Tobacco use among middle and high school students--Florida, 1998 and 1999.
(9/1417)Tobacco use is the single leading preventable cause of death in the United States, and an estimated $2 billion is spent annually in Florida to treat disease caused by smoking. Florida appropriated $23 million in fiscal year 1997 and $70 million in fiscal year 1998 to fund the Florida Pilot Program on Tobacco Control to prevent and reduce tobacco use among Florida youth. To determine the prevalence of cigarette, cigar, and smokeless tobacco (i.e., chewing tobacco and snuff) use among Florida middle and high school students in public schools, the Florida Department of Health conducted the Florida Youth Tobacco Survey (FYTS) in February 1998 and February 1999. The purpose of these surveys was to establish baseline parameters and monitor the progress of the pilot program, which began in April 1998. This report summarizes advance data from the surveys, which indicate that, from 1998 to 1999, the percentage of Florida public middle and high school students who smoked cigarettes decreased significantly and that the percentage of middle school students who smoked cigars and used smokeless tobacco products decreased significantly. (+info)
Risk for metabolic control problems in minority youth with diabetes.
(10/1417)OBJECTIVE: We examined and quantified the degree of risk for poor glycemic control and hospitalizations for diabetic ketoacidosis (DKA) among black, Hispanic, and white children and adolescents with diabetes. RESEARCH DESIGN AND METHODS: We examined ethnic differences in metabolic control among 68 black, 145 Hispanic, and 44 white children and adolescents with type 1 diabetes (mean age 12.9 [range 1-21] years), who were primarily of low socioeconomic status. Clinical and demographic data were obtained by medical chart review. Glycohemoglobins were standardized and compared across ethnic groups. Odds ratios among the ethnic groups for poor glycemic control and hospitalizations for DKA were also calculated. RESULTS: The ethnic groups were not different with respect to age, BMI, insulin dose, or hospitalizations for DKA, but black children were older at the time of diagnosis than Hispanics (P < 0.05) and were less likely to have private health insurance than white and Hispanic children (P < 0.001). Black youths had higher glycohemoglobin levels than white and Hispanic youths (P < 0.001 after controlling for age at diagnosis). Black youths were also at greatest risk for poor glycemic control (OR = 3.9, relative to whites; OR = 2.5, relative to Hispanics). CONCLUSIONS: These results underscore and quantify the increased risk for glycemic control problems of lower-income, black children with diabetes. In the absence of effective intervention, these youths are likely to be overrepresented in the health care system as a result of increased health complications related to diabetes. (+info)
Mortality in a cohort of licensed pesticide applicators in Florida.
(11/1417)OBJECTIVES: Although the primary hazard to humans associated with pesticide exposure is acute poisoning, there has been considerable concern surrounding the possibility of cancer and other chronic health effects in humans. Given the huge volume of pesticides now used throughout the world, as well as environmental and food residue contamination leading to chronic low level exposure, the study of possible chronic human health effects is important. METHODS: This was a retrospective cohort study, analysed by general standardised mortality ratio (SMR) of licensed pesticide applicators in Florida compared with the general population of Florida. A cohort of 33,658 (10% female) licensed pesticide applicators assembled through extensive data linkages yielded 1874 deaths with 320,250 person-years from 1 January 1975 to 31 December 1993. RESULTS: The pesticide applicators were consistently and significantly healthier than the general population of Florida. As with many occupational cohorts, the risks of cardiovascular disease and of diseases associated with alcohol and tobacco use were significantly lower, even in the subpopulations--for example, men, women, and licence subcategories. Among male applicators, prostate cancer mortality (SMR 2.38 (95% confidence interval (95% CI) 1.83 to 3.04) was significantly increased. No cases of soft tissue sarcoma were confirmed in this cohort, and non-Hodgkin's lymphoma was not increased. The number of female applicators was small, as were the numbers of deaths. Mortality from cervical cancer and breast cancer was not increased. Additional subcohort and exposure analyses were performed. CONCLUSIONS: Consistent with previous publications on farmers but at odds with current theories about the protective effects of vitamin D, prostate cancer was increased in these pesticide applicators. Female breast cancer was not increased despite theories linking risk of breast cancer with exposure to oestrogen disruptors--such as the organochlorines. The lack of cases of soft tissue sarcoma is at odds with previous publications associating the use of the phenoxy herbicides with an increased risk of these cancers. (+info)
Determination of nicotine, pH, and moisture content of six U.S. commercial moist snuff products--Florida, January-February 1999.
(12/1417)The use of smokeless tobacco (moist snuff and chewing tobacco) can cause oral cancer and precancerous oral lesions (leukoplakia) and is a risk factor for cardiovascular diseases and nicotine addiction. Despite these adverse effects, smokeless tobacco is used commonly in the United States by young people, especially male high school students. Officials in Florida requested CDC assistance in analyzing six moist snuff products to measure three factors that affect their nicotine dose: pH, nicotine content, and moisture content. This report summarizes the results of the analysis, which indicate that the pH, amount of nicotine, and moisture vary widely among brands. (+info)
The Women's Health Trial Feasibility Study in Minority Populations: changes in dietary intakes.
(13/1417)This randomized clinical trial examined the feasibility of low-fat dietary interventions among postmenopausal women of diverse backgrounds. During 1992-1994, 2,208 women aged 50-79 years, 28% of whom were black and 16% Hispanic, enrolled at clinics in Atlanta, Georgia, Birmingham, Alabama, and Miami, Florida. Intervention/support groups met periodically with a nutritionist to reduce fat intake to 20% of energy and to make other diet modifications. At 6 months postrandomization, the intervention group reduced fat intake from 39.7% of energy at baseline to 26.4%, a reduction of 13.3% of energy, compared with 2.3% among controls. Saturated fatty acid and cholesterol intakes were reduced, but intakes of fruits and vegetables, but not grain products, increased. Similar effects were observed at 12 and 18 months. Black and non-Hispanic white women had similar levels of reduction in fat, but the decrease in Hispanic women was less. Changes did not vary significantly by education. While bias in self-reported intakes may have resulted in somewhat overestimated changes in fat intake, the reported reduction was similar to the approximately 10% of energy decrease found in most trials and suggests that large changes in fat consumption can be attained in diverse study populations and in many subgroups. (+info)
Varicella-related deaths--Florida, 1998.
(14/1417)During 1998, the Florida Department of Health (FDH) reported to CDC six fatal cases of varicella (chickenpox). FDH investigated all death certificates for 1998 with any mention of varicella as a contributory or underlying cause. Eight deaths were identified; two were reclassified as disseminated herpes zoster and six were related to varicella, for an annual varicella death rate of 0.4 deaths per million population. Two deaths occurred in children and four in adults; none had received varicella vaccine. The infection source was identified for three cases; two adults acquired varicella from children in the home, and one child acquired varicella from a classmate. One infection source was known to be unvaccinated; the other two were presumed to be unvaccinated. This report summarizes these varicella deaths and recommends prevention strategies. (+info)
Medicaid eligibility expansion in Florida: effects on maternity care financing and the delivery system.
(15/1417)CONTEXT: In July 1989, the income limit on Medicaid eligibility for pregnant women in Florida was increased from 100% to 150% of the poverty level. This change may have led to substantial shifts in the financing of pregnancy-related care, and also may have had distinct effects on different providers in the health care delivery system. METHODS: Matched birth and death certificates, hospital discharge abstracts, Medicaid eligibility records and encounter records from county public health departments were used to estimate changes in the flows of funds and services by major payer groups during the period preceding the expansion (July 1988-June 1989) and for calendar year 1991. A total of 188,793 births in the first period and 193,292 in the second were examined. RESULTS: The number of births financed annually by Medicaid in Florida increased by 47% following the eligibility expansion, from 47,400 in 1988-1989 to 69,600 in 1991. This increase stemmed largely from covered births to women who otherwise would have been uninsured. Seventy-three percent of the additional 22,200 deliveries funded through Medicaid in 1991 are attributed to women who were eligible as a result of the expansions. The additional prenatal care financed by Medicaid was delivered almost entirely by county public health departments, which increased their capacity by more than 100%, from 177,000 visits in 1988-1989 to 433,000 in 1991. Medicaid payments for maternity care increased 39%, from $135 million to $187 million, while payments made by the uninsured dropped by 29%. These changes resulted in a 5% rise in hospital revenues, despite little change in the number of admissions. CONCLUSIONS: The Medicaid expansion benefited low-income pregnant women and hospitals in Florida. It is unknown whether the private delivery system would have accommodated the increased demand in the absence of the public health system response. (+info)
Is fasting leptin associated with insulin resistance among nondiabetic individuals? The Miami Community Health Study.
(16/1417)OBJECTIVE: Whether serum leptin levels are associated with insulin resistance independent of the effects of hyperinsulinemia and adiposity is an important unanswered question. We examined the relationship between the rate of insulin-mediated glucose uptake and serum leptin concentrations among nondiabetic men and women. RESEARCH DESIGN AND METHODS: A cross-sectional analysis was performed among 49 young to middle-aged men and women who participated in the Miami Community Health Study. All participants had measures of insulin resistance (euglycemic-hyperinsulinemic clamp), postchallenge insulin levels, fasting serum leptin levels, and several measures of adiposity. RESULTS: The rate of insulin-mediated glucose uptake (M in milligrams per kilogram per minute) was significantly associated with leptin concentrations in both men (r = -0.83; P < 0.001) and women (r = -0.59; P < 0.001). M was also inversely related to percent body fat and to the 2-h insulin area under the curve (AUC). After covariate adjustment for sex, percent body fat, and AUC, leptin remained a significant correlate of M (P = 0.04). CONCLUSIONS: Cross-sectionally, leptin was significantly associated with insulin resistance in this nondiabetic sample of men and women. There may be a different physiological mechanism to explain the leptin/insulin resistance association apart from the insulin/adiposity link. Confirmatory evidence awaits the results of clinical trials. (+info)