CHICAGO—The prevalence of hypertension is higher in Europe than in the U.S. and Canada, according to an article in the May 14 issue of The Journal of the American Medical Association (JAMA).

According to background information in the article, cardiovascular disease (CVD) remains the most common cause of death in industrialized countries, and hypertension is the most frequent treatable risk factor. Geographic variations in CVD and associated risk factors have been recognized among all regions of the world. However, little attention has been directed to potential differences in hypertension between Europe and North America. The researchers in this study wanted to determine whether higher blood pressure (BP) levels and hypertension are more prevalent in Europe than in the United States and Canada.

Katharina Wolf-Maier, M.D., of the Loyola University Stritch School of Medicine, Maywood, Ill., and colleagues conducted a study that included locating sample surveys of BP levels that were national in scope and performed in the 1990s in Germany, Finland, Sweden, England, Spain, Italy, Canada, and the United States. Survey sizes ranged from 1,800 to 23,100.

The researchers found that the "the age- and sex-adjusted prevalence of hypertension was 28 percent in the North American countries and 44 percent in the European countries at the 140/90-mm Hg threshold. The findings for men and women by region were similar. Hypertension prevalence was strongly correlated with stroke mortality and more modestly with total CVD," they write.

The authors also found that the average BP was 136/83 mm Hg in the European countries and 127/77 mm Hg in Canada and the United States among men and women combined who were 35 to 74 years of age. For all age groups, blood pressure measurements were lowest in the United States and highest in Germany The prevalence of hypertension was highest in Germany (55 percent), followed by Finland (49 percent), Spain (47 percent), England (42 percent), Sweden (38 percent), and Italy (38 percent). Prevalences in the United States (28 percent) and Canada (27 percent) were half of the rate in Germany. The average mortality rate from stroke (the cardiovascular condition with the highest risk from hypertension) in the European countries was 41.2 per 100 000 population, whereas it was 27.6 per 100,000 population in Canada and the United States.

CHICAGO—Older women who maintain or adopt a physically active lifestyle may have increased longevity, according to an article in the May 14 issue of The Journal of the American Medical Association (JAMA).

Physically active lifestyles have been consistently related to reduced death rates and illness from cardiovascular disease (CVD), diabetes, physical disability, and certain cancers, according to background information in the article. But it is not clear whether changes in physical activity affect life span among older women.

Edward W. Gregg, Ph.D., of the Centers for Disease Control and Prevention, Atlanta, and colleagues examined the relationship of changes in physical activity and mortality among older women. The study was conducted at four U.S. research centers (Baltimore; Portland, Ore; Minneapolis; and Monongahela Valley, Pa.) among 9,518 community-dwelling white women aged 65 years or older who were assessed at baseline (1986-1988), 7,553 of whom were reassessed at a follow-up visit (1992-1994; median, 5.7 years later).

"Compared with continually sedentary women, those who increased physical activity levels between baseline and follow-up [equivalent of about one mile a day of walking] had lower mortality from all causes [48 percent lower death risk], cardiovascular disease [36 percent lower risk], and cancer [51 percent lower risk], independent of age, smoking, body mass index, comorbid conditions, and baseline physical activity level," they write. "Associations between changes in physical activity and reduced mortality were similar in women with and without chronic diseases but tended to be weaker among women aged at least 75 years and among those with poor health status."

Women who were physically active at both visits also had lower all-cause mortality (32 percent lower risk) and cardiovascular mortality (38 percent lower risk) than sedentary women.

The authors speculate that increased longevity associated with increasing physical activity could arise from many factors, including reductions in CVD risk factors and events, improved cardiorespiratory fitness, and reduced risk of falls, osteoporotic fractures, and physical disability.

The researchers write that these findings are important because the population of older women in the United States is projected to double in the next 30 years and more than one-third are now sedentary.

CHICAGO—The Internet is used moderately for health information, and has less substantial effects on actual health care utilization than thought, according to an article in the May 14 issue of The Journal of the American Medical Association (JAMA).

The Internet has attracted considerable attention as a means to improve health and health care delivery, but it is not clear how prevalent Internet use for health care really is or what impact it has on health care utilization, according to background information in the article. Available estimates of use and impact vary widely. Previous estimates suggest that more than half and as much as 80 percent of adults with Internet access use the Internet for health care purposes. Without accurate estimates of use and effects, it is difficult to focus policy discussions or design appropriate policy activities.

Laurence Baker, Ph.D., of the Stanford University School of Medicine, Stanford, Calif., and colleagues assessed the extent of Internet use for health care among a representative sample of the U.S. population, examined the prevalence of e-mail use for health care, and examined the effects that Internet and e-mail use has on users' knowledge about health care matters and their use of the health care system.

The study was based on a survey conducted in December 2001 and January 2002 among a sample drawn from a research panel of more than 60,000 U.S. households. Responses were analyzed from 4,764 individuals aged 21 or older who were self-reported Internet users.

The survey found: "Approximately 40 percent of respondents with Internet access reported using the Internet to look for advice or information about health or health care in 2001. Six percent reported using e-mail to contact a physician or other health care professional. About one third of those using the Internet for health reported that using the Internet affected a decision about health or their health care, but very few reported impacts on measurable health care utilization; 94 percent said that Internet use had no effect on the number of physician visits they had and 93 percent said it had no effect on the number of telephone contacts. Five percent or less reported use of the Internet to obtain prescriptions or purchase pharmaceutical products."

The researchers add that with about half of the adult U.S. population using the Internet at all, these findings suggest that about 20 percent of the entire adult population in the U.S. used the Internet for health care purposes in 2001.

"We also found that Internet use for health is relatively infrequent. Seventy-eight percent of those who ever used the Internet for health care in 2001 reported using it every 2 to 3 months or less. Only 22 percent of those who ever used the Internet reported using it once a month or more. Again, our estimates are much lower than those reported in other studies. One recent report indicated that 59 percent of adults who search for health information online do so about once a week to once a month," they write.

CHICAGO—Advertising by the beer and liquor industries appears more frequently in magazines with higher adolescent readership, according to an article in the May 14 issue of The Journal of the American Medical Association (JAMA).

"Adolescent drinking is associated with a host of negative consequences, including injuries, suicides, driving under the influence of alcohol, driving fatalities, unsafe or increased sexual activity, sexual assault, and acquaintance or date rape," the authors provide as background information. "... in 2002, 20 percent of 8th graders admitted to drinking an alcoholic beverage in the past 30 days, as well as 35 percent of 10th graders, and 49 percent of 12th graders. Adolescent drinkers have also been found to account for nearly 20 percent of total alcohol consumption, spending an estimated $22.5 billion in 1999. Alcohol advertising has been shown to correlate at least modestly with consumption. Several studies have found that children and adolescents who are exposed to greater amounts of alcohol advertising are more likely to use or intend to use such products."

Craig F. Garfield, M.D., M.A., from the Evanston Northwestern Healthcare Research Institute, Evanston, Ill., and colleagues analyzed alcohol advertising in magazines from 1997 to 2001 to examine whether alcohol advertisement placement is associated with adolescent readership. The authors reviewed data from 35 magazines which tracked their adolescent readership. The authors divided the total readership into three age categories tracked by the advertising industry: adolescents aged 12 to 19 years; young adults aged 20 to 24 years; and older adults aged 25 years or older. The authors condensed the categories of alcohol into three umbrella categories of beer, distilled liquors, and wine and wine coolers.

"From 1997 through 2001, the alcohol industry spent $696 million placing 9,148 advertisements in the 35 magazines in the sample," the authors report. "Beer advertisements accounted for 13 percent (1,201) of the total, wine and wine coolers 5 percent (443), and distilled liquors 82 percent (7,504)." The authors continue, "After adjustment for other magazine characteristics, the advertisement rate ratio was 1.6 times more for beer and liquor for every additional million adolescent readers. Wine industry advertising was not associated with adolescent readership." The authors write that they are unable to determine if the beer and distilled liquor industries intentionally target adolescents.

FEWER PEOPLE USING INTERNET FOR HEALTH CARE INFORMATION THAN PREVIOUSLY ESTIMATED