidemiological studies are important. Positive results will substantiate an association of health effects with HCWDS. Negative results may reduce the concerns of people living near HCWDS. Future investigators need sufficient information about HCWDS materials, possible routes of exposure, and measurements of exposure, as well as sufficient statistical power to detect even modest associations of health effects with HCWDS exposure.

Health effects of a thorium waste disposal site.

A case-control study of 112 households residing in the vicinity of a thorium waste disposal site found a higher prevalence of birth defects (RR 2.1) and liver diseases (RR 2.3) among exposed than the unexposed group. The numbers were quite small and the confidence intervals wide, however, so that no definite conclusions can be drawn from these data.

Changing patterns of ischaemic heart disease mortality in New Jersey 1968-1982, and the relationship with urbanization.

Geographical variations in the declining rates of ischaemic heart disease (IHD) mortality may provide clues about various environmental risk factors responsible as a mass influence on the population IHD rate. The rate of IHD decline in 18 of 21 NJ counties was 2 to 45% less than the USA national rate of decline. The overall decline of IHD mortality in New Jersey (NJ) counties lagged significantly (p less than 0.05 to p less than 0.0003) behind the national trend. Age-adjusted mortality rate (AAMR) for IHD in NJ's 21 counties were 4% to 56% higher than the US rates. The IHD mortality rate of 14 of 21 NJ, counties and the entire state were significantly (p less than 0.005 to p less than 0.000001) above the US rate. Highly urbanized, industrialized, and densely populated NJ counties had the highest IHD rates. In these highly urbanized, industrialized and overcrowded NJ counties the AAMR for IHD was significantly higher and the IHD decline was significantly lower than that in the US. There was a significant (p less than 0.02 to p less than 0.00001) inverse association between annual per capita income and IHD rates. These data suggest that a high degree of urbanization, extensive industrialization, high population density and low socioeconomic status were acting as mass influences on the NJ population IHD rate.

Clusters of cancer mortality in New Jersey municipalities; with special reference to chemical toxic waste disposal sites and per capita income.

The state of New Jersey (NJ), USA, has been thought to have an unusually high cancer mortality rate; this assumption has been based on 1950-1969 mortality data for NJ counties. This study presents an analysis of mortality from major cancers for NJ municipalities during 1968-1977, and correlates cancer mortality rates with several potentially relevant variables. Age-adjusted mortality rates for 13 major cancer sites for 194 municipalities of 10 000 or more people in 21 NJ counties were compared with cancer mortality in the US. Municipality rates were correlated with: distribution of chemical toxic waste disposal sites (CTWDS); annual per capita income; the rates of low birth weight, birth defects and infant mortality of NJ municipalities. Clusters of cancer mortality were observed in 23 municipalities in 10 counties in which a total of 98 age-adjusted cancer death rates were at least 50% above the national rate, and each of these municipalities had at least two race-sex-specific cancers in which the observed number of cancer deaths was greater than the expected number of deaths at the p less than 0.0005 level. Of these 98 excessive cancer death rates, 72% involved the gastrointestinal tract. Most of the municipalities are located in the highly industrialized densely populated northeastern part of the State. Correlation analyses showed a consistent and significant (p less than 0.05) negative correlation between income and cancer mortality in 11 of 12 cancers studied. These analyses also showed a significant positive association between 8 of 12 cancers studied and CTWDS in one or more subgroup populations and lesser associations with birth defects, low birth weight and infant mortality.

Female reproductive organs and breast cancer mortality in New Jersey counties and the relationship with certain environmental variables.

Age-adjusted female reproductive organs and breast cancer mortality rates (all sites combined) were higher in 19 of 21 New Jersey counties than the U.S. national rates. Compared with national trends, New Jersey cervical cancer and corpus uteri rates have declined less than the national rate among all races. Ovarian and breast cancer rates have not changed over the years, a pattern similar to that of the nation. New Jersey cancer mortality rates during the period 1968-1977 that highly significantly (P less than 0.0005) exceeded national rates were cancers of the cervix in 2 counties among whites and in one county among nonwhites; of the corpus uteri and uterus not specified in 3 counties among whites; of the ovaries in 3 counties among whites; and of the breast in 10 counties among whites. The overall New Jersey cancer mortality significantly (P less than 0.0005) exceeded national rates for ovarian cancer among whites and nonwhites and for breast cancer among whites. Statistically significant and positive correlations were found between breast cancer mortality and chemical toxic waste disposal sites, annual per capita income, urbanization index, and population density among whites in 21 New Jersey counties. Ovarian cancer mortality was also significantly and positively correlated with annual per capita income, and negatively with birth defects. Cervical cancer mortality showed a significant negative correlation with annual per capita income and a significant positive correlation with birth defects and low birth weight among nonwhites in 21 New Jersey counties.

Bladder cancer mortality in New Jersey counties, and relationship with selected environmental variables.

Age-adjusted mortality rates for bladder cancer were calculated for the 21 New Jersey (NJ) counties (USA) during the period 1968-1977, and compared with the period 1950-1969, with the Surveillance, Epidemiology and End Results (SEER) survey and with cancer mortality in the US 1973-1977. The county rates were also correlated with: the rates of low birth weight, birth defects, infant mortality; chemical waste disposal sites; annual per capital income; per cent of the population working in the chemical industries; density of population and urbanization indices of 21 NJ counties. Age-adjusted bladder cancer mortality rates in 95% of NJ counties were higher than national and SEER area rates. The overall NJ State rates for four subgroup populations were highly significantly (p less than 0.001) greater than the national rates. There was a statistically significant correlation between bladder and lung cancer mortality among females in 21 NJ counties which may suggest a common risk factor--namely cigarette smoking. There was no such correlation between bladder and lung cancer mortality among males. There was a statistically significant association between bladder cancer mortality in individual counties and the percentage of the adult population working in the chemical industries.

Gastrointestinal cancer mortality in New Jersey counties, and the relationship with environmental variables.

The State of New Jersey (NJ) USA has been thought to have an unusually high cancer mortality rate; this assumption has been based on 1950-1969 mortality data for its 21 counties. This paper presents an analysis of gastrointestinal (GI) cancer mortality rates in New Jersey counties during 1968-1977, a comparison with the 1950-1969 rates, and associations between current GI cancer mortality rates and selected environmental variables. Age-adjusted mortality rates for GI cancers were calculated for the 21 NJ counties during the period 1968-1977, and were compared with the period 1950-1969, with the Surveillance, Epidemiology and End Results (SEER) survey and with cancer mortality in the US, 1973-1977. The county rates were also correlated with: the distribution of chemical toxic waste disposal sites; annual per capita income; the rates of low birth weight, birth defects, and infant mortality; chemical industry distribution; percentage of the population employed in chemical industries; the density of population; and the urbanization index for each of the counties. Some of the major findings are: Age-adjusted GI cancer mortality rates (all sites combined) were higher than national rates in 20 of 21 NJ counties. In comparison with national trends, NJ stomach cancer rates have declined less, oesophageal cancer rates have declined more, and pancreatic cancer mortality rates have followed similar patterns. Cancer mortality rates in NJ during the period 1968-1977 significantly (p less than 0.0001) exceeded national rates for cancer of the oesophagus (white male, non-white male), stomach (men and women), colon (white male, white female, non-white female), and rectum (whites only). In 18 of the 21 NJ counties, the observed number of cancer deaths for at least one GI cancer site was significantly greater than expected at the 0.0001 level for at least one population subgroup. Among white men, a significant (p less than 0.0001) excess of observed over expected cancer deaths was observed for three or more GI cancer sites in seven counties. The environmental variables that were most frequently associated with GI cancer mortality rates (except pancreatic cancer) were degree of urbanization, population density, and chemical toxic waste disposal sites. Some of the implications of the study findings are discussed and recommendations made for future investigations.

Discovery rate of dysplasia and carcinoma of the uterine cervix in an urban medical center serving patients at high risk.

File analysis based on 98,970 Pap tests on 58,053 patients from the Martland Medical Center of CMDNJ and its clinics was performed. Discovery rates, period prevalence and incidence rates were calculated for categories of mild to moderate dysplasia through invasive carcinoma. An incidence rate of 27/100,000 for invasive carcinoma was obtained, which is lower than the national average. Period prevalence and incidence rates of dysplasias are both high and similar. This indicates that epidemiologic parameters may need to be studied further. The mean age for the mild to moderate dysplasia was 25.7 years, for moderate to severe dysplasia, 29.29 years and for CIS, 33.25 years. These data may imply that younger women, especially in the urban areas, are at much higher risk than previously expected.

Life time occupation, smoking, caffeine, saccharine, hair dyes and bladder carcinogenesis.

A case-control study of bladder cancer in two northern counties of New Jersey was conducted to investigate a tumour that has been considered to be strongly associated with industrial and environmental exposures. The study population included 75 bladder cancer cases and 142 controls. Cases and controls were matched for race, sex, age, place of birth and place of residence. Statistically significant associations with bladder cancer and risk ratios of greater than 2.0 were found for cigarette smoking and for working in dye, petroleum (fuel) or plastics industries. No statistically significant association was found for: cigar and pipe smoking; caffeine, saccharine and alcohol consumption; and life time occupational history of working in other than dye, petroleum and plastics industries. No statistically significant differences between cases and controls were found in family history of cancer. Risk ratios of at least 2.5 (but without statistical significance possibly because of sample size) were found for workers in rodenticide and printing industries, for cable workers and for cancer in the spouses of bladder cancer cases. Simultaneous multiple primary cancer sites were found in 9.3% of the bladder cancer patients; this is higher than the 0.2-8% reported in the medical literature. The life time occupational history of the bladder cancer cases points to industrial determinants: some are known (petroleum and dye industries) but the association with the plastics industry is new. If our findings are confirmed, investigations will be needed to determine whether any specific chemical or combination of chemicals used in the plastics industry is responsible for bladder cancer induction.

Carcinoma of the cervix in Newark, New Jersey, 1970-76. A very low in situ: invasive ratio.

Both blacks and whites in Newark had significantly lowered incidences of in situ cervical cancer as compared to the Third National Cancer Survey (TNCS) population. In contrast, Newark blacks' invasive cancer rates were higher than those found in any individual geographic area surveyed in TNCS except for Minneapolis as compared to Newark whites, who had lower rates than all individual TNCS areas except Colorado and San Francisco. Newark blacks had a relative risk of 4.0 for invasive cancer as compared to Newark whites, whereas the corresponding relative risk for blacks versus whites in the TNCS population was 2.0. Newark blacks and whites together had the lowest in situ invasive ratio as compared to women in other parts of the United States. The invasive cancer incidence and mortality rates for both Newark blacks and whites were significantly higher than in the Surveillance, Epidemiology and End Results (SEER) population, but incidence:mortality ratios for Newark and SEER were not different. The most likely explanation for the low in situ rates and high invasive rates among Newark blacks is their failure to obtain Papanicolaou (Pap) smears. The low in situ rate among Newark whites in the absence of a high invasive rate is difficult to explain. It seems that the problem among blacks can be alleviated by the widespread use of Pap smears, which reduce the frequency of invasive cancer and the associated mortality.

Control of hepatitis B infection. The role of surveillance and an isolation hemodialysis center.

A 3 1/4-year study assessed intervention approaches for hemodialysis-associated hepatitis. A 12-month retrospective study was followed by one year of prospective surveillance (during which attention to hygienic techniques was encouraged) and then by a 15-month period during which antigen-positive cases were transferred from study centers to an isolation hemodialysis center (IHL). The incidence of hepatitis B infection (HBI) fell 35.9% in study centers during surveillance; this was followed by a 50.0% drop during the IHC phase. The total 67.9% drop during the entire study period was statistically highly significant; the IHC contributed significantly more to the total drop than did surveillance alone. At comparison units, HBI increased 97.9% during the same period. This study indicates that HBI incidence can be markedly reduced by a combination of surveillance and assignment of antigen-positive patients to a separate dialysis unit.