Search PubMed⌕ Search

Biomedical subjects

E M Lewit

Publications and source records attributed to E M Lewit.

At least 19 recordsLinked to original sources
PubMed1997

Price, public policy, and smoking in young people.

OBJECTIVE: To examine the effect of cigarette taxes, limits on public smoking, laws regulating access to tobacco by young people, and exposure to pro-tobacco and anti-tobacco messages on smoking participation and the intention to smoke among ninth-grade students (aged 13-16). DATA SOURCES: Two cross-sectional, school-based surveys (total of 15432 responses) of ninth-grade students conducted in 21 North American communities in 1990 and 1992 in conjunction with the Community Intervention Trial for Smoking Cessation. OUTCOME MEASURES: A ninth-grader was classified as a smoker if he or she reported smoking a whole cigarette on at least one of the 30 days preceding the survey. Among non-smokers, a positive intention to smoke was attributed to those who claimed they probably or definitely would be smoking within a year. RESULTS: Both smoking participation and the intent to smoke were related to differences in cigarette prices, with estimated price elasticities of -0.87 and -0.95, respectively. Boys were far more sensitive to price than girls with respect to smoking participation (elasticities of -1.51 and -0.32, respectively); however, the effect of price on the intent to smoke was similar for boys and girls. Policies limiting minors' access to tobacco (a minimum purchase age of 18 years, a ban on cigarette vending machines, and a ban on giving away free samples of tobacco products) were associated with reductions in participation and intention to smoke. Exposure to tobacco education in school was associated with decreased participation and intention to smoke. Policies that prohibited smoking in public places and in schools were not significantly related to the smoking patterns of ninth-graders. Frequency of exposure to pro-tobacco advertisements was marginally associated with increased participation and intention to smoke; paradoxically, frequency of exposure to anti-tobacco advertisements was correlated with an increased likelihood of smoking. CONCLUSIONS: Policies limiting access to tobacco by young people, increasing education about the effects of tobacco use, and a sharp and sustained increase in real cigarette excise taxes are likely to be most successful in accomplishing the US Food and Drug Administration's goal of cutting the smoking prevalence of adolescents in half over the next seven years.

Adolescent↗
PubMed1997

Hospital and patient characteristics associated with variation in 28-day mortality rates for very low birth weight infants. Vermont Oxford Network.

BACKGROUND: The outcomes for very low birth weight infants vary among neonatal intensive care units (NICUs), but the reasons for this variation are not well understood. We used the database of a large neonatology research network to determine whether either admission characteristics of the infants or specific characteristics of the units such as annual patient volume and the presence of a pediatric residency program could account for observed differences in neonatal mortality rates among units. METHODS: We studied 7672 infants with birth weights from 501 to 1500 g treated during 1991 and 1992 at 62 NICUs participating in the Vermont Oxford Network Database. RESULTS: Overall, 14.7% of the study infants died within 28 days of birth (interquartile range 9.9% to 18.1%). The ratio of the number of observed deaths at an NICU to the number of deaths predicted based on the characteristics of infants treated at the NICU (standardized neonatal mortality ratio, [SNMR]) varied significantly among units (range 0 to 1.69, z = 4.24). There was no association between annual patient volume and either mortality rate (r = .17) or SNMR (r = .22). Observed mortality rates (17% vs 13%) and SNMR (1.04 vs .87) were both higher at the 24 hospitals with pediatric residency training programs than at the 38 hospitals without such programs. Hospitals with residency programs had higher average annual patient volumes (104 vs 66). In an analysis simultaneously adjusting for patient characteristics, volume, and presence of a residency program, neither volume (odds ratio [OR] per 10 additional cases treated 1.01, 95% confidence interval [CI], .98 to 1.04) nor presence of a pediatric residency program (OR 1.18, 95% CI, .94 to 1.47) was significantly associated with neonatal mortality risk. CONCLUSION: There are differences in neonatal mortality rates among NICUs that cannot be explained by differences in the measured admission characteristics of the infants, suggesting that the effectiveness of medical care varies among units. Neither the annual volume of very low birth weight infants treated in a unit nor the presence of a pediatric residency training program was independently associated with neonatal mortality rates for very low birth weight infants.

Health Care Surveys↗
PubMed1997

Childhood hunger.

Explore the source record for details and available documents.

Adolescent↗
PubMed1995

The direct cost of low birth weight.

Medical and technological advances in the care of infants with low birth weight (less than 2,500 grams, or 5 pounds, 8 ounces) and very low birth weight (less than 1,500 grams, or 3 pounds, 5 ounces) have substantially increased the survival rate for these infants and have led to concerns about the demands their care places upon their families and society. The dollar cost of the resources used disproportionately to care for low birth weight children is one measure of the burden of low birth weight. Using analyses of national survey data for 1988 for children ages 0 to 15, this article presents estimates of the direct incremental costs of low birth weight--costs of the resources used to care for low birth weight infants above and beyond those used for infants of normal birth weight. In 1988, health care, education, and child care for the 3.5 to 4 million children ages 0 to 15 born low birth weight between $5.5 and $6 billion more than they would have if those children had been born normal birth weight. Low birth weight accounts for 10% of all health care costs for children, and the incremental direct costs of low birth cost weight are of similar magnitude to those of unintentional injuries among children and in 1988 were substantially greater than the direct costs of AIDS among Americans of all ages in that year.

Adolescent↗
PubMed1993

Workplace smoking policies in New Jersey businesses.

A New Jersey law enacted in 1985 requires smoking policies for work sites with 50 or more employees. In 1988, we surveyed a sample of New Jersey businesses to determine their smoking policies. Eighty-three percent of respondents with 50 or more employees reported implementing restrictive smoking policies. Of respondents with 2 to 49 employees, 35% had implemented policies. Our findings identify some of the factors other than a legal mandate that lead employers to restrict smoking in the workplace.

Commerce↗
PubMed1992

Responses among New Jersey's largest employers to legislation restricting smoking at the worksite.

In 1985, New Jersey enacted a state law requiring that employers with more than 50 employees implement policies to control smoking in places of employment. The 104 largest private employers in New Jersey were surveyed in 1988 to assess their worksite smoking policies. Of the 92 respondents, 97% had implemented restrictive workplace smoking policies. Only 12% of respondents had implemented such policies prior to the date required by the law, and 86% cited the law as the reason for restricting smoking in the workplace. Over two-thirds of respondents placed restrictions on smoking in open areas, while only one-third restricted smoking in private offices. Nonsmoking employees were reported by 80% of respondents to be supportive of restrictive smoking policies, but 23% reported dissatisfaction by their smoking employees. The New Jersey law appears to have been an important factor in the adoption of work place smoking restrictions by the state's largest employers.

Attitude to Health↗
PubMed1992

The response of restaurants to New Jersey's smoking control law.

The authors surveyed a representative sample of New Jersey restaurants to determine what provisions were made for patron smoking, and whether the restaurants were in compliance with the state law intended to restrict smoking in restaurants. The authors report the results of their recent study.

Humans↗
PubMed1991

Isoniazid as preventive therapy in HIV-infected intravenous drug abusers. A decision analysis.

Tuberculin skin testing is a notoriously poor marker of tuberculosis infection in patients who are serologically positive for the human immunodeficiency virus. A decision analysis was performed to determine if and when isoniazid should be prescribed to prevent tuberculosis in these patients. The decision was analyzed for an intravenous drug abuser who may have been anergic, while tuberculin test status, race, and gender were varied. The assumptions and parameter estimates selected for this investigation represent a highly conservative vantage point opposing the use of isoniazid as a preventive therapy. Nevertheless, results showed a benefit from the use of isoniazid as a preventive therapy for all groups, even without tuberculin testing, except tuberculin-negative black women. This benefit of isoniazid therapy increased patient life expectancy as much as 285 days. Further, the decisions continue to favor prescribing isoniazid even when the suspected incidence of tuberculosis infection falls as low as 3% to 8%. Tuberculin testing appears important primarily for black women, since those who have negative tuberculin skin tests may not be candidates for isoniazid therapy.

Adult↗
PubMed1991

Isoniazid preventive therapy for tuberculosis. Decision analysis considering ethnicity and gender.

The decision to prescribe or withhold isoniazid (INH) preventive therapy for low-risk tuberculin reactors has been highly controversial, primarily due to isoniazid's possible hepatotoxic effects. Previous analyses have explored the INH decision only from the perspective of patient age, recognizing that the risks of INH-induced hepatotoxicity are age related. Decision analyses presented in this paper assess the impact of gender and ethnic group, as well as age, on the INH decision. Results for low-risk patients favor prescribing INH preventive therapy for all 20-yr-olds, all 35-yr-olds except black women, and no 50-yr-olds, projecting life expectancy benefits that range from 3 to 19 days. A comparison set of analyses performed for high-risk patients favors prescribing INH for all groups except 50-yr-old black women. These findings suggest that ethnicity, gender, and age should be considered when making the decision to prescribe or withhold INH preventive therapy.

Adult↗