Nationwide survey of high-density lipoprotein cholesterol among farmers in Japan

A total of 2,134 blood samples (788 from men and 1,346 from women), were collected nationwide from adult farmers in Japan (44 regions in 21 prefectures) during the winters of 1978 through 1981. They were analyzed in a single laboratory for high-density lipoprotein cholesterol (HDL) by means of a precipitation method. The serum HDL level was 47.3 +/- 14.2 mg/100 ml (mean +/- SD; n = 788) in men and 47.4 +/- 12.8 mg/100 ml (n = 1,346) in women. Sex and age differences in HDL were not statistically significant (P greater than 0.10). Alcohol consumption was associated with elevated HDL levels in both sexes; the association was statistically significant only in men (P less than 0.05) and was positively correlated with daily alcohol consumption (P less than 0.05). Conversely, smoking habits were negatively (P less than 0.05) associated with HDL in men. The comparison of HDL in the nondrinking and nonsmoking population revealed that HDL in women (47.0 +/- 12.8 mg/100 ml; n = 900) did not differ significantly (P greater than 0.10) from the male values (45.3 +/- 12.5 mg/100 ml; n = 60). When 23 nondrinking and nonsmoking married couples were selected from 348 couples, for whom information on drinking and smoking habits was available, the HDL (+/- SD) was essentially the same in husbands (44.2 +/- 12.8 mg/100 ml) and in wives (43.7 +/- 9.5 mg/100 ml). In the blood samples collected from 535 subjects once in winter and once in summer, HDL concentration was significantly higher in summer than in winter (P less than 0.01 in both men and women); the HDL means (+/- SD) in winter and in summer were 48.1 +/- 14.3 and 50.9 +/- 11.3 mg/100 ml, respectively, for men, and 47.0 +/- 12.0 and 50.3 +/- 11.0 mg/100 ml, respectively, for women. The mean HDL distributed across a fairly wide range depending on the 44 regions studied. Maximum-minimum mean values were 58.3-33.1 mg/100 ml in men and 59.7-37.4 mg/100 ml in women, and the regional difference was statistically significant (P less than 0.01) both in men and women. Furthermore, a significant inverse relation (P less than 0.05) was observed in men between the mean regional HDL values and standardized regional ratios of mortality from coronary heart diseases.     

Perceived vulnerability in adolescents to the health consequences of cigarette smoking

Adolescent feelings of vulnerability, an aspect of the Health Belief Model and Elkind's concept of adolescent egocentrism, were examined in two groups of white, middle-class 6th to 12th graders. Feelings of vulnerability were examined with respect to developmental course, antecedents, and relationship to the specific risk-taking behavior of cigarette smoking. Feelings of vulnerability to the negative consequences of smoking were found to decrease rapidly from sixth to eighth grade and to increase slowly thereafter. Experience with illness and accidents was correlated with the general vulnerability measure. However, experience with illness due to smoking was not related to smoking vulnerability. This may have been because few adolescents were found to have had personal experiences with the health consequences of smoking. Feelings of vulnerability with respect to the negative consequences of cigarette smoking were correlated with adolescent smoking behavior. General feelings of vulnerability were unrelated to cigarette smoking.     

Persistence of health habits and their relationship to mortality

This paper explores the relationship of seven personal health practices and subsequent mortality in the $\text{9}\text{1}\text{2}$ years between an initial survey of 6,928 adults made in Alameda County, California, in 1965 and a follow-up survey in 1974. The seven health practices are: never smoking cigarettes, regular physical activity, moderate or no use of alcohol, 7–8 hr sleep/day regularly, maintaining proper weight, eating breakfast, and not eating between meals. When accumulated to form a health practice score from 0 to 7, the number of health practices showed a striking inverse relationship with age-adjusted mortality rates, especially for men. Men following seven health practices had a mortality rate only 28% that of men following zero to three health practices. Women following seven health practices had a mortality rate 43% that of women following zero to three health practices. Both the health practices themselves and their relationship to mortality are shown to be reasonably stable over the $\text{9}\text{1}\text{2}$-year period of follow-up. These results lend support to the hypothesis that good health practices and not the initial health status of the survey respondents are largely responsible for the observed mortality relationships. These and other methodological issues are explored.     

The “know your body” program: A developmental approach to health education and disease prevention

The goal of health education is to motivate society to adopt health behaviors that will reduce premature morbidity and mortality from known preventable causes, including major chronic disease (heart disease, cancer, and stroke) and accidents. This motivation can be effective only within the framework of an action-oriented school health education program with a high degree of personal involvement. This paper describes the foundations of a new school health education system combining health screening, a “Health Passport,” a behavior-oriented health curriculum, and special interventions for high-risk students. We suggest that effective health education programs such as Know Your Body (KYB) become as important in our schools as reading, writing, and arithmetic, and that these be taught each year on a developmentally progressive scale, much in the same fashion as the three Rs.     

Factors associated with the maintenance of positive health behavior

Various factors associated with positive health behavior—an index based on eight measures of health response such as seat belt use, smoking, exercise and risk-taking—were examined. Women had more positive scores than men, reflecting a higher level of drinking and risk-taking among men, and a lower level of preventive medical behavior. Other predictors include education and a conventional behavioral orientation. Positive health behavior is associated with both psychological well-being and subjective health status. The patterns of associations found support the hypothesis that positive health behavior is part of a complex life-style that may reflect the ability to anticipate problems, mobilize to meet them, and cope actively.     

Assessment of potential exposure to antineoplastic agents in the health care setting

In response to reports of measurable air levels of antineoplastic agents in hospitals and preliminary evidence of exposure to personnel handling these agents, a survey was designed and conducted to document the current handling practices of injectable antineoplastic drugs by hospital and health care workers at two major teaching hospitals and three affiliated community hospitals. The survey included assessment of drug preparation, administration, and disposal. A sample of nurses, pharmacists, physicians, and other staff who routinely come in contact with these drugs was interviewed for validation of the observed results. Typical working conditions encountered and the potential numbers of people at risk and their job titles are presented here. Drug preparation facilities and methods were not uniform even within a single institution, including local preparation in the pharmacy under controlled or uncontrolled conditions, as well as individual drug preparation and administration on the hospital floors. Handling practices for drug preparation were not consistent from practitioner to practitioner. In some cases, where laboratory coats and disposable gloves were provided, it was not a routine practice to wear them. Based on such analysis of risk factors, recommendations for improved practices are given.     

Women's smoking trends and awareness of health risk

National data on smoking cessation rates indicate that female smokers may have more difficulty than male smokers in quitting smoking. To test the hypothesis that awareness of risk of smoking and personal vulnerability may be not as strong in female as in male smokers, we conducted a series of telephone interviews dealing with smokers' awareness and knowledge of the recent Surgeon General's Report on Smoking and Health, and their perception of and attitudes toward personal risk. The results indicated no marked sex difference in awareness of the Surgeon General's Report, but showed that significantly more female than male smokers worried about what they heard and read about the risk of smoking. A larger percentage of female smokers attributed a greater health risk from smoking to men than to women, thus suggesting that women's feelings of personal vulnerability may be weaker than men's.     

The relative impact of health education for low- and high-risk patients with hypertension

An experimental study was carried out to test and analyze the effects of an educational program on a group of hypertensive patients, comparing those with known higher risks of stroke and heart attack, e.g., secondary organ damage, with a group whose risks were relatively lower. Specific interventions have been shown to be differentially effective on specific patient behaviors (e.g., compliance with therapy) and on blood pressure control for both higher- and lower-risk patients in most of the experimental groups. Such findings emphasize the importance of tailored educational approaches, not only for a hypertensive population, but, more importantly, for patients who are known to have more difficulty achieving their blood pressure control and who are at higher risk of morbidity and mortality, i.e., patients who have secondary organ damage, have been previously hospitalized for hypertension, or are black males under 50 years of age.     

Assessing needs for youth health promotion

Children and adolescents recently have become a group targeted for health promotion efforts. It is argued that early behavioral intervention will alter patterns of behavior that might place young people at increased risk for chronic diseases later in life. The Minnesota Heart Health Program is a longitudinal, community-based research and demonstration project to improve cardiovascular health in three north central communities. Reductions in cigarette smoking, improved eating and exercise patterns, and hypertension management are targeted objectives. To design educational interventions for children and adolescents in these areas as part of this program, a behavioral needs assessment was conducted in the communities prior to program implementation. This needs assessment focused on existing behavior patterns, skills related to the targeted behaviors, and environmental influences. This article describes that needs assessment, the results from two of the communities, differences due to gender and age of student, and the implications of the results for designing intervention activities for children and adolescents.     

Role of nitrosation in the mutagenic activity of coal dust: A postulation for gastric carcinogenesis in coal miners

The mutagenicity of coal dust solvent extracts with and without nitrosation was studied using the Salmonella/microsome assay system. Coal dust solvent extracts were either non-mutagenic or very weakly mutagenic with S9 activation. High mutagenic activities, however, were found when extracts of bituminous, subbituminous, and lignite coal dusts were reacted with nitrite under an acidic condition. Formation of mutagens from coal dust extracts by nitrosation was highest at pH 3.2 and decreased with increasing pH in the reaction mixture. Mutagenic activity appeared to be independent of metabolic activation. The mutagens formed from nitrosation of coal dust extracts induced frameshift mutations. The results reported here may have possible implications for the explanation of an elevated incidence of gastric cancer in coal miners.     

Obesity in relation to smoking: A population study of women in Göteborg,Sweden

A population sample of 1,462 middle-aged women (participation rate 90.1%) was studied in 1968–1969, 1,302 of whom (participation rate 80.3%) were reexamined in 1974–1975. Cigarette smoking was more frequent among younger women. Current smokers were leaner than nonsmokers. A U-shaped relationship was found between obesity index and cigarette consumption. This relationship was not explained by differences in energy intake, physical activity, or social class. Cessation of smoking was correlated with weight gain, and commencement of smoking with weight loss. Of those who quit 13% gained weight ?10.0 kg and 22% gained between 5.0 and 9.9 kg compared with 4 and 14%, respectively, among those who did not change smoking habits. The average weight change was +3.5 and ?0.7 kg among those who quit smoking and started smoking, respectively, compared with +1.4 kg among those who did not change smoking habits. A greater weight gain with the amount smoked was found both in those who stopped smoking and in those who continued smoking. Increased physical activity and reduced energy intake need consideration at cessation of smoking, especially among heavy smokers. The quantitative aspects of the relationship between smoking and obesity, and between cessation of smoking and weight gain, are considered to be of special interest for health personnel engaged in antismoking campaigns.     

The Connecticut High Blood Pressure Program: A program of public education and high blood pressure screening

The Connecticut High Blood Pressure Program (CHBP) conducted parallel programs of public education and screening at multiple sites throughout the state. From 1974 through 1976, 189,006 adults were screened, of whom 68,240 (36.1%) were classified as hypertensive. This proportion is higher than the estimate obtained by the National Health Survey but can be explained largely by the age structure and treatment status of the CHBP sample. Industries and educational institutions were the most successful sites in regard to the proportions of eligible persons who participated and hypertensive screenees who contacted the referred source of medical care. Of those who were screened as hypertensive and were previously unaware or untreated for the condition, 53% completed the referral, were diagnosed as hypertensive by a physician and placed on treatment or under surveillance, and complied with the therapeutic regimen for at least 4 months. Among hypertensives 45 through 69 years of age, awareness and adequacy of treatment increased from 1974 to 1976. Older screenees, women, and blacks in this group were the least likely to be unaware and most likely to be adequately treated. The public health implications of these findings and their usefulness in planning and guiding other screening programs are discussed.     

Cadmium levels in the blood of inhabitants in nonpolluted areas in Japan with special references to aging and smoking

Blood samples, 2259 in winter and 523 in other seasons of the year, were collected nationwide in Japan from inhabitants (primarily farmers) in areas with no known man-made pollution, and analyzed for cadmium. The levels were distributed log normally, and were lower among young adults and increased gradually to reach a plateau at the 40–59 age group, where the values in females (about 3.6 ng/ml as a geometric mean) were significantly higher than in males (3.0–3.4 ng/ml). The sex difference was positive (P < 0.01) even when 77 pairs of levels were compared between husbands and their wives, both being nonsmokers in the age range of 40–59 years. Smoking habits gave an additional increase in the blood cadmium level. The increase was dose dependent up to 20–29 cigarettes/day and leveled off with further consumption. Effects of passive smoking could not be confirmed. Seasonal variation in blood cadmium level appeared negligible. Variation in the level by geographic location in the country was of doubtful significance. The estimated ratio of cadmium doses by two routes, i.e., via the gastrointestinal tract and via the lungs, was in agreement with the ratio of the blood cadmium level among nonsmokers and the additional increase in the level due to smoking.     

Determinants of blood pressure in Jerusalem schoolchildren

In 1982, 113 first- and second-graders attending an elementary school in West Jerusalem had their blood pressure (BP), height, weight, and resting pulse measured. Three successive BP readings were taken. The mean of the second and third readings was used for data analysis. Mean systolic blood pressure (SBP) was 98.30 +/- 8.51 mm Hg and mean diastolic blood pressure (DBP) was 67.63 +/- 6.85 mm Hg. An analysis of covariance was performed in order to determine the contribution of each independent variable (height, weight-for-height, sex, age, and resting pulse) to the variance in BP, while adjusting for all other independent variables. Height, weight-for-height, and resting pulse were all found to be significantly associated with both SBP and DBP. Children in the upper quartile of weight-for-height had a mean adjusted SBP that was 10.2 mm Hg higher than those in the lower quartile and a mean adjusted DBP that was 7.9 mm Hg higher. Children in the upper quartile of height (for age) had mean adjusted SBP and DBP that were 6.1 and 4.7 mm Hg higher, respectively, than those of children in the lower quartile. Sex and age showed no significant association with SBP. The associations between DBP and both sex and age were not statistically significant (P less than 0.10), but there was a trend for girls and older children to have a slightly higher DBP. In a subsample of 93 children who had both resting pulse and recovery index measured (using the Modified Harvard Step Test for children).(ABSTRACT TRUNCATED AT 250 WORDS)     

The extent of passive smoking in the federal republic of Germany

A representative survey of 1,670 persons between 14 and 65 years of age was conducted in order to obtain current data on active and passive smoking in the Federal Republic of Germany. Overall, 36.7% were smokers, 21.3% were former smokers, and 42.0% were nonsmokers. These rates vary for sociodemographic subgroups and for states, cities, and rural areas. The time pattern during the 24 hr preceding the interview is identical in shape for active as well as passive smoking. The exposed maximum time for passive smoking varies with age and sex. It lies somewhere between 2 and 15% of the observed 24 hr; the best estimates seem to be 5% for nonsmoking men and 3-4% for nonsmoking women. It consistently compares with our preliminary definition of passive smoking. A reconstruction of Hirayama's definition reveals parallel results in terms of maximum exposure time when compared with our preliminary definition. A direct comparison between both definitions showed inconsistencies to an extent that could jeopardize the results of a case-control study. Data demonstrate a massive effect of measuring techniques on study results with regard to the frequency and extent of passive smoking. They also show the vulnerability of the calculation of equivalence of actively smoked cigarettes.     

Physical health and depression: An epidemiologic survey

Levels of mental depression, physical health, and medical care utilization for physical health conditions were measured in Los Angeles County during 1979 in a multiethnic probability sample of 1,003 adults (66% participation). A strong association was observed between the rate of depression, based on the 20-item Center for Epidemiologic Studies-Depression (CES-D) scale, and measures of physical health status. Depressed persons reported more physical illnesses than the nondepressed (1.32 versus 0.89 per person), and they were more likely to contact a health professional for these conditions (1.49 versus 0.97 consultations per physical illness). Similar patterns were observed among the depressed and nondepressed for bed-disability days, hospital admissions, and hospital bed-days. While depression was more common in women than men, a parallel association with physical health status was observed in both sexes.     

Recovery of ingested asbestos fibers from the gastrointestinal lymph in rats

Using the transmission electron microscope, asbestos fibers have been assessed in lymph fluid collected from the thoracic lymph duct in five groups of rats previously exposed to asbestos fibers (by ingestion). Ten rats were gavaged a single dose weighing approximately 20 mg. Five were given pure UICC chrysotile A while another group of five had pure UICC crocidolite. All the rats of the chrysotile group were positive animals with recovery rate values ranging from 6.9 × 10^?7 to 3 × 10^?5 (90% of the fibers being recovered during the first 16 hr following the gavage). The crocidolite group had only three positive animals and lower recovery rate values of 5.7 × 10^?8 to 5.6 × 10^?7. A third group was fed a synthetic diet containing 1%, by weight, chrysotile with a majority of short fibers (90% below 4 μm). Of the 15 rats comprising this group, 13 were positive with maximum daily recovery rates ranging from 2.1 × 10^?7 to 2.1 × 10^?6. A group of eight rats fed the same kind of diet but containing a higher proportion of long fibers, showed only four positive animals, however, they had higher daily recovery rates ranging from 1.9 × 10^?5 to 2.1 × 10^?4. No fibers were encountered in the samples of the two control rats. This study demonstrates the passage of chrysotile and crocidolite fibers across the gastrointestinal wall, with the passage rate being higher for long fibers than short ones.     

Maternal hepatic and embryonic effects of 1,2,4-trichlorobenzene in the rat

The possible maternal hepatic and reproductive effects of 1,2,4-trichlorobenzene (TCB) were assessed in rats given 0, 36, 120, 360, and 1200 mg/kg/day of TCB on Days 9-13 of gestation. The animals were sacrificed on Day 14 of pregnancy. Maternal deaths (2/9 rats, 6/6 rats) were recorded in the 360 and 1200 mg/kg/day treatment groups and body weight gain was significantly decreased in the 360 mg/kg/day TCB group. Maternal liver weight, liver/body weight ratio, and hepatic microsomal protein content were unaffected by TCB treatment. Although Day 14 NADPH-cytochrome c reductase activity was affected only at 360 mg/kg/day TCB, the maternal hepatic microsomal cytochrome P-450 content was significantly increased by administration of both 120 and 360 mg/kg/day of TCB. Hepatic microsomal aminopyrine N-demethylase, ethoxyresorufin O-deethylase, and UDP-glucuronyl transferase activity towards p-nitrophenol were also increased at 120 and 360 mg/kg TCB. Glutathione S-transferase activity to 1-chloro-2,4-dinitrobenzene and 1,2 dichloro-4-nitrobenzene were both increased by pretreatment with TCB. Although pretreatment with 360 mg/kg/day TCB did not increase resorptions, embryolethality, or teratogenicity, embryonic development was significantly retarded by all four growth criteria used (head length, crown-rump length, somite number, and protein content).     

The role of the union health and safety committee in evaluating the health hazards of hospital workers: A case study

The Union Health and Safety Committee is an important tool for evaluating and reducing job-related health risks among hospital workers. The experience of one such committee which effectively performed this duty at New York University Medical Center has led to a city-wide survey by District 1199 of working conditions and health status among hospital laboratory workers. Results showed a possible association of hepatitis with some job practices and led to constructive suggestions for improving working conditions and reducing disease risk among hospital workers.     

Evidence for an intimate geochemical factor in the etiology of esophageal cancer

Epidemiological data for esophageal cancer in the Butterworth District, Transkei, was used to calculate incidence contours which confirmed large variations within short distances (less than 5 km). High- and low-risk zones were demarcated, and a close relationship with underlying geology observed. The low-incidence zones in the study regions were underlain by dolerite intrusions, whereas higher-risk regions were on sedimentary strata. Analysis of rocks indicated that those from the higher-risk regions contain less copper, cobalt, and manganese. Soil samples were analyzed for boron, cobalt, copper, manganese, molybdenum, nickel, sodium, lead, vanadium, and zinc; the results also indicated a strong geochemical association with the disease. The concentrations of copper (P = 0.001), nickel (P = 0.001), and boron were markedly lower in the high-risk zones. Manganese, zinc, and molybdenum levels in soils also tended to be substantially lower in the high-risk zone.