Cigarette smoking behavior among Rhode Island physicians, 1963-83.

A survey of practicing physicians in Rhode Island revealed a cigarette smoking rate of only 8.3 per cent in 1983. This represents a continuation of the consistent decrease seen in the percentage of physician smokers in each such survey since 1963. Under age 30, the rate was only 4.5 per cent. An exponential model suggests that the overall rate for Rhode Island physicians will be below 3 per cent by the year 2000.     

Cause-specific mortality among Rhode Island jewelry workers

Cause-specific mortality patterns among Rhode Island jewelry manufacturing workers, as identified on death certificates from 1968 to 1978, were examined using the proportionate mortality ratio (PMR) method. Among males, elevated PMRs were observed for nonmalignant kidney disease (PMR = 163; Observed deaths [Obs] = 19; p less than or equal to .05), liver cancer (PMR = 297; Obs = 6; p less than or equal to .05), drug dependence (PMR = 379; Obs = 5; p less than or equal to .05), and accidental poisonings (PMR = 274; Obs = 8; p less than or equal to .05). All but one of the deaths from accidental poisonings involved drugs or drugs and alcohol. Among females, elevated PMRs were observed for stomach cancer (PMR = 174; Obs = 20; p less than or equal to .01), peptic ulcer (PMR = 235; Obs = 8; p less than or equal to .05), diseases of the skin and subcutaneous tissue (PMR = 383; Obs = 5; p less than or equal to .05), and drug dependence (PMR = 674; Obs = 3; p less than or equal to .05). Exposure to known renal toxins (heavy metals and solvents) used in the jewelry industry may account for the excess deaths from kidney disease. The elevated PMR for liver cancer may be due to exposure to solvents (trichloroethylene, perchloroethylene, carbon tetrachloride) that cause liver cancer in animals. The elevated PMRs for drug dependence and accidental poisonings may be due to the socioeconomic status of jewelry workers, or to the interaction between solvents used in jewelry manufacturing and drugs, or drugs and alcohol. Because of the lack of information about the specific occupational exposures of the decedents, this should be viewed as an exploratory investigation requiring further follow-up.     

Smoking behaviors among immigrant Asian Americans: rules for smoke-free homes

BACKGROUND: Higher acculturation is associated with Asian-American smoking prevalence decreasing in men and increasing in women. Asian immigrants in California are significantly more likely than their counterparts in Asia to have quit smoking. Smoke-free environments may mediate this acculturation effect because such environments are not widespread in Asia. METHODS: In 2006, Asian-American current and former smokers were analyzed using the 2003 California Health Interview Survey. A multivariate logistic regression analysis examined how the interaction between having a smoke-free-home rule and immigrating to the U.S. is associated with status as a former smoker and lighter smoking. RESULTS: For recent Asian immigrants (<10 years in the U.S.) and longer-term residents (born/>or=10 years in the U.S.), having a smoke-free-home rule was associated with status as a former smoker (OR 14.19, 95% CI=4.46, 45.12; OR 3.25, 95% CI=1.79, 5.90, respectively). This association was stronger for recent immigrants (p=0.02). Having a smoke-free-home rule was associated with lighter smoking only for longer-term residents (OR 5.37, 95% CI=2.79, 10.31). CONCLUSIONS: For Asian Americans, smoke-free-home rules are associated with status as a former smoker, particularly among recent immigrants, and lighter smoking in long-term residents. Interventions encouraging Asian Americans to adopt smoke-free-home rules should be evaluated.     

Changes in Maternal Cigarette Smoking Among Pregnant WIC Participants in Rhode Island

Objectives To describe the relationship between the timing of entry into the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) among pregnant women in Rhode Island (RI) and changes in maternal cigarette smoking (MCS) during pregnancy. Methods MCS data gathered by WIC were analyzed for pregnant women who self-identified as smokers at the onset of pregnancy between the years 2001–2005. Bivariate and multivariate analyses were performed to examine the relationship between timing of WIC entry and both increased and decreased/quit MCS during pregnancy. Results Self-reports from smokers indicated that 9.5% quit smoking, 24.6% decreased MCS, 26.8% experienced no change, 33.5% increased MCS, and 5.6% attempted to quit MCS but failed during pregnancy. The adjusted odds ratio for smokers with 1st trimester WIC entry and increased MCS was 0.64 (95% CI 0.52, 0.79). Among smokers with 1st trimester PNC entry, the adjusted odds ratio for smokers with 1st trimester WIC entry and decreased/quit MCS was 1.51 (95% CI 1.17, 1.96). Conclusions Early WIC entry appears to be associated with improvements in MCS. Participants who entered WIC in the first trimester of pregnancy were less likely to increase smoking during pregnancy, and if they also had first trimester prenatal care, were more likely to decrease/quit smoking compared to those who entered WIC later. Programs that increase the rates of first trimester WIC entry may contribute to lower rates of MCS in the WIC population.     

Cause-specific mortality among male textile workers in Rhode Island

Cause-specific mortality patterns among male textile workers in Rhode Island who died during the period 1968-1978 were examined using the proportionate mortality ratio (PMR) method. Textile worker decedents were identified by the usual occupation and industry statements on Rhode Island death certificates. A statistically significant PMR elevation was observed for nonmalignant respiratory disease (NMRD) among male textile workers (PMR = 110; Observed deaths [Obs] = 433; 95% confidence interval (CI) = 102-120). The PMRs for NMRD by specific textile occupation and by type of textile manufacturing generally exhibited the pattern expected for work-related mortality owing to textile dust exposure. High PMRs were observed among carding, lapping, and combing operatives, the decedents who probably had the highest dust exposure (PMR = 166; Obs = 24; CI = 114-243), and among operatives most likely to have worked in cotton manufacturing (PMR = 137; Obs = 47; CI = 104-179). This is the first report of excess mortality from NMRD among male textile workers in the United States. This finding is consistent with previous evidence that exposure to cotton dust can cause disabling chronic lung disease. Also noteworthy were statistically significant elevated PMRs for cancers of the rectum and esophagus among decedents who had been engaged in textile dyeing and finishing. Owing to the lack of direct information about occupational exposures and smoking habits of the decedents and uncertainties in classifying decedents by type of textile manufacturing, this investigation should be viewed as being exploratory in nature.     

Small-area variations in rates of hospitalization and surgery within Rhode Island

We analyzed variations in the usage rates and costs of 13 surgical procedures among 37 cities and towns in the state of Rhode Island. To compare different operations and years, we defined the deviation index, a percentage indicator similar to the coefficient of variation, but with chance variation removed. Tonsillectomy and disc excision were the procedures for which rates varied most around the state average; their deviation indexes for 1981 were 40.5 percent and 38.9 percent, respectively. In 14 areas, rates for one of these two procedures (standardized for age and sex) were significantly (p less than .01) above or below the state average; such outlying observations would have been expected for only one area if rates had been uniform statewide. To indicate the relative amount of surgery in an area combining rates for all 13 procedures, we computed the area's surgical index. This index, the average of the ratios of observed to expected cases (based on standardized statewide rates), doubled from the lowest- to the highest-rate areas. Overall, surgical hospital days, nonsurgical days, total hospital days, and hospital costs (all per 1,000 population) doubled from lowest- to highest-rate areas. If the rates of these 13 surgical procedures could be lowered in high-rate areas to not more than 20 percent above the state average, usage could drop by 4 percent. We conclude that even within the small state of Rhode Island, surgical practice varies considerably across communities. Identifying and studying areas with extremely high or low rates should enable more explicit consideration of the indications for surgery and perhaps lead to lower costs for medical care.     

Comprehensive medical care among HIV-positive incarcerated women: the Rhode Island experience

Our objective was to characterize the clinical presentation of human immunodeficiency virus (HIV) infection among incarcerated women in a program that provides HIV testing and primary care to all state prisoners in Rhode Island. A retrospective medical chart review on all HIV-seropositive women who were incarcerated between 1989 and 1994 and had at least two medical visits with an HIV medical care provider was used. At the Rhode Island Adult Correctional Institution (ACI), under mandatory testing laws between 1989 and 1994, 28% (172 of 623) of all women were identified with HIV infection. Of the 172 women who tested seropositive in prison, 110 were included in the study. Of the 110 women followed, 84% reported injection drug use (IDU) as their primary risk factor, and 30% reported both IDU and sex work. The median CD4 count was 596/mm3, with 60% having a CD4 count >500 cells/mm3. The most common medical conditions were vaginal candidiasis, oral candidiasis, and bronchitis. Antiretroviral therapy was well accepted and followed community standards. Continuity of medical care after release was facilitated by the same physician caring for the patient in the community setting, with 83% of women following up for HIV care after release. The medical conditions noted reflect that these women are early in the course of their HIV disease when they are initially diagnosed. This comprehensive program in Rhode Island's state prison plays a central role in the diagnosis of HIV-seropositive women and provides counseling, primary medical and gynecological care, and linkage to community resources after release.     

Mortality rates and causes among U.S. physicians

CONTENT/OBJECTIVES: No recent national studies have been published on age at death and causes of death for U.S. physicians, and previous studies have had sampling limitations. Physician morbidity and mortality are of interest for several reasons, including the fact that physicians' personal health habits may affect their patient counseling practices. METHODS: Data in this report are from the National Occupational Mortality Surveillance database and are derived from deaths occurring in 28 states between 1984 and 1995. Occupation is coded according to the U.S. Bureau of the Census classification system, and cause of death is coded according to the ninth revision of the International Classification of Diseases. RESULTS: Among both U.S. white and black men, physicians were, on average, older when they died, (73.0 years for white and 68.7 for black) than were lawyers (72.3 and 62.0), all examined professionals (70.9 and 65.3), and all men (70.3 and 63.6). The top ten causes of death for white male physicians were essentially the same as those of the general population, although they were more likely to die from cerebrovascular disease, accidents, and suicide, and less likely to die from chronic obstructive pulmonary disease, pneumonia/influenza, or liver disease than were other professional white men. CONCLUSIONS: These findings should help to erase the myth of the unhealthy doctor. At least for men, mortality outcomes suggest that physicians make healthy personal choices.     

Blizzard morbidity and mortality: Rhode Island, 1978.

The total number of outpatient visits to 10 hospital emergency rooms declined 64 per cent and emergency admissions 35 per cent immediately after the February 1978 blizzard in Rhode Island; both quickly returned to normal levels. Three days after the storm, admissions for myocardial infarction increased markedly. Total mortality and ischemic heart disease deaths showed a considerable increase for the five-day period following the blizzard. The physical and psychological stress of the blizzard probably precipitated cardiac deaths in susceptible individuals.     

Smoking habits and associated factors among Greek physicians

OBJECTIVE: To investigate the smoking habits and associated risk factors among Greek physicians. STUDY DESIGN: Cross-sectional survey of a randomly selected sample of Greek physicians. METHODS: A national sample of 1284 physicians (718 men, 566 women) participated in the study, which was conducted between September 2003 and June 2005. Data were collected through an anonymous self-completed questionnaire. Logistic regression was used to analyse the influence of different factors on the probability of a physician being a current or former smoker. RESULTS: Overall, 38.6% of the physicians (40% of men; 37% of women) currently smoked, 13.8% were former smokers, and 47.6% had never smoked. Eighty-three per cent of smokers reported starting smoking before the age of 25 years, with half of them during medical school (aged 19-24 years). Multivariate analyses revealed that physicians who were male, unmarried, divorced or widowed, surgeons or anaesthetists, and residents were more likely to be current smokers. Former smokers were more likely to be older, male and born in a rural area. Moreover, the odds of being a current or former smoker were significantly higher among physicians with a history of parents who smoked. The proportion of physicians who reported counselling patients (often or always) to stop smoking was lower among current smokers compared with those who never smoked or those who were former smokers (74.4% vs. 85.3% vs. 84.7%, P<0.0001). CONCLUSIONS: The prevalence of smoking among Greek physicians is exceedingly high and similar to that of the general population. More effective interventions that reduce smoking in the medical community should be implemented immediately so that physicians will be better able to fulfil their function as role models for the general population.     

Smoking among physicians and measures for its control

Questionnaire survey of 107 physician smokers of the city of Perm was carried out in order to find out the reasons for smoking of physicians and their opinion on the ways for its eradication among medical workers. Eighty three per cent of doctors began smoking before entering medical institutes, continued to smoke during their study at the Institute and had a long-term experience of smoking, even more than 30 years. Thirteen physicians don't want to stop smoking. On graduating from the Institute, 14.9% of physicians started smoking being fully aware of its adverse health effects. Almost all the respondents smoke at their workplace but consider prohibitive measures most effective in smoking control among medical personnel. Fourteen per cent of physicians smoke in the presence of their patients. More than half of the respondents experience adverse changes in their health state. It is pointed out that prohibitive measures have a formal character. First of all each doctor should make an adequate choice himself. Compulsory measures are also needed. It is necessary to promote antismoking propaganda among medical students and to take drastic measures with respect to each student smoker.     

Asbestos hazard evaluation in Rhode Island schools.

A statewide survey to identify and abate spray-on asbestos hazards in schools has been conducted in Rhode Island. Of 326 target schools, 24 (8 per cent) contained material confirmed in the laboratory to be spray-on asbestos. Overt hazards requiring major corrective measures were found in 4 (1 per cent) of the target schools. Simplified identification and reporting procedures allowed for the efficient conduct of the survey.     

Smoking habits and attitudes towards smoking among Estonian physicians

OBJECTIVES: This study examined the smoking habits and attitudes towards smoking among Estonian physicians. STUDY DESIGN AND METHODS: Cross-sectional data for 2668 physicians were gathered by a self-administered postal survey. RESULTS: The current smoking prevalence was 24.9% for male physicians and 10.8% for female physicians. The percentages of ex-smokers were 32.9 and 16.8%, respectively. Smoking prevalence among physicians was below the levels reported for the highest educational bracket of the total population in Estonia. Non-smoking physicians had more unfavourable views towards smoking than those who smoked. The majority of physicians were aware of the association between smoking and various diseases, with significant differences between smokers and non-smokers. Non-smoking physicians were more active in asking patients about smoking habits than those who smoked. Most Estonian physicians, especially those who smoked, failed to perceive themselves as positive role models. CONCLUSIONS: This study found a lower prevalence of smoking among physicians compared with the general population, and demonstrated the impact of personal smoking on physicians' attitudes towards smoking. The results provide an important challenge to medical education in Estonia.     

Correlates of partner-specific condom use intentions among incarcerated women in Rhode Island

CONTEXT: Few studies of incarcerated women have examined potential associations between risky sexual behavior and relationship context factors; thus, little is known about the correlates of intentions to use condoms with main and casual partners in this underserved population. METHODS: A sample of 221 women incarcerated in a Rhode Island Department of Corrections facility in 2002-2003 were interviewed. Multiple linear regression analysis was performed to assess associations between selected demographic, psychosocial and behavioral variables and participants' reported intentions to use condoms with main and casual sexual partners in the first six months after their release. RESULTS: Condom use at last sex with a main partner, sexually transmitted disease (STD) history, no strong desire to currently be pregnant, belief that others influence one's health and perceived STD risk were positively associated with women's intention to use condoms with main partners. Pregnancy history was negatively associated with intention to use condoms with a main partner. Condom use at last sex with a casual partner was positively associated with intention to use condoms with casual partners, whereas binge drinking and believing in the role of chance in determining one's health were negatively associated with intention to use condoms with casual partners. CONCLUSIONS: Whether incarcerated women define a partner as main or casual may influence their decisions about the need to protect themselves by using condoms. Programs that focus on the importance of condom use with all partners could greatly benefit incarcerated women and the communities to which they return.     

Breast biopsy rate and positivity in Rhode Island.

Breast biopsy is a common procedure for which few age-specific, population-based data are available. We identified all women who underwent breast biopsy in Rhode Island in 1989 by reviewing the specimen logs at each of 13 pathology laboratories. Among 425,000 women aged 15-97 years, 2685 underwent breast biopsy, for an overall rate of 6/1000. The rate increased with age, peaking among 45- to 54-year-olds and then declining in women over 75. Among those biopsied, 726 were diagnosed with breast cancer, for an overall biopsy positivity of 27%. In contrast to rate, positivity increased steadily with age. These results are within the range of estimates produced by smaller group studies.