PUBLIC HEALTH BRIEFS

ment completion with or without case monitoring assistance is the same. If this is the case, then additional time and expense of extended case monitoring (through treatment completion as received by Group III) may not be cost effective. Of special interest is the large proportion (78 per cent) of treatment completions involving multiple visits achieved by individuals in Group I who received no monitoring assistance. These individuals may represent a high degree of self motivation and adequate knowledge of the health care provider system needed in order to obtain care. In Dallas, treatment providers are readily available and a large, well-known public children's clinic and hospital is accessible by public transportation. In areas where providers or transportation are scarce, results may differ. Several limitations of the study must be acknowledged. The population within the jurisdiction of experimental activities and the low rate of referrals in the Dallas EPSDT program (10 per cent of those screened) resulted in an undesirably small sample. Also, experimental conditions were time-sequenced, so that changes in program operation over time could have influenced the results. Nevertheless, this

study suggests a positive effect of implementing a case monitoring system aimed at diagnosis and treatment initiation in the EPSDT program.

REFERENCES 1. Cowan DB, Bouchard JC, and Suarex MM: Child health screening for the nurse practitioner. Nurse Practitioner, Vol. 1, No. 3, Jan.-Feb. 1976, pp. 109-120. 2. Eisner V: What Happens After Screening, in A. Oglesby and H. Sterling (eds), Proceedings of the Biregional Institute on Earlier Recognition of Handicapping Conditions in Childhood, Berkeley, CA: Univ. of California School of Public Health, 1971, pp. 52-56.

ACKNOWLEDGMENTS The Research and Demonstration from which this paper was derived was supported by the Health Care Financing Administration Grant No. 1 I-P-90157/6-03. Evaluation contract was held by The Health Services Research Institute, The University of Texas Health Science Center at San Antonio with the grantee, The Texas State Department of Human Resources. The authors would like to acknowledge the support of the Health Services Research Institute and in particular, assistance given by Arthur Britt.

Smoking and Life Expectancy among U.S. Veterans EUGENE ROGOT, MA Estimates of life expectancies for white males according to cigarette smoking habits have been reported by Hammond.1 These were based on life tables constructed from a 5year mortality follow-up of 447,196 men with known smoking information, of whom 39,178 died in the study period, July 1, 1960-June 30, 1965. The present study reports on smoking and life expectancy among U.S. veterans who held government life insurance policies in December 1953 and were followed for 16 years, from January 1, 1954 through December 31, 1969. In previous reports,2 3 mortality experience was described in terms of 16-year (and 13-year) probabilities of death. By an approach described below, 1-year probabilities of death for single years of age are derived for selected groups of smokers, ex-smokers and nonsmokers and life tables are constructed. Estimated life expectancies are then compared between groups and with values obtained by Hammond. The nature of the study population, the study design, and other details have been fully described elsewhere.26 A brief review follows for purposes of this paper. In January 1954, questionnaires on smoking habits were mailed to 293,958 U.S. veterans who held insurance policies and were in the age group 31-84. A total of 198,820 or 68 per Address reprint requests to Eugene Rogot, Epidemiology Branch, Division of Heart and Vascular Diseases, National Heart, Lung, and Blood Institute, Federal Building, Room 2C08, Bethesda, MD 20014. This paper, submitted to the Journal February 13, 1978, was revised and accepted for publication April 14, 1978. AJPH October, 1978, Vol. 68, No. 10

cent responded. These respondents comprise the " 1954 cohort," and their survivorship experience is the basis of the present report. 1954 Attained age 3-31 31 - 32 32 33 33 34 4 34

1955

1956

1957

84

1969

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46 47 48 49

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99

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Smoking and life expectancy among U.S. veterans.

PUBLIC HEALTH BRIEFS ment completion with or without case monitoring assistance is the same. If this is the case, then additional time and expense of...
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