Subject: Studies in the News 02-57 (September 30, 2002)

Studies in the News:
Health Care Supplement

Contents This Week

Introductory Material HEALTH
   Health care crisis for men
   Exposure to antibiotic resistent bacteria
   Technologies for improving human performance
   Effect of mandatory parental notification
   Breast cancer and the environment
   Risks and benefits of estrogen plus progestin
   Twenty-five year findings on breast cancer
   End-of-life care for children
   Psychotropic medication of children
   Antibiotic presciptions and children
   Nicotine water ban
   Seniors and prescription drugs
   Arsenic exposure and atherosclerosis
   Genetics and privacy
   Promoting a more rational health care system
   Mandated health insurance benefits
   Heart disease treatment
   Outcomes of fetal undernourishment
   Diseases afflicting Hispanic Americans
   Therapeutic angiogenesis offers relief
   Health insurance coverage in states
   Medical malpractice insurance reform
   The growth in Medicaid costs
   Early intervention when violence strikes
   Race matters in health care
   Skilled nursing facilities
   Increasing consumption of fruits and vegetables
   Preventing childhood obesity
   Global assessment and endocrine disruptors
   Physician training inadequate
   National survey results on drug use 1975-2000
   Studies in the News, August 9, 2002
   Studies in the News, August 28, 2002
   Studies in the News, September 6, 2002
   Studies in the News, September 18, 2002
Introduction to Studies in the News

Studies in the News is a very current compilation of items significant to the Legislature and Governor's Office. It is created weekly by the State Library's Research Bureau to supplement the public policy debate in California’s Capitol. To help share the latest information with state policymakers, these reading lists are now being made accessible through the State Library’s website. This week's list of current articles in various public policy areas is presented below.

Service to State Employees:

  • When available, the URL for the full text of each item is provided.

  • Items in the State Library collection can be checked out to state officials and staff.

  • Access to all materials listed will be provided by the State Information Reference Center, either by e-mail to or by calling 654-0261.

The following studies are currently on hand:



A Poor Man's Plight: Uncovering the Disparity in Men's Health. By John A. Rich and Marguerite Ro, Community Voices: Healthcare for the Underserved, W.K. Kellogg Foundation (The Foundation, Battle Creek, Michigan) February 2002. 38 p.

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["This report finds that because men from racial and ethnic minority populations face such a high risk of heart disease, diabetes, HIV/AIDS, and other conditions and often lack access to basic care, they are now experiencing a health care crisis. Unless action is taken soon, the crisis, and attendant financial implications related to treating large numbers of men living in poverty, will grow." HandsNet (June 14, 2002) 38 p.

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"Animal Antibiotic Use Has an Early But Important Impact on the Emergence of Antibioric Resistance in Human Eommensal Bacteria." By David L. Smith and others. IN: PNAS:Proceedings of the National Academy of Science, vol. 99, no. 9 (April 30, 2002) pp. 6434-6439.

["The development of antibitoic resistance (AR) among pathogenic bacteria has emerged as a major public health concern.... Humans are exposed to new strains of AR bacteria from food, water, or contact with other humans.... Our analysis suggests that agricultural antibiotic use hastens the appearance of AR bacteria in humans."]

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Converging Technologies for Improving Human Performance: Nanotechnology, Biotechnology, Information Technology and Cognitive Science. Edited by Mihail C. Roco and William Sims Bainbridge, National Science Foundation. (The Foundation, Arlington, Virginia) July 2002. 424 p.

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["In the next 20 years, the report's authors say, technology could provide us with benefits such as direct brain-to-machine interfaces that transform work, wearable sensors that allow us to monitor our health and environment, and upgraded flesh and bone. 'The human body will be more durable, healthy, energetic, easier to repair, and resistant to many kinds of stress, biological threat, and (the) aging process.' the report states." Managing Technology Wharton (August 2002) 1.]

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"Effect of Mandatory Parental Notification on Adolescent Girls' Use of Sexual Health Care Services." By Diane M. Reddy and others. IN: JAMA: Journal of the American Medical Association, vol. 288, no. 6 (August 14, 2002) pp. 710-714.

[“Nearly half of the young girls surveyed … said they would quit going to Planned Parenthood if their parents had to be told they wanted prescribed contraceptives, according to a study. The study suggested that parental notification could lead to more teen pregnancies, abortions and the spread of sexually transmitted diseases.” Sacramento Bee (August 14, 2002) A8.]

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Breast Cancer and the Environment; Studies Conducted and Supported by the National Cancer Institute. By National Institutes of Health. (The Institute, Bethesda, Maryland)August 2002. Various pagings.

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["Study of breast cancer and environmental toxics ... found only a weak correlation between cancer rate and one form of chemical exposure.... The investigators found the risk of breast cancer rose by a 'modest' 50 percent among women who were exposed to polycyclic aromatic hydrocarbon.... A 50 percent rise in risk might not sound 'modest'.... However, it is compared to other know risk factors for cancer." San Francisco Chronicle (August 7, 2002) A5.]

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“Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women; Principal Results From the Women's Health Initiative Randomized Controlled Trial.” By Writing Group for the Women's Health Initiative Investigators. IN: JAMA: Journal of the American Medical Association, vol. 288, no. 3 (July 17, 2002) pp. 321-333.

["Estrogen Therapy Raises Ovarian Cancer Risk, Study Says: In the latest study to challenge the safety of postmenopausal hormones, Cancer Institute scientists report that women who take estrogen are more likely to develop ovarian cancer than those who don't. And the longer women take estrogen, the greater their ovarian cancer risk, the study found." USA Today (July 17, 2002) 1A.]

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"Twenty-Five-Year Follow-up of a Randomized Trial Comparing Radical Mastectomy, Total Mastectomy, and Total Mastectomy Followed by Irradiation." By Bernard Fisher and others. IN: New England Journal of Medicine, vol. 347, no. 8 (August 22, 2002) pp. 567-575.

["A trial to compare the efficacy of radical mastectomy with that of total mastectomy began in 1971 and enrolled 1665 women with breast cancer. After 10 years of follow-up, radical mastectomy was not superior to total mastectomy. Now, after 25 years of follow-up, 293 of the women are alive and free of breast cancer; radical mastectomy did not show an advantage over total mastectomy."]

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When Children Die: Improving Palliative and End-of-Life Care for Children and Their Families. By the Institute of Medicine. (National Academy Press, Washington, DC) 2002. 514 p.

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["Health System Adds to Pain of Losing Child, Panel Says: One of the most traumatic experiences a family can suffer -- the death of a child -- is often worsened by ineffective health care that fails to address the physical, emotional or spiritual needs of the patient and family members.... The committee recommended that health agencies and professionals develop clinical practice guidelines and institutional procedures for palliative care to relieve symptoms and pain for the dying." New York Times (July 26, 2002) 1.]

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"National Trends in the Use of Psychotropic Medication on Children." By M.Olfson and others. IN: Journal of the American Academy of Child and Adolescent Psychiatry, vol. 41, no. 5 (May 2002) pp. 530-537.

["In 1996, stimulant use was especially common in children aged 6 to 14 (4.1 per 100), and antidepressant sue was common in children aged 15 to 18 (2.1 per 100 persons).... We report age, gender, race, region and insurance type-specific temporal trends in the use of stimulants, antidepressants, and other psychotropic medications during the past decade."]

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"Changes in Antibiotic Prescribing for Children After a Community-wide Campaign. By Joseph F. Perz and others. IN: JAMA: Journal of the American Medical Association, vol. 287, no. 23 (June 19, 2002) pp. 3103-3109.

["One of the first signals of success in the battle against drug-resistant bacteria, federal researchers have found major reductions nationwide in the prescribing of antibiotics to children and teens. The study ... found that the number of prescriptions prescribed nationwide for children under 15 fell by 40 percent between 1990 and 2000." Health Currents (July 1, 2002)1.]

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FDA Grants Citizen's Petition Seeking Unapproved Drug Classification for "Nicotine Water." By the U.S. Food and Drug Administration. FDA News. PO2-22. (The Administration, Washington, DC) July 2, 2002. 1 p.

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["Nicotine Water Must Be Regulated as Drug, FDA Says: The FDA said that the company 'improperly' claimed that the water, which was being advertised as an alternative to smoking, was a dietary supplement that did not need FDA approval.... The decision comes after the American Medical Association, American Lung Association and the Campaign for Tobacco-Free Kids filed a citizens' petition in December calling for the FDA to ban the water." American Health Line (July 3, 2002) 1.]

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Seniors and Prescription Drugs: Findings from a 2001 Survey of Seniors in Eight States. By Dana Gelb Safran, Tufts-New England Medical Center, and others (The Common Wealth Fund, New York, New York) July 2002. 44 p.

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["This survey finds that nearly one-quarter of the elderly say they skip medication doses or fail to get prescriptions filled because of cost concerns. The survey of nearly 11,000 Medicare beneficiaries age 65 and older was conducted in California, Colorado, Illinois, Michigan, New York, Ohio, Pennsylvania, and Texas. These states account for 42 percent of the 65-and-older population, and 41 percent of low-income elderly adults (those at less than twice the poverty level), nationwide." Health Affairs (July 31, 2002) 1.]

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"Biological Gradient Between Long-Term Arsenic Exposure and Carotid Atherosclerosis." By Chih-Hao Wang and others. IN: Circulation: Journal of the American Heart Association, vol. 105 (2002) pp. 1804-1809.

["According to a study, long-term exposure to arsenic in drinking water is directly related to the development of atherosclerosis in the arteries leading to the brain.... The team found that three indices of long-term exposure to arsenic correlated directly with the amount of atherosclerosis present in the carotid arteries." Scientific American (March 26, 2002) 1.]

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Genetics and Privacy: A Patchwork of Protections. By Joanne L. Hustead, Health Privacy Project, Georgetown University. Prepared for the California HealthCare Foundation (The Foundation, Oakland, California) April 2002. 44 p.

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["The purpose of this report is to explain the state of the science as it actually is and define some genetic-related common terms; to discuss how the privacy of genetic information is and is not protected; to examine one of the new frontiers in health care -- the Internet -- and the phenomenon of people entrusting their most sensitive information, including their genetic information, to a largely unregulated cyberspace; and lastly to identify large gaps in national policy that leave genetic information exposed to misuse."]

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Spending Wisely: Promoting a More Rational Health Care System Through Better Benefit Design. By Barbara Yondorf, Yondorf & Associates. Prepared for the National Conference of State Legislatures. Balancing Health Needs with Resources. (NCSL, Denver, Colorado) March 2002. 35 p.

["This paper addresses issues in benefit design that relate to the state's interest in promoting and maintaining the health of its residents. The sections discuss: The goals of benefit design ... Criteria for evaluation a benefit plan ... Obstacles to implementing a plan ... The challenges states face ... [and] What states can do to foster the development and use of health plans that promote a more national health care system."]

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Mandated Health Insurance Benefits: Tradeoffs Among Benefits, Coverage, and Costs? By Juliette Cubanski and Helen H. Schauffler. California Health Policy Roundtable; Issue Brief. July 2002. 4 p.

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["According to NCSL, several states have placed a high priority on mandating coverage for certain health care services during their 2002 sessions, including mental health parity (23 states), cancer screenings (20 states), diabetes (17 states), and osteoporosis (10 states).... Policymakers in many states are looking for ways to balance the potential tradeoffs associated with mandated benefits legislation."]

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"Effect of Homocysteine-Lowering Therapy With Folic Acid, Vitamin B12, and Vitamin B6 on Clinical Outcome After Percutaneous Coronary Intervention: The Swiss Heart Study: A Randomized Controlled Trial." By Guido Schnyder and others. IN: JAMA: Journal of American Medical Association, vol. 288, no. 8 (August 28, 2002) pp. 973-979.

["A six month regimen of folic acid, vitamin B-12 and vitamin B-6 can help prevent reoccurrence of blocked arteries in patients who have undergone coronary angioplasty.... The treatment apparently works by lowering levels of homocysteine, an amino acid long implicated in heart attacks." Sacramento Bee (August 28, 2002) A7.]

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“Unravelling the Fetal Origins Hypothesis: is There Really an Inverse Association Between Birthweight and Subsequent Blood Pressure?” By Rachel Huxley and others. IN: Lancet, vol. 360, no. 9334 (August 31, 2002) pp. 659-665.

[“Fetal undernourishment may not spell doom later…. The rapidly emerging theory that adult health is set to a significant degree before birth, by conditions in the womb, is getting its first major challenge with new research questioning the validity of some evidence supporting the idea…. Scientist conclude that the reported link between low birth weight and higher blood pressure later in life … may not be as strong as previously thought. Because of flaws in the studies, it may not exist at all.” Sacramento Bee (August 30, 2002) A16.]

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New Medicines in Development for Major Diseases Affecting Hispanic Americans: Survey. By the Pharmaceutical Research and Manufacturers of America and The National Hispanic Medical Association. (The Manufacturers, Washington, DC) May 2002. 24 p.

["Pharmaceutical and biotechnology companies are developing 245 new medicines for diseases that disproportionately affect the nation's 35.3 million HIspanic Americans, according to a new survey.... All of the medicines included in this survey are either in clinical trials or awaiting approval by the Food and Drug Administration."]

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“Therapeutic Angiogenesis for Patients with Limb Ischaemia by Autologous Transplantation of Bone-Marrow Cells: A Pilot Study and a Randomised Controlled Trial.” By Eriko Tateishi-Yuyama and others. IN: Lancet, vol. 360, no. 9931 (August 10, 2002) pp. 427-435.

[“Injecting a patient’s stem cells into his or her leg muscles could create new blood vessels, eliminating pain from bad circulation and helping to prevent gangrene or amputations, new research indicates…. Experts say the findings offer hope to millions of people worldwide who suffer pain in their limbs because of clogged arteries but cannot have an operation.” Sacramento Bee (August 9, 2002) A7.]

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Variations Among States in Health Insurance Coverage and Medical Expenditures: How Much Is Too Much? By John Holahan, Urban Institute. (The Institute, Washington, DC) June 2002. 40 p.

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["Health insurance coverage ... varies considerably among states.... This paper explores this variation in considerable detail. We provide information on private and public insurance coverage, uninsurance rates, and on expenditures on Medicaid and other programs states and localities use to support health services."]

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Reforming the Medical Malpractice Insurance Market. By Stephanie Norris, National Conference of State Legislatures. State Legislative Report. Vol. 27, No. 13. (NCSL, Denver, Colorado) July 2002. 10 p.

["Solutions for the crisis in medical malpractice insurance include increasing patient safety and reducing medical mistakes; setting caps on damages, reforming collateral source rules; restricting contingency fees, and shortening the statute of limitations. In addition, states can reform their insurance markets to better regulate rates and monitor the performance of companies. In the past, state legislatures have used a combination of these measures to ensure a stable medical liability market."]

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State Budgets Under Stress: How are States Planning to Reduce the Growth in Medicaid Costs? By The Kaiser Commission on Medicaid and the Uninsured, The Kaiser Family Foundation (The Foundation, Menlo Park, California) July 30, 2002. 31 p.

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["States Attempt To Control Medicaid Cost Growth: The survey found that 41 states plan to reduce their Medicaid funding growth in fiscal year 2003.... More than half of the states will alter their prescription drug policies, and 28 states intend to cut or freeze Medicaid payments to providers." American Health Line (August 5, 2002) 1.]

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Mental Health and Mass Violence: Evidence-Based Early Psychological Interventions for Victims/Survivors of Mass Violence; A Workshop to Reach Consensus on Best Practices. By the United States Department of Health and Human Services and others. (The National Institute of Mental Health, Bethesda, Maryland) 2002. 123 p.

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["Early psychological intervention guided by trained and qualified mental health caregivers can reduce the harmful effects of exposure to mass violence in survivors, according to this National Institute of Mental Health report. But the report warns that some interventions—including mass education via media outlets—can have the potential for unintended harm. Early intervention in the form of a single one-to-one recital of events and emotions evoked by a traumatic event may not consistently reduce risk, and may even increase the likelihood, for some, of developing mental health problems later." Connect for Kids Weekly (September 9, 2002) online.]

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"Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. By Brian Smedley and others, Institute of Medicine, National Academy of Sciences. (The Institute, Washington, DC) 2002. 598 p.

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["For years, Black health care professionals have been pointing out racial and ethnic disparities in access to quality health care, as well as disparities in incidence rates, mortality rates and treatments for certain illnesses. Recently, the National Academy of Science's Institute of Medicine released a report documenting that minorities, regardless of income, education and access were discriminated against in health care." Black Issues in Higher Education (May 2002) 22.]

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Skilled Nursing Facilities: Providers Have Responded to Medicare Payment System by Changing Practices. By the U.S. General Accounting Office. GAO-02-841. (The Office, Washington, DC) August 2002. 27 p.

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["In 1998 the Health Care Financing Administration implemented a prospective payment system (PPS) for skilled nursing facilities (SNF)....Two years after PPS was implemented the majority of patients in rehabilitation groups received less therapy than was provided in 1999.... Across all rehabilitation group categories, fewer patients received the highest amounts of therapy associated with each payment group."]

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Fruits and Vegetables: Enhanced Federal Efforts to Increase Consumption Could Yield Health Benefits for Americans. By the U.S. General Accounting Office. GAO-02-657. (The Office, Washington, DC) July 2002. 67 p.

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["This report examines the health-related benefits associated with consuming the recommended servings of fruits and vegetables... the extent to which overall fruit and vegetable consumption by Americans has improved ... assesses the impact of key federal food assistance programs on fruit and vegetable consumption by program participants ... and identifies federal actions that experts recommend for increasing the consumption of fruits and vegetables."]

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"The Challenge of Preventing and Treating Obesity in Low-income, Preschool Children." By Leigh A. Chamberlin and others. IN: Archives Pediatrics & Adolescent Medicine, vol. 156 no. 7 (July 2002) pp. 662-668.

["Obesity has become a common nutritional concern among low-income, preschool children, a primary target population of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Nutrition counseling efforts in WIC target childhood obesity. The authors explore the challenges that exist in preventing and managing childhood obesity in the quest to develop new approaches."]

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Global Assessment Of The State-Of-The-Sciences Of Endocrine Disruptors. By World Health Organization. (The Organization, Geneva, Switzerland) 2002. Various pagings.

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["Chemical-Related Damage to Wildlife Supports Fears for Human Health: Many common household products like electrical goods, plastic food and drink containers, cleaning compounds, cosmetics, and perfumes contain endocrine disrupting chemicals (EDCs) that interfere with the function of the body's naturally occurring hormones. These substances disrupt reproductive and early developmental processes -- particularly in offspring exposed in the womb or in the egg." U.S. Newswire (August 12, 2002) 1.]

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Training Tomorrow's Doctors: The Medical Education Mission of Academic Health Centers. By the Task Force on Academic Health Centers, The Commonwealth Fund (The Fund, New York, New York) April 2002. 80 p.

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["A new report asserts that training at our nation's teaching hospitals may not be keeping pace with the changing nature and demands of modern medical practice. The Task Force finds that education is no longer a primary activity for the nation's medical schools and affiliated teaching hospitals. The report details curriculum inadequacies, changing medical practices, and the uneven nature of medical education across the country."]

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Monitoring the Future: National Survey Results on Drug Use, 1975-2000. Volume I: Secondary School Students. NIH Publication 01-4924. 492 p. Volume II: College Students and Adults Ages 19-40. NIH Publication 01-4925. By Lloyd D. Johnson and o;thers, Institute for Social Research, University of Michigan. Prepared for the National Institute on Drug Abuse. (The Institute, Bethesda, Maryland) 2001.

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["Teen Smoking in Steep Decline, Study Shows: Drug and Alcohol Figures Also Down -- Education Credited with Turnaround: Cigarette smoking is falling sharply among American teenagers.... The use of the hallucinogen Ecstasy is increasing at a slower rate than previously.... The percentage of teenagers who use alcohol dropped from 26 percent in 1996 to 22 percent this year." San Francisco Chronicle (December 20, 2001) A1.]

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[This section links to items in Studies in the News since the last Health Care Supplement.]


"Health." IN: Studies in the News, 02-45 (August 9, 2002).

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[Includes: "Few considering suicide receive counseling;" "Exercise necessary for health;" "Supreme Court's HMO review ruling;" "California Supreme Court decision on medical marijuana;" "Obesity is concern for state governments:' "Drug company expenditures;" "Proposed warning labels for anti-smoking medications;" "Untreated sexually transmitted diseases;" and others."]

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"Health." IN: Studies in the News, 02-48 (August 28, 2002).

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[Includes: "American Disabilities Act and Supreme Court;" "California's stem cell policy;" "Rural health care delivery system;" "Preventive measures for West Nile Virus;" "Medicaid and SCHIP waiver projects;" "Voters' reaction to Medi-Cal cuts;" "Nursing crisis strategies;" "Adult cigarette smoking;" and others.]

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"Health." IN: Studies in the News, 02-52 (September 6, 2002).

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[Includes: "Federal AIDS treatment grants;" "Access to treatments by HIV-infected patients;" "HHS funds for developmental disabilities;" "The consequences of a lack of health insurance;" "Poor medical care for uninsured;" "Marijuana subject to federal laws;" "Congressional action on human cloning;" "Regulation of non-reproductive cloning;" and others.]

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"Health." IN: Studies in the News, 02-55 (September 18, 2002).

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[Includes: "Health assessment for diesel exhaust;" "Surgery reduces prostate cancer;" "Adolescents forgo excercise;" "Carpal tunnel and treatments;" "Health package and long-term care needs;" "Hospital payments for medicaid grants;" "Billions in additional Medicaid reimbursements;" "HMOs drop more medicare users;" and others.]

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