Patterns of cigar use in California in 1999.

BACKGROUND: Adult cigar use in California increased substantially between 1990 and 1996. METHODS: Cigar smoking prevalence is from the 1990, 1996, and 1999 California Tobacco Surveys (CTS), large cross-sectional random-digit-dialed surveys designed to identify trends in tobacco use in the California population. Questions added to the 1999 CTS allowed a more detailed assessment of cigar smoking patterns. RESULTS: Adult cigar use prevalence increased from 2.5% (95% confidence interval [CI], 2.2-2.8) in 1990 to 4.9% (95% CI=4.5-5.3) in 1996, and declined to 4.4% (95% CI=4.1-4.7) in 1999. Nearly the entire decrease was accounted for by less use in adults who had never been cigarette smokers. Among current cigar smokers in 1999, 43.3% (95% CI=37.8-48.8) had not smoked a cigar in the last month, just 16.2% (95% CI=7.9-24.5) of never cigarette smokers smoked three or more cigars in the past month, but 10.4% (95% CI=5.0-15.8) of former cigarette smokers-the group with the highest level of cigar consumption-reported daily use. CONCLUSIONS: Cigar use may have peaked in California around 1996; in 1999, the intensity of use was generally at modest levels. California's bans on smoking in bars and restaurants may limit cigar smoking while drinking, so that the observed patterns may or may not reflect those in the rest of the United States.     

Tobacco control success versus demographic destiny: examining the causes of the low smoking prevalence in California

We examined the effect of demographics on California's low smoking prevalence. We estimated that if the United States had the same demographics as California, then the US adult smoking prevalence in 2005 would have been 19.3%, 1.6 percentage points lower than the reported 20.9% for the United States, but 4.1 percentage points higher than California's prevalence of 15.2% in 2005. Tobacco control appears to be a much more important factor than demographics in determining California's low smoking rates.     

Patterns of cigar use in Clifornia in 1999

Background: Adult cigar use in California increased substantially between 1990 and 1996.Methods: Cigar smoking prevalence is from the 1990, 1996, and 1999 California Tobacco Surveys (CTS), large cross-sectional random-digit-dialed surveys designed to identify trends in tobacco use in the California population. Questions added to the 1999 CTS allowed a more detailed assessment of cigar smoking patterns.Results: Adult cigar use prevalence increased from 2.5% (95% confidence interval [CI], 2.2–2.8) in 1990 to 4.9% (95% CI=4.5–5.3) in 1996, and declined to 4.4% (95% CI=4.1–4.7) in 1999. Nearly the entire decrease was accounted for by less use in adults who had never been cigarette smokers. Among current cigar smokers in 1999, 43.3% (95% CI=37.8–48.8) had not smoked a cigar in the last month, just 16.2% (95% CI=7.9–24.5) of never cigarette smokers smoked three or more cigars in the past month, but 10.4% (95% CI=5.0–15.8) of former cigarette smokers—the group with the highest level of cigar consumption—reported daily use.Conclusions: Cigar use may have peaked in California around 1996; in 1999, the intensity of use was generally at modest levels. California’s bans on smoking in bars and restaurants may limit cigar smoking while drinking, so that the observed patterns may or may not reflect those in the rest of the United States.     

Prevalence and Trends in Smoking: A National Rural Study

CONTEXT: Cigarette smoking is the leading preventable cause of death in the United States. PURPOSE: To estimate the prevalence of and recent trends in smoking among adults by type of rural location and by state. METHODS: Random-digit telephone survey of adults aged 18 years or older who participated in the Behavioral Risk Factor Surveillance System in 1994-1996 (n = 342,055) and 2000-2001 (n = 385,384). The main outcome measure was current cigarette smoking, defined as persons who smoke every day or some days, while nonsmokers were those who smoke not at all or reported never having smoked as many as 100 cigarettes. FINDINGS: The prevalence of smoking changed little from the mid-1990s; in 2000-2001, it was 22.0% in urban areas, 24.9% in rural adjacent areas, 24.0% in large rural nonadjacent areas, and 24.9% in small rural nonadjacent areas. For rural locations combined, smoking prevalence was not below the 12% goal of Healthy People 2010 for any state, although the 12.5% prevalence in rural Utah approached this target. Prevalence was > or = 28% for rural residents of Kentucky, Ohio, and Indiana. Since the mid-1990s, the prevalence of smoking for rural respondents decreased by more than 2 percentage points in 6 states: California, Connecticut, Maryland, North Carolina, Tennessee, and Utah. However, it increased by 2 percentage points or more in 10 states: Alabama, Delaware, Georgia, Massachusetts, Michigan, Mississippi, New Hampshire, Oklahoma, South Carolina, and Texas. CONCLUSIONS: Smoking remains a refractory public health problem. Better ways to curb smoking in rural America are needed.     

The effect of smoke-free homes on smoking behavior in the U.S

BACKGROUND: Evidence from longitudinal population surveys is needed to establish whether smoke-free homes might influence smoking behavior. METHODS: The Tobacco Use Supplement of the nationally representative U.S. Current Population Survey (TUS-CPS) interviewed 3292 adult recent smokers in 2002 and again 12 months later. Both surveys measured smoking status, rules on smoking in the home, and the number of cigarettes smoked per day (cpd). For the main study outcome, an early marker of successful cessation (>/=90 days quit) was used. Analysis was completed in 2008. RESULTS: In the 12 months ending February 2003, the prevalence of smoke-free homes among recent smokers increased from 33% to 39%. A smoke-free home at baseline was associated with >/=90 days cessation at follow-up (10.9% vs 6.2%, AOR=1.44; 95% CI=0.97, 2.21), and those who maintained a smoke-free home were more likely to be >/=90 days quit than those who did not (12.9% vs 5.7%, AOR=1.99; 95% CI=0.93, 4.25). However, adopting a smoke-free home during the year was associated with a nearly fivefold increase in the percentage of >/=90 days quit (AOR=4.81; 95% CI=3.06, 7.59). This increase was seen among all smokers, including moderate-to-heavy smokers (>/=90 days quit: a smoke-free home=13.0% vs no smoke-free home=2.9%, p<0.001). Among continuing smokers with a smoke-free home at baseline, maintenance of the smoke-free home was associated with a decline in consumption (mu=-2.18; 95% CI=-1.24; -3.10 cpd). Among continuing smokers with no smoke-free home at baseline, adoption of that status was also associated with a decline in consumption (mu=-1.72; 95% CI=-0.58; -2.85 cpd). CONCLUSIONS: This study provides strong evidence that the adoption of a smoke-free home is associated with successful quitting among smokers in the U.S.     

Population-based evidence of a strong decline in the prevalence of smokers in Brazil (1989-2003)

OBJECTIVE: To evaluate the evolution in smoking indicators in the adult Brazilian population between 1989 and 2003. METHODS: We compared age-adjusted prevalence ratios and means for smoking indicators, stratified by age, sex and sociodemographic variables, obtained from two comparable household surveys that used probabilistic sampling of the Brazilian population aged > 18 years (n = 34 808 in 1989 and n = 5000 in 2003). FINDINGS: Between 1989 and 2003, there was a substantial decrease in the prevalence of smoking (from 34.8% to 22.4%; age-adjusted prevalence ratio, 0.65; 95% confidence interval, CI, 0.60-0.70) and a modest reduction in the mean number of cigarettes smoked per day (from 13.3 to 11.6; age-adjusted difference, -1.8; 95% CI, -2.6 - -1.0). Reductions in the prevalence and intensity of smoking were greater among males, younger age groups and higher socioeconomic strata. CONCLUSION: The prevalence of smoking in the adult Brazilian population declined by 35% between 1989 and 2003, or an average of 2.5% per year. This exceptional reduction surpasses those seen in other countries that implemented wide-ranging and rigorous policies for controlling smoking during the same period. The more intense decline in smoking in younger age groups was consistent with the concentration of efforts of the Brazilian tobacco control programme to prevent the onset of smoking among youths and the total prohibition of cigarette advertising. We recommend the intensification of programme initiatives targeting women and less economically favoured population strata.     

Prevalence of HIV infection among young adults in the United States: results from the Add Health study

OBJECTIVES: We estimated HIV prevalence rates among young adults in the United States. METHODS: We used survey data from the third wave of the National Longitudinal Study of Adolescent Health, a random sample of nearly 19000 young adults initiated in 1994-1995. Consenting respondents were screened for the presence of antibodies to HIV-1 in oral mucosal transudate specimens. We calculated prevalence rates, accounting for survey design, response rates, and test performance. RESULTS: Among the 13184 participants, the HIV prevalence rate was 1.0 per 1000 (95% confidence interval [CI] = 0.4, 1.7). Gender-specific prevalence rates were similar, but rates differed markedly between non-Hispanic Blacks (4.9 per 1000; 95% CI=1.8, 8.7) and members of other racial/ethnic groups (0.22 per 1000; 95% CI=0.00, 0.64). CONCLUSIONS: Racial disparities in HIV in the United States are established early in the life span, and our data suggest that 15% to 30% of all cases of HIV occur among individuals younger than 25 years.     

An international comparison of cancer survival: relatively poor areas of Toronto, Ontario and three US metropolitan areas

BACKGROUND: This study of cancer survival compared adults in Toronto, Ontario and three US metropolitan areas: Seattle, Washington; San Francisco, California; and Hartford, Connecticut. It examined whether socioeconomic status has a differential effect on cancer survival in Canada and the United States. METHODS: The Ontario Cancer Registry and the National Cancer Institute's Surveillance, Epidemiology and End RESULTS: (SEER) programme provided a total of 23,437 and 37,329 population-based primary malignant cancer cases for the Toronto and US samples, respectively (1986-1988, followed until 1994). Census-based measures of socioeconomic status were used to ecologically control absolute income status. RESULTS: Among residents of low-income areas, persons in Toronto experienced a 5 year survival advantage for 13 of 15 cancer sites [minimally one gender significant at 95 per cent confidence interval (CI)]. An aggregate 35 per cent survival advantage among the Canadian cohort was demonstrated (survival rate ratio (SRR) = 1.35, 95 per cent CI= 1.30-1.40), and this effect was even larger among younger patients not yet eligible for Medicare coverage in the United States (SRR = 1.46, 95 per cent CI = 1.40-1.52). CONCLUSION: Systematically replicating a previous Toronto-Detroit comparison, this study's observed consistent pattern of Canadian survival advantage across various cancer sites suggests that their more equitable access to preventive and therapeutic health care services may be responsible for the difference.     

An assessment of US and Canadian smoking reduction objectives for the year 2000.

OBJECTIVES: This study assessed whether US and Canadian smoking reduction objectives for the year 2000 are attainable. The United States seeks to cut smoking in its population to 15%; the Canadian goal is 24%. METHODS: Smoking data were obtained for the United States (1974-1994) and Canada (1970-1995) for the overall populations and several age-sex subpopulations. Analyses estimated trends, future prevalences, and the likelihood of goal attainment. Structural time-series models were used because of their ability to fit a variety of trends. RESULTS: The findings indicate that smoking has been declining steadily since the 1970s, by approximately 0.7 percentage points a year, in both countries. Extrapolating these trends to the year 2000, the US prevalence will be 21% and the Canadian prevalence 24%. CONCLUSIONS: If the current trends continue, the Canadian goal seems attainable, but the US goal does not. The US goal is reachable only for 65-to 80-year-olds, who already have low smoking prevalences. It appears that both countries must increase their commitment to population-based tobacco control.     

State-specific progress toward the 1990 objective for the nation for cigarette smoking prevalence.

We predicted the smoking prevalences for 1990 for each state in the US, assuming that the decline in each state from 1985-1990 would be the same as the decline in the US from 1965-1985. In 1985, only three states had smoking prevalences less than 25 percent. Based upon the observed decline in smoking in the US from 1965-1985 of 0.5 percent per year, we predict that only seven states will have smoking prevalences less than 25 percent by 1990. States need to consider current smoking prevalence and achievable rates of decline when setting objectives for 1990 and beyond.     

Setting a challenging yet realistic smoking prevalence target for Healthy People 2020: learning from the California experience

Objectives. We sought to outline an optimistic yet achievable goal for future US smoking prevalence rates based on empirical evidence reflecting the success of smoking control efforts in California.Methods. Using a dynamic model and the smoking initiation and cessation rates achieved in California as a guide, we projected US adult smoking prevalence rates through the year 2020.Results. If smoking initiation and cessation rates for the nation do not change, population dynamics will result in smoking prevalence rates falling to 19.1% in 2010 and 16.8% in 2020. If the country attains California’s initiation and cessation rates by 2010, adult smoking prevalence rates will be 18.5% in 2010 and 14.7% as of 2020.Conclusions. If California’s smoking initiation and cessation rates are attained nationwide, the US smoking prevalence rate could be 5.9 percentage points lower than the 2005 rate by the year 2020, and there would be 10.2 million fewer smokers than in 2005. A target of 14% smoking prevalence by 2020 is aggressive yet feasible, given that it takes into account the constraints imposed by population demographics.Adult smoking prevalence rates in the United States continue to decline, although painfully slowly. Despite enormous progress in smoking control during the past 40 years (the adult prevalence rate dropped from 42.4% in 1965 to 20.9% in 20051), cigarette smoking remains the leading cause of premature death among Americans, killing approximately 440 000 citizens annually.2 Currently, more than 44 million Americans smoke, and half of these individuals will die prematurely unless they abandon their addiction in time.3The overall US smoking prevalence rate of 20.9% in 2005 (the most recent year for which data were available at the time this article was written) reflects a diverse combination of rates stemming from the differences between states in terms of demographic characteristics and implementation of tobacco control efforts. Rates vary from a low of 11.5% in Utah, commonly attributed to the state’s large Mormon population, to a high of 28.7% in Kentucky, where population demographics, the prominence of tobacco in the history and economy of the state, and limited tobacco control efforts contribute to the persistently high prevalence of smoking.4We addressed the question of how much lower, and how much faster, overall US smoking prevalence rates would fall by the year 2020 if the initiation and cessation rates achieved as of 2005 in California, the state with the second lowest adult smoking prevalence in the country (15.2% in 2005), could be reproduced across the entire country. Assessing the degree to which there is a causal link between antismoking policies and declining smoking prevalence rates in California or any other state is challenging because it is plausible that regions with strong antitobacco attitudes are more likely to implement stringent smoking control measures.5However, proof of causality is not necessary to make our intended point. If we assume, correctly or otherwise, that smoking control policies are solely responsible for California’s smoking initiation and cessation rates—and therefore its low smoking prevalence—replicating those rates across the country would allow us to derive an optimistic scenario for smoking trends in the United States in the immediate future given the effectiveness of currently available tobacco control programs. Given that the government is currently initiating the process of setting objectives for its Healthy People 2020 program, an analysis of these trends could assist the nation in selecting a challenging yet potentially reachable smoking prevalence target for the year 2020 based on best-case effects of tobacco control programming.     

Risk factors for asthma and cough among Hispanic children in the southwestern United States of America, 2003-2004.

OBJECTIVES: To investigate the impact of environmental tobacco smoke (ETS) exposure and mother's place of birth (Mexico vs. United States of America) on the prevalence of asthma and dry nighttime cough among children 2-12 years old residing in the southwestern United States. METHODS: Data were collected from November 2003 through March 2004 as part of a health survey of Hispanic mothers with young children who sought emergency, nutrition, or other clinical services. Information about respiratory health was obtained for one randomly selected child per United States-born (no. = 144) or Mexico-born (no. = 125) mother. Information on maternal and household sociodemographic variables, smoking, parental asthma, and child's exposure to room or automobile ETS during the previous seven days was also collected. Adjusted prevalence ratios were estimated with modified Poisson regression models. RESULTS: Most sociodemographic and ETS exposure variables differed significantly by mother's country of birth. Modeled asthma prevalence was 1.95 [95% confidence interval (CI) = 1.03-3.68] times greater in children of United States-born mothers than children of Mexico-born mothers. This difference persisted after known asthma risk factors were controlled for, including parental asthma, socioeconomic and demographic variables, and child ETS exposure. Children's recent automobile ETS exposure was associated with dry nighttime cough [adjusted prevalence ratio (PR) = 1.94, 95% CI = 1.19-3.15] and asthma (PR = 2.09; 95% CI = 0.99-4.39). CONCLUSIONS: Exposure to ETS in automobiles is an important risk factor for asthma and dry nighttime cough among Hispanic children in the southwest United States, regardless of mother's country of birth. Further research is needed to identify causes of the higher prevalence of asthma in Hispanic children of United States-born mothers.     

The question of declining sperm density revisited: an analysis of 101 studies published 1934-1996

In 1992 Carlsen et al. reported a significant global decline in sperm density between 1938 and 1990 [Evidence for Decreasing Quality of Semen during Last 50 Years. Br Med J 305:609-613 (1992)]. We subsequently published a reanalysis of the studies included by Carlsen et al. [Swan et al. Have Sperm Densities Declined? A Reanalysis of Global Trend Data. Environ Health Perspect 105:1228-1232 (1997)]. In that analysis we found significant declines in sperm density in the United States and Europe/Australia after controlling for abstinence time, age, percent of men with proven fertility, and specimen collection method. The declines in sperm density in the United States (approximately 1.5%/year) and Europe/Australia (approximately 3%/year) were somewhat greater than the average decline reported by Carlsen et al. (approximately 1%/year). However, we found no decline in sperm density in non-Western countries, for which data were very limited. In the current study, we used similar methods to analyze an expanded set of studies. We added 47 English language studies published in 1934-1996 to those we had analyzed previously. The average decline in sperm count was virtually unchanged from that reported previously by Carlsen et al. (slope = -0.94 vs. -0.93). The slopes in the three geographic groupings were also similar to those we reported earlier. In North America, the slope was somewhat less than the slope we had found for the United States (slope = -0.80; 95% confidence interval (CI), -1.37--0.24). Similarly, the decline in Europe (slope = -2.35; CI, -3.66--1.05) was somewhat less than reported previously. As before, studies from other countries showed no trend (slope = -0.21; CI, -2.30-1.88). These results are consistent with those of Carlsen et al. and our previous results, suggesting that the reported trends are not dependent on the particular studies included by Carlsen et al. and that the observed trends previously reported for 1938-1990 are also seen in data from 1934-1996.     

Smoking trends among Filipino adults in California, 1990-2002

OBJECTIVES: Filipinos comprise about 18% of the Asian/Pacific Islander American (APIA) population and are increasing. Few studies have examined Filipino current smoking prevalence rates (CSPR) and none have described trends over time. METHODS: Trends in CSPR were estimated for Filipinos and non-Hispanic whites (NHW) from 1990-2002 from the California Tobacco Surveys (N>42,000/year). RESULTS: CSPR for Filipino males declined: 23.7% (95% CI: 18.7, 28.7) in 1990 to 18.7% (15.3, 22.1) in 2002 (p<0.05). The decline in CSPR for Filipino women was non-significant (p=0.24), 9.8% (5.5, 14.1) in 1990 and 7.7% (5.3, 10.1) in 2002. During the same period, CSPR among NHW males declined: 24.4% (23.8, 25.0) in 1990 to 18.8% (18.1, 19.4) in 2002 (p<0.01). For female NHW, CSPR were 21.3% (20.5, 22.0) in 1990 and 15.0% (14.4, 15.6) in 2002 (p<0.01). Adjusted logistic regression for Filipinos suggest that English language use is associated with current smoking among females (p<0.01) and that, overall, 18-29 year-olds were more likely to be current smokers than those 45+ years old (p<0.01). CONCLUSION: Trends for male Filipino current smokers declined similarly to male NHW from 1990-2002; female rates were lower but did not decline. Future smoking prevention and cessation programs would benefit by taking into account important differences in smoking rates between genders and age groups.     

Changes in the prevalence of cognitive impairment among older Americans, 1993-2004: overall trends and differences by race/ethnicity

The authors used data from 6 waves of the Health and Retirement Study to evaluate changes in the prevalence of cognitive impairment among adults 70 years of age or older from 1993 to 2004. Having sampling weights for each wave enabled the authors to create merged waves that represented cross-sections of the community-dwelling older population for that year. Logistic regression analyses with year as the predictor were used to estimate trends and determine the contribution of sociodemographic and health status variables to decreasing trends in the prevalence of cognitive impairment over time (score ≤8 on a modified Telephone Interview Cognitive Screen). Results showed an annual decline in the prevalence of cognitive impairment of 3.4% after adjustment for age, gender, and prior test exposure (odds ratio (OR) = 0.966, 95% confidence interval (CI): 0.941, 0.992). The addition of socioeconomic variables to the model attenuated the trend by 72.1%. The annual percentage of decline in impairment was larger for blacks (OR = 0.943, 95% CI: 0.914, 0.973) and Hispanics (OR = 0.954, 95% CI: 0.912, 0.997) than for whites (OR = 0.971, 95% CI: 0.936, 1.006), although the differences were not statistically significant. Linear probability models used in secondary analyses showed larger percentage-point declines for blacks and Hispanics. Improvements in educational level contributed to declines in cognitive impairment among older adults-particularly blacks and Hispanics-in the United States.     

Differences in the temporal trends of HIV seroincidence and seroprevalence among sexually transmitted disease clinic patients, 1989-1998: application of the serologic testing algorithm for recent HIV seroconversion

The authors compared temporal trends in the prevalence and incidence of human immunodeficiency virus (HIV) infection based upon 34,866 specimens from patients who attended the San Francisco, California, municipal sexually transmitted disease clinic between 1989 and 1998. HIV infection data were collected during annual blinded HIV serologic surveys. Incidence was determined by applying a serologic testing algorithm for recent HIV seroconversion that uses both a sensitive and a less sensitive enzyme immunoassay to stored HIV positive sera. The HIV seroprevalence declined from 15.2% in 1989 to 7.2% in 1998 (odds ratio per year = 0.92, 95% confidence interval (CI): 0.91, 0.94). Among homosexual men, the HIV prevalence declined from 50.9% in 1989 to 19.9% in 1998 (odds ratio per year = 0.86, 95% CI: 0.85, 0.88). The pooled seroincidence was 1.6% and did not change significantly over time (odds ratio per year = 1.0, 95% CI: 0.98, 1.1). The pooled seroincidence among homosexual men was 6.6% per year and remained steady between 1989 and 1998 (odds ratio per year = 0.99, 95% CI: 0.92, 1.1). During a dramatic, 10-year decline in seroprevalence of HIV infection, the incidence of HIV infection remained remarkably stable.     

Female victims of intimate partner physical domestic violence (IPP-DV), California 1998

BACKGROUND: This study was conducted to identify factors associated with adult female victims of intimate partner physical domestic violence (IPP-DV) in California and to estimate statewide IPP-DV prevalence. METHODS: We analyzed data from the 1998 California Women's Health Survey, a random, computer-assisted telephone interview (CATI) survey of 4006 California women aged > or = 18, conducted by the California Department of Health Services. RESULTS: Data from the survey indicated that 6% of the women reported that in the previous 12 months, their intimate partners threw objects at them, or hit them with an object, or kicked, pushed, slapped, choked, beat up, or threatened them with a gun or a knife. Odds ratio (OR) analyses controlling for age and race/ethnicity suggest that a large number of factors are associated statistically with IPP-DV victims. These factors include feelings of ill physical and mental health; pregnancies at early age; smoking status; nutritional needs; low income; participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program; having children aged < 18 in the household; and limited access to health care. Among the non-U.S.-born respondents, IPP-DV victims were significantly younger when they entered the United States than their nonvictim counterparts. A multiple logistic regression model identified the following factors as main correlates with IPP-DV: feelings of being overwhelmed in the past 30 days (OR = 3.4, 95% confidence interval [CI] = 2.5-4.6); aged 18 to 44 (OR = 2.8, 95% CI = 1.9-4.1); current smoking status (OR = 2.1, 95% CI = 1.5-2.9); participation in WIC in the previous 2 years (OR = 1.8, 95% CI = 1.2-2.6); and being out of work (OR = 1.4, 95% CI = 1.1-1.9). CONCLUSIONS: The above findings suggest that a variety of venues (e.g., schools, mental and physical health care providers, WIC, immigration programs, and social services) will be needed in order to identify/gain access to IPP-DV victims, provide referral resources, and implement any future prevention efforts.     

Trends in tuberculosis incidence--United States, 2006

In 2006, a total of 13,767 tuberculosis (TB) cases (4.6 per 100,000 population) were reported in the United States, representing a 3.2% decline from the 2005 rate. This report summarizes provisional 2006 TB incidence data from the National TB Surveillance System and describes trends since 1993. The TB rate in 2006 was the lowest recorded since national reporting began in 1953, but the rate of decline has slowed since 2000. The average annual percentage decline in the TB incidence rate decreased from 7.3% per year during 1993-2000 (95% confidence interval [CI] = 6.9%-7.8%) to 3.8% during 2000-2006 (CI = 3.1%-4.5%). Foreign-born persons and racial/ethnic minority populations continue to be affected disproportionately by TB in the United States. In 2006, the TB rate among foreign-born persons in the United States was 9.5 times that of U.S.-born persons. The TB rates among blacks, Asians, and Hispanics were 8.4, 21.2, and 7.6 times higher than rates among whites, respectively. The slowing of the decline in the overall national TB rate and the inability to effectively address persistent disparities in TB rates between U.S.-born and foreign-born persons and between whites and racial/ethnic minority populations threaten progress toward the goal of eliminating TB in the United States. In 1989, CDC and the Advisory Committee for the Elimination of Tuberculosis issued a strategic plan for the elimination of TB, setting an interim target case rate of 3.5 per 100,000 population by 2000 and ultimately the elimination of TB (i.e., <1 case per 1 million population) in the United States by 2010.     

National trends in Aboriginal and Torres Strait Islander smoking and quitting, 1994-2008

Objective: To describe the trends in the prevalence of smoking, quitting and initiation among Aboriginal and Torres Strait Islander men and women aged 18 years and over. Methods: Analysis of responses to smoking questions in national Indigenous surveys in 1994, 2002, 2004 and 2008. Results: Male Indigenous smoking prevalence fell significantly from 58.5% in 1994 to 52.6% in 2008, an absolute decrease of 0.4 (CI 0.1–0.7)% per year, with the same decline in remote and non‐remote areas. Female smoking fell from 51.0% to 47.4%, with markedly different changes in remote and non‐remote areas. In non‐remote areas, there was an absolute decrease in female smoking of 0.5 (CI 0.2–0.9)% per year, but in remote areas, female smoking increased by 0.4 (CI 0.0–0.8)% per year. From 2002 to 2008, the percentage of ever‐smokers who had quit (quit ratio) increased absolutely by 1% per year in both men and women, remote and non‐remote areas. Results about trends in initiation were inconclusive. Conclusions and Implications: Health Minister Roxon has committed to halving the Indigenous smoking prevalence by 2018, and has dramatically increased Indigenous‐specific funding and activity in tobacco control. The reported historical trends in this paper are encouraging as they occurred at a time when there was little such tobacco control activity focused on Aboriginal and Torres Strait Islander people. However, to meet the Minister's goal, Indigenous smoking prevalence will need to fall more than six times as quickly as occurred from 1994 to 2008.     

Have sperm densities declined? A reanalysis of global trend data.

In 1992 a worldwide decline in sperm density was reported; this was quickly followed by numerous critiques and editorials. Because of the public health importance of this finding, a detailed reanalysis of data from 61 studies was warranted to resolve these issues. Multiple linear regression models (controlling for abstinence time, age, percent proven fertility, specimen collection method, study goal and location) were used to examine regional differences and the interaction between region (United States, Europe, and non-Western countries) and year. Nonlinear models and residual confounding were also examined in these data. Using a linear model (adjusted R2 = 0. 80), means and slopes differed significantly across regions (p = 0. 02). Mean sperm densities were highest in Europe and lowest in non-Western countries. A decline in sperm density was seen in the United States (studies from 1938-1988; slope = -1.50; 95% confidence interval (CI), -1.90--1.10) and Europe (1971-1990; slope = -3.13; CI, -4.96- -1.30), but not in non-Western countries (1978-1989; slope = 1.56; CI, -1.00-4.12). Results from nonlinear models (quadratic and spline) were similar. Thus, further analysis of these studies supports a significant decline in sperm density in the United States and Europe. Confounding and selection bias are unlikely to account for these results. However, some intraregional differences were as large as mean decline in sperm density between 1938 and 1990, and recent reports from Europe and the United States further support large interarea differences in sperm density. Identifying the cause(s) of these regional and temporal differences, whether environmental or other, is clearly warranted.