HICN242 News Part 2/2 
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 HICN242 News Part 2/2

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1970 required by the Federal  Communications  Commission's  Fairness  Doctrine
    The  largest  decrease  in  cigarette  sales  occurred  during  1982-1984,
concurrent with the largest cigarette tax increases:  Wisconsin tax,  from  16
cents  to  25 cents per pack in 1981-1982 and federal tax,  from 8 cents to 16
cents per pack in 1983.  This decrease in  cigarette  sales  in  Wisconsin  is
unlikely  to  be  due  to the purchase of cigarettes by Wisconsin residents in
neighboring states.  Even though the price of cigarettes was 5 cents-10  cents
lower  per pack in Illinois and Minnesota,  Wisconsin netted a 40% increase in
cigarette tax collections from 1981 to 1983.  In addition, cigarette sales did
not increase in Wisconsin in 1986,  when Illinois and Minnesota imposed higher
cigarette  taxes  and  the  interstate  price  differential  disappeared.  The
decrease  in  cigarette sales also coincided with the enactment of Wisconsin's
Clear Indoor Air Act in  1983  (Figure  1)  (5).  This  act  mandated  smoking
restrictions  in government worksites and public places to reduce the exposure
of nonsmokers to environmental tobacco smoke.

Health InfoCom Network News                                             Page 10
Volume  2, Number 42                                      November 16, 1989

    Despite the limitations inherent in ecologic correlations  such  as  this,
the  Wisconsin  data  suggest  that three key antismoking publicity events (in
1952,  1964,  and 1967-1970) helped to reduce  cigarette  sales.  Nonetheless,
each  of  these  periods  of  reduced  sales  was  followed  by an increase in
cigarette sales. Only the fourth period of reduction in cigarette sales (1982-
1984)  has  been  sustained--probably  because  of  continuing  interventions,
including taxes and clean indoor air acts.  This study suggests that,  because
of their continuous nature,  public policy changes such as increased taxes and
clean  indoor  air  acts  are  important  in achieving sustained reductions in
tobacco sales.


1.  Peterson DE,  Remington PL.  Publicity,  policy,  and trends in  cigarette
smoking: Wisconsin 1950-1988. Wis Med J 1989;88(11):40-2.

2.  Tobacco  Institute.  The  tax  burden on tobacco:  historical compilation.
Washington, DC: The Tobacco Institute 1988;23.

3.  CDC.  Reducing the health consequences of smoking: 25 years of progress--a
report of the Surgeon General,  1989.  Rockville,  Maryland:  US Department of
Health and Human Services, Public Health Service,  1989;  DHHS publication no.

4.  Warner KE. Cigarette advertising and media coverage of smoking and health.
N Engl J Med 1985;12:384-8.

5. Wisconsin Statutes Section 101.123 (1987-88).

*Incorporates data from the previous and the following year to  calculate  the
value for a given year.

Health InfoCom Network News                                             Page 11
Volume  2, Number 42                                      November 16, 1989

                  Medical Examiner/Coroner Reports of Deaths
               Associated with Hurricane Hugo -- South Carolina

    At 11:57 p.m.  eastern daylight time on Thursday,  September 21, 1989, the
eye of Hurricane Hugo struck the coast of South Carolina north  of  Charleston
(Figure 1).  Peak wind velocities in Charleston were measured at 135 mph,  and
there was an accompanying tidal  surge  of  12-17  feet.  Heavy  rains  caused
additional  flooding  and  further  damage.  In  addition  to  the  damage  or
destruction to homes and buildings, approximately 900,000 persons in North and
South Carolina were left without electrical power.  After striking the  coast,
Hugo moved across central South Carolina and North Carolina.  On September 22,
the National Weather Service downgraded Hugo to a tropical storm.
    As part of the Medical Examiner and  Coroner  (ME/C)  Information  Sharing
Program at CDC,  public health officials, using contact information in Medical
Examiner and Coroner Jurisdictions in the United States (1), asked ME/Cs in 25
South Carolina counties in the path of Hurricane Hugo to report 1) the  number
of  deaths  in their jurisdictions that they investigated between September 21
and October 6;  2) the number  of  these  deaths  that  were  related  to  the
hurricane; and 3) for the 35 deaths reported as hurricane related, information
about the demographic characteristics, cause, and circumstances of each death.
ME/Cs  reported  that  29 injury deaths were directly related to the hurricane
(Table  1)  and  categorized  the  manner  of  death  for  these  persons   as
"accident"*. In Dorchester and Berkeley counties, coroners reported six deaths
caused  by "heart attacks" attributed to stress associated with the hurricane.
The manner of death in these cases was "natural," and all six  occurred  after
the hurricane.
    No  deaths  are known to have occurred before the storm (preimpact phase),
13 occurred during the storm (impact phase),  and 22 occurred after the  storm
(post  impact  phase).  Of  the  13  traumatic deaths that occurred during the
impact phase,  six persons drowned (five when they attempted  to  bring  boats
inland  from  Charleston  on the Cooper River and one when her mobile home was
struck by the storm surge).  Four persons were crushed by their mobile  homes.
One  person  was  killed  when  his house collapsed during the storm,  and two
others were crushed by trees during the storm (one when a  tree  fell  on  his
house and one when a tree fell on his car).
    Of the 22 postimpact-phase deaths,  16 were traumatic.  Nine resulted from
smoke inhalation or burns from five house fires;  these fires were  attributed
to  the use of candles during power outages.  In one instance,  fire officials
concluded the fire was  the  direct  consequence  of  {*filter*}s  leaving  candles
burning  after  going to bed at night.  Of the five fires,  two separate house
fires were each responsible for the deaths of a mother and two young children.
Five of the nine fire-related deaths were among children aged 1-7 years.
    Four persons were  electrocuted  in  separate  incidents  during  clean-up
activities:  two  of  these were occupationally related deaths (one person was
working on power lines,  and one was repairing a roof).  Two  deaths  resulted
when  bystanders were injured by falling trees (one of these was an 8-year-old
child who died from head injuries sustained when a tree fell on him; the other
was a 27-year-old woman who was trapped under a tree's roots as it  fell  back
into  the  hole  from  which it had been uprooted).  One death was caused by a
chainsaw injury sustained during the clean-up. All deaths occurred immediately
or within 8 hours of the fatal incident.

Reported by:  C Copeland,  Coroner,  Beaufort County;  WB  Smith,  Coroner,  C
Langston,  Deputy  Coroner,  Berkeley  County;  JH Schuler,  Coroner,  Calhoun
County;  S Conradi, MD, Chief Medical Examiner, M Ward, MD,  Medical Examiner,

Health InfoCom Network News                                             Page 12
Volume  2, Number 42                                      November 16, 1989

Charleston County;  EW Wright, Coroner, Chester County;  RI Stephens, Coroner,
Clarendon County;  AA Bryan,  Coroner,  Colleton County;  E Nor ton,  Coroner,
Darlington County;  D Grimsley,  Coroner,  Dillon County;  J Rogers,  Coroner,
Dorchester County;  J Silvia, Coroner,  Fairfield County;  JC Gregg,  Coroner,
Florence County;  WM Williams, Coroner, Georgetown County; RL Edge, Coroner, M
Crossett,  Fire Chief,  Horry County;  LM Sauls,  Coroner,  Jasper  County;  T
Horton,  Coroner,  Kershaw  County;  M Morris,  Coroner,  Lancaster County;  M
Hancock,  Coroner,  Lee County;  HO  Harmon,  Coroner,  Lexington  County;  JM
Richardson, Coroner, Marion County;  P Simmons, Coroner, Orangeburg County;  F
Baron, Coroner, J Anasti, Deputy Coroner, Richland County; DC Gamble, Coroner,
D Jones,  Sumter County  Civil  Defense;  H  McKnight,  Coroner,  Williamsburg
County;  J Chapman,  Coroner,  York County;  JL Jones,  MD,  M Hudson,  MPH, D
Breeden, MD,  South Carolina Dept of Health and Environmental Control.  Div of
Environmental Hazards and Health Effects,  Center for Environmental Health and
Injury Control, CDC.

Editorial Note: ME/C systems have not been fully assessed in disaster settings
for the purpose of surveillance;  however,  a study is in progress by  CDC  to
evaluate  ME/Cs  and other sources of death information in Hurricane Hugo.  As
part of this study,  the completeness  and  accuracy  of  ME/C  data  will  be
    In  South  Carolina,  each  county has a coroner who is usually an elected
official and not a physician (1,2). Charleston County, which includes the city
of Charleston,  has both a  medical  examiner  and  a  coroner.  There  is  no
universally  accepted  definition  of a "hurricane-related death," and for the
purposes of this report, the determination was made by each ME/C. Because each
county in South Carolina has a different official who  used  his  or  her  own
criteria  for  determining  which deaths were hurricane related,  the types of
deaths reported as hurricane related vary among counties.  Furthermore,  other
organizations,  such  as  the  American  Red  Cross  and  the National Weather
Service,  collect information  on  disaster-related  deaths  and  might  apply
different  criteria  in determining disaster-related deaths.  These variations
suggest the need for an improved and uniform definition of  "disaster-related"
    In  the  past,  hurricane-related  mortality  has  resulted primarily from
impact-phase drownings associated with storm surges (3). However, as in Puerto
Rico,  relatively few impact-phase drownings occurred in South  Carolina  (4).
The  principal  public health response to Hurricane Hugo in South Carolina was
early warning and a coordinated evacuation plan.  By the evening of  September
21,  South  Carolina  officials  had ordered the evacuation of persons in low-
lying and high-risk areas  in  six  coastal  counties  (Beaufort,  Charleston,
Colleton,  Georgetown,  Horry, and Jasper) with a total population of 624,000.
Approximately 250,000 persons were evacuated.
    In contrast to Puerto Rico, where only two (22%) of nine hurricane-related
deaths occurred during the impact phase,  13 (45%) of 29 trauma-related deaths
in  South  Carolina  reported  here were impact-phase fatalities.  Four of the
postimpact-phase deaths in  South  Carolina  were  electrocutions  (one  power
company employee, compared with five in Puerto Rico (5)).
    The South Carolina data suggest opportunities for prevention of hurricane-
related deaths.  Accordingly, efforts to educate and prepare the public should
focus on:  1) hazards of power outages, including electrocution and the danger
of  using  candles or open flames for light and heat;  2) the need to evacuate
from mobile homes potentially in the path of the hurricane to a safe location;
3) hazards of boating during high winds;  and  4)  risks  of  injuries  during
disaster clean-up.

Health InfoCom Network News                                             Page 13
Volume  2, Number 42                                      November 16, 1989


1. Parrish RG, Ing R. Medical examiner and coroner jurisdictions in the United
States.  Colorado  Springs,  Colorado:  American Academy of Forensic Sciences,

2. CDC. Death investigation--United States, 1987. MMWR 1989;38:1-4.

3.  French J.  Hurricanes.  In:  Gregg MB,  ed.  Public health consequences of
disasters.  Atlanta: US Department of Health and Human Services, Public Health
Service (in press).

4. CDC. Deaths associated with Hurricane Hugo--Puerto Rico.  MMWR 1989;38:680-

5.  CDC.  Update: work-related electrocutions associated with Hurricane Hugo--
Puerto Rico. MMWR 1989;38:718-20,725.

*"Manner of  death"  and  "accident"  are  medicolegal  terms  used  on  death
certificates  that  refer  to  the  circumstances  under which a death occurs;
"cause of death" refers to the injury or illness responsible  for  the  death.
When  a  death  occurs  under  "accidental" circumstances,  the preferred term
within the public health community for the cause of  death  is  "unintentional


               Trends in Gonorrhea in {*filter*}ly Active Men --
                         King County, Washington, 1989

    Analysis  of  gonorrhea  morbidity  in King County,  Washington,  shows an
increase in gonorrhea among {*filter*}ly active men in 1989. During the 1980s,
substantial declines in the occurrence of gonorrhea in {*filter*} and {*filter*}
men have been documented in the United States and other countries (1-3). These
trends have been considered to reflect changes in {*filter*} behavior in  response
to the epidemic of acquired immunodeficiency syndrome (AIDS).
    King  County  has  a  population  of  1.4  million  and  includes  Seattle
(population 496,000).  Gonorrhea cases are reported to the Seattle-King County
Department of Public Health by age,  gender, race/ethnicity, and anatomic site
of infection.  Patients diagnosed in the  Seattle-King  County  Department  of
Public  Health's  {*filter*}ly  transmitted  disease  (STD)  clinic  at Harborview
Medical Center are further classified as hetero{*filter*}, {*filter*}, or {*filter*}
on the basis of the reported gender of their sex partners.
    From 1982 through 1988,  declines occurred for the annual number of  cases
of  gonorrhea in {*filter*} and {*filter*} men attending the STD clinic,  and of
rectal gonococcal infection reported by the private medical sector (Figure 1).
STD clinic gonorrhea cases in {*filter*}ly active men  declined  from  720  in
1982  to  27  in 1988 (-96%).  However,  71 cases were reported in the first 9
months of 1989.  Based on this observation, an estimated 100 cases (seasonally
adjusted)  are  anticipated  in 1989.  A similar decline occurred for cases of
rectal gonococcal infection in men reported by  the  private  medical  sector:
from  217  cases  in  1982  to  six in 1988 (-97%).  Eight cases were reported
through September 1989, and 12 are projected for the year.

Health InfoCom Network News                                             Page 14
Volume  2, Number 42                                      November 16, 1989

    In contrast,  the number  of  gonorrhea  cases  in  the  total  population
continued  to decrease in 1989.  Total reported gonorrhea cases in King County
declined 27%,  from 4709 (371 per 100,000 population) in 1982 to 3443 (244 per
100,000 population) in 1988. Through September 1989, 2416 cases were reported,
with  an  estimated  3200 cases (223 per 100,000 population) projected for the
year, a further 6% decline.
    The age distribution of public clinic cases in {*filter*} and {*filter*} men
remained relatively constant from 1982 through September 1989. In 1989, 79% of
the {*filter*} or {*filter*} men with gonorrhea were  non-Hispanic  whites,  13%
were  non-Hispanic  blacks,  and  8% belonged to other racial or ethnic groups
(primarily Hispanics);  this distribution did not change from  1982  to  1989.
Among  STD clinic hetero{*filter*}s with gonorrhea in 1989,  36% were non-Hispanic
whites,  50% were non-Hispanic blacks,  and 13% belonged to  other  racial  or
ethnic groups.

Reported by:  HH Handsfield,  MD,  B Krekeler,  MHA,  STD Control Program,  RM
Nicola,  MD,  Seattle-King County Dept of Public Health,  Washington.  Div  of
{*filter*}ly Transmitted Diseases, Center for Prevention Svcs, CDC.

Editorial  Note:  These  data  suggest  that  the number of gonorrhea cases in
{*filter*}ly active men in King County may triple  in  1989  from  1988.  This
increase  cannot  be  readily explained by differences in screening or testing
procedures at the STD clinic.  Throughout the 1980s,  patient-care  approaches
have  been  constant,  case  reporting systems for the private sector have not
been revised,  and emphasis on partner referral activities for  patients  with
gonorrhea has not been modified.  In addition,  the age and race distributions
of {*filter*}ly active men with gonorrhea have not changed during  the  1980s.
These demographic patterns suggest that the increase is not limited to a group
of  younger  men  nor to a specific racial group for which different levels of
commitment to safer sex practices may exist.
    Although reasons for this increase are uncertain,  at least two hypotheses
can be considered.  First,  the increase may be confined to men who have never
fully adopted safer sex practices.  Strains of Neisseria gonorroheae may  have
been  introduced or reintroduced into a subpopulation of men with stable high-
risk patterns of {*filter*} behavior.  Thus,  the increase might reflect variation
within existing STD core populations (4).  Second,  the frequency of high-risk
behavior may have increased.  For example,  because of declining incidence  of
STD  and  human  immunodeficiency  virus  (HIV) infections,  some {*filter*}ly
active men may have relaxed behaviors  regarding  {*filter*}  safety  (1-3,5).  In
addition,  maintenance  of  profound lifestyle changes,  such as abstinence or
monogamy,  may become more difficult with time and "risky {*filter*} relapse"  (6)
could occur. Additional efforts may be required to maintain positive lifestyle
changes  of  {*filter*}ly  active  men.  These  positive  behavior changes are
considered to have contributed to the substantial overall decline  during  the
1980s in gonorrhea among {*filter*}ly active men in King County (Figure 1).
    Studies of {*filter*}ly active men with gonorrhea are now being planned in
Seattle-King  County  to  evaluate  these two possible explanations.  However,
these data from King County support the need for continued careful  monitoring
of  STD  trends  in {*filter*} and {*filter*} men at the local level.  State and
local health departments are encouraged to implement such monitoring in  areas
where it is not under way.


1.  Judson  FN.  Fear  of  AIDS and gonorrhea rates in {*filter*} men.  Lancet

Health InfoCom Network News                                             Page 15
Volume  2, Number 42                                      November 16, 1989


2.  Handsfield HH.  Decreasing incidence of gonorrhea in  {*filter*}ly  active
men--minimal effect on risk of AIDS. West J Med 1985;143:469-70.

3.  Peterson CS, Sndergaard J, Wantain GL.  AIDS related changes in pattern of
{*filter*}ly transmitted disease (STD) in an STD clinic in Copenhagen.  Genitourin
Med 1988;64:270-2.

4.  Rothenberg RB. The geography of gonorrhea: empirical demonstration of core
group transmission. Am J Epidemiol 1983;117:688-92.

5.  Hessol NA, O'Malley P,  Lifson A,  et al.  Incidence and prevalence of HIV
infection  among  {*filter*}  and  {*filter*}  men,   1978-1988  (Abstract).   V
International Conference on AIDS. Montreal, June 4-9, 1989:50.

6.  Ekstrand ML, Stall RD, Coates TJ, McKusick L.  Risky sex relapse, the next
challenge  for AIDS prevention programs:  the AIDS Behavi{*filter*}Research Project
(Abstract). V International Conference on AIDS.  Montreal, June 4-9, 1989:699.

Health InfoCom Network News                                             Page 16
Volume  2, Number 42                                      November 16, 1989


                           Test for HCV on Horizon?
                         from ADA News October 9, 1989

Chiron Corp and  Ortho  Diagnostic  Systems  have  asked  the  Food  and  Drug
Administration  for  permission  to manufacture and market a screening test to
detect antibodies to hepatitis C virus.

Identified as the major cause of non-A,  non-B hepatitis,  HCV is  transmitted
mostly  through  {*filter*}  transfusions.  About 175,000 people in the country and
700,000 people worldwide are infected each year.  The virus also "account  for
a  substantial  proportion  of  hepatitis  cases  among patients with frequent
parenteral exposure to {*filter*}," according to the August 5 Lancet.

This test will help determine the prevalence of HCV in the general population.
Explained  Chakwan  Siew,  PhD,  director  of  the  ADA  Research  Institute's
Department of Toxicology,  the hepatitis C virus is similar in transmission to
the hepatitis B virus.  "Because the dental profession is at a higher risk  to
HBV, it would seem likely that the same would hold true for HCV.  Since we are
unable to test for HCV in the past, we do not have any data."

Although  the  new  HCV  test is not on the market,  Dr.  Siew said Chrion had
agreed to test {*filter*} samples sent to it from the ADA Health Screening  Program
at  annual  session.  "Unfortunately,  we  can't  give  results to individuals
because this is being done on an experimental,  research  basis  to  determine
prevalence," Dr.  Siew said. "We can't officially incorporate the test as part
of  the  HSP  until  is  has FDA approval because of liability and reliability

The new test,  a recombinant-based immunoassay for antibodies for hepatitis C,
is  one  part  of  an agreement among Chron,  Ortho and Abbott Laboratories to
collaborate in developing  and  supplying  hepatitis  C  diagnostic  products.
Abbott is working on a screening test that uses the Chiron hepatitis C antigen
and  will  seek FDA market approval later this year.  The three companies said
they will share their future developments in hepatitis C diagnostics.

Ortho and Chiron earlier this year began marketing a recombinant antigen-based
hepatitis  B  core  antibody  test  which  uses  an  antigen   developed   and
manufactured by Chiron.

Health InfoCom Network News                                             Page 17
Volume  2, Number 42                                      November 16, 1989

                             General Announcments

                CUSSNET (Computer Users in the Social Sciences)

    uucp:  gatech, ames, rutgers !ncar!noao!asuvax!stjhmc!cussnet-request

CUSSNET (Computer Users in the Social Sciences)  is  a  network  of  students,
faculty,  and  professionals  working  in  a  variety of social science/social
service settings and who  have  concerns  with  practice,  education,  ethics,
computerization,  and  career  advancement,  to  name  a  few.   Many  of  the
participants are students of social work,  practicing social workers or social
work educators;  however, anyone with an interest in the human services/social
sciences/social services areas is welcome to participate.  Recent topics  have
included ethics,  computerization concerns,  social work education topics, job
announcements, and adaptive technology topics.

Health InfoCom Network News                                             Page 18

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