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We read with interest the recent follow-up of the Shangdong Intervention Trial (1). In that study, volunteers received what is now recognized as a regimen with low eradication success and have been followed for more than 15 years without additional treatment. A reduction in cancer risk was confirmed over time. During the interval, the study has been in progress and it has become clear that Helicobacter pylori infection is responsible for the vast majority of gastric cancer and that cancer can be prevented if H. pylori eradication is accomplished before atrophic damage occurs (2). H. pylori eradication at later times also has a benefit in that it stops the progression of damage and the age-related increase in cancer incidence. Even in those at the highest risk (ie, those who have experienced an early gastric cancer), H. pylori eradication reduces the risk of metachronous cancer (3,4). A number of studies have shown that H. pylori–host cell interactions can in themselves cause genetic instability, including double-stranded DNA breakage, providing an additional rational for H. pylori eradication (2,5). In 2013, the Japanese government instituted a program of H. pylori eradication and surveillance to eliminate gastric cancer from that country (6). Nowhere can we find a statement that all the participants in the study have been or are being offered effective anti–H. pylori therapy and confirmation of cure. Effective regimens have been identified in China, and this is now easily accomplished (7). US government–sponsored research carries the legacy of the Tuskegee and the Guatemala syphilis experiments. Continued failure to end this experiment by providing H. pylori eradication, in our opinion, can not be justified and is long overdue.

Purpose: To determine whether there are racial differences in the frequency with which black and white girls engaged in eating practices commonly targeted for modification in weight reduction programs. Methods: This is part of the NHLBI Growth and Health Study, a longitudinal study of preadolescent girls designed to examine the factors associated with development of obesity, and its later effects on cardiovascular risk factors. Black and white girls ages 9–10 years at entry ( n = 2,379) were recruited at three clinical sites. Racial differences were examined in 11 "weight-related" eating practices such as eating with TV, eating while doing homework, and skipping meals. Multiple logistic regression analyses were then conducted for each of the dependent variables. Results: Black girls were more than twice as likely as white girls to frequently engage in the targeted weight-related eating practices. The odds of a study girl frequently engaging in most of these eating practices decreased with an increase in parents' income and education level. However, even when controlling for socioeconomic and demographic effects, black girls remained more likely to engage in these eating practices than white girls. For most of the behaviors, girls who frequently practiced a behavior had higher energy intakes compared to those who practiced it infrequently. Conclusions: The finding that black girls at an early age more frequently engage in eating practices associated with weight gain may have significant implications for obesity development. For both young black and white girls, early education efforts may be necessary in helping develop good eating habits. Since it appears that black girls have a higher risk of developing adverse weight-related eating practices, culturally appropriate education materials may be required.

Recent research has demonstrated that mortality patterns by marital status in Japan are different from corresponding patterns in other industrialized countries. Most notably, the magnitude of the excess mortality experienced by single Japanese has been staggering. For example, estimates of life expectancy for the mid-1900s indicate that single Japanese men and women had life expectancies between 15 and 20 years lower than their married counterparts. In addition, gender differences among single Japanese have been smaller than elsewhere, while those among divorced persons have been unanticipatedly large; and, the excess mortality of the Japanese single population has been decreasing over the past few decades in contrast to generally increasing differentials elsewhere. In this paper, we use a variety of data sources to explore several explanations for these unique mortality patterns in Japan. Undeniably, the traditional Japanese system of arranged marriages makes the process of selecting a spouse a significant factor. Evidence from anthropological studies and attitudinal surveys indicates that marriage is likely to have been and probably continues to be more selective with regard to underlying health characteristics in Japan than in other industrialized countries. However, causal explanations related to the importance of marriage and the family in Japanese society may also be responsible for the relatively high mortality experienced by singles and by divorced men.

Although the greater longevity of married people as compared with unmarried persons has been demonstrated repeatedly, there have been very few studies of a comparative nature. We use log-linear rate models to analyze marital-status-specific death rates for a large number of developed countries. The results indicate that divorced persons, especially divorced men, have the highest death rates among the unmarried groups of the respective genders; the excess mortality of unmarried persons relative to the married has been generally increasing over the past two to three decades; and divorced and widowed persons in their twenties and thirties have particularly high risks of dying, relative to married persons of the same age. In addition, the analysis suggests that a selection process is operating with regard to single and divorced persons: the smaller the proportion of persons who never marry or who are divorced, the higher the resulting death rates.

"In this paper, we use simulation models to demonstrate the complexity of the relationship between the marriage selection process and the resulting RMRs [relative mortality ratios]. In particular, we show that marriage selection alone can produce a relative mortality ratio which remains large and relatively constant at ages far beyond the marriage span....Our general objective...is to determine the range of age patterns of relative mortality which could, in theory, result from marriage selection on the basis of health characteristics. We also evaluate the effects of variations in the marriage selection mechanisms on the resulting mortality patterns.... We develop and apply several simple mathematical models of the marriage selection process. In order to distinguish the potential consequences of marriage selection from marriage protection, we consider hypothetical populations in which causal effects are absent.... We begin by considering an extremely simple marriage selection process and subsequently explore a more realistic selection model based on recent death and marriage rates for Japan."