Click for next page ( 392


The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement



Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.

OCR for page 391
8 BLACK AMERICANS' HEALTH 391

OCR for page 391
William H. Johnson Convalescents Mom Somewhere (1941-1942) Gouache, pen and ink National Museum of American Art, Smithsonian Institution, Gift of the Harmon Foundation

OCR for page 391
Who will live and who will die and how much handicap and disability will burden their lives depend in large part on conditions of education, environment, and employment as well as on access to adequate medical services. Health is not only an important "good" in itself, it is also a determinant of life options during the entire life span. For example, lack of prenatal care leads to greater likelihood of infant death, neurological damage, or developmental impairment; childhood ill- nesses and unhealthy conditions can reduce learning potential; adolescent childbearing, substance abuse, and injuries cause enormous personal, social, and health effects; impaired health or chronic disability in adults contributes to low earning capacity and unemployment; and chronic poor health among older adults can lead to premature retirement and loss of ability for self-care and independent living. Health status is therefore an important indicator of a group's social position as well as of its present and future well-being. OVERV! EW This chapter provides data describing trends in black health status and the differential rates of illness, disability, and death that persist between black and white Americans. The discussion focuses on conditions that sustain the continuing health differentials between blacks and whites. We consider bio- medical, environmental, and social factors that contribute to the health outcomes for blacks within defined periods of the life span, giving particular 393

OCR for page 391
A COMMON DESTINY: BLACKS AND AMERICAN SOCIETY attention to poverty and those sociocultural factors that influence access to health services. Although multiple factors contribute to the persistent health disadvantages of blacks, poverty may be the most profound and pervasive determinant. There has been a consistent finding across communities and nations that persons of the lowest socioeconomic status have higher death rates. In a classic study, Kitagawa and Hauser (1973) found that there was a gradient of mortality rates with steady increases from the highest to the lowest social classes. Mortality rates were higher as socioeconomic status declined for both whites and blacks, whether that status was measured by family income, educational level, or occupation. For people of the lowest status, overall mortality was 80 percent greater than for those at the highest socioeconomic level. In addition to increased mortality, almost every form of disease and disability is more prevalent among the poor. Because of the relationship between poverty and health, and because pov- erty has been a persistent problem for blacks in the United States, it is to be expected that blacks' greater poverty is responsible for much of the black- white health disparity. Poverty rates among children cause special concern for their future health status. Poverty in childhood often means lack of proper nutrition, unsafe housing, and poor access to health care or other resources needed for healthy growth and development. During much of the period covered in this study, there was open segrega- tion of medical facilities in the United States. In the 25-year period before 1965, persistent barriers to access to preventive, primary, and hospital care influenced the quality of life and the patterns of illness observed among blacks. Organizations such as the Medical Committee on Human Rights, the National Medical Association, and the Student National Medical Association played important roles in efforts to end discrimination in health care facilities and in health professional schools. Following the 1954 Brown Supreme Court decision, which declared segregation in public schools unconstitutional, ef- forts to desegregate health care facilities intensified. Important events that led to more equal access to medical care for blacks were the Civil Rights Act in 1964 and the Medicaid and Medicare legislation in 1965. Title VI of the Civil Rights Act prohibited racial discrimination in any institution receiving federal funds, thus giving hospitals a powerful in- centive to alter their practices. Hospitals receiving federal funds were forbid- den to deny admission to patients, to subject patients to separate treatments, or to deny admitting privileges to medical personnel solely on the basis of race. Access to health care was further increased when litigation in the 1960s explicitly defined the obligation of hospitals using; federally provided con ~ ~ ~ 1 ~ ~ ~ . ~ 1 . . .1 (~ ~ . 1 . . 1 struct~on tunds to meet their tree care requirements and to serve those unable to pay. A second method of addressing blacks' unequal access to health care con- cerned their underrepresentation in the medical care professions. During the 1960s and 1970s many efforts were mounted to enlarge the representation 394

OCR for page 391
BLACK AMERICANS' HEALTH FIGURE 8-1 Life expectancy at birth, by race and sex, 1950-1985. - cn 70 - llJ A: 65 60 55 White Females _ - Black Females White Males - . - ol I I I I I I I 1950 1955 1960 1965 1970 1975 1980 1985 YEAR Source: Data from the National Center for Health Statistics. Of blacks and other minorities in the health professions. It was believed that access to health care for poor blacks would improve if there were more black physicians. This belief prompted some medical schools to recruit more black and other minority students and to channel them into primary care special- t~es. While the chapter presents facts about past and current health disadvan- tages of blacks compared with whites, the focus on problem areas should not leave the impression that most black Americans are unhealthy. Over the past 50 years, blacks' health status and life expectancies have improved a great deal. A general overview of this point can be made by considering trends in mortality and life expectancy. A useful summary index of the effects of differing mortality rates is the average (mean) life expectancy at birth. It is calculated on the basis of age- specific death rates as of a given date, and it estimates the number of years that will be lived on the average by individuals born in a particular year, assuming a constancy of then-current age-specific mortality rates.) Figure 8-1 summarizes trends in black-white differences in life expectancy at birth. In the 1950-1985 time span, death rates fell for both races, particularly for black females, but whites continued to enjoy an advantage over blacks. The difference in life expectancy of black and white men decreased from a gap of about 11 years in 1940 to a 6-year difference in 1960 and has shown little 1. Mean life expectancy at birth is calculated by methods analogous to the calculation of mean lifetime earnings and employment used in Chapter 6. 395

OCR for page 391
A COMMON DESTINY: BLACKS AND AMERICAN SOCIETY improvement since then. Among women, there has been a consistent pat- tern of relative improvement for blacks, and the racial gap in the mid-1980s was less than one-half its size in 1940. As a result, the advantage in life expectancy black women enjoy over black men increased during this period. The life expectancy of a black male in 1985 (65.3 years) is lower than that already achieved by white males in 1950, 66.5 years (National Center for Health Statistics, 1988:80-81~. Projections of mortality rates into the future are necessarily uncertain, particularly given the current epidemic of acquired immune deficiency syn- drome (AIDS). Nonetheless, we estimate that if the 1950-1985 trends continue, life expectancies for black and white women will converge in the first half of the twenty-first century, but no convergence to white rates can be foreseen for black men (R. Farley, 1985~. These summary statements conceal a complex pattern of age-specific and cause-specif~c changes (Farley and Allen, 1987; U.S. Department of Health and Human Services, 1985e). Among children under age 15, there have been consistent and large decreases in the risk of death, but the death rates for black children are 30 percent to 50 percent higher than those for white children. Between 1950 and the late 1960s, mortality rates actually rose among adult men, especially black men, and fell at a very slow rate among adult women of both races. The last two decades have been characterized by rapid declines in mortality rates, declines that were not foreseen by health experts. Rates have fallen for almost all race-sex groups, but the decline at the older ages, 60 and above, has been unusually sharp, redacting, perhaps, improvements in the income level of the elderly and the government's assumption of many health care costs with Medicare (Crimmins, 1981~. Contagious and infectious diseases were more common causes of death among blacks than among whites in 1940, but that specific cause of disparity has been reduced. Mortality from heart disease declined slowly between 1940 and the mid- 1960s and more rapidly afterward. The pace of change was more rapid for women than men among both races. Improved detection and treatment of hypertension, and changes in smoking, diet, and exercise were factors influ- encing the reductions. There is still a large disparity and excess of black deaths from heart diseases. Mortality from suicide remains much higher for whites than blacks, while cirrhosis and diabetes death rates, although declin- ing rapidly since the late 1960s, remain higher for blacks (R. Farley, 1985~. Two causes of death merit special attention, cancer and homicide. If data from the 1930s and early 1940s are accurate, then blacks formerly had considerably lower cancer mortality rates than whites (Lilienfeld et al., 1972~. This has changed in a dramatic manner. Since the 1940s, there have been particularly sharp increases in death rates from lung cancer for both races, but the rise has been greater among blacks, especially black men. Mortality from other types of cancer has held steady or declined among whites in the last two decades but has increased among blacks. Thus, there is now a substantial excess in cancer mortality among blacks. Homicide has a particu- larly large impact on average life expectancy since its usual victims are young 396

OCR for page 391
BLACK AMERICANS' HEALTH adults. Although recent trends show lower homicide rates among blacks, it remains a leading cause of death for black men. The U.S. Department of Health and Human Services (HHS) Report of the Secreta~y's Task Force on Black and Minority Health (1986b) identified six medical conditions for which the gaps in mortality between whites and blacks are the greatest. The six causes of death, taken together, account for about 86 percent of the excess black mortality in relation to the white population: accidents and homicides (35.1 percent), infant mortality (26.9 percent), heart disease and stroke (14.4 percent), cirrhosis (4.9 percent), cancer (3.8 percent), and diabetes (1.0 percent).2 The report did not attempt to encom- pass the full dimensions of disparities in health status; while the mortality data for these six conditions are important, they do not capture the full personal and societal costs of deaths from other causes and of chronic or acute illness. In particular, this methodology has omitted important health problems of black children. In the rest of this chapter we analyze the health status of black Americans across the life span, using the following divisions: pregnancy and infancy; childhood (ages 1-14~; adolescents and young adults (ages 15-24~; adult- hood (ages 25-65~; and older adults (over age 65) . For each period of life, a few conditions of highest concern have been selected for analysis. In making these choices consideration has been given to magnitude, severity, distribu- tion, and knowledge of contributory factors. We also emphasize the poten- tial for prevention. The black population has benefited from advances in medicine, but not equally with whites. From birth to advanced old age, blacks at each stage of the life cycle still die at higher rates (except for adult black women since 1970) and suffer disproportionately from a wide range of adverse health conditions. When national health objectives for 1990 were established by the Public Health Service (U.S. Department of Health and Human Services, 1980), the black-white disparity in the late 1970s was so great that it did not appear possible to overcome it in the short term. In the areas of infant mortality and deaths by injury, separate and unequal goals for blacks and whites were set. For many of the objectives set by the Public Health Service, the national targets were achieved before 1990 for whites but not for blacks (U.S. Depart- ment of Health and Human Sen~ces, 1986d). Based on recent trends, blacks are not projected to achieve equality in health by 1990 or in the near future. PREGNANCY AND INFANCY Infant mortality, the rate at which children die before their first birthday, serves both nationally and internationally as an indicator of the overall status 2. Access death expresses the difference between the number of deaths actually observed in a minority group and the number of deaths that would have occurred if that group had experi- enced the same death rates for each age and sex as in the white population. 397

OCR for page 391
A COMMON DESTINY: BLACKS AND AMERICAN SOCIETY TABLE 8-l Infant Mortality Rates in Various Countries, 1984 Country Japan Sweden Finland Switzerland Denmark France The Netherlands Norway Canada ~- omgapore Australia United States, white Federal Republic of Germany Great Britain opam German Democratic Republic Belgium Austria Italy New Zealand Israel Greece Cuba Czechoslovakia Bulgaria United States, black Infant Mortality Rate 6 6.4 6.5 7.5 7.7 8.2 8.3 8.3 8.5 8.8 9.2 9.4 9.6 9.6 9.7 10.0 10.7 11.4 11.6 11.6 12.8 14.1 15.0 15.3 16.1 18.4 Notes: The infant mortality rate is deaths per 1,000. Rankings are Tom lowest to highest infant mortality rates based on the latest data available for countries with at least 1 million population and with complete counts of live births and infant deaths, as indicated by the United Nations (1985). Of the health of a community or a nation. Infant mortality in the United States, 10.6 deaths per 1,000 live births in 1985, remains persistently higher than the rate in many other developed nations; Finland, Japan, and Sweden enjoy the world's lowest rates, less than 7 deaths per 1,000 live births (National Center for Health Statistics, 1987c:94~; see Table 8-1. Black rates of infant mortality have remained at approximately twice the rate for whites over the course of this century despite impressive improve- ments for all groups in reduced infant mortality. In 1985, the infant mortal- ity rate for whites was 9.3, for blacks 18.2. After relative stagnation in the 1960s, the infant mortality rate began a rapid decline (see Figure 8-2~. The accumulating evidence (McCormick, 1985) indicates that a major factor in 398

OCR for page 391
BLACK AMERICANS' HEALTH FIGURE 8-2 Infant mortality rates, by race, 1940-1985. 75 70 65 c`' 60 55 m 50 o 45 As 40 co I C) as 35 30 25 20 15 10 5 o \ Relative - \ ~Black/White Odds/ \ t-. i. , ~ 'I, . . I . . . \~ck Infant Mortality White Infant Mortality - ,, 1 1 1 1 1 1 1 1To 1970 1975 19801985 1940 1945 1950 1955 1960 1965 YEAR Source: Data Mom the Nanona1 Center for Health Statistics. 2.0 1.9 o 1.8 ~ of: G oh 1.7 O > 1.6 1.5 the rapid decline after the 1960s has been the increased survival of low- birthweight infants, largely attributed to high-technology, hospital-based management and regional neonatal intensive care units. The national average figures for infant mortality do not show all the disparities between blacks and whites in infant mortality rates across the United States. Black infant mortality rates show considerable variations by region. During 1982-1984, the black infant mortality rate was lowest in the Mountain and Pacific states (15.4 and 16.2 deaths per 1,000 live births, respectively), and highest in the East North Central states (21.7), particularly in Illinois (23.3) and Michigan (23.7) (National Center for Health Statistics, 1987c:Table 14~. Across states, the lowest state mortality rate for black infants (12.5) was higher than the highest state mortality rate (10.1) for white infants. N EONATAL AN D POSTN EONATAL MORTALITY During the first half of this century most of the infant mortality was postneonatal (deaths between 28 days and 1 year) and was caused by low living standards and infectious disease. After 1960, with improved living standards and major advances in control of infection, neonatal mortality 399

OCR for page 391
A COMMON DESTINY: BLACKS AND AMERICAN SOCIETY (death prior to 28 days) became the major component of infant mortality. Low birthweight, 2,500 grams (5.5 pounds) or less, is the major predictor of neonatal mortality and accounts for 60 percent of all infant deaths. Cur- rently, 20 percent of postneonatal deaths are attributed to low birthweight (Institute of Medicine, 1985:29) . The relationship between birthweight and infant mortality has been re- peatedly documented. For infants born weighing less than 2,500 grams, the mortality rate rapidly increases with decreasing birthweight until infants weighing less than 1,000 grams (1.5 pounds) have only a 20 percent chance of survival under optimal care. Compared with normal birthweight infants, low-birthweight infants are almost 40 times more likely to die in the neonatal period; for very low birthweight (1,500 grams or less) infants, the relative risk of neonatal death is much greater. The marked gap in the infant mortality rate between whites and blacks mirrors the more than twofold difference in the rates of low birthweight and very low birthweight between the two groups. Blacks are twice as likely as whites to have low-birthweight infants: black rates are 12.4 per 1,000 live births, and white rates are 5.6 (National Center for Health Statistics, 1987c:27~. This increased risk for blacks also occurs for very low birthweight babies: 2.56 percent for blacks and 0.92 percent for whites (National Center for Health Statistics, 1987c:77~. Blacks account for 16.2 percent of all live births but 30 percent of all low-birthweight newborns and 34 percent of very low birthweight newborns. In the neonatal period there is a survival advantage of black infants in the low-birthweight range, but it is overwhelm- ingly offset by the high percentage of low-birthweight black infants. Some low-birthweight babies are very small but born at full term. How- ever, most low-birthweight infants are born prematurely (preterm). An ana- lytic review of the trends, causes, and preventive approaches to low birth- weight (Institute of Medicine, 1985) identified a high-risk profile that in- cluded such demographic factors as poverty, low educational level, unmar- ried status, and black race; medical factors such as poor obstetrical history, very young or very old age of childbearing, and urogenital infections; and behavioral factors such as use of tobacco, alcohol, or illegal drugs, exposure to toxic substances, and absent or inadequate prenatal care. The report highlighted the importance of black race as a high-risk factor and emphasized the urgent need for research to investigate causes of racial differences in birthweight. The Institute of Medicine (IOM) study showed that babies born in the United States have the best chance, worldwide, for survival at low birth- weights, a condition attributed to the excellence of sophisticated perinatal medical services. However, these medical triumphs are offset by the fact that the United States has continued to have a far higher percentage of low- birthweight babies over the past 25 years than other comparable industrial . , . zeu nations. A national study of low-birthweight births to 2 million white women and 418,000 black women for 1973-1983 showed that the racial disparity in 400

OCR for page 391
BLACK AMERICANS' HEALTH birthweights is increasing (Kleinman and Kessel, 1987~. Births of infants with moderately low birthweights (between 3.3 and 5.5 pounds) decreased much more among whites (16 percent) than among blacks (6 percent). Rates of very low birthweights (less than 3.3 pounds) decreased 3 percent among whites but increased 13 percent among blacks. The study emphasized that preterm birth, not low birthweight per se, is the primary cause of perinatal mortality. Over the decade studied, preterm low birthweight has remained constant and low birthweight at term declined. During the decade of study, blacks were found to be more highly concen- trated than whites in high-risk socioeconomic groups. Furthermore, even blacks who were at low risk in terms of age, marital status, and education had a somewhat higher incidence of preterm delivery than whites who were at high risk in terms of the same factors (17.2 for blacks and 15.1 for whites per 1,000 live births) . Causes of this persistence of black-white differences in birthweight even among black mothers at lower risk were not completely explained. This study also found that the overall contribution of teenage births to low birthweight has been overemphasized: if all teenage births had been prevented in 1983, the low-birthweight rates would have decreased by only 8 percent for whites and 3 percent for blacks. Lieberman and colleagues (1987) concluded that race is not an independ- ent risk factor and that the black-white differences in prematurity rates are attributable to specific medical and socioeconomic characteristics. This study of a hospital-based cohort of 8,903 black and white women found the rate of prematurity to be a function of the number of risk factors present regard- less of which particular risk was present. When single marital status, age under 20 years, on welfare, high school not completed, and maternal anemia were included as factors, essentially all the racial variation in prematurity was explained. A prospective study of a cohort of 29,415 Asian, black, and white pregnant women in a Kaiser-Permanente health maintenance organization considered patterns of mean birthweight and low birthweight; after exami- nation of 22 variables, it was concluded that ethnicity is not an independent risk factor (Shiono et al., 1986~. It is likely that intergenerational effects of socioeconomic conditions on the growth and development of a mother from prebirth to childhood may influence the intrauterine growth of her child. Since many middle-class blacks are the first generation in their family to achieve that status, the designation by current income may mask the effects of maternal childhood poverty. A research project is planned to track the birth histories of a cohort of blacks who have an intergenerational history of sustained economic advan- tage. This group will be drawn from descendants of black physicians who were graduates of Meharry Medical College early in the century (Samuel Kessel, personal communication, l988~. Since the highest infant death rates are associated with preterm birth, research is increasingly being directed to this problem. However, on the basis of existing knowledge, a great many medical conditions that predispose to prematurity could be prevented by appropriate prenatal care. 401

OCR for page 391
A COMMON DESTINY: BLACKS AND AMERICAN SOCIETY signs of access to care. Some of the sensitive indicators such as low birth- weight in neonates, as discussed, have already shown slowed decline or reversals. There are concerns that the adverse effects are pervasive across the life course. Many of the problems responsible for the current gap in health conditions between blacks and whites are problems for which medical knowledge is deficient, for example, knowledge of the causes of hypertension, low birth- weight, or cancer of the prostate. But progress in health status does not always depend on full knowledge of causation. There has been significant recent progress in reducing rates of hypertension among blacks, without further knowledge of its primary causes. Preventive health services and systematic programs of outreach have dem- onstrated their effectiveness in prenatal and infant care. The same concepts apply to other periods of the life span and to such problems as teenage pregnancy, hypertension, AIDS, and to the long-term care that is likely to be a major health problem of the black elderly in the near future. There is also growing awareness of the importance of interventions that provide early treatment or prevent health-damaging personal behaviors relat- ing to sexually transmitted diseases, smoking, drugs, and alcohol. In the specific Oloyectz~es for the Nathan (U.S. Department of Health and Human Services, 1980), the overall goal set by the surgeon general was to improve the health habits of youth and by 1990 to reduce deaths among people aged 15-24 by at least 20 percent, from a 1977 baseline of 115 to fewer than 93 per 100,000. Progress has been made but the goals have not yet been met. A midcourse review by HHS of the status of these objectives in 1986 showed that none of them were met for black youth regarding sexually transmitted diseases, smoking, drugs, or alcohol (U.S. Department of Health and Hu- man Services, 1986b). Many of the problems that contribute to the differentials in health status are not subject to a simple medical solution, but require an understanding of social and individual behavior and an appreciation for comprehensive interdisciplinary approaches. The disparities in black and white rates of ho- micide, teenage pregnancy, or AIDS are not likely to be eliminated purely by medical science even with the best public health expertise available. Due to progress in the prevention and cure of most infectious diseases, chronic diseases are now a significant source of illness in the United States and other developed countries. For both blacks and whites, behavioral fac- tors are crucial in the development and management of these chronic dis- eases. The combination of these behavioral factors with fewer resources to meet daily needs, less opportunity to obtain these resources, and less power to overcome disadvantaged circumstances largely accounts for blacks' poorer health status. ~I.' 1-.' 440

OCR for page 391
BLACK AMERICANS' HEALTH REFERENCES Andersen, R., M. Chen, L. Aday, and L. Cornelius 1987 Health status and medical care utilization. Health Affairs 6(Spring)~1~:136-156. Armstrong, K. A. 1981 A treatment and education program for parents and children who are at risk of abuse and neglect. Child Abuse and Neglect 5:167-175. Association of American Medical Colleges 1983 Minority Students in Medical Education: Facts and Figures. Washington, D.C.: Office of Minority Affairs. Bark, M. L., and G. R. Wilensky 1985 Health care of the poor elderly: supplementing Medicare. Gerontologist 25:311- 314. Bloom, D. E., and G. Carliner 1988 The economic impact of AIDS in the United States. Science 239:604-609. Bohman, M., S. Siquaardsson, and R. Cloninger 1981 Material inheritance of alcohol abuse. Archives of General Ps~hia~y 38:965-969. Botvin, G. J., A. Eng, and C. L. Williams 1980 Preventing the onset of cigarette smoking through life skills training. Journal of Pteventive Medicine 9:135-143. Brenner, M. H. 1983 Mortality and economic stability: detailed analysis for Britain and comparative analysis for selected industrialized countries. International~o?'rnal of Health Slices 13~4~:563. Brody, J. A., and D. B. Brock 1985 Epidemiologic and statistical characteristics of the United States elderly popula- tion. In C. E. Finch and E. L. Schneider, eds., Handbook of the Biology of Ailing. New York: Van Nostrand Reinhold. Centers for Disease Control 1983 N?~=tionSu~veillance. DHHS Pub. No. 8. Washington, D.C.: U.S. Department of Health and Human Services. 1985 ~eventin,g Lead Poisonin,!jr in Young Children. DHHS Pub. No. 99-2230. Washing- ton, D.C.: U.S. Department of Health and Human Services. 1986a Morbidity and Mortality Weekly Port 35:272. 1986b Acquired immunodeficiency syndrome (AIDS) among blacks and Hispanics- United States. Morbidity and Mortality Weekly Port 35~42~:655-666. 1987 Human immunodeficiency virus infection in the United States. Morbidity and Mortality Weekly Report 36: 1-20. 1988a Distribution of AIDS cases by racial/ethnic group and exposure category: United States, June 1, 1981-July 4, 1988. Morbidity and Mortality Weekly Port 55~3~: 1-10. 1988b Differences in death rates due to injury among blacks and whites. Morbidity and Mortality Weekly Report 55~3~:25-32. Chen, Y. 1985 Economic status of aging. Pp. 641-665 in R. B. Binstock and E. Shanas, eds., Handbook of Agings and the Social Sciences. New York: Van Nostrand Reinhold. Conant, M., D. Hardy, J. Sernatinger, D. Spicer, and J. A. Levy 1986 Condoms prevent transmission of AIDS-associated retrovirus. Journal of the American Medical Association 255:1706. Cooper, R.. M. Steinhauer, A. Schatzkin, and W. Miller 1981 Improved mortality among U.S. blacks, 1968-1978: the role of antiracist strug- gle. International Journal of Health Sauces 1 1: 51 1-522 . 441

OCR for page 391
A COMMON DESTINY: BLACKS AND AMERICAN SOCIETY Cravioto, J., and E. R. Delacardie 1978 Nutrition, mental development and learning. In F. Faulkner and J. M. Tanner, eds., Human Growth. New York: Plenum Press. Crimmins, Eileen M. 1981 The changing pattern of American mortality decline, 1940-77, and its implica- tions for the future. American Journal of Sociology 844~6~ :839-854. Curran, J. W., H. W. Jaffe, A. M. Hardy, W. M. Morgan, R. M. Selik, and T. J. Dondero 1988 Epidemiology of HIV infection and AIDS in the United States. Science 239(4840):610-616. Davis, K. 1986 Aging and the health-care system: economic and structural issues. Daedal?~s 115:227-246. Davis, Karen, and Marsha Lillie-Blanton 1987 Health Care for Black Americans: Trends in Financing and Delivery. Paper pre- pared for the Committee on the Status of Black Americans, National Research Council, Washington, D.C. Davis, K., M. Lillie-Blanton, B. Lyons, F. Mullan, N. Powe, and D. Rowland 1987 Health care for black Americans: the public sector role. Pp. 213-247 in David P. Willis, ea., Cements of Health Policy: Impacts on Black Americans, Part 1. Milbank Quarterly (Suppl.~65. Davis, K., and D. Rowland 1983 Uninsured and underserved: inequities in health care in the United States. Mill lank Quarterly 61: 149-176. Davis, R. M. 1987 Current trends in cigarette advertising and marketing. New England Journal of Medicine 316:725-732. Dischinger, P. C., A. Y. Apostolides, G. Entwisle, and J. R. Hebel 1981 Hypertension incidence in an inner city black population. Journal of Chronic Diseases 34:405-413. Dutton, D. B. 1981 Children's health care: the myth of equal access. Pp. 357-440 in Better Health for Our Children: A National Strategy. Vol. 1~ Background Papers. DHHS Pub. No. 79-55071. Washington, D.C.: U.S. Department of Health and Human Services. Easterling, R. E. 1977 Racial factors in the incidence and causation of end-stage renal disease. Transactions of the American Society for Artificial Internal Organs 23:28-33. Eghert, L. D., and I. L. Rothman 1977 Relations between the race and economic status of patients and who performs their surgery. New England Journal of Medicine 297:90. Egbuonu, L., and B. Starfield 1982 Child health and social status. Pediamcs 69(S) :550-557. Engle, P. L., M. Irwin, R. E. Klein, C. Yarbrough, and J. W. Townsend 1979 Nutrition and mental development in children. Pp. 291-306 in M. Winick, ea., Human Nutrition: A Comprehensive Treatise. Vol. 1. New York: Plenum Press. Farley, Pamela 1985 Who are the underinsured' Milbank Memorial Fund Q~rterly/Health and Society 63~3) :476-503. 442

OCR for page 391
BLACK AMERICANS' HEALTH Parley, Reynolds 1985 An Analysis of Mortality, 1940 to the Present. Paper prepared for the Committee on the Status of Black Americans, National Research Council, Washington, D.C. 1986 Racial Trends and Differentials in Mortality: 1940 to 1984. Revision of 1985 paper prepared for the Committee on the Status of Black Americans, National Research Council, Washington, D.C. Parley, Reynolds, and Walter Allen 1987 The Color Line and the Quality of American life. New York: Russell Sage Founda- tion. Francis, D. P., and J. Chin 1987 The prevention of acquired immunodeficiency syndrome in the United States: an objective strategy for medicine, public health, business and the community. ~5o?`r- nal of the American Medical Association 257: 1357-1366. Gibson, R. 1986 Blacks in an aging society. Dacdalus 115:349-372. Gibson, R. C., and J. S. Jackson 1987 The black aged. In Davis P. Willis, ea., Currents of Health Policy: Impacts on Black Americans, Part 2. Milbank Quarterly (Suppl.) 65. Gillum, R. 1979 Pathophysiology of hypertension in blacks and whites: a review of the basis of racial blood pressure differences. Hypertension 1:468-475. Goodwin, D. W., F. Schulsinger, and N. Moller 1974 Drinking problems in adopted and non-adopted sons of alcoholics. Arch zones of General Psychology 31:164-169. Gottesman, L. E., and N. C. Bourestom 1974 Why nursing homes do what they do. Gerontologist 14:501. Gray, J. D., C. A. Sutler, and J. G. Dean 1979 Prediction and prevention of child abuse and neglect. jro?~rnal of Social Issues 35(2): 127-139. Greenberg, M. R. 1983 Urbanization and Cancer Mortality: The United States Experience 1950-1975. New York: Oxford University Press. Hanft, R. S., L. E. Fishman, and W. J. Evans 1983 Blacks and the Health Professions in the 80's: A National Crisis and a Time for Action. Washington, D.C.: Association of Minority Health Professions Schools. Hanft, R. S., L. E. Fishman, and C. C. White 1985 Minorities and the Health Professions: An Update. DraBc of August 1985, Asso- ciatic~n of Minority Health Professions Schools, Washington, D.C. Hayes, Cheryl D., ed. 1987 Asking the Future: Adolescent Sexuality, J~egnancy, and Chil~ean~g. Vol. I. Panel on Adolescent Pregnancy and Childbearing, Committee on Child Development Research and Public Policy, National Research Council. Washington, D.C.: Na- tional Academy Press. Hay~vood, J. L. 1984 Coronary heart disease mortality/morbidity and risk in blacks. II. Access to medi- cal care. American Heart~o?~rnal 3 :79~796. Hofferth, Sandra L., and Cheryl D. Hayes, eds. 1987 Risking the Future: Adolescent Sexuality, Pregnancy, and Childbearing. Vol. II. Work- ing Papers and Statistical Appendixes. Panel on Adolescent Pregnancy and Child- bearing, Committee on Child Development Research and Public Policy, National Research Council. Washington, D.C.: National Academy Press. 443

OCR for page 391
A COMMON DESTINY: BLACKS AND AMERICAN SOCIETY Hogan, D. P., and E. M. Kitagawa 1985 The impact of social status, family structure and neighborhood on the fertility of black adolescents. Am~ncanfournalofSociolo~y 90:825-855. Hulka, B. 1982 Risk factors for cervical cancer. normal of Chronic Disease 35~1~:3-11. Institute of Medicine 1985 Preventing Low Birthweight. Committee to Study the Prevention of Low Birth- weight, Division of Health Promotion and Disease Prevention. Washington, D.C.: National Academy Press. Jackson, J. S. 1981 Urban black Americans. Pp. 37-129 in A. Hardwood, ea., Ethnicity and Medical Care. Cambridge, Mass.: Harvard University Press. 1985 Race, national origin, ethnicity, and aging. Pp. 264-303 in R. B. Binstock and E. Shanas, eds., Handbook of Aging and the Social Sciences. New York: Van Nostrand Reinhold. Jackson, J. S., and R. C. Gibson 1985 Work and retirement among the black elderly. Pp. 193-222 in Z. S. Blau, ea., Cement Perspectives on A,gin,~ and the Life Cycle. Vol. I. Greenwich, Conn.: JAI Press, Inc. James, S. A., E. H. Wagner, D. S. Strogatz, S. A. Beresford, D. G. Kleinbaum, C. A. Williams, L. M. Cutchin, and M. A. Ibrahim 1984 The Edgecombe County (NC) high blood pressure control program. II. Barriers to the use of care among hypertensives. American Journal of Public Health 74:468- 472. Janzen, E. 1973 Paper prepared for an institute on quality assurance for nursing care. American Nurses' Association and the American Hospital Association, Kansas City, Mis- soun. Jason, J., M. Flock, and C. W. Tyler, Jr. 1983 Epidemiologic characteristics of primary homicides in the United States. American Jo?~w~al of Epidemiology 117(4) :419-428. Jessor, R., and S. Jessor 1982 Adolescence to young adulthood: a twelve year prospective study of problem behavior and psychosocial development. In S. A. Mednick and M. Harway, eds., I~gitudinal Research in the United States. Boston: Martinus Nijhoff. Johnston, L., P. O'Malley, and J. G. Bachman 1987 1986 Senior High School Survey. University of Michigan Institute of Social Research. Ann Arbor, Mich. Kasl, S. V. 1984 Social and psychologic factors in the etiology of coronary heart disease in black populations: an exploration of research needs. American Heart~o?~rnal 108:660- 668. Katzman, R. 1985 Aging and age-dependent disease: cognition and dementia. In America's Aging: Health in an Older Society. Committee on an Aging Society, Institute of Medicine and National Research Council. Washington, D.C.: National Academy Press. Keith, Stephen N., Robert M. Bell, August G. Swanson, and Albert P. Williams 1985 Effects of affirmative action in medical schools: a study of the class of 1975. New E~glandJonw~l of Medicine 313(24):1519-1525. 444

OCR for page 391
BLACK AMERICANS' HEALTH Kennedy, E. T., S. Gershoff, R. Reed, and J. E. Austin 1982 Evaluation of the effect of WIC supplemental feeding on birthweight. Journal of the American Dietetic Association 80:220-227. Kessler, J. L., and E. Adams 1976 Human cervical cancer as a venereal disease. Cancer Research 36:783. Kessner, D., J. Singer, C. Kalk, and E. Schlesinger 1973 Contrasts in Health Status. Vol. 1: Infant Death: An Analysis by Maternal Risk and Health Care. Institute of Medicine. Washington, D.C.: National Academy of Sciences. Kitagawa, Evelyn M., and Philip M. Hauser 1973 Differential Mortality in the United States. Cambridge, Mass.: Harvard University Press. Kleinman, J. C., and S. S. Kessel 1987 Racial differences in low birth weight. New England Journal of Medicine 317:749- 753. Kotelchuck, M., J. Schwartz, M. Anderka, and K. Finison 1984 WIC participation and pregnancy outcomes: Massachusetts statewide evaluation project. American Journal of Public Health 74~0ctober):1086-1092. Kovar, M. G. 1980 Morbidity and health care utilization. In S. Haynes and M. Feinleib, eds., Epide- miolo~gy of Ming. NIH Pub. No. 80-969. Washington, D.C.: U.S. Government Printing Office. Kuller, L. H. 1985 Stroke report. Pp. 477-584 in Report of the Secreta~y's Task Force on Black and Minority Health. Sol. W: Cardiovascular and C~rebr~asc?~lar Disease. Washington, D.C.: U.S. Department of Health and Human Services. Lanzkowsky, P. 1978 Iron metabolism and iron deficiency anemia. Pp. 173-211 in D. R. Miller, H. A. Pearson, and C. H. Smith, eds., Smith's Blood Diseases in Infancy and Childhood. 4th ed. St. Louis: Mosby. Leibel, R. L. 1977 Behavioral and biochemical correlates of iron deficiency. Journal of the American Dietetic Association 71:398~04. Leibowitz, A., W. G. Manning, and E. B. Keeler 1985 Effect of cost-sharing on the use of medical services by children: interview results from a randomized controlled trial. Pediatrics 75~5~:942-951. Lieberman, E., K. J. Ryan, R. R. Monson, and S. C. Schoenbaum 1987 Risk factors accounting for racial differences in the rate of premature birth. New England Journal of Medicine 317:743-748. Lief, Beth 1985 Legal and administrative barriers to health care. New Fork State Journal of Medicine 85~4~:126-127. Lilienfeld, Abraham M., Morton L. Levin, and Irving Kessler 1972 Cancer in the United States. Cambridge, Mass.: Harvard University Press. Lloyd, S. M., Jr., D. G. Johnson, and M. Mann 1978 Survey of graduates of a traditionally black college of medicine. fonrnal of Medical Education 53:640-650. LuBt, F. C., C. E. Grim, J. T. Higgins, Jr., and M. H. Weinberger 1977 Differences in response to sodium administration in normotensive white and black subjects. Journal of Laboratory and Clinical Medicine 90:555-562. 445

OCR for page 391
A COMMON DESTINY: BLACKS AND AMERICAN SOCIETY Lutzker, J. R., and J. M. Rice 1984 Project 12-ways: measuring outcome of a large in-home service for treatment and prevention of child abuse and neglect. Child Abuse and Neglect 8:519-524. Mahaffey, K. R., J. Annest, J. Roberts, and R. Murphy 1982 National estimates of blood lead levels: United States 1976-1980: association with selected demographic and socioeconomic factors. New England Journal of Medicine 307:573-579. K., S. S. Poss, and S. Wing The black/white mortality crossover: investigation from the perspective of the components of aging. Gerontologist 19:291-300. . D. Socioeconomic effects on child mortality in the United States. American Journal of Public Health 72:539-547. McAllister, A., C. Perry, and N. Maccoby 1979 Adolescent smoking: onset and prevention. Pediatrics 63:650-658. McCormick, Marie C. 1985 The contribution of low birth weight to infant mortality and childhood morbid- ity.NewE~glandJournal of Medicine 31242):82-90. McKinney, Fred 1986 Employment implications of a changing health-care system. Pp. 199-215 in Margaret C. Simms and Julianne M. Malveaux, eds., Slipping Through the Cracks: The Statics of Black Women. New Brunswick, N.J.: Transaction Books. Mitchell, J. B., and J. Cromwell 1980 Medicaid mills: fact or fiction. Health Care Financing Renew 2: 37. Myers, H. F. 1984 Summary of workshop III: working group on socioeconomic and sociocultural influences. American Heart owl 108:706-710. National Center for Health Statistics 1982a Blood Pressure Levels undo Hypertension in Persons Aged 6-74. United States 1976-80. DHHS Pub. No. (PHS) 82-1250. Washington, D.C.: U.S. Department of Health and Human Services. 1982b The J~evalence of Dental Canes: The National Dental Cards Ptevalance Survey. NIH Pub. No. 82-2245. Washington, D.C.: U.S. Department of Health and Human Services. 1984 Monthly Vital Statistics ~port. 33(,3) Supplement. U.S Department of Health and Human Services. r~D"1'l1 rr~it~.c'.~.t.DC. 79~; nwn.s Ah No (PHS] 86-1232. Washington D.C.: Manton, 1979 Mare, R 1982 1986 . _ . U.S. Department of Health and Human Services. 1987a Advance Report of Final Mortality Statistics, 1985. Monthly Vital Statistics Port 36~5) . Washington, D.C.: U.S. Department of Health and Human Services. 1987b Annual Summary of Births, Marriages, Divorces, and Deaths: United States, 1986. Monthly Vital Statistics Report 35~13~. Washington, D.C.: U.S. Depart ment of Health and Human Services. r-rP,/tft~ rT~1~.Pd .cf.~.t.~` 79~6 nuns Pith No (PHS) 87-1232. Washington D.C.: 1987c . - vies ~ ~ - ~ - ~ - ~ - - . _ . ~ \ U.S. Department of Health and Human Services. 1988 Health United States: 1987. DHHS Pub. No. 88-1232. Washington, D.C.: U.S. Government l~r~nt~ng Office. National Commission on the Causes and Prevention of Violence 1969 To Establish Justice, to Insure Domestic Tranquility, Final ~port. 13 vols. Washing ton, D.C.: U.S. Government Printing Office. National Institute on Drug Abuse 1980 Dow Abuse Deaths in Nine Cities: A Survey ~port. Research Monograph 29. Washington, D.C.: U.S. Department of Health and Human Services. 446

OCR for page 391
BLACK AMERICANS' HEALTH 1987 Population Estimates: National Survey on Dan Arouse. DHHS Pub . No. (ADM) 87- 1539. Washington, D.C.: U.S. Department of Health and Human Services. National Senior Citizens Law Center 1980 Race discrimination in nursing homes. Nursing Home Law Letter No. 39 and 40. Needleman, H., C. Gunnoe, A. Leviton, R. Reed, H. Peresie, C. Marker, and P. Barrett 1979 Deficits in psychological and classroom performance in children with elevated dentine lead levels. New England Journal of Medicine 300:689-693. Neighbors, H. W., and J. S. Jackson 1986 Uninsured risk groups in a national survey of black Americans. Journal of the National Medical Association 78:275-282. 1987 Barriers to medical care among adult blacks: what happens to the uninsured? Journal of the National Medical Association 79~5) :489-493. Nomura, A., L. Kolonel, W. Rellahan, J. Lee, and E. Wegner 1981 Racial survival patterns for lung cancer in Hawaii. Cancer 48:1265-1271. O'Brien, M. D., J. Rodgers, and D. Baugh 1985 Ethnic and RacialPatternsin Enrollment, Health Status, and Health Services Utilization in the Medicaid Population. Washington, D.C., Health Care Financing Administra- tion. Office of Technology Assessment 1988 Children's access to health care. Pp. 52-70 in Healthy Children: Investing in the Future. U.S. Congress. Washington, D.C.: U.S. Government Printing Office. Olds, D. L., C. R. Henderson, anti R. Chamberlin 1986 Preventing child abuse and neglect: a randomized trial of nurse visitations. Pedi- atrics 78(~1~:65-78. Omran, A. R. 1977 Epidemiologic transition in the U.S. Population Bulletin 32:3-42. O'Rcilly, K. R., and S. Aral 1988 Adolescence and sexual behavior: trends and implications for STD. Journal of Adolescent Health Care 2 :43-51. Oski, F., and J. Stockman 1980 Anemia due to inadequate iron sources or poor iron utilization. Pediatric Clinics of North America 27:237-252. Page, L. B. 1976 Epidemiologic evidence on the etiology of human hypertension and its possible prevention. American Heart~o?~rnal 91 :527-534. Page, W. F., and A. J. Kuntz 1980 Racial and socioeconomic factors in cancer survival: a comparison of Veterans Administration results with selected studies. Cancer 45:1029-1040. Palmer, J. L., and S. G. Gould 1986 The economic consequences of an aging society. Dacdalus 115:295-324. Piomelli, S. 1973 A micromethod for free erythrocyte porphyrins: the FEP test. Journal of I~orato~y and Clinical Medicine 81:932-936. President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research 1983 Sec?~rin,g Access to Care. Vol. 1. Washington, D.C.: U.S. Government Printing Office. Rice, D. P., and J. J. Feldman 1983 Living longer in the United States: demographic changes and health needs of the elderly. Milbank Memorial Fund Q~arterly/Health and Society 61 :362-396. 447

OCR for page 391
A COMMON DESTINY: BLACKS AND AMERICAN SOCIETY Robert Wood Johnson Foundation 1983 Updated Report on Access to Health Care for the American People. Princeton, N.J. Robert Wood Johnson Foundation. Robins, Lee Nelkens, and G. E. Murphy 1967 Drug use in a normal population of yolmg Negro men. American Journal of Public Health 57:1580-1596. Rowe, J. W. 1985 Health care of the elderly. New England Journal of Medicine 312:827-835. Ruther, M., and A. Dobson 1981 Unequal treatment and unequal benefits: a reexamination of the use of Medicare services by race, 1967-1976. Health Care Financing Review. HCFA Pub. No. 03090. Washington, D.C.: U.S. Department of Health and Human Services. Sandier, D. P., A. J. Wilcox, and R. B. Everson 1985 Cumulative effects of lifetime passive smoking on cancer risks. Lancet 1:312. Sandson, J. I. 1983 A crisis in medical education: the high cost of student financial assistance. New England Journal of Medicine 308(21): 1286-1289. Schuckit, M. A. 1985 Genetics and the risk of alcoholism. Jo?vrnal of the American Medical Association 254:261~2617. Shanas, E. 1980 Self-assessment of physical function: white and black elderly of the United States. In S. Haynes and M. Feinleib, eds., Epidemiology of Aging. NIH Pub. No. 80- 969. Washington, D.C.: U.S. Government Printing Office. Shiono, P. H., M. A. Klebanoff, B. I. Granbard, H. W. Berendes, and G. G. Rhoads 1986 Birth weight among women of different ethnic groups. Journal of the American Medical Association 255:48-52. Siegel, J., and Davidson, M. 1984 Demographic and Socioeconomic Aspects of A,gin,g in the United States. INS. Bureau of the Census, Current Population Reports, Series P-23, No. 138. Washington, D.C.: U.S. Government Printing Office. Siegel, J. S. 1980 Recent and prospective demographic trends for the elderly population and some implications for health care. In S. Haynes and M. Feinleib, eds., Epidemiolo,gy of Aging. NIH Pub. No. 80-969. Washington, D.C.: U.S. Government Printing Office. Siegel, J. S., and C. M. Taeuber 1986 Demographic perspectives on the long-lived society. Dacdalus 115:77-118. Smith, E. A., and J. R. Udry 1985 Coital and non-coital sexual behaviors of white and black adolescents. American Jonw~l of Public Health 75:1200-1203. Smith, N., and E. Rios 1974 Iron metabolism and iron deficiency in infancy and childhood. Advances in Pedi- amcs 21:239-280. Soldo, B. 1980 America's elderly in the 1980's. Population Bulletin 35:3~7. Soldo, B., and K. G. Manton 1985 Changes in the health status and service needs of the oldest old: current patterns and future trends. Pp. 286-323 in R. Sugman and M. W. Riley, ads., Milbank Memarial Fund Q~rterly/The Oldest Old 63. 448

OCR for page 391
BLACK AMERICANS' HEALTH Starfield, B. 1977 Iron-deficiency anemia. Pp. 77-120 in Children's Medical Care Needs and Treat- ments. Cambridge, Mass.: Ballinger. Sullivan, Louis W. 1983 Special report: the status of blacks in medicine: philosophical and ethical dilem- masforthe 1980s. New E~glandJo?~rnalofMedicine 309~13~:807-808. Sulvetta, M., and K. Swartz 1986 The Uninsured and Uncompensated Care, aChartbook. Washingon, D.C.: Urban Swartz, K. Institute. 1986 Statistical Analysis of the Bureau of the Census' C?~went Population Survey 1980, 1984, 1986. Prepared for the Office of Technology Assessment, U.S. Congress. Wash- ingon, D.C.: Urban Institute. Trevino, F. M., and A. T. Moss 1983 Health insurance coverage and physician visits among Hispanic and non-His- panic people. In Health United States: 1983. DHHS Pub. No. (PHS) 84-1232. Washington, D.C.: U.S. Department of Health and Human Services. Turner, Charles F., Heather G. Miller, and Lincoln E. Mosses, ells. 1989 AIDS: Sepal Behavior and Intravenous Dan Use. Committee on AIDS Research and the Behavioral, Social, and Statistical Sciences, Commission on Behavioral and Social Sciences and Education, National Research Council. Washington, D.C.: National Academy Press. Tyroler, H. A., and S. A. James 1978 Blood pressure and skin color. American Journal of Public Health 68:1170-1172. United Nations 1985 Demographic Yearbook: 1985. Table 20. New York: United Nations. U.S. Congress, House of Representatives 1987 Abused Children in America: Victims of Official Neglect. HR 100-260. Select Com- mittee on Children, Youth, and Families. W~chin~f~n n it. ~: ~ o~`,~rnmPn' Printing Office. U.S. Department of Health Education and Welfare ~it, ~, ~ ~ ~,^, ~ _~. ~ ~ . , 1979 Smoking and Health: A Report of the Surgeon General. DHEW Pub. No. (PHS) 79- 50066. Washington, D.C.: U.S. Department of Health, Education, and Wel- fare. U.S. Department of Health and Human Services 1980 J~omotin~g Health/~eventing Disease, Objectives for the Nation. Public Health Service, Office of the Assistant Secretary for Health. Washington, D.C.: U.S. Depart- ment of Health and Human Services. 1984 Minorities and Women in the Health Fields. DHHS Pub. No. (HRSA) HRS-DV 84-5. Washington, D.C.: U.S. Department of Health and Human Services. 1985a Health Status of Minorities and Low Income Groups. DHHS Pub. No. (HRSA) HRSA-P-DV 85-1. Washington, D.C.: U.S. Department of Health and Human Services. 1985b Minority and other health professionals serving minority communities: report of the working group on health professionals. Pp. 375-549 in Report of the Task Farce on Black and Minority Health. Vol. II: Crosscutting Issues. Washington, D.C.: U.S. Department of Health and Human Services. 1985c Secreta~y's Task Farce on Black and Minority Health. Office of the Secretary of Health. Washingon, D.C.: U.S. Department of Health and Human Services. 1985d Report of the Secretary's Task Force on Black Art Minority Health. Vol. I: Summary. Washington, D.C.: U.S. Department of Health and Human Services. 1986a Current Estimates, 1985. DHHS Pub. (PHS). Washington, D.C.: U.S. Depart- ment of Health and Human Services. 449

OCR for page 391
A COMMON DESTINY: BLACKS AND AMERICAN SOCIETY 1986b Sport of the Secreta~y's Task Force on Black and Minority Health. Vol. I7: Cardiovas- cular and Cerebranasc?~lar Disease. Part 1. Washington, D.C.: U.S. Department of Health and Human Services. 1986c The 1990 Health Objectives for the Nation: A Midcourse Reriew. Office of Disease Prevention and Health Promotion, Public Health Service. Washington, D.C.: U.S. Department of Health and Human Services. 1986d Prevention of Disease, Disability and Death in Blacks and Other Minorities. Annual Program Review, 1986. Centers for Disease Control, Public Health Service. Washington, D.C.: U.S. Department of Health and Human Services. 1986e Nutrition' Monitoring in the United States: J~o,gress Hport. DHHS Pub. No. (PHS) 86-1255. Washington, D.C.: U.S. Department of Health and Human Services. Winick, M. 1970 Nutrition and mental development. Medical Clinics of North America 54~6~:1413- 1429. Wise, P. H., M. Kotelchuck, and M. L. Wilson 1985 Racial and socioeconomic disparities in childhood mortality in Boston. New Eng- k~nd Journal of Medicine 313:360-366. Woodlander, S., D. U. Himmelstein, R. Silber, M. Bader, T. Harnly, and A. A. Jones 1985 Medical care and mortality: racial differences in preventable deaths. International Journal of Health Slices 15: 1-22 . Wright, Jangles D., Peter H. Rossi, and Kathleen Daly 1983 Under the Gun: Weapons, Crime, and Violence in America. New York: Aldine Publishing Company. Wysz~wianski, L., and A. Donabedian 1981 Equity in the distribution of quality of care. Medical Care 19~12 Suppl.~:28-56. Zelnik, M., J. Kanter, and K. Ford 1981 Sex and Pregnancy in Adolescence. Beverly Hills, Calif.: Sage Publications Inc. 450