Suchergebnisse

Surveillance for emergency events involving hazardous substances--United States, 1990-1992: "Problem/Condition: A review of existing reporting systems indicated that not enough information was being collected to determine the public health consequences of emergency events involving hazardous substances. Reporting Period Covered: January 1990 through December 1992. Description of System: State health departments in selected states collect and each quarter transmit information about the events, substances released, and the public health consequences of hazardous substance releases (i.e., morbidity, mortality, and evacuations) to the Agency for Toxic Substances and Disease Registry (ATSDR). Five state health departments (Colorado, Iowa, Michigan, New Hampshire, and Wisconsin) began data collection on January 1, 1990. On January 1, 1992, the reporting state health departments included those from Colorado, Iowa, New Hampshire, New York, North Carolina, Oregon, Rhode Island, Washington, and Wisconsin. Results and Interpretation: During 1990-1992, 3,125 events were reported from participating states to ATSDR's Hazardous Substances Emergency Events Surveillance (HSEES) system. Of these events, 2,391 (77%) were fixed-facility events (i.e., occurred at stationary facilities), and 723 (23%) were transportation related. In 88% of events, a single chemical was released. The most frequently released hazardous substances were volatile organic compounds (18% of the total 4,034 substances released), herbicides (15%), acids (14%), and ammonias (11%). In 467 events (15% of all events), 1,446 persons were injured; 11 persons died as a result of these injuries. Respiratory irritation (37%) and eye irritation (23%) were the most frequently reported health effects. A total of 457 (15%) events resulted in evacuations; of these, 400 (88%) were ordered by an official (e.g., a police officer or firefighter" - p. 1 ; Dengue surveillance--United States, 1986-1992: "Problem/Condition: Dengue is an acute, mosquito-transmitted viral disease characterized by fever, headache, arthralgia, myalgia, rash, nausea, and vomiting. The worldwide incidence of dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) increased from the mid-1970s through 1992. Although dengue is not endemic to the 50 United States, it presents a risk to U.S. residents who visit dengue-endemic areas. Reporting Period Covered: 1986-1992. Description of System: Dengue surveillance in the 50 United States and the U.S. Virgin Islands relies on provider-initiated reports to state health departments. State health departments then submit clinical information and serum samples to CDC for diagnostic confirmation of disease among U.S. residents who become ill during or after travel to dengue-endemic areas and among residents of the U.S. Virgin Islands. In Puerto Rico, an active, laboratory-based surveillance program receives serum specimens from ambulatory and hospitalized patients throughout the island, clinical reports on hospitalized cases, and copies of death certificates that list dengue as a cause of death. Laboratory diagnosis relies on virus isolation or serologic diagnosis of disease (i.e., IgM or IgG antibodies against dengue viruses). Results: In 1986, the first indigenous transmission of dengue in the United States in 6 years occurred in Texas; from the time of that incident through 1992, however, no further endemic transmission was reported. During 1986-1992, CDC processed serum samples from 788 residents of 47 states and the District of Columbia. Among these 788 residents, 157 (20%) cases of dengue were diagnosed serologically or virologically. Of the 157 patients, 71 (45%) had visited Latin America or the Caribbean; 63 (40%), Asia and the Pacific; seven (4%), Africa; and nine (6%), several continents. All four dengue virus serotypes (DEN-1, DEN-2, DEN-3, and DEN-4) were isolated from travelers to Asia and the Pacific; however, travelers to the Americas acquired infections with only DEN-1, DEN-2, or DEN-4. Even though the number of laboratory-diagnosed dengue infections among travelers was small, severe and fatal disease was documented. In the U.S. Virgin Islands and Puerto Rico, three serotypes (DEN-1, DEN-2, and DEN-4) circulated during 1986-1992. In Puerto Rico, disease transmission was characterized by a cyclical pattern, with peaks in incidence occurring during months with higher temperatures and humidity (usually from September through November). The highest incidence of laboratory-diagnosed disease (1.2 cases per 1,000 population) occurred among persons < 30 years of age; rates were similar for males and females." - p. 7 ; Surveillance for emergency events involving hazardous substances--United States, 1990-1992 / -- Dengue surveillance--United States, 1986-1992 / JoseÌ? G. Rigau-PeÌ?rez, Duane J. Gubler, A.Vance Vorndam, Gary G. Clark, Division of Vector-Borne Infectious Diseases, National Center for Infectious Diseases ; "July 22, 1994." ; Also available via the World Wide Web. ; Includes bibliographical references.

PROBLEM/CONDITION: Lead is neurotoxic and particularly harmful to the developing nervous systems of fetuses and young children. Extremely high blood lead levels (BLLs) (i.e.,> or =70 microg/dL) can cause severe neurologic problems (e.g., seizure, coma, and death). However, no threshold has been determined regarding lead's harmful effects on children's learning and behavior. In 1990, the U.S. Department of Health and Human Services established a national goal to eliminate BLLs >25 microg/dL by 2000; a new goal targets elimination of BLLs > or =10 microg/dL in children aged or =10 microg/dL or two capillary blood specimens > or =10 microg/dL drawn within 12 weeks of each other. RESULTS: The NHANES 1999-2000 survey estimated that 434,000 children (95% confidence interval = 189,000-846,000) or 2.2% of children aged 1-5 years had BLLs > or =10 microg/dL. For 2001, a total of 44 states, the District of Columbia (DC), and New York City (NYC) submitted child blood lead surveillance data to CDC. These jurisdictions represent 95% of the U.S. population of children aged or =10 microg/dL steadily decreased from 130,512 in 1997 to 74,887 in 2001. In 2000, the year targeted for national elimination of BLLs >25 microg/dL, a total of 8,723 children had BLLs > or =25 microg/dL. INTERPRETATION: Both national surveys and state surveillance data indicate children's BLLs continue to decline throughout the United States. However, thousands of children continue to be identified with elevated BLLs. The 2000 goal of eliminating BLLs >25 microg/dL was not met. Attaining the 2010 goal of eliminating BLLs > or =10 microg/dL will require intensified efforts to target areas at highest risk, evaluate preventive measures, and improve the quality of surveillance data. PUBLIC HEALTH ACTIONS: States will continue to use surveillance data to 1) promote legislation supporting lead poisoning prevention activities, 2) obtain funding, 3) identify risk groups, 4) target and evaluate prevention activities, and 5) monitor and describe progress toward elimination of BLLs > or =10 microg/dL. CDC will work with state and local programs to improve tracking systems and the collection, timeliness, and quality of surveillance data. ; Pamela A. Meyer, Timothy Pivetz, Timothy A. Dignam, David M. Homa, Jaime Schoonover, Debra Brody. ; September 12, 2003. ; Also available via the World Wide Web as an Acrobat .pdf file (333.29 KB, 24 p.). ; Includes bibliographical references (p. 7-8).

"The United Nations has proclaimed October 1, 1998, through December 31, 1999, as the International Year of Older Persons (IYOP). Federal agencies are working together to sponsor IYOP activities in the United States. To commemorate the goals of IYOP, CDC has published these surveillance summaries to describe important health issues and to highlight the role of public health surveillance for older adults aged > or =65 years in the United States. Although older adults are the focus of these surveillance summaries, persons aged 55-64 years have also been included, when data were available, as a comparison group." - p. 1 ; Foreward / Jeffrey P. Koplan -- Overview: surveillance for selected public health indicators affecting older adults -- United States / Donald K. Blackman, Laurie A. Kamimoto, Suzanne M. Smith -- Surveillance for morbidity and mortality among older adults -- United States, 1995-1996 / Mayur M. Desai, Ping Zhang, Catherine Hagan Hennessy -- Surveillance for injuries and violence among older adults / Judy A. Stevens, La Mar Hasbrouck, Tonji M. Durant, Ann M. Dellinger, Prabhansu K. Batabyal, Alexander E. Crosby, Balarami R. Valluru, Marcie-jo Kresnow, Janet L. Guerrero -- Surveillance for use of preventive health-care services by older adults, 1995-1997 / Gail R. Janes, Donald K. Blackman, Julie C. Bolen, Laurie A. Kamimoto, Luann Rhodes, Lee S. Caplan, Marion R. Nadel, Scott L. Tomar, James F. Lando, Stacie M. Greby, James A. Singleton, Raymond A. Strikas, Karen G. Wooten, -- Surveillance for five health risks among older adults -- United States, 1993-1997 / Laurie A. Kamimoto, Alyssa N. Easton, Emmanuel Maurice, Corinne G. Husten, Carol A. Macera -- Surveillance for sensory impairment, activity limitation, and health-related quality of life among older adults -- United States, 1993-1997 / Vincent A. Campbell, John E. Crews, David G. Moriarty, Matthew M. Zack, Donald K. Blackman ; Cover title. ; "December 17, 1999." ; Includes bibliographical references.

PROBLEM/CONDITION: CDC monitors the incidence of mumps in the United States through the passive reporting of cases to its National Notifiable Disease Surveillance System (NNDSS). REPORTING PERIOD COVERED: 1988-1993. DESCRIPTION OF SYSTEM: Weekly reports to the NNDSS from 48 states and the District of Columbia were used to calculate incidence rates for mumps. State immunization requirements were obtained from the U.S. Department of Health and Human Services. RESULTS: After the licensure of mumps vaccine in the United States in December 1967 and the subsequent introduction of state immunization laws in an increasing number of states, the reported incidence of mumps decreased substantially. The 1,692 cases of mumps reported for 1993 represent the lowest number of cases ever reported to NNDSS and a 99% decrease from the 152,209 cases reported for 1968. During 1988-1993, most cases occurred in children 5-14 years of age (52%) and in persons > or = 15 years of age (36%). Although the incidence decreased in all age groups, the largest decreases (> 50% reduction in incidence rate per 100,000 population) occurred in persons > or = 10 years of age. Overall, the incidence of mumps was lowest in states that had comprehensive school immunization laws requiring mumps vaccination and highest in states that did not have such requirements. INTERPRETATION: Because of the extensive use of mumps vaccine and the increased number of states that had enacted mumps immunization laws, the number of reported mumps cases decreased further since the marked decline that began during the early 1970s. The earlier shift in incidence from children of school ages to older persons that was noted during 1985-1988 continued until 1992, when the proportion of cases occurring in children of school ages increased and exceeded the proportions occurring in other age groups. ACTIONS TAKEN: All health-care providers are encouraged to a) report mumps cases to their local and state health departments for transmission to NNDSS and b) enact school immunization laws requiring mumps vaccination. ; Frederik P.L. van Loon, Sandra J. Holmes, Barry I. Sirotkin, Walter W. Williams, Stephen L. Cochi, Stephen C. Hadler, Mary Lou Lindegren. ; Cover title. ; "August 11, 1995". ; Also available via the World Wide Web. ; Includes biographical references (p. 13-14).

Surveillance for chronic fatigue syndrome : four U.S. cities, September 1989 through August 1993: PROBLEM/CONDITION: Although chronic fatigue syndrome (CFS) has been recognized as a cause of morbidity in the United States, the etiology of CFS is unknown. In addition, information is incomplete concerning the clinical spectrum and prevalence of CFS in the United States. REPORTING PERIOD COVERED: This report summarizes CFS surveillance data collected in four U.S. cities from September 1989 through August 1993. DESCRIPTION OF SYSTEM: A physician-based surveillance system for CFS was established in four U.S. metropolitan areas: Atlanta, Georgia; Wichita, Kansas; Grand Rapids, Michigan; and Reno, Nevada. The objectives of this surveillance system were to collect descriptive epidemiologic information from patients who had unexplained chronic fatigue, estimate the prevalence and incidence of CFS in defined populations, and describe the clinical course of CFS. Patients aged > or = 18 years who had had unexplained, debilitating fatigue or chronic unwellness for at least 6 months were referred by their physicians to a designated health professional(s) in their area. Those patients who participated in the surveillance system a) were interviewed by the health professional(s); b) completed a self-administered questionnaire that included their demographic information, medical history, and responses to the Beck Depression Inventory, the Diagnostic Interview Schedule, and the Sickness Impact Profile; c) submitted blood and urine samples for laboratory testing; and d) agreed to a review of their medical records. On the basis of this information, patients were assigned to one of four groups: those whose illnesses met the criteria of the 1988 CFS case definition (Group I); those whose fatigue or symptoms did not meet the criteria for CFS (Group II); those who had had an identifiable psychological disorder before onset of fatigue (Group III); and those who had evidence of other medical conditions that could have caused fatigue (Group IV). Patients assigned to Group III were further evaluated to determine the group to which they would have been assigned had psychological illness not been present, the epidemiologic characteristics of the illness and the frequency of symptoms among patients were evaluated, and the prevalence and incidence of CFS were estimated for each of the areas. RESULTS: Of the 648 patients referred to the CFS surveillance system, 565 (87%) agreed to participate. Of these, 130 (23%) were assigned to Group I; 99 (18%), Group II; 235 (42%), Group III; and 101 (18%), Group IV. Of the 130 CFS patients, 125 (96%) were white and 111 (85%) were women. The mean age of CFS patients at the onset of illness was 30 years, and the mean duration of illness at the time of the interview was 6.7 years. Most (96%) CFS patients had completed high school, and 38% had graduated from college. The median annual household income/for CFS patients was $40,000. In the four cities, the age-, sex-, and race-adjusted prevalences of CFS for the 4-year surveillance period ranged from 4.0 to 8.7 per 100,000 population. The age-adjusted 4-year prevalences of CFS among white women ranged from 8.8 to 19.5 per 100,000 population. INTERPRETATION: The results of this surveillance system were similar to those in previously published reports of CFS. Additional studies should be directed toward determining whether the data collected in this surveillance system were subject to selection bias (e.g., education and income levels might have influenced usage of the health-care system, and the populations of these four surveillance sites might not be representative of the U.S. population). ACTIONS TAKEN: In February 1997, CDC began a large-scale, cross-sectional study at one surveillance site (Wichita) to describe more completely the magnitude and epidemiology of unexplained chronic fatigue and CFS. ; Malaria surveillance : United States, 1993: PROBLEM/CONDITION: Malaria is caused by infection with one of four species of Plasmodium (P. falciparum, P. vivax, P. ovale, and P. malariae), which are transmitted by the bite of an infective female Anopheles sp. mosquito. Most malaria cases in the United States occur among persons who have traveled to areas (i.e., other countries) in which disease transmission is ongoing. However, cases are transmitted occasionally through exposure to infected blood products, by congenital transmission, or by local mosquito-borne transmission. Malaria surveillance is conducted to identify episodes of local transmission and to guide prevention recommendations. REPORTING PERIOD COVERED: Cases with onset of illness during 1993. DESCRIPTION OF SYSTEM: Malaria cases confirmed by blood smear are reported to local and/or state health departments by health-care providers and/or laboratories. Case investigations are conducted by local and/or state health departments, and the reports are transmitted to CDC. RESULTS: CDC received reports of 1,275 cases of malaria in persons in the United States and its territories who had onset of symptoms during 1993; this number represented a 40% increase over the 910 malaria cases reported for 1992. P. vivax, P. falciparum, P. ovale, and P. malariae were identified in 52%, 36%, 4%, and 3% of cases, respectively. The species was not determined in the remaining 5% of cases. The 278 malaria cases in U.S. military personnel represented the largest number of such cases since 1972; 234 of these cases were diagnosed in persons returning from deployment in Somalia during Operation Restore Hope. In New York City, the number of reported cases increased from one in 1992 to 130 in 1993. The number of malaria cases acquired in Africa by U.S. civilians increased by 45% from 1992; of these, 34% had been acquired in Nigeria. The 45% increase primarily reflected cases reported by New York City. Of U.S. civilians who acquired malaria during travel, 75% had not used a chemoprophylactic regimen recommended by CDC for the area in which they had traveled. Eleven cases of malaria had been acquired in the United States: of these cases, five were congenital; three were induced; and three were cryptic, including two cases that were probably locally acquired mosquito-borne infections. Eight deaths were associated with malarial infection. INTERPRETATION: The increase in the reported number of malaria cases was attributed to a) the number of infections acquired during military deployment in Somalia and b) complete reporting for the first time of cases from New York City. ACTIONS TAKEN: Investigations were conducted to collect detailed information concerning the eight fatal cases and the 11 cases acquired in the United States. Malaria prevention guidelines were updated and disseminated to health-care providers. Persons who have a fever or influenza-like illness after returning from a malarious area should seek medical care, regardless of whether they took antimalarial chemoprophylaxis during their stay. The medical evaluation should include a blood smear examination for malaria. Malaria can be fatal if not diagnosed and treated rapidly. Recommendations concerning prevention and treatment of malaria can be obtained from CDC. ; Tetanus surveillance : United States, 1991-1994: PROBLEM/CONDITION: Despite the widespread availability of a safe and effective vaccine against tetanus, 201 cases of the disease were reported during 1991-1994. Of patients with known illness outcome, the case-fatality rate was 25%. REPORTING PERIOD COVERED: 1991-1994. DESCRIPTION OF SYSTEM: Physician-diagnosed cases of tetanus are reported to local and state health departments, the latter of which reports these cases on a weekly basis to CDC's National Notifiable Disease Surveillance System. Since 1965, state health departments also have submitted supplemental clinical and epidemiologic information to CDC's National Immunization Program. RESULTS: During 1991-1994, 201 cases of tetanus were reported from 40 states, for an average annual incidence of 0.02 cases per 100,000 population. Of the 188 patients for whom age was known, 101 (54%) were aged > or = 60 years and 10 (5%) were aged or = 80 years was more than 10 times greater than the risk for persons aged 20-29 years. All deaths occurred among persons aged > or = 30 years. The case-fatality rate (overall: 25%) increased with age, from 11% in persons aged 30-49 years to 54% in persons aged > or = 80 years. Only 12% of all patients were reported to have received a primary series of tetanus toxoid before onset of illness. For 77% of patients, tetanus occurred after an acute injury was sustained. Of patients who obtained medical care for their injury, only 43% received tetanus toxoid as part of wound prophylaxis. INTERPRETATION: The epidemiology of reported tetanus in the United States during 1991-1994 was similar to that during the 1980s. Tetanus continued to be a severe disease primarily of older adults who were unvaccinated or inadequately vaccinated. Most tetanus cases occurred after an acute injury was sustained, emphasizing the need for appropriate wound management. ACTIONS TAKEN: In addition to decennial booster doses of tetanus-diphtheria toxoid during adult life, the Advisory Committee on Immunization Practices (ACIP) recommends vaccination visits for adolescents at age 11-12 years and for adults at age 50 years to enable health-care providers to review vaccination histories and administer any needed vaccine. Full implementation of the ACIP recommendations should virtually eliminate the remaining tetanus burden in the United States. ; Surveillance for chronic fatigue syndrome : four U.S. cities, September 1989 through August 1993 / Michele Reyes, Howard E. Gary, Jr., James G. Dobbins, Bonnie Randall, Lea Steele, Keiji Fukuda, MGary P. Holmes, David G. Connell, Alison C. Mawle, D. Scott Schmid, John A. Stewart, Lawrence B. Schonberger, Walter J. Gunn, William C. Reeves -- Tetanus surveillance : United States, 1991-1994 / Hector S. Izurieta, Roland W. Sutter, Peter M. Strebel, Barbara Bardenheier, D. Rebecca Prevots, Melinda Wharton, Stephen C. Hadler, Epidemiology and Surveillance Division. National Immunization Program; Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases -- Malaria surveillance : United States, 1993 / Lawrence M. Barat, Jane R. Zucker, Ann M. Barbe,r Monica E. Parise, Lynn A. Paxton, Jacqueline M. Roberts, Carlos C. Campbell, Division of Parasitic Diseases National Center for Infectious Diseases. ; February 21, 1997 ; Includes bibliographical references.

"Problem/Condition: Trichinellosis is a parasitic disease caused by roundworms of the Trichinella genus. Humans are incidental hosts who become infected after ingestion of raw or undercooked meat containing encysted larvae of Trichinella spp. Common signs and symptoms of trichinellosis include eosinophilia, abdominal pain, fever, periorbital edema, and myalgia. National surveillance has documented a decline in the reported incidence of trichinellosis in the United States since 1947, the first year nationwide data were collected systematically. The decreased incidence of trichinellosis has mirrored the decrease of Trichinella in commercial pork products as a result of changes in pork industry management standards and government regulations. In addition, an overall decrease has occurred in the number of cases of trichinellosis related to pork consumption. During 1997-2001, meats other than pork were the most common source of infection, and more cases were associated with home-raised pork than with store-bought pork. Reporting Period Covered: 2002-2007. Description of System: Trichinellosis is a reportable disease in 48 states and has been a nationally notifiable disease since 1966. Cases are defined by clinical characteristics and the results of laboratory testing for evidence of Trichinella infection. States report cases to CDC through the National Notifiable Diseases Surveillance System. Reported cases are summarized weekly and yearly in MMWR. In addition, states are asked to submit a standardized case report form with supplementary case data to CDC's Division of Parasitic Diseases. Results: During 2002-2007, a total of 66 cases of trichinellosis were reported to CDC. Those cases for which a supplementary case report form was not submitted or that did not meet the case definition were excluded from analysis. Of the 66 cases reported during 2002-2007, a total of 12 (18%) cases were excluded from analysis. Associated meat products were classified as either pork or meat products other than pork and were identified for 43 (80%) cases. Meat products other than pork were associated with 27 (50%) cases: 21 with bear meat, one with either bear or deer meat, one with cougar meat, one with deer meat, one with walrus or seal meat, and two with commercial beef. Pork was associated with 10 (19%) cases: seven with commercial pork, two with noncommercial pork, and one with an unspecified type of pork. Of the seven cases associated with consumption of commercial pork, five were linked to U.S. commercial pork, and two were attributed to pork ingested during travel in Asia. The two cases associated with noncommercial pork were attributed to wild boar meat; one case involved wild boar meat from a farm and the other wild boar meat from a farmers' market. Six patients reported consuming both pork and meat products other than pork, but the infected meat product could not be identified. Interpretation: The number of reported trichinellosis cases attributed to commercial pork consumption remains low. The greatest number of cases continues to be associated with consumption of meat other than pork, especially bear meat. Public Health Action: For the incidence of trichinellosis in the United States to be reduced further, education regarding safe food preparation practices and prevention of trichinellosis should be targeted toward hunters and other consumers of wild game meat, especially bear." - p. 1 ; Introduction -- Methods -- Results -- Discussion -- Conclusion -- References -- Appendix: Trichinae certification program final rule, Code of Federal Regulations, October 2008 ; Erin D. Kennedy, Rebecca L. Hall, Susan P. Montgomery, David G. Pyburn, Jeffrey L. Jones. ; "December 4, 2009." ; Cover title. ; Also available via the World Wide Web. ; Includes bibliographical references (p. 7).

In proposed action steps to address the National HIV/ AIDS Strategy goal of reducing new HIV infections, the Federal Implementation Plan for the Strategy specifically encourages improved surveillance to better characterize HIV among American Indians and Alaska Natives (AI/ AN). The Implementation Plan calls for the Centers for Disease Control and Prevention (CDC) to provide state health departments that have high concentrations of AI/AN populations with recommendations on effective HIV surveillance activities. To develop these recommendations, CDC followed a two-step process. First, an assessment was conducted from July through September 2011, including a literature review and a series of discussions with representatives of AI/AN public health agencies and organizations and the Indian Health Service (IHS), as well as several state health departments. Second, current AI/AN-related HIV surveillance practices were assessed through focus group and key informant discussions with HIV surveillance staff in six states and three cities within them that have separately funded HIV surveillance programs and have the largest populations or proportions of AI/AN persons (Alaska, Arizona, California, New Mexico, Oklahoma, Texas and Los Angeles, San Francisco and Houston). This report provides these recommendations and describes the activities that led to their development. ; Executive summary - Introduction - Background - Methods - Summary of key finings on improving surveillance of HIV infection among AI/AN persons- Recommendations - Contributors - References ; January 2013 ; CS237494 ; Mode of access: World Wide Web as an Acrobat .pdf file (553 KB, 18 p.). ; Inludes bibliographical reference (p. 15-18).

Abstract PROBLEM/CONDITION: Surveillance of tobacco use is an essential component of any tobacco-control program. The information gathered can be used to guide research initiatives, intervention programs, and policy decisions. REPORTING PERIODS: This report covers the period 1900-1994 for per capita cigarette consumption; 1965-1991 for trends in cigarette smoking prevalence and cessation; 1974-1991 for trends in the number of cigarettes smoked daily by current smokers; 1987-1991 for recent patterns of tobacco use; 1970, 1987, and 1991 for trends in cigar/pipe smoking and snuff/chewing tobacco use; 1984-1992 for trends in state-specific prevalences of regular cigarette smoking; 1987-1992 for state-specific estimates of smokeless-tobacco use; and 1976-1993 for trends in cigarette smoking among U.S. high school seniors. DESCRIPTION OF SYSTEMS: Estimates of cigarette consumption are reported by the U.S. Department of Agriculture, which uses data from the U.S. Department of the Treasury, the U.S. Department of Commerce, the Tobacco Institute, and other sources. The National Health Interview Survey uses household interviews to provide nationally representative estimates (for the civilian, noninstitutionalized population) of cigarette smoking and other behaviors related to tobacco use. The Behavioral Risk Factor surveillance System uses telephone surveys of civilian, noninstitutionalized adults (> or = 18 years of age) to provide state-specific estimates of current cigarette smoking and use of smokeless tobacco. The University of Michigan's Institute for Social Research uses school-based, self-administered questionnaires to gather data on cigarette smoking from a representative sample of U.S. high school seniors. RESULTS: During the period 1900-1963, per capita cigarette consumption increased; after 1964, consumption declined. During the years 1965-1991, current cigarette smoking prevalence among persons ages > or = 18 years declined overall and in every sociodemographic category examined. Decrease in current smoking prevalence was slow in some groups (e.g., among persons with fewer years of formal education). Both the prevalence of never smoking and the prevalence of cessation increased from 1965 through 1991. The prevalence of current cigarette smoking, any tobacco smoking, and any tobacco use was highest among American Indians/Alaska Natives and non-Hispanic blacks and lowest among Asians/Pacific Islanders. The prevalence of cigar smoking and pipe smoking has declined substantially since 1970. The prevalence of smokeless-tobacco use among white males ages 18-34 years was higher in 1987 and 1991 than in 1970; among persons > or = 45 years of age, the use of smokeless tobacco was more common among blacks than whites in 1970 and 1987. Cigarette smoking prevalence has decreased in most states. The prevalence of smokeless tobacco use was especially high among men in West Virginia, Montana, and several southern states. From 1984-1993, prevalence of cigarette smoking remained constant among U.S. high school seniors. However, prevalence increased slightly for male seniors and white seniors, decreased slightly for female high school seniors, and decreased sharply for black high school seniors. INTERPRETATION: With the exceptions of increases in cigarette smoking among white and male high school seniors and in the use of smokeless tobacco among white males ages 18-34 years, reductions in tobacco use occurred in every subgroup examined. This decrease must continue if the national health objectives for the year 2000 are to be reached. ACTIONS TAKEN: Surveillance of tobacco use is ongoing. Effective interventions that discourage initiation and encourage cessation are being disseminated throughout the United States. ; Gary A. Giovino, Michael W. Schooley, Bao-Ping Zhu, Jeffrey H. Chrismon, Scott L. Tomar, John P. Peddicord, Robert K. Merritt, Corinne G. Husten, Michael P. Eriksen. ; November 18, 1994. ; Includes bibliographical references (p. 40.43).

Surveillance scholarship has long been focused on surveillance technologies in strong states. This article explores the technological challenges of governing Afghanistan, a weak state, where reliable population data do not exist. In assessing the ways governance is practiced in a country of "ghosts," I show that the failure of the state in Afghanistan is linked to a chronic poverty of reliable information on the country's population and geography. A weak state with limited access to reliable population data must use force instead of knowledge to govern the country. I also argue that the digital technologies of surveillance practiced by the Afghan state and the U.S. military to substitute for the lack of traditional forms of government data are not effective and cannot strengthen the state's capacity to deliver services. In contributing to debates on surveillance and security, this article provides a technological critique of state failure in Afghanistan by highlighting the costs of poor population information.