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Objectives. We sought to document incidence, case-fatality, and recurrence rates of venous thromboembolism (VTE) in women and to explore the relationship of demographic, lifestyle, and anthropometric factors to VTE incidence. Methods. Data from participants aged 55 to 69 years in the Iowa Women's Health Study were linked to Medicare data for 1986 through 2004 (n=40377) to identify hospitalized VTE patients. Results. A total of 2137 women developed VTE, yielding an incidence rate of 4.04 per 1000 person-years. The 28-day case-fatality rate was 7.7%, and the 1-year recurrence rate was 3.4%. Educational attainment, physical activity, and age at menopause were inversely associated with VTE. Risk of secondary (particularly cancer-related) VTE was higher among smokers than among those who had never smoked. Body mass index, waist circumference, waist-to-hip ratio, height, and diabetes were positively associated with VTE risk. Hormone replacement therapy use was associated with increased risk of idiopathic VTE. Conclusions. VTE is a significant source of morbidity and mortality in older women. Risk was elevated among women who were smokers, physically inactive, overweight, and diabetic, indicating that lifestyle contributes to VTE risk. [ABSTRACT FROM AUTHOR]

Objectives. We assessed whether markers of acculturation (birthplace and number of US generations) and socioeconomic status (SES) are associated with markers of subclinical cardiovascular disease — carotid artery plaque, internal carotid intima-media thickness, and albuminuria — in 4 racial/ethnic groups. Methods. With data from the Multi-Ethnic Study of Atherosclerosis (n=6716 participants aged45-84 years) and race-specific binomial regression models, we computed prevalence ratios adjusted for demographics and traditional cardiovascular risk factors. Results. The adjusted US-to foreign-born prevalence ratio for carotid plaque was 1.20 (99% confidence interval [CI] = 0.97, 1.39) among Whites, 1.91 (99% CI = 0.94, 2.94) among Chinese, 1.62 (99% CI = 1.28, 2.06) among Blacks, and 1.23 (99% CI = 1.15, 1.31) among Hispanics. Greater carotid plaque prevalence was found among Whites, Blacks, and Hispanics with a greater number of generations with US residence (P<.001) and among Whites with less education and among Blacks with lower incomes. Similar associations were observed with intima-media thickness. There was also evidence of an inverse association between albuminuria and SES among Whites and Hispanics. Conclusions. Greater US acculturation and lower SES were associated with a higher prevalence of carotid plaque and greater intima-media thickness but not with albuminuria. Maintenance of healthful habits among recent immigrants should be encouraged. (Am J Public Health. 2008;98:1963-1970. doi:10.2105/ A.JPH.2007.123844) [ABSTRACT FROM AUTHOR]

Objective. We sought to examine the relation between physical activity and incident hypertension in young adults over 15 years of follow-up in the Coronary Artery Risk Development in Young Adults study. Methods. A total of 3993 Black and White men and women aged 18 to 30 years were examined at baseline, and 2, 5, 7, 10, and 15 years later. Blood pressure and physical activity were measured at each exam. Hypertension was defined as systolic 140 mm Hg or higher, diastolic 90 mm Hg or higher, or antihypertensive medication use. Average physical activity and incident hypertension over 15 years of follow-up were analyzed. Results. There were 634 cases of incident hypertension over 15 years of follow-up. Those who were more versus less physically active experienced a reduced risk (hazard rate ratio =0.83; 95% confidence interval = 0.73, 0.93) for incident hypertension, after adjustment for race, sex, age, education, and family history of high blood pressure. Conclusions. Physical activity merits attention in the prevention of incident hypertension among young adults, particularly as they move into middle age. (Am J Public Health. 2007;97:703-709.) [ABSTRACT FROM AUTHOR]

Objectives. Using data from a large cohort of adults aged 45 to 84 years-old, we investigated whether availability of recreational resources is related to physical activity levels. Methods. Data from a multiethnic sample of 2723 adult residents of New York City, NY; Baltimore, Md; and Forsyth County, NC, were linked to data on locations of recreational resources. We measured the availability (density) of resources within 0.5 (0.8 km), 1, 2, and 5 miles of each participant's residence and used binomial regression to investigate associations of density with physical activity. Results. After adjustment for potential confounders, individuals in the tertile of participants residing in areas with the highest density of resources were more likely to report physical activity during a typical week than were individuals in the lowest tertile. Associations between availability of recreational resources and physical activity levels were not present for the smallest area assessed (0.5 miles) but were present for areas ranging from 1 to 5 miles. These associations were slightly stronger among minority and low-income residents. Conclusions. Availability of resources may be 1 of several environmental factors that influence individuals' physical activity behaviors. [ABSTRACT FROM AUTHOR]

Objectives. This study sought to determine whether nutrient-rich whole grains reduce mortality risk. Methods. The study included 38740 Iowa women, aged 55 to 69 years. A food frequency questionnaire was used to obtain data on grain intake. Results. Median whole grain intake quintiles ranged from a median of 0.2 to more than 3 servings per day. Women with higher intakes had healthier lifestyles and less baseline disease. The total death rate decreased in increasing quintiles, and the pattern repeated for cancer, cardiovascular disease, and other causes combined. Adjusted for lifestyle and baseline disease, the relative hazard rate ratio for total death was about 0.85 in daily consumers of whole grain. Findings persisted in strata of baseline healthy and diseased and were not explained by dietary fiber. Rates of total mortality, but not cardiovascular disease mortality, were higher among frequent consumers of refined grain. Conclusions. Total mortality risk was inversely associated with whole grain intake and positively associated with refined grain intake. Refined grains contributed more than 20% of energy intake, and whole grains contributed 1%. Substitution of whole for refined grain may reduce chronic disease risk in the United States. [ABSTRACT FROM AUTHOR]

We review a study in this issue that concludes, from analyses of ecological associations, that the use of medication to lower high blood pressure has caused at most a small decline in US stroke mortality rates. Our analysis suggests that other possible sources of the decline may be population-wide falls in levels of blood pressure, cigarette smoking, and coronary heart disease mortality, as well as improved treatment of cardiac and respiratory sequelae of stroke. Although the ecological method is powerful for answering questions about medical interventions' population-wide effects on disease, it must be used with care. Of particular concern are variables with meanings that differ between the ecological and the individual levels, the number of ecological units available for analysis, the sample size within the ecological units, and the range of independent variables used in ecological regression. [ABSTRACT FROM AUTHOR]

Several letters to the editor are presented in response to articles in previous issues including causal link between exposure factors and disease, violence as a public health priority, and the need for educating the public of the importance of wearing safety helmets when riding motorcycles.

Abstract: The relationship between smoking and weight was examined in data of the Lipid Research Clinic (LRC) Prevalence Study in Richfield, Minnesota. Weight was analyzed according to smoking status, age, and sex, holding constant self-perceived physical activity relative to others of the same age and sex. Our findings confirm that weight differences between smokers of 15-29 cigarettes a day (cig/day) and those who never smoked are noticeable in 20-39 year olds and quite marked in the 40-59 year age group. Ex smokers are somewhat heavier than those who never smoked while, among smokers, a U-shaped curve exists with those smoking 15-29 cig/day being the lightest class. Height varied lithe between smoking classes. Daily caloric intake was estimated based on 24-hour dietary recalls and analyzed according to smoking status, sex. and age. The results showed that smokers of 15-29 cig/day generally are consuming at least as many or more calories as those who never smoked yet have lower weight. (Am J Public Health 1981; 71:391-396.) [ABSTRACT FROM AUTHOR]

To determine the use and possible health risks of low-yield cigarettes, we ascertained the cigarette brands and serum thiocyanate (SCN) levels of 2,561 adult smokers (age 25-74) in population-based samples of seven upper Midwestern communities during 1980-82. Brands were coded according to December 1981 Federal Trade Commission (FTC) ratings for "tar", nicotine, and carbon monoxide (CO). Compared to 1980 data from the National Center for Health Statistics for the United States as a whole, a greater proportion of smokers in these communities smoked low-yield brands. More people with higher education than lesser and more women than men smoked low-yield cigarettes. Greater proportions of older people (65-75 years) than younger people (<65 years) smoked cigarettes in the highest and lowest brand yield categories. SCN, adjusted for number of cigarettes smoked and for sex, was only weakly associated with brand ratings for "tar" (r = +.12), nicotine (R = +.11), and CO (r = +.15). Furthermore, the gradient in SCN between lowest and highest quintiles of brand strength was less than 16 per cent--much lower than the 300-500 per cent gradient in smoke components implied by FTC ratings. These data add to the evidence that smoking low-yield cigarettes may not be significantly less hazardous than smoking high-yield brands. [ABSTRACT FROM AUTHOR]

Data from two major survey, conducted in the Minneapolis-St. Paul metropolitan area in 1973-74 and 1980-81, were used to estimate the prevalence of overweight. In 1980-8l, weight history and the prevalence of dieting behaviors were also obtained. The prevalence of overweight was greater in the 19:40-81 survey than in 1973-74. Increase, were observed in all ages in women, but only in the 40-59 year age ranges in men. in 1980-8l. dieting to control weight was widely reported by' both sexes, even among those who had never been overweight. Of those who reported having been overweight, approximately one-third reported they had successfully reduced. Mole men than women reported having been overweight, bill more women reported having dieted to lose weight. Formal weight reduction programs were used much more by women than men. Although most dieting attempts consisted of balanced, reduced calorie regimens a significant percentage were "fad" types. whose nutritional safety may be questioned. Overall, contrary to findings based on clinical populations, weight reducing efforts often appear to be successful. Nevertheless, overweight remains a significant public health problem in this community. [ABSTRACT FROM AUTHOR]

Objectives. This study estimated the amount of weight change in a biracial cohort of young adults and the separate components attributable to time-related and aging-related changes, as well as identified possible determinants of weight change. Methods. In this population-based prospective study of 18- to 30-year-old African-American and White men and women, body weight and prevalence of overweight were measured from 1985/86 to 1992/93. Results. Average weight increased over the 7 years, increases ranging from 5.2 kg (SE = 0.2, n = 811) in White women to 8.5 kg (SE = 0.3, n = 882) in African-American women. Significant time-related increases in weight, ranging from 2.0 kg (SE = 1.0) in White women to 4.8 kg (SE = 1.0, n = 711) in African-American men, accounted for 40% to 60% of the average total weight gain. Aging-related increases were also significant, ranging from 2.6 kg (SE = 0.8, n = 944) in White men to 5.0 kg (SE = 1.1) in African-American women. The prevalence of overweight increased progressively in each group. Decreased physical fitness was most strongly associated with weight gain in both sexes. Conclusions. The observed dramatic time-related weight gains, most likely due to secular (period-related) trends, are a serious public health concern. [ABSTRACT FROM AUTHOR]

Objectives. This study compared prevalence rates of health-compromising behaviors among boys and girls from different ethnic background in early, middle, and late adolescence and compared co-occurrences of such behaviors across gender and ethnic groups. Methods. The study population included 123, 132 adolescents in grades 6, 9, and 12. Adolescents completed a classroom-administered statewide survey focusing on high-risk behaviors, including unhealthy weight loss, substance abuse, suicide risk, delinquency, and sexual activity. Results. Prevalence rates of most health-compromising behaviors differed by gender, increased with age, and tended to be highest among American Indian youth and lowest among Asian Americans. Strong associations were found between substance abuse and delinquency across ethnic groups. Substance abuse and delinquency were associated with suicide risk across most ethnic groups. Covariations with sexual activity and unhealthy weight loss behaviors showed more ethnic variation. Conclusions. Prevention interventions should take into account the tendency for health-compromising behaviors to co-occur and should be sensitive to demographic and socio-economic differences in behavior patterns. [ABSTRACT FROM AUTHOR]

Objectives. The Minnesota Heart health Program is a 13-year research and demonstration project to reduce morbidity and mortality from coronary heart disease in whole communities. Methods. Three pairs of communities were matched on size and type; each pair had one education site and one comparison site. After baseline surveys, a 5- to 6-year program of mass media, community organization, and direct education for risk reduction was begun in the education communities, whereas surveys continued in all sites. Results. Many intervention components proved effective in targeted groups. However, against a background of strong secular trends of increasing health promotion and declining risk factors, the overall program effects were modest in size and duration and generally within chance levels. Conclusions. These findings suggest that even such an intense program may not be able to generate enough additional exposure to risk reduction messages and activities in a large enough fraction of the population to accelerate the remarkably favorable secular trends in health promotion activities and in most coronary heart disease risk factors present in the study communities. [ABSTRACT FROM AUTHOR]

Objectives. A randomized trial was conducted to evaluate the effectiveness of a work-site health promotion program in reducing obesity and the prevalence of cigarette smoking. Methods. Thirty-two work sites were randomized to treatment or no treatment for 2 years. Treatment consisted of health education classes combined with a payroll-based incentive system. Evaluation was based on cohort and cross-sectional surveys. Results. Of 10 000 total employees in treatment work sites, 2401 and 270 participated in weight control and smoking cessation programs, respectively. Weight losses averaged 4.8 lbs, and 43% of smoking participants quit. Net 2-year reductions in smoking prevalence in treatment vs control work sites were 4.0% and 2.1% in cross-sectional and cohort surveys, respectively. No treatment effect was found for weight. Treatment effects for smoking prevalence and weight were both positively correlated with participation rates in the intervention programs (r = .45) for smoking and r = .55 for weight). Conclusions. This work-site health promotion program was effective in reducing smoking prevalence at a cost that is believed to make the investment worthwhile. [ABSTRACT FROM AUTHOR]

Objectives. Although differences in obesity between Blacks and Whites are well documented in adult women, less information is available on potential correlates of these differences, especially in young adults. Methods. The association between behavioral and demographic factors and body size was assessed in 2801 Black and White women aged 18 to 30 years. Results. Black women had significantly higher age-adjusted mean body mass index and subscapular skinfold thickness than did White women. Obesity had different associations with age and education across racial groups. A positive relationship between age and obesity was seen in Black women but not in White women, whereas a negative association between education and body size was noted only in White women. Potential contributing factors to the increased prevalence of obesity in Black women include a more sedentary lifestyle, higher energy intake, earlier menarche, and earlier age at first childbirth. Conclusions. The difference in obesity across race could not be explained completely by these factors, since within virtually all strata, Black women had higher body mass indexes. Further investigation is needed to develop interventional strategies to prevent or reduce excess levels of obesity in Black women. [ABSTRACT FROM AUTHOR]

Abstract: The relation between age at natural menopause and all-cause mortality was investigated in a sample of 5,287 White women, ages 55 to 100 years, naturally-postmenopausal, Seventh-day Adventists who had completed mailed questionnaires in 1976. The age-adjusted odds ratio of death during 1976-82 in women with natural menopause before age 40 was 1.95 (95% confidence interval = 1.24, 3.07), compared to the reference group of women reporting natural menopause at ages 50 to 54. Corresponding odds ratios of death were 1.39 (95% CI = 1.06, 1.81) for natural menopause at ages 40 to 44, and 1.03 (95% CI = 0.84, 1.25) for natural menopause at ages 45 to 49. Among 3,166 White, 55- to 100-year-old, surgically-postmenopausal, Adventist women, there was no relation between age at surgical menopause and mortality. Logistic regression analyses indicated that findings from this study were apparently not due to confounding by smoking, over- or underweight, reproductive history, or replacement estrogen use. [ABSTRACT FROM AUTHOR]

This study compares the efficacy of a school-based program to an equivalent home-based program with 2,250 third grade students in 31 urban schools in Minnesota in order to detect changes in dietary fat and sodium consumption. The school-based program, Hearty Heart and Friends, involved 15 sessions over five weeks in the third grade classrooms. The home-based program, the Home Team, involved a five-week correspondence course with the third graders, where parental involvement was necessary in order to complete the activities. Outcome measures included anthropometric, psychosocial and behavioral assessments at school, and dietary recall, food shelf inventories, and urinary sodium data collected in the students' homes. Participation rates for all aspects of the study were notably high. Eighty-six per cent of the parents participated in the Home Team and 71 per cent (nearly 1,000 families) completed the five-week course. Students in the school-based program had gained more knowledge at posttest than students in the home-based program or controls. Students in the home-based program, however, reported more behavior change, had reduced the total fat, saturated fat, and monounsaturated fat in their diets, and had more of the encouraged foods on their food shelves. The data converge to suggest the feasibility and importance of parental involvement for health behavior changes with children of this age. (Am J Public Health 1988; 78: 1156-1160.) [ABSTRACT FROM AUTHOR]

To assess the prevalence and utility of citizen cardiopulmonary resuscitation (CPR) training, a systematic population-based sample of Minneapolis-St. Paul area adults, age 25-74 years, was interviewed in 1980-81. Twenty-three per cent were CPR trained. Of these, 13 percent reported using their skills in such an emergency. Most of those performing out-of-hospital CPR (59 per cent) were health professionals. Only 19 per cent of trainees have maintained their certification by retraining within one year. [ABSTRACT FROM AUTHOR]

Age-adjusted mortality rates and trends from coronary heart disease (CHD) in Minnesota for the years 1960 to 1980 differed among eight health service areas. Regression of ten socioeconomic and demographic factors anti intensive care and coronary care unit beds on area CHD mortality levels and slopes revealed a significant positive association only for levels of welfare income-maintenance assistance with CHD mortality levels: there were no associations with trends, Further studies arc needed to explain variation within states of CHD mortality rate levels and trends. [ABSTRACT FROM AUTHOR]