bluuebunny/crossref_metadata_2025 huggingface dataset:
Forbear

is a Homophone: Lexical Prosody Does Not Constrain Lexical Access
Authors: Cutler Anne
Published: July 2017

Because stress can occur in any position within an English word, lexical prosody could serve as a minimal distinguishing feature between pairs of words. However, most pairs of English words with stress pattern opposition also differ vocalically: OBject and obJECT, CONtent and conTENT have different vowels in their first syllables as well as different stress patterns. To test whether prosodic information is made use of in auditory word recognition independently of segmental phonetic information, it is necessary to examine pairs like FORbear — forBEAR or TRUSty — trusTEE, semantically unrelated words which exhibit stress pattern opposition but no segmental difference. In a cross-modal priming task, such words produce the priming effects characteristic of homophones, indicating that lexical prosody is not used in the same way as segmental structure to constrain lexical access.
The Duration of Syllables in American Sign Language
Authors: Wilbur Ronnie B. , Nolkn Susan Bobbitt
Published: July 2017

Data are presented for the duration of syllables in American Sign Language and for movement and hold components of those syllables. Measurements from 3072 syllables taken from four different samples of signing resulted in a grand mean of 293.7 msec. The different signing samples reflected different degrees of naturalness, and the means for each sample varied accordingly. The most natural situation, conversational signing, had a mean of 249.7 msec, comparable to the quarter of a second reported for spoken English syllables. Less natural situations, involving clicitation tasks, showed higher means (292.1 to 360.7 msec). Different syllable types varied in their duration. The presence of a final hold significantly increased the syllable duration. Statistical analysis revealed three distinct groups of syllabic types as a function of duration: short, long, and extra long. A specific test of the claim that linguistic stress significantly increases the duration of syllables was not confirmed; instead, stressed targets differed from unstressed targets in having a greater number of syllables. A related claim that the duration of movement when stressed is significantly shorter than when not stressed was also not confirmed.
Differential Shortening of Repeated Content Words Produced in Various Communicative Contexts
Authors: Fowler Carol A.
Published: July 2017

Three experiments examined the conditions under which repeated words undergo durational shortening in speech. Previous research (Fowler and Housum, 1987) showed that repeated content words are shortened in spontaneous speech. One experiment in the present series found no shortening when words are produced in lists. in a second experiment, reductions were observed for the same words produced in meaningful prose. Words preceded by homophones did not undergo shortening. The findings suggest that shortenings reflect talkers' exploitation of a word's redundancy in the context of a discourse. A final experiment found more shortening of content words produced in a communicative context than in the same discourse, transcribed and read into a microphone. Possibly, the tendency to shorten is increased by the presence of a listener; alternatively, it may reflect the slower speech rate characteristic of spontaneous as compared to read speech.
Morphological Knowledge and Early Writing Ability
Authors: Rubin Hyla
Published: July 2017

This study assessed the morphological knowledge of kindergarteners and first graders in relation to their early writing ability. Morphological knowledge was investigated because, in order to write, children need to understand that words are composed of morphemes and phonemes, and because poor writers have particular difficulty with inflected forms of words. Kindergarteners and first graders were grouped by their implicit understanding of morphology and were given tests of dictated spelling and morphological analysis. First graders with poor implicit morphological knowledge omitted more inflectional morphemes in writing and were less able to identify base morphemes in spoken words than kindergarteners and first graders with higher levels of implicit morphological knowledge. The results demonstrate the importance of morphological knowledge in the development of written language proficiency.
Changes in Voice Level Caused by Several Forms of Altered Feedback in Fluent Speakers and Stutterers
Authors: Howell Peter
Published: July 2017

Speakers change the level of their voice when they listen to noise or hear their own speech amplified: When noise level is increased the voice becomes louder, whilst the response to speech amplification is a reduction of voice level. The question posed here is whether, when the level of various sounds concurrent with vocalisation is raised, the direction of the vocal level response is like that to the speaker's speech or like that to noise. Voice level was measured in response to speech, white noise, delayed auditory feedback, frequency-shifted speech, and noise created by an “Edinburgh masker”. Selection of these sounds was governed by the role they have played in the explanation and treatment of stuttering. Fluent speakers and stutterers increased voice level when played delayed auditory feedback, the Edinburgh masker, or white noise; they reduced the level slightly in the remaining conditions. These results are used to assess auditory feedback monitoring accounts of the speech behavior of fluent speakers and stutterers, and some implications for the treatment of stuttering are pointed out.
The Hcrc Map Task Corpus
Authors: Anderson Anne H. , Bader Miles , Bard Ellen Gurman , Boyle Elizabeth , Doherty Gwyneth , Garrod Simon , Isard Stephen , Kowtko Jacqueline , McAllister Jan , Miller Jim , Sotillo Catherine , Thompson Henry S. , Weinert Regina
Published: July 2017

This paper describes a corpus of unscripted, task-oriented dialogues which has been designed, digitally recorded, and transcribed to support the study of spontaneous speech on many levels. The corpus uses the Map Task (Brown, Anderson, Yule, and Shillcock, 1983) in which speakers must collaborate verbally to reproduce on one participant's map a route printed on the other's. In all, the corpus includes four conversations from each of 64 young adults and manipulates the following variables: familiarity of speakers, eye contact between speakers, matching between landmarks on the participants' maps, opportunities for contrastive stress, and phonological characteristics of landmark names. The motivations for the design are set out and basic corpus statistics are presented.
Spatio-Temporal Patterns of Velopharyngeal Action in Phonetic and Phonological Nasalization
Authors: Solé Maria-Josep
Published: July 2017

The aim of this paper is to differentiate between effects of phonetic implementation and effects of phonological structure in the adjustment of articulatory trajectories to varying speech rate. Cross-linguistic data on coarticulatory nasalization of vowels preceding a nasal consonant at different speech rates were analyzed in American English and Spanish. The two languages show different patterns of timing, magnitude, duration, and velocity of velopharyngeal movements. In Spanish the velocity of velar port (VP) opening and closing gestures is not affected by differences in speech rate, which suggests that these trajectories reflect the default articulatory movements automatically implemented by the phonetic component. In American English, VP closing velocity is not affected by speech rate whereas opening velocity adjusts to variations in speech rate to ensure vowel nasalization across rates. The careful regulation of VP opening velocity suggests that it is centrally controlled. Interarticulatory timing data support this interpretation: In Spanish, vowels are oral for most of their duration; onset of VP opening is timed relative to the following nasal consonant and peak VP size occurs at nasal consonant onset across rates, which suggests that the motor commands for opening the velar port are part of the instructions for the nasal consonant. In American English, on the other hand, VP opening onset coincides with vowel onset and peak VP size occurs in the middle of the vowel across rates, which indicates that opening movements are part of the programming instructions for the vowel. It is argued that, in Spanish, vowels followed by a nasal consonant are targeted as oral and are nasalized as a result of a coarticulatory effect, whereas, in American English, vowels are targeted as nasalized as a result of a phonological rule.
Japanese Adults can Learn to Produce English /I/ and /l/ Accurately
Authors: Flege James Emil , Takagi Naoyuki , Mann Virginia
Published: July 2017

As is well known, Japanese adults who have just begun to learn English often err in producing /I/ and /l/ because their native language does not possess such liquid consonants. The aim of this study was to determine if Japanese adults eventually learn to produce /I/ and /l/ accurately in words like read and lead. Liquids spoken by 12 native Japanese speakers who had lived in the United States for an average of two years were often misidentified by native English-speaking listeners. Their productions of /I/ and /l/ also received much lower (and thus foreign-accented) ratings than did the native English speakers' liquids. On the other hand, liquids produced by native Japanese speakers who had lived in the United States for an average 21 years were identified correctly in forced-choice tests. This held true for liquids in words that had been read from a list as well as for words that had been spoken spontaneously. The ratings of liquids produced by 10 of the 12 experienced Japanese speakers fell within the range of ratings obtained for the 12 native English speakers. These findings challenge the widely accepted view that segmental production errors in a second language arise from the inevitable loss of ability to learn phonetic segments not found in the native language.
Acoustic Correlates of Grammatical Class
Authors: Sereno Joan A. , Jongman Allard
Published: July 2017

The present experiment investigates acoustic correlates of grammatical class in English. Results of previous studies examining the acoustic correlates of stress have established that variations in duration, amplitude and fundamental frequency are cues to lexical stress. The present study investigates whether systematic acoustic differences would also be observed in words which maintain a constant stress pattern across syntactic function. In the present experiment, five speakers were recorded producing 16 grammatically ambiguous lexical items such as answer or design. Stimuli were read either as a noun or a verb. Measurements for each stimulus consisted of a ratio of the first to the second syllable for the three acoustic parameters: duration, amplitude, and fundamental frequency. The data show slight but consistent acoustic differences in speakers' production of syntactically ambiguous words contingent upon their production as a noun or as a verb. Duration and amplitude cues appear to be the most robust cues for signaling these differences in grammatical function. These results are in accord with recent evidence documenting the paradigmatic stress pattern for grammatical class in English.
An Articulatory-Perceptual Account of Vocalization and Elision of Dark /l/ in the Romance Languages
Authors: Recasens Daniel
Published: July 2017

This investigation seeks to understand the factors causing vocalization and elision of dark /l/ in the Romance languages. Contrary to articulatory-and perceptual-based arguments in the literature it is claimed that preconsonantal vocalization conveys the phonemic categorization of the /w/-like formant transitions generated by the tongue dorsum retraction gesture (in a similar fashion to other processes such as /Vji/ > /Vjn/). The evolution /VwlC/ > /VwC/ may be explained using articulatory and perceptual arguments. A dissimilatory perceptual mechanism is required in order to account for a much higher frequency of vocalizations before dentals and alveolars than before labials and velars in the Romance languages. Through this process listeners assign the gravity property of dark /l/ to a following grave labial or velar consonant but not so to a following acute dental or alveolar consonant in spite of the alveolar lateral being equally dark (i.e., grave) in the three consonantal environments. Other articulatory facts appear to play a role in the vocalization of final /l/ (i.e., the occurrence of closure after voicing has ceased) and of geminate /ll/ (i.e., its being darker than non-geminate /l/). The elision of dark /l/ may occur preconsonantally and word finally either after vocalization has applied or not. This study illustrates the multiple causal factors and the articulatory-perceptual nature of sound change processes.
The Tobacco Industry's Response to the COMMIT Trial: An Analysis of Legacy Tobacco Documents
Authors: Carlini Beatriz H. , Patrick Donald L. , Halperin Abigail C. , Santos Verena
Published: July 2017

We analyzed internal tobacco industry documents that describe the industry's response to the Community Intervention Trial for Smoking Cessation (COMMIT), a multi-center community-based tobacco intervention project funded by the National Cancer Institute from 1988 to 1992. Our analysis of documents from the Legacy Tobacco Documents Library ( www.legacy.library.ucsf.edu ) suggests that the tobacco industry reacted to COMMIT by ( 1) closely monitoring trial activities, ( 2) confronting COMMIT in communities where it was most active, ( 3) distorting COMMIT findings on underage smoking data reported in the media, and ( 4) using COMMIT activities as practice to strengthen their attack against the subsequent ASSIST trial, falsely accusing both studies of illegal political lobbying with taxpayers' money.

The tobacco industry closely monitored COMMIT activities and organized local responses to findings and activities perceived as threatening to the industry's public image or interests. Although we could not document a concerted attack by the tobacco industry that impacted the results of the COMMIT trial, data suggest that the industry used COMMIT as a learning opportunity to mount a well orchestrated and potentially damaging response to the larger American Stop Smoking Intervention Study for Cancer Prevention Trial.
The Development, Achievements, and Aspirations of a University Network Dedicated to Tobacco Control Research and Education
Authors: Warner Kenneth E. , Burkley Dana J.
Published: July 2017

The establishment of a university-based network of colleagues with a shared goal of increasing tobacco research and educational opportunities can enrich the learning environment and ultimately contribute to reducing the toll of smoking. Such a network was established at the University of Michigan, and similar approaches can be adopted at other universities, considering a range of funding levels. This article discusses the mission, structure, accomplishments, and future goals of the network, along with lessons learned and recommendations for successful initialization. Specific examples of network activities are provided, along with references to web sites and lectures. This case study will be useful to any university leader seeking to establish a network of tobacco and nicotine researchers on campus.
Reaching and Educating the Global Tobacco Control Community: Innovative Approaches to Tobacco Control Training
Authors: Stillman Frances , Wipfli Heather , Samet Jonathan
Published: July 2017

To slow and end the growing global burden of tobacco-related death and disease, schools of public health need to provide tobacco control education and training for public health professionals generally, and for the next generation of tobacco control professionals in low- and middle-income countries specifically. As the tobacco epidemic continues to grow, there is an increasing need for training to develop the research and intervention skills required to stem the epidemic and reduce the inevitable burden of disease and death. A wide range of educational approaches has been developed to increase tobacco control educational capacity in high-, middle-, and low-income countries, including traditional on-site classes, on-line courses, open source courseware, summer school programs, and training workshops.

This article provides a perspective on the education and training needs of tobacco control researchers around the world and reviews the strengths and weaknesses of education and training approaches currently being used in tobacco control by schools of public health. In each case, we draw on the experience of the Johns Hopkins Bloomberg School of Public Health in educating national and international audiences in tobacco control.
Reducing the Gap between the Economic Costs of Tobacco and Funds for Tobacco Training in Schools of Public Health
Authors: Rovniak Liza S. , Johnson-Kozlow Marilyn F. , Hovell Melbourne F.
Published: July 2017

Tobacco use costs approximately $167 billion annually in the U.S., but few tobacco education opportunities are available in schools of public health. Reasons for the discrepancy between the costs of tobacco use and the creation of tobacco training opportunities have not been well explored. Based on the Behavioral Ecological Model, we present 10 recommendations for increasing tobacco training in schools of public health. Six recommendations focus on policy changes within the educational, legislative, and health care systems that influence funds for tobacco training, and four recommendations focus on strategies to mobilize key social groups that can advocate for change in tobacco control education and related policies. In addition, we present a model tobacco control curriculum to equip public health students with the skills needed to advocate for these recommended policy changes. Through concurrent changes in the ecological systems affecting tobacco control training, and through the collaborative action of legislators, the public, the media, and health professionals, tobacco control training can be moved to a higher priority in educational settings.
Prenatal Smoking Prevalence Ascertained from Two Population-Based Data Sources: Birth Certificates and PRAMS Questionnaires, 2004
Authors: Allen Alicia M. , Dietz Patricia M. , Tong Van T. , England Lucinda , Prince Cheryl B.
Published: July 2017

Objectives.

This study provided a population-based estimate of the prevalence of smoking during pregnancy by combining information from two data sources: birth certificates (BCs) and a self-administered questionnaire.

Methods.

We analyzed data from 39,345 women who delivered live births in one of 24 states and responded to a questionnaire from the Pregnancy Risk Assessment Monitoring System (PRAMS), an ongoing, state- and population-based surveillance system. We compared prevalence of smoking during pregnancy based on the BC, the PRAMS questionnaire, and the two data sources combined. Data were weighted to represent all women delivering live births in each of the 24 states during 2004.

Results.

The combined estimate indicated that 15.1% of women reported smoking during pregnancy, whereas the BCs alone reported 10.4% and the PRAMS questionnaires alone reported 13.4%.

Conclusions.

Based on the combined BC and PRAMS questionnaire data, the number of infants exposed to tobacco in-utero may be 31% higher than is currently reported on the BCs. Combining the data from the two different sources led to higher ascertainment of prenatal smoking.
Degrading and Non-Degrading Sex in Popular Music: A Content Analysis
Authors: Primack Brian A. , Gold Melanie A. , Schwarz Eleanor B. , Dalton Madeline A.
Published: July 2017

Objectives.

Those exposed to more degrading sexual references in popular music are more likely to initiate intercourse at a younger age. The purpose of this study was to perform a content analysis of contemporary popular music with particular attention paid to the prevalence of degrading and non-degrading sexual references. We also aimed to determine if sexual references of each subtype were associated with other song characteristics and/or content.

Methods.

We used Billboard magazine to identify the top popular songs in 2005. Two independent coders each analyzed all of these songs (n=279) for degrading and non-degrading sexual references. As measured with Cohen's kappa scores, inter-rater agreement on degrading vs. non-degrading sex was substantial. Mentions of substance use, violence, and weapon carrying were also coded.

Results.

Of the 279 songs identified, 103 (36.9%) contained references to sexual activity. Songs with references to degrading sex were more common than songs with references to non-degrading sex (67 [65.0%] vs. 36 [35.0%], p<0.001). Songs with degrading sex were most commonly Rap (64.2%), whereas songs with non-degrading sex were most likely Country (44.5%) or Rhythm & Blues/Hip-Hop (27.8%). Compared with songs that had no mention of sexual activity, songs with degrading sex were more likely to contain references to substance use, violence, and weapon carrying. Songs with non-degrading sex were no more likely to mention these other risk behaviors.

Conclusions.

References to sexual activity are common in popular music, and degrading sexual references are more prevalent than non-degrading references. References to degrading sex also frequently appear with references to other risky behaviors.
Condom Use among High-Risk Adolescents: Anticipation of Partner Disapproval and Less Pleasure Associated with Not Using Condoms
Authors: Brown Larry K. , DiClemente Ralph , Crosby Richard , Fernandez M. Isabel , Pugatch David , Cohn Sylvia , Lescano Celia , Royal Scott , Murphy Jacqueline R. , Silver Barbara , Schlenger William E. ,   For the Project Shield Study Group
Published: July 2017

Objective.

We determined the association of demographic, psychosocial, and contextual factors with condom use among a large community sample of at-risk adolescents recruited from four locations in the U.S.

Methods.

We enrolled 1,410 adolescents/young adults between the ages of 15 and 21 with a history of unprotected sex in the past 90 days at four study sites. Subjects completed an audio-assisted, computerized assessment that gathered information about sexual behavior and its contexts, substance use, and relevant risk and protective attitudes.

Results.

Nearly two-thirds of adolescents did not use condoms at the time of last intercourse and adolescents reported a mean of 15.5 (median = 5) unprotected intercourse occasions in the past 90 days. Controlling for relevant demographic variables, not using condoms was associated with the perception that condoms reduce sexual pleasure, the perception that partners will not approve of condom use, and less discussion with partners about condoms.

Conclusions.

Even across racial/ethnic groups, gender, and geographic locations, several important correlates of adolescents' sexual risk reduction were identified. Many adolescents may feel that condoms reduce their sexual pleasure and fear partner reactions if they initiate condom use. These attitudes may be malleable through clinical and community-based interventions.
Patient Risks, Outcomes, and Costs of Voluntary HIV Testing at Five Testing Sites within a Medical Center
Authors: Mehta Supriya D. , Hall Jonathan , Greenwald Jeffrey L. , Cranston Kevin , Skolnik Paul R.
Published: July 2017

Objectives.

The Centers for Disease Control and Prevention (CDC) recommends offering human immunodeficiency virus (HIV) testing to all patients in all high HIV-prevalence clinical settings. We evaluated programmatic aspects of HIV testing across multiple clinical settings within a single medical center.

Methods.

We analyzed programmatic data of HIV testing in the Urgent Care Center (UCC), inpatient floors, outpatient primary care, a non-clinical Drop-In Center, and Emergency Department (ED). HIV testing was by oral mucosal transudate, venous blood samples, or rapid testing fingersticks, with Western blot confirmation. We compared the sociodemographics and behavioral risks of individuals undergoing HIV testing across the five sites and estimated costs per person tested and per HIV-positive test result.

Results.

From 2002 to 2004, 16,750 HIV tests were conducted, with 229 (1.4%) previously unreported HIV infections diagnosed among 16,696 valid test results. HIV-positive prevalence was 1.5% for the UCC, 1.5% at the Drop-In Center, 1.4% for primary care, 1.2% for inpatient, and 0.6% in the ED. Behavioral risks were most prevalent in the UCC and the Drop-In Center. The cost per test was lowest in the UCC and highest in the Drop-In Center. The cost per previously unreported HIV infection was lowest in the UCC ($1,980) and highest in the ED ($9,724).

Conclusions.

Although a significant number of HIV infections were identified, the number of tests performed represents <10% of all clinical visits. Due to personnel and time constraints, offering HIV testing to patients hierarchically in some settings of a high-volume medical center merits evaluation.
Using Diagnostic Codes to Screen for Intimate Partner Violence in Oregon Emergency Departments and Hospitals
Authors: Schafer Sean D. , Drach Linda L. , Hedberg Katrina , Kohn Melvin A.
Published: July 2017

Objectives.

Many of the 2.5 million Americans assaulted annually by intimate partners seek medical care. This project evaluated diagnostic codes indicative of intimate partner violence (IPV) in Oregon hospital and emergency department (ED) records to determine predictive value positive (PVP), sensitivity, and usefulness in routine surveillance. Statewide incidence of care for IPV was calculated and victims and episodes characterized.

Methods.

The study was a review of medical records assigned ≥1 diagnostic codes thought predictive of IPV. Sensitivity was estimated by comparing the number of confirmed victims identified with the number predicted by statewide telephone survey. Patients were aged ≥2 years, treated in any of 58 EDs or hospitals in Oregon during 2000, and discharged with one of three primary or 12 provisional codes suggestive of IPV. Outcome measures were number of victims detected, PPV and sensitivity of codes for detection of IPV, and description of victims.

Results.

Of 58 hospitals, 52 (90%) provided records. Case finding using primary codes identified 639 victims, 23% of all estimated female victims seen in EDs or hospitalized statewide. PVP was 94% (639/677). Provisional codes increased sensitivity (51%) but reduced PVP (50%). Highest incidence occurred in women aged 20–39 years, and those who were black. Hospitalizations were highest among women aged $50 years, black people, or those with comorbid illness.

Conclusions.

Three diagnostic codes used for case finding detect approximately one-quarter of ED- and hospital-treated victims, complement surveys, and facilitate description of injured victims.
Assessment of a Media Campaign and Related Crisis Help Line following Hurricane Katrina
Authors: Beaudoin Christopher E.
Published: July 2017

Objectives.

We evaluated the impact of a media campaign targeting stress and depression following Hurricane Katrina. We specifically examined public response to the campaign's recommendation that people could contact a telephone help line for further assistance if needed.

Methods.

Call data from Via Link allowed us to track trends in 800-number Crisis Line call volume ( n=29,659), which is the number recommended in the media campaign, and 2-1-1 Information and Referral Line call volume ( n=8,035), which is employed in a control-like manner. With data from April 1, 2006, through November 30, 2006, multivariate analysis was used to assess trends and differences among and within pre-intervention, intervention, and post-intervention.

Results.

Information and Referral Line call volume, which was unrelated to the campaign, did not change over time. In contrast, Crisis Line call volume, which was related to the campaign, increased significantly from pre-intervention to intervention, but not from intervention to post-intervention. Furthermore, the daily rate of Crisis Line call volume was constant during pre-intervention, increased during intervention, but decreased during post-intervention.

Conclusion.

There is support for the media campaign's influence on public behavior to contact Via Link in regard to stress and depression following Hurricane Katrina. Analysis helps undermine alternative explanations, including general trends in help line call volume and those specific to Crisis Line call volume.
Hepatitis A Seroprevalence and Risk Factors among Homeless Adults in San Francisco: Should Homelessness Be Included in the Risk-Based Strategy for Vaccination?
Authors: Hennessey Karen A. , Bangsberg David R. , Weinbaum Cindy , Hahn Judith A.
Published: July 2017

Objectives.

Homeless adults have an increased risk of infectious diseases due to sexual and drug-related behaviors and substandard living conditions. We investigated the prevalence and risk factors for presence of hepatitis A virus (HAV) antibodies among homeless and marginally housed adults.

Methods.

We analyzed serologic and questionnaire data from a study of marginally housed and homeless adults in San Francisco from April 1999 to March 2000. We tested seroprevalance for total antibodies to HAV (anti-HAV) and analyzed data using Chi-square tests and logistic regression.

Results.

Of the 1,138 adults in the study, 52% were anti-HAV positive. The anti-HAV prevalence in this study population was 58% higher than the expected prevalence based on age-specific prevalence rates from the general population. Number of years of homelessness (≤1, 2-4, and ≥5 years) was associated with anti-HAV prevalence (46%, 50%, and 61%, respectively, p<0.001). We found other differences in anti-HAV prevalence (p<0.05) for ever having injected drugs (63% vs. 42% for non-injectors), being foreign-born (75% vs. 51% among U.S.-born), race/ethnicity (72%, 53%, and 45% for Hispanic, white, and black people, respectively), and increasing age (38%, 49%, and 62% among those aged <35, 35-45, and >45 years, respectively). These variables all remained significant in a multivariate model.

Conclusions.

We found overall anti-HAV prevalence elevated in this San Francisco homeless population compared with the general U.S. population. These data show that anti-HAV was associated with homelessness independent of other known risk factors, such as being foreign-born, race/ethnicity, and injection drug use. This increase indicates an excess risk of HAV infection and the potential need to offer hepatitis A vaccination as part of homeless services.
Acculturation and Cardiovascular Risk Factor Control among Hispanic Adults in the United States
Authors: Eamranond Pracha P. , Wee Christina C. , Legedza Anna T.R. , Marcantonio Edward R. , Leveille Suzanne G.
Published: July 2017

Objectives.

We sought to determine whether low acculturation, based on language measures, leads to disparities in cardiovascular risk factor control in U.S. Hispanic adults.

Methods.

We studied 4,729 Hispanic adults aged 18 to 85 years from the National Health and Nutrition Examination Survey, 1999–2004. We examined the association between acculturation and control of low-density lipoprotein (LDL) cholesterol, blood pressure, and hemoglobin A1c based on national guidelines among participants with hypercholesterolemia, hypertension, and diabetes, respectively. We used weighted logistic regression adjusting for age, gender, and education. We then examined health insurance, having a usual source of care, body mass index, fat intake, and leisure-time physical activity as potential mediators.

Results.

Among participants with hypercholesterolemia, Hispanic adults with low acculturation were significantly more likely to have poorly controlled LDL cholesterol than Hispanic adults with high acculturation after multivariable adjustment (odds ratio [OR] = 3.4, 95% confidence interval [CI] 1.2, 9.5). Insurance status mildly attenuated the difference in LDL cholesterol control. After adjusting for diet and physical activity, the magnitude of the association increased. Other covariates had little influence on the observed relationship. Among those with diabetes and hypertension, we did not observe statistically significant associations between low acculturation and control of hemoglobin A1c (OR=0.5, 95% CI 0.2, 1.2), and blood pressure (OR=1.1, 95% CI 0.6, 1.7), respectively.

Conclusions.

Low levels of acculturation may be associated with increased risk of inadequate LDL cholesterol control among Hispanic adults with hypercholesterolemia. Further studies should examine the mechanisms by which low acculturation might adversely impact lipid control among Hispanic adults in the U.S.
Birth and Fetal Death Records and Environmental Exposures: Promising Data Elements for Environmental Public Health Tracking of Reproductive Outcomes
Authors: Fitzgerald Edward , Wartenberg Daniel , Thompson W. Douglas , Houston Allison
Published: July 2017

Objectives.

We inventoried and reviewed the birth and fetal death certificates of all 50 U.S. states to identify nonstandard data items that are environmentally relevant, inexpensive to collect, and might enhance environmental public health tracking.

Methods.

We obtained online or requested by mail or telephone the birth certificate and fetal death record forms or formats from each state. Every state data element was compared to the 2003 standards promulgated by the National Center for Health Statistics to identify any items that are not included on the standard. We then evaluated these items for their utility in environmentally related analyses.

Results.

We found three data fields of potential interest. First, although every state included residence of mother at time of delivery on the birth certificate, only four states collected information on how long the mother had lived there. This item may be useful in that it could be used to assess and reduce misclassification of environmental exposures among women during pregnancy. Second, we found that father's address was listed on the birth certificates of eight states. This data field may be useful for defining paternal environmental exposures, especially in cases where the parents do not live together. Third, parental occupation was listed on the birth certificates of 15 states and may be useful for defining parental workplace exposures. Our findings were similar for fetal death records.

Conclusion.

If these data elements are accurate and well-reported, their addition to birth, fetal death, and other health records may aid in environmental public health tracking.
Primary Health-Care Delivery Gaps among Medically Underserved Asian American and Pacific Islander Populations
Authors: Weir Rosy Chang , Tseng Winston , Yen Irene H. , Caballero Jeffrey
Published: July 2017

Objectives.

Asian American and Pacific Islanders (AAPIs) historically have faced multiple social and racial/ethnic health disparities in the United States. We gathered national-level health-care data on AAPIs and examined medically underserved health service areas for them.

Methods.

We used 2000 U.S. Census data and the Bureau of Primary Health Care (BPHC) 2004 dataset for primary care physician full-time equivalents per 1,000 population, as well as AAPI population, AAPI poverty, and AAPI limited English proficiency, to develop an index of medically underserved AAPI counties (MUACs). The index identifies U.S. counties that do not adequately serve AAPIs.

Results.

We identified 266 counties of medically underserved health service areas for AAPIs across the nation, representing 12% of all U.S. counties. One hundred thirty-eight (52%) MUACs were not designated as BPHC medically underserved counties. Of these counties, 20 (14%) had an AAPI population of at least 10,000, and 29 (21%) had an AAPI population of at least 5,000.

Conclusion.

This project complements federal efforts to identify medically underserved health service areas and identifies U.S. counties that need new or expanded health services for medically underserved AAPIs.
Divergence in Contributing Factors for Suicide among Men and Women in Kentucky: Recommendations to Raise Public Awareness
Authors: Walsh Sabrina , Clayton Richard , Liu Li , Hodges Sue
Published: July 2017

Objectives.

The primary purpose of this study was to compile demographic information from 1999 to 2005 on suicides and examine specifically toxicology differences between men and women dying by suicide and differences in what type of intimate partner problems (IPPs) were cited as a precipitating circumstance.

Methods.

In addition to death certificate data, coroner investigation reports were available for more than three-quarters of cases in 2005 detailing precipitating factors leading up to suicide. We linked toxicology results to death certificates and coroner investigation reports in the Kentucky Violent Death Reporting System database for statewide analysis.

Results.

In 2005, IPP was documented as a contributing factor in 128 (29%) of all suicide cases where the circumstances were known. In 54 (42%) of the 128 cases, the coroner noted that the decedent's intimate was in the process of leaving, breaking up, had recently left, had recently separated, had recently filed for divorce, was awaiting divorce, or had a divorce recently finalized. Of those 54 cases involving IPPs, most (87%) of the suicide victims were men and were significantly different from the women.

Conclusions.

As a result of this study, we have two recommendations: ( 1) partnering with the media and community-based programs and services to systematically disseminate information on issues such as male IPPs and suicide, and ( 2) continuing and expanding the use of violent death surveillance to improve risk factor identification. With improved data gathering, targeted interventions can better address the various dynamics influencing the decision to take one's own life.
How Healthy Could a State Be?
Authors: Kindig David , Peppard Paul , Booske Bridget
Published: July 2017

Objective.

We predicted the amount of health outcome improvement any state might achieve if it could reach the highest level of key health determinants any individual state has already achieved.

Methods.

Using secondary county-level data on modifiable and nonmodifiable health determinants from 1994 to 2003, we used regression analysis to predict state age-adjusted mortality rates in 2000 for those younger than age 75, under the scenario of each state's “ideal” predicted mortality if that state had the best observed level among all states of modifiable determinants.

Results.

We found considerable variation in predicted improvement across the states. The state with the lowest baseline mortality, New Hampshire, was predicted to improve by 23% to a mortality rate of 250 per 100,000 population if New Hampshire had the most favorable profile of modifiable health determinants. However, West Virginia, with a much higher baseline, would be predicted to improve the most—by 46% to 254 per 100,000 population. Individual states varied in the pattern of specific modifiable variables associated with their predicted improvement.

Conclusions.

The results support the contention that health improvement requires investment in three major categories: health care, behavioral change, and socioeconomic factors. Different states will require different investment portfolios depending on their pattern of modifiable and nonmodifiable determinants.
Transitions Clinic: Creating a Community-Based Model of Health Care for Recently Released California Prisoners
Authors: Wang Emily A. , Hong Clemens S. , Samuels Liz , Shavit Shira , Sanders Ronald , Kushel Margot
Published: July 2017

Most California prisoners experience discontinuity of health care upon return to the community. In January 2006, physicians working with community organizations and representatives of the San Francisco Department of Public Health's safety-net health system opened the Transitions Clinic (TC) to provide transitional and primary care as well as case management for prisoners returning to San Francisco. This article provides a complete description of TC, including an illustrative case, and reports information about the recently released individuals who participated in the program.

From January 2006 to October 2007, TC saw 185 patients with chronic medical conditions. TC patients are socially and economically disenfranchised; 86% belong to ethnic minority groups and 38% are homeless. Eighty-nine percent of patients did not have a primary care provider prior to their incarceration. Preliminary findings demonstrate that a community-based model of care tailored to this disenfranchised population successfully engages them in seeking health care.
Impact of Non-Pharmaceutical Interventions on URIs and Influenza in Crowded, Urban Households
Authors: Larson Elaine L. , Ferng Yu-Hui , Wong-McLoughlin Jennifer , Wang Shuang , Haber Michael , Morse Stephen S.
Published: July 2017

Objectives.

We compared the impact of three household interventions—education, education with alcohol-based hand sanitizer, and education with hand sanitizer and face masks—on incidence and secondary transmission of upper respiratory infections (URIs) and influenza, knowledge of transmission of URIs, and vaccination rates.

Methods.

A total of 509 primarily Hispanic households participated. Participants reported symptoms twice weekly, and nasal swabs were collected from those with an influenza-like illness (ILI). Households were followed for up to 19 months and home visits were made at least every two months.

Results.

We recorded 5,034 URIs, of which 669 cases reported ILIs and 78 were laboratory-confirmed cases of influenza. Demographic factors significantly associated with infection rates included age, gender, birth location, education, and employment. The Hand Sanitizer group was significantly more likely to report that no household member had symptoms ( p<0.01), but there were no significant differences in rates of infection by intervention group in multivariate analyses. Knowledge improved significantly more in the Hand Sanitizer group ( p<0.0001). The proportion of households that reported ≥50% of members receiving influenza vaccine increased during the study ( p<0.001). Despite the fact that compliance with mask wearing was poor, mask wearing as well as increased crowding, lower education levels of caretakers, and index cases 0–5 years of age (compared with adults) were associated with significantly lower secondary transmission rates (all p<0.02).

Conclusions.

In this population, there was no detectable additional benefit of hand sanitizer or face masks over targeted education on overall rates of URIs, but mask wearing was associated with reduced secondary transmission and should be encouraged during outbreak situations. During the study period, community concern about methicillin-resistant Staphylococcus aureus was occurring, perhaps contributing to the use of hand sanitizer in the Education control group, and diluting the intervention's measurable impact.
Assessing the Impact of the Health Center Growth Initiative on Health Center Patients
Authors: Shi Leiyu , Lebrun Lydie A. , Tsai Jenna
Published: July 2017

Objectives.

In 2001, the Health Center Growth Initiative was launched to increase access to primary health-care services through the expansion of the health center program. We examined the impact this initiative had on the number and types of patients seen by health centers, as well as the health center characteristics significantly associated with service expansions.

Methods.

We conducted secondary and time-trend analyses of the Uniform Data System, an annual dataset submitted to the Bureau of Primary Health Care by all federally qualified health centers. We performed trend and multi-variable analyses to examine the impact of the initiative on health center performance.

Results.

Health centers that received both new access points and expanded medical capacity funding saw the most rapid growth in patients. These centers experienced a 58% increase in total number of patients and a 60% increase in total number of encounters, compared with 10% and 8%, respectively, for centers receiving no funding at all. Conclusions were unchanged even after controlling for other health center characteristics.

Conclusions.

Public funding is critical to sustaining and expanding health center services to the nation's vulnerable populations.
Addressing Gender Dynamics and Engaging Men in HIV Programs: Lessons Learned from Horizons Research
Authors: Pulerwitz Julie , Michaelis Annie , Verma Ravi , Weiss Ellen
Published: July 2017

In the field of human immunodeficiency virus (HIV) prevention, there has been increasing interest in the role that gender plays in HIV and violence risk, and in successfully engaging men in the response. This article highlights findings from more than 10 studies in Asia, Africa, and Latin America—conducted from 1997 through 2007 as part of the Horizons program—that have contributed to understanding the relationship between gender and men's behaviors, developing useful measurement tools for gender norms, and designing and evaluating the impact of gender-focused program strategies. Studies showed significant associations between support for inequitable norms and risk, such as more partner violence and less condom use. Programmatic lessons learned ranged from insights into appropriate media messages, to strategies to engage men in critically reflecting upon gender inequality, to the qualities of successful program facilitators. The portfolio of work reveals the potential and importance of directly addressing gender dynamics in HIV- and violence-prevention programs for both men and women.
Implementing Programs for the Prevention of Mother-to-Child HIV Transmission in Resource-Constrained Settings: Horizons Studies, 1999–2007
Authors: Baek Carolyn , Rutenberg Naomi
Published: July 2017

An estimated 430,00 new human immunodeficiency virus (HIV) infections occurred among children younger than 15 years of age in 2008, most in sub-Saharan Africa and most due to mother-to-child transmission (MTCT). In marked contrast, MTCT of HIV has been virtually eliminated in well-resourced settings through the use of combinations of antiretroviral (ARV) drugs for the mother during pregnancy and labor and for the infant postpartum; cesarean delivery to reduce the infant's exposure to trauma and infection in the birth canal; and formula feeding to protect the infant from transmission from breastfeeding. While effective, these interventions are costly and require strong health-care systems. From 1999 to 2003, Horizons conducted operations research to determine how interventions successful in the clinical trial setting would translate to the real-world environments of maternal and child healthcare delivery in low-resource settings. A second set of Horizons studies (2004–2007) sought to address gaps in adherence to ARV prophylaxis; examine roles of family planning in prevention of MTCT (PMTCT) programs; show the value of psychosocial support for HIV-positive mothers; and identify ways to improve the quality of care and follow-up for women in the postpartum period. This article provides an assessment of the findings of Horizons studies on PMTCT interventions from 1999 to 2007 and identifies needs for follow-on efforts.
Easier Said Than Done: Behavioral Conflicts in following Social-Distancing Recommendations for Influenza Prevention
Authors: Kozlowski Lynn T. , Kiviniemi Marc T. , Ram Pavani Kalluri
Published: July 2017

Preventing transmission of H1N1 and other infectious diseases can require individuals to change behaviors, but recommendations to change behavior can run counter to other powerful influences. For example, instructions to not shake hands or avoid certain public gatherings can run counter to substantial social pressures to shake hands or be in attendance. These behavioral conflicts are illustrated with an experience of the relative ineffectiveness of voluntary recommendations, which highlights the importance of considering these social pressures when determining what recommendations to make and how to make them. An analysis of how social pressures influence behaviors relevant to preventing disease transmission can aid public health officials in considering how to make effective recommendations concerning H1N1 and other infectious disease situations.