Minority Descent Research Articles

Risk Factors for Quantity of Cannabis Use Per Day among College Students Who Violated Their University Drug Use Policy.

Cannabis use among college students represents a continued public health issue. The objective was to assess risk factors and reasons for cannabis use among students who violated their university's drug use policy, and whether risk factors influenced cannabis use quantity. This cross-sectional survey study included 99 college students enrolled at a large U.S. public university. Descriptive statistics were calculated, and an ordinary least squares regression analysis was conducted. Students reported using cannabis an average of 7.4 (SD = 10.2) days in the past month, with 8% reporting daily use. On average, students consumed slightly over 0.25 (SD = 0.25) grams per day, with 40% reporting greater than one gram per day. The average age of onset of cannabis use was 16.8 (SD = 1.8) years old. The top reasons for cannabis use were to: relax or relieve tension (75.8%), feel good or get high (62.6%), and have a good time with friends (60.6%). Students perceived an average of 47% of their peers engaged in past-month cannabis use and only slight risk was associated with regular use. Students perceived their loved ones would mostly approve of a reduction in their cannabis use. Regression results indicated past-month cannabis frequency (p = .002) and being of racial/ethnic minority descent (p = .05) were positively associated with quantity of cannabis per day, while perceived risk of regular cannabis use (β = -0.21) was negatively associated. Evidence-based cannabis interventions for students who violate their university's drug use policies are critically needed that aim to reduce cannabis use and mitigate its associated negative consequences.

Gender disparities in ventricular tachycardia: evaluating clinical outcomes and interventions

Abstract Background Gender differences in the etiology of ventricular arrhythmia are well-known and can potentially affect clinical outcomes. Women have been under-represented in studies investigating ventricular tachycardia (VT). Thus, gender differences in clinical outcomes of VT are poorly defined. Purpose We sought to elucidate the clinical outcomes and interventions among women with VT. Methods We used the National Inpatient Sample to identify patients aged 18 and older admitted with VT from 2011 to 2019. Observations missing data on age, sex and mortality were excluded. Baseline characteristics include age, race, and comorbidities related to cardiovascular disease. Severity of comorbidities was assessed via the Deyo-Charlson Comorbidity Index (Deyo-CCI) score. Outcomes investigated include all-cause mortality, major adverse cardiovascular events (MACE), and incidence of catheter ablation, cardioversion, and automated implantable cardioverter defibrillator (AICD) insertion. Gender and outcomes association were analyzed using multivariable logistic regression adjusted for baseline characteristics that were significantly different (P<0.05) between cohorts expressed as adjusted odds ratios (aOR) and 95% confidence intervals (CI). SPSS v28.0 (IBM, Armonk, NY) was used to carry out all calculations. Results Between 2011 and 2019, there were an estimated 3,544,445 hospital admissions for VT, of which, 33.8% were women, who were more likely to be older (69.2 vs 68.0 years) and of minority descent (30.3% vs 26.7%) compared to men. Women were less likely to have coronary artery disease (43.5% vs 62.2%) or ischemic cardiomyopathy (5.0% vs 11.9%) and had a lower mean Deyo-CCI score (2.2 vs 2.4; p<0.001 for all). Women had a higher incidence of mortality (10.6% vs 9.2%) and ischemic stroke (5.3% vs 4.5%), but less acute coronary syndrome (17.6% vs 21.4%; p<0.001 for all). Overall incidence of MACE was lower among women (28.6% vs 31.4%; p<0.001). Multivariate regression analysis demonstrated that female sex remained independently associated with increased odds for all-cause mortality (aOR: 1.089; 95% CI: [1.062–1.116], p<0.001) although decreased odds for MACE (aOR: 0.952; 95% CI: [0.939–0.965]). Female sex was also independently associated with decreased odds for cardioversion (aOR: 0.936; 95% CI: [0.910–0.963]), AICD insertion, (aOR: 0.737; 95% CI: [0.711–0.764]) and ablation (aOR: 0.806; 95% CI: [0.766–0.847]; all p<0.001). Conclusion In this retrospective analysis of patients hospitalized with VT, women had less coronary artery disease and less MACE, yet all-cause mortality was higher. Female sex was also independently associated with fewer interventions, including AICD insertion and ablation. Although there are gender differences in risk factors and causes of VT, this does not fully explain disparities in care and outcomes. Further studies are needed to explore and elucidate these gender disparities. Funding Acknowledgement Type of funding sources: None.

Award acknowledges Tennessee pharmacy school for diversity, inclusion.

Just walk through the halls of the pharmacy school at the University of Tennessee’s health sciences campus in Memphis to see the commitment to diversity, said Marie Chisholm-Burns, dean since 2012. “A large percentage of our students are of minority descent and are underrepresented” in the pharmacy profession, she said. About 30% of the total student body, according to the school’s latest figure on enrollment, reports being from minority groups. That’s in a city where the estimate from the federal government’s American Community Survey is that about 70% of the residents are members of racial groups other than white. This past December, the University of Tennessee Health Science Center College of Pharmacy was recognized by the magazine Insight Into Diversity for demonstrating “an outstanding commitment to diversity and inclusion.” The magazine bestowed a Health Professions Higher Education Excellence in Diversity (HEED) Award on the school, the only one in the pharmacy field to receive the honor in 2017.

One case of platelet donor selection for a platelet transfusion refractory patient of the ethnic minority descent

One case of platelet donor selection for a platelet transfusion refractory patient of the ethnic minority descent

Das mehrsprachige Abgeordnetenhaus der Tschechoslowakei in seiner parlamentarischen Praxis 1920–1938

The Multilingual Chamber of Deputies of Czechoslovakia in its Parliamentary Practice, 1920–1938 In addition to the two official languages of Czech and Slovak, German, Hungarian, Russian, Ukrainian, and Polish were allowed to be spoken as secondary languages in the lower house of Czechoslovakia’s parliament in 1920 in order to increase the acceptance of the new republic by the deputies of all national minorities. By swearing the oath in one of these languages, a deputy obtained the right to use this language in parliament. This article examines in which situations and how often members of parliament of minority descent took advantage of this right, regardless of their political convictions. The paper finds that although minority deputies, especially Hungarian or Polish ones, intensively took advantage of their right to participate in the debates in their languages, the use of German among German-speaking deputies progressively declined over the 1930s. This corresponded to the growing self-disintegration of Germans, especially after 1935. Keywords: Czechoslovakia; Czechoslovak-German relations; 1918–1938; national minorities; language policy; parliament DOI: 10.14712/23363231.2017.2

Living Kidney Donors' Information Needs and Preferences.

Past research suggests the information exchanged from transplant centers to potential living kidney donors is, in many cases, suboptimal. The purpose of this study was to assess donors' perceptions of the information provided while considering living donation. Semistructured telephone interviews conducted with 81 past living donors seen at 1 mid-Atlantic transplant center assessed the extent to which living kidney donors deemed Centers for Medicare and Medicaid Services (CMS)-mandated information useful to making a decision about donation and to which more information was or would have been desired before donating. Understanding of and satisfaction with the information was also assessed. Participants were primarily white (67.9%), females (67.9%), with an average age of 57.8 years. Perceived usefulness ranged from a mean of 3.1 for the confidentiality of the transplant center's communication to 4.1 for postoperative care and short-term medical risks of donation. Donors of minority descent as well as those with more education and less income found the information provided most useful. Few donors desired additional information about the right to opt out of (8.6%) or decline (13.6%) donation; however, most wanted more information regarding the risk of being refused health, disability and/or life insurance after donating (77.8%), and insurance coverage for future health problems (66.7%). This study revealed limited usefulness of certain CMS-mandated topics and a desire for additional information about donation. Efforts to standardize the informed consent process should incorporate donors' perspectives as to the specific topics, quantity of information, and the mode of communication found most useful when considering living donation.

Haplo-Cord UCB SCT with Low Cell Dose, Well Matched UCB Units. a Prospective Multicenter Study

The outcome of umbilical cord blood transplantation is governed by UCB cell dose and matching. But stringent cell dose requirements limit access to well matched units. In haplo –cord transplant, early engraftment is determined by the adult graft. Elsewhere we have shown that excessive doses of haplo-identical cells resulted in failure of the UCB graft. Here we investigated the effect of a lower UCB cell dose threshold on ability to identify well matching units. We also prospectively evaluated the effects of UCB cell dose and matching (combined with a fixed dose haplo-graft ) on cord engraftment, platelet recovery, neutrophil recovery and acute GVHD, PFS and OS.We enrolled three consecutive cohorts with increasingly lower UCB cell dose thresholds (1) UCB cell dose >2x 10^ NC/kg (2)≥1x 10^ NC/kg and (3)≥.5x 10^ NC/kg. Additional selection criteria included (1) best HLA match (initially based on 6 HLA, as of mid 2013 based on 8 HR antigens (2)UCB viability, (3) avoidance of DSA antibodies and (4) NIMA compatibility. We continued enrollment on each cohort until at least 10 patients were evaluable for day 100 chimerism. If more than 7 of ten evaluable patients in a cohort achieved >40% UCB chimerism by d 100, the next cohort was started. This rate of success was achieved in all three cohorts, so we have continued accrual in the lowest cell dose. Sixty patients have been accrued at two institutions over 19 months. 43/60 pts had AML or MDS. The majority had ASBMT advanced and intermediate disease. Nearly half of the pts were of minority descent. Conditioning in all pts consisted of fludarabine-melphalan (three pts also received TBI 400) and GVHD prophylaxis of tacrolimus and mycophenolate. Haplo identical CD34 selected cells were co-administered at a dose of 3-5 x10^6 CD34 cells/kg. Pt characteristics and preliminary outcomes are summarized in the table below.TableCohort123Minimum TNC x10^5/kg210.5n152025Age486264ASBMT Low/Int/Adv4/5/67/5/78/6/11Weight (kg)73 (56-96)72 (50-136)85(46-122)Caucasian/Other7/813/712/13Median UCB TNC collected (x10^7/kg) and range2.7 (2.1-8.3)2.1 (1.4-2.9)1.7 (0.9-2.7)UCB TNC/kg>3x10^7/kg7 (46%) (0 UCB failure)1 (5%) (0 UCB failure)2 (8%) (0 UCB failure)2-3 x10^7/kg8 (54%) (0 UCB failure)9 (45%) (2 UCB failure)(32%) (0 UCB failure)1.5-2 x10^7/kg05 (25%) (0 UCB failure)8 4 (16%) (0 UCB failure)1-1.5 x10^7/kg05 (25%) (0 UCB failure)10 (40%) (4 UCB failure)<1 x10^7/kg001 (4%) (1 UCB failure)High Resolution HLA match8/801 (5%)4 (16%)7/82 (6%)7 (35%)7 (28%)6/803 (15%)8 (32%)5/86 (40%)9 (45%)5 (20%)<5/88 (54%)01 (4%)Median Time to ANC>500 (range)14 (10-60)12 (9-18)12 (9-51)Median Time to Plt >20 (range)35 (15-88)20 (13-NR)21 (10-NR)% with >40% UCB chimerism @d1001008376* Analysis of UCB graft characteristics includes all patients. Engraftment and GVHD analysis excludes 10 patients with early fatal complications or relapse. Chimerism analysis excludes two additional patients with missing information. NR= not reachedThe average HLA matching was significantly better (P<.001) in groups 2 and 3 (66% with >6/8 match), than in group 1 (6% with >6/8 match). UCB cell doses were significantly lower in groups 2 and 3 (55% with UCB cell dose <2x10^7/kg vs none in group 1). There were no significant difference between the groups in hematologic recovery, OS, PFS or UCB engraftment.Seven of 50 evaluable pts had failure of the UCB graft (<40% UCB chimerism on d 100). 4 of them had 100% haplo chimerism, 2 had autologous recovery and 1 had partial <40% UCB chimerism. The incidence of UCB failure increased with decreasing UCB cell dose (P<0.001 U test), with five of seven graft failures occurring in patients receiving UCB doses <1.2 x10^7/kg.This novel cord blood selection algorithm allows identification of well-matched UCB cells (at least 6/8 HR) in two thirds of patients. In approximately one third of cases the best matching UCB unit has a cell dose <1.5 x10^7/kg. Very low UCB cell doses appear to be associated with somewhat increased risk of UCB graft failure-delay. Long-term follow up will establish the impact of this selection algorithm on OS, PFS, chronic GVHD. Disclosuresvan Besien:Miltenyi Biotec: Research Funding. Stock:Sigma-Tau: Membership on an entity’s Board of Directors or advisory committees, Research Funding. Mark:Celgene: Membership on an entity’s Board of Directors or advisory committees, Research Funding, Speakers Bureau; Millennium: Membership on an entity’s Board of Directors or advisory committees, Speakers Bureau; Onyx: Research Funding, Speakers Bureau.

Challenging the empire

This paper considers how Paul Gilroy transformed hitherto dominant understandings of the relationship between race and class by developing an innovative account that foregrounded questions of racist oppression and collective resistance amid the organic crisis of British capitalism. The returns from this rethinking were profound in that he was able to make transparent both the structuring power of racism within the working class, and the necessity for autonomous black resistance. At the same time, significant lacunae in his account are identified, including the neglect of the episodic emergence of working-class anti-racism and the part played by socialists, particularly those of racialized minority descent in fashioning a major anti-racist social movement. The paper concludes with a lament for the disappearance of such work informed by a ‘Marxism without guarantees’ in the contemporary field of racism studies, and asks readers to consider the gains to be derived from such a re-engagement.

Overcoming Stereotypes Through the Other Women’s Communicative Daily Life Stories

Communicative daily life stories (CDLS) conducted with Other women (without academic background) from migrant or ethnic minority descent are contributing to dismantle existing sexist and racist stereotypes and prevent gender violence. In this article, drawing from a research focused on the effects of nonacademic mothers on learning activities, it is shown how these women’s stories on their own participation make them reflect on the intersection of discrimination and the ways in which they are active agents that are already contributing to dismantling them. Through the use of CDLS, under the communicative approach, the present article contributes to the ongoing debate about the implications of the intersectionality at the research methodological level.

How Innovative Treatment Models and Data Use are Improving Diabetes Care among Older African American Adults

By 2030, the number of older adults within the United States will have doubled to approximately 71.5 million. Included in this population estimate is the relative growth in the number of older adults of racial and ethnic minority descent. Research has indicated that these individuals, specifically African Americans, have a higher incidence of diabetes than whites, as well as a higher rate of hospitalization compared to whites. This is also true for the older African American. Unfortunately, those with the greatest need for diabetes-related care are least likely to access that care. Moreover, in spite of the indication of need, it is extremely difficult to fully identify strategies that would be optimal for these older minority populations. This paper addresses strategies and techniques to fill gaps in knowledge by detailing efforts, such as the use of health information technologies and multilevel diabetes education teams, to improve the health outcomes of older adult African Americans who have diabetes.

Effects of Higher-Order Cognitive Strategy Training on Gist-Reasoning and Fact-Learning in Adolescents

Improving the reasoning skills of adolescents across the United States has become a major concern for educators and scientists who are dedicated to identifying evidence-based protocols to improve student outcome. This small sample randomized, control pilot study sought to determine the efficacy of higher-order cognitive training on gist-reasoning and fact-learning in an inner-city public middle school. The study compared gist-reasoning and fact-learning performances after training in a smaller sample when tested in Spanish, many of the students’ native language, versus English. The 54 eighth grade students who participated in this pilot study were enroled in an urban middle school, predominantly from lower socio-economic status families, and were primarily of minority descent. The students were randomized into one of three groups, one that learned cognitive strategies promoting abstraction of meaning, a group that learned rote memory strategies, or a control group to ascertain the impact of each program on gist-reasoning and fact-learning from text-based information. We found that the students who had cognitive strategy instruction that entailed abstraction of meaning significantly improved their gist-reasoning and fact-learning ability. The students who learned rote memory strategies significantly improved their fact-learning scores from a text but not gist-reasoning ability. The control group showed no significant change in either gist-reasoning or fact-learning ability. A trend toward significant improvement in overall reading scores for the group that learned to abstract meaning as well as a significant correlation between gist-reasoning ability and the critical thinking on a state-mandated standardized reading test was also found. There were no significant differences between English and Spanish performance of gist-reasoning and fact-learning. Our findings suggest that teaching higher-order cognitive strategies facilitates gist-reasoning ability and student learning.

A systematic review of compliance with palivizumab administration for RSV immunoprophylaxis.

Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infection (LRTI) in infants and young children, accounting for approximately 75,000-125,000 hospitalizations per year. It is estimated that in 2000, RSV infection accounted for 1.7 million office visits, 402,000 emergency room visits, and 236,000 hospital outpatient visits per year for children younger than 5 years of age. Palivizumab, a humanized monoclonal antibody directed against RSV, is the only immunoprophylaxis therapy approved by the FDA for prevention of serious lower respiratory tract disease caused by RSV in infants (up to 2 years of age) who meet 1 or more of the following criteria for high risk: (a) gestational age up to 35 weeks;(b) diagnosis of chronic lung disease (CLD, formerly bronchopulmonary dysplasia [BPD]); or (c) diagnosis of cyanotic or complex congenital heart disease. The RSV season typically occurs between November and March but may vary by region. During the period of our review, depending on local duration of the RSV season, infants usually required 5 monthly (every 28-30 days) intramuscular injections of palivizumab. Infants born in the middle of the season received their palivizumab doses from the time of birth to the end of the season and, therefore, may have required less than 5 doses.It is unclear if compliance with monthly doses is a problem and whether noncompliance increases the risk of RSV hospitalizations in routine clinical practice. To (a) identify and describe compliance rates and the factors that influence parental compliance with immunoprophylaxis regimens, (b)review intervention programs and describe those that have been associated with increased compliance, and (c) summarize the association of compliance with RSV hospitalization rates. An electronic literature search was conducted using journal databases, including Ovid, Current Contents, Embase, Medline In-Process & Other Non-Indexed Citations; Ovid Medline, PubMed, and Web of Science;and an abstract database, Medical Intelligence Solution, for citations through April 2008. Specific search terms used were palivizumab with patient compliance, patient adherence, or patient persistence. Twenty-five articles and abstracts met the inclusion criteria. Available studies were mostly retrospective or observational prospective.Compliance, defined in various ways across the studies, varied between 25% and 100%, and 12 studies identified some of the factors related to noncompliance. Compliance generally was lower among Medicaid patients,African American patients, and other minorities. Ten studies (3 manuscripts and 7 abstracts) investigated the association of administration of prophylaxis through monthly home visits by a health professional with parental compliance with therapy. Most of the home-based programs were associated with higher compliance rates compared with clinic or office programs.Rates as high as 94% and 64% were achieved when Medicaid infants and infants of minority descent, respectively, received their doses through a home health program. When these infants received their doses at a clinic or office, depending on the definition of compliance, rates were 61%-100% for Medicaid infants and 44% for infants of minority descent. Reminder telephone calls to parents or caregivers, comprehensive multidisciplinary programs that included extensive counseling of parents, calendars with sticker reminders, and education in the language native to parents also were associated with increased compliance, although statistical significance was reported in only 1 study. Several studies recommended educating parents on the benefits of RSV prophylaxis, alleviating transportation and language difficulties, recognizing cultural differences and biases, and clarifying misperception of RSV illness severity. Home health programs had lower rates of RSV hospitalizations than office-based programs in 3 analyses conducted in 2 studies. In 4 other abstracts, the rates of RSV hospitalization for home health programs and office-based administration did not significantly differ. In a large, 4-season, prospective outcome study, compliant infants had lower RSV hospitalization rates than those who were not compliant under one definition of compliance (doses within 35-day intervals). RSV hospitalization rates were not significantly different using another definition of compliance (receipt of anticipated doses, expected vs. observed rates).In a large survey of 10,390 infants identified from pharmacy dispensing records, RSV hospitalization rates were 1.4% in the compliant group versus 3.1% in the noncompliant group (OR = 2.2, 95% CI = 1.4-3.5, P < 0.001).Adjustment for confounding was not reported in these studies. Medicaid and minority infants were less likely to receive scheduled palivizumab doses. Home-based programs for the administration of palivizumab have been investigated more than other interventions and are associated with improved compliance compared with office-based administration. Compliance with dosing, in general, was associated with lower RSV hospitalization rates. However, these strategies should be further investigated using well-designed studies.

L'articulation de la voix dans la poésie de Bronis?awa Wajs (Papusza) et de Lumini?a Cioab?

In this paper I compare discursive practices related to the metaphor of &#8220;voice&#8221; in the texts of two Romani writers, Bronis&#322;awa Wajs (Papusza) (1910-1987), Polish poet and Lumini&#355;a Cioab&#259;, contemporary Romanian poet. The feminine voice in an emerging literature in the language of the other is the subject of my investigation. In Papusza&#8217;s case, the poetic voice is reduced to silence following its written expression. The poet produces written texts based on her songs which she burns following her exclusion from her tribe. In the fifties, Papusza stops writing and lives in isolation for the rest of her life.I compare the creative practices of Papusza and Cioab&#259;, both poets coming from the Roma community but living under different circumstances. I will discuss the transition from orality to writing and the metamorphosis of the tragic biography of Papusza into legend. I will interrogate the conditions under which, decencies later, a Romanian poet like Cioab&#259; manages to be professionally accomplished and to become an icon of literary success in Romania and a militant for Roma rights. What are the negotiations involved in the case of a woman writer of minority descent nowadays? What is the price to be paid for this negotiation? How is one stretched between languages and between a hegemonic culture and the culture of one&#8217;s community (which is not one but multiple and diverse)? Did Papusza&#8217;s tragic lesson inspire prudence in women&#8217;s voices of Romani culture? In this paper will try to investigate these complex questions.

Explaining Ethnic Inequality in the Juvenile Justice System: An Analysis of the Outcomes of Dutch Prosecutorial Decision Making

Most studies of the treatment of minorities in criminal justice systems show that ethnic minorities are punished more harshly. This paper aims to explain ethnic inequality in prosecutorial decision making in the Dutch juvenile justice system. Based on statistical analyses of 409 case files, it emerged that ethnic minorities are more often summoned to juvenile court. The prevailing source of the ethnic unequal treatment lies in the reporting of troublesome encounters between judicial officials and suspects from ethnic minority descent. A qualitative analysis of 97 descriptions of such troublesome encounters showed that native Dutch suspects were more often regarded as defiant, while ethnic minorities were more often perceived as equivocating. Future research might focus on the ways in which judicial officials interpret the observed and reported behaviour of suspects, and the extent to which these stem from broader cultural stereotypes, ideologies and anxieties regarding ethnic minorities.

Ethnicity, socio-economic position and gender—do they affect reported health—care seeking behaviour?

While the pursuit of equity of access to health care is a central objective of many health care systems, there is evidence that patients of ethnic minority descent, in lower socio-economic position (SEP) or of female gender are less likely than Whites, more affluent groups or men, respectively, to access secondary and tertiary medical care. However, it is unclear at which point in the chain of events leading from perception of need through attendance at primary/emergency care, to referral and receipt of secondary care, this inequality occurs. This study examined the influence of ethnicity, socio-economic position and gender on an individual's perception of the need and urgency for seeking health care. A random sample was selected from two large city General Practices in the UK who were sent postal questionnaires which included two clinical vignettes describing characters experiencing chest pain and discovering a lump in the armpit. The main outcome measure was response to the ‘chest pain’ and ‘lump’ vignettes in terms of immediate health care utilisation. The questionnaire survey ( n=1350, response rate 66%) indicated that Black respondents, respondents from lower socio-economic groups and women were at least as likely to report immediate health care seeking in response to the clinical vignettes than White respondents, those from higher socio-economic groups or men. This finding was consistent across all scenarios after adjustment for interpretation of the vignette, access to health services and attitudes to health and health care. For example, those in the lowest SEP group were almost 60% more likely to report immediate care seeking in response to the lump vignette (OR 1.59, 95% CI 1.08–2.33) compared to those in the highest SEP group; and Black respondents 40% more likely (OR 1.41, 95% CI 0.92–2.17). This study suggests inequalities in access to health care by ethnicity, socio-economic position and gender are not related to patients in these groups failing to self-refer to primary or accident and emergency care, barriers must therefore occur at the level of health care provision.

The effect of a health promotion campaign on mortality in children.

Previous research has shown that in the Netherlands there is a certain degree of preventable mortality associated with long-distance travel, particularly among children of ethnic minority descent. In 1985 a health promotion campaign was launched in Amsterdam with the aim of reducing travel-related deaths by increasing knowledge in ethnic minority communities about the risks involved in travel. In the present study, two data sets are used to examine the possible effects of this health promotion campaign on travel-related mortality in children. The first data set, which was collected locally, indicates that the number of Amsterdam children dying abroad has dropped considerably since 1985. This is particularly true within one group which is highly likely to exhibit risky travel behavior. The second data set, which was collected nationally, shows that an upward trend in mortality among children aged 0-14 years before 1985 has in fact changed into a downward trend since 1985. A similar pattern is observed in the Netherlands as a whole, but to a significantly less pronounced degree than in Amsterdam. Although the influence of extraneous factors can never be fully dismissed, the analysis provides support for the conclusion that the health promotion campaign did in fact succeed in reducing the number of travel-related deaths.

Physical and sexual abuse as predictors of substance use and suicide among pregnant teenagers

In order to better define risk factors for perinatal substance abuse, data from 352 pregnant teenagers enrolled in a comprehensive prenatal clinic were analyzed. Fifteen years was the average age, 82% were of minority descent, and all were receiving public assistance. At their first visit, a social worker obtained information on their home environment, family history, education, peer relationships, physical and mental health, and history of substance use. Following the interview, all teens were given a complete prenatal examination, including drug toxicology screening. The results indicate relatively low rates of substance use based on toxicology at the time of enrollment (3.6%). Self-reported rates of substance use prior to awareness of conception varied from 23% for tobacco to 17% for alcohol and marijuana; 7% of the subjects reported use of illicit substances after conception was confirmed. In addition, 80 of the 352 subjects acknowledged having been physically or sexually abused and 40 admitted to having suicidal ideation or actions. A comparison of those teenagers who had been physically or sexually abused with the remaining cohort revealed significant differences on marijuana ( p < 0.01) and cocaine ( p < 0.05) use prior to awareness of conception and on prior suicidality ( p < 0.0001). A positive history of physical or sexual abuse delineated a subset of pregnant teenagers who were at high risk for self-destructive behaviors. Teenagers in prenatal clinics should be screened, not only for current and past substance use, but also for sexual and physical abuse, domestic violence, and suicidal thoughts and actions.