ÿ@FROM :david@STAT.COM Message-ID: <199410270755.DAA19209@coyote.channel1.com> From <@ARIZVM1.ccit.arizona.edu:owner-mednews@ASUVM.INRE.ASU.EDU> Thu Oct 27 03:55:09 1994 Received: from ARIZVM1.ccit.arizona.edu (arizvm1.CCIT.Arizona.EDU [128.196.133.84]) by coyote.channel1.com (8.6.9/8.6.4) with SMTP id DAA19209 for ; Thu, 27 Oct 1994 03:55:09 -0400 Message-Id: <199410270755.DAA19209@coyote.channel1.com> Received: from ARIZVM1.CCIT.ARIZONA.EDU by ARIZVM1.ccit.arizona.edu (IBM VM SMTP V2R2) with BSMTP id 2793; Thu, 27 Oct 94 00:48:12 MST Received: from ARIZVM1.CCIT.ARIZONA.EDU (NJE origin LISTSERV@ARIZVM1) by ARIZVM1.CCIT.ARIZONA.EDU (LMail V1.2a/1.8a) with BSMTP id 8690; Wed, 26 Oct 1994 23:12:14 -0700 Date: Wed, 26 Oct 1994 22:07:38 MST Sender: MEDNEWS - Health Info-Com Network Newsletter From: David Dodell Organization: Stat Gateway Service, WB7TPY Subject: HICN753 Medical News X-To: asumednews@stat.com To: Multiple recipients of list MEDNEWS HICNet Medical News Digest Wed, 26 Oct 1994 Volume 07 : Issue 53 Today's Topics: [MMWR 14 Oct 94] Homicides Among 15 to 19 yr olds [MMWR] Adolescent Suicides [MMWR] Prevalence of Disabilities and Associated Health Conditions [MMWR] Outbreak of Salmonella associated with Ice Cream [MMWR 21 Oct 94] Tobacco Use and Nicotine Withdrawal in Adolescents [MMWR] Lead-Contaminated Drinking Water in Bulk-Water Storage Tanks +------------------------------------------------+ ! ! ! Health Info-Com Network ! ! Medical Newsletter ! +------------------------------------------------+ Editor: David Dodell, D.M.D. 10250 North 92nd Street, Suite 210, Scottsdale, Arizona 85258-4599 USA Telephone +1 (602) 860-1121 FAX +1 (602) 451-1165 Internet: mednews@stat.com Bitnet: ATW1H@ASUACAD Mosaic WWW Asia/Pacific: http://biomed.nus.sg/MEDNEWS/welcome.html Americas: http://cancer.med.upenn.edu:3000/ Compilation Copyright 1994 by David Dodell, D.M.D. All rights Reserved. License is hereby granted to republish on electronic media for which no fees are charged, so long as the text of this copyright notice and license are attached intact to any and all republished portion or portions. The Health Info-Com Network Newsletter is distributed biweekly. Articles on a medical nature are welcomed. If you have an article, please contact the editor for information on how to submit it. If you are interested in joining the automated distribution system, please contact the editor. Associate Editors: E. Loren Buhle, Jr. Ph.D. Dept. of Radiation Oncology, Univ of Pennsylvania Tom Whalen, M.D., Robert Wood Johnson Medical School at Camden Douglas B. Hanson, Ph.D., Forsyth Dental Center, Boston, MA Lawrence Lee Miller, B.S. Biological Sciences, UCI Dr K C Lun, National University Hospital, Singapore W. Scott Erdley, MS, RN, SUNY@UB School of Nursing Jack E. Cross, B.S Health Care Admin, 882 Medical Trng Grp, USAF Albert Shar, Ph.D. CIO, Associate Prof, Univ of Penn School of Medicine Martin I. Herman, M.D., LeBonheur Children's Medical Center, Memphis TN Stephen Cristol, M.D. MPH, Dept of Ophthalmology, Emory Univ, Atlanta, GA Subscription Requests = mednews@stat.com anonymous ftp = vm1.nodak.edu; directory HICNEWS FAX Delivery = Contact Editor for information ---------------------------------------------------------------------- Date: Wed, 26 Oct 94 21:35:09 MST From: mednews@stat.com (HICNet Medical News) To: hicnews Subject: [MMWR 14 Oct 94] Homicides Among 15 to 19 yr olds Message-ID: Homicides Among 15-19-Year-Old Males -- United States, 1963-1991 In 1991, nearly half (13,122 [49%]) of the 26,513 homicide victims in the United States were males aged 15-34 years. In addition, among males in this age group, homicide accounted for 18% of all deaths and was the second leading cause of death (Table 1). During 1963-1991, the pattern of homicide rates changed substantially; the change was greatest for males aged 15-19 years, for whom rates increased substantially (Figure 1). This report summarizes these trends and presents strategies for violence prevention and intervention. Mortality data were obtained from CDC's National Center for Health Statistics; population estimates were projected from census data. Arrest rates were calculated using data from the U.S. Department of Justice. From 1985 to 1991, the annual crude homicide rate for the United States increased 25% (from 8.4 to 10.5 per 100,000 persons). The homicide rate for persons aged 15-34 years increased 50% during this period (from 13.4 to 20.1 per 100,000), accounting for most of the overall increase. Rates increased for both sexes and all 5-year age groups within the 15-34-year age group. For persons in other age groups, rates were relatively stable from 1985 to 1991: for persons aged less than or equal to 14 years, 1.9 and 2.4, respectively; for persons aged 35-64 years, 8.8 and 9.1, respectively; and for persons aged greater than or equal to 65 years, 4.3 and 4.1, respectively. From 1963 through 1985, annual homicide rates for 15- 19-year-old males were one third to one half the rates for the next three higher 5-year age groups (Figure 1). However, during 1985- 1991, annual rates for males aged 15-19 years increased 154% (from 13.0 to 33.0), surpassing the rates for 25-29- and 30-34-year-old males, even though those rates increased 32% (from 24.4 to 32.3) and 16% (from 22.1 to 25.7), respectively. The homicide rate for 20-24-year-old males increased 76% (from 23.4 to 41.2) from 1985 through 1991. During 1985-1991, age-specific arrest rates for murder and nonnegligent manslaughter increased 127% for males aged 15-19 years, 43% for males aged 20-24 years, and declined 1% and 13% for males aged 25-29 and 30-34 years, respectively (1,2). In 1991, 15- 19-year-old males were more likely to be arrested for murder than males in any other age group. Reported by: Div of Violence Prevention, National Center for Injury Prevention and Control, CDC. Editorial Note: The increase in the annual homicide rate for 15- 19-year-old males during 1985-1991 was a dramatic change from the pattern during 1963-1984. Although the immediate and specific causes of this problem are unclear, the increase in the occurrence of homicide may be the result of the recruitment of juveniles into drug markets, the use of guns in these markets, and the consequent diffusion of guns to other young persons in the community, resulting, in turn, in more frequent use of the guns for settling disputes (3). Among 15-19-year-old males, firearm-related homicides accounted for 88% of all homicides in 1991 and 97% of the increase in the rate from 1985 through 1991. Factors underlying the immediate precursors may include poverty, inadequate educational and economic opportunities, social and family instability, and frequent personal exposure to violence as an acceptable or preferred method of resolving disagreements (4,5). Although the most effective strategies to prevent youth violence have not been determined, efforts to prevent this problem should employ established principles of health promotion and should emphasize the use of multiple complementary interventions (6,7). These interventions include o Strengthening the science base for prevention efforts. Strategies and methods to prevent violence in youth should be rigorously assessed (6). o Establishing primary-prevention programs. Primary prevention aims to prevent the occurrence of violence rather than focusing on known perpetrators and victims after the occurrence of violence. This strategy addresses all forms of violence (e.g., spouse abuse, child abuse, and violence among youth) and could affect both potential perpetrators and victims. o Targeting youths of all ages. Violence-reduction efforts should address the needs of infants, children, and older youths. Measures that have been successful in reducing violent behavior and its precursors in these age groups (8-10) should be considered when developing new programs. o Involving adults (e.g., parents and other role models). They influence violence-related attitudes and behaviors of youth and should be provided the appropriate knowledge and skills to function as role models. o Presenting messages in multiple settings. Lessons in one setting (e.g., a school) should be reinforced in other settings in which children and youth congregate, including homes, churches, recreational settings, and clinics. o Addressing societal and personal factors. Societal factors (e.g., poverty, unemployment, undereducation, and social acceptance of violence [4,5]) should be addressed simultaneously with efforts to affect personal behavior change through activities such as home visitation, school-based training, or mentoring. References 1. Federal Bureau of Investigation. Crime in the U.S., 1985. Washington, DC: US Department of Justice, Federal Bureau of Investigation, 1986. 2. Federal Bureau of Investigation. Crime in the U.S., 1991. Washington, DC: US Department of Justice, Federal Bureau of Investigation, 1992. 3. Blumstein A. Youth violence, firearms, and illicit drug markets [Working paper]. Pittsburgh: Carnegie Mellon University, The Heinz School, June 1994. 4. Reiss AJ Jr, Roth JA, eds. Understanding and preventing violence. Washington, DC: National Academy Press, 1993. 5. National Committee for Injury Prevention and Control. Injury prevention: meeting the challenge. Am J Prev Med 1989;5(suppl):1992-2203. 6. Mercy JA, Rosenberg ML, Powell KE, Broome CV, Roper WL. Public health policy for preventing violence. Health Aff 1993 (Winter):7- 29. 7. Green LW, Kreuter MW. Health promotion planning: an educational and environmental approach. 2nd ed. Mountain View, California: Mayfield Publishing Company, 1991. 8. Olds DL, Henderson CR Jr, Chamberlin R, Tatelbaum R. Preventing child abuse and neglect: a randomized trial of nurse home visitation. Pediatrics 1986;78:65-78. 9. Zigler E, Taussig C, Black K. Early childhood intervention: a promising preventative for juvenile delinquency. American Psychologist 1992;47:997-1006. 10. Hammond RW, Yung BR. Preventing violence in at-risk African-American youth. J Health Care Poor Underserved 1991;2:359- 73. ------------------------------ Date: Wed, 26 Oct 94 21:35:53 MST From: mednews@stat.com (HICNet Medical News) To: hicnews Subject: [MMWR] Adolescent Suicides Message-ID: Adolescent Homicide -- Fulton County, Georgia, 1988-1992 In Fulton County, Georgia (1990 population: 648,951), during 1988-1992, 12% of homicides occurred among persons aged less than or equal to 18 years, of whom 75% were adolescents aged 13-18 years (1). Recognition of homicide as the leading cause of death among adolescents in Fulton County has prompted planning of local surveillance, prevention, intervention, advocacy, and mentoring programs and antiviolence media campaigns. This report summarizes descriptive information for homicides of adolescents in Fulton County during 1988-1992 and addresses the use of this information for local prevention and intervention programs. Data were obtained from death investigation records of the Fulton County Medical Examiner (FCME), death certificates, and birth certificates (of homicide victims who were born in Fulton County). FCME data were used to identify decedents to be included in the study, demographic information about the decedent, and location of the homicide. Death certificates provided information about the decedent's place of birth, county of residence, and occupational status. For decedents who were born in Fulton County, birth certificates were reviewed for mother's place of birth and for maternal age and marital status when the decedent was born. A map was used to divide Fulton County into 1-square-mile sectors, plot the location of each homicide, and compare the location of the homicide with the location of the decedent's residence. Based on names listed in FCME records, death certificates were located for 106 of the 107 adolescent homicide victims during 1988- 1992. The number and rates of homicides increased with age (Table 1). Most (89 [84%]) decedents were black males. Almost all (104 [98%]) decedents were classified by family members (usually the mother) as being of U.S. origin (i.e., an ancestor's foreign birthplace or nationality group was not specified); 87 (82%) were born in Georgia, and 76 (72%) were born in Fulton County. Ninety-six (91%) were born in urban areas (i.e., counties included in a metropolitan statistical area); 10 were born in rural areas or place of birth was unknown. At the time of their deaths, 85 (80%) were Fulton County residents, and 98 (92%) were residents of the metropolitan Atlanta area; two were residents of other Georgia counties, and six were residents of other states or residence was unknown. Of the 106 decedents, 71 (67%) were students; 16 (15%), employed; and 19 (18%), unemployed or had never worked. Birth certificate data were available for all 76 decedents who were born in Fulton County (Table 2); two decedents killed in separate incidents had the same mother. The mothers of 46 (61%) decedents were aged less than or equal to 20 years when the decedent was born, and 34 (45%) mothers were married at the time of the decedent's birth. Sixty-nine (91%) of the mothers were born in Georgia; 49 (64%) were born in Fulton County or the city of Atlanta. Thirty-five (33%) of the 106 victims were killed in an area located in the same map sector as their place of residence (i.e., within 1.4 miles of home), while 59 (56%) were killed within 2.8 miles of home. Of the 106 homicides, 102 occurred in the incorporated areas of Fulton County (i.e., Atlanta, College Park, East Point, or Union City). Homicides were clustered in the central southwest and central northwest portions of the city of Atlanta. Reported by: R Hanzlick, MD, P Schilke, MD, Dept of Pathology, Emory Univ School of Medicine; Fulton County Vital Records Office, Fulton County Health Dept; Fulton County Medical Examiner, Atlanta. Surveillance and Programs Br, Div of Environmental Hazards and Health Effects, National Center for Environmental Health, CDC. Editorial Note: Violence is recognized as a public health emergency in Fulton County by the county Board of Commissioners (R. Michael Green, Fulton County Health Department, personal communication, August 29, 1994). The findings in this report will be used to assist in planning, implementing, and monitoring targeted prevention and intervention programs in Fulton County. Because these and previous findings in Fulton County indicate that most decedents and perpetrators of adolescent homicide were black males (1), prevention and intervention programs should be available for young black males. The high proportion of decedents who were students suggests that such programs might be school-based or associated with school activities. In addition, the substantial portion of young, single mothers suggests that programs could be integrated with other services for single parents and their children, including role-model mentoring programs. The data also provide a basis for geographic location of neighborhood and other local community programs in selected areas of the county, particularly in the incorporated and inner-city areas of Atlanta. For example, detailed maps of locations where homicides occurred can assist law enforcement agencies, other local agencies, foundations, and prevention-oriented organizations in targeting precincts or zones for special efforts. The finding that a high portion of the decedents (and their mothers) were long-term residents in the community provides a basis for incorporating prevention programs into civic, social, and cultural activities and locally available services. Interpretation of the findings in this study are subject to at least two limitations. First, the study was not designed to assess risk factors for homicide; as a consequence, for example, the high proportion of decedents who were students or born to young mothers cannot be interpreted to indicate that such persons are at higher risk for homicide than nonstudents or those born to older mothers. Second, the geographic clustering of deaths may reflect higher population densities in some areas or other factors and may not indicate increased risk for fatal or nonfatal violence. Although death certificate data have been used previously to determine the geographic distribution of homicides in Fulton County (1), these findings refine understanding of this problem by providing additional information about the decedents, residences of the decedents and their mothers, and the location of the homicide. Poverty, lack of jobs, and other socioeconomic variables that underlie the elevated risk for young black males in Fulton County have not been evaluated in this study; however, other research indicates that these factors must be considered when addressing this public health problem. Other recent findings also support the strategies of integrating drug-abuse and homicide-prevention programs; developing programs that might influence the social interactions of adolescents away from home between 6 p.m. and midnight (1); and implementing measures to reduce fatalities involving firearms (1). Additional efforts to assist in the development of prevention and intervention programs include the need to evaluate victim characteristics, perpetrators' access to firearms (e.g., who owned the gun and where and when the perpetrator obtained it), and demographic and psychosocial characteristics of perpetrators, and the effectiveness of intervention programs. Reference 1. CDC. Homicides of persons aged less than or equal to 18 years-- Fulton County, Georgia, 1988-1992. MMWR 1994;43:254-5,261. ------------------------------ Date: Wed, 26 Oct 94 21:36:57 MST From: mednews@stat.com (HICNet Medical News) To: hicnews Subject: [MMWR] Prevalence of Disabilities and Associated Health Conditions Message-ID: Prevalence of Disabilities and Associated Health Conditions -- United States, 1991-1992 An estimated 35-49 million persons in the United States have a disability (1); estimated direct and indirect annual costs related to disability (including medical expenses and lost workdays) total $170 billion (2). Because definitions of disability used in previous analyses generally contained limited measures of disability, the prevalence of disability in the United States may have been underestimated. The Survey of Income and Program Participation (SIPP), a subsample of the 1990 U.S. census, collected comprehensive data about disability using several measures. The U.S. Bureau of the Census and CDC analyzed data from SIPP to provide more precise prevalence estimates of disability and health conditions associated with disability in the United States during 1991-1992. This report summarizes the findings from that analysis. From October 1991 through January 1992, SIPP collected information about disability during personal household interviews of a representative sample (n=97,133 persons in 34,100 households) of the U.S. civilian, noninstitutionalized population. Only data for persons aged greater than or equal to 15 years are presented in úÿ (continued next message) ÿ@FROM :david@STAT.COM úÿ(Continued from last message) this analysis. The measures of disability used in SIPP were derived from D- and I-codes in the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) (1). Disability was assessed using five measures: 1) ability to perform functional activities* (ICIDH D-codes 21, 23, 26, 40-45, and 48), 2) activities of daily living (ADLs)** (ICIDH D-codes 30, 33, 35, 36, 37-39, and 46), or 3) instrumental activities of daily living (IADLs)*** (ICIDH D-codes 50, 51, 60, and 61), 4) presence of selected impairments**** (ICIDH D-codes 15 and 16 and I-codes 14- 18), and 5) use of assistive aids (e.g., wheelchair or cane). Participants were asked whether they had "difficulty" performing functional activities, ADLs, and IADLs; whether they had selected impairments; and whether they used assistive aids for 6 months or longer. In addition, participants who had difficulty with activities other than seeing, hearing, and having their speech understood by others were asked to select up to three conditions (from a list of 30) that they believed caused limitation or difficulty with a functional activity, ADL, or IADL. Data were weighted to calculate national estimates. Based on SIPP, during 1991-1992, of the 195.7 million persons in the United States aged greater than or equal to 15 years, 34.2 million (17.5%) had difficulty performing one or more functional activities (Table 1, page 737); most persons had difficulty climbing one flight of stairs (17.5 million [8.9%]) or walking one quarter mile (17.3 million [8.9%] persons). A total of 7.9 million (4.0%) persons had difficulty performing one or more ADLs, and 11.7 million (6.0%) persons had difficulty performing one or more IADLs. Use of a wheelchair for 6 months or longer was reported by 1.5 million ( less than 1%) persons. Of the persons who did not use a wheelchair, 4.0 million (2.0%) persons had used a cane, crutches, or a walker for 6 months or longer. For all five measures of disability, the age-specific prevalence of disability was higher for persons aged greater than or equal to 65 years than persons aged less than 65 years (Table 1, page 737). The prevalence of disability among men and women was 18.7% and 20.2%, respectively. Overall, 42.0 million (21%) persons reported one or more conditions they believed to be associated with their disability (Table 2, page 738). The most commonly reported condition was arthritis or rheumatism (7.2 million [17.1%]), followed by back or spine problems (5.7 million [13.5%]), and heart trouble (including coronary heart disease and arteriosclerosis) (4.6 million [11.1%]). Reported by: JM McNeil, Bur of the Census, Economics and Statistics Administration, US Dept of Commerce. Statistics and Epidemiology Br, Div of Surveillance and Epidemiology, Epidemiology Program Office; Disabilities Prevention Program, Office of the Director, National Center for Environmental Health, CDC. Editorial Note: The prevalence estimates of disability in this report indicate that nearly one fifth (19.4%) of the U.S. population aged greater than or equal to 15 years has a disability. Prevalence estimates of disability derived from SIPP are based on broader measures of disability than previously used for estimates derived from the 1992 Current Population Survey (3), the 1990 census (4), and the National Health Interview Surveys (5,6). This broader definition--which included an assessment of limitations in functional activities, ADLs, IADLs, and selected impairments-- provided a more comprehensive assessment of the scope, extent, and epidemiology of disability in the United States. Definitions used for surveillance and assessment of disability are more clearly understood by linking them to a conceptual framework of consequences of disease and injury, such as the ICIDH (7). In the ICIDH, three concepts define the consequences of disease and injury: 1) impairment (i.e., the loss of psychological, physiological, or anatomical structure or function), 2) disability (i.e., the limitation in functional performance resulting from an impairment), and 3) handicap (i.e., the disadvantage experienced by a person as a result of impairments and/or disabilities, which limits interaction of the person with the physical and social environment). Despite the usefulness of the estimates based on SIPP, the findings in this report are subject to limitations that may underestimate the public health impact of disability in the United States. For example, SIPP failed to collect data about the effects of physical and social barriers (e.g., within the home, community, school, or workplace) and ex-periences with discrimination. Recent efforts underscore the importance of clarifying the role of environment in determining the consequences of an impairment or disability (8). Therefore, efforts to provide more precise national estimates of disability should include development of measures that address environmental factors (i.e., physical and social barriers) and the effects of discrimination. Revision of the ICIDH is under way and should improve collection of valid and reliable survey information about physical and social barriers (8,9). References 1. McNeil JM. Americans with disabilities, 1991-1992. Washington, DC: US Department of Commerce, Bureau of the Census, 1993. (Current population reports; series P70, no. 33). 2. Chirikos TN. Aggregate economic losses from disability in the United States: a preliminary assay. Milbank Q 1989;67(suppl 2):59- 91. 3. CDC. Prevalence of work disability--United States, 1990. MMWR 1993;42:757-9. 4. CDC. Prevalence of mobility and self-care disability--United States, 1990. MMWR 1993;42: 760-1,767-8. 5. LaPlante MP. Data on disability from the National Health Interview Survey, 1983-1985. Washington, DC: Department of Education, National Institute on Disability and Rehabilitation Research, 1988. 6. LaPlante MP, Hendershot GE, Moss AJ. Assistive technology devices and home accessibility features: prevalence, payment, need, and trends. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, NCHS, 1992. (Advance data no. 217). 7. World Health Organization. International classification of impairments, disabilities, and handicaps. Geneva: World Health Organization, 1993. 8. Badley EM. An introduction to the concepts and classifications of the International Classification of Impairments, Disabilities, and Handicaps. Disabil Rehabil 1993;15:161-78. 9. Fougeyrollas P. Documenting environmental factors as determining variables in the performance of day-to-day activities and the fulfillment of social roles by persons with impairments and functional limitations. ICIDH International Network 1993;5:8-13. *Functional activities: ability to 1) "see words and letters in ordinary newspaper print," 2) "hear normal conversations," 3) "have speech understood by others," 4) "lift and carry up to 10 pounds (e.g., a full bag of groceries)," 5) "climb a flight of stairs without resting," and 6) "walk one quarter mile." **ADLs: ability to 1) "get around inside the home"; 2) "get in and out of bed or a chair"; and 3) take a bath or shower, dress, and eat; and 4) get to and use the toilet. ***IADLs: ability to 1) "get around outside the home," 2) "keep track of money and bills," 3) "prepare meals," 4) "do light housework," and 5) "use the telephone." ****Learning disabilities; mental retardation; other developmental disabilities; and Alzheimer disease, senility, dementia, and other mental or emotional conditions. Prevalence of Disabilities and Associated Health Conditions -- United States, 1991-1992 An estimated 35-49 million persons in the United States have a disability (1); estimated direct and indirect annual costs related to disability (including medical expenses and lost workdays) total $170 billion (2). Because definitions of disability used in previous analyses generally contained limited measures of disability, the prevalence of disability in the United States may have been underestimated. The Survey of Income and Program Participation (SIPP), a subsample of the 1990 U.S. census, collected comprehensive data about disability using several measures. The U.S. Bureau of the Census and CDC analyzed data from SIPP to provide more precise prevalence estimates of disability and health conditions associated with disability in the United States during 1991-1992. This report summarizes the findings from that analysis. From October 1991 through January 1992, SIPP collected information about disability during personal household interviews of a representative sample (n=97,133 persons in 34,100 households) of the U.S. civilian, noninstitutionalized population. Only data for persons aged greater than or equal to 15 years are presented in this analysis. The measures of disability used in SIPP were derived from D- and I-codes in the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) (1). Disability was assessed using five measures: 1) ability to perform functional activities* (ICIDH D-codes 21, 23, 26, 40-45, and 48), 2) activities of daily living (ADLs)** (ICIDH D-codes 30, 33, 35, 36, 37-39, and 46), or 3) instrumental activities of daily living (IADLs)*** (ICIDH D-codes 50, 51, 60, and 61), 4) presence of selected impairments**** (ICIDH D-codes 15 and 16 and I-codes 14- 18), and 5) use of assistive aids (e.g., wheelchair or cane). Participants were asked whether they had "difficulty" performing functional activities, ADLs, and IADLs; whether they had selected impairments; and whether they used assistive aids for 6 months or longer. In addition, participants who had difficulty with activities other than seeing, hearing, and having their speech understood by others were asked to select up to three conditions (from a list of 30) that they believed caused limitation or difficulty with a functional activity, ADL, or IADL. Data were weighted to calculate national estimates. Based on SIPP, during 1991-1992, of the 195.7 million persons in the United States aged greater than or equal to 15 years, 34.2 million (17.5%) had difficulty performing one or more functional activities (Table 1, page 737); most persons had difficulty climbing one flight of stairs (17.5 million [8.9%]) or walking one quarter mile (17.3 million [8.9%] persons). A total of 7.9 million (4.0%) persons had difficulty performing one or more ADLs, and 11.7 million (6.0%) persons had difficulty performing one or more IADLs. Use of a wheelchair for 6 months or longer was reported by 1.5 million ( less than 1%) persons. Of the persons who did not use a wheelchair, 4.0 million (2.0%) persons had used a cane, crutches, or a walker for 6 months or longer. For all five measures of disability, the age-specific prevalence of disability was higher for persons aged greater than or equal to 65 years than persons aged less than 65 years (Table 1, page 737). The prevalence of disability among men and women was 18.7% and 20.2%, respectively. Overall, 42.0 million (21%) persons reported one or more conditions they believed to be associated with their disability (Table 2, page 738). The most commonly reported condition was arthritis or rheumatism (7.2 million [17.1%]), followed by back or spine problems (5.7 million [13.5%]), and heart trouble (including coronary heart disease and arteriosclerosis) (4.6 million [11.1%]). Reported by: JM McNeil, Bur of the Census, Economics and Statistics Administration, US Dept of Commerce. Statistics and Epidemiology Br, Div of Surveillance and Epidemiology, Epidemiology Program Office; Disabilities Prevention Program, Office of the Director, National Center for Environmental Health, CDC. Editorial Note: The prevalence estimates of disability in this report indicate that nearly one fifth (19.4%) of the U.S. population aged greater than or equal to 15 years has a disability. Prevalence estimates of disability derived from SIPP are based on broader measures of disability than previously used for estimates derived from the 1992 Current Population Survey (3), the 1990 census (4), and the National Health Interview Surveys (5,6). This broader definition--which included an assessment of limitations in functional activities, ADLs, IADLs, and selected impairments-- provided a more comprehensive assessment of the scope, extent, and epidemiology of disability in the United States. Definitions used for surveillance and assessment of disability are more clearly understood by linking them to a conceptual framework of consequences of disease and injury, such as the ICIDH (7). In the ICIDH, three concepts define the consequences of disease and injury: 1) impairment (i.e., the loss of psychological, physiological, or anatomical structure or function), 2) disability (i.e., the limitation in functional performance resulting from an impairment), and 3) handicap (i.e., the disadvantage experienced by a person as a result of impairments and/or disabilities, which limits interaction of the person with the physical and social environment). Despite the usefulness of the estimates based on SIPP, the findings in this report are subject to limitations that may underestimate the public health impact of disability in the United States. For example, SIPP failed to collect data about the effects of physical and social barriers (e.g., within the home, community, school, or workplace) and ex-periences with discrimination. Recent efforts underscore the importance of clarifying the role of environment in determining the consequences of an impairment or disability (8). Therefore, efforts to provide more precise national estimates of disability should include development of measures that address environmental factors (i.e., physical and social barriers) and the effects of discrimination. Revision of the ICIDH is under way and should improve collection of valid and reliable survey information about physical and social barriers (8,9). References 1. McNeil JM. Americans with disabilities, 1991-1992. Washington, DC: US Department of Commerce, Bureau of the Census, 1993. (Current population reports; series P70, no. 33). 2. Chirikos TN. Aggregate economic losses from disability in the United States: a preliminary assay. Milbank Q 1989;67(suppl 2):59- 91. 3. CDC. Prevalence of work disability--United States, 1990. MMWR 1993;42:757-9. 4. CDC. Prevalence of mobility and self-care disability--United States, 1990. MMWR 1993;42: 760-1,767-8. 5. LaPlante MP. Data on disability from the National Health Interview Survey, 1983-1985. Washington, DC: Department of Education, National Institute on Disability and Rehabilitation Research, 1988. 6. LaPlante MP, Hendershot GE, Moss AJ. Assistive technology devices and home accessibility features: prevalence, payment, need, and trends. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, NCHS, 1992. (Advance data no. 217). 7. World Health Organization. International classification of impairments, disabilities, and handicaps. Geneva: World Health Organization, 1993. 8. Badley EM. An introduction to the concepts and classifications of the International Classification of Impairments, Disabilities, and Handicaps. Disabil Rehabil 1993;15:161-78. 9. Fougeyrollas P. Documenting environmental factors as determining variables in the performance of day-to-day activities and the fulfillment of social roles by persons with impairments and functional limitations. ICIDH International Network 1993;5:8-13. *Functional activities: ability to 1) "see words and letters in ordinary newspaper print," 2) "hear normal conversations," 3) "have speech understood by others," 4) "lift and carry up to 10 pounds (e.g., a full bag of groceries)," 5) "climb a flight of stairs without resting," and 6) "walk one quarter mile." **ADLs: ability to 1) "get around inside the home"; 2) "get in and out of bed or a chair"; and 3) take a bath or shower, dress, and eat; and 4) get to and use the toilet. ***IADLs: ability to 1) "get around outside the home," 2) "keep track of money and bills," 3) "prepare meals," 4) "do light housework," and 5) "use the telephone." ****Learning disabilities; mental retardation; other developmental disabilities; and Alzheimer disease, senility, dementia, and other mental or emotional conditions. ------------------------------ Date: Wed, 26 Oct 94 21:38:50 MST From: mednews@stat.com (HICNet Medical News) To: hicnews Subject: [MMWR] Outbreak of Salmonella associated with Ice Cream Message-ID: Outbreak of Salmonella enteritidis Associated with Nationally Distributed Ice Cream Products -- Minnesota, South Dakota, and Wisconsin, 1994 From September 19 through October 10, 1994, a total of 80 confirmed cases of Salmonella enteritidis (SE) infection were reported to the Minnesota Department of Health (MDH); in comparison, 96 cases were reported statewide during all of 1993. Cases were characterized by diarrhea, abdominal cramps, and fever. Recent increases in SE cases also were reported from South Dakota (14 cases during September 6-October 7, compared with 20 cases during all of 1993) and Wisconsin (48 cases during September 6- October 7, compared with 187 during all of 1993). This report summarizes preliminary findings from the outbreak investigation. On October 5 and 6, to assess potential risk factors for infection, the MDH conducted a case-control study of 15 cases and 15 age- and neighborhood-matched controls. A case was defined as culture-confirmed SE in a person with onset of illness during September. Eleven case-patients (73%) and two controls (13%) reported consumption of Schwan's ice cream within 5 days of illness onset for case-patients and a similar period for controls (odds ratio=10.0; 95% confidence interval=1.4-434.0). On October 7 and 9, the MDH issued press releases informing the public of this problem and advising persons who had been ill since September 1 and who had consumed Schwan's ice cream to contact the health department. During October 8-11, a total of 2014 persons who had consumed suspected products and had been ill with diarrhea contacted the MDH by telephone. Samples of ice cream from households of ill persons grew SE. Ill persons reported eating all types and flavors of ice cream products produced at the Schwan's plant in Marshall, Minnesota, including ice cream, sherbet, frozen yogurt, and ice cream sandwiches and cones; these products had production dates in August and September. The implicated products are distributed nationwide, primarily by direct delivery to homes, and are sold only under the Schwan's label. Investigations to examine the extent and causes of the outbreak are under way. On October 7, the company voluntarily stopped distribution and production at the Marshall plant pending further findings from these investigations. Reported by: Acute Disease Epidemiology Section, Minnesota Dept of Health. South Dakota Dept of Health. Wisconsin Dept of Health and Social Svcs. Center for Food Safety and Applied Nutrition, Food and Drug Administration. Foodborne and Diarrheal Diseases Br, Div of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, CDC. Editorial Note: Gastroenteritis caused by Salmonella is characterized by abdominal cramps and diarrhea, vomiting, fever, and headache. Antimicrobial therapy is not indicated in uncomplicated gastroenteritis, which typically resolves within 1 week. Persons at increased risk for infection or more severe disease include infants; the elderly; persons with achlorhydria; those receiving immunosuppressive therapy; persons who may have received antimicrobials for another illness; and those persons with sickle-cell anemia, cancer, or acquired immunodeficiency syndrome (1). Complications include meningitis, septicemia, Reiter syndrome, and death (1). Salmonella sp. are second only to Campylobacter as a cause of úÿ (continued next message) ÿ@FROM :david@STAT.COM úÿ(Continued from last message) bacterial diarrheal illness in the United States, causing an estimated 2 million illnesses annually (2). Among the more than 2000 Salmonella serotypes, SE has ranked first or second in frequency of isolation from humans since 1988 and accounted for 21% of reported isolates in 1993. Each year, an average of 55 outbreaks of SE infections are reported to CDC; approximately 11% of patients are hospitalized, and 0.3% die (3). Preliminary findings from this outbreak indicate that the number of persons exposed to contaminated products may be substantial. Approximately 400,000 gallons of the implicated products are produced weekly and are distributed throughout the contiguous United States. Previous investigations have established the potential for large-scale outbreaks of foodborne salmonellosis; for example, in 1985, pasteurized milk produced at one dairy plant caused up to 197,000 Salmonella infections (4). Consumers should discard or return any Schwan's ice cream products. Persons who have become ill since September 1 with diarrhea and who have consumed Schwan's ice cream products are urged to contact their state health departments. References 1. Pavia AT, Tauxe RV. Salmonellosis: nontyphoidal. In: Evans AS, Brachman PS, eds. Bacterial infections in humans: epidemiology and control. 2nd ed. New York: Plenum Medical Book Company, 1991:573- 91. 2. Helmick CG, Griffin PM, Addiss DG, Tauxe RV, Juranek DD. Infectious diarrheas. In: Everheart JE, ed. Digestive diseases in the United States: epidemiology and impact. Washington, DC: US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 1994:85-123; DHHS publication no. (NIH)94-1447. 3. CDC. Outbreaks of Salmonella enteritidis gastroenteritis-- California, 1993. MMWR 1993; 42:793-7. 4. Ryan CA, Nickels MK, Hargrett-Bean NT, et al. Massive outbreak of antimicrobial-resistant salmonellosis traced to pasteurized milk. JAMA 1987;258:3269-74. ------------------------------ Date: Wed, 26 Oct 94 21:51:58 MST From: mednews@stat.com (HICNet Medical News) To: hicnews Subject: [MMWR 21 Oct 94] Tobacco Use and Nicotine Withdrawal in Adolescents Message-ID: Reasons for Tobacco Use and Symptoms of Nicotine Withdrawal Among Adolescent and Young Adult Tobacco Users -- United States, 1993 Cigarettes and other forms of tobacco are addictive because of the presence of nicotine (1). Among adults in the United States who have ever smoked daily, 91.3% tried their first cigarette and 77.0% became daily smokers before age 20 years (2). Among high school seniors who had ever tried smokeless tobacco (SLT), 73% did so by the ninth grade (2). To further characterize the development of nicotine addiction among persons aged 10-22 years, CDC analyzed data from the 1993 Teenage Attitudes and Practices Survey (TAPS-II). This report summarizes the results of that analysis and focuses on assessments of reasons for using tobacco and symptoms of nicotine withdrawal. For TAPS-II, data about knowledge, attitudes, and practices of tobacco use were collected by telephone interviews; persons who could not be contacted by telephone were contacted in person. The TAPS-II sample for this analysis had two components: 1) of the 9135 respondents (aged 12-18 years) to the 1989 TAPS telephone interview*, 7960 (87.1%) participated in TAPS-II (these respondents were aged 15-22 years); and 2) an additional 4992 persons from a new probability sample of 5590 persons aged 10-15 years (89.3% response rate) participated in TAPS-II. Data were weighted to provide national estimates, and 95% confidence intervals (CIs) were calculated using SUDAAN (3). Persons who had smoked cigarettes (n=2121) or who had used SLT (n=470) during the 30 days preceding the survey were asked if they used tobacco because "it relaxes or calms me" and if they used it because "it's really hard to quit" (either answer indicates an influence of the psychopharmacologic properties of nicotine [1]). Smokers who had tried to quit and persons who had quit smoking (n=1925)** were asked, "When you quit/tried to quit did you feel a strong need or urge to have a cigarette; feel more irritable; find it hard to concentrate; feel restless; feel hungry more often; feel sad, blue, or depressed?" SLT users who had tried to quit and persons who had discontinued use (n=1216) were asked similar questions adapted to SLT use. Lifetime history of tobacco use was assessed through three categories for cigarette smoking (20 or fewer cigarettes smoked during lifetime, 21-98 cigarettes smoked, and 100 or more cigarettes smoked) and with two categories for SLT use (never used regularly versus ever used regularly). Frequency of use was measured by the number of days on which cigarettes were smoked or SLT was used during the preceding month (0, 1-14, 15-29, or 30 days). Intensity of use was measured by the average number of cigarettes smoked per day during the preceding 7 days (five or fewer, 6-15, or 16 or more) and by the number of times SLT was used on the days it was used (1-2, or three or more). For persons who had smoked during the preceding 30 days and for those who had used SLT during the preceding 30 days, the frequency of reporting that tobacco was used because it is relaxing or because it is hard to quit increased in relation to increasing lifetime use, frequency of use, and intensity of use (Table 1); this pattern characterized the overall sample and persons in both age categories (10-18 years and 19-22 years). The percentages of persons who reported smoking cigarettes or using SLT for these two reasons also were similar across age groups. Among smokers and SLT users with the greatest lifetime use or intensity of use, the proportions who reported using tobacco to relax were similar to those who reported using it because it was hard to quit. Among those with the lowest lifetime use or frequency or intensity of use, relaxation was more commonly cited as a reason for use than was difficulty quitting. For every category of usage frequency, cigarette smokers were more likely to report use for relaxation than were SLT users. Regardless of age, approximately three fourths of daily cigarette smokers (73.8%) and daily SLT users (74.2%) reported that one of the reasons they used tobacco was because it was hard to quit. The likelihood of reporting symptoms of nicotine withdrawal increased in relation to frequency (Table 2) and intensity (Figure 1) of use. Younger and older smokers were equally likely to report increasing nicotine withdrawal symptoms as exposure to nicotine increased (Table 2). The same pattern characterized SLT users among both age groups combined (group-specific analyses are not presented because of limitations in sample sizes of persons who used SLT during the preceding 30 days). Among persons aged 10-22 years, those who smoked cigarettes and those who used SLT on a daily basis were equally likely to report symptoms of nicotine withdrawal (with the exception of depression, which was less prevalent among SLT users). Among persons who reported using tobacco on 1-14 days during the preceding 30 days, those who smoked cigarettes were generally more likely to report symptoms of nicotine withdrawal than were persons who used SLT. At least one symptom of nicotine withdrawal was reported by 92.4% of daily cigarette smokers and 93.3% of daily SLT users who had previously tried to quit. Persons who smoked six or more cigarettes per day were more likely than those who smoked five or fewer cigarettes per day to report difficulty concentrating, feeling more irritable, and craving cigarettes during a previous quit attempt; however, among persons who smoked five or fewer cigarettes per day, 28.7% reported difficulty concentrating; 47.5%, feeling more irritable; and 56.9%, craving cigarettes during a previous quit attempt (Figure 1). Reported by: D Barker, MHS, Robert Wood Johnson Foundation, Princeton, New Jersey. Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC. Editorial Note: This analysis of TAPS-II underscores the relation between use of tobacco and reasons for using tobacco--a relation that reflects the psycho- pharmocologic properties of nicotine. In addition, the frequency of smoking and of using SLT strongly correlated with self-reported symptoms of nicotine withdrawal. These findings are consistent with previous studies that indicated high prevalences of symptoms of nicotine addiction among adolescent and adult smokers (2,4,5). Previous reports indicate that adolescents initially tried cigarettes for reasons related to social norms, advertising, social pressure, and curiosity (2,6). However, once the behavior becomes established, regular smokers are more likely than beginning smokers to report that they smoke for pleasure and because they are addicted (2,6). Among students who were high school seniors during 1976-1986, a total of 44% of daily smokers believed that in 5 years they would not be smoking; however, follow-up indicated that 5-6 years later, 73% of these persons remained daily smokers (2). This finding suggests that many of these persons could not overcome the social, psychological, and chemical influences that maintain or advance the smoking behavior once it is established (2) and indicates that many adolescents do not understand the personal risks of smoking, including nicotine addiction (7). The findings in this report are subject to at least two limitations. First, because of small sample sizes, the prevalence of SLT withdrawal symptoms could not be analyzed in relation to lifetime history of cigarette smoking; however, SLT users who tried to quit were probably less likely to experience symptoms of nicotine withdrawal if they concurrently smoked cigarettes (1). Second, the relation of nonpharmacologic (e.g., social and psychological) influences on tobacco use were not quantified; however, the findings are consistent with previous reports documenting the psychopharmacologic effects of nicotine on tobacco use and tobacco withdrawal (1,2,4). In 1992, approximately two thirds of adolescent smokers reported that they wanted to quit smoking, and 70% indicated that they would not have started smoking if they could choose again (8). Most adults probably could be prevented from becoming tobacco users if they could be kept tobacco-free during adolescence (2). Four strategies that may assist in supporting tobacco-free adolescence include 1) strict enforcement of the prohibition of sales to minors (sales to persons aged less than 18 years are illegal in all 50 states), 2) reduction of advertising and promotion practices that stimulate demand, 3) increases in the real (i.e., inflation-adjusted) prices of tobacco products, and 4) school health education programs that are reinforced by media-based and other community programs (2). The Institute of Medicine recently published recommendations for a comprehensive national strategy to prevent nicotine addiction among youth (9). These recommendations especially address tobacco-free policies; restrictions on tobacco advertising and promotion; tobacco taxation; enforcement of youth access laws; regulation of the labeling, packaging, and contents of tobacco products; further research on nicotine addiction and on prevention and cessation programs; and the coordination of policies and research. Copies of this report can be purchased from National Academy Press, telephone (800) 624-6242 or (202) 334-3313. References 1. CDC. The health consequences of smoking: nicotine addiction--a report of the Surgeon General. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1988; DHHS publication no. (CDC)88-8406. 2. US Department of Health and Human Services. Preventing tobacco use among young people: a report of the Surgeon General. Atlanta: US Department of Health and Human Services, Public Health Service, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1994. 3. Shah BV, Barnwell BG, Hunt PN, LaVange LM. Software for Survey Data Analysis (SUDAAN) version 5.5 [Software documentation]. Research Triangle Park, North Carolina: Research Triangle Institute, 1991. 4. McNeill AD, West RJ, Jarvis M, Jackson P, Bryant A. Cigarette withdrawal symptoms in adolescent smokers. Psychopharmocology 1986;90:533-6. 5. Giovino GA, Shelton DM, Schooley MW. Trends in cigarette smoking cessation in the United States. Tobacco Control 1993;2(suppl):S3- S10. 6. Sarason IG, Mankowski ES, Peterson AV, Dinh KT. Adolescents' reasons for smoking. J School Health 1992;62:185-90. 7. Leventhal H, Glynn K, Fleming R. Is the smoking decision an "informed choice"?: effect of smoking risk factors on smoking beliefs. JAMA 1987;257:3373-6. 8. George H. Gallup International Institute. Teen-age attitudes and behavior concerning tobacco: report of the findings. Princeton, New Jersey: George H. Gallup International Institute, 1992. 9. Institute of Medicine. Growing up tobacco free: preventing nicotine addiction in children and youths. Washington, DC: National Academy Press, 1994. *TAPS respondents who completed the survey by mail questionnaire were not eligible for TAPS-II. TAPS-II included household interviews of persons who did not respond by telephone. **Persons who reported that they had never smoked regularly were excluded from these analyses. ------------------------------ Date: Wed, 26 Oct 94 21:52:51 MST From: mednews@stat.com (HICNet Medical News) To: hicnews Subject: [MMWR] Lead-Contaminated Drinking Water in Bulk-Water Storage Tanks Message-ID: Lead-Contaminated Drinking Water in Bulk-Water Storage Tanks -- Arizona and California, 1993 Lead poisoning is a major environmental health problem for children in the United States (1,2): during 1988-1991, approximately 1.7 million U.S. children aged 1-5 years had elevated blood lead levels (BLLs) (greater than or equal to 10 ug/dL) (3). To determine the source of lead exposure for children with BLLs greater than or equal to 20 ug/dL, the Arizona Department of Health Services (ADHS) conducts environmental investigations. In 1993, as a result of investigations of increased BLLs in two children in southwestern Arizona, ADHS detected lead levels approximately 30 times the Environmental Protection Agency (EPA) action level of 15 parts per billion (ppb) in bulk-delivered drinking water in the homes of these children. Because two of the three companies that supplied bulk water to southwestern Arizona were based in California, ADHS notified the California State Department of Health Services (CSDHS) about the problem. As a result, CSDHS conducted a separate investigation and identified one child with an elevated BLL whose drinking water sources included bulk-delivered water with lead levels exceeding EPA standards. This report summarizes the investigations of elevated BLLs in these three children and high lead levels in bulk-delivered drinking water in Arizona and California. Arizona In July 1993, routine screening by ADHS for lead poisoning detected a BLL of 42 ug/dL (CDC BLL of concern=10 ug/dL) in a 6-month-old infant in Yuma County, Arizona. To determine the source of lead exposure, ADHS initiated an environmental investigation. Lead was not detected in a first-draw water sample from the kitchen faucet, which was connected to a private well. However, the parents reported that the child's formula was prepared using bulk-stored water, and a first-draw water sample taken through the brass fitting of a bulk-water storage tank contained 495 ppb lead. Other potential environmental sources of lead included peeling lead paint on the outside of the house and on one kitchen wall covered with wallpaper. ADHS advised the parents to stop drinking bulk-stored water, informed them about professional paint removal and encapsulation, recommended measures to prevent lead exposure, and notified the water-delivery company about the high lead level in the bulk-stored water. In August 1993, a BLL of 37 ug/dL was detected in a 12-month-old child in Yuma County who was tested by ADHS for lead poisoning following a complaint of abdominal pain. Lead was not detected in a first-draw water sample from the kitchen faucet, which was connected to the municipal water supply. However, the parents reported that the child's source of drinking water was bulk-delivered water, and a first-draw water sample obtained from a kitchen faucet supplied by a bulk-water storage tank contained 450 ppb lead. The investigation also identified lead-contaminated soil (68 ppm) at a relative's home where the child routinely stayed during the day. ADHS advised the parents to stop drinking bulk-stored water, recommended measures to prevent lead exposure, and notified the water-delivery company about the high lead levels in the bulk-delivered water. Two weeks after the first-draw sample was obtained, lead levels in water taken through the brass fitting on the tank and directly from the tank were 1050 ppb and 602 ppb, respectively. Because the source of bulk-delivered water for both cases was a California-based water-delivery company, ADHS notified CSDHS about the potential problem of lead-contaminated bulk-delivered water. California In November 1993, a newspaper report about lead-contaminated bulk-delivered water prompted parents in Imperial County, California, to have their 14-month-old child screened for lead poisoning by the county health department. A BLL of 15 ug/dL was detected in the child. The parents reported that the child's drinking water sources were bulk-delivered water and surface water. A first-draw water sample from the kitchen faucet, which was connected to a bulk-water tank supply, contained 66 ppb lead. After running the water for 3 minutes, a second-draw water sample from the same faucet contained 9 ppb lead. A first-draw water sample from the refrigerator faucet, also connected to the bulk storage tank, contained 50 ppb lead. First-draw water samples obtained from two other faucets in the house, which were connected to a surface water supply, had lead levels lower than the detection limit of 5 ppb. No other potential sources of lead exposure were identified. The county health department advised the parents to stop drinking bulk-delivered water and recommended measures to prevent lead exposure. Investigation of Bulk-Water Sources ADHS identified three water companies (two based in California and one based in Arizona) that supplied bulk water to southwestern Arizona. ADHS obtained water samples from 96 residential and business storage tanks serviced by the two California water companies; no water samples were obtained from the Arizona company because the company used plastic tanks and fittings. Samples were drawn directly from the tanks, from the brass fittings on the tanks, and from the kitchen sinks. Twenty-two (23%) of the 96 water samples contained lead levels exceeding EPA's action level. Samples from three bulk-water delivery trucks containing the source water for the storage tanks met EPA drinking water standards (i.e., less than 15 ppb lead). Both California water companies notified their customers about the possibility of lead leaching from soldered seams and brass fittings in bulk-water storage tanks. In addition, one company identified the sources of lead in its bulk-delivered water: lead solder in tanks manufactured before March 1987, lead-containing brass fittings, and lead solder in household plumbing. The company initiated replacement of all lead-soldered storage tanks and brass fittings and informed homeowners of the probable presence of lead-soldered household plumbing. Reported by: NJ Peterson, MS, FW Chromec, PhD, CM Fowler, MS, P úÿ (continued next message) ÿ@FROM :david@STAT.COM úÿ(Continued from last message) Arreola, MS, E Arvizu, B Erickson, PhD, P Alder, J Soltis, L Sands, DO, State Epidemiologist, Arizona Dept of Health Svcs. V Freeman, M Miramontes, M Johnston, Imperial County Health Dept, El Centro; J Flattery, MPH, R Gambatese, MPH, S Gilmore, MA, R Ehling, MD, AM Osorio, MD, L Barrett, DVM, C Lee, PhD, I Small, GW Rutherford, III, MD, State Epidemiologist, California State Dept of Health Svcs. Lead Poisoning Prevention Br, Div of Environmental Hazards and Health Effects, National Center for Environmental Health, CDC. Editorial Note: In southwestern Arizona and southeastern California, bulk water delivered and stored in tanks is not an uncommon source of drinking water. Approximately 2500 residences and businesses in southwestern Arizona and 8500 in Imperial and San Diego counties, California, are served by bulk-delivered water. Although lead in the bulk-delivered water probably contributed to the high BLLs detected in the children described in this report, the role of other potential sources of lead could not be determined. The Food and Drug Administration (FDA) has proposed a provisional total tolerable intake level of lead for infants and children of 6 ug daily (4). U.S. residents ingest an estimated 5-11 ug of lead daily (5). On average, lead-containing drinking water is estimated to contribute 10%-20% of the total lead exposure for children in the United States (5). For infants and young children, ingestion of only 0.5 L of water per day with a lead concentration of 450 ppb (450 ug/L) will result in a daily dose of lead of 225 ug--a level approximately 38 times higher than FDA's total tolerable intake level. The children described in this report ingested daily doses of lead from six to 41 times higher than the total tolerable intake level. Federal legislation authorizes both FDA and EPA to regulate drinking water (6): the Food, Drug, and Cosmetic Act* empowers FDA to regulate drinking water (including bottled water and water used in food and for processing), and the Safe Drinking Water Act** and other statutes enable EPA to regulate public water systems that provide drinking water for human consumption. In 1986, an amendment to the Safe Drinking Water Act*** prohibited the use of 1) water pipes and pipe fittings with greater than 8% lead and 2) solder and flux with greater than 0.2% lead in public water systems and plumbing (in residential or nonresidential facilities) that provide drinking water for humans and are connected to public water systems (5). Although lead-containing faucets and fittings may comply with the lead restrictions in the Safe Drinking Water Act, lead from these fixtures can leach into the water supply and result in lead levels in drinking water that exceed EPA's action level. To address this concern, guidelines that further limit the amount of lead in plumbing fixtures are being developed by EPA, National Sanitation Foundation International (a nonprofit organization that tests and certifies water products), and the Plumbing Manufacturers Institute. References 1. CDC. Preventing lead poisoning in young children: a statement by the Centers for Disease Control. Atlanta: US Department of Health and Human Services, Public Health Service, CDC, October 21, 1991. 2. Committee on Environmental Health, American Academy of Pediatrics. Lead poisoning: from screening to primary prevention. Pediatrics 1993;92:176-83. 3. Brody DJ, Pirkle JL, Kramer RA, et al. Blood lead levels in the US population: phase I of the Third National Health and Nutrition Examination Survey (NHANES III, 1988 to 1991). JAMA 1994;272:277- 83. 4. Food and Drug Administration. Lead-soldered food cans: proposed rule. Federal Register 1993;58;33860-71. 5. Bolger PM, Carrington CD, Capar SG, Adams MA. Reductions in dietary lead exposure in the United States. Chemical Speciation Bioavailability 1991;3:31-6. 6. US Environmental Protection Agency/Food and Drug Administration. Memorandum of understanding between the EPA and FDA. Federal Register 1979;44:42775-8. *21 U.S.C. 301 et seq. **42 U.S.C. 300 et seq, 1974 ed. ***42 U.S.C. 300 et seq, 1986 ed. ------------------------------ End of HICNet Medical News Digest V07 Issue #53 *********************************************** --- Editor, HICNet Medical Newsletter Internet: david@stat.com FAX: +1 (602) 451-1165 Bitnet : ATW1H@ASUACAD