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Objectives. We investigated whether foreign birthplace and residence were associated with an increased risk of childhood lead poisoning. Methods. We conducted a matched case-control study among New York City children (mean age=3 years) tested for lead poisoning in 2002 (n=203 pairs). Children were matched on age, date of test, and residential area. Blood lead and housing data were supplemented by a telephone survey administered to parents or guardians. Conditional logistic regression analysis was used to examine the relationship of lead poisoning status to foreign birthplace and time elapsed since most recent foreign residence after adjustment for housing and behavioral risk factors. Results. Both foreign birthplace and time since most recent foreign residence had strong adjusted associations with lead poisoning status, with children who had lived in a foreign country less than 6 months before their blood test showing a particularly elevated risk of lead poisoning relative to US-born children with no foreign residential history before their blood test (odds ratio [OR] = 10.9; 95% confidence interval [CI]=3.3, 36.5). Conclusions. Our findings demonstrate an increased risk of lead poisoning among immigrant children. (Am J Public Health. 2008;98:92-97. doi:10.2105/ AJPH.2006.093229)

Objective: A common clinical conception of alcohol dependence is that it is chronic, and the idea of impaired control figures prominently in an influential definition of alcohol dependence. We investigated the meaning of a diagnosis of DSM-IV alcohol dependence in untreated individuals. Method: Household residents screened for elevated drinking were assessed for DSM-IV alcohol dependence and reinterviewed 1 year later. We report on 115 subjects with and 460 subjects without current DSM-IV alcohol dependence at baseline. Follow-up drinking indicators included a measure of sustained reduction in drinking. Results: No support was found for a lower probability of sustained reduction in drinking at follow-up among the group with baseline DSM-IV alcohol dependence. Significant group differences indicated that the dependent group was more likely to reduce drinking. Conclusions: A diagnosis of DSM-IV alcohol dependence among untreated individuals implies a prognosis that is different from that for the same diagnosis among those seen in treatment settings. This does not necessarily indicate that the diagnosis is invalid, but rather suggests that risk factors for chronic course are more applicable to cases of DSM-IV alcohol dependence seen in treatment settings. (J. Stud. Alcohol 62: 509-517, 2001), ALCOHOL-RELATED MORBIDITY and mortality have long been significant problems in the United States. Alcohol-related traffic crashes and deaths from cirrhosis are among the most serious health consequences of excessive alcohol [...]

Objective: The clinical and research importance of tolerance and/or withdrawal in the diagnosis of substance dependence has been identified as a key area needing clarification. Earlier longitudinal studies did not identify whether diagnoses of alcohol dependence were current or lifetime. In this study, the prognostic significance of the DSM-IV physiological specifier was investigated among cases of alcohol dependence current at the baseline interview. The role of tremors, required in DSM-III and DSM-III-R, was investigated as well. Method: Household residents (N = 130; 57% men) meeting full criteria for current DSM-IV alcohol dependence in a baseline interview were re-interviewed a year later and DSM-IV alcohol dependence was again evaluated. Reliable structured interviews were used to make the diagnoses. The DSM-IV physiologic specifier and its components were tested as predictors of outcome of DSM-IV alcohol dependence, and included an additional definition of alcohol withdrawal that required tremors. Chi-square tests and adjusted odds ratios indicated statistical significance of group differences on outcome. Results: The DSM-IV physiological specifier (tolerance or withdrawal) did not predict 1-year chronicity of DSM-IV alcohol dependence, nor did tolerance when considered separately. However, withdrawal predicted poor outcome (e.g., 1-year chronicity of DSM-IV alcohol dependence). The effect of withdrawal was strengthened when tremors were required as part of the withdrawal syndrome. Conclusions: In contrast to earlier longitudinal research, this study supports the prognostic relevance of one component of the present DSM-IV psysiological specifier--withdrawal. Withdrawal appears to have stronger prognostic meaning when the DSM-III-R version, in which tremors were required, is used. Further studies of the physiological subtype may benefit from studying subjects who have been clearly identified at the baseline evaluation as having a current diagnosis of dependence. (J. Stud. Alcohol 61: 431-438, 2000), THE CLINICAL AND RESEARCH importance of alcohol withdrawal and tolerance in the diagnosis of alcohol dependence has been unclear for many years. Although the Feighner criteria (Feighner et al., 1972) [...]

ALCOHOL ABUSE was first formally differentiated from alcohol dependence with the publication of DSM-III in 1980 (American Psychiatric Association, 1980). At the time that DSM-III was published, the grounds for [...]

Objective: Little is known about the effects of contextual factors on the chronicity of alcohol dependence in the general population. Many adults in the United States live with others in a wide range of relationships. The drinking of household members was investigated as a potential risk factor for persistence of DSM-IV alcohol dependence in a prospective study of household residents. Method: At-risk drinking (five or more drinks on at least one occasion) in adult household members living with respondents was assessed at the time of the baseline interview for the index subjects in the study (N = 128; 56% men) who lived with other adults and who met DSM-IV criteria for current alcohol dependence. Index subjects' drinking and demographic variables were also measured at baseline. Approximately 1 year later, follow-up interviews determined the status of alcohol dependence in the 128 subjects. Results: Alcohol dependence was significantly more likely to be persistent among subjects with at-risk drinking among household members. Conclusions: The presence of other adult heavy drinkers in a household increased the risk of persistence of alcohol dependence in this community sample. Considerably more remains to he learned about the relationship and its treatment implications. (J. Stud. Alcohol 60: 769-775, 1999), CONTEXTUAL FACTORS have become increasingly important in the understanding of various behavioral phenomenon. Such a perspective is consistent with theoretical models that focus on factors external to the individual as [...]

Objective: Although a category for alcohol abuse has been included in the major nomenclatures since DSM-III, many questions have been raised about the definitions and validity of this category. Method: We investigated DSM-IV alcohol abuse in 628 at-risk drinkers residing in households who never met criteria for DSM-IV alcohol dependence at the time of a baseline interview. Cross-sectional and prospective longitudinal information were used. Results: Subjects most often met criteria for abuse with the single criterion, recurrent hazardous use (usually driving after drinking too much, on average 4.5 times per year). Younger and white subjects were more likely to receive the abuse diagnosis at baseline, as were drug users and those who drank five or more drinks per occasion frequently. Very few subjects received a diagnosis of DSM-IV alcohol dependence at follow-up, and those who did were equally likely to come from the abuse and non-abuse baseline groups. A current abuse diagnosis at baseline strongly and significantly predicted an abuse diagnosis at follow-up, although a past-only (remitted) abuse diagnosis at baseline was not clearly predictive of abuse at follow-up. Conclusions: The DSM-IV alcohol abuse category has some predictive validity. However, given the manner in which respondents met criteria for the disorder, its merits as a diagnostic category remain in question. Researchers should be cautious about combining alcohol dependence and abuse into the same category. (J. Stud. Alcohol 60:181-187, 1999), The validity of the concept of alcohol dependence as defined in DSM-III-R (American Psychiatric Association, 1987) and DSM-IV (American Psychiatric Association, 1994) has now been well-established through numerous studies with [...]

Evaluates the performance of a test statistic for the analysis of correlated binary data. Usability of the method in testing for the association between a binary exposure and a binary outcome of interest; Applicability of the method to clustered binary data arising in a variety of settings; Production of software for the adjusted statistic.

A letter to editor is presented in response to a study by Tehranifar and colleagues which revealed an 11-fold increase in the odds of lead poisoning among children in New York City who had recently lived in another country compared with children who had not.

In Pennsylvania on February 16, 2006, a New York City resident collapsed with rigors and was hospitalized. On February 21, the Centers for Disease Control and Prevention and the New York City Department of Health and Mental Hygiene were notified that Bacillus anthracis had been identified in the patient's blood. Although the patient's history of working with dried animal hides to make African drums indicated the likelihood of a natural exposure to aerosolized anthrax spores, bioterrorism had to be ruled out first. Ultimately, this case proved to be the first case of naturally occurring inhalational anthrax in 30 years. This article describes the epidemiologic and environmental investigation to identify other cases and persons at risk and to determine the source of exposure and scope of contamination. Because stricter regulation of the importation of animal hides from areas where anthrax is enzootic is difficult, public healthcare officials should consider the possibility of future naturally occurring anthrax cases caused by contaminated hides. Federal protocols are needed to assist in the local response, which should be tempered by our growing understanding of the epidemiology of naturally acquired anthrax. These protocols should include recommended methods for reliable and efficient environmental sample collection and laboratory testing, and environmental risk assessments and remediation.

Polycyclic aromatic hydrocarbons (PAH) are potent mammary carcinogens in rodents, but their effect on breast cancer development in women is not clear. To examine whether currently measurable PAH damage to DNA increases breast cancer risk, a population-based case-control study was undertaken on Long Island, NY. Cases were women newly diagnosed with in situ and invasive breast cancer; controls were randomly selected women frequency matched to the age distribution of cases. Blood samples were donated by 1102 (73.0%) and 1141 (73.3%) of case and control respondents, respectively. Samples from 576 cases and 427 controls were assayed for PAH-DNA adducts using an ELISA. The geometric mean (and geometric SD) of the log-transformed levels of PAH-DNA adducts on a natural scale was slightly, but nonsignificantly, higher among cases [7.36 (7.29)] than among controls [6.21 (4.17); P = 0.51]. The age-adjusted odds ratio (OR) for breast cancer in relation to the highest quintile of adduct levels compared with the lowest was 1.51 [95% confidence interval (CI), 1.04-2.20], with little or no evidence of substantial confounding (corresponding multivariate-adjusted OR, 1.49; 95% CI, 1.00-2.21). There was no consistent elevation in risk with increasing adduct levels, nor was there a consistent association between adduct levels and two of the main sources of PAH, active or passive cigarette smoking or consumption of grilled and smoked foods. These data indicate that PAH-DNA adduct formation may influence breast cancer development, although the association does not appear to be dose dependent and may have a threshold effect.