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PubMed1998

Effects of participation in bariatric support group after Roux-en-Y gastric bypass.

BACKGROUND: Support group is a service provided by Pacific Bariatric Surgical Medical Group to its gastric bypass patients before and after surgery. It has already been well established that group therapy helps breast cancer patients survive longer. METHODS: 102 patients answered self-report questionnaires that were mailed out in the spring 1998 newsletter. The questionnaire was designed to investigate weight loss, mood, postsurgical problems, and the reasons patients chose not to attend the support group meetings. RESULTS: The mean preoperative weight was 303.65 lb (137.73 kg), with a mean weight loss of 95.79 lb (43.45 kg). The mean desired goal weight was 152.47 lb (69.16 kg), and there was a 63.3% loss of excess weight. The mean elapsed time since surgery was 15.2 months. After surgery, 25.5% of patients reported seeing a mental health professional. There was no difference in mood between group meeting attenders and nonattenders. There was a statistical trend for more weight loss (P = .08) in group attenders than in nonattenders. For group attenders, the more often patients attended group meetings, the more weight they lost (P < .05). Patients with reported emotional, psychosocial, dietary, and lifestyle problems were no more likely to attend group than nonattenders. CONCLUSIONS: The mean weight loss was as good as or better than reported in the literature. Patients who attended group meetings regularly tended to lose more weight, and increased frequency of attendance was associated with greater weight loss. The implications are discussed.

Adult↗
PubMed2005

Preparing African-American men in community primary care practices to decide whether or not to have prostate cancer screening.

BACKGROUND: This study was a randomized trial to test the impact of an informed decision-making intervention on prostate cancer screening use. METHODS: The study population included 242 African-American men from three primary care practices who were 40-69 years of age and had no history of prostate cancer. Participants completed a baseline survey questionnaire and were randomly assigned either to a Standard Intervention (SI) group (N=121) or an Enhanced Intervention (EI) group (N=121). An informational booklet was mailed to both groups. EI group men were also offered a screening decision education session. Two outcomes were considered: (1) complete screening (i.e., having a digital rectal exam (DRE) and prostate specific antigen (PSA) testing), and (2) complete or partial screening (i.e., having a PSA test with or without DRE). An endpoint chart audit was performed six months after initial intervention contact. The data were analyzed via exact logistic regression. RESULTS: Overall, screening use was low among study participants. EI group men had a screening frequency two times greater than that of SI group men, but the difference was not statistically significant: 8% vs. 4 % (OR = 1.94) fo rcomplete screening, and 19% vs. 10% (OR = 2.08) for complete or partial screening. Multivariable analyses showed that being in the EI group and primary care practice were significant predictors of complete or partial screening (OR = 3.9 and OR = 5.64, respectively). CONCLUSION: Prostate cancer screening use may be influenced by exposure to decision education and the influence of screening-related primary care practice factors.

Adult↗
PubMedDate not supplied

Infection control knowledge, practice, and attitudes of Mississippi dental hygienists.

PURPOSE: The purpose of this study was to assess Mississippi dental hygienists' knowledge and use of infection control techniques, attitudes pertaining to universal precautions and the risk of clinician/patient cross-infection, and attitudes toward treatment of patients with infectious diseases. METHODS: A 41-item questionnaire was mailed to all 508 licensed dental hygienists in Mississippi. Inactive, retired, and out-of-state hygienists (n = 59) were deleted from this study. The data were tested for significant associations using Chi-square. RESULTS: After adjusting for the 59 unusable returns, the response rate for analysis was 58% (n = 297). Dental hygienists reported using infection control techniques including sterilization or disposal of common items such as prophylaxis angles, suction tips, and air/water syringe tips. Although 98% of the respondents believed that barrier techniques were effective, some believed patients infected with HIV/AIDS (43%), hepatitis B (31%), or tuberculosis (40%) are best treated in public clinics rather than in private settings and that these clients pose a threat to dental hygiene practitioners. Further, a majority of the respondents believed that all oral healthcare workers and patients should be tested for HIV/AIDS. CONCLUSIONS: The incongruity between perceived knowledge, reported practice, and attitudes suggests the need for continuing education courses designed to allow dental hygienists to explore the affective domain regarding the care of patients with infectious diseases. In addition, courses on working with patients with HIV/AIDS should be offered in smaller cities for greater accessibility.

Adult↗
PubMed1999

Predicting clinician injury prevention counseling for young children.

BACKGROUND: Injury is the primary cause of morbidity and mortality in children and an important topic for counseling. OBJECTIVE: To describe and explain clinicians' reported counseling behavior during the well-child examinations for children aged 5 years and younger on the following 4 injury prevention topics: motor vehicle crashes, toxic ingestion, drowning, and firearm injuries. METHODS: A random sample of 465 pediatricians, family physicians, and pediatric nurse practitioners in an urban setting received mailed questionnaires; 325 (69.9%) responded. Multivariate logistic regression predicting counseling on each injury prevention topic was performed. RESULTS: Most reported discussing motor vehicle occupant protection (66.2%) and toxic ingestion prevention (62.1%) during the well-child examination. Only 31.8% stated they counseled on drowning prevention and 15.7%, on firearm injury prevention. Knowledge of injury mortality and morbidity rates was not associated with counseling. For most topics, female respondents were more likely to counsel than male respondents (motor vehicle crash odds ratio [OR], 2.24 [P = .03]; toxic ingestion OR, 1.82 [P = .05]; drowning OR, 1.97 [P = .04]). Health maintenance organization settings predicted injury prevention counseling for most topics (motor vehicle crash OR, 2.52 [P = .04]; toxic ingestion OR, 2.77 [P = .01]; firearm injury OR, 2.97 [P = .001]). Clinicians placing lower importance on counseling were less likely to counsel on drowning and firearm injury (drowning OR, 0.73 [P = .006]; firearm injury OR, 0.58 [P<.001]). CONCLUSIONS: Clinicians' knowledge of local injury epidemiology did not influence their counseling on these topics. Clinicians and their patients might benefit by using programs such as The Injury Prevention Program to help them standardize their approach to injury prevention counseling during the routine well-child examination.

Accident Prevention↗
PubMed1999

Comparison of open and closed questionnaire formats in obtaining demographic information from Canadian general internists.

The objective of this study was to compare the impact of closed- versus open-ended question formats on the completeness and accuracy of demographic data collected in a mailed survey questionnaire. We surveyed general internists in five Canadian provinces to determine their career satisfaction. We randomized respondents to receive versions of the questionnaire in which 16 demographic questions were presented in a closed-ended or open-ended format. Two questions required respondents to make a relatively simple computation (ensuring that three or four categories of response added to 100%). The response rate was 1007/1192 physicians (80.0%). The proportion of respondents with no missing data for all 16 questions was 44.7% for open-ended and 67.0% for closed-ended formats (P < 0.001). The odds of having missing items remained higher for open-ended response options after adjusting for a number of respondent characteristics (2.67, 95% confidence interval 2.01 to 3.55). For the two questions requiring computations focused on professional activity and income, there were more missing data (P = 0.02, 0.02, respectively) but fewer inaccurate responses (P = 0.009, 0.20, respectively) for the open-ended compared to the closed-ended format. Investigators can achieve higher response rates for demographic items using closed format response options, but at the risk of increasing inaccuracy in response to questions requiring computation.

Adult↗
PubMed2003

Use of mouthguards by basketball players in Victoria, Australia.

Basketball is a popular sport in Australia. Although orofacial injuries are common, mouthguard (MG) wear in basketball appears to be low. The purposes of this study were: to measure mouthguard wear by basketball players before and after a promotional intervention; to assess players' knowledge of the value of mouthguards for prevention of injury; and to describe their experience of orofacial injury. Two questionnaires (baseline and follow-up) were administered to a convenience sample of 496 basketball players in Victoria, Australia. Players recruited were youths (12-15-year olds, n = 208) and adults (18 years and over, n = 288), from all basketball levels (social to elite). Completion of the baseline questionnaire was followed immediately by an intervention comprising written and verbal information, a mouthguard blank and instructions on mouthguard construction. The follow-up questionnaire was mailed to all respondents 10-12 weeks later; 135 youths (65%) and 157 adults (54%) completed this. Mouthguard wear at baseline was low but was more frequent at games (62%) than at training (25%). Despite 90% of players acknowledging the protective value of a mouthguard, wear by youths did not increase following the intervention, and wear by adults increased by only 14% for training and 10% at games. Previous orofacial injury was recorded at baseline by 23% of players, but few had requested compensation from Basketball Australia (youths, 17%; adults, 30%). Two predictor variables were statistically identified as related to mouthguard wear: previous orofacial injury and age group. Mouthguard wear was significantly more frequent amongst players with previous injury; such players were 2.76 times more likely to be wearers than those without previous injury. Youths were 2.31 times more likely to wear mouthguards than adults. Only 34 players (12% of respondents at follow-up) had a mouthguard constructed from the blank provided. Although youth and adult groups differed, the overall extent of mouthguard use was disappointingly low. Despite wide recognition of mouthguard value, the intervention had little effect on promoting their use.

Adolescent↗
PubMed2001

The prevalence of Peyronie's disease: results of a large survey.

OBJECTIVES: To determine the prevalence of Peyronie's disease, a localized connective tissue disorder of the penile tunica albuginea, the symptoms of which include palpable plaque, painful erections and curvature of the penis, in a large sample of men in Germany. SUBJECTS AND METHODS: A standardized questionnaire was sent to 8000 male inhabitants (age range 30-80 years) of the greater Cologne area (approximately 1.5 million inhabitants). Three questions about the self-diagnosis of Peyronie's disease were previously assessed for validity on 158 healthy men and 24 patients with confirmed Peyronie's disease. To optimize the response rate, the questionnaire was mailed three times to all the men. RESULTS: The response rate after the third mailing was 55.4% (4432 men): 142 men (3.2%, mean age 57.4 years, SD 13.4) reported the new appearance of a palpable plaque which, from the previous validation, was the most sensitive question and the main symptom of the disease. In men aged 30-39 years only 1.5% reported localized penile induration, compared with 3.0% in those 40-49 and 50-59 years, 4.0% in those 60-69 years and 6.5% of those > 70 years old. Newly occurring angulation was reported by 119 of the 142 men (84%) and painful erection by 66 (46.5%). The combination of the three symptoms (plaque, deviation and painful erection) was reported by 46 of the 4432 respondents (1.04%), i.e. 32% of the 142 men with penile induration; 58 of the 142 men (41%) reported erectile dysfunction. CONCLUSIONS: This is the first large cross-sectional, community-based study to examine the prevalence of Peyronie's disease. Using previously validated questions the prevalence of Peyronie's disease in the sample was 3.2%; this is much higher than indicated in previous reports. A comparably high prevalence is reported for diabetes and urolithiasis, suggesting that this 'rare' disease is more widespread than previously thought.

Adult↗
PubMed2005

An epidemiological survey of overactive bladder symptoms in Japan.

OBJECTIVE: To report an epidemiological survey of lower urinary tract symptoms (LUTS) to determine the prevalence of overactive bladder (OAB) symptoms (defined as a symptom complex of daily urinary frequency of eight or more times and urgency once or more per week) in Japan. SUBJECTS AND METHODS: A self-administered questionnaire was mailed to 10,096 Japanese men and women aged > or = 40 years selected by a two-stage randomized process. Survey questions, developed by members of the Japan Neurogenic Bladder Society Committee, covered four areas: demographic characteristics, LUTS, health-related quality of life (HRQoL), and hospital attendance. RESULTS: The responses from 4570 respondents (mean age 61 years) were analysed. The estimated prevalence of OAB was 12.4% (men 14%, women 11%). Prevalence rates for OAB with and without urgency incontinence (one or more episode/week) were 6.4% and 6.0%, respectively. Prevalence rates increased with age; 5% of respondents aged 40-49 and 37% of those aged > or = 80 years had OAB. HRQoL was compromised in 53% of respondents with OAB symptoms, specifically emotions (42%), sleep/vitality (37%), physical limitation (34%), role limitation (29%), and social limitation (22%). Among those whose HRQoL was affected, 23% (men 36%, women 8%) had visited a medical institution because of their urinary problems. CONCLUSION: The results from this survey indicate that the prevalence of OAB was high and increased with age, but the rate of hospital attendance was low. Public awareness of OAB should be increased so that there can be optimum management of this condition.

Adult↗
PubMed2003

The rural physician workforce in Florida: a survey of US- and foreign-born primary care physicians.

CONTEXT: To meet the challenge of primary care needs in rural areas, continuing assessment of the demographics, training, and future work plans of practicing primary care physicians is needed. PURPOSE: This study's goal was to assess key characteristics of primary care physicians practicing in rural, suburban, and urban communities in Florida. METHODS: Surveys were mailed to all of Florida's rural primary care physicians (n = 399) and a 10% sampling (n = 1236) of urban and suburban primary care physicians. FINDINGS: Responses from 1000 physicians (272 rural, 385 urban, 343 suburban) showed that rural physicians were more likely to have been raised in a rural area, foreign-born and trained, a National Health Service Corps member, or a J-1 visa waiver program participant. Rural physicians were more likely to have been exposed to rural medical practice or living in a rural environment during their medical school and residency training. Factors such as rural upbringing and medical school training did not predict future rural practice with foreign-born physicians. Overall, future plans for practice did not seem to differ between rural, urban, and suburban physicians. CONCLUSIONS: Recruiting and retaining doctors in rural areas can be best supported through a mission-driven selection of medical students with subsequent training in medical school and residency in rural health issues. National programs such as the National Health Service Corps and the J-1 visa waiver program also play important roles in rural physician selection and should be taken into account when planning for future rural health care needs.

Age Distribution↗
PubMed1999

[Self-reported skills in practical procedures among young physicians].

There is at present no consensus as to which clinical procedures a student should be able to perform after graduation. The present study was undertaken to evaluate the self-reported skills level in practical procedures among graduates from the medical schools in Norway. A questionnaire was mailed to all students who entered internship between July 1996 and January 1998. They were asked to indicate on a visual-analogue scale the level of skill he or she had acquired in 88 practical clinical procedures. 519 of 621 (84%) graduates replied; 89% started internship immediately after graduation. Graduates from Tromsø reported significantly better skills than graduates from Oslo and Bergen. There was considerable variation within and between the universities with respect to several procedures. Overall, men reported a significantly better skills level than their female colleges. The present study demonstrates that the skills level in several procedures vary considerably between candidates graduating from different Norwegian universities after undergraduate medical education. For some procedures the skills level is, in our opinion, disquietingly low. The results of this survey indicate that teaching of clinical procedures in medical school is often random and of inferior quality. There is a need for a systematic approach and a national consensus on the clinical procedures to be acquired and the levels of skills to be attained.

Adult↗
PubMed2004

Factors influencing intention to obtain a genetic test for a hereditary disease in an affected group and in the general public.

BACKGROUND: To ensure successful implementations of genetic screening in the future, the attitudes of the public are an important factor to consider. The primary aim of this study is to investigate the intention to take a genetic test for an unidentified hereditary disease. A further objective is to assess the predictive values of attitudes, subjective norms, and perceived personal control on the intention to take a genetic test. These aims are investigated in two groups differing in their experience and knowledge of genetic testing. METHOD: A questionnaire was developed according to the Theory of Planned Behavior (TPB) and mailed to a random sample of 1000 persons from the general public and to 330 persons in FAP families. The response rate was 60% and 74%, respectively. RESULTS: The probability of taking a genetic test was high in both groups but significantly higher in the FAP group. The attitudes of the FAP group were significantly more positive when compared to the attitudes of the general public. For the persons in the FAP group, the most significant others in the decision to take a genetic test were their children, whereas spouses proved to be the most important significant others in the general public. The most important predictor of the intention to take a test in both groups was attitude, accounting for 64% of the variance. CONCLUSIONS: The study indicated that most of the individuals in the FAP group and many in the general public intended to take a genetic test. Our findings suggest that living in an affected group and having some kind of experience of a hereditary disease may lead to an even more positive attitude to genetic testing. Using the TPB, attitudes were found to be the strongest predictor of intention to take a genetic test in both groups.

Adult↗
PubMed2002

Periodontal treatment practices of Finnish dentists.

OBJECTIVES: To evaluate the treatment practices of Finnish general practitioners (GPs) and dental teachers (DTs) regarding periodontal treatment modalities, and their knowledge of possible contraindications for periodontal surgery. MATERIAL AND METHODS: A questionnaire on two periodontal cases was mailed to 400 GPs, selected by stratified randomization from the public and private sector, and to 47 DTs. The response rate was 77%. Respondents were asked to choose the optimal treatment for a patient with a bleeding, 8-mm-deep periodontal pocket and to consider the influence on their treatment decision of the six possible contraindications for periodontal surgery presented, two of which were absolute (inadequate oral hygiene and poorly controlled diabetes) and four of which were relative contraindications. The respondents' treatment decisions were compared with recommendations from textbooks and the Consensus Report from the 1996 World Workshop of Periodontology. RESULTS: The majority of public (65%) and private (70%) dentists and almost all of the DTs chose treatment in agreement with recommendations. Correct answers from dentists were associated with a greater number of days in continuing education (OR = 1.5; p= 0.005). The two absolute contraindications were known by 38% of public and 31% of private sector dentists, and by 29% of DTs. The respective figures for relative contraindications were 40, 58 and 53%. CONCLUSION: The majority of Finnish dentists followed the recommendations, but elaboration of international guidelines for good clinical practice is still needed to help clinicians to make optimal treatment decisions.

Adult↗
PubMed2003

Barriers to limiting the practice of feeding tube placement in advanced dementia.

OBJECTIVE: In advanced dementia, many difficult decisions may arise as the disease progresses, including whether to use feeding by tube. Several recent articles question the benefit of percutaneous endoscopic gastrostomy (PEG) tube placement in persons with advanced dementia. However, patients with advanced dementia are still referred for PEG tubes. This study attempts to understand more about physician decisions to recommend PEG tube placement in patients with advanced dementia. DESIGN: Mailed survey. SETTING: Random sample of 500 physicians from the American Medical Association Masterfile. PARTICIPANTS: Primary care physicians. MEASUREMENTS: Physician knowledge, beliefs, and self-reported practices of PEG tubes in advanced dementia. RESULTS: Of the 416 eligible participants, 195 completed surveys (response rate of 46.9%). A significant number of physicians believe PEG tubes have the following benefits in advanced dementia: reduce aspiration pneumonia (76.4%), and improve pressure ulcer healing (74.6%), survival (61.4%), nutritional status (93.7%), and functional status (27.1%). Most physicians underestimate 30-day mortality in patients who receive a PEG and more than half of physicians believe PEG tubes in advanced dementia are the standard of care. Also, a majority of physicians believe speech therapists, nurses, and nutritional support teams recommend feeding tubes, which influences their decision to recommend a PEG. Last, almost half of these respondents had a nursing home request PEG tube placement, leading physicians to recommend a PEG. CONCLUSIONS: We find a notable discord between physician opinion, reported practice, and the literature regarding PEG tubes in advanced dementia that reveals some of the barriers to decreasing the referral of these patients for PEG.

Adult↗
PubMed1993

Factors associated with fissure sealant delegation: dentist characteristics and office staffing patterns.

The purpose of this research was to identify dentist characteristics and dental office staffing patterns related to delegation of sealant applications. Results from a 1989 mailed survey were used to characterize Michigan general dentists (N = 300) who did or did not delegate sealant applications to auxiliaries and to identify factors associated with delegation. Nearly 50 percent of respondents were applying all sealants themselves. In offices that delegated the procedure, the mean proportion of sealants being applied by dentists was 39.9 percent. Registered dental hygienists were applying 51 percent, while registered dental assistants were applying 6.5 percent. Delegating dentists were more knowledgeable about sealant procedures, held more favorable attitudes, treated more young patients, placed more sealants, and were better informed about the legality of delegation according to the state practice act. Logistic regression analysis found that employing a registered dental hygienist was the most significant factor associated with sealant delegation, followed by employing a registered dental assistant. Findings suggest that dental auxiliaries, and particularly registered dental assistants, are underutilized for applying sealants. Approaches to increasing delegation of sealants may include changing dentists' traditional hiring patterns, highlighting the skills of auxiliaries such as the registered dental hygienist (RDH) and the registered dental assistant (RDA), and increasing awareness of legally allowable procedures that RDHs and RDAs can perform.

Adolescent↗
PubMed2004

Randomized trial of an intensive care unit-based early discharge planning intervention for critically ill elderly patients.

BACKGROUND: Few investigators have targeted elderly patients and monitored outcomes of care in studies on discharge planning interventions after critical illness. OBJECTIVES: To pilot test an intensive care unit-based nursing screening intervention to assist in determining the discharge needs and outcomes of critically ill elderly patients. METHOD: A randomized clinical trial with in-hospital and mailed questionnaires was used. Patients 65 years and older who were hospitalized in 1 of 2 intensive care units at 2 midwestern university-affiliated medical centers were recruited for the study. Control patients (n = 53) received usual discharge planning, experimental patients (n = 47) were screened in the intensive care unit by using the Discharge Planning Questionnaire. Both groups were assessed for readiness for discharge when discharged from the hospital and were followed up 2 weeks later with a survey completed at home. RESULTS: One hundred patients 65 to 90 years old (mean 73, SD 5.78) completed the study. Sixty-six percent were men. The 2 groups did not differ with regard to age, race, sex, severity of illness, lengths of stay in the intensive care unit or hospital, education level, or income. Patients in the experimental group were more ready than patients in the control group for discharge (P =.06). Patients in the experimental group were also more likely to report they had adequate information, had less concern about managing their care at home, knew their medicines, and knew danger signals indicating potential complications. CONCLUSION: Intensive care unit-based early discharge planning can affect elderly patients' preparation for discharge.

Aged↗
PubMed2006

Quality of life in advanced oropharyngeal carcinoma after chemoradiation versus surgery and radiation.

OBJECTIVE: The objective of this cohort study from a tertiary academic university practice was to identify differences in patients' perceived quality of life after either chemoradiation or surgery and radiation for advanced-stage oropharyngeal carcinoma. METHODS: From institutional databases, thirty-five patients were identified who had undergone either primary chemoradiation or primary surgery and postoperative radiation for advanced oropharyngeal cancer (stage II-IV). Patients voluntarily responded by mail using the University of Washington quality-of-life instrument version 4 (UW-QOL). Data were analyzed using chi and Wilcoxon tests. RESULTS: There were 17 patients who underwent chemoradiation and 18 patients who underwent surgery and postoperative radiation. All surgical patients had undergone free-flap reconstruction. Patients completed the UW-QOL an average of 25 months after treatment. There was no statistically significant difference between the two groups with regard to any specific domain, including pain, appearance, swallowing, chewing, speech, saliva, or mood. There was a trend toward significance for taste (P = .07) with chemoradiation patients reporting poorer taste function. The lack of difference in the patients' perception of appearance and swallowing was rather surprising given the vastly different treatment modalities. Respondents reported equivalent overall quality of life in response to global quality-of-life questions. CONCLUSION: Most patients with advanced oropharyngeal carcinoma report good quality of life after treatment, regardless of treatment modality. Although the short-term side effects of treatment may be different between the groups, long-term quality of life is remarkably similar whether the patients choose primary chemoradiation or surgery with postoperative radiation.

Chi-Square Distribution↗
PubMed1995

Smoking and oral health: a population survey in Finland.

OBJECTIVES: A survey was conducted to study smokers' oral health behaviors and attitudes, and to determine if smokers were advised by their dentists to quit smoking. METHODS: A random sample of 1,200 adults 15 to 64 years of age living in the province of North Karelia, Finland, was selected in each of two study years (1990 and 1991) and surveyed using a mail questionnaire. The 102-item questionnaire solicited information on smoking status, oral health behaviors, missing teeth, perceptions of tobacco's harmful effects on oral health, smoking status and quitting, and advice on smoking cessation provided by dentists. Variations in behaviors and opinions according to smoking status were analyzed. RESULTS: Nonsmokers reported more frequent healthy oral health behaviors than did daily smokers, with the exception that no difference in toothbrushing frequencies existed among women. Daily smoking was associated with increased use of sugar in tea or coffee, and with more frequent alcohol consumption. Daily smoking was correlated with the number of missing teeth in bivariate analyses, but not in multivariate analyses. Fewer daily smokers than nonsmokers considered smoking to have harmful effects on oral health. The majority of daily smokers, however, wanted to quit. Eight percent of daily smokers reported that they had been advised by their dentist to quit. CONCLUSIONS: Dentists need to provide patients with counseling on tobacco use because of the desire of many smokers to quit. Counseling of smokers by the oral health team requires special attention and skills, because smokers' health behaviors and attitudes appear to be less favorable to oral health compared to nonsmokers.

Adolescent↗
PubMed1998

Characteristics of a gun exchange program, and an assessment of potential benefits.

OBJECTIVES: To describe a gun exchange program and assess potential benefits for participants and host communities. METHODS: Mail survey of participants in a Sacramento, California gun exchange program, August 1993; the response rate was 79%. Comparative data were obtained from nationwide polls of gun owners. RESULTS: Most (62%) respondents were men; 40% were more than 55 years old; none was less than 25. Concern that children might find and use the gun was the most frequently cited reason for participating (46% of respondents). Of 141 firearms exchanged, 72% were handguns; 23% of respondents indicated that the guns they turned in were not in working order. Of respondents who owned a gun at the time of the program (rather than those who owned no guns and turned in a gun owned by someone else), 41% owned no guns after participating; the prevalence of handgun ownership declined from 79% to 32%. Those who continued to own guns were as likely as gun owners nationwide to keep a gun loaded in the house (odds ratio (OR) 0.9, 95% confidence interval (CI) 0.4 to 1.7) or to carry a gun with them (OR 1.5, 95% CI 0.6 to 3.8). CONCLUSIONS: Gun exchange programs may reduce risk for firearm violence among some participants, but a number of factors limit their overall benefits to host communities.

Adult↗