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J S Marks

Publications and source records attributed to J S Marks.

122 records · Page 7Linked to original sources
PubMedDate not supplied

A cost-benefit/cost-effectiveness analysis of smoking cessation for pregnant women.

Research has shown that pregnant women who smoke cigarettes increase their risk of having low birthweight (LBW) infants. Recent randomized trials indicate that women who quit smoking early in pregnancy reduce their risk of delivering a LBW infant. Using various sources, we estimated the cost-effectiveness of a smoking cessation program for preventing LBW and perinatal mortality. Assuming the program would cost $30 a participant and that 15% of the participants would quit smoking, we determined that a program offered to all pregnant smokers would shift 5,876 LBW infants to normal birthweight and would cost about $4,000 for each LBW infant prevented. Since infants born to smokers are at 20% greater risk for a perinatal death, a smoking cessation program could prevent 338 deaths at a cost of $69,542 for each perinatal death averted. Compared with the costs of caring for these LBW infants in a neonatal intensive care unit (NICU), smoking cessation programs would save $77,807,054, or $3.31 per $1 spent. The ratio of savings to costs increases to more than six to one when we include reducing long-term care for infants with disabilities secondary to LBW in the benefits from smoking cessation programs. These findings argue for routinely including smoking cessation programs in prenatal care for smokers.

Adult↗
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Screening mammography for women 50 years of age and older: practices and trends, 1987.

Recently, public and private efforts have been mounted to promote screening mammography. To assess recent trends in the percentage of women 50 years of age and older who have had a screening mammogram, we analyzed data from interviews from women from 33 states who participated in the 1987 Behavioral Risk Factor Surveillance System. Our study group included 8,402 women 50 years of age and older who had visited a physician for a routine checkup in the last year; among these 8,402 women, only 29% reported having had a screening mammogram in the past year. However, of the women in the study group, the percentage who had a screening mammogram in the last year showed a relative increase of 38% during 1987, from 24% for women interviewed in the first quarter of 1987 to 33% for women interviewed in the fourth quarter. However, not all groups of patients benefited equally from the observed trend--the absolute and relative increases in the percentage of women screened were lowest for women who were older, less educated, in low-income groups, and who had poor personal health practices. Although the percentage of women 50 years of age and older who reported being screened increased dramatically during 1987, special efforts are needed to reach the patient groups that are being left behind in the trend toward increased use of screening mammograms.

Age Factors↗
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Premarital rubella screening program: from identification to vaccination of susceptible women in the state of Hawaii.

Premarital rubella screening programs are effective in identifying women of childbearing age who are susceptible to rubella. There is concern, however, that once identified, susceptible women may not be subsequently vaccinated. Therefore, a study was conducted to test the effectiveness of a motivational letter mailed at the time of serologic testing. Rubella-susceptible women identified by a premarital screening program were randomly divided into two groups: one group of 134 received a motivational letter and one group of 143 did not. Three months later, 52 percent of the women in the motivational group had been vaccinated, compared with only 24 percent (P less than 0.05) of the women in the control group. In this study, a motivational letter was found to lead to a significant increase in rubella vaccination rates among susceptible women. With the increasing emphasis on rubella vaccination programs for adult women, active approaches are necessary to identify and vaccinate susceptible women.

Adult↗
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Variation in state-specific infant mortality risks.

Data from the National Infant Mortality Surveillance project were used to examine the State-specific variations in infant, neonatal, and postneonatal mortality and to examine some of the factors affecting the risks of death. The infant mortality risk, defined as the risk of death before 1 year of age to an infant born in the 1980 birth cohort, in the highest risk State was nearly three times that in the lowest risk State. Mortality risk ratios of two or greater were found when comparing high and low States for overall black infant mortality risks, overall neonatal mortality, neonatal mortality risks for black and white infants examined separately, neonatal mortality risks for low birth weight infants regardless of race, and overall postneonatal mortality and postneonatal mortality for white infants. The lowest State-specific black mortality risks were higher than the highest white risks for overall infant mortality and neonatal mortality. The differences between State extremes in mortality risks are greater than the differences between the United States and the Scandinavian countries with the lowest infant mortality.

Female↗
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Birth weight and subsequent growth among Navajo children.

An examination of length, weight, and birth weight data routinely collected from the clinics supported by the Navajo Nation Special Supplemental Program for Women, Infants, and Children (WIC) showed an association between birth weight and subsequent growth status. Navajo children less than 2 years of age entering the WIC Program were divided into low, normal, and high birth weight groups, and their growth patterns were plotted when they returned periodically for reassessment. Overall, the children tended to have low length-for-age and high weight-for-length measures, relative to the reference population, that suggest suboptimal nutritional status. Children with birth weights less than 2,500 grams (g) were consistently shorter, lighter, and thinner than children with birth weights greater than 2,500 g. Although the overall growth status of the children improved between 1975 and 1980, the growth among the children with low birth weights never fully caught up with that of the other Navajo children. Moreover, during that period, the normal birth weight group had a modest improvement in length-for-age relative to the reference population, but the low birth weight group did not. These findings suggest that prenatal interventions to improve the birth weight status of Navajo infants may result in improving the growth status of Navajo children.

Birth Weight↗
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The behavioral risk factor surveys: I. State-specific prevalence estimates of behavioral risk factors.

The prevalence of most behavioral risk factors varies substantially among states. The prevalence of current cigarette smoking ranges from 22 percent to 38 percent. Estimates of alcohol use show geographic clustering, with lower rates in the southeastern states. The prevalence of sedentary lifestyle, uncontrolled hypertension, overweight, and seatbelt use differs markedly among states. These findings represent an initial step toward the analysis of state-specific baseline risk-factor data for use in developing state programs aimed at reducing the leading causes of death in the United States.

Adult↗
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The behavioral risk factor surveys: III. Chronic heavy alcohol use in the United States.

Results of adult telephone interview data from aggregated state surveys show significant chronic alcohol use (two or more drinks per day) by 8.7 percent of the U.S. population. Rates are higher in men than in women (13.8 percent versus 4.0 percent, and higher in whites than in blacks (9.1 percent versus 4.5 percent). Women 25-44 years of age have significantly lower rates (2.9 percent) than women 18-24 (5.7 percent) or women 45-64 (4.6 percent). Also, rates are higher in heavy smokers (over one pack per day) than nonsmokers (22.4 percent versus 5.9 percent), among nonusers of seatbelts than users of seatbelts (10.5 percent versus 6.2 percent), and in those who reported driving after having had "too much" to drink than in those who did not (32.3 percent versus 7.5 percent). Overweight women (2.7 percent) and those who eat in response to stress (3.1 percent) have lower rates of chronic heavy alcohol use than those without these risk factors. Alcohol-related morbidity contributes substantially to the loss of productive life. We conclude that examining alcohol consumption in the light of other lifestyle behaviors would help in the design of effective prevention programs based on multiple risk factor interventions.

Adult↗
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The behavioral risk factor surveys: II. Design, methods, and estimates from combined state data.

Behavioral risk factor (BRF) telephone surveys were conducted by 28 states and the District of Columbia from April 1981 through October 1983 to obtain baseline prevalence estimates for risk factors associated with the leading causes of death among adults. A supplemental survey was conducted to cover the remaining states (except Hawaii) in order to provide individual states with national-level data for comparison purposes. The complex sampling designs and variable sampling rates among state surveys required the computation of sample weights before estimates on a national level could be made. Estimates from the combined individual surveys are similar to those obtained from more expensive in-person interviews. The BRF national prevalence estimate of chronic heavier drinking is 8.7 percent, equivalent to the 1979 National Institute on Alcoholism and Alcohol Abuse (NIAAA) estimate of 9 percent. The BRF estimate of 31.5 percent for current smokers compares closely with the 32.6 percent estimated by the 1980 Health Interview Survey. Despite recognized technical limitations, this type of telephone survey can be a practical and affordable source of information both for initially gathering prevalence data and for monitoring trends in the prevalence of behavioral risk factors of public health concern.

Adult↗
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Current smoking trends in the United States. The 1981-1983 behavioral risk factor surveys.

Based on the aggregate of behavioral risk factor surveys, almost one third of adults were smokers in 1982. Overall, significantly fewer Hispanics smoked compared with whites or blacks. Among young adults, however, the rate of smoking was highest among whites compared with blacks and Hispanics. Compared with nonsmokers, smokers--especially young women--had higher rates of other risk behaviors, including alcohol misuse and lack of seat-belt use. Since 1965, the rate of decline of smoking among women has not been as great as that among men, due in part to the high rate--more than 40%--of smoking among young white women. Despite continued decrease in the overall proportion of smokers, the high rate among young women emphasizes the need for continued efforts toward prevention and cessation, before the well-documented health consequences develop.

Adolescent↗
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Maternal age and births in the 1980s.

Projections from the US Bureau of the Census show that as the large "baby boom" cohort ages in the 1980s, the percentage of births to women 35 years or older will increase by 37%, while the percentage of births to teenaged women, the small post-baby-boom cohort, will decrease by 32%. Between 1980 and 1990, for women aged 35 to 44 years, fertility rates are projected to increase modestly, whereas for teenagers aged 15 to 19 years, fertility rates are projected to decrease modestly. Assuming that half of pregnant women aged 35 years or older request prenatal chromosomal diagnosis, an estimated 1.1 million pregnant women aged 35 years or older will request this service during the 1980s, increasing substantially the demand for it. Simultaneously, demand for prenatal care for teenagers will decrease, due to the decrease in births to teenagers.

Adolescent↗
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Stroke mortality and its socioeconomic, racial, and behavioral correlates in Florida.

Stroke mortality is associated both with being black and with having low socioeconomic status. However, it is uncertain to what extent that increased risk is related to rates of behavior-related risk factors, such as hypertension, cigarette smoking, obesity, or alcohol consumption. The investigators performed an ecologic analysis to estimate the contributions of behavioral risks, socioeconomic status, and black race to regional variations in stroke mortality rates among persons 55-84 years of age in Florida. They used data from the 1980 census and from the Behavioral Risk Factor Surveillance System (BRFSS) for 1986 through 1988. Weighted multiple linear regression models indicated that regions in Florida with high stroke mortality rates were characterized by high prevalences of poverty, obesity, and hypertension. Although limited by its ecologic design, this study suggests that socioeconomic status and prevalence of behavioral risks contribute independently to interregional disparities in stroke mortality rates in Florida. BRFSS data, now available for more than 45 States, can be used to help clarify the relative contributions of behavioral and other risks to population-based mortality rates.

Black or African American↗
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Violence and adverse pregnancy outcomes: a review of the literature and directions for future research.

INTRODUCTION: Violence during pregnancy has been estimated to affect between 0.9% and 20.1% of pregnant women in the United States. This article presents a review of the research on the potential association between violence during pregnancy and adverse outcomes, explores mechanisms by which violence might influence pregnancy outcomes, and suggests directions for future research aimed at the development of successful interventions. METHODS: A review of the literature pertaining to violence during pregnancy and adverse pregnancy outcomes, trauma, and stress during pregnancy was completed. RESULTS: Overall, no pregnancy outcome was consistently found to be associated with violence during pregnancy. The trauma literature offers insight about the effects that injuries caused by physical violence might have on pregnancy outcomes. Information from the stress literature investigates potential mechanisms through which physical violence could indirectly affect pregnancy outcomes. The trauma and stress literature offers methodologic approaches that could be employed in future research on violence during pregnancy and pregnancy outcomes. CONCLUSIONS: This review lays the groundwork for the development of a future research agenda to investigate the association between violence during pregnancy and adverse outcomes. Future research should include quantitative and qualitative approaches, and investigation into the mechanisms and antecedents of how violence during pregnancy may lead to adverse outcomes. Only with such information can successful interventions to limit violence and its potential effects during pregnancy be implemented.

Causality↗