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Am Fam Physician. 1998;58(3):790-792

Alcohol and Tobacco

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has published a report on the concurrent use of alcohol and tobacco (Alcohol Alert No. 39, January 1998). The report discusses why alcohol and tobacco are so frequently used together, the risk of cancer from tobacco and alcohol use, and treatment for alcoholics who smoke.

The report states that approximately 70 percent of alcoholics are heavy smokers (defined as those who smoke more than one pack of cigarettes daily). This compares with 10 percent in the general population. Drinking influences smoking more than smoking influences drinking. Postulated mechanisms for the concurrent use of alcohol and tobacco fall into two categories: either drug may increase the desired effects of the other, or either may decrease the toxic or unpleasant effects of the other.

Being both a smoker and a drinker increases the risk of cancer. For example, according to the report, compared with the risk for nonsmoking nondrinkers, the approximate relative risks for developing mouth and throat cancer are seven times greater for those who use tobacco, six times greater for those who use alcohol, and 38 times greater for those who use both tobacco and alcohol.

Research has shown that smoking cessation does not jeopardize treatment for alcoholism, and some data suggest that alcoholism recovery may help nicotine abstinence. Alcoholics who smoke and have a history of depressive disorders may be less successful at smoking cessation than those without such a history. The report emphasizes that medication levels should be carefully monitored in patients undergoing treatment for depression and addiction to alcohol and tobacco.

The text of this report on alcohol and tobacco can be found on the NIAAA Web site at Copies of the Alcohol Alert are available free of charge from the NIAAA, Publications Distribution Center, P.O. Box 10686, Rockville, MD 20849-0686.

Palivizumab for Respiratory Syncytial Virus

Palivizumab (Synagis) has been approved by the U.S. Food and Drug Administration for the prevention of serious lower respiratory tract disease caused by respiratory syncytial virus (RSV) in pediatric patients at high risk for RSV disease. Palivizumab is the first monoclonal antibody to be approved for an infectious disease.

In the Impact-RSV trial, hospitalizations occurred in 53 of 500 (10.6 percent) subjects receiving placebo, compared with 48 of 1,002 (4.8 percent) subjects receiving palivizumab, a 5.8 percent reduction. Palivizumab was generally well tolerated, and the percentage of subjects in both the placebo and treatment groups who experienced any adverse event were similar. The subjects included infants with bronchopulmonary dysplasia and premature infants (35 weeks' gestational age or less).

Decline in Pregnancy Rates in Adolescents

The most recent data from the Centers for Disease Control and Prevention (CDC) show a downward trend in the pregnancy rates in adolescents during the first half of the 1990s. From 1991 to 1992, the rate declined substantially in 31 of the 42 states for which data were available, after increasing 9 percent from 1985 to 1990. From 1992 through 1995, the birth rate continued to decline steadily and state-specific abortion rates also decreased annually. The report appears in the June 26, 1998, issue of Morbidity and Mortality Weekly Report.

Rates decreased for those aged 18 to 19 years in all 42 reporting states from 1992 to 1995. However, pregnancy rates increased for those younger than 15 years in nine of 40 states for which data were available and for those aged 15 to 17 years in two of the 42 states. Rates for persons aged 15 to 19 years were higher in most cases for blacks than for whites. However, in 24 of 26 states for which data were available, the decline in the pregnancy rate was higher for blacks than for whites.

The CDC reports that sexual experience, sexual activity and use of effective contraception are important reasons for changes in pregnancy rates. After an increase in the 1980s, the estimated percentage of females aged 15 to 19 years who were sexually experienced and the percentage who were sexually active stabilized from 1988 to 1995. The number of adolescents who reported having used contraception at first intercourse increased from 1988 to 1995, but little change was found in the numbers who reported using a contraceptive method within one month of being interviewed. Among the adolescents using a contraceptive method within one month of interview, use of oral contraceptives decreased and use of condoms and long-acting contraceptive methods increased.

The CDC believes that a continued decline in adolescent pregnancies will require solutions that address complex individual and community level factors that can affect adolescents' sexual and reproductive behavior. Programs should have strong educational components, messages tailored to the needs of different groups and youth development programs that seek to strengthen self-esteem and planning for the future.

Hantavirus Update

A report in the June 12, 1998, issue of Morbidity and Mortality Weekly Report, describes three cases of hantavirus pulmonary syndrome that occurred in the southwestern United States in late April 1998. Two of the cases occurred in New Mexico and one in Colorado. Two of the patients died as a result of hantavirus infection. All three of the patients had a history of exposure to rodent droppings.

In addition to the three persons described in this report, 183 confirmed cases of hantavirus pulmonary syndrome from 29 states have been reported to the Centers for Disease Control and Prevention. More cases have occurred among males (61 percent) than among females, and the mean age of patients is 37 years (age range: 11 to 69 years). Most of the cases have occurred in rural areas and have been associated with hantavirus-carrying rodents. Of all cases, 75 percent occurred among whites and 20 percent among American Indians.

According to the report, the most common early symptoms of hantavirus pulmonary syndrome include fever, myalgia (particularly in large muscle groups of the lower back), nausea, vomiting and diarrhea. Distinguishing signs of hantavirus include fever and myalgia associated with thrombocytopenia, presence of immunoblasts and hemoconcentration. Hantavirus should be suspected in patients with these signs and symptoms, especially if they live in rural areas or may have rodent exposure. The report notes that the survival rate in patients with hantavirus may be increased with early recognition of the infection, case management with careful hemodynamic monitoring, early use of inotropes, avoidance of overhydration, and supportive therapy. The report states that limiting exposure to rodents and their excreta is the most effective way to decrease the risk of acquiring hantavirus infection. It is important to eliminate food sources and nesting places for rodents in and around the home and workplace.

NIOSH Document on Selecting and Using Sharps Disposal Containers

The National Institute for Occupational Safety and Health (NIOSH) has published a document titled “Selecting, Evaluating, and Using Sharps Disposal Containers,” which presents a comprehensive framework for selecting sharps disposal containers and evaluating their efficacy as part of an overall needlestick injury prevention plan. The document discusses the four areas of safety performance criteria for sharps disposal containers: functional, accessibility, visibility and accommodation. Existing standards and recommended strategy for selecting and using the containers are also included. NIOSH notes that prevention strategies include implementing engineering controls, using personal protective equipment, training employees and involving occupational health professionals and workers. To receive a free copy, call NIOSH at 800-35-NIOSH or visit the NIOSH home page at

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Copyright © 1998 by the American Academy of Family Physicians.

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