Tip Sheet for American Journal of Public Health, January 2006

BODY MASS INDEX NOT AN ACCURATE MEASURE OF DISEASE RISKIt's not a license to pig out over the holidays, but a recent study concluded body mass index is not an accurate measure of a person's risk of early death.

Researchers linked self-reported height and weight data with causes of death and found "normal" weight men with a BMI of 20-25 had the same risk of mortality as men with BMIs classifying them as mildly obese. For women, researchers found the risk of mortality is smallest for those with BMIs or 23-24, and mortality increases steadily with BMI greater than 27. Yet mortality risk increases in the study were small for those with BMIs of 25-35, suggesting "negligible risk differences for minor differences in weight for most of the population." [From: "A Semiparametric Analysis of the Body Mass Index's Relationship to Mortality." ]

LOWERING LEGAL DRINKING AGE INCREASES TEENS'CAR CRASH RISKSince New Zealand lowered the legal drinking age from 20 to 18, the country has seen an increase in traffic crash injuries among 15-to-19-year-olds.

Researchers analyzed traffic crash data before and after the 1999 law change and found a 12 percent increase in injuries for 18-to-19-year-olds and a 14 percent increase among 15-to-17-year-olds.

The study's authors pointed out that vehicle crashes were only "part of the total picture of alcohol-related harm among young people. Other effects attributed to reducing the drinking age observed in other countries include increases in non-injury hospitalizations, suicide, and juvenile crime."

The authors strongly encouraged lawmakers to consider raising the legal drinking age as well as implementing such strategies as limiting liquor outlets' operating hours and increasing alcohol taxes. [From: "Traffic crash injuries among 15-19 year-olds and the Minimum Purchasing Age for Alcohol in New Zealand." ]

BREASTFEEDING CRITICAL TO CHILDREN'S HEALTH IN SOME COUNTRIES HARD HIT BY HIVBreastfed infants who are forced to wean before their second birthday in developing countries face a high risk of death, a particular concern given the high HIV rates in sub-Saharan Africa.

According to a study of 12,208 children born between 1988 and 1997 in rural Senegal, less than 1 percent of the children were weaned before 15 months of age. The main reasons for weaning were a mother's death or new pregnancy. More than one in four of the children weaned before 15 months died before their second birthday, according to the study. Other recent studies have shown the importance of breastfeeding in the health of sub-Saharan African infants and children.

"Given the rarity of non- or only briefly breastfed infants in sub-Saharan Africa, prospective studies of infants of HIV-1 positive mothers are needed to provide reliable estimates of the effects of early weaning and type of replacement feeding on infant morbidity and mortality in various African contexts," the study's authors said. "Re-lactation by wet-nurses tended to be associated with lower child mortality, so despite its multiple constraints this strategy deserves further investigation in settings where it is culturally acceptable." [From: "Early breastfeeding cessation in rural Senegal: causes, modes and consequences." .]

LOW SOCIOECONOMIC STATUS MAY INCREASE HEART ATTACK AND STROKE RISK FOR MENAn 11-year follow-up study of nearly 600,000 Korean men ages 30-58 found lower socioeconomic status was linked to higher risks of death from myocardial infarction and stroke.

The findings held true even if higher-income men had one or more risk factors for heart disease and stroke, such as smoking cigarettes, being overweight or having high blood pressure. The study's authors say their findings point to the need for better health care access and education across the economic spectrum about the symptoms of heart attack and stroke. [From: "Socioeconomic position and cardiovascular disease in men. The Korean National Health Service prospective cohort study." .]

TEACHING HOSPITALS IMPORTANT FOR BREAST CANCER TREATMENT AMONG MINORITIES AND THE MEDICALLY UNDERSERVEDEven though the American Association of Medical Colleges recognized that teaching hospitals diagnosed 12.5 percent of breast cancer cases in Florida, teaching hospitals cared for 21.3 percent of uninsured or Medicaid-insured women who needed breast cancer treatment.

The study, based on data collected by the Florida Cancer Data System from July 1997-December 2000, found that for adjuvant chemotherapy use, women diagnosed in Florida 's teaching hospitals were more likely to receive therapy regardless of health insurance or race/ethnicity. Hispanics had a higher likelihood of receiving combined adjuvant therapy, while women with private insurance and Medicare were less likely to receive similar therapy. The study's authors believe their findings may hold true for teaching hospitals across the country. ""¦[I] n an environment of threatening cuts to Medicaid and funding decreases to teaching hospitals, this study provides support for maintaining or increasing funding to these health care facilities because of the significant amount of care they provide to minority, uninsured and Medicaid-insured women," the study's authors wrote. "Ultimately, delivery of appropriate breast cancer treatment based on stage at diagnosis will lessen disparities noted among medically underserved women." [From: ""The roles of teaching hospitals, insurance status, and race/ethnicity in receipt of adjuvant therapy for regional-stage breast cancer in Florida." .]

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The American Journal of Public Health is the monthly journal of the American Public Health Association, the oldest organization of public health professionals in the world. APHA is a leading publisher of public health-related books and periodicals promoting high scientific standards, action programs and policy for good health. More information is available at http://www.apha.org.