bluuebunny/crossref_metadata_2025 huggingface dataset:
State of Emergency Preparedness of Kentucky's Rural Public Health Workforce: Assessing its Ability to Identify Community Health Problems
Authors: Williams John C.
Published: January 2017

Objective.

The author examined the emergency preparedness readiness of all workgroups within Kentucky's rural public health departments as it related to the 10 Essential Public Health Services. This article describes the results related to the three emergency preparedness competencies for the first Essential Public Health Service: the ability to monitor health status to identify community health problems.

Methods.

Onsite surveys were conducted in one urban and 93 rural Kentucky public health agencies during 2005 and 2006. Categorical data were analyzed using univariate and multivariate analysis techniques. The author compared responses to the level of confidence (LOC) and need for training (NFT) among the seven workgroup classifications.

Results.

One thousand nine hundred ninety-four public health workers completed the surveys. Of these, 1,813 workers represented 55% of the state's rural local public health workforce. Kentucky's rural public health workforce can be described as predominantly Caucasian, female, and not planning to retire within the next five years. There were significant differences among workgroups for LOC and NFT for each competency examined. Across all workgroups, there was a mean LOC (58%) in the ability to describe the actions to take and procedures to follow in an emergency. There was a correspondingly higher mean perceived NFT (73%) for this competency.

Conclusion.

This study raises the question of whether we are adequately prepared to monitor our communities' health status. Further research that minimizes the limitations of self-reports and, instead, requires the worker to demonstrate the competency may provide a more accurate assessment of emergency preparedness.
Health Status and Access to Health Care of Migrant Workers in China
Authors: Hesketh Therese , Jun Ye Xue , Lu Li , Mei Wang Hong
Published: January 2017

Objectives.

We explored living and working conditions, health status, and health-care access in Chinese rural-to-urban migrants and compared them with permanent rural and urban residents.

Methods.

A questionnaire was administered to 1,958 urban workers, 1,909 rural workers, and 4,452 migrant workers in Zhejiang Province, Eastern China, in 2004. Blood samples for human immunodeficiency virus (HIV) and syphilis were taken from the migrant and urban workers.

Results.

Migrants were young, worked very long hours, and their living conditions were very basic. Nineteen percent had some form of health insurance and 26% were entitled to limited sick pay compared with 68% and 66%, respectively, for urban workers. Migrants had the best self-rated health and reported the least acute illness, chronic disease, and disability, after controlling for age and education. There were no HIV infections detected in either the migrant or urban workers. However, 15 urban workers (0.68%, 95% confidence interval [CI] 0.35, 1.02) and 20 migrants (0.48%, 95% CI 0.26, 0.66, p=0.06) tested positive for syphilis. The high cost of health care in the city was a barrier to health-care access in the last year for 15% of the migrants and 8% of the urban workers. Forty-seven percent of the migrants were unwilling to make contributions to health insurance.

Conclusions.

These migrants demonstrated the “healthy migrant effect.” However, poor living conditions and inattention to health may make migrants vulnerable to poor long-term health. Because health insurance schemes will remain limited for the forseeable future, attention should focus on providing affordable health care to both uninsured migrants and the urban poor.
Educational Posters and Leaflets on Leprosy: Raising Awareness of Leprosy for Health-Care Workers in Rural South Africa
Authors: Ukpe Idongesit Sunday
Published: January 2017

Leprosy is still occurring in the Republic of South Africa, but it has been eliminated as a public health problem. The country's leprosy care and control program is being provided as a primary health-care program within the general health-care services. Maintaining health workers' leprosy knowledge and awareness at the primary health-care level is one of the program's goals. In one of the country's rural areas, the availability of good-quality leprosy poster and leaflets at primary health-care facilities has been shown to contribute significantly to maintaining health workers' leprosy knowledge and awareness.
Articulation of Undergraduate and Graduate Education in Public Health
Authors: Lee Joel M.
Published: January 2017

The rapid growth of individual undergraduate courses, minors, and baccalaureate degrees in public health presents a new issue for graduate public health education: how does a graduate or professional program address previously completed undergraduate public health coursework? A review of college directories found listings for 154 North American baccalaureate degrees in public health, public health education, and public health nursing. This article addresses the purposes of public health undergraduate education as ( 1) general liberal arts education, ( 2) education complementary to other non-public health graduate degrees, ( 3) preprofessional education, and ( 4) professional education preparing undergraduates for entry-level careers. Following a discussion of reasons to consider articulation of undergraduate and graduate degrees, as well as barriers to articulation, the article presents potential strategies for articulation and future issues to consider in addressing admission of undergraduate public health students to master of public health programs.
Professionalism and Ethics in the Public Health Curriculum
Authors: Slomka Jacquelyn , Quill Beth , desVignes-Kendrick Mary , Lloyd Linda E.
Published: January 2017

As the public's health-care needs increase in complexity, renewed attention is being given to the ethical dimensions of public health decision-making and the development of public health ethics as a bounded area of teaching and research. This article provides an overview of approaches to public health ethics and decision-making, and suggests ways to incorporate the professionalism competencies into the teaching of public health practice. The teaching of ethics language, concepts, and tools for decision analysis helps to prepare students for the inevitable ethical choices they will have to make in their professional practice. The teaching of ethics and professionalism and the experiences of professionals enrich each other and foster the critical link between education and practice.
Partnering to Meet Training Needs: A Communicable-Disease Continuing Education Course for Public Health Nurses in North Carolina
Authors: Alexander Lorraine K. , Dail Kathy , Horney Jennifer A. , Davis Mary V. , Wallace John W. , Maillard Jean-Marie , MacDonald Pia
Published: January 2017

In 2004, the General Communicable Disease Control Branch of the North Carolina Division of Public Health and the North Carolina Center for Public Health Preparedness partnered to create a free continuing education course in communicable-disease surveillance and outbreak investigations for public health nurses. The course was a competency-based curriculum with 14 weeks of Internet-based instruction, culminating in a two-day classroom-based skills demonstration.

In spring 2006, the course became mandatory for all public health nurses who spend at least three-fourths of their time on tasks related to communicable diseases. As of December 2006, 177 nurses specializing in communicable diseases from 74 North Carolina counties had completed the course. Evaluations indicated that participants showed statistically significant improvements in self-perceived confidence to perform competencies addressed by the course. This course has become a successful model that combines academic expertise in curriculum development and teaching technologies with practical expertise in course content and audience needs. Through a combination of Internet and classroom instruction, this course has delivered competency-based training to the public health professionals who perform as frontline epidemiologists throughout North Carolina.
Practice-Based Teaching for Health Policy Action and Advocacy
Authors: Hearne Shelley A.
Published: January 2017

The Institute of Medicine has issued numerous reports calling for the public health workforce to be adept in policy-making, communication, science translation, and other advocacy skills. Public health competencies include advocacy capabilities, but few public health graduate institutions provide systematic training for translating public health science into policy action. Specialized health-advocacy training is needed to provide future leaders with policy-making knowledge and skills in generating public support, policy-maker communications, and policy campaign operations that could lead to improvements in the outcomes of public health initiatives. Advocacy training should draw on nonprofit and government practitioners who have a range of advocacy experiences and skills. This article describes a potential model curriculum for introductory health-advocacy theory and skills based on the course, Health Advocacy, a winner of the Delta Omega Innovative Public Health Curriculum Award, at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland.
Determining Accurate Vaccination Coverage Rates for Adolescents: The National Immunization Survey-Teen 2006
Authors: Jain Nidhi , Singleton James A. , Montgomery Margrethe , Skalland Benjamin
Published: January 2017

Since 1994, the Centers for Disease Control and Prevention has funded the National Immunization Survey (NIS), a large telephone survey used to estimate vaccination coverage of U.S. children aged 19–35 months. The NIS is a two-phase survey that obtains vaccination receipt information from a random-digit-dialed survey, designed to identify households with eligible children, followed by a provider record check, which obtains provider-reported vaccination histories for eligible children. In 2006, the survey was expanded for the first time to include a national sample of adolescents aged 13–17 years, called the NIS-Teen. This article summarizes the methodology used in the NIS-Teen. In 2008, the NIS-Teen was expanded to collect state-specific and national-level data to determine vaccination coverage estimates. This survey provides valuable information to guide immunization programs for adolescents.
Distributing Free Fresh Fruit and Vegetables at School: Results of a Pilot Outcome Evaluation
Authors: Coyle Karin K. , Potter Susan , Schneider Doris , May Gary , Robin Leah E. , Seymour Jennifer , Debrot Karen
Published: January 2017

Objectives.

Consumption of fruit and vegetables among children is generally below recommended levels. This evaluation addressed two questions: ( 1) To what extent did children's attitudes toward, familiarity with, and preferences for fruit and vegetables change during the school year? and ( 2) To what extent did children's consumption of fruit and vegetables change during the school year?

Methods.

During the 2004–2005 school year, the Mississippi Department of Education, Child Nutrition Programs initiated a pilot program to distribute free fruit and vegetables to students (kindergarten through 12th grade) during the school day. Data were collected in 2004–2005 within a one-group pretest/posttest design using a self-report questionnaire ( n=725) and 24-hour dietary recalls ( n=207) with a sample of students from five schools in Mississippi. Data were analyzed in 2006–2007.

Results.

Results showed greater familiarity with fruit and vegetables at all grade levels ( p<0.05) and increased preferences for fruit among eighth- and 10th-grade students ( p<0.01). Eighth-grade students also reported more positive attitudes toward eating fruit and vegetables ( p<0.01), increased perceived self-efficacy to eat more fruit ( p<0.01), and increased willingness to try new fruit. Finally, results showed increased consumption of fruit, but not vegetables, among eighth- and 10th-grade students ( p<0.001).

Conclusions.

Distributing free fruit and vegetables at school may be a viable component of a more comprehensive approach for improving students' nutrition attitudes and behaviors. More program emphasis is needed on ways to promote vegetable consumption.
Improvements in Access to Care for Vulnerable Children in California between 2001 and 2005
Authors: Stevens Gregory D. , Seid Michael , Tsai Kai-Ya , West-Wright Carmen , Cousineau Michael R.
Published: January 2017

Objective. We examined population changes in access to care for children in California during a period of major efforts to improve access to care for children.

Methods.

We used cross-sectional data on 36,010 children aged 0–19 years from the 2001 and 2005 California Health Interview Survey to assess population changes in access to care. We assessed changes in access by individual risk factors and a composite risk profile.

Results.

In 2005, a smaller proportion of children were uninsured (8.2% vs. 10.9% in 2001), living in poverty (20.7% vs. 23.2% in 2001), and in families without a high school education (20.8% vs. 23.6% in 2001), all p<0.001. Before and after adjusting for these changes in risk, children were more likely in 2005 to have had a physician visit (odds ratio [OR] = 1.09, 95% confidence interval [CI] 1.07, 1.12) and dental visit (OR=1.11, 95% CI 1.08, 1.14). Children were slightly less likely in 2005 to have a regular source of care (OR=0.94, CI 0.91, 0.96). Children who had the highest risk profiles (≥4 risk factors) experienced the largest gains in access. For example, children with three and ≥4 risk factors had gains in dental visits of 11 and 20 percentage points, respectively ( p<0.001 for each), compared with ≤3 percentage points for children with fewer risk factors.

Conclusions.

This study found improvements in physician and dental visits between 2001 and 2005 that were not fully explained by changes in insurance coverage or other demographic risk factors. Vulnerable children fared well during this period, suggesting that California may be making important and potentially replicable strides in reducing disparities.
Time Trends and Seasonal Patterns of Health-Related Quality of Life among U.S. Adults
Authors: Jia Haomiao , Lubetkin Erica I.
Published: January 2017

Objectives.

Although numerous studies have examined health-related quality of life (HRQOL) longitudinally, little is known about the impact of seasonality on HRQOL. We examined trend and seasonal variations of population HRQOL.

Methods.

We used data from the monthly Behavioral Risk Factor Surveillance System (BRFSS). We examined monthly observed mean physically and mentally unhealthy days from January 1993 to December 2006, using the structural time-series model to estimate the trend and seasonality of HRQOL.

Results.

We found overall worsening physical and mental health during the time period and a significant and regular seasonal pattern in both physical and mental health. The worst physical health was during the winter and the best physical health was during the summer. The mean number of physically unhealthy days in January was 0.63 days higher than in July. The worst mental health occurred during the spring and fall, but the magnitude of the seasonal effect was much smaller. The difference between the best and worst months of mentally unhealthy days was approximately 0.23 days. We found significant differences in unadjusted and season-adjusted unhealthy days in many counties.

Conclusions.

Our findings can be used to examine time-varying causal factors and the impact of interventions, such as policies designed to improve population health. Our findings also demonstrated the need for calculating season-adjusted HRQOL scores when examining cross-sectional factors on the population HRQOL measures for continuous surveys or longitudinal data.
Alcohol Control Policies and Practices at Professional Sports Stadiums
Authors: Lenk Kathleen M. , Toomey Traci L. , Erickson Darin J. , Kilian Gunna R. , Nelson Toben F. , Fabian Lindsey E.A.
Published: January 2017

Objective.

Alcohol-related problems such as assaults and drinking-driving at or near professional sporting events are commonly reported in the media. An important strategy to reduce such problems may be the use of alcohol control policies at sports stadiums. The objective of this study was to examine alcohol control policies and practices at professional sports stadiums in the U.S.

Methods.

We conducted a telephone survey of food/beverage managers from 66 of the 100 U.S professional sports stadiums that house a professional hockey, basketball, baseball, and/or football team. The survey consisted of 18 items pertaining to policies regulating alcohol sales and consumption.

Results.

Most managers indicated that their stadium had a range of alcohol control policies and practices. For example, all or nearly all reported their stadium allows no more than two alcoholic beverages per sale and their alcohol servers are required to check age identification of patrons who appear younger than age 30. In contrast, only about half prohibit servers younger than 21 years of age from selling alcohol both in seating areas and at concession booths, and approximately one-third designate sections of their stadiums as alcohol-free.

Conclusions.

Although we found that some alcohol control policies appear to be common across stadiums, others are uncommon, leaving room for potential areas of improvement in reducing or preventing alcohol-related problems at professional sporting events. The results provide an important starting point for identifying policies that can be evaluated to determine their effectiveness in reducing alcohol-related injuries and deaths at sporting events.
Is There Progress toward Eliminating Racial/Ethnic Disparities in the Leading Causes of Death?
Authors: Keppel Kenneth G. , Pearcy Jeffrey N. , Heron Melonie P.
Published: January 2017

Objectives.

We examined changes in relative disparities between racial/ethnic populations for the five leading causes of death in the United States from 1990 to 2006.

Methods.

The study was based on age-adjusted death rates for four racial/ethnic populations from 1990–1998 and 1999–2006. We compared the percent change in death rates over time between racial/ethnic populations to assess changes in relative differences. We also computed an index of disparity to assess changes in disparities relative to the most favorable group rate.

Results.

Except for stroke deaths from 1990 to 1998, relative disparities among racial/ethnic populations did not decline between 1990 and 2006. Disparities among racial/ethnic populations increased for heart disease deaths from 1999 to 2006, for chronic obstructive pulmonary disease deaths from 1990 to 1998, and for chronic lower respiratory disease deaths from 1999 to 2006.

Conclusions.

Deaths rates for the leading causes of death are generally declining; however, relative differences between racial/ethnic groups are not declining. The lack of reduction in relative differences indicates that little progress is being made toward the elimination of racial/ethnic disparities.
Risk and Protective Factors for Unprotected Intercourse among Rural African American Young Adults
Authors: Kogan Steven M. , Brody Gene H. , Chen Yi-Fu , Grange Christina M. , Slater LaTrina M. , DiClemente Ralph J.
Published: January 2017

Objectives.

Despite increasing risk for human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs), few data are available concerning the factors associated with risky sexual behavior among African American young adults who do not attend college. Additionally, the possibility that different risk mechanisms affect men and women remains understudied. This article reports on the risk and protective factors associated with unprotected intercourse and gender differences in these factors' influence among this group. Predictors were derived from ecological and self-regulatory theories of risk behavior.

Methods.

African Americans aged 18–21 years were recruited via respondent-driven sampling (RDS) from seven contiguous rural counties. Risk and protective factors for unprotected intercourse were analyzed for 214 of 292 participants who reported sexual intercourse during the past three months.

Results.

Among sexually active participants, 62.6% used condoms inconsistently. The influence of leaving the parental home, perceived discrimination, risk-taking peers, family relationships, risk-taking propensity, and binge drinking on unprotected intercourse were moderated by gender. Positive attitudes toward condom use were associated with less unprotected intercourse controlling for the influence of risk variables for both men and women.

Conclusions.

Men and women have unique STI prevention needs. Additional research addressing these needs is necessary, particularly for rural African American men.
Influenza: The Once and Future Pandemic
Authors: Taubenberger Jeffery K. , Morens David M.
Published: January 2017

Influenza A viruses infect large numbers of warm-blooded animals, including wild birds, domestic birds, pigs, horses, and humans. Influenza viruses can switch hosts to form new lineages in novel hosts. The most significant of these events is the emergence of antigenically novel influenza A viruses in humans, leading to pandemics. Influenza pandemics have been reported for at least 500 years, with inter-pandemic intervals averaging approximately 40 years.
The U.S. Military and the Influenza Pandemic of 1918–1919
Authors: Byerly Carol R.
Published: January 2017

The American military experience in World War I and the influenza pandemic were closely intertwined. The war fostered influenza in the crowded conditions of military camps in the United States and in the trenches of the Western Front in Europe. The virus traveled with military personnel from camp to camp and across the Atlantic, and at the height of the American military involvement in the war, September through November 1918, influenza and pneumonia sickened 20% to 40% of U.S. Army and Navy personnel. These high morbidity rates interfered with induction and training schedules in the United States and rendered hundreds of thousands of military personnel non-effective. During the American Expeditionary Forces' campaign at Meuse-Argonne, the epidemic diverted urgently needed resources from combat support to transporting and caring for the sick and the dead. Influenza and pneumonia killed more American soldiers and sailors during the war than did enemy weapons.
The American Red Cross and Local Response to the 1918 Influenza Pandemic: A Four-City Case Study
Authors: Jones Marian Moser
Published: January 2017

The role of the American Red Cross in the U.S. response to the 1918–1919 influenza pandemic holds important lessons for current-day pandemic response. This article, which examines local ARC responses in Boston, Pittsburgh, St. Louis, and Richmond, Virginia, demonstrates how the ARC coordinated nursing for military and civilian cases; produced and procured medical supplies and food; transported patients, health workers, and bodies; and aided influenza victims' families. But the organization's effectiveness varied widely among localities. These findings illustrate the persistently local character of pandemic response, and demonstrate the importance of close, timely, and sustained coordination among local and state public health authorities and voluntary organizations before and during public health emergencies. They further illustrate the persistently local character of these emergencies, while underscoring the centrality and limits of voluntarism in American public health.
“There Wasn't a Lot of Comforts in Those Days:” African Americans, Public Health, and the 1918 Influenza Epidemic
Authors: Gamble Vanessa Northington
Published: January 2017

When the 1918 influenza epidemic began, African American communities were already beset by many public health, medical, and social problems, including racist theories of black biological inferiority, racial barriers in medicine and public health, and poor health status. To address these problems, African Americans mounted efforts such as establishing separate hospitals and professional organizations and repudiating racist scientific theories. Contradicting prevailing theories about African Americans' increased susceptibility to disease, it appears that during the 1918 epidemic the incidence of influenza was lower in African Americans. Although the epidemic had a less devastating impact on African American communities, it still overwhelmed their medical and public health resources. Observations about the lower rates of influenza in African Americans did not derail racist theories about the biological inferiority of black people or overturn conceptualizations of black people as disease threats to white people. When the epidemic ended, the major problems that African Americans faced still remained.
Tuberculosis and Stigmatization: Pathways and Interventions
Authors: Courtwright Andrew , Turner Abigail Norris
Published: January 2017

The institutional and community norms that lead to the stigmatization of tuberculosis (TB) are thought to hinder TB control. We performed a systematic review of the literature on TB stigma to identify the causes and evaluate the impact of stigma on TB diagnosis and treatment. Several themes emerged: fear of infection is the most common cause of TB stigma; TB stigma has serious socioeconomic consequences, particularly for women; qualitative approaches to measuring TB stigma are more commonly utilized than quantitative surveys; TB stigma is perceived to increase TB diagnostic delay and treatment noncompliance, although attempts to quantify its impact have produced mixed results; and interventions exist that may reduce TB stigma.

Future research should continue to characterize TB stigma in different populations; use validated survey instruments to quantify the impact of TB stigma on TB diagnostic delay, treatment compliance, and morbidity and mortality; and develop additional TB stigma-reduction strategies.
Associations of Sex Ratios and Male Incarceration Rates with Multiple Opposite-Sex Partners: Potential Social Determinants of HIV/STI Transmission
Authors: Pouget Enrique R. , Kershaw Trace S. , Niccolai Linda M. , Ickovics Jeannette R. , Blankenship Kim M.
Published: January 2017

Objectives.

Racial/ethnic disparities in heterosexual transmission of human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) have been hypothesized to be related to the high rate of incarceration and the shortage of men in black communities. This study tested associations of having multiple sex partners with these factors.

Methods.

Racial/ethnic-specific Census data on the sex ratio and the male incarceration rate were categorized into tertiles and matched with individual data from the National Health and Nutrition Examination Survey 1999–2004 by county of residence for non-Hispanic black, non-Hispanic white, and Mexican American participants. We used logistic regression analyses to examine whether these factors were associated with having multiple opposite-sex partners in the past year.

Results.

Sex ratios and incarceration rates varied greatly by race/ethnicity; however, we observed significant associations within each racial/ethnic group. Non-Hispanic black men in counties with a greater shortage of males (adjusted odds ratio [AOR] = 1.9; 95% confidence interval [CI] 1.1, 3.5) and a greater number of incarcerated males (AOR=1.6; 95% CI 1.1, 2.3) in the non-Hispanic black population had significantly greater odds of having two or more partners. Those in two low sex-ratio categories (AOR=2.4; 95% CI 1.0, 5.8 and AOR=4.1; 95% CI 1.6, 10.0) and one high incarceration-rate category (AOR=2.1; 95% CI 1.2, 3.6) had significantly greater odds of having five or more partners.

Conclusion.

Sex ratios and incarceration rates were associated with the number of opposite-sex partners in some groups. Because the risk of HIV/STI transmission depends, in part, on the number of partners, it is important to determine the causal relationships among these associations to help better understand racial/ethnic HIV/STI disparities and improve prevention programs and interventions.
The Context of Economic Insecurity and its Relation to Violence and Risk Factors for HIV among Female Sex Workers in Andhra Pradesh, India
Authors: Reed Elizabeth , Gupta Jhumka , Biradavolu Monica , Devireddy Vasavi , Blankenship Kim M.
Published: January 2017

Objective.

We examined the context of economic insecurity and debt among female sex workers (FSWs), how this context varies among FSWs, and its association with experiences of violence and sexual risk factors for human immunodeficiency virus (HIV).

Methods.

We recruited FSWs aged ≥18 years ( n=673) through respondent-driven sampling for a survey on HIV risk in this region. Using logistic regression models (adjusted for partner status, education, financial support, and literacy), we assessed the relation between debt and sexual and physical victimization as well as sexual risk. We also conducted qualitative interviews with a subsample of the survey participants and examined these for related themes.

Results.

In adjusted logistic regression models, FSWs who reported debt were more likely to report the following: recent physical violence (adjusted odds ratio [AOR] = 2.4, 95% confidence interval [CI] 1.5, 3.9), unprotected sex with occasional clients in the past week (AOR=2.3, 95% CI 1.2, 4.3), anal sex with clients in the past 30 days (AOR=2.0, 95% CI 1.1, 3.9), and at least one sexually transmitted infection symptom in the past six months (AOR=1.6, 95% CI 1.1, 2.4). FSWs with debt were more likely to report current husbands or other male partners, and less likely to report condom use with these partners, further increasing their sexual risk. Qualitative data elaborated on these findings.

Conclusion.

Findings indicate the violence- and HIV-related vulnerability of FSWs who report debt and further highlight how male partners may contribute to the debt and economic insecurity of FSWs.
A Comparison of Registered and Unregistered Female Sex Workers in Tijuana, Mexico
Authors: Sirotin Nicole , Strathdee Steffanie A. , Lozada Remedios , Nguyen Lucie , Gallardo Manuel , Vera Alicia , Patterson Thomas L.
Published: January 2017

Objective.

Sex work is regulated in Tijuana, Mexico, but only half of the city's female sex workers (FSWs) are registered with the municipal health department, which requires regular screening for sexually transmitted infections (STIs) and human immunodeficiency virus (HIV). We examined correlates of registration to determine if it confers measurable health benefits.

Methods.

From 2004 to 2006, we interviewed FSWs in Tijuana ≥18 years of age who reported recent unprotected sex with at least one client and were not knowingly HIV-positive, and tested them for HIV, syphilis, gonorrhea, and chlamydia. Logistic regression identified factors associated with registration.

Results.

Of 410 FSWs, 44% were registered, 69% had been tested for HIV, 6% were HIV-positive, and 44% tested positive for any STI. Compared with unregistered FSWs, registered FSWs were more likely to have had HIV testing (86% vs. 56%, p<0.001) and less likely to test positive for any STI (33% vs. 53%, p<0.001) or HIV (3% vs. 8%, p=0.039). Factors independently associated with registration included ever having an HIV test (adjusted odds ratio [AOR] 5 4.19) and earning >$30 per transaction without a condom (AOR52.41), whereas working on the street (AOR50.34), injecting cocaine (AOR50.06), snorting or smoking methamphetamine (AOR50.27), and being born in the Mexican state of Baja California (AOR50.35) were inversely associated with registration.

Conclusion.

Registered FSWs were more likely than unregistered FSWs to have had HIV testing and to engage in less drug use, but did not have significantly lower HIV or STI prevalence after adjusting for confounders. Current regulation of FSWs in Tijuana should be further examined to enhance the potential public health benefits of registration.
Does Education Matter? Examining Racial Differences in the Association between Education and STI Diagnosis among Black and White Young Adult Females in the U.S.
Authors: Annang Lucy , Walsemann Katrina M. , Maitra Debeshi , Kerr Jelani C.
Published: January 2017

Objectives.

Education has long been considered a protective factor against sexual risk behaviors and sexually transmitted infections (STIs) among adolescents; however, few have explored this association and determined differences across racial/ethnic groups of young adult females on a national scale. The purpose of this study was to (1) describe the association between education and STI diagnosis among a national sample of black and white young adult females and (2) examine racial differences in this association.

Methods.

We used data from the National Longitudinal Study of Adolescent Health (Add Health) to assess the association between education and chlamydia, gonorrhea, and/or trichomoniasis (self-reported and assay-diagnosed) in 2001–2002 using logistic regression analysis.

Results.

After adjustment for risk behaviors, education was inversely associated with any assay-diagnosed STI, but this association was nonsignificant among black women for self-reported STI. Additionally, black females enrolled in, or who graduated from, college had significantly higher predicted probabilities of having an STI (12.4% self-reported; 13.4% assay-diagnosed) compared with white females who had less than a high school diploma (6.4% self-reported; 2.3% assay-diagnosed).

Conclusions.

Educational status was not uniformly protective against STIs for black and white females in this sample. Particularly for young black women, other factors may play a more prominent role in determining STI risk. Social determinants, such as education, should be viewed as important factors associated with STI prevalence, but their differential impact on various racial/ethnic groups should also be considered when addressing the disproportionate rates of STIs in the U.S.
Effective State-Based Surveillance for Multidrug-Resistant Organisms Related to Health Ca re-Associated Infections
Authors: Duffy Jonathan , Sievert Dawn , Rebmann Catherine , Kainer Marion , Lynfield Ruth , Smith Perry , Fridkin Scott
Published: January 2017

In September 2008, the Council of State and Territorial Epidemiologists and the Centers for Disease Control and Prevention sponsored a meeting of public health and infection-control professionals to address the implementation of surveillance for multidrug-resistant organisms (MDROs)—particularly those related to health care-associated infections. The group discussed the role of health departments and defined goals for future surveillance activities. Participants identified the following main points: (7) surveillance should guide prevention and infection-control activities, (2) an MDRO surveillance system should be adaptable and not organism specific, (3) new systems should utilize and link existing systems, and (4) automated electronic laboratory reporting will be an important component of surveillance but will take time to develop. Current MDRO reporting mandates and surveillance methods vary across states and localities. Health departments that have not already done so should be proactive in determining what type of system, if any, will fit their needs.
Sensitivity of Birth Certificate Reports of Birth Defects in Atlanta, 1995–2005: Effects of Maternal, Infant, and Hospital Characteristics
Authors: Boulet Sheree L. , Shin Mikyong , Kirby Russell S. , Goodman David , Correa Adolfo
Published: January 2017

Objectives.

We assessed variations in the sensitivity of birth defect diagnoses derived from birth certificate data by maternal, infant, and hospital characteristics.

Methods.

We compared birth certificate data for 1995–2005 births in Atlanta with data from the Metropolitan Atlanta Congenital Defects Program (MACDP). We calculated the sensitivity of birth certificates for reporting defects often discernable at birth (e.g., anencephaly, spina bifida, cleft lip, clubfoot, Down syndrome, and rectal atresia or stenosis). We used multivariable logistic regression models to examine associations with sociodemographic and hospital factors.

Results.

The overall sensitivity of birth certificates was 23% and ranged from 7% for rectal atresia/stenosis to 69% for anencephaly. Non-Hispanic black maternal race/ethnicity, less than a high school education, and preterm birth were independently associated with a lower probability of a birth defect diagnosis being reported on a birth certificate. Sensitivity also was lower for hospitals with >1,000 births per year.

Conclusions.

The underreporting of birth defects on birth certificates is influenced by sociodemographic and hospital characteristics. Interpretation of birth defects prevalence estimates derived from birth certificate reports should take these issues into account.
Secular Trends in Hospital Emergency Department Visits for Dental Care in Kansas City, Missouri, 2001–2006
Authors: Hong Liang , Ahmed Arif , McCunniff Michael , Liu Yifei , Cai Jinwen , Hoff Gerald
Published: January 2017

Objectives.

We determined the trends, risk factors, and costs of emergency department (ED) visits for dental complaints during a six-year period in Kansas City, Missouri (KCMO).

Methods.

We used de-identified hospital discharge data from all facilities serving KCMO during 2001–2006. Using the International Classification of Diseases, Ninth Revision codes, we determined both counts and rates of ED visits related to toothache or tooth injury and analyzed the discharge diagnosis and costs of these visits. We used multivariable regression analysis to assess risk factors for the ED visits for dental complaints.

Results.

We found a significant increasing trend in dental complaint visits during the six-year period (from 13.1% to 19.0%, p<0.01). Dental caries accounted for 20.4%, pulpitis or periapical abscess accounted for 14.8%, dental injury accounted for 8.7%, temporomandibular joint (TMJ) disorders accounted for 1.5%, and all other unspecified dental diseases accounted for 54.6% of the ED visits for dental complaints. The mean charge was approximately $360 per visit and was highest for TMJ disorders ($747) and lowest for unspecified other dental diseases ($277). Self-pay (38.3%) and Medicaid (32.3%) constituted the majority of the payment sources. Multivariable regression analysis indicated that self-payers, nonwhite people, adults, people with lower family income, and weekends were associated with increased use of ED visits for dental complaints.

Conclusions.

There was a significant increasing trend in dental complaint-related ED visits. EDs have become an important site for people with dental problems to seek urgent care, particularly for individuals who self-pay or are on Medicaid.
Food Safety Perceptions and Practices of Older Adults
Authors: Anderson Amy L. , Verrill Linda A. , Sahyoun Nadine R.
Published: January 2017

Objectives.

Older adults are considered more vulnerable to foodborne illness due to lowered immune function. We compared the food safety perceptions and practices of older and younger adults and determined associations with demographic characteristics.

Methods.

We focused on 1,317 participants ≥60 years of age from the U.S. Food and Drug Administration's 2006 Food Safety Survey, a telephone survey of a nationally representative sample of American consumers. We used data on participants <60 years of age to compare younger and older adults, and used Pearson's Chi-square tests to determine whether perceptions and practices differed by age, gender, level of education, living arrangement, and race/ethnicity We conducted multiple logistic regression analysis to assess relationships of demographic characteristics and food safety perceptions with food safety practices of older adults.

Results.

We found that adults ≥60 years of age were more likely to follow recommended food safety practices than those <60 years of age. Sixty-six percent of adults ≥60 years of age reported eating potentially hazardous foods in the past year compared with 81% of adults <60 years of age. Among people ≥60 years of age, women, those with less education, and nonwhite individuals generally had better food safety practices and a greater awareness of food safety risk.

Conclusions.

These findings suggest that certain subsets of the older adult population are less likely to follow recommended food safety practices and, thus, are at greater risk of foodborne illness. Food safety education for older adults should target men and those with more education and higher incomes.
The 2009 National Environmental Public Health Conference: One Model for Planning Green and Healthy Conferences
Authors: Ruckart Perri Zeitz , Moore Cory , Burgin Deborah , Byrne Maggie Kelly
Published: January 2017

The Centers for Disease Control and Prevention's National Center for Environmental Health and the Agency for Toxic Substances and Disease Registry committed to making their 2009 National Environmental Public Health Conference a model for green and healthy conferences. The conference included increased opportunities for physical activity, both as part of conference events and for transportation to the conference. In addition, conference meals were healthy and sustainably sourced. The conference also implemented intuitive, accessible recycling; online scheduling and evaluation to minimize hard-copy materials; and the purchase of carbon offsets to reduce the unwanted environmental impact of the conference. Public health professionals have an opportunity and obligation to support healthy behaviors at their events and to serve as leaders in this area. Facilitating healthy and sustainable choices is in alignment with goals for both public health and broader social issues—such as environmental quality—that have a direct bearing on public health.
Health Outcomes and Green Renovation of Affordable Housing
Authors: Breysse Jill , Jacobs David E. , Weber William , Dixon Sherry , Kawecki Carol , Aceti Susan , Lopez Jorge
Published: January 2017

Objective.

This study sought to determine whether renovating low-income housing using “green” and healthy principles improved resident health and building performance.

Methods.

We investigated resident health and building performance outcomes at baseline and one year after the rehabilitation of low-income housing using Enterprise Green Communities green specifications, which improve ventilation; reduce moisture, mold, pests, and radon; and use sustainable building products and other healthy housing features. We assessed participant health via questionnaire, provided Healthy Homes training to all participants, and measured ventilation, carbon dioxide, and radon.

Results.

Adults reported statistically significant improvements in overall health, asthma, and non-asthma respiratory problems. Adults also reported that their children's overall health improved, with significant improvements in non-asthma respiratory problems. Post-renovation building performance testing indicated that the building envelope was tightened and local exhaust fans performed well. New mechanical ventilation was installed (compared with no ventilation previously), with fresh air being supplied at 70% of the American Society of Heating, Refrigerating, and Air-Conditioning Engineers standard. Radon was <2 picocuries per liter of air following mitigation, and the annual average indoor carbon dioxide level was 982 parts per million. Energy use was reduced by 45% over the one-year post-renovation period.

Conclusions.

We found significant health improvements following low-income housing renovation that complied with green standards. All green building standards should include health requirements. Collaboration of housing, public health, and environmental health professionals through integrated design holds promise for improved health, quality of life, building operation, and energy conservation.
Attitudes about Carbon Monoxide Safety in the United States: Results from the 2005 and 2006 HealthStyles Survey
Authors: King Michael E. , Damon Scott A.
Published: January 2017

Objectives.

We sought to identify attitudes and behaviors related to carbon monoxide (CO) safety that can be targeted with public health prevention strategies in the U.S.

Methods.

The Centers for Disease Control and Prevention added questions about ( 1) proper placement of gas-powered generators, ( 2) maintenance of fuel-burning appliances, and ( 3) use of CO detectors to the 2005 and 2006 HealthStyles national health marketing surveys.

Results.

In 2005, 63.3% of HealthStyles respondents agreed with or were uncertain about the incorrect statement, “It is safe to run a generator in a garage as long as the door is open,” while 43.1% agreed with or were uncertain about the incorrect statement, “It is safe to run a generator in the basement.” Most of the 2006 respondents (63.5%) agreed that it is important to have their furnace inspected annually. However, fewer than half of the 2006 respondents (42.0%)—most of whom were homeowners—reported owning a CO detector.

Conclusions.

A large proportion of adults in the U.S. reported attitudes and behaviors that may place them at increased risk for unintentional, non-firerelated CO poisoning, suggesting that current safety messages may not be reaching much of the public. Prevention messages should continue to promote proper generator placement, maintenance of fuel-burning appliances, and use of CO detectors. Development of a comprehensive national strategy for CO surveillance and communication may help identify populations at increased risk and prevent future poisonings.
Carbon Monoxide Poisoning after an Ice Storm in Kentucky, 2009
Authors: Lutterloh Emily C. , Iqbal Shahed , Clower Jacquelyn H. , Spiller Henry A. , Riggs Margaret A. , Sugg Tennis J. , Humbaugh Kraig E. , Cadwell Betsy L. , Thoroughman Douglas A.
Published: January 2017

Objectives.

Carbon monoxide (CO) poisoning is a leading cause of morbidity and mortality during natural disasters. On January 26–27, 2009, a severe ice storm occurred in Kentucky, causing widespread, extended power outages and disrupting transportation and communications. After the storm, CO poisonings were reported throughout the state. The objectives of this investigation were to determine the extent of the problem, identify sources of CO poisoning, characterize cases, make recommendations to reduce morbidity and mortality, and develop prevention strategies.

Methods.

We obtained data from the Kentucky Regional Poison Center (KRPC), hyperbaric oxygen treatment (HBOT) facilities, and coroners. Additionally, the Kentucky Department for Public Health provided statewide emergency department (ED) and hospitalization data.

Results.

During the two weeks after the storm, KRPC identified 144 cases of CO poisoning; exposure sources included kerosene heaters, generators, and propane heaters. Hospitals reported 202 ED visits and 26 admissions. Twenty-eight people received HBOT. Ten deaths were attributed to CO poisoning, eight of which were related to inappropriate generator location. Higher rates of CO poisoning were reported in areas with the most ice accumulation.

Conclusions.

Although CO poisonings are preventable, they continue to occur in postdisaster situations. Recommendations include encouraging use of CO alarms, exploring use of engineering controls on generators to decrease CO exposure, providing specific information regarding safe use and placement of CO-producing devices, and using multiple communication methods to reach people without electricity.