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EMBARGOED UNTIL Oct. 28, 2004, 4 PM (ET)
CONTACT: For copies of articles, contact Natalie Raynor, (202) 777-2511 or natalie.raynor@apha.org
All articles are online at www.ajph.org after the embargo. To view the preliminary table of contents, visit http://www.ajph.org/future/94.11.shtml

American Journal of Public Health November 2004 Highlights

· Lack of health insurance a growing problem in most states
· Cigarette smoking a serious public health threat in China
· Firefighters are at high risk for hospitalization
· Older men and women need similar alcohol use guidelines
· Overcrowded and noisy living conditions have life-long affect on low-income kids' health

The articles highlighted below appear in the November 2004 issue of the American Journal of Public Health, the Journal of the American Public Health Association.

Lack of health insurance a growing problem in most states
The percentage of people who lack health insurance remained a persistent problem from 1992-2001 and actually worsened in most states.
According to an analysis of insurance rates among people aged 18-64, the rate of uninsured rose in 35 states from 1992-2001 despite the booming economy recorded during this period. Particularly striking were the large number of states experiencing increases in uninsurance among persons aged 30 to 64 years, those with middle-level incomes, and those employed for wages. Rates of insurance from all states were analyzed except for Alaska, Arkansas, Wyoming and the District of Columbia, as these areas were either missing data for one or more years or had difficulty classifying insurance status.
The researcher found that; even in states such as Tennessee and Oregon where ambitious health care reform efforts aimed to bring insurance to more residents, there was little population-wide change in insurance rates. Unfortunately, reforms in even these states have already been cut back sharply because of budget concerns.
"This study strongly suggests that state-level health reform efforts have not been successful in producing population-wide reductions in uninsurance among persons aged 18 to 64 years," the study's authors said. Given the fiscal challenges experienced by states over the past few years, the financial difficulties facing many employers, and rapidly increasing health care costs, the problem of uninsurance among adults aged younger than 65 years is likely to increase in the absence of broader efforts to address this issue.
[From: "State Trends in Uninsurance Among Individuals Aged 18 to 64 Years: United States 1992-2001." Contact: Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion
Press.Room.NCCD@cdc.gov]

Cigarette smoking a serious public health threat in China
Adopting a westernized lifestyle has spelled disaster for many people in China, where 60 percent of men smoke cigarettes, more than half of women are exposed to secondhand smoke at home and one in four men and women breathe smoke-filled air at work.
Researchers surveyed more than 15,000 Chinese adults. When generalized to the entire population the survey found that more than 147 million men and almost 16 million Chinese women currently smoke. Secondhand smoke was commonplace among those surveyed, with 51.3 percent of women being exposed to such smoke at home, and 27 percent of men and 26 percent of women being exposed to secondhand smoke on the job.
Clean indoor air laws have not yet been enacted in China, where smoking is the leading cause of death.
"The high prevalence of cigarette smoking among Chinese men indicates an urgent need for smoking prevention and cessation efforts," the study's authors said. "The large number of men and women being exposed passively to cigarette smoke in their workplace argues for legal prohibition of cigarette smoking in the workplace environment in China."
[From: "Cigarette Smoke and Exposure to Environmental Tobacco Smoke in China: The International Collaborative Study of Cardiovascular Disease in Asia." Contact: Jiang He, MD, PhD, Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, mailto:jhe@tulane.edu?subject_ajph_news_release]

Firefighters are at high risk for hospitalization
Firefighters not only put their lives on the line at work, they are nearly twice as likely to be hospitalized as people working in lower-risk professions.
A study of 238,236 employed men found that firefighters aged 30-39 years were 1.93 times as likely to be hospitalized as other employed men in their age group. Older firefighters had less risk of hospitalization than men working in other occupations, possibly because more were likely to be in supervisory positions.
"Findings from this study and the ongoing monitoring of occupational morbidity and mortality among firefighters reinforce the need for better training, the use and proper
maintenance of safety equipment, the implementation of an incident management system by fire departments, and a focus on firefighter fitness," the study's authors said. "Finally, this study, along with others documenting a range of adverse health effects associated with firefighting, supports the call for longitudinal studies to monitor the health of this high-risk occupational group."
[From: "Risk of Hospitalization Among Firefighters: The National Health Interview Survey, 1986-1994." Contact: David J. Lee, PhD, University of Miami School of Medicine, dlee@med.miami.edu?subject_ajph_news_release.]

Older men and women may need similar alcohol use guidelines
Traditional guidelines that suggest men can safely consume more daily alcoholic drinks than women need to be rethought.

A study of 1,884 adults aged 55-65 measured their alcohol consumption and abuse problems in the late 1980s and then 10 years later. About 70 percent of those surveyed drank at least once a week, and 50 percent had an alcoholic drink three or more days a week. Researchers found that men who drank more than recommended were more likely to develop an alcohol abuse problem than women. Current guidelines suggest men have no more than two daily drinks or 14 a week and women consume one daily drink or no more than seven weekly. The study's findings support the idea of rewriting those guidelines to seven drinks per week for both men and women over aged 55, with an maximum limit of three drinks on any one occasion.
[From: High-Risk Alcohol Consumption and Late-Life Alcohol Use Problems. Contact: Rudolf H. Moos, PhD, Center for Health Care Evaluation, VA Health Center, Menlo Park, Calif., rmoos@stanford.edu?subject_ajph_news_release]

Overcrowded and noisy living conditions may contribute to bad health among low-income children
Low-income children exposed to such environmental risk factors as overcrowding, excessive noise and substandard housing are being set up for health problems later in life, according to a recent study.
A study of 216 low- and middle-income children in upstate New York found that the poor children were most likely to live with environmental stressors and more likely to show signs of chronic stress because of their living conditions. Researchers examined crowding, noise and housing quality for the sample of 8-10-year-olds and found that the levels of stress hormones measured among the low-income children were consistently higher, indicating those children were under physiological and psychological stress. The low-income children were five times as likely as the middle-income children to be exposed to two or more environmental risk factors such as overcrowding or excessive noise.
[From: "Environmental Justice, Cumulative Environmental Risk and Health Among Low- And Middle-Income Children in Upstate New York." Contact: Gary Evans, PhD, Department of Design and Environmental Analysis and Department of Human Development, Cornell University, Ithaca, N.Y., gwe1@cornell.edu?subject_ajph_news_release.]

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. APHA is a leading publisher of public health-related books and periodicals promoting high scientific standards, action programs and policy for good health. More information is available at www.apha.org.