bluuebunny/crossref_metadata_2025 huggingface dataset:
State Efforts to Measure the Health Care Safety Net
Authors: Blewett Lynn A. , Beebe Timothy J.
Published: January 2017

This article describes the role states could play in a national effort to measure and monitor the public health safety net. The authors developed a data collection framework using information from five states on two components of the safety net: structure and demand. Because states are the primary vehicle for access expansions and programs to care for the poor, the authors suggest that they be the primary coordinating mechanism for data collection on the safety net. Because the necessary mechanisms for more uniform standards or criteria to evaluate state data collection activities and capacity remain undeveloped, they recommend using existing data to begin building state capacity to measure and monitor the safety net.
Vaccine Coverage Levels after Implementation of a Middle School Vaccination Requirement, Florida, 1997–2000
Authors: Fogarty Kieran J. , Massoudi Mehran S. , Gallo William , Averhoff Francisco M. , Yusuf Hussain , Fishbein Daniel
Published: January 2017

Objective.

Little information is available about the effectiveness of school entry vaccination requirements at the middle school level. This study examined coverage levels among students entering seventh grade in Florida following implementation of a school entry vaccination requirement in 1997.

Methods.

The authors analyzed county-specific vaccination coverage levels (three doses of hepatitis B vaccine, a second dose of measles, mumps, and rubella [MMR] vaccine, and a booster dose of tetanus and diphtheria toxoids [Td]) among students entering public and private schools in Florida from 1997 through 2000. In 1998, a survey of all county health departments was conducted, and the resulting data were linked to county-specific vaccination rates.

Results.

During the 1997–1998 school year, the first year the requirement went into effect, at school entry 121,219 seventh-grade students (61.8%) were fully vaccinated, 72,275 seventh grade students (36.9%) lacked one or more doses of vaccine but were considered in process, 1,817 were non-compliant (0.9%), and 763 had medical or religious exemptions (0.4%). In the 2000–2001 school year, the proportions of students reported fully vaccinated at school entry had increased to 66%. Most of this change was related to an increase in hepatitis B coverage. There was a significant inverse relationship between the proportion of students fully vaccinated and the size of the county's seventh grade population.

Conclusions.

The seventh grade vaccination entry requirement was associated with sustained high levels of vaccination coverage. Passing a school entry vaccination requirement appears may be sufficient to increase coverage, but other strategies may be required to achieve full immunization of middle school students.
Bridging between Two Standards for Collecting Information on Race and Ethnicity: An Application to Census 2000 and Vital Rates
Authors: Parker Jennifer D. , Schenker Nathaniel , Ingram Deborah D. , Weed James A. , Heck Katherine E. , Madans Jennifer H.
Published: January 2017

Objectives.

The 2000 Census, which provides denominators used in calculating vital statistics and other rates, allowed multiple-race responses. Many other data systems that provide numerators used in calculating rates collect only single-race data. Bridging is needed to make the numerators and denominators comparable. This report describes and evaluates the method used by the National Center for Health Statistics to bridge multiple-race responses obtained from Census 2000 to single-race categories, creating single-race population estimates that are available to the public.

Methods.

The authors fitted logistic regression models to multiple-race data from the National Health Interview Survey (NHIS) for 1997–2000. These fitted models, and two bridging methods previously suggested by the Office of Management and Budget, were applied to the public-use Census Modified Race Data Summary file to create single-race population estimates for the U.S. The authors also compared death rates for single-race groups calculated using these three approaches.

Results.

Parameter estimates differed between the NHIS models for the multiple-race groups. For example, as the percentage of multiple-race respondents in a county increased, the likelihood of stating black as a primary race increased among black/white respondents but decreased among American Indian or Alaska Native/black respondents. The inclusion of county-level contextual variables in the regression models as well as the underlying demographic differences across states led to variation in allocation percentages; for example, the allocation of black/white respondents to single-race white ranged from nearly zero to more than 50% across states. Death rates calculated using bridging via the NHIS models were similar to those calculated using other methods, except for the American Indian/Alaska Native group, which included a large proportion of multiple-race reporters.

Conclusion.

Many data systems do not currently allow multiple-race reporting. When such data systems are used with Census counts to produce race-specific rates, bridging methods that incorporate geographic and demographic factors may lead to better rates than methods that do not consider such factors.
Integration of Academia and Practice in Preparedness Training: The Harvard School of Public Health Experience
Authors: Orfaly Rebecca A. , Biddinger Paul D. , Burstein Jonathan L. , Leaning Jennifer
Published: January 2017

Given the need for public health professionals well trained in emergency preparedness and response, students in public health programs require ample practical training to prepare them for careers in public health practice. The Harvard School of Public Health Center for Public Health Preparedness has been instrumental in the creation and implementation of a course entitled, “Bioterrorism: Public Health Preparedness and Response.” This course features lectures on specific applications of public health practice in emergency preparedness and response. In addition, it provides students the opportunity to operationalize and apply their knowledge during an interactive tabletop exercise. In light of their university affiliations and expertise in providing preparedness training, other Academic Centers for Public Health Preparedness have the opportunity to be instrumental in providing similar training to graduate students of public health.
The South Central Center for Public Health Preparedness Training System Model: A Comprehensive Approach
Authors: Sarpy Sue Ann , Chauvin Sheila W. , Hites Lisle S. , Santacaterina Laurita , Capper Stuart , Cuccia Martha , Anderson Ann C. , Petersen Donna
Published: January 2017

The South Central Center for Public Health Preparedness (SCCPHP) is a collaboration among the schools of public health at Tulane University and the University of Alabama at Birmingham and the state health departments in Alabama, Arkansas, Louisiana, and Mississippi. The SCCPHP provides competency-based training via distant delivery methods to prepare public health workers to plan for and rapidly respond to public health threats and emergency events. This article presents the training system model used by the SCCPHP to assess, design, develop, implement, and evaluate training that is both competency driven and practice based. The SCCPHP training system model ensures a standardized process is used across public health occupations and geographic regions, while allowing for tailoring of the content to meet the specific training needs of the workforce in the respective state and local health departments. Further, the SCCPHP training system model provides evidence of the reciprocal nature between research and practice needed to advance the area of emergency preparedness training and workforce development initiatives in public health.
The Practice Community Meets the Ivory Tower: A Health Department/Academic Partnership to Improve Public Health Preparedness
Authors: Covich Judith R. , Parker Cindy L. , White Vanessa A.
Published: January 2017

When the local health department of Montgomery County, Maryland, was chosen to participate in Project Public Health Ready and was charged with the daunting task of providing a comprehensive emergency preparedness plan, training all 600 employees to carry out that plan, and conducting exercises to demonstrate the department's competency, it realized it couldn't do it alone. The department sought the assistance of the Johns Hopkins Bloomberg School of Public Health. The first challenge for these unlikely partners, one a bastion of research and the other firmly immersed in the practice world of public health, was to figure out how to work together. This article describes the development of their partnership; outlines the preparedness plan, training, and exercises that resulted from the partnership; summarizes the challenges and benefits for each entity; and enumerates lessons learned that could be useful to other public health entities planning to undertake similar partnerships.
Cross-Sector Leadership Development for Preparedness
Authors: Potter Margaret A. , Burns Helen K. , Barron Gerald , Grofebert Alice , Bednarz G. Daniel
Published: January 2017

After fall 2001, scientists and professionals recognized the importance of integrating public health with traditional first-response professions in planning and training for disasters. However, operationalizing this approach among professionals in the field confronted barriers that were both inter-cultural and jurisdictional. The Pennsylvania Preparedness Leadership Institute (PPLI) is a collaboration of the Pennsylvania Department of Health and the University of Pittsburgh Center for Public Health Preparedness. Team members are recruited from public health, emergency medicine, emergency management, hospitals, and public safety agencies from each of nine multi-county regions in Pennsylvania. Each team takes on a year-long project that addresses a strategic problem as a focus for capacity-building within its region. Unexpectedly during PPLI's first year in operation, a hepatitis-A outbreak tested whether one regional team could successfully mount the necessary integrated response. This experience, as well as the planned evaluation for PPLI, demonstrated both the successful processes and the positive impact of this integrated leadership training initiative.
Settlement-Funded Tobacco Control in Texas: 2000–2004 Pilot Project Effects on Cigarette Smoking
Authors: McAlister Alfred L. , Huang Philip , Ramirez Amelie G.
Published: January 2017

Because settlement proceeds allocated for tobacco control in Texas are insufficient for statewide activity at federally recommended funding levels, the Texas Department of State Health Services has used the available funds in quasi-experimental pilot studies in which varying amounts of support are provided for selected parts of the state. Trends in tobacco use were measured in telephone surveys of 7,998 (2000), 5,150 (2002), and 5,721 (2004) adults. Prevalence of cigarette smoking declined by almost one-third in the pilot area where comprehensive and sustained pilot activities to reduce tobacco use were organized at close to the federally recommended funding level. Significantly smaller reductions were observed in other parts of the state. In the group with the highest use, white non-Hispanic men, cigarette consumption declined by half in the pilot area. It is reasonable to expect similar reductions in tobacco use if funds are provided for statewide expansion of the pilot activities.
The Association of Low Birthweight and Chronic Renal Failure among Medicaid Young Adults with Diabetes and/or Hypertension
Authors: Fan Z. Joyce , Lackland Daniel T. , Lipsitz Stuart R. , Nicholas Joyce S.
Published: January 2017

Objective.

The purpose of this study was to assess the effect of low birthweight on chronic renal failure among young Medicaid patients with diabetes and/or hypertension.

Methods.

The study included Caucasian and African American young adults, aged 18–50, who enrolled in the Medicaid program from 1993 to 1996 in South Carolina and were diagnosed with diabetes and/or hypertension. The odds of chronic renal failure by low birthweight (<2,500 grams) was estimated using logistic regression.

Results.

Of the 7,505 Medicaid patients with diabetes and/or hypertension, 179 (2.4%) were diagnosed with chronic renal failure. These patients were younger (mean age of 33.9 vs. 37.6, p=0.0024) and had a higher proportion of low birthweight (15.1% vs. 11.4%, p=0.07) compared with the 7,326 patients without renal failure. The odds ratio of chronic renal failure for low birthweight was significantly higher compared with normal birthweight (2,500-3,999 grams) (adjusted odds ratio [OR] 1.56, 95% confidence interval [95% CI] 1.0, 2.4). The association between low birthweight and chronic renal failure was stronger among the 888 patients with both diabetes and hypertension (OR 2.6, 95% CI 1.3, 5.7) than the 1,812 diabetes or the 4,805 hypertension patients.

Conclusions.

The odds of chronic renal failure by low birthweight was highest in patients with both diabetes and hypertension, suggesting that the mechanism(s) involved in the disease progression to chronic renal failure may have a fetal early life origin.
The Role of Flushing Dental Water Lines for the Removal of Microbial Contaminants
Authors: Rice Eugene W. , Rich William K. , Johnson Clifford H. , Lye Dennis J.
Published: January 2017

Objectives.

This study was designed to determine the role of flushing dental water lines for the removal of heterotrophic plate count bacteria, Legionella spp., and free-living protozoa.

Methods.

Forty dental offices were surveyed in the study. An initial sample and a sample taken after three minutes of flushing were obtained from the air/water syringe at each location. All samples were quantitatively analyzed for heterotrophic bacteria using three bacteriological procedures. The samples were analyzed for the presence of Legionella spp. using cultural, immunological, and molecular procedures and for the occurrence of free-living protozoa using a killed bacteria plate procedure.

Results.

The flushing process reduced the level of heterotrophic plate count bacteria by 1.1 to 1.5 log10 CFU/ml. Compliance with recommendations for bacterial levels varied depending on the methodology employed in the analysis. The flushing process did not reduce the occurrence of Legionella spp. or free-living protozoa.

Conclusion.

The results support recent U.S. Centers for Disease Control and Prevention recommendations that the process of flushing dental water lines cannot be relied upon as a sole means of reliably improving the quality of water used in dental treatment.
Children's Health Services in a “System of Care”: Patterns of Mental Health, Primary and Specialty Use
Authors: Grimes Katherine E. , Kapunan Patricia E. , Mullin Brian
Published: January 2017

Objectives.

This study was designed to investigate demonstrable impacts of the Mental Health Services Program for Youth (MHSPY), a highly coordinated, intentionally integrated “system of care,” on patterns of health service utilization for youth with multiple needs.

Methods.

The MHSPY intervention is available to a target population of urban youth who face barriers to health care and are at risk for out-of-home placement. These youth are enrolled in a non-profit managed care organization (MCO). Patterns of medical, pharmacy, and mental health and substance abuse service use were compared for children aged 3 to 19 across insurance categories.

Results.

Despite risks for access and engagement barriers to care, and for greater medical expense due to greater morbidity, MHSPY enrollees received significantly more ambulatory care per person-year than either the privately insured population or the Medicaid Standard population, and medical expense for MHSPY members was significantly lower than expected. During the four years studied, individuals in the privately insured and Medicaid Standard populations were less likely than MHSPY enrollees to have had an ambulatory pediatric visit (odds ratio [OR] 0.833, 95% confidence interval [CI] 0.765, 0.908 and OR 0.823, 95% CI 0.775, 0.897, respectively). Medical expenses per member per month for MHSPY enrollees were significantly less than that for the similarly impaired Medicaid Disabled population with any medical claim ( p<0.001) or with any outpatient mental health claim ( p<0.01).

Conclusions.

Patterns of health care for subpopulations with known risk are important to identify to evaluate system-of-care effectiveness. The service utilization patterns for youth enrolled in the MHSYP system of care vs. those for similar MCO youth suggest health care access for individuals can be affected by delivery system design variables.
Health Services for HIV/AIDS, HCV, and Sexually Transmitted Infections in Substance Abuse Treatment Programs
Authors: Brown Lawrence S. , Kritz Steven , Goldsmith R. Jeffrey , Bini Edmund J. , Robinson Jim , Alderson Donald , Rotrosen John
Published: January 2017

The National Drug Abuse Treatment Clinical Trials Network conducted this study to determine the availability of and factors associated with infection-related health services in substance abuse treatment settings. In a cross-sectional descriptive design, state policies, reimbursement for providers, state level of priority, and treatment program characteristics were studied via written surveys of administrators of substance abuse treatment programs and of state health and substance abuse departments.

Data from health departments and substance abuse agencies of 48 states and from 269 substance abuse treatment programs revealed that human immunodeficiency virus/acquired immunodeficiency syndrome-related services are more frequent than hepatitis C virus or sexually transmitted infection-related services, and that nonmedical services are more frequent than medical services. While the availability of infection-related health services is associated with medical staffing patterns, addiction pharmacotherapy services, and state priorities, reimbursement was the most significant determining factor.

These findings suggest that greater funding of these health services in substance abuse treatment settings, facilitated by supportive state policies, represents an effective response to the excess morbidity and mortality of these substance use-related infections.
Enrolling in Medicaid through the National School Lunch Program: Outcome of a Pilot Project in California Schools
Authors: Cousineau Michael R. , Wada Eriko O. , Hogan Laura
Published: January 2017

California has several health insurance programs for children. However, the system for enrolling into these programs is complex and difficult to manage for many families. Express Lane Eligibility is designed to streamline the Medicaid (called Medi-Cal in California) enrollment process by linking it to the National School Lunch Program. If a child is eligible for free lunch and the parents consent, the program provides two months of presumptive eligibility for Medi-Cal and a simplified application process for continuation in Medi-Cal. For those who are ineligible, it provides a referral to other programs.

An evaluation of Express Lane shows that while many children were presumptively enrolled, nearly half of the applicants were already enrolled in Medi-Cal. Many Express Enrolled children failed to complete the full Medi-Cal enrollment process. Few were referred to the State Children's Health Insurance Program or county programs. Express Lane is less useful as a broad screening strategy, but can be one of many tools that communities use to enroll children in health insurance.
Assessment of Kindergarten Immunization Rates in Colorado: School Self-Reports vs. Health Department Audits, 2004–2005
Authors: Stanwyck Carol , Davila Jill , Wake Lane , Koshak Marianne
Published: January 2017

In 2005, the Colorado Department of Public Health and Environment audited a sample of kindergarten school records to determine vaccination coverage at school entry. In addition to the audit, the traditional method of collecting immunization data by self-reports from schools continued through that school year. The results of the two surveys were compared. The audit results indicated that 76.3% ( n = 1,776; 95% confidence interval 73.2, 79.4) of Colorado's kindergarteners received all required vaccines. In contrast, the series coverage estimated from school self-reports for the same time frame was 89.4% ( n=46,559). Self-reports by school staff in Colorado appear to overestimate the immunization status of children entering kindergarten. Because more than three-quarters of U.S. states use some form of school self-report to assess immunization status, this finding has significant implications for most state health departments.
Modified Directly Observed Therapy for Antiretroviral Therapy: A Primer from the Field
Authors: Goggin Kathy , Liston Robin J. , Mitty Jennifer Adelson
Published: January 2017

Modified directly observed therapy (mDOT), in which a portion of total doses of a medication regime is ingested under supervision, has demonstrated efficacy as an intervention to assist patients in maintaining adherence to complicated antiretroviral therapy (ART). Although findings are favorable, existing efficacy studies fail to provide sufficient detail to guide others who wish to implement mDOT interventions. The aim of this article is to provide a primer for practitioners and researchers who wish to implement mDOT interventions.

Drawing on the experience of 10 federally funded research projects, we provide guidance on critical questions for program implementation, including: who should be targeted, length/duration/content/location/tapering of sessions, staffing, incentives, and approaches to data collection. In addition, guidance on staff training and minimum requirements for mDOT interventions is offered along with real-world examples of mDOT interventions.

mDOT is feasible and easily adapted to many settings and target populations. Interventions should match the specific needs of the target population and setting and be flexible in terms of design and delivery. mDOT should be considered among the spectrum of adherence interventions.
Health-Care Use and Expenditures for Children in Special Education with Special Health-Care Needs: Is Dual Classification a Marker for High Use?
Authors: Sices Laura , Harman Jeffrey S. , Kelleher Kelly J.
Published: January 2017

Objectives.

Children with special health-care needs are an important group for policy and research planning. Special education engages a group of children with increased utilization of services related to education. While increased service utilization in education or health-care settings is often used to classify children as having special needs, considerable heterogeneity exists within each group. The extent to which being identified in two functionally defined systems—special education and health care—relates to health-care utilization is unknown. We sought to determine health-care and mental health utilization and expenditures for children dually classified as receiving special education and having special health-care needs (SHCN) compared with those who only have SHCN, only are in special education, or don't fall into either category.

Methods.

A nationally representative sample of children aged 5–17 years from the Medical Expenditure Panel Survey was used to compare mean health-care and mental health utilization and expenditures for the four groups.

Results.

Dually classified children had significantly higher mean utilization of health-care services than the other three groups ( p,0.05). Mean 12-month total health-care expenditures were highest for dually classified children ($3,891/year) ( p,0.05) and higher for children classified only as having SHCN ($1,426/year) than for children with neither classification ($644/year, p,0.05).

Conclusions.

Children dually classified as receiving special education and having SHCN represent a subgroup of children with SHCN with high levels of health-care utilization and expenditures. This information can assist policy makers in identifying characteristics that place children at risk for very high expenditures, and in allocating health-care resources.
How Much Time is Safety Worth? A Comparison of Trigger Configurations on Pneumatic Nail Guns in Residential Framing
Authors: Lipscomb Hester J. , Nolan James , Patterson Dennis , Makrozahopoulos Dimitrios , Kucera Kristen L. , Dement John M.
Published: January 2017

Objective.

Nail gun injuries are among the most common in wood frame construction. Despite evidence that the majority of injuries from unintentional firings could be prevented with a sequential trigger mechanism on the tools, the safer trigger has not been embraced in the fast-paced residential construction industry. An experiment was conducted in an attempt to realistically evaluate the magnitude of productivity concerns.

Methods.

Ten journeymen carpenters built a yard shed on two occasions, using nail guns with two different trigger configurations, alternately, under controlled conditions. Mean differences in time required, nails used, and proper placement were evaluated considering the trigger used and whether the building was the carpenter's first or second project.

Results.

The sequential trigger tool required a mean of 10 additional minutes of active nailing time, which represented 10% of mean nailing time (97 minutes) but only 0.77% of the total mean work time (1,298 minutes) to construct each shed. No significant differences were observed in nail count or placement. The majority of the time variability was related to who was using the tool, rather than the type of tool in the person's hand.

Conclusions.

Productivity concerns should focus more on improving the skill of the carpenter rather than on the trigger mechanism. Failure to place tools with the safer trigger configuration, which requires the nose piece to be depressed before the trigger is pulled, in the hands of workers does not make sense given the frequency and potential repercussions of injuries associated with the use of these tools in wood framing.
Ethnic Disparities in Stroke Recognition in Individuals with Prior Stroke
Authors: Ellis Charles , Egede Leonard E.
Published: January 2017

Objective.

Studies of stroke awareness suggest that knowledge of early warning signs of stroke is low in high-risk groups. However, little is known about stroke knowledge among individuals with a history of prior stroke who are at significant risk for recurrent stroke.

Methods.

Data from 2,970 adults with a history of prior stroke from the 2003 Behavioral Risk Factor Surveillance System were examined. Recognition of the five warning signs of stroke and appropriate action to call 911 was compared across three racial/ethnic groups: non-Hispanic white, non-Hispanic black, and Hispanic/other. Multiple logistic regression analyses were used to: ( 1) determine the association between race/ethnicity and recognition of multiple stroke signs and appropriate first action and ( 2) identify independent correlates of recognition of multiple stroke signs and taking appropriate action to seek treatment among individuals with prior stroke.

Results.

Recognition of all five signs of stroke and taking appropriate action to call 911 was lowest among the non-Hispanic black group (22.3%) and Hispanic/other group (16.7%). In multivariate models, Hispanic/other (odds ratio [OR] 0.42 [0.25, 0.71]), age 50–64 (OR 0.64 [0.43, 0.97]), age ≥65 (OR 0.36 [0.23, 0.55]), and >high school education (OR 1.79 [1.22, 2.63]) emerged as independent correlates of recognition of all five signs of stroke and first action to call 911.

Conclusions.

Less than 35% of people with prior stroke can distinguish the complex symptom profile of a stroke and take appropriate action to call 911. Targeted educational activities that are sensitive to differences in race/ethnicity, age, and education levels are needed for individuals with prior stroke.
Health-Care Reform and School-Based Health Care
Authors: Lear Julia Graham , Barnwell Elizabeth A. , Behrens Donna
Published: January 2017

There is growing recognition that health and health care at school can significantly impact children's health. From childhood obesity interventions to new immunization mandates, schools are at the forefront of child health discussions. The 2008 presidential campaign and the renewed focus on health-care reform raise the possibility that in 2009 school health will play a larger role in health policy conversations than previously.

This article explores the proposition that both school health and national health policy will benefit from closer attention to the role of school health within the U.S. health system. It offers a Maryland case study to suggest both the opportunities and operational challenges of linking school health to the larger community health system.
Current Status of State Policies That Support School-Based Health Centers
Authors: Schlitt John J. , Juszczak Linda J. , Eichner Nancy Haby
Published: January 2017

Objectives.

This study explored the current status of the role of state school-based health center (SBHC) initiatives, their evolution over the last two decades, and their expected impact on SBHCs' long-term sustainability.

Methods.

A national survey of states was conducted to determine ( 1) the amount and source of funding dedicated by the state directly for SBHCs, ( 2) criteria for funding distribution, ( 3) designation of staff/office to administer the program, ( 4) provision of technical assistance by the state program office, ( 5) types of performance data collected by the program office, ( 6) state perspective on future outlook for long-term sustainability, and ( 7) Medicaid and the State Children's Health Insurance Program (SCHIP) policies for reimbursement to SBHCs.

Results.

Nineteen states reported allocating a total of $55.7 million to 612 SBHCs in school year 2004–2005. The two most common sources of state-directed funding for SBHCs were state general revenue ($27 million) and Title V of the Social Security Act ($7 million). All but one of the 19 states have a program office dedicated to administering and overseeing the grants, and all mandate data reporting by their SBHCs. Sixteen states have established operating standards for SBHCs. Eleven states define SBHCs as a unique provider type for Medicaid; only six do so for SCHIP.

Conclusions.

In 20 years, the number of state SBHC initiatives has increased from five to 19. Over time, these initiatives have played a significant role in the expansion of SBHCs by earmarking state and federal public health funding for SBHCS, setting program standards, collecting evaluation data to demonstrate impact, and advocating for long-term sustainable resources.
Taking the “Guest” Work Out of School-Health Interagency Partnerships
Authors: Mandel Leslie A.
Published: January 2017

Objective.

School-based health centers (SBHCs) have proliferated rapidly, demonstrated success in health outcomes and access, and gained national recognition. Despite these accomplishments, organizational dissimilarities exist among health and school systems that are potentially leading to SBHC partnership barriers. This study sought to determine how partnering agencies promote cooperation and manage conflict across institutional boundaries.

Methods.

Utilizing case study methods, we conducted semistructured interviews of 55 stakeholders involved in program operations from four Massachusetts SBHCs. All had similar characteristics, yet based on a state-level rating system, two had successful interagency partnerships and two were experiencing difficulties.

Results.

Success designation played a role in how sites managed conflict and promoted understanding and cooperation. Data also revealed similarities such as frequent use of the term “guest” by all study subjects when describing SBHCs. School representatives stated that as guests, SBHCs should adhere to school rules. Health representatives assumed that as guests, they were not full partners and could be asked to leave. Successful sites were less likely to perceive themselves as guests. At successful sites, guest terminology also dissipated over time and evolved into interdependence and cooperation among school-health interagency partners.

Conclusion.

Viewing SBHCs as guests creates a tenuous partnership that may be counterproductive to SBHC growth and sustainability. Given current levels of public interest in education, SBHCs may afford enhanced attention to youth health. Additional financial and training resources are needed to build the common purpose that will encourage the formation and sustainability of strong, interdependent school-health partnerships.
Is the Elimination of HIV Infection within Reach in the United States? Lessons from an Epidemiologic Transmission Model
Authors: Holtgrave David R.
Published: January 2017

Recent estimates show that the transmission rate of human immunodeficiency virus (HIV) in the U.S. has substantially decreased. This raises the question, is elimination of HIV infection in the nation feasible in the foreseeable future? We demonstrate that if the HIV transmission rate were reduced by 50%, then the reproductive rate of HIV infection would drop below unity and lead to eventual elimination of infection. In recent congressional testimony, the director of the Centers for Disease Control and Prevention and others asserted that the HIV transmission rate can be halved by 2020, if not earlier, provided sufficient investment is made toward achieving this goal. We assert that if adequate investment is made and the transmission rate is in fact lowered by 50%, then the HIV reproductive rate would fall below unity, setting the stage for eventual elimination of HIV infection in the U.S.
Trends in Tuberculosis Mortality in the United States, 1990–2006: A Population-Based Case-Control Study
Authors: Jung Richard S. , Bennion Jonathan R. , Sorvillo Frank , Bellomy Amy
Published: January 2017

Objective.

We assessed demographic and temporal trends of tuberculosis (TB)-related deaths in the United States and examined associated comorbidities listed on death certificates.

Methods.

We analyzed TB-related mortality from 1990 through 2006 by examining multiple-cause-of-death data from the National Center for Health Statistics. We assessed age-adjusted mortality rates, secular trends, associations with demographic variables, and comorbid conditions.

Results.

From 1990 through 2006, TB was reported as a cause of death among 53,505 people in the U.S. with a combined overall mean age-adjusted mortality rate of 1.16 per 100,000 person-years. The age-adjusted TB mortality rate declined from 2.22 per 100,000 person-years in 1990 to 0.47 per 100,000 person-years in 2006, demonstrating mean annual decline of about 10%. People aged 75 years and older; males; foreign-born people; and those of Hispanic, Asian, black, and Native American race/ethnicity had comparatively elevated TB-related mortality rates. The mortality rate in foreign-born people was more than two times higher than in U.S.-born people. About 89% of deaths among people of Asian race/ethnicity and nearly 50% among black people were foreign-born individuals. Human immunodeficiency virus and selected autoimmune diseases were more common in TB-related deaths.

Conclusions.

TB mortality decreased substantially from 1990 through 2006, but remains an important cause of preventable mortality. The observed decrease was more pronounced among U.S.-born people than among foreign-born people. Disparities in TB-related mortality and the identification of important comorbid conditions can inform strategies targeting subpopulations at increased risk for fatal TB infection.
Heightened Risk of Fire Deaths among Older African Americans and Native Americans
Authors: Bishai David , Lee Sunmin
Published: January 2017

Objective.

We examined disparities in burn and fire injuries by age and race/ethnicity to identify disparities during the life course.

Methods.

Burn and fire mortality rates were disaggregated by five-year age groups, gender, and race/ethnicity from 1999 to 2004.

Results.

Compared with non-Hispanic white people, Native American and African American people older than 55 years of age experienced a higher risk of death from fires and burns. The rate ratio of burn/fire deaths for African Americans compared with white people was 3.14 (95% confidence interval [CI] 2.98, 3.31) for those aged 55 years and older. The corresponding rate ratio for Native Americans compared with white people was 1.93 (95% CI 1.49, 2.46) for those aged 55 years and older.

Conclusion.

The especially heightened risk among minority seniors could reflect living arrangements that place them at higher risk. Heightened fire risks for minority seniors require broad attention and the development of effective interventions.
Prognostic Factors Associated with Hepatitis C Disease: A Case-Control Study Utilizing U.S. Multiple-Cause-of-Death Data
Authors: Wise Matthew , Finelli Lyn , Sorvillo Frank
Published: January 2017

Objectives.

Hepatitis C, an important cause of premature mortality, is the most common chronic bloodborne infection in the United States. The severity of disease is strongly affected by a number of other medical conditions and health behaviors. We sought to estimate the association of several exposures with hepatitis C on death certificates.

Methods.

We enrolled 63,189 hepatitis C deaths as cases in a case-control study using multiple-cause-of-death data for the U.S. from 1999 to 2004. Three control groups were assembled from all remaining deaths with no mention of hepatitis C, including a random sample of all deaths, digestive disease deaths, and circulatory disease deaths.

Results.

Hepatitis B, human immunodeficiency virus (HIV), hemochromatosis, and alcohol use were all strongly associated with hepatitis C, even after controlling for confounding variables. The simultaneous presence of many of these exposures had a synergistic association with hepatitis C being listed as a cause of death. Hepatitis B, HIV, and alcohol use were recorded among 6.4%, 10.5%, and 18.2% of case deaths, respectively.

Conclusions.

The strong association of alcohol use, HIV, and hepatitis B with hepatitis C, as well as the frequent occurrence of these conditions, indicates that targeted interventions for mitigating the potential effect of these exposures may present an efficient means of limiting progression of hepatitis C-related liver disease and reducing the population burden of hepatitis C mortality.
Television and Video Game Viewing and its Association with Substance Use by Kentucky Elementary School Students, 2006
Authors: Armstrong Kia E. , Bush Heather M. , Jones Jeff
Published: January 2017

Objective.

We sought to determine if the number of hours elementary school students viewed television (TV) and video games is associated with substance use.

Methods.

We distributed the California Healthy Kids Survey Elementary School Questionnaire to elementary schools in Kentucky in 2006. A total of 4,691 students, primarily fourth and fifth graders, completed the survey. The students provided responses to questions on topics such as drug use, alcohol use, TV and video game viewing time, and their home life. We analyzed the survey using Chi-square tests and logistic regression.

Results.

Approximately one-third of respondents indicated substance use, which was defined as alcohol use, illegal drug use, smoking/tobacco use, or sniffing solvents. Significantly more children (28% of those watching ≥3 hours of TV/video games compared with 20% of those watching greater than zero but ≤2 hours of TV/video games) reported alcohol use ( p<0.05). Similar results were seen for sniffing solvents, with 9% of those watching ≥3 hours of TV/video games reporting they sniffed solvents compared with 4% who watched TV/video games for greater than zero but ≤2 hours ( p<0.05). The results of the logistic regression indicated that the odds of drinking alcohol (odds ratio [OR] = 1.48, 95% confidence interval [CI] 1.23, 1.79) and sniffing solvents (OR=1.97, 95% CI 1.42, 2.75) were significantly higher for those watching ≥3 hours of TV/video games compared with those who watched TV/video games for greater than zero but ≤2 hours.

Conclusions.

The hours of TV and video games viewed were associated with alcohol use and sniffing solvents for our sample. However, limitations exist due to the inability to separate TV viewing from video game viewing.
Hyperendemic H. Pylori and Tapeworm Infections in a U.S.-Mexico Border Population
Authors: Cardenas Victor M. , Mena Kristina D. , Ortiz Melchor , Karri Sitrulasi , Variyam Easwaran , Behravesh Casey Barton , Snowden Karen F. , Flisser Ana , Bristol John R. , Mayberry Lillian F. , Ortega Ynes R. , Fukuda Yoshihiro , Campos Armando , Graham David Y.
Published: January 2017

Objective.

A higher incidence of infectious disease has been documented in U.S. regions bordering Mexico compared with non-border areas. We assessed the prevalence of important gastrointestinal infections in Ciudad Juarez, Mexico, and El Paso, Texas, the largest binational community along the U.S.-Mexico border.

Methods.

Fecal specimens from a sample of the asymptomatic population representing all ages were tested for Helicobacter pylori (H. pylori), Cryptosporidium spp., Giardia spp., and other intestinal parasitic pathogens using flotation, immunoassays, and/or polymerase chain reaction. We also measured indicators of microbiological contamination of drinking water, hands of food preparers, and kitchen surfaces.

Results.

Overall, of the 386 participants, H. pylori was present in 38.2%, Taenia spp. in 3.3%, Giardia spp. in 2.7%, Cryptosporidium spp. in 1.9%, Entamoeba dispar in 1.3%, and Ascaris lumbricoides and Necator americanus in 0.3% of the study subjects; Cyclospora spp. and Entamoeba histolytica were not found. H. pylori infection was associated with handwashing (prevalence ratio [PR] = 1.3, 95% confidence interval [CI] 1.0, 1.8). Taenia spp. was found more often on the U.S. side (PR=8.6, 95% CI 2.3, 30.8). We did not find an association between these infections and the occurrence of total coliforms or fecal coliforms on kitchen surfaces. In addition, Escherichia coli was not found in any drinking water sample.

Conclusion.

The study results indicated that H. pylori and Taenia spp. infections may be highly prevalent along the U.S.-Mexico border. Additional research is necessary to adequately characterize the prevalence, as well as determine whether interventions that reduce these infections are warranted.
Achievement of Healthy People 2010 Objective for Adult Pneumococcal Vaccination in an American Indian Community
Authors: Traeger Marc S. , Say Kenneth R. , Hastings Verna , Yost David A.
Published: January 2017

Objective.

Streptococcus pneumoniae ( S. pneumoniae) causes significant mortality throughout the United States and greater mortality among American Indian/Alaska Natives. Vaccination reduces S. pneumoniae illness. We describe the methods used to achieve the Healthy People 2010 coverage rate goals for adult pneumococcal vaccine among those at high risk for severe disease in this population.

Methods.

We implemented a pneumococcal vaccination project to bolster coverage followed by an ongoing multidisciplinary program. We used community, home, inpatient, and outpatient vaccinations without financial barriers together with data improvement, staff and patient education, standing orders, and electronic and printed vaccination reminders. We reviewed local and national coverage rates and queried our electronic database to determine coverage rates.

Results.

In 2007, pneumococcal vaccination coverage rates among people ≥65 years of age and among high-risk people aged 18–64 years were 96.0% and 61.2%, respectively, exceeding Healthy People 2010 goals. Government Performance and Results Act analyses reports revealed a 2.7-fold increase (36.0% to 98.0%) of coverage from 2000 to 2007 among people ≥65 years of age at Whiteriver Service Unit in Whiteriver, Arizona.

Conclusions.

We achieved pneumococcal vaccination rates in targeted groups of an American Indian population that reached Healthy People 2010 goals and were higher than rates in other U.S. populations. Our program may be a useful model for other communities attempting to meet Healthy People 2010 goals.
Characteristics of Pesticide-Related Hospitalizations, Louisiana, 1998–2007
Authors: Badakhsh Roshan , Lackovic Michelle , Ratard Raoult
Published: January 2017

Objective.

Pesticides are widely used on agricultural crops and in homes, workplaces, and public spaces. Exposure to pesticides can cause acute and chronic health effects. We analyzed data from the Louisiana Hospital Inpatient Discharge Database from 1998 through 2007 to characterize hospitalizations involving pesticides.

Methods.

Data for the study period consisted of 384 pesticide-related hospitalizations. We used demographic information and diagnosis codes for analysis.

Results.

Males consistently had higher hospitalization rates than females ( p=0.0073). Children aged 0–4 years had the highest pesticide-related hospitalization rate of all age groups (2.69 hospitalizations per 100,000); children aged 5–9 years had the lowest rate (0.36 hospitalizations per 100,000). Compared with adults, children had a higher rate of disinfectant exposure (15% vs. 5%; odds ratio [OR] = 3.41, 95% confidence interval [CI] 1.61, 7.21; p=0.0008) and rodenticide exposure (14% vs. 2%; OR=8.55, 95% CI 3.07, 23.78; p<0.0001). Rural parishes (counties) were more likely than urban parishes to have higher pesticide hospitalization rates (OR=4.72, 95% CI 2.34, 9.54; p<0.0001). Intentional poisonings accounted for 27% of cases. Only eight cases were coded as work-related.

Conclusions.

Analyzing pesticide-related hospitalization data provides important information about some of the most severe pesticide poisoning cases. Significant findings include the elevated rate of hospitalizations among young children and men, and the large proportion of self-inflicted poisonings. Health departments and health-care providers may use these findings to target outreach and prevention activities.
Prevalence of High-Risk HPV Types and Abnormal Cervical Cytology in American Indian/Alaska Native Women, 2003–2005
Authors: Alfonsi Grace A. , Datta S. Deblina , Mickiewicz Theresa , Koutsky Laura A. , Ghanem Khalil , Hagensee Michael , Kerndt Peter , Hsu Katherine , Weinstock Hillard , Shlay Judith C.
Published: January 2017

Objectives.

We described prevalence estimates of high-risk human papillomavirus (HR-HPV), HPV types 16 and 18, and abnormal Papanicolaou (Pap) smear tests among American Indian/Alaska Native (AI/AN) women compared with women of other races/ethnicities.

Methods.

A total of 9,706 women presenting for cervical screening in a sentinel network of 26 clinics (sexually transmitted disease, family planning, and primary care) received Pap smears and HR-HPV type-specific testing. We compared characteristics of 291 women self-identified as AI/AN with other racial/ethnic minority groups.

Results.

In our population, AI/AN and non-Hispanic white (NHW women had similar age- and clinic-adjusted prevalences of HR-HPV (29.1%, 95% confidence interval [CI] 23.9, 34.3 for AI/AN women vs. 25.8%, 95% CI 24.4, 27.2 for NHW women), HPV 16 and 18 (6.7%, 95% CI 3.9, 9.6 for AI/AN women vs. 8.8%, 95% CI 7.9, 9.7 for NHW women), and abnormal Pap smear test results (16%, 95% CI 11.7, 20.3 for AI/AN women vs. 14.9%, 95% CI 13.7, 16.0 for NHW women). AI/AN women had a higher prevalence of HR-HPV than Hispanic women, and a similar prevalence of HPV 16 and 18 as compared with Hispanic and African American women.

Conclusions.

We could not demonstrate differences in the prevalence of HR-HPV, HPV 16 and 18, or abnormal Pap smear test results between AI/AN and NHW women. This finding should improve confidence in the benefit of HPV vaccine and Pap smear screening in the AI/AN population as an effective strategy to reduce rates of cervical cancer.