Robert W. Tuthill

Resumption of Smoking After Release From a Tobacco-Free Correctional Facility

Approximately 70% of incarcerated people smoke tobacco, and an estimated 12% of all smokers in the United States leave correctional facilities annually. Many facilities prohibit smoking, but no published study has measured the relapse to tobacco after release. In a study of 200 people with chronic health conditions reentering the community from jail, 165 (83%) were cigarette smokers. Of these, 129 were interviewed at 1 and/or 6 months after release. Self-reported sustained abstinence rates were 37.3% at the end of the first day, 17.7% for the first week, 13.7% for 1 month, and 3.1% for 6 months. These abstinence rates are lower than those reported after military basic training and medical hospitalization but similar to rates after inpatient psychiatric and addiction programs. More efforts and resources are needed to determine successful tobacco cessation interventions during incarceration and after release.

Facilitators and barriers to continuing healthcare after jail: A community-integrated program

A cooperative, community-oriented “public health model of correctional healthcare”  was developed to address the needs of persons temporarily displaced into jail from the community, and to improve the health and safety of the community. It emphasizes 5 key elements: early detection, effective treatment, education, prevention, and continuity of care. In the program, physicians and case managers are “dually based”—they work both at the jail and at community healthcare centers. This, together with discharge planning, promotes continuity of care for inmates with serious and chronic medical conditions. This report characterizes the health status and healthcare in this group, and identifies facilitators and barriers to engagement in primary medical and mental health care after release from jail.

A cost-effectiveness evaluation of a jail-based chlamydia screening program for men and its impact on their partners in the community.

Background: Few cost-effectiveness evaluations of screening men in jails for chlamydia have been published, and none have evaluated the cost-effectiveness of providing partner notification services to the partners of chlamydia-infected inmates. Goal: The goal of this study was to evaluate the cost-effectiveness of the chlamydia screening and partner notification programs for men conducted by a Massachusetts jail compared with 3 hypothetical alternatives. Study Design: Using jail cost and testing data, we used decision analyses to compare the cost and effectiveness of universal screening, age-based screening with 2 age cutoffs, and testing of symptomatic inmates at intake using treated cases of chlamydia and gonorrhea as the primary outcome. We also evaluated the cost-effectiveness of adding partner notification to these alternatives. Results: Universal screening was the most effective and expensive alternative. Age-based screening would have identified slightly fewer cases at half the cost of universal screening. The net cost of partner notification was low. Assuming high sequelae costs in female partners made partner notification a cost-saving intervention. Conclusions: Age-based screening could lower costs without substantially sacrificing effectiveness. Notifying partners of infected inmates was a cost-effective adjunct to screening inmates.

Potential health effects of chlorine dioxide as a disinfectant in potable water supplies

Chlorination of potable water supplies high in organics may yield carcinogenic compounds such as trihalomethanes. Chlorine dioxide has been proposed as an alternative disinfectant to chlorine. However, chlorine dioxide is a strong oxidant that forms significant amounts of chlorite when added to potable water supplies, and chlorite is similar to nitrite in its molecular structure and may be similar in its mechanism of methemoglobin production. Nitrites and chlorites are thought to act synergistically to produce MetHb. Neonates and persons with G-*-PD deficiency are likely to be unusually susceptible to MetHb formation from these compounds because their red cells lack the metabolic machinery to adequately protect against oxidant stress. Since male blacks represent the largest population in the U.S. to be G-6PD deficient, Black male neonates may represent the group at highest risk to the use of chlorine dioxide as a disinfectant in the nations water supplies.

A multi-city community based smoking research intervention project in the African-American population.

Objective: To carry out a community-based research approach to determine the most effective educational interventions to reduce smoking among African-American smokers. The intervention included preparation of the community, planning and developing a model of change, and developing a community-based intervention. The study population consisted of 2,544 randomly selected adult African-American smokers residing in four sites in the northeastern and southeastern parts of the United States. The research design provided a comparison of active intervention sites with passive control sites as well as low income and moderate income areas. Major Outcome Measures: Point prevalence of non-smoking at the time of interview; Period prevalence of non-smoking at the time of interview; Period prevalence of quit attempts in the prior six months; Number of smoke-free days in the prior six months; Number of cigarettes smoked daily at the time of interview. Results: Based upon a survey eighteen months after baseline data was collected, all four measures of cigarette smoking behavior showed a strong statistically significant reduction of personal smoking behavior among those receiving active interventions versus the passive group. On the basis of process variable analysis, direct contact with the project staff in the prior six months was significantly higher in the active intervention areas. There was only a small non-significant increase in personal smoking behavior in moderate income groups as opposed to low income groups. Conclusion: An analysis of process variables strongly suggests that, within this African-American Community, “hands on” or “face to face” approaches along with mass media, mailings, and other less personal approaches were more effective in reducing personal smoking behavior than media, mailings, and other impersonal approaches alone addressed to large audiences.

The Massachusetts Blood Pressure Study, Part 3. Experimental Reduction of Sodium in Drinking Water: Effects On Blood Pressure

An experimental bottled water study assessed the effect on blood pressure of lowering Na concentration in the water of some of the high sodium community fourth graders. For three months, trios of children matched by sex, school, and baseline BP each used different water for all cooking and drinking purposes, with BP monitored bi-weekly. Pupils were randomly allocated to the three water conditions: (1) high sodium water bottled from their own community distribution system, (2) low sodium water bottled from the distribution system of the comparison community with sodium added to the level of the high sodium community water and (3) low sodium water bottled from the distribution system of the low sodium community but with no sodium added. The results indicate that BP levels among the girls but not boys on the low sodium water exhibited marked decreases in BP over the test period when compared to the other two groups.

Household Hazardous Waste in Massachusetts

Household wastes, when disposed of improperly, are hazardous to health. This paper reports a random digit dial telephone survey of Massachusetts households concerning household hazardous waste (HHW) disposal with a 54% response. Of the automotive oil disposed of by 33% of survey households, 57% was deposited in the ground, sewer, or landfill. Annually by household oil disposal in Massachusetts is estimated to be 8.8 million quarts. Four percent of hazardous waste generated in Massachusetts is from households. Improper disposal makes it a major environmental contaminant. More households (41.5%) in smaller communities disposed of oil compared with 26% of households in larger communities. Paint and pesticides were disposed of by 10% of the households, but were dumped on the ground sewer or landfills more than 90% of the time.

Factors associated with repeat mammography in a New York State public health screening program.

Screening mammography is the most effective method for early detection of breast cancer, but repeat mammography rates are not optimal in most populations. Since 1988, New York State has supported a program of breast cancer screening for underserved, uninsured, or underinsured women. The present study was designed to identify sociodemographic and clinical factors associated with failure to return for repeat mammography screening after a negative initial mammogram. Of women initially screened between 1988 and 1991 (N = 9,485), 27 percent obtained repeat mammograms by 1993. The final logistic regression model contained program site, race and ethnicity, family income, and time since last mammogram.

Focused Female Condom Education and Trial: Comparison of Young African American and Puerto Rican Women's Assessments

This article compares the experience of young African-American and Puerto Rican women with the female condom during a thirty-day trial period by examining qualitative data from participant observations and in-depth interviews conducted at the end of the trial. Research was funded by CDC and conducted in two neighborhood health centers in the city of Springfield, Massachusetts. Salient findings identify inter-group similarities and differences in the local sociocultural community context in which African-American and Latina young women considered using the female condom as a method of protection against unplanned pregnancy and sexually transmitted infections, including HIV, adopted strategies to introduce and negotiate the device with male partners, and communicated their experiences in post-trial interviews. Inter-group diversity is highlighted in community structures for promoting sexual health protection, and in womens patterns of communication, descriptions of their male partners reactions to the device and trial activities and suggestions for health education focused on the female condom. Potential implications of these findings for future research and interventions in multicultural communities are also discussed.

The Massachusetts Blood Pressure Study, Part 4. Modest sodium supplementation and blood pressure change in boarding school girls.

Based upon the results of the earlier work, a sodium supplement study was designed and carried out at a private boarding school. Two hundred and sixteen 9th-12th grade girls were randomly assigned to one of three groups while continuing to eat their regular meals at the dining commons. All participating students took two capsules, under supervision, both mid-morning and subsequent to the evening meal. One group received placebos at both times, one group received 2 G of salt in the morning and a placebo in the evening, and the final group received a placebo in the morning and 2 G of salt in the evening. One week of baseline data and eight weeks of follow-up data were collected twice weekly for BP, pulse, 24-hour urine specimen, and stress of daily events. Repeated measures analysis of variance failed to detect a significant difference in change in systolic and diastolic BP between groups. Extensive analysis of other variables did not uncover any negative confounding or interaction. Drop out rates were very low and compliance rates very high. The urinalysis clearly demonstrated that the Na excretion in the two supplement groups was similar and significantly elevated over the placebo group, thus documenting the high Na supplement compliance rates.