International Skeletal Society: eighteenth annual refresher course, September 1991.
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Biomedical subjects
Publications and source records attributed to E Whalen.
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OBJECTIVE: To evaluate whether tobacco advertising encourages teenagers younger than 18 years to start smoking. DESIGN: Comparison of 1990 California telephone survey data with data from a 1986 national telephone survey (both used a random-digit dialing system); 95% confidence intervals were calculated. To test our hypothesis, we considered whether the perception of advertising was related to age, whether the pattern of market share across age and sex groups followed the pattern of perceived advertising, and whether changes in market share paralleled changes in advertising as perceived by the youngest age group. PARTICIPANTS: There were 24,296 adults and 5040 teenagers. RESULTS: The most advertised brands of cigarettes were Marlboro, according to 33.6% of adults and 41.8% of teenagers, and Camel, according to 13.7% of adults and 28.5% of teenagers--named most often by 12- to 13-year-olds (34.2%). The brands that were purchased most often were Marlboro and Camel. Together these were the brands of choice of 79.9% of males and 85% of females aged 12 through 17 years. Marlboro's market share increased in youths and young adults up to age 24 years and then decreased gradually with age; Camel's market share decreased abruptly with age: it was the brand of choice of 24.5% +/- 5.8% of males aged 12 through 17 years but was chosen by only 12.7% +/- 3.6% of males aged 18 through 24 years; for females, 21.7% +/- 13.7% aged 12 through 17 years chose Camels, while only 5.5% +/- 3.2% aged 18 through 24 years preferred this brand. Both Marlboro and Camel brands had a higher market share in California in 1990 compared with that for the United States in 1986. Of interest is that the market share for Camel increased among the younger smokers but was more evenly distributed for Marlboro. CONCLUSIONS: Perception of advertising is higher among young smokers; market-share patterns across age and sex groups follow the perceived advertising patterns; and changes in market share resulting from advertising occur mainly in younger smokers. Cigarette advertising encourages youth to smoke and should be banned.
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The primary goal of triage is to identify the majority of field trauma victims at risk for life-threatening injuries. When triage criteria are made sufficiently sensitive to accomplish this goal, high rates of overtriage occur. Orange County's original physiologic criteria were associated with an overtriage rate of 18-40% depending on the definition of a major trauma victim. During the first year's experience with the original physiologic criteria, 21% of non-CNS motor vehicle trauma deaths occurred in nondesignated hospitals. When the criteria were made more sensitive by adding non-time dependent triage criteria such as anatomic and mechanism of injury criteria, deaths in nondesignated hospitals dropped to 4.4%, but the rate of overtriage doubled. Despite this apparent high rate of overtriage, only 5.5% of all paramedic transports were for patients judged to have met field triage criteria. Based on this experience, an approach is suggested for evaluating the balance between over- and undertriage that occurs for a given set of triage criteria. Once this balance has been defined, triage guidelines can be modified to meet regional triage objectives.