Biomedical subjects

Dimitri A Christakis

Publications and source records attributed to Dimitri A Christakis.

At least 37 records · Page 2Linked to original sources

PubMed2005

A systematic review of school-based smoking prevention trials with long-term follow-up.

BACKGROUND: Several systematic reviews of school-based smoking prevention trials have shown short-term decreases in smoking prevalence but have not examined long-term follow-up evaluation. The purpose of this study was to conduct a systematic review of rigorously evaluated interventions for school-based smoking prevention with long-term follow-up data. METHODS: We searched online bibliographic databases and reference lists from review articles and selected studies. We included all school-based, randomized, controlled trials of smoking prevention with follow-up evaluation to age 18 or 12th grade and at least 1 year after intervention ended, and that had smoking prevalence as a primary outcome. The primary outcome was current smoking prevalence (defined as at least 1 cigarette in the past month). RESULTS: The abstracts or full-text articles of 177 relevant studies were examined, of which 8 met the selection criteria. The 8 articles included studies differing in intervention intensity, presence of booster sessions, follow-up periods, and attrition rates. Only one study showed decreased smoking prevalence in the intervention group. CONCLUSIONS: Few studies have evaluated the long-term impact of school-based smoking prevention programs rigorously. Among the 8 programs that have follow-up data to age 18 or 12th grade, we found little to no evidence of long-term effectiveness.

Adolescent↗

PubMed2005

Pediatricians' screening urinalysis practices.

OBJECTIVE: To determine pediatricians' routine screening urinalysis practices. STUDY DESIGN: This was a survey of a nationally representative sample of pediatricians practicing in the U.S. regarding their screening urinalysis practices in childhood. RESULTS: Of the 1502 pediatricians sampled, 653 eligible subjects participated, for an estimated response rate of 49.5%. The vast majority of participants (78%) routinely screen asymptomatic children with urinalysis in at least 1 age group. Pediatricians' screening urinalysis practice varies based on age group: 9% screen during infancy (<1 year), 60% screen during early childhood (1 up to 5 years), 55% screen during late childhood (5 to 12 years), and 58% screen during adolescence (13 to 20 years). The majority of pediatricians (58%) routinely screen more than 1 age group. Some 38% of the pediatricians surveyed believe that the overall health of children is improved by screening all asymptomatic children with urinalysis. CONCLUSIONS: Many pediatricians routinely conduct screening urinalysis during childhood, frequently at ages not recommended by the American Academy of Pediatrics.

Adolescent↗

PubMed2005

Risk of death for children with down syndrome and sepsis.

OBJECTIVE: To determine differences in case fatality rates between children with and without Down syndrome. STUDY DESIGN: We used the Pediatric Health Information System (PHIS) database, which includes demographic and diagnostic data from freestanding children's hospitals. Using Poisson regression, we determined the risk of mortality from sepsis for children with Down syndrome, after controlling for potential confounding factors. RESULTS: A total of 35,645 patients met our inclusion criteria, of which 3936 (11%) died during hospitalization. Altogether, 620 of the included patients also had a diagnosis of Down syndrome; 106 (17%) of these died during hospitalization. Children with Down syndrome had significantly elevated risk of mortality (mortality rate ratio = 1.30; 95% confidence interval = 1.06 to 1.59) after adjusting for potential confounding factors including demographics, pathogens, and concomitant conditions. CONCLUSIONS: Children with Down syndrome and sepsis have elevated risk of mortality. These findings have implications for treatment decisions, communications about prognosis, and future research.

Adolescent↗

PubMed2005

Parental emotional support and subsequent internalizing and externalizing problems among children.

This study examined the association between early emotional support provided by parents and child internalizing and externalizing problems, using a nationally representative, longitudinal sample of 1361 children. Parental emotional support was assessed using the Home Observation for the Measurement of the Environment, incorporating both parent report and interviewer observation. We found that, controlling for child externalizing problems at age 6 years, parental emotional support at age 6 years was negatively related to child externalizing problems at age 8 years. A developmental model that assessed the timing of the emergence of this relationship was then analyzed by including parental emotional support at ages 2, 4, and 6 years as predictors of child externalizing problems at age 8 years. The developmental model suggested that less parental emotional support as early as age 2 years is associated with later externalizing problems in children. This study discusses the importance of very early parental emotional support in promoting positive child development.

Affect↗

PubMed2005

Association between parental satisfaction and antibiotic prescription for children with cough and cold symptoms.

BACKGROUND: Providers' interest in satisfying parents may provide an impetus for unnecessary antibiotic use in children. OBJECTIVES: To determine (1) whether receipt of antibiotics at a visit for cough and cold symptoms was associated with increased satisfaction and (2) whether nonreceipt of antibiotics at an initial visit but subsequent receipt of antibiotics in the course of the same illness episode was associated with decreased satisfaction. METHODS: Prospective cohort study of patients 2-10 years of age presenting to a university-affiliated pediatric clinic with cough and cold symptoms. Parents were enrolled at the index visit and then followed up by phone at least 7 days later (mean time to follow-up, 14.9 days). Satisfaction with the index visit on a 10 point scale was the primary outcome. The primary predictors were whether antibiotics were prescribed at the index visit and, if not, whether they were prescribed since that visit. Linear and median regression were used to adjust for income, child age, parental race and individual provider. RESULTS: A total of 539 parents were enrolled in the study, and 378 (70%) completed follow-up interviews. The mean age of participating children was 4.67 years (SD 2.16). Overall 47% of patients received antibiotics at the index visit, and 8% of those that did not reported receiving them between the index visit and the follow-up assessment. In the regression model, receiving antibiotics at the index visit trended toward being associated with higher satisfactions scores (0.28; P = 0.08). Among those who did not receive antibiotics initially, receiving them subsequently was associated with significantly lower median satisfaction score for the index visit (-3.0; P < 0.01). CONCLUSIONS: Receiving antibiotics after an initial visit for cough and cold symptoms at which antibiotics were not prescribed is associated with decreased satisfaction. Use of contingency prescriptions may be an important intervention.

Anti-Bacterial Agents↗

PubMed2005

Nonfebrile illness seizures: a unique seizure category?

PURPOSE: To describe the clinical characteristics of children with a first-time nonfebrile seizure in the setting of mild illness and to test the hypothesis that these seizures are associated with illness characterized by diarrhea. METHODS: This retrospective cohort study was performed in a pediatric emergency department. Patients ages 6 months to 6 years who were evaluated with first-time seizures were eligible for inclusion. Subjects were divided into three groups on the basis of symptoms accompanying their seizure: febrile (temperature, >38.0 degrees C with seizure), unprovoked (no symptoms of illness), and nonfebrile illness (no fever at the time of seizure, but other symptoms of illness present). RESULTS: Of the 323 children with first-time seizures, 247 (76%) had febrile seizure, 37 (12%) had unprovoked seizures, and 39 (12%) had nonfebrile illness seizures. Children with nonfebrile illness seizures were more likely than children with febrile seizures to have diarrheal illnesses accompanying their seizure (44 vs. 16%; p=0.001). Frequency of cough, rhinorrhea, and rash did not differ significantly between children with febrile and nonfebrile illness seizures. Diagnostic testing for infectious etiologies was not performed frequently in either group. CONCLUSIONS: Nonfebrile illness seizures may represent a distinct group of seizures with unique epidemiology. Further study to define this seizure group better is warranted.

Child, Preschool↗

PubMed2005

Variation in inpatient diagnostic testing and management of bronchiolitis.

OBJECTIVES: We know little about the variation in diagnosis and management of bronchiolitis. The objectives of this study were (1) to document variations in treatment and diagnostic approaches, lengths of stay (LOSs), and readmission rates and (2) to determine which potentially modifiable process of care measures are associated with longer LOSs and antibiotic usage. METHODS: We used the Pediatric Health Information System, which includes demographic, diagnostic, and detailed patient-level data on 30 large children's hospitals. We examined infants who were younger than 1 year and hospitalized for bronchiolitis (October 2001-September 2003). Multivariate analysis of variance was used to determine whether the variance in the outcomes was hospital related after controlling for other covariates. Linear regression was used to model predictors of increased LOS. Logistic regression was used to model antibiotic usage. Analyses were stratified by age group (<3 months and 3-11 months). RESULTS: A total of 17397 patients were included in the analysis. The mean LOS was 2.97 days; 72% of patients received chest radiographs, 45% received antibiotics, and 25% received systemic steroids. The mean LOS varied considerably across hospitals (range: 2.40-3.90 days), and hospital remained a significant contributor to LOS variation after controlling for our covariates. Variations in the use of diagnostic tests and medications as well as readmission rates also existed and also remained significant after controlling for covariates. The factors associated with the greatest increases in LOS in the regression analyses included higher severity scores and use of antibiotics, bronchodilators, and corticosteroids. The strongest predictors of antibiotic use in the logistic regression analyses were higher severity scores and receipt of a blood or cerebrospinal fluid culture. Receiving a chest radiograph was a significant predictor of antibiotic use in older but not younger infants. CONCLUSIONS: Considerable, unexplained variation exists in the inpatient management of bronchiolitis. The development of national guidelines and controlled trials of new therapies and different management approaches are indicated.

Adrenal Cortex Hormones↗

PubMed2005

Compliance with guidelines for the medical care of first urinary tract infections in infants: a population-based study.

BACKGROUND: No population-based studies have examined the degree to which practice parameters are followed for urinary tract infections in infants. OBJECTIVE: To describe the medical care of children in their first year of life after a first urinary tract infection. METHODS: Using Washington State Medicaid data, we conducted a retrospective cohort study of children with a urinary tract infection during their first year of life to determine how many of these children received recommended care based on the most recent guidelines from the American Academy of Pediatrics. Recommended care included timely anatomic imaging, timely imaging for reflux, and adequate antimicrobial prophylaxis. Multivariate logistic-regression models were used to evaluate if hospitalization for first urinary tract infection, young age at time of diagnosis, gender, race, primary language of parents, having a managed care plan, and rural location of household residence were associated with recommended care. RESULTS: Less than half of all children diagnosed with a urinary tract infection in their first year of life received the recommended medical care. Children who were hospitalized for their first urinary tract infection were significantly more likely than children who were not hospitalized to receive anatomic imaging (relative risk [RR]: 1.38; 95% confidence interval [CI]: 1.20-1.57) and imaging for reflux (RR: 1.62; 95% CI: 1.34-1.90). CONCLUSIONS: There is poor compliance with guideline-recommended care for first urinary tract infections in infants in a Medicaid population. Given the trend toward increased outpatient management of urinary tract infections, increased attention to outpatient imaging may be warranted.

Anti-Bacterial Agents↗

PubMed2005

Infection control policies and hospital-associated infections among surgical patients: variability and associations in a multicenter pediatric setting.

BACKGROUND: Hospital-associated infections are an important cause of patient morbidity and death. Little is known about the variability of infection rates and infection control practices among pediatric hospitals. METHODS: This cross-sectional study was performed with the Pediatric Health Information System database, which includes demographic and diagnostic data for 35 freestanding, noncompeting, children's hospitals, and with data from a survey of the hospitals, which yielded additional information on infection control policies and practices. Patients undergoing elective surgical procedures were included in this study. RESULTS: Of the 35 eligible hospitals, 31 (89%) chose to participate in the survey component of this study. A total of 48278 patients met the inclusion criteria for the study; 2.3% of these patients had respiratory infections and 0.8% had gastrointestinal infections. The frequency of patients diagnosed with respiratory or gastrointestinal infections varied considerably among the hospitals and ranged from <1% to 6%. Certain infection control processes also varied among the hospitals during the study period. For instance, of the 31 hospitals, 12 monitored hand hygiene, 19 had administrative support of hand hygiene, and 16 had alcohol hand gel present for the entire study period. The presence of alcohol hand gel for the entire study was strongly and independently associated with lower odds of gastrointestinal infections (adjusted odds ratio: 0.64; 95% confidence interval: 0.49-0.85). CONCLUSIONS: Hospitals should support the use of alcohol hand gel, with the aim of decreasing hospital-associated infection rates.

Alcohols↗

PubMed2005

Medicaid acceptance and availability of timely follow-up for newborns with Medicaid.

OBJECTIVE: Decreased physician participation in Medicaid has been shown to affect adversely timeliness of adult acute care and pediatric specialty care, but it is not clear whether this is the case for newborn follow-up. The objectives of this study were to determine whether there is a difference within clinics in the timeliness of follow-up appointments that are given to newborns with Medicaid compared with newborns with private insurance and to determine whether there is a difference between clinics that do and do not accept Medicaid in the timeliness of appointments that are given for newborn follow-up. METHODS: A randomized crossover study was conducted among general pediatric clinics and practices that were identified from the yellow pages and Internet searches of hospitals and health departments in 8 metropolitan areas from September 2003 to March 2004. A simulated parent telephoned clinics to find the earliest available appointment for a 1-day-old infant who needed routine follow-up after discharge that day. Clinics were randomly assigned to receive a first call from a patient with either Medicaid or private insurance; each clinic received the same call at least 3 weeks later with the patient's insurance status reversed. The main outcome measure was whether the appointment was timely (< or =2 days from the day of the call). RESULTS: Of 401 participating clinics, 22% did not accept Medicaid. Among clinics that accepted Medicaid, availability of a timely appointment for a newborn with Medicaid was similar to that for a newborn with private insurance (87% vs 90%, respectively). Appointments that were provided to privately insured newborns were as likely to be timely in clinics that accept Medicaid as in clinics that do not accept Medicaid (89.5% vs 93.4%, respectively). However, providing timely appointments was significantly less likely in clinics that were in high-poverty locations compared with clinics that were not (86.1% vs 92.7%, respectively). CONCLUSIONS: Although newborns with Medicaid did not have access to >20% of clinics because of their insurance, among clinics that did accept Medicaid, timeliness of available follow-up was similar for newborns with Medicaid compared with newborns with private insurance and similar between clinics that did and did not accept Medicaid. However, to the extent that care for newborns with Medicaid is concentrated in clinics in high-poverty areas, some newborns with Medicaid may not be able to receive timely appointments.

Community Health Services↗

PubMed2005

The association between television viewing and irregular sleep schedules among children less than 3 years of age.

BACKGROUND: Regular sleep schedules are an important part of healthy sleep habits. Although television viewing is associated with altered sleep patterns and sleep disorders among children and adolescents, the effect of television viewing on the sleep patterns of infants and toddlers is not known. OBJECTIVE: To test the hypothesis that television viewing by infants and toddlers is associated with having irregular naptime and bedtime schedules. METHODS: We used data from the National Survey of Early Childhood Health, a nationally representative, cross-sectional study of the health and health care of children 4 to 35 months of age. Our main outcome measures were whether children had irregular naptime and bedtime schedules. Our main predictor was hours of television watched on a daily basis. We performed multivariate logistic regression analyses, adjusting for a variety of factors including demographic information, measures of maternal mental health, and measures of family interactions, to test the independent association of television viewing and irregular naptime and bedtime schedules. RESULTS: Data were available for 2068 children. Thirty-four percent of all children had irregular naptime schedules, and 27% had irregular bedtime schedules. Mean hours of television viewing per day were as follows: 0.9 hours/day (95% confidence interval [CI]: 0.8-1.0 hours/day) for children <12 months of age, 1.6 hours/day (95% CI: 1.4-1.8 hours/day) for children 12 to 23 months of age, and 2.3 hours/day (95% CI: 2.1-2.5 hours/day) for children 24 to 35 months of age. In our logistic regression model, the number of hours of television watched per day was associated with both an irregular naptime schedule (odds ratio: 1.09; 95% CI: 1.01-1.18) and an irregular bedtime schedule (odds ratio: 1.13; 95% CI: 1.04-1.24). CONCLUSIONS: Television viewing among infants and toddlers is associated with irregular sleep schedules. More research is warranted to determine whether this association is causal.

Child Care↗

PubMed2005

Household computer and Internet access: The digital divide in a pediatric clinic population.

Past studies have noted a digital divide, or inequality in computer and Internet access related to socio-economic class. This study sought to measure how many households in a pediatric primary care outpatient clinic had household access to computers and the Internet, and whether this access differed by socio-economic status or other demographic information. We conducted a phone survey of a population-based sample of parents with children ages 0 to 11 years old. Analyses assessed predictors of having home access to a computer, the Internet, and high-speed Internet service. Overall, 88.9% of all households owned a personal computer, and 81.4% of all households had Internet access. Among households with Internet access, 48.3% had high speed Internet at home. There were significant associations between home computer ownership or Internet access and parental income or education. There was no relationship these factors and high speed Internet access. Over 60% of families with annual household income of $10,000-$25,000, and nearly 70% of families with only a high-school education had Internet access at home. While income and education remain significant predictors of household computer and internet access, many patients and families at all economic levels have access, and might benefit from health promotion interventions using these modalities.

Computers↗

PubMed2004

Mental illness hospitalizations of youth in Washington State.

OBJECTIVE: To determine if mental health hospitalizations have increased among youth. DESIGN: A retrospective cross-sectional time trend study. The Washington State Comprehensive Hospital Abstract Reporting System data set was used to examine hospitalizations among youth (aged 5-19 years) from January 1, 1990, through December 31, 1999. The yearly rates of youth hospitalized for mental illness were calculated, as were the proportions of hospitalizations due to mental illness. Chi(2) tests of trend were computed to assess for significant change over time. Additional analyses examined trends in hospital days due to mental illness and repeated hospitalizations and compared mental illness with other major causes of child and adolescent hospitalization. RESULTS: The rate of school-aged children (aged 5-14 years) hospitalized for mental illness increased by 22% during the 1990s (P =.004). The proportion of hospitalizations due to mental illness in school-aged children increased from 7.8% in 1990 to 12.8% in 1999 (P<.001). Among adolescents (aged 15-19 years), no significant change occurred in the rate of mental illness hospitalizations, but the proportion of hospitalizations due to mental illness increased from 14.5% in 1990 to 21.5% in 1999 (P<.001). Although injuries were the leading cause of hospitalizations among youth in 1990, mental illness has since surpassed injuries as a cause for hospitalization. Mental illness accounted for one third of all hospital days for youth in 1999. CONCLUSIONS: Mental illness hospitalizations account for an increasing proportion of admissions and hospital days among children and adolescents in Washington State. During the past decade, mental illness has surpassed injury as a leading cause of hospitalization for Washington youth.

Adolescent↗

PubMed2004

Quality of care for medicaid-covered youth treated with antidepressant therapy.

BACKGROUND: Although antidepressant use has increased in pediatric populations, few studies have addressed the quality of follow-up care or duration of treatment for depressed youth. OBJECTIVE: To evaluate the quality of care for antidepressant-treated youth, using the Health Plan Employer Data and Information Set guidelines (>or=3 visits in the 3 months after a new antidepressant prescription fill and continuation of antidepressant use at 3 and 6 months) as a benchmark. DESIGN: Administrative records were examined for 1205 Medicaid-covered youth (aged 5-18 years) who presented with a "new episode" of depression in 1998. Statistics were generated to describe the number of follow-up visits and duration of treatment within 6 months of first prescription fill. RESULTS: A total of 507 (42.1%) youth with new episodes of depression were treated with antidepressants. Selective serotonin reuptake inhibitors accounted for 80.9% of prescriptions. Twenty-eight percent (28.1%) of youth with an antidepressant fill had 3 or more follow-up visits in the subsequent 3 months; however, an additional 29.2% had no further provider visits. Selective serotonin reuptake inhibitors were continued by 46.6% of treated youth at 3 months and by 26.3% at 6 months. CONCLUSIONS: Many antidepressant-treated youth do not receive adequate follow-up or duration of treatment. Future studies should address reasons for poor follow-up and methods to improve monitoring for these youth.

Adolescent↗

PubMed2004

Prevention of smoking-related deaths in the United States.

BACKGROUND: Tobacco is the leading cause of death in the United States. The majority of people who smoke begin before age 18. OBJECTIVE: Determine the number of smoking-attributable deaths and years of potential life lost (YPLL) in adults that might be saved through interventions to reduce smoking prevalence among children and adolescents. METHODS: Calculation of the smoking-attributable mortality and years of potential life lost by age 85 among the cohort of people aged 18 in 2000. RESULTS: By age 85, there would be 127,670 smoking-attributable deaths among women and 284,502 deaths among men, for a total 412,172 smoking-attributable deaths in the United States among the cohort of 3,964,704 people aged 18 years alive in 2000. Through large-scale multimedia campaigns and a $1 increase in the price per pack of cigarettes, smoking prevalence could be reduced by 26% and would result in an annual savings of 108,466 lives and 1.6 million YPLL. CONCLUSIONS: Interventions to decrease smoking prevalence among children and adolescents can have large effects on adult mortality.

Adolescent↗

PubMed2004

Television, video, and computer game usage in children under 11 years of age.

OBJECTIVE: To conduct a population-based survey of television and other media usage in young children to determine (1) total media usage; (2) the proportion of children who have televisions in their bedrooms and who eat breakfast or dinner in front of the television; and (3) predictors of parental concern about the amount of television their child watches. STUDY DESIGN: Telephone survey administered to 1454 parents of children <11 years old derived from a diverse clinic population. RESULTS: The mean age of the index child was 5.05 years. Mean daily reported child media use was as follows: television (1.45 hours; SD, 1.5); videos (1.1 hours; SD, 1.30); and computer games (0.54 hours; SD, 0.96). Thirty percent of parents reported that their child ate breakfast or dinner in front of the television in the past week, and 22% were concerned about the amount of television that their child watched. In multivariate linear regression, eating breakfast or dinner in front of the television in the past week was associated with increased hours of television viewing (0.38 hours [0.21, 0.54]) and video (0.19 hours [0.04, 0.34]). Having a television in a child's bedroom was associated with increased hours of television (0.25 hours [0.07, 0.43]), video viewing (0.31 hours [0.16, 0.47]), and computer games (0.21 hours [0.10, 0.32]). In general, higher parental education was associated with decreased hours of television and video but not computer games. Older children were 2 to 3 times more likely than younger children to have a television in their bedroom and to have eaten a meal in front of it in the past week. More educated parents were less likely to report that their child had a television in their bedroom and more likely to be concerned about the amount of television their child viewed. CONCLUSIONS: Combined video and computer game usage exceeded television usage. Both children of low- and high-income parents are at risk for certain behaviors associated with television usage. Parents whose children watched more television were more likely to be concerned about the amount of television their child viewed.

Child↗

PubMed2004

Tinker, tailor, soldier, patient: work attributes and depression disparities among young adults.

Prior studies have consistently found the occurrence of depression to be higher among persons with lower socio-economic status (SES), but causal mechanisms for this relationship are often not well understood. For example, while depression has been shown to increase during spells of unemployment, little work has been done on job attributes that may be related to depression among employed people early in their careers. This study links the 1992 wave of the National Longitudinal Survey of Youth 1979 cohort-which included Depression symptom scores on the Center for Epidemiologic Studies Depression (CES-D) instrument-to the US Department of Labor's new occupational characteristics O*Net dataset. The resulting dataset includes information regarding depression, SES, and specific attributes of jobs held by the young adult respondents. Job attributes included measures of social status, interpersonal stressors, and physical conditions. Multivariate analysis revealed that for young men, higher job status is associated with lower CES-D scores. Higher scores on the opposition scale, which measures the extent to which employees are obliged to take a position opposed to others, is associated with higher CES-D scores. For young women, physically uncomfortable or dangerous jobs are associated with more depressive symptoms. Results are stratified by race/ethnicity. For Black men, unlike for White men or Latinos, job security is associated with fewer depressive symptoms; and for Latino men, but not for Black or White men, physically uncomfortable or dangerous jobs are associated with more depressive symptoms. For Black women, job status is associated with fewer depressive symptoms. We conclude that part of the SES-depression relationship may arise from the psychosocial aspects of jobs, which we have found to be significantly and meaningfully associated with depressive symptoms among employed young adults.

Adolescent↗

PubMed2004

Mortality attributable to harmful drinking in the United States, 2000.

OBJECTIVE: Although alcohol has been associated with death from a variety of causes, there are no recent data on the number of deaths in the United States attributable to harmful alcohol use. This study provides updated information on the number of deaths in the United States attributable to harmful drinking. METHOD: We used the etiologic-fraction method to calculate alcohol-related mortality by cause of death, using U.S. mortality data for 2000, the most recent year available. Prevalence of alcohol use was estimated from the Behavioral Risk Factor Survey and from the National Household Survey on Drug Abuse. Medium and high levels of regular drinking or heavy episodic drinking were defined as harmful drinking. RESULTS: An estimated 63,718 deaths were attributable to harmful drinking in the U.S. in 2000. Of these, an estimated 45,988 were in men and 17,730 in women, accounting for 4% of all deaths among men and 1.5% among women. Among men, 47.6% were due to medium and high levels of regular drinking, and 52.4% due to heavy episodic drinking, whereas among women these proportions were 54.2% and 45.8%. CONCLUSIONS: Harmful drinking accounts for a substantial number of deaths each year in the United States. Prevention of this underlying cause of mortality must be a public health priority.

Alcohol Drinking↗