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Ninety-six children attended an 8-week residential summer camp program and were evaluated for hoarseness using a 4 point integral scale. Eighteen percent were hoarse at the start of the camp season and 35% subsequently developed hoarseness during the camping season. Only 4.1% of the children in the first screening and 12.5% of those in the second screening had a moderate degree of hoarseness, while the majority of the hoarse children were judged as having only a mild degree. We believe that children should not be considered for voice screenings until 8 weeks after the start of the school term.

The changing association between community occupational structure and ischaemic heart disease mortality in white men and women of the United States from 1968 to 1982 has been investigated. Occupational structure was represented by the proportion of workers in white-collar jobs. A negative association, with lower mortality in communities with higher levels of white-collar employment, emerged over the period in both men and women. The results for men may be interpreted as suggesting a recapitulation in the US of the changing association between social class and heart disease observed in Britain. Occupational structure, however, reflects resources and opportunities in a community derived from its contribution to the national and international economy. Thus the growing inequalities in heart disease mortality presented in this ecological study relate more appropriately to communities than to individual workers.

We mapped average age-adjusted stroke mortality rates for white men and white women aged 35-74 years for state economic areas (counties or groups of counties) in the continental United States for three 7-year periods between 1962 and 1982. Despite the decline of national stroke mortality rates, rates in some areas failed to decline between 1962-1968 and 1969-1975. All areas experienced declines in 1976-1982, by which time some rates in the highest decile of the rate distribution were comparable to rates that had been in the lowest decile in 1962-1968. An east-west gradient of high-to-low stroke mortality rates was evident for both white men and white women in all three periods. Within the eastern part of the United States, high rates appeared more commonly in the South, and more so for white men than for white women. The "stroke belt" (area of very high stroke mortality rates in the coastal plain of the South) became less concentrated over the 2 decades, while a clustering of state economic areas with high rates along the Mississippi River and in the Ohio River valley became more pronounced.

A pilot screening program for the evaluation of former asbestos-cement workers was carried out in the Chest Disease Clinic of the Acco Public Health Office (Ministry of Health), Israel. A total of 184 subjects were evaluated using medical and occupational questionnaires, clinical examinations, and pulmonary function tests (forced expiratory volume, forced vital capacity). Thirty percent of individuals with more than 1 year of work experience had symptoms of breathlessness or cough. Individuals with 10 years or more of work experience showed a high prevalence of râles and reduced pulmonary function, as compared to those with shorter work histories. These findings indicate the urgent need for active follow-up of Israeli ex-asbestos workers. A proposed screening and surveillance program for this high-risk group is discussed with emphasis on follow-up, health education, and smoking cessation.

The relation of community socioenvironmental characteristics to timing of the onset of decline of ischemic heart disease (IHD) mortality was investigated among the 507 State Economic Areas of the continental United States. Onset of decline was measured using data for White men aged 35-74 and classified as early (1968 or before) vs late (after 1968). Ten socioenvironmental characteristics derived from US Census Bureau data were strongly related to onset of decline. Areas with the poorest socioenvironmental conditions were two to 10 times more likely to experience late onset than those areas with the highest levels. We found that income-related characteristics could account for most of the difference in onset of decline of IHD between metropolitan and non-metropolitan places. We conclude that community socioenvironmental characteristics provide the context for changes in risk factors and medical care.