Human papillomavirus infection at the United States-Mexico border: implications for cervical cancer prevention and control.

The United States-Mexico border is a region comprised of a country with one of the highest rates of invasive cervical cancer (Mexico) and a country with one of the lowest rates (United States). Recent evidence clearly indicates that human papillomavirus (HPV) infection is the cause of cervical cancer. The distribution of specific types of HPV is known to vary in different regions of the world, as do the cofactors that may inhibit or promote HPV carcinogenesis. Estimating the prevalence of oncogenic HPV is needed for guiding vaccine development. The purpose of this study was to determine the prevalence of oncogenic and nononcogenic HPV types and risk factors for HPV among women residing along the United States-Mexico border. A cross-sectional study of 2319 women, ages 15-79 years, self-referring for gynecological care was conducted between 1997 and 1998. HPV was detected by PCR using the PYGMY 09/11 L1 consensus primer, and HPV genotyping was conducted using the reverse line blot method. Overall, the HPV prevalence was 14.4% with no significant differences observed by country after adjustment for age. HPV 16 was the most commonly detected HPV type in both the United States and Mexico. Among women with high-grade squamous intraepithelial lesions, HPV types 58, 45, 51, 31, 35, 55, and 73 were most common in Mexico, and HPV types 18, 31, 35, 51, 52, and 58 were most common in the United States. In both countries, HPV prevalence declined linearly with age from 25% among women ages 15-19 years to 5.3% among women 56-65 years. Factors significantly independently associated with HPV infection were older age [adjusted odds ratio (AOR) = 0.15 for ages 56-65 years compared with those 15-19 years], a marital status other than married (AOR = 1.58-3.29), increased numbers of lifetime male partners (AOR = 3.8 for > or =10 partners compared with 1 partner), concurrent infection with Chlamydia trachomatis (AOR = 1.79), ever use of Norplant (AOR = 2.69), and current use of injectable contraceptives (AOR = 2.29). Risk factors for HPV infection did not differ by country. Results from this study suggest that in addition to HPV 16 and 18, HPV types 31, 45, 51, and 58 should be considered for inclusion in an HPV prevention vaccine for distribution in Mexico.

Smoking behavior in a smoking workplace.

PURPOSE: This report addresses whether smoking increases as a function of working in a smoking environment. METHODS: Casino employees were targeted to complete a survey designed to assess smoking behavior. The survey contained standardized questions consistent with other major surveys on tobacco use to ensure comparability with state and national trends. Data collection occurred between September and November 1997. RESULTS: Out of 755 surveys distributed, 587 completed surveys were returned, resulting in a response rate of 77 percent. A test of proportions showed that the proportion of smokers had not changed significantly as a result of working in a smoking environment although the amount of smoking decreased significantly (one-sample t-test). The change in the amount of smoking was assessed using difference scores. Males and females did not differ in the rate in which their smoking changed. A significant correlation between age and the change score suggested that younger smokers were more likely to increase their intake whereas the older smoking employees were more likely to decrease their consumption by the time of the survey. IMPLICATIONS: The finding that individuals who work in a smoking environment decreased their smoking behavior merits further investigation in the area of smoking aversion.

Evaluation of a peer health worker prenatal outreach and education program for Hispanic farmworker families.

This article contains the findings from an evaluation of a prenatal education program to Hispanic migrant farmworker families using peer health workers. The focus of the evaluation was on establishing the validity of the intervention model in the target population. Data are presented on the program setting, characteristics of the clients served, and effects of the educational program on the clients and peer health workers. The evaluation identified factors that established confidence in the program model: (1) there were existing barriers to health care and health information; (2) the program served a culturally specific and disadvantaged population; (3) the prenatal curriculum was culturally sensitive; (4) the peer workers were accepted by the target community; and (5) the model did not threaten the medical community. The directions for future research are presented.

Using lay health workers: case study of a community-based prenatal intervention.

This article reports on the design and implementation of a prenatal outreach and education intervention for low income, Hispanic women living in three migrant and seasonal farmworker communities in Arizona. The program included three major elements: a Spanish language prenatal curriculum; a group of mature Hispanic women recruited from the target communities and trained as "Comienzo Sano" (healthy beginning) Promotoras (health promoters), and the organization of a support network of local health professionals. The rationale for the demonstration is reviewed, and the structure of the intervention is described. Factors which facilitated and constrained implementation of the program are identified, and guidelines are provided for other health care providers and health educators interested in developing similar programs.

A comparison of coping strategies used effectively by older Anglo and Mexican-American widows: a longitudinal study.

This longitudinal study of older Anglo and Mexican-American widows provides data on coping strategies and coping effectiveness as measured by perceived physical and psychological health. Previous health levels were the best predictors of later physical and psychological symptoms. Contrary to expectations, both ethnic groups preferred nonconfrontational strategies for widowhood problems, with the Mexican Americans using more confrontational strategies. Ways of coping with problems during the first months of widowhood had significant long-term effects upon the widow's health. The most effective coping methods over the first year involved combinations of independent action and emotional release. Over a longer period, more effective strategies included being able to ignore problems, accept the situation, and release tensions, or to actively seek advice about general problems. Contradictory findings over the two time periods for those Mexican Americans using independent action and emotional release strategies appear to be related to cultural patterns of familial support after a death occurs.

The health and symptom care of widows.

This paper compares the ways in which Anglo and Mexican American widows perceive, interpret and respond to problems of illness. It reports on a study which followed a sample of older, low income recent widows for 15 months after their bereavement. In this account Mexican American widows were found to differ from Anglo widows in aspects affecting their health: socioeconomic background, previous histories of health, health care resources and symptom care practices.