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OBJECTIVES: The results of an evaluation of "Eat for Health," a supermarket nutrition intervention, are presented. The study tested whether such a program could be successfully carried out and whether it could effect changes in knowledge, attitudes, and food purchasing behavior in line with nutrition and cancer risk reduction guidelines. METHODS: The evaluation consisted of an in-store monitoring element, an in-store and telephone consumer survey, and an analysis of sales data on selected foods. A matched-pair design, using a total of 40 stores in the intervention and comparison groups, was used. RESULTS: The intervention was successfully implemented and had limited success in changing some food purchasing behaviors. There appeared to be no effect on knowledge and attitudes except for increased awareness of a link between diet and cancer and of the program itself. CONCLUSIONS: Despite the intervention's success, limitations of the consumer survey and sales data analyses and the continuing diffusion of nutrition messages throughout society make it difficult to specify the impact of this program on consumer nutrition knowledge and behaviors.

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Data from the 1987 National Health Interview Survey Cancer Control Supplement were used to estimate multivariate logistic regression models of diet change, mammography utilization, stool blood test utilization, and smoking. Predictor variables included race, sex, age, income, dietary concerns, and four knowledge-related variables: education and three measures of cancer prevention knowledge. When knowledge variables were included in the models, race was not a significant predictor of behavior, with one exception: among women, Blacks were found to smoke less than Whites.

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The growing evidence linking dietary patterns to the incidence and prevention of chronic disease has prompted a number of prominent health and scientific agencies to publish dietary guidelines for the public. Some dietary guidelines address specific diseases, such as cancer or heart disease; others focus on overall health promotion. This situation has created a demand for nutrition education and information programs for the public. Increasingly, supermarkets are seen as potential sites for effective consumer education. Eat for Health is a joint research study by the National Cancer Institute (NCI) and Giant Food Inc., a regional supermarket chain in the Washington-Baltimore area. The study's goal was to test the feasibility of supermarkets as a site for consumer nutrition education. Eat for Health's educational focus was diet and cancer control issues in the context of dietary patterns that promote health. Particular attention was paid to reduction of fat intake and increases in consumption of dietary fiber from grains, vegetables, and fruits. Analysis of program results is currently underway; data should be available in early 1990.

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The American Cancer Society (ACS) Plan for Youth Education for the Year 2000 is discussed in consideration of other health initiatives such as the U.S. Dept. of Health and Human Services' Objectives for the Nation and the National Cancer Institutes' Cancer Control Objectives for the Year 2000. Objectives of the ACS Plan are detailed with corresponding data sources to monitor progress. The Plan is designed to serve as a framework for ACS program planning, implementation, and evaluation in substance use, nutrition and eating patterns, cancer-early detection, cancer-the disease, and the environment. Justification for selecting the priority program areas also is described.

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Though implementing health education in schools has numerous advantages, many barriers impede adoption of effective curricula. Diffusion theory provides a framework for understanding why some school systems do not implement comprehensive, sequential, and behaviorally oriented curricula. Reasons for failure to provide optimal health education include competition for time, unawareness of resources and research results, political considerations, long-range planning difficulties, lack of teacher training, lack of testing, other academic priorities, uncertainty about responsibility for health education, and costs. Health educators can overcome such difficulties by working within existing curricular agendas, political interests, and budgets, and by organizing interventions through school health councils, while recognizing local programs, conditions, and resources.

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The National Adolescent Student Health Survey (NASHS) provides information on student knowledge, attitudes, and self-reported practices of eighth and 10th grade students in eight health areas. Data from the NASHS were reviewed relative to cancer risk factors, specifically, smoking, smokeless tobacco use, and nutrition. About 21% of 10th grade students reported smoking and a large percentage of both eighth and 10th grade students reported eating foods high in fat. The data indicate youth may be at increased risk for cancer and that much of that risk can be reduced by eliminating smoking and lowering dietary fat.

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With the increased availability of personal computers and statistical software packages, it is inevitable that there will be increasing attempts by clinical investigators to perform data management and statistical analysis. Reviews of statistical packages are abundant in computer and statistical journals. However the majority of them were not written for clinical investigators in medicine. This paper presents an analytic approach to evaluate the suitability of statistical packages for use by clinical investigators for data-management and preliminary statistical-analysis purposes. The evaluation scheme addresses five areas of concern: availability of data-management features; availability of basic statistical-analysis features; ease of use; documentation; and quality of programs. Among six statistical packages reviewed by this process, CRISP is recommended as the most suitable package for clinical investigators to use for data-management and preliminary statistical-analysis purposes.

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Clinical and laboratory features of 86 infants admitted with diarrhea and dehydration were evaluated prospectively. Human rotavirus (HRV) infection was documented in 35 infants (41%) by the Rotazyme test. Those with HRV gastroenteritis (HRV+ group) had a shorter duration of diarrhea prior to admission, more severe dehydration on presentation, and a longer hospital course than the HRV-negative (HRV-) group. Vomiting, fever, upper respiratory tract symptoms, otitis media, and cough were present in equal numbers of infants in both groups. The HRV+ infants had lower serum bicarbonate and higher serum albumin, alanine aminotransferase, aspartate aminotransferase, and uric acid concentrations than did the HRV- infants. Serum uric acid levels greater than 10 mg/dL (590 mumol/L) were present in 69% of HRV+ vs 29% of HRV- infants. The Rotazyme test was found to be a valuable tool in diagnosis; testing on two days increased the yield from 74% to 97% of all infants finally diagnosed as HRV+. The optimal time for testing was within the first five days of illness.

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Over a 6-week period, 35 (41%) of 86 infants admitted with diarrhea and dehydration were found to have human rotavirus (HRV) gastroenteritis, using the Rotazyme (RTZ) test. Serum transaminase levels were measured on 44 infants on admission and 72 infants during the first 3 days of hospitalization. On admission, RTZ-positive (RTZ+) infants had higher mean and median alanine aminotransferase (ALT) levels [mean 87.5 U/L in RTZ+ vs. 50.0 U/L in RTZ-negative (RTZ-), p = 0.001; medium 60 U/L in RTZ+ vs. 41 U/L in RTZ- infants, p = 0.002], and higher mean and median aspartate aminotransferase (AST) levels (mean 64.3 U/L in RTZ+ vs. 44.0 U/L in RTZ- infants, p = 0.008; median 67.5 U/L vs. 42.0 U/L, respectively, p = less than 0.05). On admission, 72% of RTZ+ vs. 19% of RTZ- infants had ALT levels greater than 50 U/L (p = 0.0004). Maximum ALT levels from the first 3 days were also higher in the RTZ+ group (67.7% of RTZ+ vs. 34.1% of RTZ- having levels greater than 50 U/L, p = 0.005). Transaminase elevations did not correlate with dehydration of any electrolyte abnormalities. These findings suggest that transaminase elevations are common in infants hospitalized with HRV enteritis.

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This paper examines the maternal mortality and the age-specific mortality rates for the under 25 year olds in six border regions on the U.S. side of the U.S.-Mexico border and compares them with those of adjoining regions in Mexico. On the U.S. side of the border, the improvement in the general mortality status of maternal and child health from 1970 to 1980 was equal to or better than that of the nation as a whole. Despite this improvement, in 1980 five of the six border regions showed higher mortality rates due to external causes for the 1-4 age-group. On the Mexican side, maternal and child mortality was lower in the border region than in other parts of Mexico but much higher than in the United States. The 1-4 year olds in Mexico had the highest mortality rates among the three age-groups over 1 year of age.

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The California Health Plan for Children, 1979, compiled by the Committee on Health Planning of California, District IX of the American Academy of Pediatrics, is an extensive report on health problems unique to the children of California. Since its publication, many local and state health agencies have been using it as a guide and source of data in their planning efforts for child and youth health. The creation of the plan demonstrated a successful working relationship between health care practitioners and biostatisticians, the acceptance by health professionals of the use of health statistics in planning, the different uses of health statistics in formulating recommendations, and an approach to organizing and summarizing large bodies of data. Nevertheless, our experience indicates that although collection systems for data on population, mortality, natality, morbidity, and health services statistics abound, their use in community health planning for subpopulations is still limited by problems in the definition, validity, and completeness of the data elements. The establishment of an individualized data system for the entire population, to be developed, coordinated, and controlled by one central agency, could be a significant step toward solving these long-standing problems in our data systems.

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Clinical trials of monovalent A/USSR/77 (H1N1) and trivalent A/USSR/77 (H1N1), A/Texas/77 (H3N2), and B/Hong Kong/72 inactivated influenza virus vaccines were carried out in 358 children and adolescents. Only split-virus vaccines were administered to children younger than 13 years of age. No serious local or systemic reactions were observed among the study participants. Two doses of vaccine containing 7-20 micrograms of the A/USSR/77 (H1N1) viral antigen were required to achieve serum titers of hemagglutinin-inhibiting (HA1) antibody greater than 1:40. However, single doses containing 7-20 micrograms of the A/Texas/77 (H3N2) or B/Hong Kong/72 antigens stimulated serum HAI antibody levels of 1:40.

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Vaccine reaction data were obtained from 154 patients with sickle cell disease immunized with tetradecavalent pneumococcal polysaccharide vaccine. There was a high rate (70%) of mild reactions, primarily at the site of injection. Fever over 100 degrees F was uncommon and precipitation of symptoms similar to sickling crisis was rare. Development of local reactions was associated with the level of preimmunization pneumococcal antibody titer.

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One-hundred seventy-four children with sickle cell disease (SCD) were immunized with a single dose of tetradecavalent pneumococcal vaccine. Preimmunization and postimmunization antibody against 13 of the 14 pneumococcal capsular antigens was measured by indirect hemagglutination (IHA). The ability of each antigen to stimulate antibody following immunization was characterized by one of three types of responses: (1) poor antibody response regardless of the age at immunization (capsular types 6A, 14, and 19F); (2) improving antibody response with advancing age at immunization (capsular types 1, 4, 9N, 12F, 18C, and 23F); and (3) good antibody response regardless of age at immunization (capsular types 2, 3, 7F, and 8). An increase in antibody following immunization was significantly correlated (P less than 0.0005) with an increasing level of preimmunization antibody titer for all 13 antigens. Through the first 24 months of study, two episodes of pneumococcal sepsis caused by group 23 pneumococci were documented in two children immunized prior to 24 months of age (incidence rate, 4.40/100 patient-years in children less than 5 years of age), and one additional episode caused by a group 23 pneumococcus occurred in a 5 7/12-year-old child (incidence rate, 0.66/100 patient-years in children greater than 5 years of age). These observations suggest that anamnestic immune response significantly contributed to the enhanced antibody response observed in older children and adults. Only modest vaccine efficacy may be expected among children with SCD who receive a single dose of pneumococcal vaccine.

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Clinical trials using interferon to treat human malignancies are currently hampered by limited supplies of the compound. We have utilized a human tumor cloning system as an assay for the antitumor effects of human leukocyte interferon. Interferon was tested against 62 patients' tumors growing in this soft agar system. A dose-dependent cytotoxic effect of interferon was noted against only five of the patients' tumors. A greater than or equal to 70% decrease in tumor colony-forming units (TCFUs) was noted with one lymphosarcoma cell leukemia, one small cell lung cancer, one adenocarcinoma of the lung, one breast cancer, and a pancreatic cancer. One patient had his tumor cultured in vitro and had a clinical trial with interferon. This patient whose tumor demonstrated in vitro sensitivity had a clinical antitumor effect with interferon therapy. The in vitro results in this study suggest that the human leukocyte interferon currently available has a low level of activity in a human tumor cloning system. Additional testing is needed to determine whether the cloning system can identify the patient(s) who might have an antitumor effect from the interferon.

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