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Highlights From AHCPR's August Research Activities

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Media Advisory: September 3, 1998

The Agency for Health Care Policy and Research (AHCPR) works to improve the quality of health care, reduce costs, and broaden access to essential services. Here are some of the findings described in the most recent issue of AHCPR's Research Activities.

Racial Differences in Nicotine Metabolism Mean that Blacks Take in More Nicotine Per Cigarette than Whites

Black cigarette smokers take in 30 percent more nicotine per cigarette than white smokers and take nearly two hours longer to clear cotinine, a nicotine metabolite from the bloodstream, according to a study funded in part by AHCPR. This means that blacks who smoke 12 to 15 cigarettes per day get as much as whites who smoke a full pack of 20 cigarettes a day. Researchers simultaneously infused nicotine and cotinine into the bloodstream of 40 black and 39 white smokers of similar age at San Francisco General Hospital Medical Center. Blacks had blood levels of cotinine that were 50 percent higher per cigarette than whites, and blacks also cleared cotinine significantly more slowly from their blood streams. In addition, the nicotine intake per cigarette was 30 percent greater in blacks than whites (1.41 vs. 1.09 mg per cigarette). Most blacks (78 percent) smoked mentholated cigarettes, compared with only 5 percent of white smokers, and they tended to smoke brands with a higher content of nicotine, tar, and carbon monoxide. This study suggests that there may be a racial genetic difference in cotinine metabolism, however, smoking mentholated cigarettes also may influence cotinine metabolism.

["Nicotine metabolism and intake in black and white smokers," by Eliseo J. Perez-Stable, M.D., Brenda Herrera, M.S., Peyton Jacob III, Ph.D., and Neal L. Benowitz, M.D., in the July 8, 1998, Journal of the American Medical Association 280(2), pp. 152-156.]

Today's Primary Care Physicians Are Being Asked to Approach Their Practices with a Community Perspective

Primary care physicians (PCPs) are being asked to step out of their offices and into the neighborhoods where their patients live and work to help solve some of their communities' health problems. University of North Carolina researchers found that two-thirds of younger PCPs had spoken to community groups about a health issue in the past two years. However, only one-third had worked with a community group to address a local health problem. The AHCPR-funded study also found physicians who worked with poor and minority groups were less involved in their communities than other physicians. These findings are based on a survey of 247 PCPs who graduated from medical school between 1985 and 1990 in the United States.

["The four community dimensions of primary care practice," Donald E. Pathman, M.D., M.P.H., Beat D. Steiner, M.D., M.P.H., Eric William, Ph.D., and Toija Riggins, Ph.D., in the April 1998 The Journal of Family Practice 46(4), pp. 293-303.]

Women with Chronic Disease Are Less Likely than Other Women to Undergo Screening for Breast and Cervical Cancer

Although screening for breast and cervical cancer reduces death from those diseases by 20 to 60 percent, such screening is underused. According to a study supported by AHCPR, women with chronic conditions, such as diabetes in particular, are less likely to be screened. Researchers at the University of Alabama reviewed the medical records of 1,764 women aged 43 and over who were followed for about three years in two of the university's primary care clinics, checking their screening history against the recommendations of the U.S. Preventive Services Task Force. They found that woman were less likely to be screened if they had multiple chronic medical conditions. With each additional chronic condition, a woman was 17 percent less likely to have had a mammogram, 13 percent less likely to have had a clinical breast exam, and 19 percent less likely to have had a Pap smear within the recommended time period. Researchers conclude that there may be two possible explanations: one, care associated with the chronic condition may be competing with screening, or clinicians may be less likely to use cancer screening in elderly patients or in patients whose life expectancy has been shortened by disease.

["Chronic disease as a barrier to breast and cervical cancer screening," by Catarina I. Kiefe, Ph.D., M.D., Ellen Funkhouser, Ph.D., Mona N. Fouad, M.D., M.P.H., and Daniel S. May, Ph.D., in the June 1998 Journal of General Internal Medicine 13, pp. 357-365.]

Treating Acute Asthma Attacks in Special ER Observation Units Is More Effective and Costs Less than Inpatient Care

Asthma patients treated in emergency department observation units (EDOUs) for 12 hours have better outcomes and cost less to treat than those who are admitted to the hospital from the emergency department if their asthma hasn't resolved after 3 hours, says an AHCPR-supported study. These patients should remain in the ED up to 12 hours before physicians decide to hospitalize them, conclude the study's authors. They randomly assigned 113 adult asthma emergency department patients whose asthma didn't resolve in three hours to a hospital EDOU or inpatient care. EDOU patients had better health status in five of eight areas measured after treatment and had lower treatment costs than hospitalized patients ($1,202 vs. $2,247).

["Emergency department observation unit versus hospital inpatient care for a chronic asthmatic population," by Robert J. Rydman, Ph.D., Miriam L. Isola, Dr.P.H., Rebecca R. Roberts M.D., and others, in Medical Care 36(4), pp. 599-609, 1998.]

Other articles in Research Activities include findings on:

  • Educating Mexican American children about their diabetes risk.
  • Side effects of early prostate surgery.
  • Reducing dosing errors in patients on high-dose chemotherapy.
  • Hospitalization after outpatient treatment for pneumonia.
  • Providers' responses to reduced Medicare payments.
  • Controlling HMO outpatient costs.
  • Lack of insurance among Medicaid-eligible children.
  • Contracting for specialty care via carve-outs.
  • Insurance coverage for chiropractic care.
  • Use of the ER for nonurgent care.
  • Use of carotid endarterectomy to prevent stroke.
  • Use of antibiotics to treat prostatitis.
  • Diagnosis of depression among the elderly.
  • Reducing the risk of death among women with AIDS.
  • Comparing HIV seropositive and high-risk seronegative women.
  • Community programs for patients with HIV disease.
  • Implementation of practice guidelines.
  • Career choices of medical students.
  • Factors that influence physician work satisfaction.

For additional information, contact AHCPR Public Affairs: Salina Prasad, (301) 427-1864 (

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