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PubMed1997

Neighborhood risk factors for low birthweight in Baltimore: a multilevel analysis.

OBJECTIVES: Past research on low birthweight has focused on individual-level risk factors. We sought to assess the contribution of macrolevel social factors by using census tract-level data on social stratification, community empowerment, and environmental stressors. METHODS: Census tract-level information on social risk was linked to birth certificate records from Baltimore, Md, for the period 1985 through 1989. Individual level factors included maternal education, maternal age, medical assistance health insurance (Medicaid), and trimester of prenatal care initiation. Methods of multilevel modeling using two-stage regression analyses were employed. RESULTS: Macrolevel factors had both direct associations and interactions with low birthweight. All individual risk factors showed interaction with macrolevel variables; that is, individual-level risk factors for low birthweight behaved differently depending upon the characteristics of the neighborhood of residence. For example, women living in high-risk neighborhoods benefited less from prenatal care than did women living in lower-risk neighborhoods. CONCLUSIONS: Multilevel modeling is an important tool that allows simultaneous study of macro- and individual-level risk factors. Multilevel analyses should play a larger role in the formulation of public health policies.

Baltimore↗
PubMed1996

Income, social stratification, class, and private health insurance: a study of the Baltimore metropolitan area.

Most studies of inequalities and access to health care have used income as the sole indicator of social stratification. Despite the significance of social theory in health insurance research, there are no empirical studies comparing the ability of different models of social stratification to predict health insurance coverage. The aim of this study is to provide a comparative analysis using a variety of theory-driven indicators of social stratification and assess the relative strength of the association between these indicators and private health insurance. Data were collected in a 1993 telephone interview of a random digit dialing sample of the white population in the Baltimore Metropolitan Statistical Area. Indicators of social stratification included employment status, full-time work, education, occupation, industry, household income, firm size, and three types of assets: ownership, organizational, and skill/credential. The association between social stratification and private health insurance was strongest for those having higher household incomes, having attained at least a bachelor's degree, and working in a firm with more than 50 employees, followed by being an owner or manager, and by being employed. The addition of education and firm size improved the prediction of the household income model. The authors conclude that studies of inequalities in health insurance coverage can benefit from the inclusion of theory-driven indicators of social stratification such as human capital, labor market segmentation, and control over productive assets.

Adult↗
PubMed1989

The effect of swimming in asthmatic children--participants in a swimming program in the city of Baltimore.

Forty-five asthmatic children were enrolled in a swimming program in Baltimore. After participating in a 2-month swimming session, the children showed significant improvement in all clinical variables including symptoms, hospitalizations, emergency room visits, and school absenteeism compared with their previous medical history or to those of age-matched controls. These health benefits continued to be observed even 12 months after the session had been completed. The implications of these findings and the potential usefulness of adding sports programs as adjunct therapy in the comprehensive care of asthma in children are discussed.

Asthma↗
PubMed2000

"Alcohol dependence" and death: survival analysis of the Baltimore ECA sample from 1981 to 1995.

OBJECTIVE: Evidence is provided about the association between "alcohol-use disorders" and the 14-year risk of death in a community sample. Most prior descriptions of this association come from treatment samples. METHOD: 3,481 adult household residents were recruited into the NIMB Baltimore Epidemiologic Catchment Area survey and interviewed in 1981. The Diagnostic Interview Schedule (DIS) was employed to assess alcohol drinking and other drug-taking behaviors, and to determine fulfillment of DSM-III criteria for "alcohol abuse" and/or "dependence" diagnoses. Participants were followed-up in 1993-1996, by which time 24% of the sample had died. Median age of death was estimated for persons with and without alcohol disorders, and for "heavy" and "nonheavy" drinkers. Cox proportional hazards models adjusted for the influence of age, sex, race, "drug-use disorders," and tobacco smoking. RESULTS: "Alcohol abuse" and/or "dependence" was associated with a higher risk of death and a younger median age of death (adjusted relative risk = 1.3, p = .016). "Heavy" alcohol consumption was also associated with a significantly elevated risk of death. The DIS diagnosis of "alcohol use disorder" helped predict mortality over and above a prediction based solely upon "heavy drinking" (p < .01). CONCLUSIONS: These findings indicate that the observed increased risk of death associated with "alcohol dependence" is not limited to cases severe enough to have been treated but is also present among cases in the household population.

Adolescent↗
PubMed2000

"Drug dependence" and death: survival analysis of the Baltimore ECA sample from 1981 to 1995.

AIMS: Illicit drug use and dependence often are associated with premature death, but available evidence comes mainly from clinical samples. The present paper examines drug-related mortality experience over 14 years in a United States community sample. PARTICIPANTS: Following probability sampling, 3,481 adult community household residents were recruited for the 1981 NIMH Baltimore Epidemiologic Catchment Area survey. Follow-up occurred in 1993-1996. METHODS: Survival analyses were used to estimate median age at death and relative risk of dying in relation to drug use and dependence as assessed in 1981 using the Diagnostic Interview Schedule (DIS). FINDINGS: Cases with DIS "drug dependence" were more likely to have died and to have a younger median age at death (p < .05), with and without statistical adjustment for confounding variables. Higher levels of drug involvement also were associated with increased age-adjusted mortality. CONCLUSIONS: The evidence favors the hypothesis that DIS-elicited "drug dependence," as well as subthreshold drug use, help to account for premature death in this community sample.

Adolescent↗
PubMed1992

Terminology for drug injection practices among intravenous drug users in Baltimore.

Terms for four discrete drug injection practices were obtained by presenting photographs and a brief description of practices to intravenous drug users who enrolled in a longitudinal study of HIV infection in Baltimore. The 2,921 respondents were predominantly male (81%) and Black (90%), the median age was 34 years (range: 18-68 years), and the median duration of intravenous drug use was 13 years (range 0-50 years). Forty-six different terms were used to characterize direct injection into a vein, 51 for the practice of repeatedly withdrawing and reinjecting one's own blood following injection of drug, 39 for subcutaneous injection, and 45 for transferring drug between different syringes. Terms tended to cluster by race and duration of drug use. These data indicate substantial variation in terminology for drug injection practices. Further, they augment prior research showing that photographs may be used as a useful aid in survey research on drug experiences in the population.

Adolescent↗
PubMed1992

Needle-cleaning practices among intravenous drug users who share injection equipment in Baltimore, Maryland.

In Baltimore, Maryland, between 1988 and 1989, 2,921 intravenous drug users were recruited into a study of drug injection practices and human immunodeficiency virus (HIV) infection. Sixty-three percent reported both current use and sharing of needles; almost all these (N = 1,757) reported using injection equipment immediately after it was used by another intravenous drug user. Of the 1,757, 62% said that they "typically" cleaned the used equipment with bleach or alcohol before injecting. These data suggest that information about disinfecting needles has disseminated into this population and identifies several groups to target for interventions.

Adult↗
PubMed1999

Pre-AIDS mortality and morbidity among injection drug users in Amsterdam and Baltimore: an ecological comparison.

Mortality and morbidity between injecting drug users in Amsterdam (n = 624) and Baltimore (n = 2,185) are compared to generate a hypothesis about the role of different health care systems and drug user policies (universal care and harm reduction versus episodic care and criminalization, respectively). Overdose/suicide mortality was twofold higher in Amsterdam; no sufficient explanation was found. Other independent "risk factors" for overdose/suicide mortality were recent injecting, polydrug use, and HIV-seropositivity (especially with CD4 count < 200/mm3). High dose methadone maintenance was associated with lower mortality. Incidence of hospitalizations and emergency room visits was substantially lower in Amsterdam, suggesting that higher accessibility to primary care in Amsterdam lowers (inpatient) hospital visits and presumably societal costs.

Adult↗
PubMed1992

Lymphocytic choriomeningitis virus infection and house mouse (Mus musculus) distribution in urban Baltimore.

Four hundred eighty house mice (Mus musculus) were trapped primarily from urban sites in Baltimore, Maryland from 1984 to 1989 and tested for antibody to lymphocytic choriomeningitis virus (LCMV). The majority of mice (95%) were trapped in residences at two city locations (n = 260), or in an urban park (n = 196); five additional sites were sampled. Overall, 9.0% of the mice were LCMV antibody positive and infected animals were obtained from six of eight sites, including all three of the primary city sites, where the prevalence varied significantly (3.9-13.4%). The location with the highest prevalence was an inner city residential site where positive mice were found significantly clustered within blocks and households. In this location, LCMV antibody prevalence was also significantly correlated with estimates of mouse density within individual blocks. The focal nature of LCMV infection in house mice may result from contact or vertical transmission of virus in conjunction with the highly structured social system of mice, which promotes inbreeding and limited dispersal.

Animals↗
PubMed1999

Serologic evidence of rickettsialpox (Rickettsia akari) infection among intravenous drug users in inner-city Baltimore, Maryland.

We tested single serum samples from 631 intravenous (i.v.) drug users from inner-city Baltimore, Maryland for serologic evidence of exposure to spotted fever group rickettsiae. A total of 102 (16%) individuals had titers > or = 64 to Rickettsia rickettsii by an indirect immunofluorescence assay. Confirmation that infection was caused by R. akari was obtained by cross-adsorption studies on a subset of serum samples that consistently resulted in higher titers to R. akari than to R. rickettsii. Current i.v. drug use, increased frequency of injection, and shooting gallery use were significant risk factors for presence of group-specific antibodies reactive with R. rickettsii. There was a significant inverse association with the presence of antibodies reactive to R. rickettsii and antibodies reactive to the human immunodeficiency virus. This study suggests that i.v. drug users are at an increased risk for R. akari infections. Clinicians should be aware of rickettsialpox, as well as other zoonotic diseases of the urban environment, when treating i.v. drug users for any acute febrile illness of undetermined etiology.

Antibodies, Bacterial↗
PubMedDate not supplied

A community care initiative: Maryland and Hopkins students take to the streets in Baltimore City.

Medical students from University of Maryland and Johns Hopkins University, with a grant from the Maryland Chapter of the American College of Physicians, held a free health fair in a Baltimore City neighborhood. The goals were to heighten awareness of common health problems, learn more about a medically underserved community, and increase access to primary care services in that community. The students planned booths to offer information and screening on 19 common health topics. Fair organizers worked with a local clinic, People's Community Health Center, and a neighborhood development organization, the Safe and Smart Center, to create an event that would engage and educate people on relevant issues. Approximately 100 medical students participated in the event and 350 people attended the fair. An optional survey filled out by fair participants revealed that a diverse group of people attended the event. Comments about the day from medical students and fair participants show that the event was enjoyable and offered a tremendous learning opportunity for both groups. This paper also discusses problems that arose during the planning stages as well as suggestions for those interested in planning a similar event.

Adolescent↗
PubMed1991

Soviet nurses help alleviate Baltimore hospital's shortage.

A pilot program is boosting a Baltimore hospital's nursing rolls while providing on-the-job training to immigrant Soviet nurses. For the short term, the Soviets fill important non-professional positions in the hospital's nursing department while working toward gaining their nursing credentials so they can become eligible to be hired by the hospital, easing its long-term nursing shortage.

Baltimore↗
PubMed1999

The relationship between optic disc area and open-angle glaucoma: the Baltimore Eye Survey.

PURPOSE: To determine if eyes with larger optic disc area are more likely to have open-angle glaucoma or to have glaucoma at lower intraocular pressure (IOP). METHODS: Data were collected from a population-based sample of adults residing in East Baltimore, consisting of demographic information, ocular examinations, automated and static/kinetic visual field tests, IOP as measured by applanation tonometry, and image analysis of the optic disc. Optic disc area was calculated using refractive error to correct magnification. Open-angle glaucoma was defined by visual field and optic disc criteria. One eye from each of 75 patients with glaucoma was compared to those of 3,518 subjects without glaucoma. RESULTS: Although optic disc area was somewhat larger among patients with glaucoma than control subjects, in a regression model adjusting for age, gender, and race, the significance of this difference had a probability of 0.06. Among patients with glaucoma, disc area was not related to IOP level measured at study examination. CONCLUSION: Disc area is a weak risk factor for open-angle glaucoma. Disc area did not differ between patients with glaucoma who had lower IOP and those who had higher IOP among a group with glaucoma that were identified in a population survey.

Adult↗
PubMed2000

Cognitive impairment and syndromal depression in estimates of active life expectancy: the 13-year follow-up of the Baltimore Epidemiologic Catchment Area sample.

OBJECTIVE: Our hypothesis was that including cognitive status and syndromal depression in specifying functional impairment would result in significant differences in estimates of active life expectancy from specifications that included only standard functional measures (such as activities of daily living). METHOD: The subjects were the 3481 continuing participants of the Baltimore Epidemiologic Catchment Area Program. Interviews included criterion-based diagnosis of depression, assessment of cognitive status and standard survey questions on function. RESULTS: Estimates of active life expectancy decreased from 9.8 years to 8.9 years at age 65 years for men, and from 10 years to 8.4 years at age 65 years for women, when the definition of active life expectancy included measures of cognitive impairment and syndromal depression. CONCLUSION: Measurements of active life expectancy tend to ignore dependencies related to psychological causes, and should move beyond mere enumeration of activities of daily living and instrumental activities of daily living.

Adolescent↗
PubMed1992

Thalassemia screening in Baltimore.

An education and screening program for beta-thalassemia was offered to members of the Greek and Italian communities in the Baltimore area to allow for educated decisions regarding childbearing. Similar programs have been effective in decreasing the incidence of beta-thalassemia major in other countries.

Baltimore↗
PubMed1992

Surgical sterilization among women and use of condoms--Baltimore, 1989-1990.

Since 1980, surgical sterilization among women has become the most common contraceptive method used among women aged greater than 30 years in the United States and is used by 28% of women aged 15-44 years. A previous report of women in drug treatment suggested that women who have been surgically sterilized were less likely to report condom use--an effective measure for prevention of human immunodeficiency virus (HIV) infection and sexually transmitted diseases (STDs)--than were nonsterilized women. This report summarizes a study of the relation between surgical sterilization, risk status for STDs and HIV, and use of condoms among women who reside in two inner-city, minority neighborhoods in Baltimore.

Adolescent↗
PubMed2006

Exercise participation before and during pregnancy among low-income, urban, Black women: the Baltimore Preterm Birth Study.

National data demonstrate that Black women have poorer health status, and greater risk of death from chronic diseases, than their White counterparts. Exercise can help prevent chronic disease, and adult Black women are less likely to engage in exercise than White women. However, few data are available about exercise among pregnant Black women. Pregnant Black women were enrolled in this study at hospital-based prenatal clinics in Baltimore, Maryland. Exercise before and during pregnancy were assessed at the first prenatal visit, along with exposure to stressors, depression, John Henryism Active Coping, and behavioral factors such as smoking. Among the 922 women in the sample, approximately three quarters reported engaging in exercise before pregnancy, and two thirds exercised during pregnancy. Most women engaged in non-strenuous exercise during pregnancy (56%) and exercised for > or = 20 minutes at least three times per week (80%). Exercise participation was significantly associated with higher levels of John Henryism Active Coping and lower levels of depression but was not significantly associated with behavioral factors or exposure to stressors. Prior research, based on older women, may have underestimated exercise participation by young Black women. These results suggest that Black women may decrease exercise participation after pregnancy and as they age. Encouraging Black women to continue to exercise as they age may have promising implications for the prevention of chronic diseases.

Adaptation, Psychological↗
PubMed1991

Infectious keratitis in Baltimore.

One hundred thirty cases of ulcerative keratitis occurring from 1985 to 1989 at Sinai Hospital of Baltimore were reviewed. Positive corneal cultures were obtained from 40% of cases. The most common isolates were Staphylococcus epidermidis (28%), S. aureus (16%), and Pseudomonas aeruginosa. P. aeruginosa was the most common in contact lens wearers. Antibiotic pretreatment did not affect the rate of positive cultures significantly. Bilateral conjunctival and eyelid margin cultures also were examined. An association was found between corneal and ipsilateral conjunctival isolates (P = .05). Gram stains were consistently negative. Most patients were treated successfully as outpatients. The value of simultaneous conjunctival and eyelid margin cultures and Gram stains was questioned.

Baltimore↗