bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of a Smoke-Free Hospital Campus Policy on Employee and Consumer Behavior
Authors: Wheeler J. Gary , Pulley LeaVonne , Felix Holly C. , Bursac Zoran , Siddiqui Nadia J. , Stewart M. Kathryn , Mays Glen P. , Gauss C. Heath
Published: July 2017

Objective.

Although smoke-free hospital campuses can provide a strong health message and protect patients, they are few in number due to employee retention and public relations concerns. We evaluated the effects of implementing a clean air policy on employee attitudes, recruitment, and retention; hospital utilization; and consumer satisfaction in 2003 through 2005.

Methods.

We conducted research at a university hospital campus with supplemental data from an affiliated hospital campus. Our evaluation included (1) measurement of employee attitudes during the year before and year after policy implementation using a cross-sectional, anonymous survey; (2) focus group discussions held with supervisors and security personnel; and (3) key informant interviews conducted with administrators. Secondary analysis included review of employment records and exit interviews, and monitoring of hospital utilization and patient satisfaction data.

Results.

Employee attitudes toward the policy were supportive (83.3%) at both institutions and increased significantly (89.8%) at post-test at the university hospital campus. Qualitatively, administrator and supervisor attitudes were similarly favorable. There was no evidence on either campus of an increase in employee separations or a decrease in new hiring after the policy was implemented. On neither campus was there a change in bed occupancy or mean daily census. Standard measures of consumer satisfaction were also unchanged at both sites.

Conclusion.

A campus-wide smoke-free policy had no detrimental effect on measures of employee or consumer attitudes or behaviors.
Energy and Public Health: The Challenge of Peak Petroleum
Authors: Frumkin Howard , Hess Jeremy , Vindigni Stephen
Published: July 2017

Petroleum is a unique and essential energy source, used as the principal fuel for transportation, in producing many chemicals, and for numerous other purposes. Global petroleum production is expected to reach a maximum in the near future and to decline thereafter, a phenomenon known as “peak petroleum.”

This article reviews petroleum geology and uses, describes the phenomenon of peak petroleum, and reviews the scientific literature on the timing of this transition. It then discusses how peak petroleum may affect public health and health care, by reference to four areas: medical supplies and equipment, transportation, energy generation, and food production. Finally, it suggests strategies for anticipating and preparing for peak petroleum, both general public health preparedness strategies and actions specific to the four expected health system impacts.
PTSD Prevalence, Associated Exposures, and Functional Health Outcomes in a Large, Population-Based Military Cohort
Authors: Smith Tyler C. , Wingard Deborah L. , Ryan Margaret A.K. , Kritz-Silverstein Donna , Slymen Donald J. , Sallis James F. ,   for the Millennium Cohort Study Team
Published: July 2017

Objectives.

Posttraumatic stress disorder (PTSD) results from experiencing or witnessing traumatic, life-threatening events including combat-related experiences. The purpose of this study was to investigate the prevalence of PTSD symptoms and diagnosis, self-reported exposures, and functional health in a large cross-section of the U.S. military.

Methods.

This study used baseline Millennium Cohort data (July 2001 to June 2003) of 75,156 U.S. military members to assess the population-based prevalence of PTSD symptoms, self-reported exposures, and functional health as measured by the Medical Outcomes Study Short Form 36-Item Health Survey for Veterans (SF-36V).

Results.

PTSD diagnosis without current symptoms was reported by 953 respondents (1.2%, weighted), 1,490 respondents (2.1%, weighted) reported no diagnosis but reported PTSD symptoms, and 287 respondents (0.4%, weighted) reported diagnosis and current symptoms. Self-reported exposure to chemical or biological warfare agents, protective countermeasures, or hearing alarms were associated with PTSD symptoms independent of other combat-like exposures. Physical health was similar among those with PTSD diagnosis and current PTSD symptoms. However, compared with the overall cohort, lower mental health summary means for those reporting current PTSD symptoms (mean 5 27.8), current symptoms and diagnosis (mean = 24.6), and diagnosis without current symptoms (mean = 47.5) were found.

Conclusions.

Results suggest a 2.0% prevalence of PTSD symptoms without diagnosis and that self-reported threatening exposures were significantly associated with PTSD symptoms. Mental and physical health scores of those with current PTSD symptoms appear diminished, but suggest a return to cohort levels with resolution of PTSD symptoms.
Does Influenza Transmission Occur from Asymptomatic Infection or Prior to Symptom Onset?
Authors: Patrozou Eleni , Mermel Leonard A.
Published: July 2017

A better understanding of transmission dynamics is essential in influenza pandemic planning. If a substantial proportion of transmissions were to occur during the presymptomatic phase or from asymptomatic individuals, then infection control measures such as contact tracing and quarantine of exposures would be of limited value. Infectiousness has been inferred based on the presence of influenza in the upper respiratory tract rather than from transmission experiments. Although asymptomatic individuals may shed influenza virus, studies have not determined if such people effectively transmit influenza.

We performed a systematic review of published studies describing the relationship between viral shedding and disease transmission. Based on the available literature, we found that there is scant, if any, evidence that asymptomatic or presymptomatic individuals play an important role in influenza transmission. As such, recent articles concerning pandemic planning, some using transmission modeling, may have overestimated the effect of presymptomatic or asymptomatic influenza transmission. More definitive transmission studies are sorely needed.
Gender-Specific Mental and Behavioral Outcomes among Physically Abused High-Risk Seventh-Grade Youths
Authors: Logan Joseph E. , Leeb Rebecca T. , Barker Lawrence E.
Published: July 2017

Objective.

Research has shown that physical abuse during childhood (early PA) is associated with various mental and behavioral problems in adolescence. However, there is little research on the differences in these associations by gender among youths residing in high-risk communities. This study investigated gender differences in the relationship between early PA and various internalizing (e.g., thoughts of suicide or victimization) and externalizing (e.g., perpetration of violence) behaviors.

Methods.

A cross-sectional study was conducted using survey data (collected in 2004) provided by 1,484 seventh-grade youths residing in a high-risk community (83% participated). Students were considered victims of early PA if they reported experiencing abuse prior to age 10 years. Prevalence ratios (PRs) were calculated to estimate the association between early PA and various outcomes (e.g., suicidality, victimization, violence, and illegal drug use), adjusting for race/ethnicity and other forms of abuse. Poisson regression with robust variance estimates was used to estimate the PRs and test for early PA-gender interaction.

Results.

Early PA was positively associated with suicidality, illegal drug use, and victimization with no significant differences by gender. The association between early PA and criminal behavior was significantly higher for females; the association between early PA and peer violence perpetration was significantly higher for males (interaction term PA*gender was significant at the p≤0.005 level).

Conclusions.

Young high-risk adolescents who experienced early PA may need counseling or other services (e.g., home visitation) to help prevent suicidality, victimization, violence perpetration, criminal behavior, and illegal drug use. Furthermore, male victims may need more attention in the area of violence prevention; female victims may need particular attention with regard to preventing criminal behavior.
Club Drug Use and Dependence among Young Adults Recruited through Time-Space Sampling
Authors: Parsons Jeffrey T. , Grov Christian , Kelly Brian C.
Published: July 2017

Objectives.

Ketamine, methylenedioxymethamphetamine (MDMA/ecstasy), cocaine, gamma-hydroxybutyrate (GHB), methamphetamine, and d-lysergic acid diethylamide (LSD/acid) have been identified as “club drugs” because of their link to club culture among young adults. Yet little is known about users' demographic differences in the prevalence of club drugs. This study sought to provide a comprehensive profile of users' demographic differences in prevalence of club drug use and dependence.

Methods.

Using time-space sampling, a stratified sample of 400 18- to 29-year-old club-going young adults was recruited into the Club Drugs and Health Project.

Results.

Though participants reported using an array of club drugs, almost all participants (90.0%) were cocaine users. Although there were several sexual orientation and gender differences in recent drug exposure, patterns of use (measured in days) were fairly similar across gender, sexual orientation, and age. Finally, a majority of individuals (58.5%) met or exceeded criteria for club drug dependence, with most (61.7%) indicating cocaine was the one drug causing them significant problems.

Conclusions.

Cocaine is a major drug in club culture. It is essential to develop culturally appropriate drug education and prevention initiatives for young adults using club drugs.
Assessing Mediation in HIV Intervention Studies
Authors: Hardnett Felicia P. , Pals Sherri L. , Borkowf Craig B. , Parsons Jeffrey , Gomez Cynthia , O'Leary Ann
Published: July 2017

Objectives.

A mediator is a psychosocial construct that is targeted by an intervention to bring about behavior change. Recent literature suggests that a widely used approach for assessing mediation, namely the causal steps method, can be severely statistically underpowered. This article describes three standard methods for assessing mediation: causal steps, difference in coefficients, and product of coefficients. We also demonstrate the use of asymmetric confidence limits (ACLs) in testing mediation.

Methods.

We compared the results obtained by ACL construction with results obtained based on the causal steps and product of coefficients approaches to analyze data from the Seropositive Urban Men's Intervention Trial.

Results.

ACL construction uncovered previously unidentified mediating factors. We also identified a marginally significant suppressor, which means that, with regard to this factor, the intervention had effects that were opposite from the desired direction.

Conclusions.

ACLs are preferred for this type of analysis because of their statistical power and because they are informative regardless of whether the intervention has a significant effect on the outcome. Furthermore, ACLs present the size of the mediating effect rather than just a binary decision regarding significance.
Practical Considerations for Matching STD and HIV Surveillance Data with Data from other Sources
Authors: Newman Lori M. , Samuel Michael C. , Stenger Mark R. , Gerber Todd M. , Macomber Kathryn , Stover Jeffrey A. , Wise Wendy
Published: July 2017

Data to guide programmatic decisions in public health are needed, but frequently epidemiologists are limited to routine case report data for notifiable conditions such as sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV). However, case report data are frequently incomplete or provide limited information on comorbidity or risk factors. Supplemental data often exist but are not easily accessible, due to a variety of real and perceived obstacles. Data matching, defined as the linkage of records across two or more data sources, can be a useful method to obtain better or additional data, using existing resources. This article reviews the practical considerations for matching STD and HIV surveillance data with other data sources, including examples of how STD and HIV programs have used data matching.
Trends in Neisseria Gonorrhoeae Incidence among HIV-Negative and HIV-Positive Men in Washington State, 1996–2007
Authors: Stenger Mark R. , Courogen Maria T. , Carr Jason B.
Published: July 2017

Objectives.

We assessed population-level trends in human immunodeficiency virus (HIV) and Neisseria gonorrhoeae co-infection among adult males in Washington State between 1996 and 2007.

Methods.

Population-based categorical disease surveillance registries for gonorrhea and for HIV were electronically matched and merged at the record level and incidence rates were calculated for reported HIV-positive and presumed HIV-negative men.

Results.

The incidence of gonorrhea infection increased significantly among both HIV-positive and presumed HIV-negative men from 1996 to 2005, and this trend has recently reversed for both groups. The annual incidence rate of gonorrhea among HIV-positive men was found to be higher in all years than among men presumed to be HIV-negative.

Conclusions.

Inequality in the burden of gonorrhea by HIV-infection status suggests continuing sexual risk-taking among HIV-positive men as well as possible barriers to diagnosis, treatment, and partner services. This inequality may also reflect significant differences in gonorrhea burden among men who have sex with men as well as by HIV status. Monitoring emergent secular trends in population-level HIV/sexually transmitted infection comorbidity through registry matching is an achievable strategy for developing an evidence base to inform program collaboration and service integration efforts aimed at providing more comprehensive disease prevention services.
Assessment of the Association of Chlamydia Trachomatis Infection and Adverse Perinatal Outcomes with the Use of Population-Based Chlamydia Case Report Registries and Birth Records
Authors: Chow Joan M. , Kang Mi-Suk , Samuel Michael C. , Bolan Gail
Published: July 2017

Objective.

We assessed the relationship between Chlamydia trachomatis (CT) infections identified during pregnancy and adverse perinatal birth outcomes (including premature rupture of membranes, preterm delivery, and low birthweight) by matching CT reports and birth records.

Methods.

We merged California birth records from 1997, 1998, and 1999 with California CT reports from the same years to determine the proportion of birth records matched to a female CT report, using maternal last name, first name, date of birth, and county of residence. We used logistic regression to assess the crude and adjusted association between a CT report less than 10 months before the birth record date and premature rupture of membranes, preterm delivery, and low birthweight. These results were adjusted for age, race/ethnicity, level of education, and prenatal care.

Results.

Of 675,786 birth records and 101,296 female CT reports, 14,039 women had a CT case report and a birth record; 10,917 birth records (1.6%) were matched to a CT report during pregnancy, and 10,940 (10.8%) of CT reports were matched to a birth record date 10 months after date of diagnosis/report. For premature rupture of membranes, the adjusted odds ratio (AOR) was 1.2, 95% confidence interval (CI) 1.0, 1.3; for low birthweight, the AOR was 1.2, 95% CI 1.1, 1.3. The reduction in birthweight associated with prenatal CT infection was 31.7 grams.

Conclusions.

The increased risk of adverse perinatal outcomes associated with prenatal CT infection supports current prenatal CT screening guidelines. Matching of surveillance and vital statistics data sources was an efficient method to assess this association.
Integration of Surveillance for STDs, HIV, Hepatitis, and TB: A Survey of U.S. STD Control Programs
Authors: Dowell Deborah , Gaffga Nicholas H. , Weinstock Hillard , Peterman Thomas A.
Published: July 2017

Objectives.

Integration of surveillance for sexually transmitted diseases (STDs), human immunodeficiency virus (HIV), hepatitis, and tuberculosis (TB) may improve disease prevention and control. We determined the extent of surveillance integration in these programs, the benefits of integration, and barriers to increased integration.

Methods.

We e-mailed a survey to the 58 federally funded local and state STD control programs and followed up with phone interviews of nine program representatives.

Results.

The response rate was 81%. Many had compared infections by population subgroup for STDs and HIV (89%), STDs and hepatitis (53%), or STDs and TB (28%). Most (74%) had examined co-infections with HIV and STDs at the individual level and entered STD and HIV surveillance data into the same database (54%). All respondents thought some integration would be useful. Many (72%) used integrated data to disseminate information or change program strategies. The most commonly reported barriers to integration were policies preventing work with HIV data (85%) and incompatible databases (59%).

Conclusions.

Most STD control programs in the United States have some experience integrating surveillance data, but the degree of integration varies widely. Specific barriers to further integration were identified. The Centers for Disease Control and Prevention can help address these barriers by facilitating access to information and sharing technical solutions. Local and state programs can continue advancing surveillance integration by improving understanding of where integrated data are needed, increasing the use of available data, and pressing for appropriate and secure data sharing.
Charting a Path to Location Intelligence for STD Control
Authors: Gerber Todd M. , Du Ping , Armstrong-Brown Janelle , McNutt Louise-Anne , Coles F. Bruce
Published: July 2017

This article describes the New York State Department of Health's GeoDatabase project, which developed new methods and techniques for designing and building a geocoding and mapping data repository for sexually transmitted disease (STD) control. The GeoDatabase development was supported through the Centers for Disease Control and Prevention's Outcome Assessment through Systems of Integrated Surveillance workgroup. The design and operation of the GeoDatabase relied upon commercial-off-the-shelf tools that other public health programs may also use for disease-control systems. This article provides a blueprint of the structure and software used to build the GeoDatabase and integrate location data from multiple data sources into the everyday activities of STD control programs.
Improving Surveillance of Sexually Transmitted Diseases through Geocoded Morbidity Assignment
Authors: Stover Jeffrey A. , Kheirallah Khalid A. , Delcher Philip Christopher , Dolan Carrie B. , Johnson LaShonda
Published: July 2017

Objectives.

We assessed the added value of using a geocoderto improve sexually transmitted disease (STD) surveillance data and decision support through redistribution of inaccurately assigned morbidity in Richmond, Virginia.

Methods.

Virginia initiated geocoding of STD data as a data quality tool in 2002. Geocoded output files were assessed and discordant proportions of reported gonorrhea and chlamydia morbidity were reassigned appropriately for the city of Richmond, Chesterfield County, and Henrico County (2002 to 2006). We used Chi-square analysis to compare assignment proportions and calculated crude odds ratios for 2006 data to estimate increased case reassignment likelihood.

Results.

From 2002 to 2006, 149,229 cases of gonorrhea and chlamydia were reported within the Commonwealth of Virginia. Of the reported morbidity, 81% of cases ( n=120,875) were successfully geocoded; 7% ( n=8,461) of geocoded addresses were reassigned. Approximately 76% ( n=6,412) of all reassigned cases occurred within Richmond and Chesterfield and Henrico counties. In 2006, 84% ( n=654) of reassigned cases in this tri-city/county area were initially reported as Richmond morbidity. Data quality improvements reduced Richmond's artificially inflated morbidity by 18% and increased Chesterfield and Henrico morbidity by 17% and 55%, respectively. Richmond morbidity was three times more likely to be reassigned than Chesterfield cases (odds ratio [OR] = 2.93, 95% confidence interval [CI] 2.21, 3.90), and two times more likely than Henrico cases (OR=2.12, 95% CI 1.63, 2.76). Richmond's number one national rank for STD rates was reduced beginning in 2002.

Conclusions.

Declining rates of STDs were statistically associated with geocoded morbidity reassignments. Implementation of this data quality business process has improved epidemiologic analyses, prevention planning, and assessment of resource allocations. The reduction in Richmond's national STD rankings is indicative of the effect geocoding can have on surveillance data.
Providing Mailing Cost Reimbursements: The Effect on Reporting Timeliness of Sexually Transmitted Diseases in Virginia
Authors: Vasiliu Oana E. , Stover Jeffrey A. , Mays Marissa J. E. , Bissette Jennifer M. , Dolan Carrie B. , Sirbu Corina M.
Published: July 2017

Objectives.

We investigated the effect of providing mailing cost reimbursements to local health departments on the timeliness of the reporting of sexually transmitted diseases (STDs) in Virginia.

Methods.

The Division of Disease Prevention, Virginia Department of Health, provided mailing cost reimbursements to 31 Virginia health districts from October 2002 to December 2004. The difference (in days) between the diagnosis date (or date the STD paperwork was initiated) and the date the case/STD report was entered into the STD surveillance database was used in a negative binomial regression model against time (as divided into three periods—before, during, and after reimbursement) to estimate the effect of providing mailing cost reimbursements on reporting timeliness.

Results.

We observed significant decreases in the number of days between diagnosis and reporting of a case, which were sustained after the reimbursement period ended, in 25 of the 31 health districts included in the analysis. We observed a significant initial decrease (during the reimbursement period) followed by a significant increase in the after-reimbursement phase in one health district. Two health districts had a significant initial decrease, while one health district had a significant decrease in reporting timeliness in the period after reimbursement. Two health districts showed no significant changes in the number of days to report to the central office.

Conclusion.

Providing reimbursements for mailing costs was statistically associated with improved STD reporting timeliness in almost all of Virginia's health districts. Sustained improvement after the reimbursement period ended is likely indicative of improved local health department reporting habits.
Not Enough Fruit and Vegetables or Too Many Cookies, Candies, Salty Snacks, and Soft Drinks?
Authors: Cohen Deborah A. , Sturm Roland , Scott Molly , Farley Thomas A. , Bluthenthal Ricky
Published: July 2017

Objectives.

There are many contributors to obesity, including excess consumption of “discretionary calories” (foods high in sugar and fat and low in essential nutrients), lack of fruit/vegetable consumption, and insufficient physical activity. This study contrasted physical activity, fruit/vegetable consumption, and discretionary calorie consumption from selected foods relative to the 2005 dietary guidelines.

Methods.

We conducted a cross-sectional survey in 228 urban census tracts in Los Angeles County (LAC) and Southern Louisiana (SL) and estimated calories in the past 24 hours from fruit, vegetables, cookies, candy, salty snacks, sweetened soda, and alcohol among 2,767 participants.

Results.

The population-weighted mean daily intake of calories from candy, cookies, salty snacks, soda, and alcohol was 438 in LAC and 617 in SL. Alcohol comprised a small portion of the calories consumed. Reported discretionary calorie consumption from a small set of items exceeded guidelines by more than 60% in LAC and 120% in SL. In contrast, the mean consumption of fruit and vegetables fell 10% short in LAC and 20% in SL. There was significant heterogeneity in consumption of cookies, candy, salty snacks, and soda across income, gender, and race.

Conclusions.

The overconsumption of discretionary calories was much greater than the underconsumption of fruit and vegetables. This finding suggests that unless the excessive consumption of salty snacks, cookies, candy, and sugar-sweetened beverages is curtailed, other interventions focusing on increasing physical activity and fruit and vegetable consumption will have a limited impact on obesity control. It may be politically more expedient to promote an increase in consumption of healthy items rather than a decrease in consumption of unhealthy items, but it may be far less effective.
Evaluating Real-Time Syndromic Surveillance Signals from Ambulatory Care Data in Four States
Authors: Yih W. Katherine , Deshpande Swati , Fuller Candace , Heisey-Grove Dawn , Hsu John , Kruskal Benjamin A. , Kulldorff Martin , Leach Michael , Nordin James , Patton-Levine Jessie , Puga Ella , Sherwood Edward , Shui Irene , Platt Richard
Published: July 2017

Objectives.

We evaluated a real-time ambulatory care-based syndromic surveillance system in four metropolitan areas of the United States.

Methods.

Health-care organizations and health departments in California, Massachusetts, Minnesota, and Texas participated during 2007–2008. Syndromes were defined using International Classification of Diseases, Ninth Revision diagnostic codes in electronic medical records. Health-care organizations transmitted daily counts of new episodes of illness by syndrome, date, and patient zip code. A space-time permutation scan statistic was used to detect unusual clustering. Health departments followed up on e-mailed alerts. Distinct sets of related alerts (“signals”) were compared with known outbreaks or clusters found using traditional surveillance.

Results.

The 62 alerts generated corresponded to 17 distinct signals of a potential outbreak. The signals had a median of eight cases (range: 3–106), seven zip code areas (range: 1–88), and seven days (range: 3–14). Two signals resulted from true clusters of varicella; six were plausible but unconfirmed indications of disease clusters, six were considered spurious, and three were not investigated. The median investigation time per signal by health departments was 50 minutes (range: 0–8 hours). Traditional surveillance picked up 124 clusters of illness in the same period, with a median of six ill per cluster (range: 2–75). None was related to syndromic signals.

Conclusions.

The system was able to detect two true clusters of illness, but none was of public health interest. Possibly due to limited population coverage, the system did not detect any of 124 known clusters, many of which were small. The number of false alarms was reasonable.
Viral Hepatitis and Injection Drug Use in Appalachian Kentucky: A Survey of Rural Health Department Clients
Authors: Christian W. Jay , Hopenhayn Claudia , Christian Amy , McIntosh Deana , Koch Alvaro
Published: July 2017

Objectives.

We identified correlates of exposure to hepatitis B and C viruses among health department clients in Appalachian Kentucky, a rural region noted for high poverty and low education. Additionally, we investigated risk factors for transmission, and the frequency of use of preventive measures.

Methods.

Patients screened for hepatitis B or C at four county health departments in Appalachian Kentucky were administered a routine prescreening questionnaire and an additional survey designed to obtain detailed personal and behavioral risk factor data. These data were linked to produce a more comprehensive dataset for analysis, including test results, which were attached to the prescreening questionnaire.

Results.

In total, 92 health department clients participated in the study survey. Of these, test results were available for 80 of the clients. Very few subjects who enrolled in this study tested positive for hepatitis B. Twelve out of 80 participants (15%) tested positive for previous exposure to hepatitis C. No participants reported having human immunodeficiency virus.

Conclusions.

Transmission of hepatitis C in these rural Appalachian communities is predominantly due to injection drug use. Patients with hepatitis C exposure are similar in their demographic and risk profiles as those seen in urban areas and, despite small numbers, can have a serious impact on small, rural public health systems.
The Positive Role of Social Networks and Social Networking Technology in the Condom-Using Behaviors of Homeless Young People
Authors: Rice Eric
Published: July 2017

Objective.

To examine the impact of condom-using peers in the social networks of homeless young people, differences in behaviors were assessed based on the social location of ties (home-based vs. street-based) and how those ties are maintained (face-to-face vs. via social networking technology).

Methods.

“Ego-centric” social network data were collected from 103 currently sexually active homeless young people aged 16–26 years in Los Angeles, California. Associations between condom use and the condom-using behaviors of social network influences were assessed using standard logistic regression.

Results.

About 52% of respondents had a street-based peer who was a condom user. Having such a peer was associated with a 70% reduction in the odds of having unprotected sex at last intercourse. About 22% of respondents had a condom-using, home-based peer with whom they communicated only via social networking technology. Having such a peer was associated with a 90% reduction in risky sexual behavior and a 3.5 times increase in safer sex behavior.

Conclusion.

The study revealed several implications for new human immunodeficiency virus-prevention interventions that mobilize these networks and social networking technologies.
Informing Faith-Based HIV/AIDS Interventions: HIV-Related Knowledge and Stigmatizing Attitudes at Project F.A.I.T.H. Churches in South Carolina
Authors: Lindley Lisa L. , Coleman Jason D. , Gaddist Bambi W. , White Jacob
Published: July 2017

Objectives.

Project F.A.I.T.H. (Fostering AIDS Initiatives that Heal) was established in January 2006 to reduce the stigma of human immunodeficiency virus (HIV) among African American faith-based organizations in South Carolina. During its first year, Project F.A.I.T.H. funded 22 churches to provide HIV-related programs and services to their congregations and surrounding communities. To determine the baseline level of HIV-related knowledge and stigmatizing attitudes, we conducted a survey with parishioners, pastors, and care team members at Project F.A.I.T.H. churches.

Methods.

During 2007, 20 Project F.A.I.T.H. churches conducted cross-sectional surveys with 1,445 parishioners, 61 pastors, and 109 care team members measuring their HIV-related knowledge and stigmatizing attitudes.

Results.

While most parishioners were very knowledgeable about HIV transmission via unprotected sex and needle sharing during injection drug use, they were less knowledgeable about transmission via casual contact, mosquitoes, donating blood, and an HIV test. Overall, HIV-related stigma was low at Project F.A.I.T.H. churches. However, males and older parishioners (aged ≥65 years) were significantly less knowledgeable and had greater HIV-related stigma than females and younger parishioners. Pastors and care team members at Project F.A.I.T.H. churches were significantly more knowledgeable and harbored significantly less stigma than their parishioners.

Conclusions.

To effectively address HIV-related stigma at African American churches, educational programs must reinforce the ways in which HIV can and cannot be transmitted, and pay particular attention to educating males and older populations. These findings may be helpful to HIV-prevention efforts targeting African American faith-based organizations in South Carolina and elsewhere.
Men Seeking Sex on an Intergenerational Gay Internet Website: An Exploratory Study
Authors: Sowell Richard L. , Phillips Kenneth D.
Published: July 2017

Objective.

This study explored the characteristics and sexual behaviors reported by men who have sex with men (MSM) seeking sex on an intergenerational website. Of special interest was to determine whether and how seeking sex on the Internet contributed to risky sex behaviors.

Methods.

This descriptive exploratory study extracted data from a stratified random sample of 1,020 profiles posted by men seeking sex on a gay intergenerational website. Frequencies and percentages were calculated for all categorical variables. Analysis of variance was used to test for differences in subgroup categories.

Results.

The men in the sample were primarily Caucasian (92.3%) with a mean age of 50 years (range: 18–88 years). More than one-fourth of the men (28.5%) reported being married. Of the married men, 76.0% indicated they would engage in receptive anal intercourse. Only a small number of men in the total sample expressed interest in safe sex (17.5%), while 91 men (8.9%) directly stated that they wanted unsafe sex. Most men in the sample were seeking intergenerational sexual encounters, with 71.0% of younger men expressing a preference for older men.

Conclusions.

The Internet can play a significant role in seeking same-sex encounters across generational groups. Safe sex was not a stated priority for most men in this study, and the Internet provides an effective method of seeking unsafe sex. A number of MSM seeking sex on the Internet were married and Caucasian. This finding suggests the need for greater attention to married and/or publicly identified Caucasian, heterosexual men in human immunodeficiency virus prevention efforts. Effective Internet-based prevention programs need to be implemented and researched.
Enrollment in Outpatient Care among Newly Released Prison Inmates with HIV Infection
Authors: Baillargeon Jacques G. , Giordano Thomas P. , Harzke Amy Jo , Baillargeon Gwen , Rich Josiah D. , Paar David P.
Published: July 2017

Objectives.

Although many prisoners infected with human immunodeficiency virus (HIV) initiate and adhere to treatment regimens while incarcerated, the benefits of in-prison therapy are frequently lost after community reentry. Little information is available on the percentage of released inmates who establish community-based HIV outpatient treatment in a timely fashion. We sought to determine the proportion of HIV-infected Texas prison inmates who enrolled in an HIV clinic within 90 days after release and to identify variables associated with timely linkage to clinical care.

Methods.

This was a retrospective cohort study of 1,750 HIV-infected inmates who were released from the Texas Department of Criminal Justice (TDCJ) and returned to Harris County between January 2004 and December 2007. We obtained demographic and clinical data from centralized databases maintained by TDCJ and the Harris County Health District, and used logistic regression analysis to identify factors associated with linkage to post-release outpatient care.

Results.

Only 20% of released inmates enrolled in an HIV clinic within 30 days of release, and only 28% did so within 90 days. Released inmates ≥30 years of age were more likely than their younger counterparts to have enrolled in care at the 30- and 90-day time points. Inmates diagnosed with schizophrenia were more likely to have initiated care within 30 days. Inmates who received antiretroviral therapy while incarcerated and those who received enhanced discharge planning were more likely to begin care at both time points.

Conclusions.

A large proportion of HIV-infected inmates fail to establish outpatient care after their release from the Texas prison system. Implementation of intensive discharge planning programs may be necessary to ensure continuity of HIV care among newly released inmates.
The Role, Challenges, and Support of PulseNet Laboratories in Detecting Foodborne Disease Outbreaks
Authors: Boxrud David , Monson Timothy , Stiles Tracy , Besser John
Published: July 2017

In recent years, there have been several high-profile nationwide foodborne outbreaks due to enteric organisms in food products, including Salmonella Typhimurium in peanut products, Salmonella Saintpaul in peppers, and Escherichia coli O157:H7 in spinach. PulseNet, the national molecular subtyping network for foodborne disease surveillance, played a key role in detecting each of these outbreaks.

PulseNet laboratories use bacterial subtyping methods to rapidly detect clusters of foodborne disease, which are often the first indication that an outbreak is occurring. Rapid outbreak detection reduces ongoing transmission through product recalls, restaurant closures, and other mechanisms. By greatly increasing the sensitivity of outbreak detection, PulseNet allows us to identify and correct problems with our food production and distribution systems that would not otherwise have come to our attention. Annually, millions of potentially preventable cases of foodborne illness result in billions of dollars in lost productivity and health-care expenses. We describe the critical role PulseNet laboratories play in the detection of foodborne outbreaks and discuss current challenges and potential improvements for PulseNet laboratories to more rapidly identify future foodborne outbreaks.
Basic Personnel Tools to Help Ensure a Future Public Health and Environmental Laboratory Workforce
Authors: DeBoy John M. , Luedtke Patrick , Warren Nancy , Wichman Michael
Published: July 2017

Competition is growing in the United States for a shrinking national pool of qualified laboratory scientists. Public health and environmental laboratories (PHELs) must address this problem using a range of strategies and tools to ensure that a highly technical workforce of PHEL scientists is available in the future. One of these tools is the use of common personnel standards involving job titles and definitions, job classifications and minimum qualifications, and multi-step career paths. This article explains in detail the need for structure and use of common, basic personnel standards in developing and retaining a national workforce of PHEL scientists.
10 Guiding Principles of a Comprehensive Internet-Based Public Health Preparedness Training and Education Program
Authors: Alexander Lorraine K. , Horney Jennifer A. , Markiewicz Milissa , MacDonald Pia D.M.
Published: July 2017

Distance learning is an effective strategy to address the many barriers to continuing education faced by the public health workforce. With the proliferation of online learning programs focused on public health, there is a need to develop and adopt a common set of principles and practices for distance learning. In this article, we discuss the 10 principles that guide the development, design, and delivery of the various training modules and courses offered by the North Carolina Center for Public Health Preparedness (NCCPHP). These principles are the result of 10 years of experience in Internet-based public health preparedness educational programming. In this article, we focus on three representative components of NCCPHP's overall training and education program to illustrate how the principles are implemented and help others in the field plan and develop similar programs.
Southeastern Regional Pediatric Disaster Surge Network: A Public Health Partnership
Authors: Ginter Peter M. , Rucks Andrew C. , Duncan W. Jack , Wingate Martha S. , Beeman S. Kenn , Reeves Jane , West Maury A.
Published: July 2017

In the event of a natural or man-made disaster involving large numbers of children, resources in the Southeastern U.S. are extremely limited. This article chronicles the efforts of the Alabama Department of Public Health, the Mississippi State Department of Health, and the South Central Center for Public Health Preparedness in conjunction with more than 40 organizations to develop a voluntary network of health-care providers, public health departments, volunteers, and emergency responders from Alabama, Florida, Louisiana, Mississippi, and Tennessee. The purpose of the Southeastern Regional Pediatric Disaster Surge Network (the Network) is to improve the pediatric preparedness response strategies of public health, emergency response, and pediatric providers in the event of large-scale emergencies or disasters that overwhelm local or state pediatric resources.

The planning and development of the Network is proceeding through three general phases—information sharing, mutual goal setting and collective action, and long-term formal linkages. In Phase 1, critical planning tasks to be undertaken in the development of the Network were identified. In Phase 2, the agencies developed a draft operational handbook that served as the basis for a formal memorandum of understanding. In Phase 3, participants will engage in exercises and evaluations that will further identify and work out logistical and operational details.
Michigan Clostridium Difficile Hospital Discharges: Frequency, Mortality, and Charges, 2002–2008
Authors: VerLee Kerrie E. , Finks Jennie L. , Wilkins Melinda J. , Wells Eden V.
Published: July 2017

Objective.

Clostridium difficile (C. difficile) causes an intestinal bacterial infection of increasing importance in Michigan residents and health-care facilities. The specific burden and health-care costs of C. difficile infection (CDI) were previously unknown. We evaluated the frequency, mortality, and health-care charges of CDI from Michigan hospital discharge data.

Methods.

The Michigan Department of Community Health purchased discharge data from all Michigan acute care hospitals from the Michigan Health and Hospital Association. We extracted all hospital discharges from 2002 through 2008 containing the International Classification of Diseases, Ninth Revision code for intestinal infection due to C. difficile. Discharges were stratified by principle diagnosis and comorbidity level. Total hospitalization charges were standardized to the 2008 U.S. dollar.

Results.

From 2002 through 2008, 68,686 hospital discharges with CDI occurred. The annual rate increased from 463.1 to 1096.5 CDI discharges per 100,000 discharges. CDI discharge rates were substantially higher among the elderly, females, and black people. Of all CDI discharges, 5,924 (8.6%) patients died. The mean total health-care charge for the time period was $67,149, and the annual mean increased 35% from 2002 to 2008. Hospital charges varied significantly by race/ethnicity and age. People with Medicaid insurance accrued the highest charges.

Conclusion.

Across Michigan, the CDI burden is growing substantially and affecting vulnerable populations. Surveillance utilizing hospital discharge data can illuminate trends and inform intervention targets. To reduce disease and health-care charges, increased prevention and infection-control efforts should be directed toward high-risk populations, such as the elderly.
Using Emergency Department Data to Conduct Dog and Animal Bite Surveillance in New York City, 2003–2006
Authors: Bregman Brooke , Slavinski Sally
Published: July 2017

Objectives.

Most animal bites in the United States are due to dogs, with approximately 4.7 million reports per year. Surveillance for dog and other animal bites requires a substantial investment of time and resources, and underreporting is common. We described the use and findings of electronic hospital emergency department (ED) chief complaint data to characterize patients and summarize trends in people treated for dog and other animal bites in New York City (NYC) EDs between 2003 and 2006.

Methods.

Retrospective data were obtained from the syndromic surveillance system at the NYC Department of Health and Mental Hygiene. We used a statistical program to identify chief complaint free-text fields as one of four categories of animal bites. We evaluated descriptive statistics and univariate associations on the available demographic data. The findings were also compared with data collected through the existing passive reporting animal bite surveillance system.

Results.

During the study period, more than 6,000 animal bite patient visits were recorded per year. The proportion of visits for animal bites did not appear to change over time. Dog bites accounted for more than 70% and cat bites accounted for 13% of animal bite patient visits. Demographic characteristics of patients were similar to those identified in NYC's passive surveillance system.

Conclusions.

Our findings suggest that the use of ED data offers a simple, less resource-intensive, and sustainable way of conducting animal bite surveillance and a novel use of syndromic surveillance data. However, it cannot replace traditional surveillance used to manage individual patients for potential rabies exposures.
Passenger Contact Investigation Associated with a Transport Driver with Pulmonary Tuberculosis
Authors: Powell Krista , Lamb Molly M. , Sisk Mary K. , Federline Lynn , Seechuk Kimberly , Lambert Lauren A. , Buff Ann M.
Published: July 2017

Objectives.

In October 2008, pulmonary tuberculosis (TB) was diagnosed in a driver who had transported 762 passengers in the District of Columbia metropolitan area during his infectious period. A passenger contact investigation was conducted by the six public health jurisdictions because of concern that some passengers might be infected with HIV or have other medical conditions that put them at increased risk for developing TB disease if infected.

Methods.

Authorities evaluated 92 of 100 passengers with at least 90 minutes of cumulative exposure. Passengers with fewer than 90 minutes of cumulative exposure were evaluated if they had contacted the health department after exposure and had a medical condition that increased their risk of TB. A tuberculin skin test (TST) result of at least 5 millimeters induration was considered positive.

Results.

Of 153 passengers who completed TST evaluation, 11 (7%) had positive TST results. TST results were not associated with exposure time or high-risk medical conditions. No TB cases were identified in the passengers.

Conclusions.

The investigation yielded insufficient evidence that Mycobacterium tuberculosis transmission to passengers had occurred. TB-control programs should consider transportation-related passenger contact investigations low priority unless exposure is repetitive or single-trip exposure is long.
State-Specific ATV-Related Fatality Rates: An Update in the New Millennium
Authors: Helmkamp James C. , Aitken Mary E. , Graham James , Campbell Corey R.
Published: July 2017

Objectives.

We compared state-specific all-terrain vehicle (ATV) fatality rates from 2000–2007 with 1990–1999 data, grouping states according to helmet, training, and licensure requirements.

Methods.

We used the CDC WONDER online database to identify ATV cases from 2000–2007 and calculate rates per 100,000 population by state, gender, and age.

Results.

ATV deaths ( n=7,231) occurred at a rate of 0.32 per 100,000 population. Males accounted for 86% of ATV-related deaths at a rate that was six times that for females (0.55 vs. 0.09 per 100,000 population, respectively); 60% of the male deaths occurred in the 15- to 44-year age group. With the exception of the two oldest age categories, rates were consistently higher in the no-helmet-law group. Both the number and rate of ATV-related deaths increased more than threefold between 1990–1999 and 2000–2007. West Virginia and Alaska continue to have the highest ATV fatality rates (1.63 and 2.67 ATV deaths per 100,000 population, respectively).

Conclusions.

Helmet-use requirements seem to slightly mitigate ATV-related death, but training requirements do not. For policy to be effective, it must be enforced.