Geospatial analysis of childhood pertussis in Victoria, 1993-97

OBJECTIVE: To demonstrate the feasibility of using Geographical Information Systems (GIS) in public health research. METHODS: Area-based relationships between the incidence of pertussis and immunisation coverage using data on Victorian children aged 0-4 years who contracted pertussis in 1993-97, were analysed at the Local Govemment Area (LGA) level. DTP3 immunisation uptake by LGA was first stratified into two groups: > or = 90% or < 90% (national target). Those under 90% were then divided into two equal bands. The incidence rates for LGAs were classified into quartiles. Immunisation records of children in the 1996-97 birth cohort were reviewed. RESULTS: When the DTP3 immunisation uptake was > or = 90%, seven LGAs were in the upper quartile and eight LGAs in the lower quartile of childhood pertussis notifications incidence. An equal amount of LGAs were in the upper (n = 6) and lower quartiles (n = 6) of notified childhood pertussis incidence rates with an associated DTP3 coverage rate in the lowest band. Of children bom between 1996-97 who contracted pertussis under the age of two, 29% were not immunised and 78.6% were partially immunised at the time of pertussis onset. CONCLUSIONS: GIS enabled the integration of disparate immunisation-related datasets and identified geographic LGAs where immunisation rates were low and pertussis rates were high. IMPLICATIONS: Future research needs to explore the social and environmental factors associated with those not fully immunised at onset of pertussis disease, particularly those in geographic areas highlighted by this research. GIS has the potential to add value in the monitoring and surveillance of geographical patterns of child health, but investments in data quality are urgently required.     

Tuberculosis cases reported among migrant farm workers in the United States, 1993-97

Migrant farm workers (MFWs) are considered a high-risk group for tuberculosis. MFW tuberculosis cases reported to the Centers for Disease Control and Prevention represented 1 percent of all reported tuberculosis cases from 1993 to 1997. Most of these cases (70 percent) were reported from Florida, Texas, and California. MFW tuberculosis cases were more likely to be male, foreign-born, or Hispanic and to have a history of alcohol abuse and homelessness than were non-MFWs. Most (79 percent) foreign-born MFWs were from Mexico. HIV status was poorly reported, with results available for only 28 percent of MFW and 33 percent of non-MFW cases. Of the MFWs tested, 28 percent were HIV infected, whereas 34 percent of non-MFWs were HIV infected. Twenty percent of MFWs move or are lost to follow-up before completing therapy; these cases pose a management challenge for the nation's tuberculosis control efforts.     

The tobacco industry and pesticide regulations: case studies from tobacco industry archives

Tobacco is a heavily pesticide-dependent crop. Because pesticides involve human safety and health issues, they are regulated nationally and internationally; however, little is known about how tobacco companies respond to regulatory pressures regarding pesticides. In this study we analyzed internal tobacco industry documents to describe industry activities aimed at influencing pesticide regulations. We used a case study approach based on examination of approximately 2,000 internal company documents and 3,885 pages of U.S. Environmental Protection Agency documents obtained through Freedom of Information Act requests. The cases involved methoprene, the ethylene bisdithiocarbamates, and phosphine. We show how the tobacco industry successfully altered the outcome in two cases by hiring ex-agency scientists to write reports favorable to industry positions regarding pesticide regulations for national (U.S. Environmental Protection Agency) and international (World Health Organization) regulatory bodies. We also show how the industry worked to forestall tobacco pesticide regulation by attempting to self-regulate in Europe, and how Philip Morris encouraged a pesticide manufacturer to apply for higher tolerance levels in Malaysia and Europe while keeping tobacco industry interest a secret from government regulators. This study suggests that the tobacco industry is able to exert considerable influence over the pesticide regulatory process and that increased scrutiny of this process and protection of the public interest in pesticide regulation may be warranted.     

The tobacco industry, state politics, and tobacco education in California.

OBJECTIVES. Proposition 99 added 25 cents to the California state cigarette tax and mandated that 20% of the new revenues be spent on tobacco education and prevention programs. This paper examines the implementation of these programs and the tobacco industry's response to Proposition 99. METHODS. Political expenditure data for twelve tobacco firms and associations were gathered from California's Fair Political Practices Commission and secretary of state's Political Reform Division. Tobacco education expenditure data were collected from Governor's Budgets and the Department of Finance. RESULTS. Since Proposition 99 passed, tobacco industry political expenditures in California have risen 10-fold, from $790,050 in the 1985-1986 election to $7,615,091 in the 1991-1992 election. The tobacco industry is contributing more heavily to the California legislature than to Congress. A statistical analysis of data on campaign contributions indicates that California legislators' policy-making is influenced by campaign contributions from the tobacco industry. Since fiscal year 1989-1990, the state has ignored the voters' mandate and spent only 14.7% of the new revenues to tobacco education. Medical care programs received more money than permitted by the voters. CONCLUSIONS. The tobacco industry has become politically active in California following the passage of Proposition 99. One result may be that the state has underfunded tobacco education by $174.7 million through the 1993-1994 fiscal year. The estimated redirection of funds to medical care would essentially eliminate the tobacco education campaign by the year 2000.     

Work-related asthma in the educational services industry: California, Massachusetts, Michigan, and New Jersey, 1993-2000

OBJECTIVES: To characterize work-related asthma (WRA) cases working in the educational services industry identified by state-based occupational disease surveillance systems. METHODS: We examined 2,995 WRA cases reported from 1993 to 2000 to four states: California, Massachusetts, Michigan, and New Jersey. RESULTS: A total of 265 (9%) WRA cases were employed in the educational services industry; 69% of cases were classified as new-onset asthma and 31% as work-aggravated asthma. New-onset asthma cases were further classified as occupational asthma (61%) or as reactive airways dysfunction syndrome (8%). The most frequently reported occupation was teachers and teachers' aides (54%). The most frequently reported agents were indoor air pollutants (28%), unspecified mold (16%), dusts (14%), and cleaning products (7%). CONCLUSIONS: Asthma within the educational services industry is an occupational health problem. The health of school employees should also be considered when initiatives addressing asthma among schoolchildren are instituted. The identification, elimination, and/or control of respiratory hazards are important factors for the protection of staff and students alike.     

‘A grim health future’: food risks in the Sydney press

Food scares and newsworthy stories about risks associated with food often receive a high level of attention in the news media. This article examines the reporting of food risks over a recent 14-month period in three metropolitan newspapers available to readers in Sydney. The major topic reported over this time was the relationship between food intake and obesity, which comprised almost half of news stories about food risks. This topic was followed in frequency by the risks associated with primary food production and the risks from processed, restaurant or takeaway food. The article looks in detail at how each of these topics was reported, including the discourses that were employed to give meaning to the news stories. Much emphasis was placed upon personal responsibility for avoiding food risks, particularly in relation to overweight. News stories suggested that Australians, and in particular, Australian children, were facing a crisis in relation to the numbers of people over-eating and becoming fat as a result. The overweight body was represented as grotesque, out of control, unhealthy and unAustralian. In other news stories, various aspects of farming were presented as ‘unnatural’ and thus as rendering foodstuffs risky. Food prepared outside the home was portrayed as far more dangerous than food prepared within the home, with an emphasis in reporting on the potential for contamination in such foods.     

The Fag Lady,revisited: Margaret Thatcher's efforts on behalf of the tobacco industry

ObjectiveThe death of former British Prime Minister Margaret Thatcher has offered many opportunities to reappraise her career. However it is not widely known that she acted as a consultant for the tobacco industry following her resignation from office. The availability of evidence from tobacco documents archives offers the opportunity to explore her work for Philip Morris, and more generally to assess how industry seeks to influence and use elected and former public officials.Study design and methodsAnalysis of documents from the Legacy Tobacco Documents Library (http://legacy.library.ucsf.edu). Memos, letters and other documents were sought which mentioned Margaret Thatcher or other key individuals. Documents (n = 151) were downloaded as PDFs. Of these 51 provided relevant information.ResultsMargaret Thatcher advised Philip Morris on issues including advertising bans, lowering of tobacco tariffs in EEC countries, reducing tobacco taxes, and anti-tobacco programs. She had previously been involved in moving two of her ministers from their posts in response to tobacco industry pressure. She advised Philip Morris to exert political pressure through the House of Commons by lobbying MPs against the Conservative government accepting ECOFIN, an European Union (EU) tax harmonisation agreement. Other activities included trips to Prague, Tokyo, Chicago, Geneva and Hong Kong on Philip Morris' behalf, or for meetings with Philip Morris executives.ConclusionsRelationships between politicians and industry remain relevant today, not least because Article 5.3 of the WHO Framework Convention on Tobacco Control includes the protection of public health policies from tobacco industry interference. The findings are consistent with findings from other studies which show tobacco industry attempts to influence governments, for example to attempt to weaken the WHO Framework Convention on Tobacco Control. They particularly point out the value of former senior politicians to industry, specifically their 'insider knowledge' which can be employed to gain access to and influence other policymakers on industry's behalf.     

Air pollution and daily mortality in Sydney, Australia, 1989 through 1993.

OBJECTIVES: This study examined the effects of outdoor air pollutants in Sydney, Australia, on daily mortality. METHODS: Time-series analysis was performed on counts of daily mortality and major outdoor air pollutants (particulates, ozone, and nitrogen dioxide) in Sydney (1989 to 1993) with adjustment for seasonal and cyclical factors. Poisson regression was calculated with allowance for overdispersion and autocorrelation. The effects of lagging exposure by 0 to 2 days were assessed with single- and multiple-pollutant models. RESULTS: An increase in daily mean particulate concentration from the 10th to the 90th centile was associated with an increase of 2.63% (95% confidence interval 0.87 to 4.41) in all-cause mortality and 2.68% (0.25 to 5.16) in cardiovascular mortality. An increase in daily maximum 1-hour ozone concentration from the 10th to the 90th centile was associated with an increase of 2.04% (0.37 to 3.73) in all-cause mortality and 2.52% (-0.25 to 5.38) in cardiovascular mortality. An increase in the daily mean nitrogen dioxide concentration from the 10th to the 90th centile was associated with an increase of 7.71% (-0.34 to 16.40) in respiratory mortality. Multiple-pollutant models suggest that the effects of particulates and ozone on all-cause and cardiovascular mortality, and of nitrogen dioxide on respiratory mortality, are independent of the effects of the other pollutants. CONCLUSIONS: Current levels of air pollution in Sydney are associated with daily mortality.     

Revised pregnancy rates, 1990-97, and new rates for 1998-99: United States.

OBJECTIVES: This report presents detailed pregnancy rates for 1990-99. Rates for 1991-97 are revised using populations consistent with the April 1, 2000, census; the revised populations are also used for the new 1998-99 rates. METHODS: Tabular and graphic data on pregnancy rates by age, race, and Hispanic origin, and by marital status are presented and described. RESULTS: In 1999, an estimated 6.23 million pregnancies resulted in 3.96 million live births, 1.31 million induced abortions, and 1.0 million fetal losses. The pregnancy rate in 1999 was 102.1 pregnancies per 1,000 women aged 15-44 years. The 1999 rate was similar to the rates since the mid 1990s, but it was 12 percent below the peak rate in 1990 (115.6). These data extend a consistent series of pregnancy rates from 1976 through 1999. The teenage pregnancy rate dropped steadily through the 1990s, reaching a record low of 86.7 per 1,000 aged 15-19 years in 1999, 25 percent lower than the 1990 peak (116.3). Rates fell more for younger than for older teenagers. The declines reflect reductions in births and abortions.     

Quid pro quo: tobacco companies and the black press

Objectives. We explored the relationship between tobacco companies and the Black press, which plays an important role in conveying information and opinions to Black communities.Methods. In this archival case study, we analyzed data from internal tobacco industry documents and archives of the National Newspaper Publishers Association (NNPA), the trade association of the Black press.Results. In exchange for advertising dollars and other support, the tobacco industry expected and received support from Black newspapers for tobacco industry policy positions. Beginning in the 1990s, resistance from within the Black community and reduced advertising budgets created counterpressures. The tobacco industry, however, continued to sustain NNPA support.Conclusions. The quid pro quo between tobacco companies and the Black press violated journalistic standards and represented an unequal trade. Although numerous factors explain today''s tobacco-related health disparities, the Black press''s service to tobacco companies is problematic because of the trust that the community placed in such media. Understanding the relationship between the tobacco industry and the NNPA provides insight into strategies that the tobacco industry may use in other communities and countries.Tobacco use is a leading cause of health disparities affecting African Americans.^1–4 Older African Americans (≥ 44 years) have the highest smoking rates of any group (about 30%).⁵ Among lower-income African Americans, smoking rates are as high as 59%.^6,7 Over 45 000 African Americans die from tobacco-related diseases each year,^3,8,9 which constitutes the highest smoking-related disease burden of any US group.^7,10–12 African American communities also disproportionately bear lost productivity from tobacco-caused diseases. Although constituting only 6% of California''s population, African Americans account for 8% of smoking-attributable expenditures and 13% of smoking-attributable mortality costs.¹³Although smoking prevalence results from complex interactions of multiple factors, including socioeconomic status, cultural characteristics, acculturation, stress, advertising, cigarette prices, parental and community disapproval, and abilities of local communities to mount effective tobacco-control initiatives,¹⁴ the disproportionate tobacco-related disease burden among African Americans suggests the need for closer examination of the factors related to smoking prevalence that may be unique to the community. One factor in creating a climate in which smoking seems acceptable is the influence of the tobacco industry on cultural and social institutions,¹⁵ including the media.African American communities have long been targeted with tobacco advertisements, products, and philanthropy.^7,16–18 Tobacco companies have also sought to influence journalism¹⁹ and sustain extensive ties with African American leadership groups¹⁵ to undermine tobacco control. Although some research has previously recognized tobacco company support of minority-targeted media,^20,21 no previous studies have examined the longstanding relationship between tobacco companies and the National Newspaper Publishers Association (NNPA), the most important Black media organization. We explored the role of tobacco industry patronage of African American newspaper publishers and the expectations that such patronage involved. (Note that we use the terms Black and African American here interchangeably, as is common in US minority health research.²² Additional terms may be used, depending on the context and historical period; for instance, Negro was a common term used to refer to people of African descent through the 1970s.)     

Effect of temperature on mortality during the six warmer months in Sydney, Australia, between 1993 and 2004

Studies of heat-related mortality have been predominantly based on analyses of underlying cause of death as the single indicator of a population's vulnerability to high temperatures. Examination of both underlying and associated causes of death could provide a more comprehensive understanding of the population at risk. This study analyzes the impact of high temperatures on mortality in Sydney, Australia, during the warmer six months (October-March) between 1993 and 2004, using the underlying and associated cause of death due to all-cause, circulatory, and respiratory disease. Some mortality datasets were also divided into two age groups, 0-64 and 65+. A generalized linear model assuming negative binomial distribution was constructed for the daily mortality counts using daily maximum temperature and hourly maximum concentrations of ozone (O₃) and particulate matter (PM₁₀) as covariates. With the air pollution terms in a model, the change in mortality was estimated to be between 4.5% and 12.1% for a 10 °C increase in maximum daily temperature, depending on mortality dataset. When air pollutants were removed from a model, the above mortality percentages changed by −1.1% to 0.9%. When both underlying and associated causes of death were considered, the effect remained the same or became lower. Maximum temperature has been found to have a significant effect on mortality in Sydney, with PM₁₀ and O₃ confounding the association.     

Fatalities construction industry in the United States, 1992 and 1993

To improve the estimates of occupational fatality rates for persons employed in the construction industry, several sources of data on the number of fatalities (the numerator) and the number of persons engaged in construction work (the denominator) were examined. Based on this examination, the Census of Fatal Occupational Injuries (CFOI), compiled by the Bureau of Labor Statistics (BLS), was used to obtain numerators and the Current Population Survey, conducted by the Bureau of the Census for the BLS, was used to obtain denominators. Adjustments were made in the numerator to include only occupations that were included in the denominator. Occupations were divided into two groups—those in the construction trades and those in other occupations within construction (e.g., clerical, sales). The analysis found fatality rates of 14.2 and 13.3 per 100,000 person-years, respectively, for 1992 and 1993, with wide variation in rates among the different trades. There were also major differences among the trades in the types of fatal injuries. Self-employed workers had much lower death rates overall than wage workers, but this is largely due to much lower proportions of high hazard trades among the self-employed. There have been wide variations in the occupational fatality rates reported for construction workers each year due to the differing methods of estimating the number of fatalities by the different data sources. This study provides a baseline of fatality rates using the best available current data. It compares the results from these data sources with those from other sources that have been used and discusses some of the problems inherent in the data from other sources. This study provides a significantly improved protocol for the calculation of fatality rates against which later rates can be compared consistently. Nevertheless, many deficiencies in the data sources used are identified. There remains ample room for continued improvement. © 1996 Wiley-Liss, Inc.     

91 种平面媒体烟草广告及控烟报道刊出情况分析

目的 监测平面媒体烟草广告及控烟报道刊出情况,评价全面禁止烟草广告政策在我国平面媒体的执行情况.方法 监测91种平面媒体2013年5月13日-19日所有版面的刊出内容,对其刊出的烟草广告及控烟报道进行记录、分析和比较.结果 11种报纸杂志刊出烟草广告12篇,占监测媒体种类的12.1％;其中直接烟草广告2篇,新闻专访和新闻特写等深度报道占33.3％ （4/12）.17种报纸刊出控烟报道37篇,占监测媒体种类的18.7％,未见杂志刊登控烟报道;控烟报道中64.9％ （24/37）为新闻消息.结论 须尽快修改烟草广告相关法律,明确烟草广告定义,去除法律盲区;加强平面媒体烟草广告监管力度;加强控烟媒体报道.     

Pictures worth a thousand words: noncommercial tobacco content in the lesbian, gay, and bisexual press

Smoking prevalence in the lesbian, gay, and bisexual (LGB) community is higher than in the mainstream population. The reason is undetermined; however, normalization of tobacco use in the media has been shown to affect smoking rates. To explore whether this might be a factor in the LGB community, we examined noncommercial imagery and text relating to tobacco and smoking in LGB magazines and newspapers. Tobacco-related images were frequent and overwhelmingly positive or neutral about tobacco use. Images frequently associated smoking with celebrities. Text items unrelated to tobacco were often illustrated with smoking imagery. Text items about tobacco were likely to be critical of tobacco use; however, there were three times as many images as text items. The number of image items was not accounted for by the number of text items: nearly three quarters of all tobacco-related images (73.8%) were unassociated with relevant text. Tobacco imagery is pervasive in LGB publications. The predominant message about tobacco use in the LGB press is positive or neutral; tobacco is often glamorized. Noncommercial print images of smoking may normalize it, as movie product placement does. Media advocacy approaches could counter normalization of smoking in LGB-specific media.     

Spatial analysis of heat-related mortality among the elderly between 1993 and 2004 in Sydney,Australia

This study analyzed the geographical patterns of heat-related mortality among the population aged 65 and over within the metropolitan area of Sydney, Australia between 1993 and 2004, and evaluated the role of some physical and socio-demographic risk factors associated with it. The effect of temperature on all-cause mortality during unusually hot days was investigated using spatial analytic techniques, such as cluster analysis and spatial regression analysis. Generalized Linear Models (GLMs) were used to investigate the role of daily average temperature, ozone (O₃) and particulate matter of diameter less than 10 μm (PM₁₀) at the regions that showed a significant increase in mortality on unusually hot days.