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AJPH NEWS Release

EMBARGOED UNTIL March 26, 2003, 4:00 PM (ET)
CONTACT: For copies of articles, call Natalie Raynor, (202) 777-2511

All articles are online at www.ajph.org

American Journal of Public Health: April 2003 Highlights

• More than a third of mothers suffer health problems during labor and delivery
• California smoking ban hasn't hurt bar business
• Doctors don't have time to offer comprehensive preventive services
• Young workers need protection from pesticide exposure

The articles highlighted below appear in the April 2003 issue of the American Journal of Public Health, the Journal of the American Public Health Association.

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More than a third of mothers suffer health problems during labor and delivery
Millions of women suffer health problems during labor and delivery, and many of those problems are preventable, according to a new study. An analysis of more than 19 million deliveries that occurred between 1993 and 1997 revealed that nearly 1.2 million women annually, or 31 percent of those who gave birth, suffered an obstetric complication, a pre-existing medical condition or both. The most common obstetric complications included third- and fourth-degree lacerations, other obstetric traumas such as cervical lacerations and pelvic trauma, preeclampsia and eclampsia, gestational diabetes, infections and postpartum hemorrhages. The most common pre-existing medical condition was chronic hypertension. A goal of Healthy People 2010 is to reduce maternal morbidity during labor and delivery, and one way to reach that goal is to more closely monitor the kinds of health problems women most often face when giving birth, according to the study's authors. This could also contribute to reducing the nation's maternal death rate, which has remained unchanged since 1982.
[From: "Magnitude of Maternal Morbidity During Labor and Delivery: United States, 1993-1997." Contact: Isabella Danel, MD, MS, World Bank, idanel{at}worldbank.org.]

California smoking ban hasn't hurt bar business
Despite fears that a California law banning smoking in most bars would cripple the industry, the state's bar patrons are increasingly supporting the law. Researchers surveyed about 1,000 people during three periods ­ three months, six months and two and a half years after California bars became smoke-free. Their findings: California bar patrons increasingly support and comply with the 1998 smoke-free bar law. In the first survey, almost 60 percent of respondents approved of the law. By the third survey in June 2000, the approval rating was more than 73 percent. Furthermore, self-reported non -compliance dropped from almost 25 percent to 14 percent. Also, in the first survey 85.6 percent of respondents said the law wouldn't keep them from visiting bars. By the third survey, 91 percent of respondents said they either visited bars the same amount or even more frequently because of the law. "The increasingly positive attitudes may be partly attributed to the public's better understanding of the [second-hand smoke] health issue, which has been emphasized by the California Tobacco Control Program efforts, especially media messages that stress the benefits of the law and the importance of compliance," the study's authors wrote. "There may be a snowball effect, in which people who become accustomed to a smoke-free indoor air environment at work, in restaurants and other public places become less tolerant of exposure to [second-hand smoke]." In 1994, California became the first state to ban smoking in virtually all indoor workplaces, and a provision of the law banning smoking in bars went into effect Jan. 1, 1998.
[From: "Changes of Attitudes and Patronage Behaviors in Response to a Smoke-Free Bar Law." Contact: Hao Tang, MD, PhD, California Department of Health Services, Sacramento, htang{at}dhs.ca.gov.]

Doctors don't have time to offer comprehensive preventive services
There simply aren't enough hours in the day for primary care physicians to offer all the recommended preventive care services to each patient, according to a recent study. Researchers looked at the list of preventive screenings and services recommended by the U.S. Preventive Services Task Force and calculated how much time is required for each of those services. Preventive care includes such services as clinician performed exams, nutritional counseling, clinical breast exams and advice on quitting smoking. The study's findings: doctors cannot possibly give each patient the full list of preventive services. "Current recommended preventive services require an unreasonable amount of physician time," wrote the authors, who found that even if the average doctor cut his or her patient load in half, preventive service guidelines could not be met. "New methods of preventive screening are required, as well as a clearer focus on which services can best be provided, and by whom."
[From: "Primary Care: Is There Enough Time for Prevention?" Contact: Kimberly S.H. Yarnall, MD, Duke University Medical Center, Durham, NC, yarna001{at}mc.duke.edu.]

Young workers need protection from pesticide exposure
Teen workers are more likely than adults to become sick from pesticide exposure, and the system designed to track such exposure is woefully inadequate. Those were the findings of a study of national and state-by-state statistics collected on working youth and acute pesticide-related illnesses suffered from 1988-1999. Researchers used data collected from such sources, such as state health departments and the TESS, which is maintained by the American Association of Poison Control Centers. During the time period of the study, 531 workers age 17 and younger were reported to suffer acute pesticide-related illness while on the job. Young workers were almost twice as likely as adults to suffer such illnesses, according to the study. The authors offer several recommendations for reducing harmful pesticide exposure, including improvements in surveillance and a better system of informing students, parents, school officials and employers about child labor laws. Although the authors wrote that it would be useful if all states conducted surveillance of acute pesticide poisoning, currently only eight states do so. Another 38 states must rely on TESS data to obtain counts of occupational pesticide-related illnesses. They noted that four states neither participated in the nationwide TESS nor had a state-based surveillance system for pesticide-related illnesses.
[From: "Acute Pesticide-Related Illnesses Among Working Youths, 1988-1999." Contact: Geoffrey M. Calvert, MD, MPH, National Institute for Occupational Safety And Health, Centers for Disease Control and Prevention, Cincinnati, jac6{at}cdc.gov.]

The American Journal of Public Health is the monthly Journal of the American Public Health Association, the oldest and largest organization of public health professionals in the world and the foremost publisher of public health-related books and periodicals promoting high scientific standards, action programs and policy for good health. The Journal is online at www.ajph.org.

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