Expanding the National Electronic Injury Surveillance System to monitor all nonfatal injuries treated in US hospital emergency departments.

STUDY OBJECTIVE: Injury is a major cause of morbidity and mortality in the United States. Although the National Vital Statistics System provides data on injury-related deaths, a national surveillance system is needed for timely identification of emerging nonfatal injury problems and continuous monitoring of severe nonfatal injuries. This work assesses the feasibility of expanding the National Electronic Injury Surveillance System (NEISS) to monitor all types and causes of nonfatal injuries treated in US hospital emergency departments and reports national estimates generated by a pilot study of this system. METHODS: At a stratified sample of US hospital EDs, persons receiving first-time treatment for an injury were monitored from May 1 through July 31, 1997. National estimates of the annual number and rate of ED-treated injuries overall, by patient characteristics, injury diagnosis, and external cause of injury were generated, and the sensitivity of the system for detecting ED-treated injuries was assessed. RESULTS: An estimated 29. 1 million injuries were treated in US EDs in 1997 (rate of 108.6/1, 000 population). The leading causes of injury were falls, being struck by or striking against an object or person, cutting or piercing, and motor vehicle traffic. Of 593 cases of injury detected by investigators from the Centers for Disease Control and Prevention during visits to 6 of the 21 NEISS hospitals in the study, 490 were also detected by NEISS coders for an overall sensitivity of 82.6%. CONCLUSION: Expanding the NEISS is a feasible means of timely and continuous monitoring of all types and causes of nonfatal injuries treated in US hospital EDs.

Childhood drownings and fencing of outdoor pools in the United States, 1994.

OBJECTIVES: To determine the prevalence of proper fencing around outdoor swimming pools among US households and to describe this fencing in relation to demographic and other household factors. To estimate the number of drownings among children <5 years of age that might be prevented by having proper fencing around all residential pools in the United States. METHODS: A 1994, randomly dialed national telephone survey contacted 5238 adults who reported demographic information and household characteristics including whether the household had an outdoor swimming pool and the fencing around the pool. Data were weighted to obtain national estimates and percentages. The number of preventable drownings was estimated with a population-attributable risk equation. RESULTS: Approximately 18.5 million American households owned or had access to an outdoor swimming pool in 1994, and 76% (13.9 million) of them appeared to have had adequate fencing. Adequate fencing was associated with household income and type of home. We estimate that 19% of pool-related drownings among children <5 years of age in 1994 (88 drownings) might have been prevented if all residential pools in the United States were properly fenced. CONCLUSIONS: Adequate pool fencing prevents a child from having access to a swimming pool if a responsible adult is not present and has been promoted as a method to prevent drowning. Our research suggests that even if all residential pools in the United States were properly fenced, most drownings among children <5 years of age would not be prevented. Thus, additional strategies to prevent drowning will be needed.

Suicide after natural disasters.

BACKGROUND: Among the victims of floods, earthquakes, and hurricanes, there is an increased prevalence of post-traumatic stress disorder and depression, which are risk factors for suicidal thinking. We conducted this study to determine whether natural disasters affect suicide rates. METHODS: From a list of all the events declared by the U.S. government to be federal disasters between 1982 and 1989, we selected the 377 counties that had each been affected by a single natural disaster during that period. We collected data on suicides during the 36 months before and the 48 months after the disaster and aligned the data around the month of the disaster. Pooled rates were calculated according to the type of disaster. Comparisons were made between the suicide rates before and those after disasters in the affected counties and in the entire United States. RESULTS: Suicide rates increased in the four years after floods by 13.8 percent, from 12.1 to 13.8 per 100,000 (P<0.001), in the two years after hurricanes by 31.0 percent, from 12.0 to 15.7 per 100,000 (P<0.001), and in the first year after earthquakes by 62.9 percent, from 19.2 to 31.3 per 100,000 (P<0.001). The four-year increase of 19.7 percent after earthquakes was not statistically significant. Rates computed in a similar manner for the entire United States were stable. The increases in suicide rates were found for both sexes and for all age groups. The suicide rates did not change significantly after tornadoes or severe storms. CONCLUSIONS: Our study shows that suicide rates increase after severe earthquakes, floods, and hurricanes and confirms the need for mental health support after severe disasters.

Long-term trends in cigarette smoking among young U.S. adults.

Retrospective examination of a national probability sample revealed that young women, particularly those who dropped out of high school, have reached smoking rates as high or higher than subgroups of young men. These results suggest that surveillance, research, and public health programs are needed to address the rapid increase in smoking among young women.

Smoking prevalence in US birth cohorts: the influence of gender and education.

OBJECTIVES: To assess long-term trends in cigarette smoking according to the combined influence of sex and education, this study examined smoking prevalence in successive US birth cohorts. METHODS: Data from nationally representative surveys were examined to assess smoking prevalence for six successive 10-year birth cohorts stratified by race or ethnicity, sex, and educational attainment. RESULTS: Substantial declines in smoking prevalence were found among men who had a high school education or more, regardless of race or ethnicity, and slight declines among women of the same educational background were revealed. However, little change was found in smoking prevalence among men of all race/ethnic groups with less than a high school education, and large increases were found among women with the same years of schooling, especially if they were White or African American. CONCLUSIONS: These data suggest that persons of low educational attainment have yet to benefit from policies and education about the health consequences of cigarette smoking.

The extent of cigarette brand and company switching: results from the Adult Use-of-Tobacco Survey.

To evaluate the effects of cigarette advertising on brand switching, an accurate estimate of the extent of cigarette brand and company switching among current smokers is needed. Data from the 1986 Adult Use-of-Tobacco Survey were analyzed to estimate the percentage of adult smokers who switched cigarette brands and companies in the previous year. Approximately 9.2% of adult smokers (4.2 million) switched cigarette brands in 1986, and 6.7% (3.1 million) switched cigarette companies. The aggregate profitability of brand switching in 1986 was approximately $362 million. Based on this analysis, brand switching alone justifies only a small percentage of a cigarette company's advertising and promotion expenditures, suggesting that future research should address other potential effects of advertising, including maintenance of brand loyalty and expanding the cigarette market. Medical Subject Headings (MeSH): addictive behavior, advertising, smoking, tobacco.

The association between veteran status and cigarette-smoking behaviors.

Although the prevalence of smoking has decreased since 1980 among active duty military personnel, it remains higher than among the adult civilian population; among military veterans, the prevalence of smoking has not been well described. The objectives of this study were to describe patterns of cigarette smoking behaviors among United States veterans and nonveterans and to examine the association between military veteran status and cigarette smoking. We analyzed data from a cross-sectional survey from a national probability sample of the civilian, noninstitutionalized adult population (National Health Interview Survey supplements). We estimated the prevalence of ever, current, and former smoking, as well as crude and adjusted odds ratios (AORs) of each outcome measure among veterans and nonveterans, by gender. The prevalence of ever smoking was 74.2% (+/- 0.7%) among veterans and 48.4% (+/- 0.5%) among nonveterans; current smoking prevalence was 33.9% (+/- 1.0%) among veterans and 27.7% (+/- 0.5%) among nonveterans. Among those who had not initiated smoking before the age of 18 years, veterans were more likely than nonveterans to report ever smoking (AOR = 1.8 for men and 1.9 for women) and current smoking (AOR = 1.9 for both men and women). After statistical adjustment, no difference was seen in cessation behavior. We concluded that the prevalence of ever and current smoking was higher among U.S. military veterans. The association was the strongest among veterans who had not initiated smoking before the age of 18 years. These findings are consistent with the hypothesis that military service is a risk factor for cigarette smoking, and they support the military's current prevention and cessation efforts.

Surveillance for selected tobacco-use behaviors--United States, 1900-1994.

PROBLEM/CONDITION: Surveillance of tobacco use is an essential component of any tobacco-control program. The information gathered can be used to guide research initiatives, intervention programs, and policy decisions. REPORTING PERIODS: This report covers the period 1900-1994 for per capita cigarette consumption; 1965-1991 for trends in cigarette smoking prevalence and cessation; 1974-1991 for trends in the number of cigarettes smoked daily by current smokers; 1987-1991 for recent patterns of tobacco use; 1970, 1987, and 1991 for trends in cigar/pipe smoking and snuff/chewing tobacco use; 1984-1992 for trends in state-specific prevalences of regular cigarette smoking; 1987-1992 for state-specific estimates of smokeless-tobacco use; and 1976-1993 for trends in cigarette smoking among U.S. high school seniors. DESCRIPTION OF SYSTEMS: Estimates of cigarette consumption are reported by the U.S. Department of Agriculture, which uses data from the U.S. Department of the Treasury, the U.S. Department of Commerce, the Tobacco Institute, and other sources. The National Health Interview Survey uses household interviews to provide nationally representative estimates (for the civilian, noninstitutionalized population) of cigarette smoking and other behaviors related to tobacco use. The Behavioral Risk Factor surveillance System uses telephone surveys of civilian, noninstitutionalized adults (> or = 18 years of age) to provide state-specific estimates of current cigarette smoking and use of smokeless tobacco. The University of Michigan's Institute for Social Research uses school-based, self-administered questionnaires to gather data on cigarette smoking from a representative sample of U.S. high school seniors. RESULTS: During the period 1900-1963, per capita cigarette consumption increased; after 1964, consumption declined. During the years 1965-1991, current cigarette smoking prevalence among persons ages > or = 18 years declined overall and in every sociodemographic category examined. Decrease in current smoking prevalence was slow in some groups (e.g., among persons with fewer years of formal education). Both the prevalence of never smoking and the prevalence of cessation increased from 1965 through 1991. The prevalence of current cigarette smoking, any tobacco smoking, and any tobacco use was highest among American Indians/Alaska Natives and non-Hispanic blacks and lowest among Asians/Pacific Islanders. The prevalence of cigar smoking and pipe smoking has declined substantially since 1970. The prevalence of smokeless-tobacco use among white males ages 18-34 years was higher in 1987 and 1991 than in 1970; among persons > or = 45 years of age, the use of smokeless tobacco was more common among blacks than whites in 1970 and 1987. Cigarette smoking prevalence has decreased in most states. The prevalence of smokeless tobacco use was especially high among men in West Virginia, Montana, and several southern states. From 1984-1993, prevalence of cigarette smoking remained constant among U.S. high school seniors. However, prevalence increased slightly for male seniors and white seniors, decreased slightly for female high school seniors, and decreased sharply for black high school seniors. INTERPRETATION: With the exceptions of increases in cigarette smoking among white and male high school seniors and in the use of smokeless tobacco among white males ages 18-34 years, reductions in tobacco use occurred in every subgroup examined. This decrease must continue if the national health objectives for the year 2000 are to be reached. ACTIONS TAKEN: Surveillance of tobacco use is ongoing. Effective interventions that discourage initiation and encourage cessation are being disseminated throughout the United States.

Cigarette smoking prevalence by occupation in the United States. A comparison between 1978 to 1980 and 1987 to 1990.

We analyzed data from 1987 to 1990 National Health Interview Surveys and compared them with 1978 to 1980 National Health Interview Surveys data to determine changes in cigarette smoking prevalence by occupation. During this period, cigarette smoking prevalence declined from 31.7% to 24.2% among white-collar workers, from 43.7% to 39.2% among blue-collar workers, and from 37.2% to 34.5% among service workers. For occupational groups, the largest significant declines in smoking prevalence occurred among male sales workers (10.5 percentage points), female and male managers and administrators (9.9 and 8.7 percentage points), female professional and technical workers (8.0 percentage points), and male transportation equipment operatives (7.5 percentage points). Analyses of 1987 to 1990 detailed occupation codes revealed that roofers (57.8%) and crane and tower operators (57.6%) had the highest prevalences of cigarette smoking, whereas physicians (5.4%) and clergy (6.5%) had the lowest smoking prevalences. Since 1978 to 1980, the differences in smoking prevalence by occupation have widened, providing further evidence that smoking has moved from a relatively common behavior practiced by most segment of society to one that has become more concentrated among selected subpopulations. Health professionals need to play an important role in encouraging smoking cessation among workers and in advising management and labor about the benefits of strong work-site smoking policies.

Trends in cigarette smoking among US physicians and nurses.

OBJECTIVE: To determine trends in cigarette smoking prevalence among physicians, registered nurses, and licensed practical nurses since 1974. DESIGN: Analyses of data on smoking prevalence among persons 20 years of age and older using combined National Health Interview Survey data sets from 1974, 1976, and 1977; 1978, 1979, and 1980; 1983 and 1985; 1987 and 1988; and 1990 and 1991. MAIN OUTCOME MEASURES: Prevalence of cigarette smoking and average annual change in smoking prevalence. RESULTS: Based on the data for 1990 and 1991, there were an estimated 18,000 physicians, 322,000 registered nurses, and 128,000 licensed practical nurses who smoked cigarettes in the United States. Compared with 1974, 1976, and 1977, by 1990 and 1991 cigarette smoking prevalence had declined from 18.8% to 3.3% among physicians (average annual decline of 1.15 percentage points); from 31.7% to 18.3% among registered nurses (average annual decline of 0.88 percentage point); and from 37.1% to 27.2% among licensed practical nurses (average annual decline of 0.62 percentage point). CONCLUSION: Since 1974, cigarette smoking has declined most rapidly among physicians, at an intermediate rate among registered nurses, and at a lower rate among licensed practical nurses. Because of their important roles as exemplars and health educators, persons in these occupations should not smoke.