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Objectives. The Minnesota Heart Health Program was a research and demonstration project designed to reduce risk factors for heart disease in whole communities. This paper describes smoking-specific interventions and outcomes. Methods. Three pairs of matched communities were included in the study. After baseline surveys, one community in each pair received a 5-year education program, while both cross-sectional and cohort surveys continued in all sites. Adult education programs for smoking cessation included Quit and Win contests, classes, sell-help materials, telephone support, and home correspondence programs. Remits. Encouraging short-term results were obtained for several adult education programs. Overall long-term outcomes were mixed, with evidence of an intervention effect only for women in cross-sectional survey data. Unexpectedly strong secular declines in smoking prevalence were observed in comparison communities. Conclusions. The findings suggest that community education may be unlikely to exceed dramatic secular reductions In smoking prevalence. The success of several key interventions and the incorporation of Minnesota Heart Health Program interventions by education communities are encouraging, however. [ABSTRACT FROM AUTHOR]

Objectives. The Class of 1989 Study is part of the Minnesota Heart Health Program (MHHP), a populationwide research and demonstration project designed to reduce cardiovascular disease in three educated communities from 1980 to 1993. This paper describes an intensive, school-based behavioral intervention on cigarette smoking, comparing long-term outcomes in one of the intervention communities with those in a matched reference community. Methods. Beginning in sixth grade (1983), seven annual waves of cohort and cross-sectional behavioral measurements were taken from one MHHP intervention community and its matched pair. All students in each community were eligible to participate (baseline n = 2401). Self-reported data collected at each period described prevalence and intensity of cigarette smoking. Results. There were no differences at baseline for either weekly smoking prevalence or intensity of smoking. Throughout the follow-up period, however, smoking rates as determined by these measures were significantly lower in the intervention community: 14.6% of students were weekly smokers at the end of high school compared with 24.1% in the reference community. Cconclusions. These results suggest that multiple intervention components such as behavioral education in schools, booster programs to sustain training, and complementary communitywide strategies may all be needed for lasting reductions in adolescent tobacco use. [ABSTRACT FROM AUTHOR]

Objectives. To report insurance-based discrimination rates for nonelderly adults with private, public, or no insurance between 2011 and 2019, a period marked by passage and implementation of the Affordable Care Act (ACA) and threats to it. Methods. We used 2011–2019 data from the biennial Minnesota Health Access Survey. Each year, about 4000 adults aged 18 to 64 years report experiences with insurance-based discrimination. Using logistic regressions, we examined associations between insurance-based discrimination and (1) sociodemographic factors and (2) indicators of access. Results. Insurance-based discrimination was stable over time and consistently related to insurance type: approximately 4% for adults with private insurance compared with adults with public insurance (21%) and no insurance (27%). Insurance-based discrimination persistently interfered with confidence in getting needed care and forgoing care. Conclusions. Policy changes from 2011 to 2019 affected access to health insurance, but high rates of insurance-based discrimination among adults with public insurance or no insurance were impervious to such changes. Public Health Implications. Stable rates of insurance-based discrimination during a time of increased access to health insurance via the ACA suggest deeper structural roots of health care inequities. We recommend several policy and system solutions. (Am J Public Health. 2023;113(2):213–223. https://doi.org/10.2105/AJPH.2022.307126) [ABSTRACT FROM AUTHOR]

This paper deals with the political strategies employed by the Minnesota Comprehensive Health Planning Program to remove legal impediments to effective manpower planning, as well as the consequences. Conclusions as to alternative courses of action are stated. [ABSTRACT FROM AUTHOR]

The article discusses patient engagement and empowerment within the National Institute on Minority Health and Disparities Research Framework in relation to the study, published in the issue, which examined insurance-based discrimination in Minnesota. Topics covered include how to enhance patient-physician interactions, the importance of patient activation, confidence and empowerment and the systematic approach to improve patient-centered care.

Objectives. This study examined adolescent smokers' provision of tobacco to other adolescents. Methods. Data from a survey of 8th-, 9th-, and 10th-grade students in Minnesota were analyzed by using mixed-model logistic regression. Results. More than two thirds (68.8%) of adolescent smokers had provided tobacco to another adolescent in the previous 30 days. Mother's smoking, number of friends who smoke, owning tobacco merchandise, number of cigarettes smoked in the past week, source of last cigarette (commercial), and recent attempt to buy cigarettes were associated with providing. Conclusions. The social availability of tobacco to youth needs further examination. [ABSTRACT FROM AUTHOR]

As successes mount in reducing commercial tobacco use, an alarming disparity has taken shape in Minnesota. Recent studies revealed that overall smoking rates have dropped to 14%,whereas American Indians' rates remain higher than 50%.With support from ClearWay Minnesota, the organization created from the state's tobacco settlement, advocates working within sovereign tribal governments to create smoke-free policies came together to discuss effective strategies within tribal Nations. We discussed the history behind mainstream tobacco control's failure to resonate with Native audiences and the need to reframe the movement to a goal of restoring traditional tobacco practices. We share our insights on this critical area for achieving health equity and provide recommendations for tribes, non-Indian advocates, and funders, with a plea for tribal inclusion in commercial tobacco "end-game" strategies. [ABSTRACT FROM AUTHOR]

Objectives. We examined perpetration of bullying among youths in vulnerable groups relative to youths in peer groups not categorized as vulnerable. Methods. Data were collected in 2013 from a large school-based survey of adolescents conducted in Minnesota (n = 122 180). We used the v2 test and logistic regression to compare measures of perpetration of physical and relational bullying, as well as experiences of victimization and perpetration (or both), across categories of sexual orientation, weight status, and disability status. Results. Rates of physical and relational bullying perpetration were significantly higher among youths in vulnerable groups than among those not in vulnerable groups. With respect to context of victimization experiences, young men and women from vulnerable groups were overrepresented in the group comprising both perpetrators and victims. For example, odds of being both a perpetrator and a victim were 1.41 to 3.22 times higher among gay, lesbian, and bisexual youths than among heterosexual youths. Conclusions. Vulnerable youths, who are prone to peer harassment, may also act as perpetrators of bullying. Prevention strategies should address the particular needs of these populations; targeted programming may be appropriate. [ABSTRACT FROM AUTHOR]

Objectives. We describe how scientific evidence about obesity has been used in Minnesota legislative materials to understand how research evidence might more effectively be translated into policymaking. Methods. We selected 13 obesity-related bills introduced from 2007 to 2011 in Minnesota. Using state archives, we collected all legislative committee meeting materials and floor testimony related to each bill. We used a coding instrument to systematically analyze the content of a sample of 109 materials for their use of research evidence and non–research-based information. Results. Research evidence was mentioned in 41% of all legislative materials. Evidence was often used to describe the prevalence or consequences of obesity or policy impacts but not to describe health disparities. In 45% of materials that cited evidence, no source of evidence was indicated. By contrast, 92% of materials presented non–research-based information, such as expert beliefs, constituent opinion, political principles, and anecdotes. Conclusions. Despite an abundance of available research evidence on obesity, less than half of legislative materials cited any such evidence in discussions around obesity-related bills under consideration in Minnesota. [ABSTRACT FROM AUTHOR]

Objectives. The Minnesota Department of Health, in collaboration with the Centers for Disease Control and Prevention, implemented the Pertussis Active Surveillance Project to better understand pertussis epidemiology. We evaluated the program's impact. Methods. Clinics in 2 counties were offered free diagnostic testing and an educational presentation covering pertussis epidemiology. Clinics were identified as either active or intermittent, with active clinics testing 33% or more of the total number of months enrolled. We used generalized estimating equations to assess changes in provider testing behavior over the project period. Results. Ninety-seven clinics enrolled, with 38% classified as active. Active clinics were more likely to use the state lab for diagnostic testing and had a larger staff. During the project period, a decline in days coughing at the time of visit occurred in both jurisdictions. Conclusions. Providing clinics with free diagnostic testing influenced their participation levels. Among active clinics, results suggest changes in provider testing behavior over the course of the project. However, given the lack of robust participation, this resource-intensive strategy may not be a cost-effective approach to evaluating trends in pertussis epidemiology. [ABSTRACT FROM AUTHOR]

Objectives. We examined differences in self-reported mental health (SRMH) between US-born and Somalia-born Black Americans compared with White Americans. We tested how SRMH was affected by stigma toward seeing a mental health provider, discrimination in the health care setting, or symptoms of depression. Methods. Data were from a 2008 survey of adults in Minnesota and were limited to US-born and Somalia-born Black and White Americans (n = 938). Results. Somalia-born adults were more likely to report better SRMH than either US-born Black or White Americans. They also reported lower levels of discrimination (18.6%) than US-born Black Americans (33.4%), higher levels of stigma (23.6% vs 4.7%), and lower levels of depressive symptoms (9.1% vs 31.6%). Controlling for stigma, discrimination, and symptomatology, Somaliaborn Black Americans reported better SRMH than White and Black Americans (odds ratio = 4.76). Conclusions. Mental health programming and health care providers who focus on Black Americans' mental health might be missing important sources of heterogeneity. It is essential to consider the role of race and ethnicity, but also of nativity, in mental health policy and programming. [ABSTRACT FROM AUTHOR]

Objectives. We described 27-year secular trends in added-sugar intake and body mass index (BMI) among Americans aged 25 to 74 years. Methods. The Minnesota Heart Survey (1980-1982 to 2007-2009) is a surveillance study of cardiovascular risk factors among residents of the Minneapolis- St Paul area. We used generalized linear mixed regressions to describe trends in added-sugar intake and BMI by gender and age groups and intake trends by weight status. Results. BMI increased concurrently with added-sugar intake in both genders and all age and weight groups. Percentage of energy intake from added sugar increased by 54% in women between 1980 to 1982 and 2000 to 2002, but declined somewhat in 2007 to 2009; men followed the same pattern (all P < .001). Added sugar intake was lower among women than men and higher among younger than older adults. BMI in women paralleled added-sugar intake, but men's BMI increased through 2009. Percentage of energy intake from added sugar was similar among weight groups. Conclusions. Limiting added-sugar intake should be part of energy balance strategies in response to the obesity epidemic. [ABSTRACT FROM AUTHOR]

Objectives: We examined the correlates of having ever had sexual intercourse among American Indians aged 13 to 18 years in Minnesota. Methods: To assess key environmental, social, and individual correlates of sexual experience, we analyzed data from 4135 American Indian youths who participated in the 1998 and 2001 Minnesota Student Surveys. Results: Forty-two percent of those aged 13 to 15 years and 69% of those aged 16 to 18 years reported that they had ever had sexual intercourse. Correlates of sexual experience varied by age and gender. School connections had the strongest negative associations with sexual experience in young girls, and living with a father had negative associations with sexual experience for younger, but not older, youths. Sexual experience was most strongly and positively associated with risk behaviors such as substance use, violence exposure, and violence perpetuation. Conclusions: The strongest correlates of sexual experience for American Indian youths were high-risk behaviors and exposure to violence. Future work is needed to develop and employ measures that reflect youth assets and that specifically reflect the experiences of American Indian youths. [ABSTRACT FROM AUTHOR]

We compared the cost-effectiveness of a free nicotine replacement therapy (NRT) program with a statewide smoke-free workplace policy in Minnesota. We conducted 1-year simulations of costs and benefits. The number of individuals who quit smoking and the quality-adjusted life years (QALYs) we re the measures of benefits. After 1 year, a NRT program generated 18500 quitters at a cost of $7020 per quitter ($4440 per QALY), and a smoke-free workplace policy generated 10400 quitters at a cost of $799 per quitter ($506 per QALY), Smoke-free workplace policies are about 9 times more cost-effective per new nonsmoker than free NRT programs are. Smoke-free workplace policies should be a public health funding priority, even when the primary goat is to promote individual smoking cessation. [ABSTRACT FROM AUTHOR]

Objectives. This cross-sectional, community-based, epidemiological study characterized Somali and Ethiopian (Oromo) refugees in Minnesota to determine torture prevalence and associated problems. Methods. A comprehensive questionnaire was developed, then administered by trained ethnic interviewers to a nonprobability sample of 1134. Measures assessed torture techniques; traumatic events; and social, physical, and psychological problems, including posttraumatic stress symptoms. Results. Torture prevalence ranged from 25% to 69% by ethnicity and gender, higher than usually reported. Unexpectedly, women were tortured as often as men. Torture survivors had more health problems, including posttraumatic stress. Conclusions. This study highlights the need to recognize torture in African refugees, especially women, identify indicators of posttraumatic stress in torture survivors, and provide additional resources to care for tortured refugees. (Am J Public Health. 2004; 94:591-598) [ABSTRACT FROM AUTHOR]

Objectives. This study assessed the effectiveness of an intervention to reduce wood dust, a carcinogen, by approximately 26% in small woodworking businesses. Methods. We randomized 48 businesses to an intervention (written recommendations, technical assistance, and worker training) or comparison (written recommendations alone) condition. Changes from baseline in dust concentration, dust control methods, and worker behavior were compared between the groups 1 year later. Results. At follow-up, workers in intervention relative to comparison businesses reported greater awareness, increases in stage of readiness, and behavioral changes consistent with dust control. The median dust concentration change in the intervention group from baseline to follow-up was 10.4% (95% confidence interval = -28.8%, 12.7%) lower than the change in comparison businesses. Conclusions. We attribute the smaller-than-expected reduction in wood dust to the challenge of conducting rigorous intervention effectiveness research in occupational settings. (Am J Public Health. 2002;92:1498-1505) [ABSTRACT FROM AUTHOR]

Objectives. This study sought to determine physicians' attitudes and practices regarding varicella vaccine. Methods. A sample of Minnesota family physicians and pediatricians was surveyed in January 1997. Results. Of 255 physicians surveyed, 108 (42%) reported routinely offering varicella vaccine. Physicians who perceived their professional organization's recommendations as "very important" were more likely to routinely offer varicella vaccine. Physicians who preferred natural disease over vaccination and those concerned about waning immunity were less likely to routinely offer vaccine. Conclusions. Recommendations of professional organizations have encouraged varicella vaccine use and may further enhance future use. Differences in pediatricians' and family physicians' attitudes and practices regarding this vaccine suggest that education of providers by specialty may be needed to increase acceptance of newly licensed vaccines. (Am J Public Health. 2000;90: 1917-1920) [ABSTRACT FROM AUTHOR]

Objectives. This study tested the hypothesis that adoption and implementation of local policies regarding youth access to tobacco can affect adolescent smoking. Methods. A randomized community trial was conducted in 14 Minnesota communities. Seven intervention communities participated in a 32-month community-organizing effort to mobilize citizens and activate the community. The goal was to change ordinances, merchant policies and practices, and enforcement practices to reduce youth access to tobacco. Outcome measures were derived from surveys of students before and after the intervention and from tobacco purchase attempts in all retail outlets in the communities. Data analyses used mixed-model regression to account for the clustering within communities and to adjust for covariates. Results. Each intervention community passed a comprehensive youth access ordinance. Intervention communities showed less pronounced increases in adolescent daily smoking relative to control communities. Tobacco purchase success declined somewhat more in intervention than control communities during the study period, but this difference was not statistically significant. Conclusions. This study provides compelling evidence that policies designed to reduce youth access to tobacco can have a significant effect on adolescent smoking rates. [ABSTRACT FROM AUTHOR]

Objectives. A randomized school-based trial sought to increase fruit and vegetable consumption among children using a multicomponent approach. Methods. The intervention, conducted in 20 elementary schools in St. Paul, targeted a multiethnic group of children who were in the fourth grade in spring 1995 and the fifth grade in fall 1995. The intervention consisted of behavioral curricula in classrooms, parental involvement, school food service changes, and industry support and involvement. Lunchroom observations and 24-hour food recalls measured food consumption. Parent telephone surveys and a health behavior questionnaire measured psychosocial factors. Results. The intervention increased lunchtime fruit consumption and combined fruit and vegetable consumption, lunchtime vegetable consumption among girls, and daily fruit consumption as well as the proportion of total daily calories attributable to fruits and vegetables. Conclusions. Multicomponent school-based programs can increase fruit and vegetable consumption among children. Greater involvement of parents and more attention to increasing vegetable consumption, especially among boys, remain challenges in future intervention research. [ABSTRACT FROM AUTHOR]

Objectives. This study examined the extent to which comprehensive, age-appropriate adolescent health screening is undertaken in the clinical setting and whether the extent of such screening varies by setting. Methods. Charts of adolescents 13 to 17 years old (n = 788) were randomly selected from five practice settings in Minneapolis, Minn. Each was assessed for the number of biomedical and sociobehavioral health risks screened. Results. In no practice setting was there screening to the level recommended. The two teen clinics screened more extensively for behavioral. psychosocial, substance use and sexual behavior risks than the community family practice setting, which, in turn, screened more extensively than either the private family practice or private pediatric practice settings, which did not differ from each other. Age differences and gender accounted for only small amounts of variance in total number of health risks screened, whereas differences among practice settings accounted for a larger amount. Conclusion. Results suggest substantive deficiencies in private practice settings' implementation of preventive care screening protocols for adolescents. [ABSTRACT FROM AUTHOR]

Objectives. This study examined the prevalence of occasional smoking in a population of working adults, compared the characteristics of occasional and daily smokers, and prospectively examined the long-term smoking patterns of occasional smokers. Methods. At 32 Minnesota work sites, 5681 randomly selected workers were surveyed at baseline; 5248 of these were surveyed again 2 years later. A cross-sectional sample of 5817 workers was also surveyed at follow-up. Results. Occasional smokers constituted 18.3% of all smokers in the baseline sample and 21.5% of all smokers in the cross-sectional sample surveyed 2 years later. Baseline occasional smokers were significantly more likely than daily smokers to have quit at follow-up. Job monotony or repetitiveness was related to an increase to daily smoking at follow-up among baseline occasional smokers, and a change to a more restrictive workplace smoking policy was associated with quitting. Conclusions. The results confirm that a substantial proportion of smokers are low-rate users and suggest that the proportion may be rising. Further research on this group is warranted. [ABSTRACT FROM AUTHOR]

Objectives. Project Northland is an efficacy trial with the goal of preventing or reducing alcohol use among young adolescents by using a multilevel, communitywide approach. Methods. Conducted in 24 school districts and adjacent communities in northeastern Minnesota since 1991, the intervention targets the class of 1998 (sixth-grade students in 1991) and has been implemented for 3 school years (1991 to 1994). The intervention consists of social-behavioral curricula in schools, peer leadership, parental involvement/education, and communitywide task force activities. Annual surveys of the class of 1998 measure alcohol use, tobacco use, and psychosocial factors. Results. At the end of 3 years, students in the intervention school districts report less onset and prevalence of alcohol use than students in the reference districts. The differences were particularly notable among those who were nonusers at baseline. Conclusions. The results of Project Northland suggest that multilevel, targeted prevention programs for young adolescents are effective in reducing alcohol use. [ABSTRACT FROM AUTHOR]

The association of parity and infant mortality was studied using linked birth-death files for 46985 infants born to 11- to 19-year-old Minnesota residents between 1980 and 1988. Compared with infants of primiparas, infants of multiparas were at twice the risk for infant and postneonatal death but at no increased risk for neonatal death. They were also at two to three times the risk for deaths due to accidents, infections, and sudden infant death syndrome. The higher sociodemographic disadvantage and poorer prenatal care of multiparas did not explain the excess infant mortality risk that was concentrated in causes of death that are potentially preventable through primary care and parent education. [ABSTRACT FROM AUTHOR]

Objectives. The Minnesota Heart health Program is a 13-year research and demonstration project to reduce morbidity and mortality from coronary heart disease in whole communities. Methods. Three pairs of communities were matched on size and type; each pair had one education site and one comparison site. After baseline surveys, a 5- to 6-year program of mass media, community organization, and direct education for risk reduction was begun in the education communities, whereas surveys continued in all sites. Results. Many intervention components proved effective in targeted groups. However, against a background of strong secular trends of increasing health promotion and declining risk factors, the overall program effects were modest in size and duration and generally within chance levels. Conclusions. These findings suggest that even such an intense program may not be able to generate enough additional exposure to risk reduction messages and activities in a large enough fraction of the population to accelerate the remarkably favorable secular trends in health promotion activities and in most coronary heart disease risk factors present in the study communities. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of the study was to provide descriptive data and incidence data on adolescent work-related injuries and to determine whether such injuries are underreported to the Minnesota Department of Labor and Industry. Methods: The study consisted of a 1-year survey of 534 adolescent work-related injuries reported to the Department of Labor and Industry and a cross-sectional survey of 3312 public high school students from throughout Minnesota. The high school survey used an abbreviated questionnaire with a subset of items from the Department of Labor and Industry survey. Results: Ninety-six percent of the injuries were strains and sprains, cuts and lacerations, burns, bruises and contusions, and fractures. There were 11 hospitalizations; 4 were for burns that occurred during work in restaurants. Eighty workers (15%) reported permanent impairment as a result of their injuries. It was estimated that there were 2268 reportable injuries to working adolescents in Minnesota during the study year. Conclusions. The most common serious injuries were injuries to the lower back and burns. The demographic characteristics of adolescents whose injuries were reported to the Department of Labor and Industry were similar to those of injured adolescent workers identified through the high school survey. The results suggest that there is substantial underreporting of adolescent work injuries. [ABSTRACT FROM AUTHOR]

Background. The impact of the Minnesota Parental Notification Law on abortion and birth was examined. Methods. Using linear models, outcome parameters were compared before and after enactment of the law. Time by age group interactions also were examined. Results. The pre-enactment to post-enactment change in the Minnesota abortion rate reflected a greater decline for minors (less than or equal to 17 years old) than for 18-19 year-olds (who were not under the law). An increase in abortion rate occurred for women ages 20-44. The law appeared to have had no impact on birth rate in minors. Following the enactment of the law, the rate of early abortions (less than or equal to 12 weeks) declined among minors more than the rate of late abortions (greater than 12 weeks). This resulted in a pre-enactment to post-enactment increase in the ratio of late-to-early abortions among minors. Conclusions. These data suggest that parental notification facilitated pregnancy avoidance in 15-17 year-old Minnesota women. Abortion rates declined unexpectedly while birth rates continued to decline in accordance with a long-term trend. [ABSTRACT FROM AUTHOR]

We conducted a population-based study of drownings in Minnesota from 1980 through 1985. Five hundred and forty-one drownings (2.1 per 100,000 person-years) were identified from death certificates and from incident reports filed with the Minnesota Department of Natural Resources. Most drownings (334, 62 percent) occurred during summer months (May-August) and involved boating (42 percent and swimming (35 percent) events However, 62 drownings (11 percent) occurred during winter months (December-February) and primarily involved snowmobiles and motor vehicles (71 percent) breaking through ice on lakes and waterways. The risk of drowning estimated by the ratio of drownings to number of water-related activities, was highest during March and April, when the ice on lakes and waterway surfaces is melting, and during October and November, when lake arid waterway surfaces are starting to greeze. Drowning rates were highest for males (3.7 per 100,000 person-years), persons 15 to 25 years of age (3.3 per 100,000 person-years), and children less than 5 years of age (2.5 per 100,000 person-years). These data can be used to target prevention strategies, particularly in northern climates. [ABSTRACT FROM AUTHOR]

Abstract: In Minnesota, several health care cost containment measures occurred about the time Medicare's Prospective Payment System (PPS) was implemented. These included a moratorium on additional nursing home beds, preadmission screening of nursing home applicants, and rapid growth in HMO (health maintenance organization) enrollment by Medicare recipients. Hospital days per elderly Medicaid recipient decreased by 38 percent for those in nursing homes and by 35 percent for those not in nursing homes from 1982 to 1984. By 1986, hospital days per recipient had decreased 53 and 55 percent, respectively, from the 1982 level. Age-adjusted mortality rates for elderly Medicaid nursing home residents for the period 1977 through 1986 showed an increasing trend after 1982. Estimated age-adjusted mortality rates for the entire County population, which had decreased steadily from 1970 to 1982, rose significantly above the projected rate in 1984, 1985, 1986, and 1987. We conclude that, coincident with the institution of the PPS and other health care cost containment measures, use of hospital care has fallen for all elderly Medicaid recipients, age-adjusted mortality rates among those in nursing homes have increased, and the mortality rate trend for the total Hennepin County elderly population has stopped declining. [ABSTRACT FROM AUTHOR]

Abstract: Two cross-sectional surveys were conducted in 1985 and 1986 to measure the prevalence of coronary heart disease (CHD) risk factors in Blacks and Whites. A home interview was followed by a survey center visit. Participation rates were 78 per ¢ and 90 per ¢ for the home interview and 65 per ¢ and 68 per ¢ for the survey center visit. Adjusted for age and education, systolic and diastolic blood pressure was 3 to 4 mmHg higher in Blacks. Hypertension was more prevalent in Blacks than Whites (44 per ¢ vs 28 per ¢); serum total cholesterol was approximately 0.4 mmol/l lower in Black than White men and 0.08 mmol/l lower in Black than White women. Among men, more Blacks than Whites were current cigarette smokers (44 per ¢ vs 30 per ¢); however, White smokers smoked more cigarettes per day (26 vs 17). Similar differences were noted for women, although the prevalence and quantity of cigarette consumption was < men. The excess prevalence of these CHD risk factors in Blacks, especially among women, may explain their elevated CHD and stroke mortality rates in the Twin Cities. [ABSTRACT FROM AUTHOR]

This study compares the efficacy of a school-based program to an equivalent home-based program with 2,250 third grade students in 31 urban schools in Minnesota in order to detect changes in dietary fat and sodium consumption. The school-based program, Hearty Heart and Friends, involved 15 sessions over five weeks in the third grade classrooms. The home-based program, the Home Team, involved a five-week correspondence course with the third graders, where parental involvement was necessary in order to complete the activities. Outcome measures included anthropometric, psychosocial and behavioral assessments at school, and dietary recall, food shelf inventories, and urinary sodium data collected in the students' homes. Participation rates for all aspects of the study were notably high. Eighty-six per cent of the parents participated in the Home Team and 71 per cent (nearly 1,000 families) completed the five-week course. Students in the school-based program had gained more knowledge at posttest than students in the home-based program or controls. Students in the home-based program, however, reported more behavior change, had reduced the total fat, saturated fat, and monounsaturated fat in their diets, and had more of the encouraged foods on their food shelves. The data converge to suggest the feasibility and importance of parental involvement for health behavior changes with children of this age. (Am J Public Health 1988; 78: 1156-1160.) [ABSTRACT FROM AUTHOR]

Abstract: Social indicator systems can serve as a social accounting method to guide public policy on alcoholism, utilizing data which are routinely collected at public expense. An attempt to develop an alcoholism social indicator system for Minnesota demonstrated many differences in the coding schemes used by various state agencies and institutions. These findings have relevance to other social indicator systems being developed to assess public policies regarding the people's health. INSET: Survey Says On-the-go Americans Prefer Somke-Free Air. [ABSTRACT FROM AUTHOR]

Abstract: Alcohol abuse in the State of Minnesota has an impact on health, health care resources, and the economy. Alcohol abuse was related to 3.3 per ¢ (1, 150) of deaths in Minnesota in 1983: of these, almost one-third were the result of fatal injuries. Alcohol abuse contributed to 12 per ¢ (33,909) of all years of potential life lost, two-thirds of which were secondary to injury. The estimated cost of alcohol abuse ranged from $1.4 billion to $2.1 billion, representing from 2.8 per ¢ to 4.3 per tent of rill personal income of Minnesotans, from 32 per ¢ to 50 per ¢ of State expenditures. and from 26 to 39 times the alcohol excise tax revenues generated in 1983. Alcohol-related direct medical CaFe costs were estimated to be at least $216 million. 3.8 per ¢ of Minnesota medical costs for 1983. Costs of reduced on-the-job productivity and short-term absentecism related to alcohol abuse were estimated to be between $630 million and $1.2 billion. The documentation of the costs of alcohol abuse is an important step in the campaign to reduce alcohol-related deaths, morbidity, and health care costs. [ABSTRACT FROM AUTHOR]

The relationship of worksite and occupational norms about smoking to workers' attitudes toward smoking cessation was studied in a defined population. From smokers identified in a self-administered questionnaire circulated to all employees of 10 worksites in suburban Minneapolis, 447 smokers were randomly selected and interviewed. Attitudes and social norms about smoking cessation were compared by occupation and worksite using analysis of covariance, controlling for age, sex, and education. Similarly, the relationships of social norms to attitudes were examined using multiple regression analysis. Interest in quitting smoking, confidence in the ability to quit, and coworker support of prior quit attempts were equally pervasive among workers from blue collar and white collar occupations. Yet substantial differences between worksites in attitudes and norms about smoking cessation suggest the importance of the unique social milieu of individual worksites. Of particular importance is the impact of coworker discouragement of prior quit attempts, which varied across worksites and was directly related to confidence in the ability to ,quit and the desire to seek formal help in future quit attempts. These findings point to the relevance of intervention programs aimed at changing worksite norms about smoking and smoking cessation. [ABSTRACT FROM AUTHOR]

Data from two major survey, conducted in the Minneapolis-St. Paul metropolitan area in 1973-74 and 1980-81, were used to estimate the prevalence of overweight. In 1980-8l, weight history and the prevalence of dieting behaviors were also obtained. The prevalence of overweight was greater in the 19:40-81 survey than in 1973-74. Increase, were observed in all ages in women, but only in the 40-59 year age ranges in men. in 1980-8l. dieting to control weight was widely reported by' both sexes, even among those who had never been overweight. Of those who reported having been overweight, approximately one-third reported they had successfully reduced. Mole men than women reported having been overweight, bill more women reported having dieted to lose weight. Formal weight reduction programs were used much more by women than men. Although most dieting attempts consisted of balanced, reduced calorie regimens a significant percentage were "fad" types. whose nutritional safety may be questioned. Overall, contrary to findings based on clinical populations, weight reducing efforts often appear to be successful. Nevertheless, overweight remains a significant public health problem in this community. [ABSTRACT FROM AUTHOR]

Abstract: The relationship between smoking and weight was examined in data of the Lipid Research Clinic (LRC) Prevalence Study in Richfield, Minnesota. Weight was analyzed according to smoking status, age, and sex, holding constant self-perceived physical activity relative to others of the same age and sex. Our findings confirm that weight differences between smokers of 15-29 cigarettes a day (cig/day) and those who never smoked are noticeable in 20-39 year olds and quite marked in the 40-59 year age group. Ex smokers are somewhat heavier than those who never smoked while, among smokers, a U-shaped curve exists with those smoking 15-29 cig/day being the lightest class. Height varied lithe between smoking classes. Daily caloric intake was estimated based on 24-hour dietary recalls and analyzed according to smoking status, sex. and age. The results showed that smokers of 15-29 cig/day generally are consuming at least as many or more calories as those who never smoked yet have lower weight. (Am J Public Health 1981; 71:391-396.) [ABSTRACT FROM AUTHOR]

External peer review of each of the 8917 Medicaid patients in 228 Skilled Nursing Facilities in Minnesota demonstrated characteristics and needs of patients and produced documented recommendations for Medical Evaluation Studies to strengthen multiple aspects of treatment programs. As a whole. Medicaid patients were welt placed and well cared for However, wide variations were observed in individual facilities. Principal problem areas were those which prevail in all long term care facilities in this country; weakness of individualized treatment, weakness of restorative goal-oriented treatment, severe mental/emotional/behavioral disabilities, lack of strong leadership in medical and nursing professions, and weakness of psychosocial support programs. [ABSTRACT FROM AUTHOR]

As state and local governments increase restrictions on cigarette smoking, tobacco manufacturers have shifted to marketing alternative tobacco products. Tobacco control laws need to be updated to reflect this shifting marketplace. With the 2010 enactment of the Tobacco Modernization and Compliance Act, Minnesota addressed regulatory gaps and created a model law for other states. We have detailed the updated definitions of tobacco and tobacco products and identified ways that future laws could be strengthened. [ABSTRACT FROM AUTHOR]

Increasing concern with the problem of providing medical care to rural populations had led to interest in the use of former medical corpsmen as physician assistants. This study of attitudes and opinions on this approach suggests potentially serious problems to be overcome. Evidence is cited and the need for prior preparation of the medical and lay public is stressed. [ABSTRACT FROM AUTHOR]

A questionnaire study of Minnesota dentists and dental students dealing with current issues revealed differences in their perception among various subgroups according to age, size of community and type of practice. Younger dentists and other students were more willing to delegate new duties. [ABSTRACT FROM AUTHOR]

In 1991, 1008 suburban St. Paul, Minn, high school students were surveyed via self-administered questionnaire regarding use of commercial fanning facilities, injuries experienced from tanning, use of protective measures while tanning indoors, and knowledge of the risks of tanning. Overall, 34% of the respondents had used commercial tanning facilities. Fifty percent said they had not been warned by tanning facility operators about the risks of tanning indoors, 28% reported not being told to wear goggles, and 17% reported never wearing goggles. The results indicate that these adolescents use commercial tanning services at high rates, and often in ways that increase their risk for a variety of health problems. [ABSTRACT FROM AUTHOR]

This case-control study investigated factors associated with late initiation (i.e., initiation after the age of 17 years) of smoking among young women. The most significantly elevated odds ratios for late initiation were having a significant other, played an important role in smoking initiation among young women. Prevention efforts should focus on strategies that reduce the acceptability of smoking in the social environment. [ABSTRACT FROM AUTHOR]

Recent ecological comparison studies have suggested a positive association between fluoridation and hip fracture. Using data from the Rochester Epidemiology Project, we found the incidence of hip fracture for the 10 years before the fluoridation of the Rochester, Minn, public water supply was 484 per 100,000, compared with 450 per 100,000 in the following 10 years. When the effects of calendar time and age were controlled for, the relative risk associated with fluoridation was 0.63. These ecologic trend data suggest that the fluoridation of public water supplies is not associated with an immediate increase in rates of hip fracture. Further studies of this association at the individual level are clearly required before public policy decisions can be made. [ABSTRACT FROM AUTHOR]

The prevalence of smoking among physicians has gradually declined over the past 25 years. Few recent studies have examined specific smoking habits. Of 393 physicians in the Minnesota Medical Association who responded to a survey (response rate of 83%), 9% reported smoking any form of tobacco. The prevalence of cigarette smoking was 4.9%, while 5.1% smoked a pipe and 2.1% smoked cigars. The prevalence estimates of current and former smokers were greater among men than women and among older than younger physicians. Cigarette and overall smoking prevalence among physician continues to be well below levels reported for the general population. [ABSTRACT FROM AUTHOR]

Objectives. Policymakers, researchers, and citizens are beginning to recognize the need to limit minors' access to tobacco by restricting the sale of cigarettes through vending machines. One policy alternative that has been proposed by the tobacco industry is a requirement that vending machines be fitted with electronic locking devices. This study evaluates such a policy as enacted in St. Paul, Minnesota. Methods. A random sample of vending machine locations was selected for cigarette purchase attempts conducted before implementation and at 3 and 12 months postimplementation. Results. The rate of noncompliance by merchants was 34% after 3 months and 30% after 1 year. The effect of the law was to reduce the ability of a minor to purchase cigarettes from locations originally selling cigarettes through vending machines from 86% at baseline to 36% at 3 months. The purchase rate at these locations rose to 48% at 1 year. Conclusions. Our results suggest that cigarette vending machine locking devices may not be as effective as vending machine bans and require additional enforcement to ensure compliance with the law. [ABSTRACT FROM AUTHOR]

Abstract: In 1986, the ambient air for lead in radiator repair shops in the Minneapolis-St. Paul metropolitan area exceeded the Occupational Safety and Health Administration (OSHA) action level in nine of 12 shops sampled by Minnesota OSHA. We therefore sought to determine the prevalence of lead exposure/toxicity in this industry. Thirty-five radiator shops were identified, 30 were visited, and 53 workers were studied. The mean blood lead level was 1.53 (range 0.24-2.80). Seventeen individuals had blood lead levels is ≥ 1.93 µ mol/L (40 µ g/dl). The mean zinc protoporphyrin level (ZPP) was 0.55 µ mol/L (range 0.16-1.43). No single worksite or personal characteristic was a strong determinant of either blood lead or ZPP level. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of this study was to assess changes in the physician-population ratio in non-SMSA Minnesota counties between 1965 and 1985 using county specific data published by the American Medical Association. The physician-population ratio actually decreased by 2 per ¢ for primary care physicians and by 11 per ¢ for family practitioners in the non-SMSA counties. The large increase in the number of physicians in Minnesota has not translated into improved access to primary care physicians in Minnesota's rural areas. [ABSTRACT FROM AUTHOR]

A mail survey of all 54 US State and Territorial Public Health Laboratories and the 165 Hospital Clinical Laboratories in Minnesota was carried out, soliciting information on laboratory-acquired infections and injuries for calendar year 1986. The aggregate infection incidence rates were 3.5/1,000 full-time equivalent (FTE) workers for hospital laboratories and 1.43/1,000 for public health laboratories. Injury rates were 21.2/100 FTE workers for hospital laboratories and 7.21/100 for public health labs. (Am J Public Health 1988: 78:1213-1215.) [ABSTRACT FROM AUTHOR]

Abstract: The prevalence of ownership 17.5 per cents and the accuracy of home sphygmomanometers were determined in a population-based survey in the Minneapolis. St. Paul metropolitan area. Sixty-four per ¢ of home sphygmomanometers were accurate within [sup +]2mm Hg of a calibrating sphygmomanometer: another 26 per ¢ were within +/-3-6 mm Hg. These results suggest that although many home sphygmomanometers are accurate, some are very inaccurate. Health care providers should advise regular calibration when home sphygmomanometers are used for therapeutic sell-management of hypertension. (Am J Public Health 1987: 77: 1459-1461.) [ABSTRACT FROM AUTHOR]

In a two-year investigation of cigarette smoking incidence in a population of Minnesota adolescents, the perceived smoking behavior of friends at baseline was a strong predictor of smoking onset. Additional predictors included: siblings' smoking behavior, parents' education level, and seven psychosocial scales including independence and rebelliousness. Smoking prevention strategies which teach youth to cope with social influences are well founded. Results also indicate that younger adolescents may yet be dissuaded from beginning smoking by knowledge of the health consequences of smoking. [ABSTRACT FROM AUTHOR]

A study of the total cost of head injury in Olmsted County. Minnesota with the costs projected to the United States population, revealed that the annual cost for head trauma in the US can be estimated at approximately $12.5 billion using a 6 per cent discount rate. The nonmedical costs accounted for more than 92 per cent ($11.5 billion of the total cost, while direct medical costs amounted to $1.0 billion. (Am J Public Health 1984; 74:710-712.) [ABSTRACT FROM AUTHOR]