William G. LeBlanc

Obesity in US Workers: The National Health Interview Survey, 1986 to 2002

OBJECTIVES Obesity has emerged as one of the most important public health issues in the United States. We assessed obesity prevalence rates and their trends among major US occupational groups. METHODS Self-reported weight and height were collected annually on US workers, aged 18 years or older, from the 1986 to 1995 and the 1997 to 2002 National Health Interview Surveys. Overall, occupation-, race-, and gender-specific rates of obesity (defined as a body mass index>30.0 kg/m2) were calculated with data pooled from both study periods (n>600,000). Annual occupation-specific prevalence rates were also calculated, and their time trends were assessed. RESULTS Obesity rates increased significantly over time among employed workers, irrespective of race and gender. The average yearly change increased from 0.61% (+/-.04) during the period from 1986 to 1995 to 0.95% (+/-.11) during the period from 1997 to 2002. Average obesity prevalence rates and corresponding trends varied considerably across occupational groups; pooled obesity prevalence rates were highest in motor vehicle operators (31.7% in men; 31.0% in women). CONCLUSIONS Weight loss intervention programs targeting workers employed in occupational groups with high or increasing rates of obesity are urgently needed.

Trends in U.S. smoking rates in occupational groups: The National Health Interview Survey 1987-1994

Learning ObjectivesIdentify current rates of cigarette smoking in 209 occupations, and ways in which occupation and gender interact to determine smoking rates.Describe trends in smoking rates over the years 1987–1994, and characterize those occupational groups in which rates increased or declined in this period.Describe possible job-related measures for lowering prevalence rates of cigarette smoking. Abstract It is unknown if reductions in U.S. adult smoking rates are uniform across occupational groups. The National Health Interview Survey (NHIS) is a multistage area probability cross-sectional survey of the U.S. civilian population. Data on occupational and smoking status were collected on 141,122 adult participants from the 1987, 1988, and 1990 –1994 NHIS annual surveys. Overall smoking rates ranged from 58% in roofers to 4% in physicians, with higher rates found among blue collar professions. There were reductions in smoking from 1987–1994 within 72% of occupational groups; 19 of these downward trends were significant and occurred exclusively within white collar professions. Blue collar workers continue to smoke in large numbers, whereas white collar workers report lower rates along with corresponding significant downward trends in rates among selected occupational groups. The development of effective smoking prevention strategies targeting blue collar groups is needed.

Smoking rate trends in U.S. occupational groups : The 1987 to 2004 national health interview survey

Objective: It is unknown if the gap in smoking rates observed between United States blue- and white-collar workers over the past four decades has continued into the new millennium. Methods: The National Health Interview Survey is a nationally representative survey of the US civilian population. Smoking and current occupational status were assessed over survey periods 1987 to 1994 and 1997 to 2004 (n= 298,042). Results: There were significant annual reductions in smoking rates for all adult US workers in both survey periods. Several blue-collar groups had greater annual smoking rate reductions in the most recent survey period relative to the earlier survey period. However, the majority of blue-collar worker groups had pooled 1997 to 2004 smoking rates in excess of the 24.5% smoking prevalence noted for all workers. Conclusion: Development of effective smoking prevention strategies specifically targeting blue-collar groups is warranted.

Secondhand smoke exposure and depressive symptoms

Objective: To evaluate the association between secondhand smoke (SHS) exposure and depression. Tobacco smoking and depression are strongly associated, but the possible effects of SHS have not been evaluated. Methods: The 2005 to 2006 National Health and Nutrition Examination Survey (NHANES) is a cross-sectional sample of the noninstitutionalized civilian U.S. population. SHS exposure was measured in adults aged ≥20 years by serum cotinine and depressive symptoms by the Patient Health Questionnaire. Zero-inflated Poisson regression analyses were completed with adjustment for survey design and potential confounders. Results: Serum cotinine-documented SHS exposure was positively associated with depressive symptoms in never-smokers, even after adjustment for age, race/ethnicity, gender, education, alcohol consumption, and medical comorbidities. The association between SHS exposure and depressive symptoms did not vary by gender, nor was there any association between SHS smoke exposure and depressive symptoms in former smokers. Conclusions: Findings from the present study suggest that SHS exposure is positively associated with depressive symptoms in never-smokers and highlight the need for further research to establish the mechanisms of association. NHANES = National Health and Nutrition Examination Survey; SHS = secondhand smoke; CDC = Centers for Disease Control and Prevention; OR = odds ratio; GABA = γ-aminobutyric acid.

Sustained Low Influenza Vaccination Rates in US Healthcare Workers

INTRODUCTION A substantial morbidity and mortality burden attributable to the influenza virus is observed annually in the United States. Healthcare workers are an occupational group at increased risk of exposure, demonstrated to transmit influenza to their patient populations, and vital to the care of these patient populations. The prevention of the spread of the flu is a significant public health concern. In the present study, we examined influenza vaccination rates and their 5-year trends within the major occupational healthcare worker groups and compared them to non-Healthcare Workers. METHODS Using data from the nationally representative 2004-2008 National Health Interview Survey (NHIS), US healthcare workers (n=6349) were analyzed. RESULTS Seasonal influenza vaccination coverage estimates remain low among all healthcare workers, highest among the health diagnosing and treating practitioners (52.3%), and lowest among other healthcare support occupations (32.0%). Among all other occupational groups, pooled influenza vaccination rates were highest for white collar workers (24.7%), and lowest for farm workers (11.7%). There were no significant upward or downward trends in influenza vaccination rates for any healthcare or other occupational worker group during the 5-year survey period. CONCLUSION Improving these low vaccination rates among healthcare workers warrants a comprehensive national approach to influenza prevention that includes education and strong encouragement of routine annual vaccination among healthcare workers. Policy enhancements such as free provision of seasonal influenza vaccine, coverage for treatment and workers compensation for vaccine-related complications are needed.

Puncture technique and portals of entry for diagnostic and operative arthroscopy of the temporomandibular joint

Cadaveric research, expansion of successful arthrography techniques, and improved understanding of normal anatomy, pathology, and open surgery have led to the development of safe, repeatable, and effective puncture techniques and portals of entry in the temporomandibular joint. Single and multiple punctures are described. Two-year outcomes of operative procedures with favorable results are presented for 145 joints in 95 patients. Complications are discussed.

Food label use and awareness of nutritional information and recommendations among persons with chronic disease

BACKGROUND Because of the relation between chronic disease and poor nutritional habits, the use of food labels and adherence to dietary recommendations are important for chronic disease populations. We explored whether persons with chronic disease read nutrient information on food labels and whether they were aware of dietary guidelines. OBJECTIVE This study aimed to assess dietary information use among persons with chronic disease by using a nationally representative sample of the US population. DESIGN A total of 5603 respondents aged > or =17 y from the 2005-2006 National Health and Nutrition Examination Survey participated in the study. This representative sample of US civilians were asked 17 questions regarding their awareness of federal nutrition information and their food label use and were given two 24-h recall dietary interviews. Participants were classified into 5 disease categories: 1) hypertension, 2) hypercholesterolemia, 3) diabetes/at risk of diabetes, 4) overweight, and 5) heart disease. RESULTS Subjects with chronic diseases were more aware of nutritional recommendations, checked more often for specific nutrients, and used nutrition information on food labels more often than did participants without such diseases. Label use behavior was inconsistently associated with dietary guideline compliance. CONCLUSIONS People with chronic disease generally reported better nutrition awareness and food label use and checking behaviors compared with those without chronic disease, but this did not translate into unequivocally better eating behaviors. New strategies are needed to improve the actual nutritional behaviors of persons with chronic disease.

Reported Skin Cancer Screening of US Adult Workers

BACKGROUND Early detection of skin cancer by skin examination may reduce its associated morbidity and mortality, in particular for workers routinely exposed to sun. OBJECTIVES We sought to describe the proportion of US workers reporting skin cancer screening examination in a representative sample of the US worker population in the National Health Interview Survey. METHODS Report of skin cancer examination in the 2000 and 2005 National Health Interview Survey cancer control supplements were examined by a range of variables. RESULTS Lifetime and 12-month reported clinical skin examination prevalence was 15% and 8%, respectively. Workers with elevated occupational exposure to ultraviolet light were less likely to have ever received a skin examination than the average US worker. Logistic regression analysis identified occupational category and age, sex, race, education level, health insurance, and sun-protective behavior as significant independent correlates of skin cancer examination. LIMITATIONS A limitation is potential healthy worker effect and underestimation of skin cancer screening with self-reported data. CONCLUSIONS Routine examination by primary care physicians frequently does not include a thorough skin examination. Physicians should be even more vigilant with patients at increased risk of excessive occupational sun exposure, as early detection of skin cancer by periodic skin examination decreases morbidity and can improve survival.

Cardiovascular responses elicited by hypothalamic stimulation in rabbits reveal a mediolateral organization

Heart rate and blood pressure response patterns were elicited by relatively low intensity (approximately 0.2 mA) stimulation (10 s trains; 100 pulses/s; 0.25 ms pulse duration) in different regions of the hypothalamus in anesthetized rabbits. A bradycardia/depressor pattern was elicited from both anterior and posterior stimulating electrode sites in the far lateral hypothalamus. Medial sites including the ventromedial hypothalamus elicited a tachycardia/pressor pattern. A bradycardia/pressor pattern was elicited from both the anterior and posterior hypothalamus at sites between the lateral hypothalamic (bradycardia/depressor) and the medial hypothalamic (tachycardia/pressor) zones. Paralysis by injection of decamethonium in conjunction with artificial ventilation did not reveal systematic differences in cardiovascular response threshold, form, or magnitude between the paralyzed and non-paralyzed state, indicating that the cardiovascular response patterns were not secondary to changes in respiration. Bilateral vagotomy abolished the bradycardia responses evoked by hypothalamic stimulation indicating that the cardiodeceleration was mediated by the vagus nerves; vagotomy attenuated tachycardia responses indicating that the responses in part reflected a decrease in vagal restraint. Bradycardia responses to ipsilateral but not contralateral hypothalamic stimulation were attenuated or abolished when examined 10-14 days after unilateral destruction of the central nucleus of the amygdala. This indicates that the bradycardia responses elicited by hypothalamic stimulation are in part mediated by fibers of passage. Stimulation of lateral hypothalamic sites eliciting a bradycardia/depressor pattern in anesthetized rabbits, evoked mild orienting in the same animals when conscious, whereas medial hypothalamic sites producing the tachycardia/pressor response pattern in anesthetized animals elicited intense excitement with autonomic concomitants in the nonanesthetized state. The results indicate that the rabbit hypothalamus has a mediolateral organization in terms of at least some cardiovascular and behavioral responses to intracranial stimulation.

Declining Trends in Serum Cotinine Levels in US Worker Groups : the Power of Policy

Objective: To explore trends in cotinine levels in US worker groups. Methods: Using NHANES III data, serum cotinine levels of US workers not smokers nor exposed to secondhand smoke (SHS) at home were evaluated for trends by occupational/industrial and race/ethnicity-gender sub-groups. Results: Decreases from 1988 to 2002 ranged from 0.08 to 0.30 ng/mL (67% to 85% relative decrease), with largest absolute reductions in: blue-collar and service occupations; construction/manufacturing industrial sectors; non-Hispanic Black male workers. Conclusions: All worker groups had declining serum cotinine levels. Most dramatic reductions occurred in sub-groups with the highest before cotinine levels, thus disparities in SHS workforce exposure are diminishing with increased adoption of clean indoor laws. However, Black male workers, construction/manufacturing sector workers, and blue-collar and service workers have the highest cotinine levels. Further reductions in SHS exposure will require widespread adoption of workplace clean air laws without exemptions.