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PubMed2003

Classroom injuries in Utah public schools.

OBJECTIVES: School injuries are a serious public health problem, yet classroom injuries have received little attention. The purpose of this study was to describe the epidemiology of classroom injuries in Utah public schools. METHODS: Utah statewide school injury data on kindergarten through 12th grade students for 1996 through 1998 were used. The data were generated from a standardized Student Injury Report (SIR) form completed by school personnel for injuries that (1) caused loss of at least one half of a day of school or (2) warranted medical attention and treatment. Injuries occurring in laboratories, shop, and physical education classes were excluded. To determine the medical outcome and charges associated with classroom injuries, the authors probabilistically linked the SIR database to Utah statewide emergency department (ED) records and Utah statewide hospital inpatients discharge records for 1996 through 1998. RESULTS: During the period 1996 through 1998, there were 1,366 classroom injuries. Nearly two thirds of the injuries occurred to male students. More than half the classroom injuries were related to equipment use. Weapon use was rare. Twenty percent of students injured in the classroom obtained treatment in an ED, where 71% of these injuries were determined to involve the head, neck, and upper extremity. Two incidents, one involving carbon monoxide and the other tear gas, accounted for 11% of the ED admissions. CONCLUSIONS: Classroom injuries are not sufficiently frequent, severe, or costly to justify special studies focused solely on acute injuries in standard classrooms. This does not negate the need for continued surveillance of classroom injuries along with other school injuries.

Adolescent↗
PubMed1997

Ambulatory care sensitive hospitalization rates in the aged Medicare population in Utah, 1990 to 1994: a rural-urban comparison.

The objective of this study is to compare the likelihood of hospitalization for conditions that are related to the adequacy and use of ambulatory health care services for Medicare beneficiaries residing in rural and urban regions in Utah. The Health Care Financing Administration's (HCFA) hospital discharge database (Utah hospitals: 1990 to 1994) was used to estimate hospitalization rates (with adjustment for out-of-state admissions) for ambulatory care sensitive conditions. Population estimates were obtained from HCFA beneficiary files. Regional hospitalization rates were obtained through ZIP code matching of the hospital discharge and beneficiary files. Medicare beneficiaries aged 65 and older residing in Utah during 1990 to 1994 are the subjects for the study. The main outcome measures include age and sex-adjusted hospitalization rates by region for the entire state and rate ratio estimates for nonurban regions. The results of the study show that Medicare beneficiaries residing in two rural-frontier regions were more likely than urban beneficiaries to be hospitalized for ambulatory care sensitive conditions. Rate ratio estimates were greater than 1.4 for both regions during the study period. These findings suggest a pattern of an increased burden of avoidable secondary complications and disease progression among Utah Medicare beneficiaries residing in some rural regions. This increased burden may be the result of limitations in the ambulatory care system, medical care provider supply, and/or beneficiary propensity to seek care. Variation in disease prevalence or hospital use patterns for these conditions also may be responsible for all or part of the observed variation in ambulatory care sensitive admission rates.

Aged↗
PubMed2005

Examination of ELN as a candidate gene in the Utah intracranial aneurysm pedigrees.

BACKGROUND AND PURPOSE: A study of intracranial aneurysm (IA) sibpairs suggested association of an ELN haplotype with IA risk. Subsequent linkage analysis of the ELN region on chromosome 7q11 in high-risk Utah IA pedigrees significantly confirmed linkage between IA and the ELN region. METHODS: We have investigated the ELN gene as a potential candidate gene for IA in Utah pedigrees. One IA case from each pedigree, who shared an ELN region haplotype segregating in the pedigree, was screened for mutation. The promoter region, 34 exons, and the 3'UTR (UnTranslated Region) of the ELN gene were screened for variants using DHPLC. RESULTS: Variants were observed in the promoter region, exons 4 and 6, and the 3'UTR. Variants in exon 6 and in one 3'UTR position were unique to Utah. The remaining variants were absent in the controls. There was no evidence for segregation of the ELN variants found in IA cases with the hypothesized chromosome 7 haplotypes segregating in pedigrees. CONCLUSIONS: Our analysis does not support ELN as the gene responsible for familial IA in the linked Utah IA pedigrees.

3' Untranslated Regions↗
PubMed2004

Dietary protein intake and risk of osteoporotic hip fracture in elderly residents of Utah.

UNLABELLED: The role of protein intake in osteoporosis is unclear. In a case-control study in Utah (n = 2501), increasing level of protein intake was associated with a decreased risk of hip fracture in men and women 50-69 years of age but not in those 70-89 years of age. Protein intake may be important for optimal bone health. INTRODUCTION: Protein is an important component of bone, but the role of dietary protein intake in osteoporosis and fracture risk remains controversial. MATERIAL AND METHODS: The role of dietary protein intake in osteoporotic hip fracture was evaluated in a statewide case-control study in Utah. Patients, 50-89 years of age, with hip fracture (cases) were ascertained through surveillance of 18 Utah hospitals during 1997-2001. Age- and gender-matched controls were randomly selected. Participants were interviewed in their place of residence, and diet was assessed using a picture-sort food frequency questionnaire previously reported to give a useful measure of usual dietary intake in the elderly Utah population. The association between protein intake and risk of hip fracture was examined across quartiles of protein intake and stratified by age group for 1167 cases (831 women, 336 men) and 1334 controls (885 women, 449 men). RESULTS: In logistic regression analyses that controlled for gender, body mass index, smoking status, alcohol use, calcium, vitamin D, potassium, physical activity, and estrogen use in women, the odds ratios (OR) of hip fracture decreased across increasing quartiles of total protein intake for participants 50-69 years of age (OR: 1.0 [reference]; 0.51 [95% CI: 0.30-0.87]; 0.53 [0.31-0.89]; 0.35 [0.21-0.59]; p < 0.001). No similar associations were observed among participants 70-89 years of age. Results from analyses stratified by low and high calcium and potassium intake did not differ appreciably from the results presented above. CONCLUSION: Higher total protein intake was associated with a reduced risk of hip fracture in men and women 50-69 years of age but not in men and women 70-89 years of age. The association between dietary protein intake and risk of hip fracture may be modified by age. Our study supports the hypothesis that adequate dietary protein is important for optimal bone health in the elderly 50-69 years of age.

Age Factors↗
PubMed2005

Providing diabetes education and care to underserved patients in a collaborative practice at a utah community health center.

Many underserved patients in Utah lack insurance coverage for health care and prescription drugs but are provided medical care in community health centers (CHCs). Before June 2000, comprehensive pharmacy services were not provided to these patients at a Utah CHC. As part of a Health Resources and Services Administration grant, a collaborative agreement between the University of Utah College of Pharmacy and Utah CHCs was established so that a faculty clinician who is a certified diabetes educator (CDE) could provide diabetes education and care to underserved patients. The College of Pharmacy faculty clinician (pharmacist CDE) collaborated with physicians and midlevel practitioners to provide diabetes education and care for 176 patients. In addition to initial diabetes education, the pharmacist CDE provided continuing disease management by providing information and feedback to patients and recommendations to providers. The pharmacist CDE conducted continuing chart reviews to track certain parameters, such as laboratory test results for hemoglobin A 1c (A1C) and lipid levels, and blood pressure. Patients were followed for 1-3 years. The same outcome data were also collected for 176 patients with diabetes mellitus in another CHC clinic to provide a comparison group. Total cholesterol, low-density lipoprotein cholesterol, A1C, and triglyceride levels declined significantly from baseline at both sites. However, more patients who were provided care by the pharmacist CDE reached the American Diabetes Association A1C target goal of below 7%.

Allied Health Personnel↗
PubMed2000

Library outreach: addressing Utah's "Digital Divide".

A "Digital Divide" in information and technological literacy exists in Utah between small hospitals and clinics in rural areas and the larger health care institutions in the major urban area of the state. The goals of the outreach program of the Spencer S. Eccles Health Sciences Library at the University of Utah address solutions to this disparity in partnership with the National Network of Libraries of Medicine-- Midcontinental Region, the Utah Department of Health, and the Utah Area Health Education Centers. In a circuit-rider approach, an outreach librarian offers classes and demonstrations throughout the state that teach information-access skills to health professionals. Provision of traditional library services to unaffiliated health professionals is integrated into the library's daily workload as a component of the outreach program. The paper describes the history, methodology, administration, funding, impact, and results of the program.

Area Health Education Centers↗
PubMed2005

Increase in poisoning deaths caused by non-illicit drugs--Utah, 1991-2003.

Deaths caused by drug poisoning of unintentional and undetermined intent are an increasing problem in Utah and elsewhere in the United States. To characterize the trend in drug-poisoning deaths in Utah, CDC and the Utah Department of Health analyzed medical examiner (ME) data for 1991-1998 and 1999-2003. This report summarizes the results of that analysis, which determined that, during 1991-2003, the number of Utah residents dying from all drug poisoning increased nearly fivefold, from 79 deaths in 1991 (rate: 4.4 per 100,000 population) to 391 deaths in 2003 (rate: 16.6). This increase has been largely the result of the tripling of the rate (from 1.5 during 1991-1998 to 4.4 during 1999-2003) in poisoning deaths of unintentional or undetermined intent caused by non-illicit drugs (i.e., medications that can be legally prescribed). Further study is needed to understand these trends and to develop strategies to prevent deaths of unintentional or undetermined intent from non-illicit drug poisoning.

Adult↗
PubMed1993

The prevalence of substance abuse among pregnant women in Utah.

OBJECTIVE: To determine the rate of substance use among Utah's pregnant women, who are primarily white and middle class, for comparison to rates reported in studies of inner-city populations. METHODS: Urine specimens and demographic data were obtained anonymously from women who delivered infants at ten hospitals in urban and suburban Utah. Urine samples were screened by enzyme immunoassay for amphetamines, marijuana, cocaine, methadone, opiates, benzodiazepines, and ethanol. RESULTS: Among 792 women screened, the mean age was 26.2 years, 86.1% were white, 62.9% were multigravidas, and 66.3% had private insurance. Cocaine was detected in nine samples (1.1%), illicit amphetamines in five (0.6%), marijuana in 23 (2.9%), ethanol in 32 (4.0%), over-the-counter amphetamines in 51 (6.4%), and benzodiazepines in seven (0.9%). The prevalence rate for women positive for illicit drugs and alcohol combined was 7.8%. Cocaine-positive and marijuana-positive women were more likely to be non-white or Hispanic and to have Medicaid or no insurance than were women negative for either substance. Women with Medicaid or no insurance were four times more likely to be positive for illicit substances (10.7%) than were those with private insurance (2.3%) (P = .0001). CONCLUSION: The rates and patterns of substance use differ between Utah's pregnant women and inner-city populations. The patterns in Utah may be more representative of many communities in the United States that have a predominantly middle-class, white population.

Adult↗
PubMedDate not supplied

Particulate pollution and health: a review of the Utah valley experience.

Utah Valley has provided an interesting and unique opportunity to evaluate the health effects of respirable particulate pollution (PM10) for several reasons. (1) It has moderately high average PM10 levels, and during low-level temperature inversion episodes, local emissions may become trapped in a stagnant air mass near the valley floor, resulting in highly elevated PM10 concentrations. (2) The valley experienced the intermittent operation of the local integrated steel mill, the largest single particulate pollution source. (3) Valley residents have very low smoking rates. (4) Levels of sulfur dioxide, ozone, and aerosol strong acidity are relatively low. Several studies specific to Utah Valley have evaluated associations between various indicators of health and PM10 pollution. Each of these individual studies has limitations imposed by data and analytic constraints. Taken together, however, they suggest a coherence or cascade of associations across various health end points for a specific location and population. Apparent health effects of elevated PM10 pollution observed in Utah Valley include: 1) decreased lung function; 2) increased incidence of respiratory symptoms; 3) increased school absenteeism; 4) increased respiratory hospital admissions; 5) increased mortality, especially respiratory and cardiovascular mortality; and 6) possibly increased lung cancer. This paper reviews these Utah Valley studies and evaluates the possibility that the overall health associations observed are due primarily to methodological bias or confounding by inadequate controls for risk factors such as smoking, weather, season, infectious agents, and socioeconomic distress.

Air Pollutants↗
PubMed2000

Why the ISMNI and the Utah paradigm? Their role in skeletal and extraskeletal disorders.

Besides bringing problems, aging can let the mind's eye see more clearly than before, and it can let us express ourselves better. As age, experience and common sense examine today's skeletal medicine and surgery two questions keep popping up: A) How did we fail?; B) How to make it better? The Utah paradigm of skeletal physiology and the seminal ISMNI offer some answers, but exploiting them faces problems. Problem #1: By 1960 all clinicians and physiologists 'knew' (as the ancients 'knew' this world is flat) that effector cells controlled solely by nonmechanical agents explain all skeletal physiology and disorders ('effector cells' include osteoblasts, osteoclasts, chondroblasts and fibro-blasts). Or, nonmechanical agents -->cell level -->organ and intact subject. Adding later-discovered information to that 1960 view led to the Utah paradigm, which reveals the formerly hidden tissue-level 'dimension' of skeletal physiology. It builds on this idea: (mechanical + nonmechanical agents) -->(tissue level + cell level) --> organ and intact subject. The paradigm assigns great influence of neuromuscular physiology and physical activities on skeletal architecture, strength and mechanical competence. It also exposes flaws in many older views so controversies arise. Problem #2: The Utah paradigm and Wegner's concept of plate tectonics in geology seem alike in that each is valid but came before its time, so others fought it. They differ in this: The fight about Wegner's idea is over, but for the Utah paradigm and the ISMNI it just began. Hence more controversies. Nevertheless: A growing minority realizes that paradigm provides a far better base to build on than its antecedents, and since it keeps evolving as more evidence comes in it could endure for some decades. Yet very few realize this: It and the ISMNI have important implications for fields besides biomechanics and orthopaedics. Examples include anatomy, cardiovascular disease, dentistry, endocrinology, family medicine, gastroenterology, general surgery, genetics, gerontology, gynecology, maxillofacial surgery, neurology, neurosurgery, nutrition, ophthalmology, pathology, pediatrics, physical medicine and rehabilitation, plastic surgery, radiology, rheumatology, space and sports medicine, and urology. Quite a list! For the italicized questions above this article offers answers, of which its conclusion distills an essence.

Journal Article↗
PubMed1977

Low cancer incidence and mortality in Utah.

Utah cancer mortality for the years 1950-1969 and morbidity for the years 1966-1970 are reported. Utah had 18% fewer cases of cancer than expected based on the Third National Cancer Survey, and 24% fewer cancer deaths than expected based on national mortality data. Cancer sites associated with cigarette smoking and alcohol use accounted for nearly half of these differences. Several major sites not strongly associated with smoking showed lower incidence and mortality than expected. These included pancreas, colon, rectum, female breast, uterine cervix and ovary. A marked excess occurrence above expectation was observed for cancer of the lip. Some possible explanations of these findings are discussed, including some of the unique aspects of the Utah population.

Adolescent↗
PubMed2004

Methodology of a multistate study of congenital hearing loss: preliminary data from Utah newborn screening.

A multistate Centers for Disease Control and Prevention (CDC) study was designed to investigate the etiology of congenital hearing loss in infants ascertained through state-mandated hearing screening or early hearing loss detection and intervention (EHDI) programs. At least 50% of permanent childhood-onset hearing loss is due to genetic causes, and approximately 20% of all infants with congenital hearing loss have mutations in the GJB2 gene. Another 1% of childhood hearing loss is due to mitochondrial DNA (mtDNA) mutations. The specific aims of this study are to 1) classify the etiology of congenital hearing loss in infants by doing prospective genetic evaluations of all newborns with permanent hearing loss from defined geographic areas, 2) determine the frequency of mutations in GJB2 and two common mitochondrial mutations in these populations, and 3) establish a model infrastructure linking genetic services to statewide EHDI programs. As of April 2003, Utah is the only center evaluating patients. Study subjects identified through the Utah Department of Health EHDI program are contacted by letter and offered a comprehensive medical genetics evaluation with DNA testing for GJB2 and mitochondrial mutations A1555G and A7445G. To date, 25 probands and their immediate family members have been evaluated. We have identified 20 cases with nonsyndromic hearing loss (7 multiplex and 13 simplex), 4 with syndromic hearing loss, and 1 with presumed cytomegalovirus (CMV)-induced hearing loss. Six of 19 (32%) nonsyndromic cases with sensorineural hearing loss have mutations of one or both alleles of the GJB2 gene, and 21% are homozygous or compound heterozygotes for the 35delG mutation. No A1555G or A7445G mtDNA mutations have been found. Data reported to date include only children born in Utah, but EHDI programs in Hawaii, Rhode Island, and designated areas of Georgia have begun enrolling children in what is now a multistate collaborative study. This is the first comprehensive investigation to determine the etiology of hearing loss from populations ascertained through EHDI programs. The results of this study will facilitate the incorporation of genetic services into EHDI programs.

Centers for Disease Control and Prevention, U.S.↗
PubMed2002

Contrasts in cancer prevalence in Connecticut, Iowa, and Utah.

BACKGROUND: Cancer prevalence--the proportion of a population with cancer, including those recently diagnosed, those in treatment, and survivors--is an important indicator of future health care requirements. Only limited information on cancer prevalence is available for the United States. In particular, comparative interstate studies are not available. In this study, we estimate and analyze the prevalence of seven major cancers in Connecticut, lowa, and Utah using the tried and tested PREVAL method applied to National Cancer Institute registry data. METHODS: We analyzed data on 242,851 carcinomas of the stomach, colorectum, pancreas, breast, uterus (corpus), ovary, and non-Hodgkin lymphoma (NHL), diagnosed in white Americans from 1973 through 1992. Observed prevalence was estimated by applying the PREVAL method to incidence and life status data from the cancer registries. Complete prevalence was estimated by applying correction factors obtained by modeling incidence and survival rates. RESULTS: The ratio of the highest to the lowest prevalence (as proportions) ranged from 1.69 for uterine carcinoma to 2.73 for stomach carcinoma, showing that marked differences in cancer prevalence exist within the United States. Utah had the lowest prevalence for each carcinoma. Connecticut and lowa had similar prevalence levels for carcinomas of the colorectum, pancreas, and ovary and for NHL. Breast carcinoma was the most prevalent, with 826 cases per 100,000 of population in Utah, 1518 per 100,000 in lowa, and 1619 per 100,000 in Connecticut. Cancer survival did not differ greatly among the three registry populations. The major determinants of prevalence differences were incidence and the population age distribution. CONCLUSIONS: PREVAL provides reliable estimates of the numbers of living people in a population who have had a cancer diagnosis. Prevalence depends on incidence and survival and on the age structure of population. All these factors have changed markedly in recent years and will continue to do so in the future. Cancer prevalence should be monitored over time to evaluate changes by area, sex, age, and cancer site. The prevalence figures presented are directly comparable with those from European cancer registries.

Adult↗
PubMed1988

Segregation and linkage analysis of nine Utah breast cancer pedigrees.

The analysis of nine Utah families that were ascertained for clusters of breast cancer cases is reported. Segregation analysis of an inherited susceptibility to breast cancer shows two distinct maximum likelihood solutions that have almost equal likelihood. One model indicates that most females had zero risk for breast cancer, but 10% of the female population had risks much greater than the Utah age-specific incidence rates. The other model indicates that most females have a risk defined by the Utah rates for breast cancer, but a rare dominant gene is segregating for increased susceptibility to breast cancer. Our analysis shows that linkage results under the two models are consistent in sign but not in magnitude. No evidence for linkage was found with the 14 marker loci examined. In addition to demonstrating distortion of linkage results from ignoring sporadic cases, this analysis shows the inherent difficulty of obtaining parameter estimates for segregation analysis when families are ascertained from a cluster of cases.

Breast Neoplasms↗
PubMed2005

Genomic search for prostate cancer predisposition loci in Utah pedigrees.

BACKGROUND: We report a genome linkage scan in extended Utah pedigrees, utilizing a pedigree-splitting approach to reduce intra-familial heterogeneity. METHODS: Fifty-nine pedigrees with at least four Prostate cancer (PrCa) cases and no more than two meioses separating PrCa cases were analyzed using the CIDR genomic search STRP marker set. Parametric linkage analyses using dominant and recessive models were performed on four datasets resulting from a pedigree splitting algorithm. In addition, age at diagnosis subset analyses were performed. RESULTS: Four regions of interest (LODs>1.9) were identified on chromosomes 1p, 3q, 5q, and 22q. The linkage peaks on 1p, 3q, and 22q have been previously implicated for PrCa, though not significantly. The 1p region was supported by a single large Utah pedigree with a multipoint LOD score of 3.1. An additional 10 regions gave LOD scores>1.22 (nominal linkage evidence), including moderate evidence supporting the HPC20 region with a recessive model. CONCLUSIONS: Our genome-wide search in the informative, extended Utah pedigrees continues to illustrate an ability to identify and replicate linkage peaks, and supports four regions of interest for PrCa predisposition genes.

Chromosome Mapping↗
PubMed1994

Cancer incidence among Mormons and non-Mormons in Utah (United States) 1971-85.

We calculated age-adjusted incidence rates per 100,000 by religion (Mormon, non-Mormon) for Utah (United States) using the 49,182 cancer cases occurring between 1971-85. For all causes of cancer, the rate in Utah for male members of the Church of Jesus Christ of Latter-day Saints (LDS or Mormons) was about 24 percent less than the comparable US rate. There was a 50-percent lower rate of cancers associated with cigarette smoking among LDS men. Non-LDS (NLDS) men in Utah experienced an incidence of smoking-associated cancers slightly higher than other US men. LDS men had an incidence of those cancers not associated with smoking slightly lower than US men, and NLDS men had a 40-percent higher rate than US men because of higher rates of melanoma and cancers of the lip and prostate gland. LDS women had an all-sites cancer rate 24 percent below the comparable US rate, and a 60-percent lower rate of smoking-associated cancers. The incidence of cancer not associated with smoking was 20 percent lower for LDS women compared with US women and was the result of lower rates of cancers of the colon, breast, and uterine cervix. NLDS women had a 13-percent higher incidence of cancers not associated with smoking because of higher rates of cancers of the lip and breast.

Age Factors↗
PubMed2005

The UTAH VBAC Study.

BACKGROUND: In July 1999, The American College of Obstetricians and Gynecologists (ACOG) issued Practice Guideline number 5 on vaginal birth after cesarean section (VBAC) and trial of labor (TOL). This updated guideline recommends that a physician be immediately available during a TOL in the rare case of complications. We examined the effect this new guideline would have on physician's VBAC/TOL practices in Utah. OBJECTIVE: 1) Explore physician knowledge of ACOG Practice Guideline number 5; 2) Evaluate change in physician's VBAC practices in the previous 12 months; 3) Evaluate physician's ability to comply with ACOG Practice Guideline number 5 recommendations by rural, suburban, and urban location. METHODS: In spring 2001, we surveyed by mail all physicians practicing obstetrics in Utah. Questions included demographics, hospital data, VBAC/TOL practice patterns and awareness of ACOG Practice Guideline number 5. Physicians were classified as urban, suburban, or rural by their primary delivery hospital. RESULTS: We found 97% of obstetricians and 79% of family physicians were aware of ACOG Practice Guideline number 5. Forty-five percent of all physicians reported a decline in VBAC practices in the preceding 12 months. Urban physicians' use of VBAC/TOL decreased the least, followed by rural and suburban. Eighty-seven percent of physicians had C/S "immediately" available during TOL: urban physicians 100%, suburban 88%, and rural physicians 76%. Emergency C/S delivery was performed fastest at urban hospitals, slower at suburban, and slowest at rural hospitals. CONCLUSION: Physicians use of VBAC/TOL has changed. TOL is offered less by obstetrical providers in Utah and more repeat C/S are performed since 1999 when ACOG updated this policy guideline. This decline has been more noticeable in suburban and rural hospitals and is consistent with recent national trends. Many rural physicians are unable to comply with ACOG Practice Guideline number 5 recommendations.

Adult↗
PubMed1989

Validity of cigarette smoking habits in three epidemiologic studies in Utah.

Utah has lower incidence and mortality for many smoking-related forms of cancer and heart disease. It is an important epidemiologic question to assess whether the population attributable risk associated with cigarette smoking in this low-risk population is biased from under-reporting because of societal pressures not to smoke. To answer this question, we compared reported cigarette use to serum cotinine values in three different epidemiologic study designs. Included in these analyses were data from men interviewed for a cross-sectional study of dietary intake and hormones, women interviewed as a part of a case-control study of cervical cancer, and men interviewed in conjunction with a cardiovascular disease and hypertension family follow-up study. Cross-sectional study participants reported accurate cigarette usage 93.8% of the time; case-control participants accurately reported cigarette use 98.5% of the time; participants interviewed in the family cohort study correctly reported usage 82.8% of the time. Most inaccurate reporting of smoking was by exsmokers being followed for a disease known to be linked to smoking. The low attributable risk of smoking related to diseases in Utah is not from underreporting of cigarette smoking, and makes Utah an ideal population to examine other risk factors for diseases where smoking increases risk.

Adolescent↗