Knud J. Helsing

Symptoms of depression in two communities

Histories of depression-related symptoms were obtained from 3845 randomly selected adult residents of Kansas City, Missouri, and Washington County, Maryland. Depressed persons were slightly more common in Kansas City than in Washington County but within the latter area no urban-rural differences were observed. More depressed persons were found among blacks than among whites. Slightly more white females than males were depressed; no significant differences were found between black females and males. After adjustment for the effects of other independent variables, the probability of having symptoms of depression was highest among persons who were young adults, unmarried, not employed outside the home, poorly paid, and not well educated.

Serum beta-carotene, vitamins A and E, selenium, and the risk of lung cancer

We studied the relation of serum vitamin A (retinol), beta-carotene, vitamin E, and selenium to the risk of lung cancer, using serum that had been collected during a large blood-collection study performed in Washington County, Maryland, in 1974. Levels of the nutrients in serum samples from 99 persons who were subsequently found to have lung cancer (in 1975 to 1983) were compared with levels in 196 controls who were matched for age, sex, race, month of blood donation, and smoking history. A strong inverse association between serum beta-carotene and the risk of squamous-cell carcinoma of the lung was observed (relative odds, 4.30; 95 percent confidence limits, 1.38 and 13.41). Mean (+/- SD) levels of vitamin E were lower among the cases than the controls (10.5 +/- 3.2 vs. 11.9 +/- 4.90 mg per liter), when all histologic types of cancer were considered together. In addition, a linear trend in risk was found (P = 0.04), so that persons with serum levels of vitamin E in the lowest quintile had a 2.5 times higher risk of lung cancer than persons with levels in the highest quintile. These data support an association between low levels of serum vitamin E and the risk of any type of lung cancer and between low levels of serum beta-carotene and the risk of squamous-cell carcinoma of the lung.

Factors associated with mortality after widowhood.

A non-concurrent prospective study in Washington County, Maryland identified 4,032 (1,204 male, 2,828 female) White persons aged 18 and over who were enumerated in a 1963 non-official census and who became widowed between 1963 and 1974, and an equal number of married persons, each matched to a widowed as to race, sex, year of birth and geography of residence. All were followed to 1975, the date of a second census. Mortality rates based on person-years at risk were about the same for widowed as for married females, but significantly higher for male widowed than male married, even after adjustment for a number of demographic, socioeconomic, and behavioral variables. Mortality rates among widowed males who remarried were very much lower than among those who did not remarry, but no significant difference was observable among widowed females who did nor did not remarry. Multiple regression analysis also showed that, for both sexes and independently of other factors, moving into a nursing home or other chronic care facility was associated with higher mortality than any other residential change or no change, and living alone was associated with higher mortality than living with someone else in the household.

Deaths from all causes in non-smokers who lived with smokers.

Mortality associated with passive smoking was evaluated in a 12-year study of 27,891 White adult smokers and 19,035 never smokers identified in 1963. Death rates were calculated using an estimate of the person-years at risk. Adjusted for age, marital status, education, and quality of housing, the estimated relative risks of death from all causes were 1.17 (approximate 95% confidence interval 1.01, 1.36) for men and 1.15 (1.06, 1.24) for women with passive exposure. These relative risks were similar to those for ex-smokers and for pipe or cigar smokers. Risks increased slightly with level of exposure. The relative risk from passive smoking was greatest for men under age 50 (RR = 2.09, 1.31-3.34). Risks from passive smoking were slightly elevated for several causes among men and women, and may be broader than those previously reported. On the other hand, these small nonspecific increases in death rates may reflect other characteristics of passive smokers that increase mortality.

What kinds of people do not use seat belts

In the course of a Community Mental Health Epidemiology study conducted in Washington County, Maryland between December, 1971 and July, 1974, interviews were conducted with randomly selected adults in a weekly systematic sampling of households. In a subsequent re-interview of 1009 respondents who had family cars with seat belts, nearly 47 per cent said they did not use them. Non-use of seat belts was significantly higher among females and among persons with less than high school education or low income. Non-use of seat belts was also higher among those who felt that their station in life as measured by the Cantril ladder was unsatisfactory, who felt powerless to change at least some aspects of their lives, and who were infrequent church attenders. Significant associations were also found with infrequency of two other preventive health behaviors, dental checkups and Pap tests. Among young adults the tendency seemed to be for marriage to increase the non-use of seat belts among females but to decrease non-use among males.

Respiratory effects of household exposures to tobacco smoke and gas cooking.

The records of 1,724 residents of Washington County, Maryland, who had participated in 2 studies of respiratory symptoms and ventilatory function were analyzed to evaluate the effects of exposures at home to tobacco smoke generated by other members of their households and to fumes from the use of gas as a cooking fuel. Currently smoking subjects showed the highest frequency of respiratory symptoms and impaired ventilatory function; former smokers showed a lower frequency of these findings; and persons who had never smoked had the lowest prevalence of abnormal respiratory findings. The presence of a smoker in the household other than the subject was not associated with the frequency of respiratory symptoms, and only suggestively associated with evidence of impaired ventilatory function. The use of gas for cooking was related to an increased frequency of respiratory symptoms and impaired ventilatory function among men, being most marked among men who had never smoked. There was no evidence that cooking with gas was harmful to women.

Respiratory effects of household exposures to tobacco smoke and gas cooking on nonsmokers

The records of 708 nonsmoking white adult residents of Washington County, MD, who had participated in two of respiratory symptoms were analyzed to evaluate the effects of exposure at home to two potential sources of indoor air pollution: cigarette smoking by other household members, and use of gas as a cooking fuel. After adjustment for the effects of age, sex, socioeconomic level, occupational exposure to dust, and years of residence in household, the presence of one or more smokers in the household was only suggestively associated with a higher frequency of chronic phlegm and impaired ventilatory function defined as FEV1 < 80% predicted. The use for cooking was associated with a significantly increased frequency of chronic cough and a significantly greater percentage with impaired ventilatory function as measured both by FEV1 < 80% predicted and by FEV1/FVC < 70%.

Cure of a sick building: A case study

Abstract This case study illustrates the crisis atmosphere that can develop if occupants of a building get the feeling that their complaints are being ignored. Following several years of complaints about stale air and poor temperature control, allegations were made publicly that faculty and students were being poisoned by high levels of carbon monoxide (CO) and carbon dioxide (CO 2 ) in a five-year-old school. As a result, a multidisciplinary study was initiated to assess: 1) available records of health and academic achievement of students; 2) actual levels of CO and other contaminants in the air; and 3) measurable ventilation characteristics of classrooms. No excess absenteeism, illnesses, or lack of academic achievement were found, nor were any significant levels of CO, HCHO, or CO 2 found. However, there was an insufficient fresh air supply to some classrooms, and a large percentage of students exhibited classic symptoms of Sick Building Syndrome, i.e., headache, eye burning, and fatigue. Correcting the ventilation problems resulted in a reduction of symptoms to a level approximately equal to that of students in other schools in the county.

Psychosocial characteristics and cytologic screening for cervical cancer

Abstract In the course of a Community Mental Health Study conducted in Washington County, Maryland during 1971–1974, interviews were conducted with a representative sample of adults. In a subsequent reinterview, 40.6% of 709 adult white females said they had not had a Pap smear in the past two years. Failure to be screened for cervical cancer occurred more often among persons who were older, unmarried, less well-educated, poorer, and unemployed. It was also associated with some other types of poor preventive health behavior such as having infrequent physical examinations, tuberculosis tests, and electrocardiograms, but not with non-use of automobile seat belts, and only marginally with infrequent dental checkups. No explanation for less frequent use of cervical cytologic screening could be found by examination of selected behavioral and psychosocial characteristics such as smoking, uncontrolled drinking, depressed feelings, alienation, belonginglessness, normlessness, and powerlessness.

Mood and Lithium in Drinking Water

To assess the possible relationship of lithium in the drinking water to some aspects of mental health, drinking water samples were collected from the homes of 384 individuals in Washington County, Md, who had been randomly selected for interview in a community mental health assessment program. The water was analyzed for lithium by atomic absorption spectrophotometry without knowledge of the interview results. The questionnaire contained the Lubin depression adjective check list, Center for Epidemiologic Studies depression and functioning scales, a general happiness question (Gurin), an aggression scale, and the Cantril ladder for self-rating of present status. In an area with low-to-moderate levels of lithium in the drinking water, there was no evidence to confirm earlier suggestions that the presence of lithium might be beneficial.