American Journal of

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Nov 1, 1992 - Magnetic Fields of Video Display Terminals and Spontaneous Abortion. Marja-Liisa. Lindbohm .... Or as an illustrator,. Or simply as a medical ...
ISSN 0002-9262

American Journal of

EPIDEMIOLOGY 136

Published by The Johns School of Hygiene and Public Health

Number 9 Sponsored by the Society for Epidemiologic Research

November 1, 1992

ORIGINAL CONTRIBUTIONS (•Indicates a Brief Original Contribution) 1041

1052 1060

1069

1082 1091 1101

1110

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1122

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1138 1148

Magnetic Fields of Video Display Terminals and Spontaneous Abortion. Marja-Liisa Lindbohm, Maila Hietanen, Pentti Kyyronen, Markku Sallmen, Patrick von Nandelstadh, Helena Taskinen, Matti Pekkarinen, Matti Ylikoski, and Kari Hemminki Pregnancy and Lactation as Determinants of Bone Mineral Density in Postmenopausal Women. Donna Kritz-Silverstein, Elizabeth Barrett-Connor, and Kathryn A. Hollenbach Lipoprotein(a) Concentrations in Mexican Americans and Non-Hispanic Whites: The San Antonio Heart Study. Steven M. Haffner, Katherine K. Gruber, Philip A. Morales, Helen P. Hazuda, Rodolfo A. Valdez, Braxton D. Mitchell, and Michael P. Stern Short-term Intraindividual Variability in Lipoprotein Measurements: The Atherosclerosis Risk in Communities (ARIC) Study. Lloyd E. Chambless, Robert P. McMahon, Spencer A. Brown, Wolfgang Patsch, Gerardo Heiss, and Yuan-Li Shen Serum Ceruloplasmin Level and the Risk of Myocardial Infarction and Stroke. Antti Reunanen, Paul Knekt, and Ritva-Kaarina Aaran Blood Lead as a Cardiovascular Risk Factor. Lars Moller and Tage S. Kristensen The Roles of Insulin, Obesity, and Fat Distribution in the Elevation of Cardiovascular Risk Factors in Impaired Glucose Tolerance: The San Luis Valley Diabetes Study. Cecil M. Burchfiel, Susan M. Shetterly, Judith Baxter, and Richard F. Hamman * Post-Challenge Glucose Concentration, Impaired Glucose Tolerance, Diabetes, and Cancer Mortality in Men. George Davey Smith, Matthias Egger, Martin J. Shipley, and M. G. Marmot *Age at First Establishment of Chronic Hepatitis B Virus Infection and Hepatocellular Carcinoma Risk: A Birth Order Study. Chung-Cheng Hsieh, Anastasia Tzonou, Xenophon Zavitsanos, Evagelia Kaklamani, Shou-Jen Lan, and Dimitrios Trichopoulos Persistent Hepatitis B Virus Infection and Hepatoma in The Gambia, West Africa: A Case-Control Study of 140 Adults and Their 603 Family Contacts. Robert W. Ryder, Hilton C. Whittle, Abdoulie B. K. Sanneh, Andrew B. Ajdukiewicz, Stevenson Tulloch, and Bernard Yvonnet Sexual Transmission of Hepatitis C Virus among Female Prostitutes and Patients with Sexually Transmitted Diseases in Fukuoka, Kyushu, Japan. Koya Nakashima, Seizaburo Kashiwagi, Jun Hayashi, Akinori Noguchi, Miki Hirata, Wataru Kajiyama, Kunihiro Urabe. Kikuo Minami, and Yoshiaki Maeda Familial Aggregation of a Disease Consequent upon Correlation between Relatives in a Risk Factor Measured on a Continuous Scale. John L. Hopper and John B. Carlin Sample Size for Studying Intermediate Endpoints within Intervention Trials or Observational Studies. Laurence S. Freedman and Arthur Schatzkin Continued on Inside Front Cover

Founded 1920 by W. H. Welch and W. H unvel' a- t

American Jr irnal of Hygiene

Contents Continued From Front Cover

ON THE LIGHTER SIDE 1160

Leave No Stone Unturned. P. Michael Nordberg LETTERS TO THE EDITOR

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1169 1170 1172 1172

Re: "Dietary Cholesterol and Incidence of Lung Cancer The Western Electric Study." Heather G. Stockwell and Elizabeth C. Candelora Re: "Dietary Antioxidants and the Risk of Lung Cancer" and "Dietary Cholesterol and Incidence of Lung Cancer The Western Electric Study." Tsukasa Namekata, Yoshiharu Shimizu, and Lawrence H. Kushi Shekelle et al. Reply. Richard B. Shekelle, Arthur H. Rossof, and Jeremiah Stamler Re: "A Simple Method to Calculate the Confidence Interval of a Standardized Mortality Ratio (SMR)." J. W. J. van der Gulden and A. L. M. Verbeek The Author Replies. Kurt Ulm

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Re: "Tests for Trend and Dose Response: Misinterpretations and Alternatives." Debra T. Silverman and Robert N. Hoover The Authors Reply. Malcolm Maclure and Sander Greenland

1174

ERRATUM

Fifth International Conference of The International Society of Environmental Epidemiology Stockholm, Sweden, August 15-18, 1993 The conference has the purpose of bringing together people working in environmental epidemiologyto discuss methodology, findings and applications of their research. Epidemiologists, toxicologists, those who are working with exposure assessment, public health administrators and all others interested in the field are very welcome. The program will include a variety of presentations on important issues of current interest in environmental epidemiology. In particular, special symposia will be arranged on residential radon exposure and lung cancer, electromagnetic fields and cancer, and air pollution epidemiology. Other topics for presentations include methods in environmental epidemiology, exposure assessment, health effects related to water and water pollution, environmental causes of allergy and

hypersensitivity, metals and environmental health, health effects related to the indoor environment, community noise, international collaboration in environmental epidemiology, training in environmental epidemiology, and ethics. For further details and application forms write to: ISEE '93 Goran Pcrshagcn Institute of Environmental Medicine Karolinska Institutct Box 60208 S-104 01 STOCKHOLM, Sweden Phone: 46-8-728 64 00 Telefax: 46-8-31 39 61

PREVENTION April 17-20, 1993 The Adams Mark Hotel St. Louis, Missouri

LEADERSHIP FOR PREVENTION IN HEALTH CARE REFORM PREVENTION 93 will bring together leaders and experts from governmental agencies, foundations, managed care and other clinical settings, insurance, industry and academia to explore the scientific advances that have moved prevention to the forefront of health care issues and corporate policy and to examine the overall role of prevention in health care reform. Participants will examine the roles and responsibilities of public health, organized medicine, the private sector and individuals in the proposed health care systems. Major areas of consideration will be access and delivery, the relationship between prevention and primary care, the inclusion of public health and clinical preventive services and the costs human and economic - of including or excluding prevention strategies in health care reform. The manner in which preventionists are trained will also be explored to determine how to adapt the training of preventive medicine specialists to the evolving system and how to integrate prevention into the training of generalist physicians and other health professionals. Lead prevention into the future at PREVENTION 93. Earn CME and CHES credit. Call (202)789-0006 for registration information. PREVENTION 93 1015 15th Street, NW, Suite 403 Washington, DC 20005

CONFERENCE

WOMEN'S HEALTH: OCCUPATION AND CANCER November 1-2,1993 Baltimore Inner Harbor, Maryland Sponsored by

National Institutes of Health National Cancer Institute, National Institute of Environmental Health Sciences, and Office of Research on Women's Health The objectives of this International Conference are to review available epidemiologic data on occupational cancer risks among women, to identify existing data resources, to define research needs, and to encourage further research on occupational and environmental determinants of cancer among women. Invited presentations include: Changing Patterns of Female Employment, Gender Differences in Cancer Rates, Methodologic Issues, Gender Differences in Occupational Exposures, and Cancer Risks in Typical Female Occupations. Contributed papers and posters will be solicited. journal.

Proceedings will be published in a peer-reviewed

For further information, contact: Ms. Carmen Warren, TASCON, Inc. (301) 907-3844

LEONARDO COULD HAVE QUALIFIED FOR AMWA MEMBERSHIP.

AW

AMERICAN r \N\' MEDICAL WRITERS ASSOCIATIO

~

CAN YOU?

The great Renaissance man could have made u on the strength of his medical writing alone . Or as an illustrator, Or simply as a medical scientist. You can earn membership in the American Medical Writers Association — AMWA— by being any one of these, as well as by being a doctor, dentist, editor, librarian, educator, medical photographer or by being professionally involved in medical communication The one inflexible criterion: you must share the conviction of AMWA's 3,700 members that clear, concise communication is a vitally important art that must be cultivated and refined. To achieve that end, AMWA conducts extraordinary workshops, plenary sessions and forums in a variety of specialized facets of communications — including explorations into the latest electronic media It holds local, regional, national, ana international meetings that enable writers, editors, physicians, film- and videomakers, publishers, illustrators — a wide spectrum of scientific communicators to meet and exchange ideas. And AMWA publishes a refereed journal that exists for one purpose only — to encourage and nurture concise, lucid medical communications To learn more about how to |Oin the rapidly growing ranks of AMWA members who share your concerns, write, call, or fax the American Medical Writers Association, 9650 Rockville Pike, Bcthcsda Maryland 20814, (301-493-0003, fax 301-493-0005) Just because da Vinci missed out on AMWA membership is no reason you should1

Information for Contributors The American Journal of Epidemiobgy publishes original research as Original Contributions and Brief Original Contributions that comprise field and laboratory contributions on infectious and noninfectious acute and chronic diseases or papers on statistical or methodological topics. The Reviews and Commentary section features signed editorials, reviews, and comments on various aspects of epidemiologic research. Letters to the editor pertain to articles published in the Journal. We also publish reviews of books of interest to epidemiologists. Copyright. In accordance with the copyright law effective January 1, 1978, authors of manuscripts accepted for publication in the Journal will be asked to sign a Publication Agreement for the assignment of copyright to The Johns Hopkins University School of Hygiene and Public Health. The published manuscript becomes the sole property of the Journal and may not be submitted elsewhere for later publication without written permission from the Journal. Previously published data will not be accepted for publication. Questions regarding copyright and requests to reproduce published data should be directed to the Journal office. Manuscripts. The detailed instructions for preparation of manuscripts are published in the first issue of each volume, i.e., in the first January and first July issues. Reprints of these instructions are available on request from the editorial office. In brief, the manuscript should be typed double-spaced, with VA inch margins at top, bottom, and sides of page, on one side of 8Vii x 11 inch paper, with the author's name and page number at the top right on each page. An original typed version will be needed for editing rather than a photocopy. Print should be letter quality. Guidelines for maximum length of article: Original Contributions, 4,000 words; Brief Original Contributions, 1,500 words; Reviews and Commentaries, 4,000 words; Letters to the Editor, 500-600 words (plus relevant tables, figures, and references). Contributors should note that published Letters to the Editor (or replies) must not exceed one and one-half printed pages. For all manuscripts, an original and three complete copies, including tables and figures, are required. The cover letter, in duplicate, should include a phone number and address to which galleys, etc., should be sent. Abstract and Keywords. The abstract should not exceed 200 words for an Original Contribution or 100 words for a Brief Original Contribution. Include a list of not more than eight keywords after the abstract. Keywords (in al-

phabetical order) should be selected from a current copy of the National Library of Medicine's Medical Subject Headings (MeSH). Because the keywords are used in indexing, they should also be provided for Reviews and Commentaries. Abbreviations. An alphabetical list of abbreviations used in the paper, and their meanings, should be supplied. Abbreviations should be defined the first time used in the text. Journal policy is to avoid acronyms except for immediately recognizable acronyms employed for conciseness in tables, etc., and ones needed to stand for long, involved terms. Naturally, abbreviations of measurements and chemicals are not affected. References are consecutively numbered (in parentheses) in the text. The list of references should follow Journal style. Important: Authors must verify the accuracy of all citations. Tables and Figures are numbered in the order in which they are mentioned in the text. Four by six inch glossy prints of figures are required. If tables or figures are reproduced or closely adapted from a previously published book or paper (including the author's own previously published data), the author must supply the Journal with written permission from the original copyright holder. Charges. Authors are charged for printed pages in excess of 4 as follows: Original Contributions, $75 per page for the 5th and 6th pages and $90 per page for every page thereafter; Reviews and Commentaries, $60 per page for pages in excess of 4. (Multi-part papers in a single issue are considered a single contribution in computing charges for printed pages over 4.) A flat rate of $45 is charged per article for author's alterations amounting to 10 changes or less. Changes of 11 or more are charged at $3.50 per change. Additional charges are assessed for changes in tables or figures. Reprints. Authors are requested to order enough reprints to meet anticipated needs. Published manuscripts may not be reproduced without permission of the Journal. If the supply of reprints is exhausted, or if the author fails to order reprints before the issue is published, the author should contact the Journal office for rate schedules and specific permission to reproduce. Address correspondence to: Editor, American Journal of Epidemiology 2007 E. Monument St. Baltimore, MD 21205, USA

American Journal of

Founded 1920 by W. H. Welch and

EPIDEMIOLOGY BOARD OF OVERSEERS ALFRED SOMMER,

Chairman LOUISE A. BRINTON LEON GORDIS CHARLES H. HENNEKENS ALLYN W. KIMBALL W. HENRY MOSLEY NOEL R. ROSE

W. H. HoweU as the American Journal of Hygiene

TECHNICAL EDITORS

BOARD OF EDITORS ADRIAN M. OSTFELD,

MOYSES SZKLO,

Editor-in-Chief

SANDRA L. BRYANT JANET M. MCNAUOHTON SUSAN G. MURRAY AMY W. REDMON

Editor Emeritus

GEORGE W. COMSTOCK,

Editor-in-Chwf Emeritus HAROUTUNE K. ARMENIAN TEHRI H. BEATY PETER BURNEY TOM D. Y. CHIN JANET R. DALINO C. E. DAVIS ALLAN DONNER FRED EDERER GARY D. FRIEDMAN MARY MONK

DIANA B. PETTTTI JONATHAN M. SAMET W. EUGENE SANDERS, JR. DAVID A. SAVTTZ MEIR J. STAMPFER DAVID B. THOMAS STEPHEN D. WALTER

ADMINISTRATIVE ASSISTANT HARRIETT TELLJOHANN ADMINISTRATIVE SECRETARIES ANN TEN EYCK DUNBAR SHAWNISE F. SMITH

MANAGING EDITOR EARLE V. HART, JR.

SUBSCRIPTION MANAGER

ASSOCIATE MANAGING EDITOR

SANDRA ADAMS

CHRISTOPHER T. GEORGE

ASSOCIATE EDITORS ANDERS AHLBOM, Stockholm, Sweden JORDI ALONSO, Barcelona, Spain

JOSEP M. ANTO, Barcelona, Spain BEN ARMSTRONG, Montreal, Canada PETER H. BENNETT, Phoenix, AZ ROBERTO BERTOLLINI, Rome, Italy AARON BLAIR, Bethesda, MD STEVEN N. BLAIR, Dallas, TX MARTIN J. BLASER, Nashville, TN ERIC BOERWINKLE, Houston, TX PHILIP S. BRACHMAN, Atlanta, GA LOUISE A. BRINTON, Bethesda, MD SHELLEY B. BULL, Toronto, ON, Canada GARY A. CHASE, Baltimore, MD HARVEY CHECKOWAY, Seattle, WA GRAHAM A. COLDITZ, Boston, MA JAMES W. CURRAN, Atlanta, GA A. MICHAEL DAVIES, Jerusalem, Israel ALAN R. DYER, Chicago, 1L PHILIP E. ENTERLINE, Pittsburgh, PA MANNING FEINLEIB, Bethesda, MD W DANA FLANDERS, Atlanta, GA AARON FOLSOM, Minneapolis, MN LINDA P. FRIED, Baltimore, MD PETER J. GERGEN, Hyattsuille, MD W. PAUL GLEZEN, Houston, TX ROBERT J GOLDBERG, Worcester, MA MARC T. GOODMAN, Honolulu, HI SAXON GRAHAM, Buffalo, NY RAYMOND S. GREENBERG, Atlanta, GA SANDER GREENLAND, LOS Angeles, CA STEPHEN C. HADLER, Atlanta, GA ROBERT W. HALEY, Dallas, TX M. ELIZABETH HALLORAN, Atlanta, GA JEAN H HANKIN. Honolulu, HI

ROBERT A. HIATT, Oakland, CA THEODORE R. HOLFORD, New Hauen, CT WALTER W. HOLLAND, London,

England DONALD R. HOOVER, Baltimore, MD HAROLD W. JAFFE, Atlanta, GA

ULRICH KEIL, Bochum, Germany MUIN J. KHOURY, Atlanta, GA ALLYN W KIMBALL, Baltimore, MD LAURENCE N. KOLONEL, Honolulu, HI LEWIS KULLER, Pittsburgh, PA CARLO LA VECCHIA, Milan, Italy FRANK E. LUNDIN, Rockville, MD JACK S. MANDEL, Minneapolis, MN JAMES R. MARSHALL, Buffalo, NY JAMES E. MAYNARD, Atlanta, GA JOSEPH K. MCLAUGHLIN, Bethesda, MD L. JOSEPH MELTON, III, Rochester, MN DAVID L. MILLER, London, England PATRICIA P. MOLL, Ann Arbor, MI

ARNOLD S. MONTO, Ann Arbor, MI HAL MORGENSTERN, LOS Angeles, CA EVE K. MOSCICKI, Rockville, MD JAMES W. MOSLEY, LOS Angeles, CA NANCY ELSA MUELLER, Boston, MA

C. S. MuiR, Lyon, France KENRAD E. NELSON, Baltimore, MD F. JAVIER NIETO, Baltimore, MD ABRAHAM M. Y. NOMURA, Honolulu, HI RALPH S. PAFFENBARGER, JR.,

Stanford, CA PAOLO PASQUINI, Rome, Italy NEIL PEARCE, Wellington, New Zealand MARVIN J. PODCOR, Bethesda, MD CHARLES POOLE, Cambridge, MA

Ross PRENTICE, Seattle, WA WILLIAM C. REEVES, Atlanta, GA ARTHUR L. REINGOLD, Berkeley, CA JAMES M. ROBINS, Boston, MA ELAINE RON, Bethesda, MD LYNN ROSENBERG, BrookUne, MA BERNARD ROSNER, Boston, MA JUKKA T. SALONEN, Kuopio, Finland DALE P. SANDLER, Research Triangle Park, NC

RODOLFO SARACCI, Lyon, France WILLIAM SCHAFFNER, Nashville, TN MARK H. SCHIPFMAN, Bethesda, MD WILLIAM J. SCHULL, Houston, TX CHRISTOPHER T. SEMPOS, Hyattsville, MD

A. RiCHEY SHARRETT, Bethesda, MD RICHARD B. SHEKELLE, Houston, TX STEPHEN SIDNEY, Oakland, CA JACK SIEMIATYCKI, Laual, QU, Canada DAVID SISCOVICK, Seattle, WA PAUL D. SORLIE, Bethesda, MD J. MICHAEL SPRAFKA, Minneapolis, MN JANET L. STANFORD, Seattle, WA CLADD E. STEVENS, New York, NY JAMES M. TIELSCH, Baltimore, MD HERMAN A. TYROLER, Chapel Hill, NC CESAR VICTORA, Pelotas, Brazil ROBERT B. WALLACE, Iowa City, IA ALLEN J. WILCOX, Research Triangle

Park, NC WALTER WILLETT, Boston, MA WARREN WINKELSTEIN, JR., Berkeley, CA ROBERT F. WOOLSON, Iowa City, IA

AiMERICAN JOURNAL OF EPIDEMIOLOGY (ISSN 0002-9262) is published twice monthly for $190.00 (Domestic) and $198.00 (Foreign) per year by The Johns Hopkins University School of Hygiene and Public Hearth, 615 N. Wolfe St, Baltimore, MD 21205. Second-class postage paid at Baltimore, MD, and additional mailing offices. Postmaster Send address changes to: AMERICAN JOURNAL OF EPIDEMIOLOGY, 2007 E. Monument St., Baltimore, MD 21205-2216. Sponsored by the Society for Epidemioiogic Research. Supported in part by a bequest from the DeLamar Fund. Editorial Office telephone no.: 410-955-3441; fax: 410-9550344. Printed by Waverly Press, 1314 Guilford Ave., Baltimore, MD 21202-3995.