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PubMed1987

Screening term LGA neonates for hypoglycemia: the Colorado vs. the Portland Intrauterine Growth Chart.

It was postulated that identification of term (LGA) large for gestational age newborns by the Portland Intrauterine Growth Curve rather than the Colorado Curve would classify a lesser number of neonates as LGA, but would identify the LGA neonates at risk for hypoglycemia. One hundred inborn neonates who plotted LGA on the Colorado Chart were reviewed. Sixty-one infants were LGA on the Portland Chart. Of the 100 infants, 17 were found to have dextrostix less than 45 mg% in the first two hours of life, 15 of these had quantitative blood glucose (BG) test performed. Eleven of the 15 neonates had a BG less than 40 mg%; all 11 hypoglycemic neonates were identified LGA on the Colorado Graph whereas only seven were identified LGA by the Portland Graph. The authors conclude that the Colorado Graph is a better tool in their population than the Portland in identifying term LGA neonates at risk for hypoglycemia.

Embryonic and Fetal Development↗
PubMed1985

Diagnosis of Colorado tick fever virus infection by enzyme immunoassays for immunoglobulin M and G antibodies.

An immunoglobulin M (IgM) capture enzyme immunoassay technique was adapted for the detection of antibody to Colorado tick fever virus in sera from 84 individuals for whom diagnosis had been confirmed by virus isolation or neutralization test. Titers were compared with those for IgG and neutralizing antibodies in these Colorado tick fever cases. IgM antibody titers were higher than neutralizing antibody titers, but neither appeared until 1 to 2 weeks after the onset of illness. Neutralizing antibodies were detected earlier than IgM antibodies, and both were detected with greater frequency than IgG antibodies. Late-convalescent-phase sera contained both neutralizing and IgG antibodies, but IgM was all but undetectable by 2 months after onset. Although the neutralization test may remain the serological test of choice, the enzyme immunoassay for IgM antibody offers a simple and more rapid method of serodiagnosis; the enzyme immunoassay is, however, less sensitive than the neutralization test. Furthermore, because there was a sharp decline in IgM antibody after 45 days, the presence of IgM antibody in a single serum sample provides a basis for the presumptive serodiagnosis of recent Colorado tick fever virus infection.

Adolescent↗
PubMed2006

Workers' compensation experience of Colorado agriculture workers, 2000-2004.

BACKGROUND: Agriculture is among the most hazardous of occupations. The lack of information regarding agriculture injuries or fatalities has been recognized as an obstacle for effective injury prevention. Workers' compensation claims data for non-fatal injuries among agriculture and agri-business workers in the State of Colorado between the years of 2000 and 2004. METHODS: Workers' compensation claims are utilized to estimate injury claim incidence rates, determine the distributions of sources, causes, types and body locations of injuries, and estimate the costs of these injuries. RESULTS: Colorado agriculture and agri-business workers (e.g., cattle dealers, cattle or livestock raisers, dairy farmers) have high rates of injury claims, especially in sectors that involve interaction with animals or livestock. Grain milling operations had a high rate of injury claims among agri-business operations. Injuries related to animals, strains, machinery, and falls or slips were the most frequent among all occupations analyzed. CONCLUSIONS: Understanding the occurrence of injuries among Colorado agriculture and agri-business workers is critical to implementing and evaluating effective intervention programs for specific agriculture-related occupations. The development of safety interventions that address the worker-animal interface, fall protection systems, machinery usage, and overexertion prevention strategies is recommended.

Accidents, Occupational↗
PubMed2004

Studies of radon-exposed miner cohorts using a biologically based model: comparison of current Czech and French data with historic data from China and Colorado.

The biologically based two-stage clonal expansion (TSCE) model is used to analyze lung cancer in several miners studies, two new ones (Czech, French) and two historic ones (Chinese, Colorado). In all cases, the model assumptions are identical. An action of radiation on initiation, promotion, and transformation is allowed. While all four studies indicate a highly significant action of radiation on promotion, the action on initiation is not significant in the French cohort, and barely significant in the Colorado miners cohort. No action on transformation is found in the Colorado miners, while the other data sets indicate a borderline significance. The model can describe all the data sets adequately, with different model parameters. The observed patterns in exposure, time since beginning of exposure, birth year, age and calendar year are reproduced well. The doubling exposure rate for initiation is about 3.5 WLM/year in the new data sets, while it is higher in the historic data sets. For transformation the doubling rate is about 20 WLM/year for the new data sets, while again the historic data give higher estimates. The action of radiation on promotion is quite different in the four data sets. These differences also induce different risk estimates at low exposures. The larger power of the new studies at these low exposures, compared to the historic data requires less extrapolation when the risk at very low exposures is estimated.

Age Distribution↗
PubMedDate not supplied

Impact of infants born at the threshold of viability on the neonatal mortality rate in Colorado.

OBJECTIVE: To determine the contribution of infants born at the threshold of viability (< 750 gm) on neonatal mortality in Colorado. STUDY DESIGN: For the period of January 1991 to December 1996, all Colorado live births who expired were evaluated for gestational age, birth weight, gender, hospital level of care, age at time of death, delivery room resuscitation, mechanical ventilation, medical and surgical complications, and serious malformations. RESULTS: Although infants weighing < 750 gm represent only 0.31% of all live births, they account for 46.3% of deaths. While those infants weighing < 500 gm and with a gestation of < 24 weeks almost always died (94.7%), the majority born in the 500- to 745-gm category (55.8%) survived. The vast majority (88.5%) of deaths occurred on the first day of life. A total of 38.4% of births in which the infant weighed < 750 gm occurred outside bona fide regional perinatal centers. CONCLUSION: Future attempts to reduce the Colorado neonatal mortality rate would best focus on the 500- to 750-gm weight group through the re-regionalization of high-risk perinatal care.

Cause of Death↗
PubMed2002

Association of low maternal education with neural tube defects in Colorado, 1989-1998.

Despite increasing use of folate prior to conception, neural tube defects remain among the most common birth defects in the United States. The Study objective was to investigate the maternal and child characteristics associated with having an infant born with a neural tube defect (NTD) in Colorado between 1989 and 1998. Data were derived from a population-based case control study of all live-born infants in Colorado from 1989 to 1998 (n=551,285), utilizing birth certificate records and a statewide neural tube defect registry. Chi-square analysis and multiple logistic regression were used to assess the strength of association between sociodemographic characteristics and the main outcome measure, the birth of a child with an NTD. Final analysis was limited to those children born to mothers who themselves were born in either the United States or Mexico. In this ten-year period, there were 251 confirmed cases of NTDs in Colorado, 224 of whom were born to women who were born in either the United States or Mexico. Significant bivariate associations were found between NTDs and the following: female sex of the child, lower maternal age, maternal country of birth in Mexico, and maternal education less than tenth grade. The single strongest predictor of having a child with an NTD was low maternal education (adjusted OR 1.8, 95% CI 1.1-3.1). Low maternal education is an important predictor of having a child with an NTD. In order to further reduce the incidence of neural tube defects, interventions should target women of low educational status.

Adult↗
PubMed1999

The incidence and nature of surgical adverse events in Colorado and Utah in 1992.

BACKGROUND: Despite more than three decades of research on iatrogenesis, surgical adverse events have not been subjected to detailed study to identify their characteristics. This information could be invaluable, however, for guiding quality assurance and research efforts aimed at reducing the occurrence of surgical adverse events. Thus we conducted a retrospective chart review of 15,000 randomly selected admissions to Colorado and Utah hospitals during 1992 to identify and analyze these events. METHODS: We selected a representative sample of hospitals from Utah and Colorado and then randomly sampled 15,000 nonpsychiatric discharges from 1992. With use of a 2-stage record-review process modeled on previous adverse event studies, we estimated the incidence, morbidity, and preventability of surgical adverse events that caused death, disability at the time of discharge, or prolonged hospital stay. We characterized their distribution by type of injury and by physician specialty and determined incidence rates by procedure. RESULTS: Adverse events were no more likely in surgical care than in nonsurgical care. Nonetheless, 66% of all adverse events were surgical, and the annual incidence among hospitalized patients who underwent an operation or child delivery was 3.0% (confidence interval 2.7% to 3.4%). Among surgical adverse events 54% (confidence interval 48.9% to 58.9%) were preventable. We identified 12 common operations with significantly elevated adverse event incidence rates that ranged from 4.4% for hysterectomy (confidence interval 2.9% to 6.8%) to 18.9% for abdominal aortic aneurysm repair (confidence interval 8.3% to 37.5%). Eight operations also carried a significantly higher risk of a preventable adverse event: lower extremity bypass graft (11.0%), abdominal aortic aneurysm repair (8.1%), colon resection (5.9%), coronary artery bypass graft/cardiac valve surgery (4.7%), transurethral resection of the prostate or of a bladder tumor (3.9%), cholecystectomy (3.0%), hysterectomy (2.8%), and appendectomy (1.5%). Among all surgical adverse events, 5.6% (confidence interval 3.7% to 8.3%) resulted in death, accounting for 12.2% (confidence interval 6.9% to 21.4%) of all hospital deaths in Utah and Colorado. Technique-related complications, wound infections, and postoperative bleeding produced nearly half of all surgical adverse events. CONCLUSION: These findings provide direction for research to identify the causes of surgical adverse events and for targeted quality improvement efforts.

Adult↗
PubMed2000

10-year experience with extracorporeal shockwave lithotripsy in the state of Colorado.

PURPOSE: To evaluate trends in the utilization of extracorporeal shockwave lithotripsy (SWL) and the potential need for medical prophylaxis of urolithaisis in the state of Colorado. MATERIALS AND METHODS: We examined patient and stone characteristics of individuals undergoing SWL for renal or upper-ureteral stones over a 10-year period (1987-1996) at the Kidney Stone Center of the Rocky Mountains. There were no significant changes in the in-state physician referral patterns nor SWL treatment criteria over this time interval. All patients were treated on the Dornier HM3 lithotripter. From September 1999 to December 1999, 198 consecutive patients undergoing SWL filled out a 10-point questionnaire regarding their interest in medical prophylaxis of urolithiasis. RESULTS: The number of patients from Colorado rose 32.5%: from 15.7 per 100,000 population in 1987 to 20.8 per 100,000 in 1996. Patient demographics such as sex, race, age, and history of nephrolithiasis did not change. Furthermore, there were no significant changes in the treated stone size or stone location. The overall increase in treatment numbers was attributable equally to increases in the number of upper ureteral and renal stones. Of the 198 patients questioned, 114 (58%) were recurrent stone formers, but only 52 (45%) of these had been offered a metabolic evaluation. CONCLUSIONS: Over the 10 years since the introduction of WSL in Colorado, there has been a gradual increase in its utilization. This higher utilization is probably multifactorial. Patients undergoing SWL have a strong desire to prevent future stone episodes and are very interested in medical prophylaxis of their stone disease.

Colorado↗
PubMed1993

Case-control study of bladder cancer and water disinfection methods in Colorado.

A population-based case-control study of bladder cancer and drinking water disinfection methods was conducted during 1990-1991 in Colorado. Surface water in Colorado has historically been disinfected with chlorine (chlorination) or with a combination of chlorine and ammonia (chloramination). A total of 327 histologically verified bladder cancer cases were frequency matched by age and sex to 261 other-cancer controls. Subjects were interviewed by telephone about residential and water source histories. This information was linked to data from water utility and Colorado Department of Health records to create a drinking water exposure profile. After adjustment for cigarette smoking, tap water and coffee consumption, and medical history factors by logistic regression, years of exposure to chlorinated surface water were significantly associated with risk for bladder cancer (p = 0.0007). The odds ratio for bladder cancer increased for longer durations of exposure to a level of 1.8 (95% confidence interval 1.1-2.9) for more than 30 years of exposure to chlorinated surface water compared with no exposure. The increased bladder cancer risk was similar for males and females and for nonsmokers and smokers. Levels of total trihalomethanes, nitrates, and residual chlorine were not associated with bladder cancer risk after controlling for years of exposure to chlorinated water.

Adult↗
PubMed2002

Plutonium in Colorado residents: results of autopsy bone samples collected during 1975-1979.

Concentrations of (239,240)Pu and the 240Pu/239Pu atom ratios were measured in rib samples from 55 non-occupationally exposed Colorado residents. Samples were collected at autopsy during 1975-1979 under an earlier study intended to compare plutonium levels in liver and lung of people who lived at various proximities to the Rocky Flats Environmental Technology Site (RFETS) near Denver. Overall, median (239,240)Pu concentrations from rib samples were 100, 80, and 57 microBq g(-1) ash weight for area locations A, B, and C, respectively. Area A encompassed subjects who lived within 25 km of RFETS, area B was between 25 and 50 km from RFETS, and area C included all of Colorado outside 50 km from the site and east of the continental divide. The corresponding median plutonium skeletal burdens estimated for these area locations were 146, 93, and 71 mBq, respectively. A statistically significant difference was noted only between plutonium concentrations in male rib samples and their skeletal burdens from area A compared to area C. However, based on a regression analysis of all study subjects, distance from RFETS was not statistically correlated to plutonium rib concentrations or skeletal burdens in this sample. Overall, median 240Pu/239Pu atom ratios were 0.20, 0.18, and 0.17 for areas A, B, and C, respectively. Although higher (239,240)Pu concentrations and skeletal burdens were indicated in area A males than area C males, we cannot conclude that RFETS releases may have caused this difference. The decreasing trends in the 240Pu/239Pu ratios with distance from RFETS are contrary with such a conclusion and strongly indicate that the material was primarily global fallout rather than weapons-grade plutonium that was processed at RFETS. Furthermore, there are other plausible explanations for the differences observed between area A and C residents. These include a decreasing trend in global fallout from the Rocky Mountain foothills eastward, smoking history differences, sample selection criteria, and possibly other unidentified factors. Nevertheless, estimated levels of total plutonium in this sample of Colorado residents were low and within the range of reported literature values for general, world-wide populations.

Autopsy↗
PubMed1997

The Colorado motorcycle safety survey: public attitudes and beliefs.

BACKGROUND: Motorcycle riders have a high risk of traumatic brain injury, disability, and death. Epidemiologic studies have proven that helmets reduce the severity of brain injuries and the cost of care. Yet, Colorado remains one of three states with no helmet law for riders. OBJECTIVES: This study measured public support for (1) a mandatory motorcycle helmet use law and (2) mandatory motorcycle operator safety training. We also sought to ascertain citizens' attitudes toward traffic safety mandates from the federal government. METHODS: Structured telephone interviews were conducted with 407 Colorado adults selected by random-digit dialing. RESULTS: Sixty-five percent of respondents believed that motorcycle riders of all ages should be required to wear helmets. An additional 18% believed that only riders under age 21 should be required to wear helmets. Only 17% of respondents opposed all helmet laws. Even among motorcyclists, most supported helmet laws for all riders (47%) or for those <21 years of age (26%). In a multiple logistic regression, there were three significant independent predictors of a pro-helmet law stance: older age, female gender, and not possessing a motorcycle operator's license. Most respondents also supported mandatory motorcycle operator safety training. Despite supporting state helmet use regulations, a large proportion (41%) opposed mandatory Federal mandates to enact them. CONCLUSION: Even in Colorado, a state with no helmet use requirements, there is strong public support for a regulatory strategy of motorcycle helmet use laws.

Adult↗
PubMed2000

Negligent care and malpractice claiming behavior in Utah and Colorado.

BACKGROUND: Previous studies relating the incidence of negligent medical care to malpractice lawsuits in the United States may not be generalizable. These studies are based on data from 2 of the most populous states (California and New York), collected more than a decade ago, during volatile periods in the history of malpractice litigation. OBJECTIVES: The study objectives were (1) to calculate how frequently negligent and nonnegligent management of patients in Utah and Colorado in 1992 led to malpractice claims and (2) to understand the characteristics of victims of negligent care who do not or cannot obtain compensation for their injuries from the medical malpractice system. DESIGN: We linked medical malpractice claims data from Utah and Colorado with clinical data from a review of 14,700 medical records. We then analyzed characteristics of claimants and nonclaimants using evidence from their medical records about whether they had experienced a negligent adverse event. MEASURES: The study measures were negligent adverse events and medical malpractice claims. RESULTS: Eighteen patients from our study sample filed claims: 14 were made in the absence of discernible negligence and 10 were made in the absence of any adverse event. Of the patients who suffered negligent injury in our study sample, 97% did not sue. Compared with patients who did sue for negligence occurring in 1992, these nonclaimants were more likely to be Medicare recipients (odds ratio [OR], 3.5; 95% CI [CI], 1.3 to 9.6), Medicaid recipients (OR, 3.6; 95% CI, 1.4 to 9.0), > or =75 years of age (OR, 7.0; 95% CI, 1.7 to 29.6), and low income earners (OR, 1.9; 95% CI, 0.9 to 4.2) and to have suffered minor disability as a result of their injury (OR, 6.3; 95% CI, 2.7 to 14.9). CONCLUSIONS: The poor correlation between medical negligence and malpractice claims that was present in New York in 1984 is also present in Utah and Colorado in 1992. Paradoxically, the incidence of negligent adverse events exceeds the incidence of malpractice claims but when a physician is sued, there is a high probability that it will be for rendering nonnegligent care. The elderly and the poor are particularly likely to be among those who suffer negligence and do not sue, perhaps because their socioeconomic status inhibits opportunities to secure legal representation.

Adolescent↗
PubMedDate not supplied

A tale of two sexually transmitted diseases. Prevalences and predictors of chlamydia and gonorrhea in women attending Colorado family planning clinics.

BACKGROUND: The comparative prevalences and predictors of chlamydia and gonorrhea have not been studied in the family planning clinic population. GOALS: To determine the comparative prevalences and predictors of chlamydia and gonorrhea among Colorado family planning clinic patients. STUDY DESIGN: Cross-sectional study of public and private family planning clinic patients in Colorado tested for both chlamydia and gonorrhea (n = 12,926). RESULTS: Among women tested for both infections, the chlamydia prevalence rate was 4.5% and the gonorrhea prevalence rate was 0.5%. Multivariate analysis showed that independent predictors of chlamydia were age younger than 25 years, black or Hispanic race-ethnicity, cervical friability, mucopus, exposure to a sex partner with chlamydia, or multiple recent sex partners. Independent predictors of gonorrhea were age younger than 20 years, black or Hispanic race-ethnicity, or exposure to a sex partner with gonorrhea; adjusted odds ratios for exposure to gonorrhea and black race were the highest for either infection. CONCLUSIONS: The gonorrhea prevalence rate was very low compared to that of chlamydia in patients at Colorado family planning clinics. Cost-effective gonorrhea testing strategies are needed for this population.

Adult↗
PubMed1997

Blood lead levels in radiator repair workers in Colorado.

A laboratory-based blood lead surveillance system in Colorado identified radiator repair workers as having the highest blood lead levels of all worker groups reported. A survey of 42 radiator repair shops in ten locales throughout Colorado was undertaken to estimate the prevalence of workers with elevated blood lead levels > 25 micrograms/dL. The survey was designed to test the sensitivity of the surveillance system and to assess working conditions and practices in the radiator repair industry in Colorado. Of 63 workers, 39 (62%) had blood lead levels > 25 micrograms/dL. The sensitivity of the surveillance system for detecting radiator repair workers with elevated blood lead levels was estimated at 11%. None of the radiator repair shops had adequate local exhaust ventilation. Work practice and engineering modifications are needed to reduce lead exposure in this industry.

Adult↗
PubMed2002

Mental health costs and access under alternative capitation systems in Colorado.

OBJECTIVE: To examine service cost and access for persons with severe mental illness under Medicaid mental health capitation payment in Colorado. Capitation contracts were made with two organizational models: community mental health centers (CMHCs) that manage and deliver services (direct capitation [DC]) and joint ventures between CMHCs and a for-profit managed care firm (managed behavioral health organization, [MBHO]) and compared to fee for service (F.F.S.). DATA SOURCES/STUDY SETTING: Both primary and secondary data were collected for the year prior to the new financing policy and the following two years (1995-1998). STUDY DESIGN: A stratified random sample of 522 severely mentally ill subjects was selected from comparable geographic areas within the capitated and FFS regions of Colorado. Major variables include service cost, utilization, and access (probability of service use) derived from secondary claims data, subject reported access collected at six-month intervals, and baseline outcomes (symptoms, functioning, and quality of life). PRINCIPAL FINDINGS: In comparison to the FFS area, cost per person was reduced in the capitated areas in each of the two years following implementation. By the end of year two, cost per person was reduced by two-thirds in the MBHO areas and by one-fifth in the DC areas. Reductions in access were found for both capitated areas, although reductions in utilization for those receiving service were found only in the MBHO model. CONCLUSIONS: Medicaid mental health capitation in Colorado resulted in cost reducing service changes for persons with severe mental illness. Assessment of outcome change is necessary to identify cost effectiveness.

Adolescent↗
PubMed1997

Childhood injury deaths: rural and urban differences, Colorado 1980-8.

OBJECTIVES: The purpose of this study is to describe and compare the distribution of injury deaths among rural and urban Colorado children that occurred between 1980-8. METHOD: Death certificates coded E800-E969 were obtained for children who were 0-14 years of age at death between 1980-8 and who were Colorado residents. Average annual rates were computed for rural and urban children, separately by gender. The 1980 census was used to compute rates. Rate ratios were calculated to summarize information related to specific external causes of deaths, contrasting rural and urban children. These differences were evaluated using Z tests. RESULTS: Statistically significant elevated risks were found along rural children for motor vehicle injury deaths. Firearms were involved more often in rural deaths among unintentional injury deaths of children older than 4 years of age, and among homicide related deaths of children 5 years and younger. All rural children who committed suicide used a firearm. CONCLUSIONS: Comparisons between rural and urban injury deaths provide important information that can be used to guide prevention strategies. For example, in Colorado, a child restraint law, passed in 1984, covered children under 4 years of age or under 40 pounds. It was not until 1995, however, that legislation was passed requiring restraint of children 5-16 years of age. Traditionally, rural residents are slower to accept new ideas and to alter current practices than urban residents.

Adolescent↗
PubMed2005

A Colorado statewide survey of walking and its relation to excessive weight.

INTRODUCTION: There is an urgent need to increase the physical activity in the population. Small-scale success has been achieved in programs like Colorado on the Move (COM), an obesity prevention program using electronic pedometers. METHODS: To provide baseline information for COM, this first-ever statewide survey of walking was conducted with 1098 individuals. The weighted mean BMI was 25.3 +/- 0.18 kg x m(-2), and mean age was 44 +/- 0.42 yr of age. Subjects participated in a short telephone interview and then were sent a pedometer to wear for four consecutive days. A total of 742 of the 1098 subjects completed the pedometer phase. RESULTS: The average adult in Colorado reported taking 6804 steps per day. About 33% reported taking fewer than 5000 steps per day, and only 16% reported taking 10,000 or more steps per day. Steps per day increased with other self-reported measures of physical activity (P = 0.0001) and decreased with self-reported inactivity (P = 0.0001). Significant determinants of steps per day included increasing age (negative, P = 0.001), marital status (positive for single status, P = 0.05), income (positive for incomes of dollar 25,000 to dollar 99,000, P = 0.003), and increasing BMI (negative for BMI > or = 30 kg x m(-2), P = 0.000). Obese individuals (BMI > or = 30 kg x m(-2)) walked about 2000 fewer steps per day than normal-weight individuals. These results provide the first population data on current walking levels, on how this relates to self-reported physical activity, and on determinants of walking. Results also provide a baseline level of walking for future evaluation of COM. CONCLUSION: Increasing steps per day appears to be a good target to use in interventions to increase physical activity. Even in Colorado, one of the leanest states, very low levels of physical activity are seen in much of the population.

Adolescent↗
PubMed2006

Comparisons of Colorado women's cancer screening practices by residence: metropolitan, non-metropolitan, and farm.

Combining farm residents and non-farm rural residents into a single category designated as rural may obscure differences in preventive care utilization, including cancer screening practices in each group, because of distinctive characteristics of farmers. This study compared three cancer screening practices (mammography, breast physical examination, and Pap smears) across three residence groups (metropolitan, non-metropolitan, and farms) of Colorado women and described demographic and socioeconomic characteristics of the groups. Females interviewed in the 1993 Colorado Behavioral Risk Factor Surveillance System (BRFSS) were divided into residence as metropolitan or non-metropolitan. Farm residents were female respondents interviewed as part of the Colorado Farm Family Health and Hazard Survey (CFFHHS) conducted in 1993-1997. Univariate and multivariate analyses were conducted to determine characteristics related to the screening practices. Farm women were more likely to be non-Hispanic white and older, to report their health as very good, and to have medical insurance and at least one source of primary care compared to non-metropolitan women. After controlling for related variables, residence was not associated with the screening practices, with the exception of breast physical examination; farm women were less likely to have a recent examination than metropolitan women (OR = 1.50, 95% CI = 1.07-2.10). When non-metropolitan and farm women were combined, there was no association between residence and having had a physical breast examination. There were important differences between non-metropolitan women and farm women in demographic and socioeconomic characteristics, which influenced screening practices. Further studies are needed to examine farm residents' cancer screening practices separately from other rural residents in order to fully understand the implications of these differences for health status in other geographic areas.

Adolescent↗