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Sexually transmitted diseases: a neglected public health priority.

Sexually transmitted diseases remain uncontrolled although millions of cases occur annually in the United States. The advent of acquired immunodeficiency syndrome (AIDS), which is also a sexually transmitted disease, has not altered this situation. The major portion of federal funding for sexually transmitted diseases is allocated to a search for an AIDS vaccine or cure. State health department funding for sexually transmitted diseases, although only a small fraction of the $1.3 billion AIDS research budget of the National Institutes of Health, is largely consumed by AIDS. A single adequately funded sexually transmitted disease control program that applies well-established public health principles for the control of communicable diseases would make sense. However, a consensus to develop and support such a program does not exist in the United States.

Acquired Immunodeficiency Syndrome↗

Increase in years of life after eliminating causes of death: significance for health priorities.

The theory of competing risks of death has been applied in this study for the construction of two indices: (1) increase in the expectation of life as a function of age, and (2) increase in the average number of years to be lived by a newborn up to various ages, when selected causes of death are eliminated. The indices have been applied to the 1970 mortality in Finland. Vascular diseases comprise the most important cause of death in both sexes, when the first index is applied. According to the second index, considering ages up to 65 years, violent deaths emerge as the most important cause of death among men and neoplasms appear equally important as vascular diseases among women. The magnitude of a health problem was found to be dependent on the index selected, which should be considered in health planning.

Accidents↗

Smoking cessation and prevention: an urgent public health priority for American Indians in the Northern Plains.

OBJECTIVE: The purpose of this study was to compare the prevalence of cigarette smoking and smoking cessation among American Indians living on or near Montana's seven reservations to those of non-Indians living in the same geographic region. METHODS: Data for Montana Behavioral Risk Factor Surveillance System (BRFSS) respondents (n = 1,722) were compared to data from a BRFSS survey of American Indians living on or near Montana's seven reservations in 1999 (n = 1,000). Respondents were asked about smoking and smoking cessation as well as cardiovascular disease (CVD) and selected risk factors. Quit ratios were calculated for both groups. RESULTS: American Indians were more likely to report current smoking (38%) than non-Indians (19%; p < 0.001). Thirty-seven percent of Indian respondents with CVD risk factors reported current smoking, compared with 17% of non- Indians with CVD risk factors. However, there was no significant difference in reported smoking rates between Indians (21%) and non-Indians (27%) with a history of CVD. Indian smokers were more likely to report quitting for one or more days in the past year (67%), compared with non-Indians (43%). Quit ratios were significantly lower among Indians (43%) than among non-Indians (65%). CONCLUSIONS: High smoking rates in Indians, particularly among those with other CVD risk factors, demonstrate an urgent need for culturally sensitive smoking cessation interventions among Northern Plains Indians and highlight the need for the Surgeon General's focus on smoking in minority populations.

Adolescent↗