Multi-person Sex among a Sample of Adolescent Female Urban Health Clinic Patients

Adolescent sexual activity involving three or more people is an emerging public health concern. The goal of this exploratory, cross-sectional study was to describe the prevalence, correlates, and context of multiple-person sex among a sample of adolescent females seeking health care from an urban clinic. Because sex involving multiple people may either be consensual (i.e., “three-ways” or “group sex”) or forced (i.e., “gang rape”), we use the term “multi-person sex” (MPS) to encompass these experiences. Subjects were 328 females, ages 14–20 years old, who utilized a Boston-area community- or school-based health clinic between April and December of 2006, and completed an anonymous survey using computer-assisted self-interview software. Overall, 7.3% reported ever having had a MPS experience. Of these, 52% reported ever being pressured to engage in MPS and 43% reported ever being threatened or forced. Condom nonuse by at least one male participant in the most recent MPS was reported by 45%. Controlling for potential demographic confounders, MPS was associated with cigarette smoking (adjusted prevalence ratio [APR], 3.83; 95% confidence interval [CI], 1.56–9.44), sexual initiation prior to age 15 (APR, 2.50; 95% CI, 1.04–5.98), ever being diagnosed with an STI (APR, 2.55; 95% CI, 1.08–6.03), dating violence victimization (APR, 4.43; 95% CI, 1.68–11.69), childhood sexual abuse victimization (APR, 4.30; 95% CI, 1.83–10.07) and past-month pornography exposure (APR, 4.79; 95% CI, 1.91–11.98). Additional study of the perpetration and prevention of adolescent MPS is urgently needed.     

Early Healthcare Provider Communication with Patients and Their Workplace Following a Lost-time Claim for an Occupational Musculoskeletal Injury

Problem: One of the key players in the return-to-work (RTW) and work accommodation process is the healthcare provider (HCP). This study examines the association between RTW approximately one month post injury and early, proactive HCP communication with the patient and workplace. Methods: In this cross-sectional study 187 Ontario workers completed a telephone survey 17–43 days post injury. All had accepted or pending lost-time claims for back, neck or upper extremity occupational musculoskeletal injuries. Logistic regression was used to analyze the effects of three self-reported items “your HCP told you the date you could RTW,” “your HCP advised you on how to prevent re-injury or recurrence,” “your HCP made contact with your workplace” on self-reported RTW. Fourteen potential confounders were also tested in the model including sex, age, income, education, occupational classification, worksite size, co-morbidity, psycho-physical work demands, pain, job satisfaction, depression, and time from injury to interview. Results: The HCP giving a patient a RTW date (adjusted OR=3.33, 95% CI=1.62–6.87) and giving a patient guidance on how to prevent recurrence and re-injury (adjusted OR=2.71, 95% CI=1.24–5.95) were positively associated with an early RTW. Contact by the HCP with the workplace was associated with RTW, however, this association became weaker upon adjusting for confounding variables (crude OR=2.11, 95% C1=1.09–4.09; adjusted OR=1.72, 95% CI=0.83–3.58). Interpretation: Our study lends support to the HCP playing an active role early in the RTW process, one that includes direct contact with the workplace and proactive communication with the patient.

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Outdoor work and skin cancer incidence: a registry-based study in Bavaria

Objective  To analyse the association between occupational ultraviolet (UV) light exposure and skin cancer (basal cell carcinoma, BCC; squamous cell carcinoma, SCC; cutaneous malignant melanoma, CMM) based on data from the Bavarian population-based cancer registry. Methods  The population-based cancer registry of Bavaria (Germany) provided data on incident cases of BCC, SCC, and CMM, respectively, during the period 2001 until 2005. Eleven Bavarian districts with complete skin cancer registration were included in this analysis based on 2,156,336 person years. Cases were assigned to “indoor”, “mixed indoor/outdoor”, and “outdoor” exposure categories according to their job title. We computed age-specific and age-adjusted incidence rates of BCC (n = 1,641), SCC (n = 499), and CMM (n = 454) by work type, and the relative risk (RR) of skin cancer occurrence for “outdoor” and “mixed indoor/outdoor” workers, respectively, compared to “indoor” workers. Results  The risk of BCC was substantially elevated in male (RR, 2.9; 95% CI, 2.2–3.9) and female (RR, 2.7; 95% CI, 1.8–4.1) outdoor workers compared to male and female indoor workers, respectively. We also found an elevated risk of similar magnitude for SCC in male (RR, 2.5; 95% CI, 1.4–4.7) and female (RR, 3.6; 95% CI, 1.6–8.1) outdoor workers compared to male and female indoor workers, respectively. CMM risk was not significantly associated with outdoor work. Conclusion  Our study confirms previous reports on the increased risk of BCC and SCC in outdoor workers compared to indoor workers.     

The prevalence of symptoms attributed to electromagnetic field exposure: a cross-sectional representative survey in Switzerland

Summary. Objectives To investigate health risk perception as well as to assess the prevalence of self-reported symptoms attributed to electromagnetic fields (EMF) and other environmental exposures in the general population of Switzerland. Methods Between May and June 2004, telephone interviews of a representative sample of the Swiss population (n = 2 048, >14 years old) about: 1) health symptoms attributed to five environmental factors (one of which was EMF), 2) health risk perception related to 12 environmental risk factors (five of which were different EMF sources). Results We found a prevalence of 5% (95% CI 4–6%) for electromagnetic hypersensitivity (EHS) in our study sample. The most common health complaints among EHS individuals were sleep disorders (43%) and headaches (34%), which were mostly attributed to power lines and mobile phone handsets. In addition, 53 percent (95% CI 51–55%) were worried about adverse health effects from EMF, without attributing their own health symptoms to them. Conclusions The large proportion of the population who is concerned or attributes own symptoms to EMF may cause societal conflicts given the ubiquity of EMF in our everyday life. Submitted: 27 May 2005; Accepted: 6 March 2006     

Language Preference and Perceptions of Healthcare Providers’ Communication and Autonomy Making Behaviors among Hispanics

Background To examine influence of language preference—English versus Spanish—on Hispanics’ perceptions of their healthcare providers’ communication behaviors. Methods Using the 2005 Medical Expenditure Panel Survey (MEPS), we observed non-institutionalized Hispanics (n = 5197; US population estimate = 27,070,906), aged ≥18 years, reporting visiting a healthcare provider within the past 12 months. Results When compared to Spanish responders (reference group), English responders were more likely to report that their healthcare provider “always” listened to them carefully (adjusted odds ratio (OR) = 1.39, 95% confidence interval (CI) 1.09–1.78), “always” explained things so that they understood (adjusted OR 1.37, 95% CI 1.08–1.73), “always” spent enough time with them (adjusted OR = 1.62, 95% CI 1.24–2.11),”always” asked them to help make decisions (adjusted OR 1.37, 95% CI 1.03–1.82), and “always” showed respect for treatment decisions (adjusted OR = 1.66, 95% CI 1.27–2.19). Discussion Healthcare providers should consider the complex needs of Hispanic patients whose language of choice is not English.     

Exposure to radio-frequency electromagnetic fields and behavioural problems in Bavarian children and adolescents

Only few studies have so far investigated possible health effects of radio-frequency electromagnetic fields (RF EMF) in children and adolescents, although experts discuss a potential higher vulnerability to such fields. We aimed to investigate a possible association between measured exposure to RF EMF fields and behavioural problems in children and adolescents. 1,498 children and 1,524 adolescents were randomly selected from the population registries of four Bavarian (South of Germany) cities. During an Interview data on participants’ mental health, socio-demographic characteristics and potential confounders were collected. Mental health behaviour was assessed using the German version of the Strengths and Difficulties Questionnaire (SDQ). Using a personal dosimeter, we obtained radio-frequency EMF exposure profiles over 24 h. Exposure levels over waking hours were expressed as mean percentage of the reference level. Overall, exposure to radiofrequency electromagnetic fields was far below the reference level. Seven percent of the children and 5% of the adolescents showed an abnormal mental behaviour. In the multiple logistic regression analyses measured exposure to RF fields in the highest quartile was associated to overall behavioural problems for adolescents (OR 2.2; 95% CI 1.1–4.5) but not for children (1.3; 0.7–2.6). These results are mainly driven by one subscale, as the results showed an association between exposure and conduct problems for adolescents (3.7; 1.6–8.4) and children (2.9; 1.4–5.9). As this is one of the first studies that investigated an association between exposure to mobile telecommunication networks and mental health behaviour more studies using personal dosimetry are warranted to confirm these findings.     

Maternal-Infant Bedsharing: Risk Factors for Bedsharing in a Population-Based Survey of New Mothers and Implications for SIDS Risk Reduction

Objectives: Maternal-infant bedsharing is a common but controversial practice. Little has been published about who bedshares in the United States. This information would be useful to inform public policy, to guide clinical practice and to help focus research. The objective was to explore the prevalence and determinants of bedsharing in Oregon. Methods. Oregon Pregnancy Risk Assessment Monitoring System (PRAMS) surveys a population-based random sample of women after a live birth. Women were asked if they shared a bed with their infant “always,” “almost always,” “sometimes” or “never.” Results: 1867 women completed the survey in 1998–99 (73.5% weighted response rate). Of the respondents, 20.5% reported bedsharing always, 14.7% almost always, 41.4% sometimes, and 23.4% never. In multivariable logistic regression, Hispanics (adjusted odds ratio [ORa] 1.69, 95% Confidence Interval [CI] 1.17–2.43), blacks (ORa 3.11, 95% CI 2.03–4.76) and Asians/Pacific Islanders (ORa 2.14, 95% CI 1.51–3.03), women who breastfed more than 4 weeks (ORa 2.65, 95% CI 1.72–4.08), had annual family incomes less than $30,000 (ORa 2.44, 95% CI 1.44–4.15), or were single (ORa 1.55, 95% CI 1.03–2.35) were more likely to bedshare frequently (always or almost always). Among Hispanic and black women, bedsharing did not vary significantly by income level. Bedsharing black, American Indian/Alaska Native and white infants were much more likely to be exposed to smoking mothers than Hispanic or Asian/Pacific Islander infants (p < .0001). Conclusions: Bedsharing is common in Oregon. The women most likely to bedshare are non-white, single, breastfeeding and low-income. Non-economic factors are also important, particularly among blacks and Hispanics. Campaigns to decrease bedsharing by providing cribs may have limited effectiveness if mothers are bedsharing because of cultural norms.     

Asthma,eczema, and reports on pollen and cat allergy among pupils in Shanxi province,China

Objectives To study self-reported asthma, eczema, and pollen and furry pet allergy among pupils (9–20 years) in Shanxi province, China, in relation to dietary and environmental factors. Methods A standardised questionnaire was distributed to pupils in two primary and two secondary schools, one in Taiyuan city (3.0 milj. inhabitants), the others in Qingxu county, a rural area 30 km outside Taiyuan. Totally, 2,116 pupils (90%) participated. Results Fifty percent were girls, 61% had been growing up on the countryside, 18% lived in Taiyuan now, 1.7% had ever had asthma, 0.8% had doctor’s diagnosed asthma, 1.4% pollen allergy, 1.7% cat allergy, and 0% had dog allergy. Multiple logistic regression was applied, controlling for age, gender, diet, indoor exposures, rural childhood, and current urban residency. Girls had less eczema (OR = 0.51; 95%CI 0.28–0.92). Pupils in the city had more eczema (OR = 5.05; 95% CI 1.11–23.3). Those with a rural childhood had less asthma (OR = 0.17; 95% CI 0.05–0.60), eczema (OR = 0.15; 95% CI 0.13–0.66) and pollen/cat allergy (OR = 0.50; 95%CI 0.25–0.99). None of the indoor variables was related to asthma or allergy. Children with frequent fruit consumption had less asthma (OR = 0.40; 95% CI 0.19–0.82) and pollen/cat allergy (OR = 0.49; 95% CI 0.29–0.84). Those with frequent fish consumption had less asthma (OR = 0.32; 95% CI 0.11–0.97). Those with frequent hamburgers consumption had more asthma (OR = 2.05; 95% CI 1.09–3.87) and eczema (OR = 1.85; 95% CI 1.12–3.04). Conclusion Asthma, eczema, and pollen or pet allergy was uncommon, compared with western countries and other areas in China. Pupils with a rural childhood had less asthma and allergy, which is consistent with the “hygiene hypothesis”. Fruit and fish consumption may reduce, and fast food consumption may increase the risk for asthma. Finally, the higher prevalence of asthma and eczema among younger children, born in the 1990s, indicates a cohort effect similar to that observed in western countries.     

Factors associated with short-term recovery of health status among emergency department patients with acute exacerbations of chronic obstructive pulmonary disease

Objective  To determine the factors associated with short-term recovery of health status following chronic obstructive pulmonary disease (COPD) exacerbation. Methods  In a prospective multicenter cohort study, consecutive emergency department (ED) patients with COPD exacerbation were enrolled. Patients were interviewed and instructed to complete the validated Short Form Chronic Respiratory disease Questionnaire. Follow-up data were collected 2 weeks later, and included the global transition question. The primary outcome was recovery of health status, which was assigned to patients who stated that their COPD was “a little better” or “much better” than at the time of their ED presentation. Results  Of the 330 patients, 270 [82%; 95% confidence interval (CI), 77–86%] reported recovery of health status following acute exacerbations. Multivariable analysis showed that recovery of health status was associated with having a primary care provider (PCP) [odds ratio (OR), 3.1; 95% CI, 1.5–6.4] and a co-diagnosis of asthma (OR, 2.2; 95% CI, 1.2–3.8). By contrast, frequent exacerbations (two or more exacerbations in the past year) (OR, 0.4; 95% CI, 0.2–0.7) was inversely associated with recovery. Conclusions  Reducing exacerbation frequency and provision of adequate PCP follow-up after ED visit may help improve the recovery of health status following acute exacerbations of COPD.     

Exposure to electromagnetic fields and suicide among electric utility workers: a nested case-control study

OBJECTIVES—This nested case-control study examines mortality from suicide in relation to estimated exposure to extremely low frequency electromagnetic fields (EMFs) in a cohort of 138 905 male electric utility workers.METHODS—Case-control sampling included 536 deaths from suicide and 5348 eligible controls. Exposure was classified based on work in the most common jobs with increased exposure to magnetic fields and indices of cumulative exposure to magnetic fields based on a measurement survey.RESULTS—Suicide mortality was increased relative to work in exposed jobs and with indices of exposure to magnetic fields. Increased odds ratios (ORs) were found for years of employment as an electrician (OR 2.18; 95% confidence interval (95% CI) 1.25 to 3.80) or lineman (OR 1.59; 95% CI 1.18 to 2.14), whereas a decreased OR was found for power plant operators (OR 0.67; 95% CI 0.33 to 1.40). A dose response gradient with exposure to magnetic fields was found for exposure in the previous year, with a mortality OR of 1.70 (95% CI 1.00 to 2.90) in the highest exposure category. Stronger associations, with ORs in the range of 2.12-3.62, were found for men <50 years of age.CONCLUSION—These data provide evidence for an association between occupational electromagnetic fields and suicide that warrants further evaluation. A plausible mechanism related to melatonin and depression provides a direction for additional laboratory research as well as epidemiological evaluation.     

Association between personal exposure to volatile organic compounds and asthma among US adult population

Objectives There is growing concern about adverse respiratory health effects from exposure to indoor air pollution. The purpose of this study was to analyze association between exposure to volatile organic compounds (VOC) and asthma in adults. Methods This study utilized passive personal exposure data on ten VOC collected as part of the National Health and Nutrition Examination Survey (NHANES) 1999–2000. A total of 550 subjects who were of non-Hispanic whites, Mexican-Americans, or non-Hispanic Blacks race/ethnicity were included in this analysis. The primary outcome variable was physician-diagnosed asthma and the secondary outcome variable was presence of wheezing in the previous 12 months among those without physician-diagnosed asthma. Exploratory factor analysis was used to generate factor scores to group VOCs, which were included as indicator variables in the analyses. Associations between exposure to VOCs, physician-diagnosed asthma, and wheezing in the previous 12 months were evaluated using multiple logistic regression analyses. Odds ratios are for 1-U increase in level of exposure. Results Seven of the ten VOC variables loaded on two factors, “aromatic compounds” and “chlorinated hydrocarbons.” The geometric mean concentration of VOCs varied from as low as 0.03 μg/m³ for trichloroethene to as high as 14.33 μg/m³ for toluene. Mexican-Americans had the highest personal exposures to benzene (geometric mean = 2.38 μg/m³) as compared to non-Hispanic whites (geometric mean = 1.15 μg/m³) and non-Hispanic Blacks (geometric mean = 1.07 μg/m³). The odds of physician-diagnosed asthma were significantly higher among those exposed to aromatic compounds (Adjusted OR = 1.63, 95% CI: 1.17–2.27). Among those subjects never diagnosed by a physician to have asthma, a significantly increased odds of one to two wheezing attacks were observed for aromatic compounds (Adjusted OR = 1.68, 95% CI: 1.08–2.61) and chlorinated hydrocarbons (Adjusted OR = 1.50, 95% CI: 1.01–2.23) as compared to no wheezing. No association with three wheezing attacks or more was observed in the study. Conclusion In this cross-sectional study of a representative sample of the US population, environmental exposures to VOCs, especially aromatic compounds, were associated with adverse respiratory effects. An erratum to this article can be found at     

Hurricane Katrina-Related Maternal Stress,Maternal Mental Health,and Early Infant Temperament

To investigate temperament in infants whose mothers were exposed to Hurricane Katrina and its aftermath, and to determine if high hurricane exposure is associated with difficult infant temperament. A prospective cohort study of women giving birth in New Orleans and Baton Rouge, LA (n = 288) in 2006–2007 was conducted. Questionnaires and interviews assessed the mother’s experiences during the hurricane, living conditions, and psychological symptoms, 2 months and 12 months postpartum. Infant temperament characteristics were reported by the mother using the activity, adaptability, approach, intensity, and mood scales of the Early Infant and Toddler Temperament Questionnaires, and “difficult temperament” was defined as scoring in the top quartile for three or more of the scales. Logistic regression was used to examine the association between hurricane experience, mental health, and infant temperament. Serious experiences of the hurricane did not strongly increase the risk of difficult infant temperament (association with three or more serious experiences of the hurricane: adjusted odds ratio (aOR) 1.50, 95% confidence interval (CI) 0.63–3.58 at 2 months; 0.58, 0.15–2.28 at 12 months). Maternal mental health was associated with report of difficult infant temperament, with women more likely to report having a difficult infant temperament at 1 year if they had screened positive for PTSD (aOR 1.82, 95% confidence interval (CI) 0.61–5.41), depression, (aOR 3.16, 95% CI 1.22–8.20) or hostility (aOR 2.17, 95% CI 0.81–5.82) at 2 months. Large associations between maternal stress due to a natural disaster and infant temperament were not seen, but maternal mental health was associated with reporting difficult temperament. Further research is needed to determine the effects of maternal exposure to disasters on child temperament, but in order to help babies born in the aftermath of disaster, the focus may need to be on the mother’s mental health.     

Depressive symptoms and self-reported occupational injury in small and medium-sized companies

Objectives  This survey was designed to determine whether depressive symptoms had an effect on the risk of self-reported occupational injury in South Korea. Methods  We conducted a prospective follow-up survey of workers at 44 small- to medium-sized companies classified into manufacturing or service businesses; 1,350 questionnaires were used in the final analysis. The first survey requested information regarding personal characteristics, work characteristics, and depressive symptoms (CES-D); the second survey queried participants in the first survey about self-reported occupational injuries (including minor scratches or cuts) experienced in the previous 4 months. Risk ratios (RRs) were calculated through Poisson regression analysis. The number of occupational injuries during the previous 4 months served as the dependent variable, and depressive symptoms served as the independent variable. Results  After adjustment for demographic factors, the RRs were 1.75 (95% CI: 1.41–2.18) and 2.68 (95% CI: 1.98–3.64) in male and female, respectively. Additional adjustment for work-related variables did not alter the RR considerably in females (2.65; 95% CI: 1.95–3.59). Among the male workers, however, the RR was not significant (1.21; 95% CI: 0.95–1.55). On the other hand, when the analysis was limited to blue-collar workers, after adjustment for demographic and work-related factors, the RRs remained significant in both genders (male: 1.34; 95% CI: 1.03–1.74; female: 2.04; 95% CI: 1.41–2.95). Conclusions  We found that the risk of self-reported occupational injury experience was higher in workers who reported depressive symptoms. Additional study using objective data is required to confirm our results.     

Self-Reported Moisture or Mildew in the Homes of Head Start Children with Asthma is Associated with Greater Asthma Morbidity

This study used results from a cross-sectional survey of parents of 3- to 5-year-old children with asthma to assess the frequency of self-reported home environmental conditions that could contribute to worsening asthma and examined the relationship between these factors and the child's asthma morbidity. Participants were 149 parents drawn from the two largest agencies that provide subsidized preschool childcare services in East and Central Harlem, inner-city communities with high prevalence of asthma. The sample represented 77% of eligibles determined by a validated case-identification instrument. Data were collected on demographics, symptoms, medication use, Emergency Department visits and hospitalization, and environmental conditions in the home. One or more of these home environmental conditions were reported by 92% of participants. Controlling for other environmental conditions and demographics, associations were found between self-reported presence of moisture or mildew on ceilings, walls, or windows and higher frequency of hospitalizations for breathing-related problems (OR = 3.31; 95% CI 1.62–6.75), frequent episodes of wheezing (OR = 3.25; 95% CI 1.8–6.0), and higher frequency of night symptoms due to asthma (OR = 2.19; 95% CI 1.4–3.41). Having a carpet or rug in the child's bedroom or the living room was also associated with hospitalizations (OR = 3.23; 95% CI 1.53–6.8), and male gender was marginally associated with the frequency of night symptoms (OR = 1.51; 95% CI .95–2.4). Asthma is prevalent in the Head Start population, and exposure to home environmental conditions that may worsen asthma is common in the socially disadvantaged populations served by Head Start programs. Drs. Bonner PhD, Matte and Fagan and Ms. Andreopoulus are with the Center for Urban Epidemiologic Studies (CUES) of the New York Academy of Medicine.     

Occupational exposure to chemicals and risk of thyroid cancer in Sweden

Purpose  To explore thyroid cancer (TC) risk in the Swedish population, associated with occupational exposure to certain chemicals. Methods  National cancer and death registries were used to follow-up (1971–1989) all Swedish workers employed in the 1970 census. Each combination of occupation and industry was linked to a Swedish job-exposure matrix (JEM), with exposure to 13 chemicals classified as “possible exposure”, “probable exposure” or “unexposed”. Relative risks were obtained using Poisson models adjusted for age, period and geographical area. A second analysis was performed, in which adjustment was additionally made for simultaneous exposure to other matrix chemicals and ionising radiations. Results  Probable exposure to solvents among women displayed an increased risk (RR = 1.91; 95%CI:1.05–3.45), mainly due to a higher risk observed among shoe-cutters, lasters and sewers engaged in shoe-making. Conclusions  Exposure to solvents, used mainly in the shoe and leather industry, seems to be associated with excess TC among women.     

Prediction of complicated urinary tract infections in patients with type 2 diabetes: a questionnaire study in primary care

Background Relatively few data are available to predict a complicated course of community-acquired complicated urinary tract infections (UTIs) in patients with diabetes type 2 (DM2). The aim of this study was to assess predictors for a complicated course of UTIs in DM2 patients in primary care. Method We conducted a cross-sectional questionnaire study among DM2 patients aged over 45 years as part of an educational trial. The combined outcome measure was a complicated course of UTI, defined as a self-reported episode of acute pyelonephritis, prostatitis or recurrent cystitis in the 12 months before the trial. Patients with an outcome were all verified by review of medical records. A prediction model was derived with multivariable logistic regression analysis. Results Of the 1151 trial participants, 94 (8%) had a self-reported community-acquired complicated course of UTIs and 62 (66%) of these were medically-attended. Independent predictors for a complicated course were age above 60 years (adjusted odds ratio (OR): 1.74; 95% confidence interval (CI): 0.99–3.03), chronic use of antibiotics (adjusted OR: 5.50; 95% CI: 2.31–13.08), more than 6 physician contacts in previous year (adjusted OR: 3.60; 95% CI: 2.00–6.49), hospitalization in previous year (adjusted OR: 1.36; 95% CI: 1.00–1.85), renal disease (adjusted OR: 4.92; 95% CI: 1.59–15.18) and incontinence of urine (adjusted OR: 3.78; 95% CI: 1.93–7.38). Area under the receiver-operating curve was 0.72 (95% CI: 0.66–0.78). Analysis according to medically attended complicated UTIs did not change our findings. Conclusion Easily obtainable predictors from medical history can be used to accurately predict a complicated course of UTIs in DM2 patients.     

Self-Efficacy and Health Locus of Control: Relationship to Occupational Disability Among Workers with Back Pain

Objectives Although self-efficacy and health locus of control (HLC) have been extensively studied in health research, little is known about their contribution to occupational disability among workers with back pain. This 2 year prospective study examined the association between these control belief constructs and “return to work in good health” (RWGH), a four-category, composite index of back pain outcome. Methods The participants (n = 1,007, participation = 68.4%, follow-up = 86%) were workers with occupational disruptions who sought a medical consultation for non specific back pain in primary care and emergency settings in the Quebec City area, Canada. Information about self-efficacy for return to work (SERW) and HLC, as well as potential confounders, was collected during a telephone interview about 3 weeks after the baseline medical consultation. Polytomous logistic regression was used to assess the relationship between the baseline control variables and RWGH at 2 year. Odds ratios (OR) and their 95% confidence intervals were used to quantify the strength of associations. For all analyses, the “success” category was considered the reference group. Results Although bivariate analyses showed a significant association between external HLC and RWGH at 2 year, this relationship was not significant in multivariate analyses. Higher scores on the self-efficacy questionnaire were however protective of “failure to return to work after attempt(s)” (OR: 0.28; 95% CI: 0.14–0.57) and of “failure to return to work” (OR: 0.19; 95% CI: 0.07–0.48) in multivariate analyses. Conclusion Self-efficacy is an important determinant of the occupational outcome of back pain.     

Quantifying Urbanization as a Risk Factor for Noncommunicable Disease

The aim of this study was to investigate the poorly understood relationship between the process of urbanization and noncommunicable diseases (NCDs) in Sri Lanka using a multicomponent, quantitative measure of urbanicity. NCD prevalence data were taken from the Sri Lankan Diabetes and Cardiovascular Study, comprising a representative sample of people from seven of the nine provinces in Sri Lanka (n = 4,485/5,000; response rate = 89.7%). We constructed a measure of the urban environment for seven areas using a 7-item scale based on data from study clusters to develop an “urbanicity” scale. The items were population size, population density, and access to markets, transportation, communications/media, economic factors, environment/sanitation, health, education, and housing quality. Linear and logistic regression models were constructed to examine the relationship between urbanicity and chronic disease risk factors. Among men, urbanicity was positively associated with physical inactivity (odds ratio [OR] = 3.22; 2.27–4.57), high body mass index (OR = 2.45; 95% CI, 1.88–3.20) and diabetes mellitus (OR = 2.44; 95% CI, 1.66–3.57). Among women, too, urbanicity was positively associated with physical inactivity (OR = 2.29; 95% CI, 1.64–3.21), high body mass index (OR = 2.92; 95% CI, 2.41–3.55), and diabetes mellitus (OR = 2.10; 95% CI, 1.58 – 2.80). There is a clear relationship between urbanicity and common modifiable risk factors for chronic disease in a representative sample of Sri Lankan adults.     

A Dose-Dependent Relationship between Exposure to a Street-Based Drug Scene and Health-Related Harms among People Who Use Injection Drugs

While the community impacts of drug-related street disorder have been well described, lesser attention has been given to the potential health and social implications of drug scene exposure on street-involved people who use illicit drugs. Therefore, we sought to assess the impacts of exposure to a street-based drug scene among injection drug users (IDU) in a Canadian setting. Data were derived from a prospective cohort study known as the Vancouver Injection Drug Users Study. Four categories of drug scene exposure were defined based on the numbers of hours spent on the street each day. Three generalized estimating equation (GEE) logistic regression models were constructed to identify factors associated with varying levels of drug scene exposure (2–6, 6–15, over 15 hours) during the period of December 2005 to March 2009. Among our sample of 1,486 IDU, at baseline, a total of 314 (21%) fit the criteria for high drug scene exposure (>15 hours per day). In multivariate GEE analysis, factors significantly and independently associated with high exposure included: unstable housing (adjusted odds ratio [AOR] = 9.50; 95% confidence interval [CI], 6.36–14.20); daily crack use (AOR = 2.70; 95% CI, 2.07–3.52); encounters with police (AOR = 2.11; 95% CI, 1.62–2.75); and being a victim of violence (AOR = 1.49; 95 % CI, 1.14–1.95). Regular employment (AOR = 0.50; 95% CI, 0.38–0.65), and engagement with addiction treatment (AOR = 0.58; 95% CI, 0.45–0.75) were negatively associated with high exposure. Our findings indicate that drug scene exposure is associated with markers of vulnerability and higher intensity addiction. Intensity of drug scene exposure was associated with indicators of vulnerability to harm in a dose-dependent fashion. These findings highlight opportunities for policy interventions to address exposure to street disorder in the areas of employment, housing, and addiction treatment.     

Paternal and maternal exposure to welding fumes and metal dusts or fumes and adverse pregnancy outcomes

Objective  We assessed whether paternal exposure prior to conception and maternal exposure during pregnancy to welding fumes (WF) and metal dusts or fumes (MD/F) independently and jointly increases the risk of preterm delivery, low birth weight, and small-for-gestational age. Methods  The study population was selected from The Finnish Prenatal Environment and Health Study of 2,568 newborns (response rate 94%) and included 1,670 women who worked during pregnancy of which 68 were exposed either to WF and/or MD/F. Results  The risk of SGA was related to maternal exposure to WF only (adjusted OR = 1.78; 95% CI 0.53–5.99), MD/F only (adjusted OR = 1.77; 95% CI 0.38–8.35) and both exposures (2.92; 1.26–6.78). The corresponding effect estimates for preterm delivery were 2.66 (0.32–22.08), 5.64 (1.14–27.81) and for birth weight below 3,000 g 3.79 (1.09–13.19), 1.85 (0.56–6.14) and 1.70 (0.70–4.15), respectively. There was some suggestive, inconsistent evidence that the risk of preterm delivery and SGA is related to paternal exposure to WF. Conclusions  The present results provide evidence that maternal exposure to WF or MD/F combination during pregnancy may reduce fetal growth and suggestive evidence that paternal exposure to WF may increase the risk of preterm delivery and small-for-gestational age. The small number of exposed women and the lack of data for exposure concentrations suggest the need for further study to verify our findings.