JAMA : the journal of the American Medical Association
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We examined the tobacco industry's new strategy to defeat and then repeal tobacco control ordinances in California and the efforts of health professionals to pass and defend these ordinances. Case studies were conducted in California communities in 1991 and 1992, using published reports, public documents, attendance at public meetings, and interviews. The tobacco industry is spending millions of dollars to intervene in California communities to oppose legislation protecting nonsmokers from secondhand smoke. ⋯ If these efforts do not weaken or defeat an ordinance, the tobacco industry initiates a referendum petition drive to suspend it to pressure local elected officials to repeal or weaken it. If this tactic fails, the industry often finances an election campaign to repeal the ordinance by popular vote. Although the tobacco industry's new strategy has hindered the passage of some local tobacco control ordinances, when health professionals and elected officials remained active and committed, the industry's efforts have failed and the ordinances have been upheld.
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To assess whether risk-adjusted mortality rates for hospitals reflect primarily chance variation. ⋯ Risk-adjusted outcomes for CABG patients derived from administrative data exhibit substantial patterns of consistency. Such patterns cannot be detected for low-risk patients but are evident for the top quartile of patients stratified by risk. Even with reporting lags and changes in hospital outcomes over time, a policy of channeling high-risk patients away from high-outlier hospitals and toward low-outlier hospitals could lower their overall risk-adjusted mortality rate by 45% [corrected].