Annals of Epidemiology - Articles in Press

Associations Between Duration of Illicit Drug Use and Health Conditions: Results from the 2005–2007 National Surveys on Drug Use and Health - Corrected Proof

Beth Han, Joseph C. Gfroerer, James D. Colliver — 2010-02-22

Purpose: To estimate and compare prevalence rates of lifetime health conditions by inferred duration of illicit drug use among the general U.S. adult population and to investigate associations between duration of use of each specific illicit drug (marijuana, cocaine, heroin, hallucinogens, or inhalant) and each lifetime health condition after controlling for potential confounding factors.MethodS: Data from respondents aged 35 to 49 (N = 29,195) from the 2005–2007 National Surveys on Drug Use and Health (NSDUH) were analyzed.Results: The prevalence rates of a broad range of health conditions by duration of use of specific illicit drug among persons 35 to 49 years of age in the United States were estimated and compared. After adjustment for potential confounding factors, the results of 20 multivariate logistic regression models indicated positive associations between duration of marijuana use and anxiety, depression, sexually transmitted disease (STD), bronchitis, and lung cancer; between duration of cocaine use and anxiety and pancreatitis; between duration of heroin use and anxiety, hepatitis, and tuberculosis; between duration of hallucinogen use and tinnitus and STD; and between duration of inhalant use and anxiety, depression, HIV/AIDS, STD, tuberculosis, bronchitis, asthma, sinusitis, and tinnitus.Conclusions: This study provides initial analyses on the relationships between illicit drug use and health conditions based on a large nationally representative sample. These results can help prepare for treating health problems among former and continuing illicit drug users.

Physical Activity, Cognitive Function, and Mortality in a US National Cohort - Corrected Proof

R.F. Gillum, Thomas O. Obisesan — 2010-02-22

Purpose: Increasing physical activity is postulated to slow cognitive decline associated with aging. Low levels of both physical activity and cognitive function are associated with increased risk of mortality. We test the hypothesis that the relative protective effect of high physical activity level as related to mortality is greater in persons with impaired cognitive function than in others.Methods: Data were analyzed from a longitudinal mortality follow-up study of 5903 American men and women aged 60 years and older examined in 1988 to 1994 who were followed an average of 8.5 years. Measurements at baseline included self-reported leisure-time physical activity (LTPA), a short index of cognitive function (SICF), sociodemographic data, health status, and physical and biochemical measurements.Results: Death during follow-up occurred in 2431 persons. In bivariate cross-sectional analyses, more frequent LTPA was associated with greater cognitive function. In proportional hazards regression analysis, no significant interaction of LTPA with cognitive function was found; however, there was a significant age-LTPA interaction. After adjusting for confounding by baseline sociodemographic data and health status at ages 60 to 74, the hazards ratio (95% confidence intervals) was for LTPA more than 8 times weekly compared with none (0.51; 0.38−0.76, p < .001) and for low SICF score compared with high 1.43 (1.36; 1.00−1.84, p < .05). After controlling for health behaviors, blood pressure, and body mass, C-reactive protein, and high-density lipoprotein cholesterol, the LTPA hazards ratio was 0.52 (0.35–0.78; p = .002), but cognitive function was no longer significant. At ages 75 and older, results were similar for LTPA, but cognitive function remained significant after adjustment.Conclusions: In a nationwide cohort of older Americans, analyses demonstrated a lower risk of death independent of confounders among those with frequent LTPA. Much of the effect of low cognitive function could be explained by other risk factors at ages 60 to 74 but not 75 years and older.

The Impact of Attrition in an 11-Year Prospective Longitudinal Study of Younger Women - Corrected Proof

Jennifer Powers, Deborah Loxton — 2010-02-12

Purpose: To investigate the impact of attrition on prevalence and associations between variables across four waves of a longitudinal study.Methods: Prevalence of socio-demographic and health characteristics were estimated for respondents to one, two, three or all four waves of the Australian Longitudinal Study of Women's Health cohort born between 1973 and 1978. Associations with self-rated General Health (GH) and Mental Health (MH) were compared using fixed effects in separate mixed models for respondents to at least one wave, at least two waves, at least three waves, or four waves of the longitudinal study.Results: 14,247 women aged 18-23 years responded to Wave 1 in 1996. Respondents to all waves were more educated, and less likely to be stressed about money, to be smokers and to have children than respondents to some waves. Across all models, better GH was consistently associated with more education, no monetary stress, being married, having children, fewer visits to the doctor and not smoking. Similar results were obtained for MH.Conclusions: Although the potential for bias due to attrition must be considered, the current paper contributes to the growing body of evidence that suggests such biases are insufficient to preclude meaningful longitudinal analyses.

Prevalence of Overweight and Obesity in Italy (2001–2008): Is There a Rising Obesity Epidemic? - Corrected Proof

2010-02-12

Purpose: To provide national, population-based estimates of the prevalence of overweight and obesity in the Italian population.Methods: Prevalence estimates of overweight and obesity were calculated in seven waves (2001–2008) of the cross-sectional Multipurpose Household Survey organized by the Italian National Institute of Statistics, which are representative of the general adult Italian population. Sampling weights were used to estimate prevalence figures as well as their standard errors. Mean-difference plot was used to evaluate changes in the distribution of body mass index across sex and age categories.Results: Almost half of Italian men and about 1 of 3 Italian women are overweight or obese. Between 2001 and 2008 the age-standardized prevalence of overweight (obesity) increased of 1.4% (1.9%) in men and of 0.4% (0.5%) in women. Mean-difference plots showed an upward shift for body mass index distribution with an increasing skewness.Conclusions: The obesity epidemic is one of the major issue in United States and other developed countries. However, if for “epidemic” we mean that in Italy obesity is steadily increasing, then our data give little support to this interpretation. In fact, trends observed between 1983 and 2008 suggest that the rates of changes in the prevalence of overweight and/or obesity are not increasing.

Investigating the Risk of Cancer in 1990-1991 US Gulf War Veterans With the Use of State Cancer Registry Data - Corrected Proof

2010-01-29

Purpose: The purpose of this study was to determine whether proportional cancer incidence is greater among Gulf War veterans compared with non-Gulf War veterans.Methods: Files obtained from the Defense Manpower Data Center included data for 621,902 veterans who were deployed to the Persian Gulf during the 1990 to 1991 Gulf War (August 2, 1990, to March 1, 1991) and 746,248 non-Gulf War veteran controls. Identification of veterans who received a cancer diagnosis between 1991 and 2006 was accomplished through record linkage of the Defense Manpower Data Center dataset with files from 28 state cancer registries and the Department of Veterans Affairs Central Cancer Registry. By the use of logistic regression, proportional incidence ratios adjusted for demographic and military characteristics were calculated by comparing the proportion of a specific cancer among all cancers in the Gulf War veterans to the proportion of that specific cancer among all cancers in the non-Gulf War veterans.Results: Only lung cancer showed a statistically significant relative excess among Gulf War veterans compared with non-Gulf War veterans (adjusted proportional incidence ratios, 1.15; 95% confidence interval, 1.03−1.29). When adjusted for race, age, and sex, the overall proportion of cancers among Gulf War and non-Gulf War veterans was similar (odds ratio, 0.99; 95% CI, 0.96−1.02).Conclusions: With the exception of lung cancer, there is little evidence of excess risk of cancer associated with Gulf War deployment. A follow-up study is warranted to confirm this finding and to evaluate the role of greater smoking rates among deployed personnel.

When Less Is Better: A Comparison of Bach® Flower Remedies and Homeopathy - Corrected Proof

Robert A. Halberstein, Alicia Sirkin, Maria M. Ojeda-vaz — 2010-01-25

Purpose: Homeopathy and Bach® Flower Remedy (BFR) therapy, historically-related over-the-counter complementary healing modalities classified as nutritional supplements by the FDA, are compared with regard to indications, dosage philosophies, associated procedures, reported outcomes, safety profiles, and the possible operation of the placebo effect.Methods: Original data and published research reports, including case studies, retrospective meta-analyses, and double-blind clinical trials are compiled and evaluated for both healing systems.Results: Homeopathy and BFR therapy both feature highly diluted natural medicinal substances, flexible dosage schedules tailored to individual patients, and energy-based healing action. They differ with respect to practitioner training and certification, number and types of medicinal source materials, remedy combinations and applications, and potential toxicity or other side-effects.Conclusions: Extensive testing has produced mixed or equivocal results regarding the efficacy of both of these health care systems. While a variety of positive outcomes have been frequently recorded with Homoeopathy and BFR treatments, it is likely that the placebo effect operates to a significant extent in both approaches.

Criminal Victimization and Comorbid Substance Use and Psychiatric Disorders in the United States: Results from the NESARC - Corrected Proof

2010-01-25

Purpose: Criminal victimization produces enormous personal and societal costs, yet few investigations have systematically examined substance use and psychiatric disorders of crime victims. Our objectives were to (i) examine the prevalence and patterns of criminal victimization in the United States and (ii) their associations with specific substance use disorders, prevalent psychiatric conditions, and violent and nonviolent antisocial behaviors in controlled multivariate analyses.Methods: Data were derived from the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative sample of US residents 18 years of age and older (N=43,093). Interviews conducted between 2001 and 2002 included measures of past-year criminal victimization and Diagnostic and Statistical Manual of Mental Disorders, IV mood, anxiety, substance use, and personality disorders.Results: More than 1-in-25 adults in the United States (4.1%) reported past-year criminal victimization. Respondents who reported lower levels of income, lived in urban areas, and were separated or divorced were at significantly heightened risk for criminal victimization. Persons reporting various forms of violent and nonviolent antisocial behavior also were more likely to be victims of crime. In controlled multivariate analyses, crime victims evidenced significantly increased rates of alcohol, cocaine, and opioid use disorders. Paranoid personality disorder, major depressive disorder, and a family history of antisocial behavior were also significantly associated with past-year criminal victimization.Conclusion: Criminal victimization is prevalent in the United States and associated with significant psychiatric comorbidities and behavioral dysfunction. Poor, unmarried persons living in urban areas who have family histories of antisocial conduct and personal histories of specific substance use and psychiatric disorders are at substantially elevated risk for criminal victimization.

Age- and Gender-Specific Estimates of Partnership Formation and Dissolution Rates in the Seattle Sex Survey - Corrected Proof

2010-01-13

Purpose: Partnership formation and dissolution rates are primary determinants of sexually transmitted infection (STI) transmission dynamics.Methods: The authors used data on persons' lifetime sexual experiences from a 2003–2004 random digit dialing survey of Seattle residents aged 18–39 years (N=1,194) to estimate age- and gender-specific partnership formation and dissolution rates. Partnership start and end dates were used to estimate participants' ages at the start of each partnership and partnership durations, and partnerships not enumerated in the survey were imputed.Results: Partnership formation peaked at age 19 at 0.9 (95% confidence interval [CI]: 0.76–1.04) partnerships per year and decreased to 0.1 to 0.2 after age 30 for women and peaked at age 20 at 1.4 (95% CI: 1.08–1.64) and declined to 0.5 after age 30 for men. Nearly one fourth (23.7%) of partnerships ended within 1 week and more than one half (51.2%) ended within 12 weeks. Most (63.5%) individuals 30 to 39 years of age had not formed a new sexual partnership in the past 3 years.Conclusion: A large proportion of the heterosexual population is no longer at substantial STI risk by their early 30s, but similar analyses among high-risk populations may give insight into reasons for the profound disparities in STI rates across populations.