American journal of preventive medicine
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Cigarette smoking remains the most important preventable cause of death in the United States, and the burden is especially great for African Americans. A promising approach to better understanding smoking behavior involves the application of a stages-of-change model. The purpose of this study was to analyze the smoking behavior of a population-based sample of African Americans in two rural southern counties using this model. ⋯ This study provides support for applying a stages-of-change model to African Americans who smoke. Many of the predictors of the stage of change are the same as those found in other populations. In addition, finding an association between stages and both physician visits and believing stopping smoking can improve health has important implications for providing smoking cessation services in health care settings.
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To describe the clinical causes of fetal death in black women, we performed a record review of the primary causes of fetal deaths (n = 315, > or = 500 g or > or = 24 weeks' gestation) occurring over an 11-year period in a population of 26,852 black women who delivered at the Chicago Lying-in Hospital, University of Chicago Hospitals, Chicago, IL. The over-all fetal death rate (FDR) per 1,000 total births was 11.7, consistent with U. S. vital statistics data for blacks. ⋯ Furthermore, hypertension in pregnancy accounted for 15% of the excess fetal mortality in our population of urban black women as compared to the population of Canadian white women. Health care providers should be aware of the risk of fetal death in hypertensive, innercity, U. S. black women.
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To describe characteristics of persons with late (at or after death) acquired immunodeficiency syndrome (AIDS) diagnosis, we analyzed national surveillance data among all persons with AIDS diagnosed through December 1991 under the pre-1993 AIDS case definition and with a known date of death. Late diagnosis was present in 15.8% of 163,202 decreased persons with AIDS and in 15.3% of decreased men with AIDS, 20.6% of women, 12.1% of whites, 20.0% of blacks, 21.1% of Hispanics, 12.3% of men who have sex with men (MSM), 21.9% of injecting drug users (IDU), and 19.6% of persons exposed to human immunodeficiency virus (HIV) through heterosexual contact. ⋯ Late AIDS diagnosis, especially among ethnic minorities and IDU and their sex partners, may represent delays in HIV diagnosis and care. In addition to not receiving early clinical intervention, persons who are diagnosed later in the course of HIV disease represent missed opportunities for receiving prevention efforts such as education, counseling, and substance abuse treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
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Recent reviews of medical education at the undergraduate and graduate level call for a greater emphasis on community-relevant teaching and development of partnerships between providers, academic health centers, and the community. The cluster committee, developed by the Center for Community Responsive Care, Inc., sets the stage. ⋯ It is designed to meet the following goals: initiate the fellow in the steps of community-oriented primary care (COPC); develop a fellow's leadership skills; encourage relationships and coalitions within the community and among providers; and bring together the perspectives of community members, public health practitioners, academicians, and local clinicians regarding community health, as well as teach each about COPC. This article describes the cluster committee process, provides examples of a series of meetings, and presents lessons learned from the first six years of implementation.