Maps of regional morbidity and mortality rates are useful tools in determining spatial patterns of disease. Combined with socio-demographic census information, they also permit assessment of environmental justice, i.e., whether certain subgroups suffer disproportionately from certain diseases or other adverse effects of harmful environmental exposures. Bayes and empirical Bayes methods have proven useful in smoothing crude maps of disease risk, eliminating the instability of estimates in low-population areas while maintaining geographic resolution. In this paper we extend existing hierarchical spatial models to account for temporal effects and spatio-temporal interactions. Fitting the resulting highly-parametrized models requires careful implementation of Markov chain Monte Carlo (MCMC) methods, as well as novel techniques for model evaluation and selection. We illustrate our approach using a dataset of county-specific lung cancer rates in the state of Ohio during the period 1968--1988...

environmental health its highest priority. Data on how and when children may be at risk are vital for accomplishing this goal. Recent examples of the link between research and policy include U.S. EPA actions to carry out the recommendations of the National Academy of Sciences on pesticides in children's food, reduce and prevent childhood lead poisoning, and revise national ambient air quality standards for ozone and particulate matter. Today, the Food Quality Protection Act (FQPA), which makes protecting children from pesticide residues in food a national priority, is contributing to the growing need for data for decision making. Further impetus comes from provisions in the FQPA and 1996 Safe Drinking Water Act Amendments for establishing a screening and testing program for potential risks from endocrine disruptors. Another factor is the analysis that will be required under President William J. Clinton's executive order directing all federal agencies, for the first time, to reduce environmental health and safety risks to children. Success of the U.S. international commitment to protect children is directly tied to the strength and availability of environmental data. To meet such challenges, the U.S. EPA is revising key science policies, expanding research opportunities, and adding to the public's right-to-know tools. In this dynamic climate, there are growing opportunities for the research community to play a greater role in helping ensure the wellbeing of children living today and in generations to come. Environ Health Perspect 1 06(Suppl 3):

To Mom, Dad, and Crystal, for always believing in me and being such great blessings and sources of strength and encouragement during this time and all my life. I love you all. vii

Obstetrical crisis in Canada: The decline of intrapartum care by family physicians L. Bartlett

This Provisional PDF corresponds to the article as it appeared upon acceptance. Fully formatted PDF and full text (HTML) versions will be made available soon. Using the National Health Interview Survey to understand and address the impact of tobacco in the United States: past perspectives and future considerations Epidemiologic Perspectives & Innovations 2008, 5:8 doi:10.1186/1742-5573-5-8

The Impact of Violence in Pennsylvania 2 for grants to communities to develop strategies to address juvenile problems and $17 million for new or expanded correctional facilities. The budget also allocated increased federal funds to provide services to victims of domestic violence and to educate school-aged children about rape prevention. The objective of this report is to systematically identify the relative frequency of violence in Pennsylvania, and to estimate the health care costs related to it. This information serves two purposes; (a) it identifies the impact of violence on the health care system in Pennsylvania, and (b) it provides information of relevance to the evaluation of violence prevention programs. Background Violence often appears to be an intractable problem in the United States. Crime, and specifically homicide, has been an important concern for Americans for many years. Concerns about violence have led to interest in finding better ways to prevent and control viol...

expert on the methods of cost-effectiveness analysis in health care. He is engaged in numerous research projects concerned broadly with issues of resource allocation and decision making in health policy. He directs the Program on Economic Evaluation of Medical Technology, a unit in the Harvard Center for Risk Analysis. He is principal co-investigator for methodology in the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) research group, whose purpose is to evaluate the health and economic consequences of alternative policies for the identification and treatment of persons with HIV infection in the US and the developing world. He co-directed a similar modeling effort in coronary heart disease, which has been used to estimate the cost-effectiveness of national guidelines for serum cholesterol reduction; to evaluate the costs and consequences of alternative drug therapies for hypertension; to predict changes in life expectancy achievable by prevention of coronary heart disease; and to assess the relative contributions of prevention and treatment in the decline of coronary heart disease mortality. His methodological research concerns the adaptation and use of infectious disease transmission models in cost-effectiveness analyses, and the analysis and representation of uncertainty in economic evaluations. Dr. Weinstein was co-chairman of the Panel on Cost-Effectiveness in Health and Medicine and is a member of the Institute of Medicine. He has served on several of IOM’s committees, including the Committee on Priorities for

• About one-third of adults complied with most—six or more out of nine—of the recommendations. Persons 60 years and older were more likely to have high compliance than those 20–59 years old. • Persons with higher income were more likely to have high compliance than persons in the lower income categories. • Over 90 percent of adults reported having their blood pressure checked in the last two years and only 62.6 % of adults reported having their blood cholesterol checked in the past five years. • Dietary recommendations in general and the daily fruit intake recommendation in particular were least likely to be followed, even among those with high compliance. A number of U.S. Department of Health and Human Services programs recommend behaviors to reduce risk of cardiovascular disease (CVD), including the National High Blood Pressure Education Program (NHBPEP) and the National Cholesterol Education Program (NCEP) (1–6). The objective of this report is to estimate the prevalence of persons engaging in multiple behaviors recommended to reduce risk of CVD. Behaviors identified by NHBPEP and NCEP as primary lifestyle modifications to reduce CVD risk include physical activity, four dietary recommendations, smoking abstention, moderate alcohol consumption, and screening for high blood pressure and high blood cholesterol (5,6).

The suicide rate for American Indians/Alaska Natives was 10.84 per 100,000, higher than the overall US rate of 10.75. Adults aged 25-29 had the highest rate of suicide in the American Indian/Alaska Native population, 20.67 per 100,000. Suicide ranked as the eighth leading cause of death for American Indians/Alaska Natives of all ages. • Suicide ranked as the second leading cause of death for those from age of 10 to 34.

overall U.S. rate of 10.75 per 100,000. • Young males (ages 20-24) had the highest rate of suicide in the black population, 18.18 per 100,000. • Suicide was the third leading cause of death for Black Americans between the ages of 15 and 24. Black Americans have a lifetime prevalence rate of attempted suicide of 4.1%, similar to the general population rate of 4.6%. 2