bluuebunny/crossref_metadata_2025 huggingface dataset:
Demographic and Socioeconomic Factors Associated with Blood Lead Levels among Mexican-American Children and Adolescents in the United States
Authors: Morales Leo S. , Gutierrez Peter , Escarce Jose J.
Published: January 2017

Objective.

This study was designed to assess demographic and socioeconomic differences in blood lead levels (BLLs) among Mexican-American children and adolescents in the United States.

Methods.

We analyzed data from the Third National Health and Nutrition Examination Survey, 1988–1994, for 3,325 Mexican-American youth aged 1 to 17 years. The main study outcome measures included a continuous measure (μg/dL) of BLL and two dichotomous measures of BLL (⩾5 μg/dL and ⩾10 μg/dL).

Results.

The mean BLL among Mexican-American children in the United States was 3.45 μg/dL (95% confidence interval [CI] 3.07, 3.87); 20% had BLL ⩾5 μg/dL (95% CI 15%, 24%); and 4% had BLL ⩾10 μg/dL (95% CI 2%, 6%). In multivariate analyses, gender, age, generational status, home language, family income, education of head of household, age of housing, and source of drinking water were statistically significant independent predictors ( p<0.05) of having higher BLLs and of having BLL ⩾5 μg/dL, whereas age, family income, housing age, and source of drinking water were significant predictors ( p<0.05) of having BLL ⩾10 μg/dL.

Conclusions.

Significant differences in the risk of having elevated BLLs exist among Mexican-American youth. Those at greatest risk should be prioritized for lead screening and lead exposure abatement interventions.
The First Decade of the Massachusetts Tobacco Control Program
Authors: Koh Howard K. , Judge Christine M. , Robbins Harriet , Celebucki Carolyn Cobb , Walker Deborah K. , Connolly Gregory N.
Published: January 2017

This article provides a comprehensive overview of the first decade of the Massachusetts Tobacco Control Program (MTCP). Born after Massachusetts passed a 1992 ballot initiative raising cigarette excise taxes to fund the program, MTCP greatly reduced statewide cigarette consumption before being reduced to a skeletal state by funding cuts. The article describes the program's components and goals, details outcomes, presents a summary of policy accomplishments, and reviews the present status of MTCP in the current climate of national and state fiscal crises. The first decade of the MTCP offers many lessons learned for the future of tobacco control.
Pediatric Asthma Surveillance Using Medicaid Claims
Authors: Dombkowski Kevin J. , Wasilevich Elizabeth A. , Lyon-Callo Sarah K.
Published: January 2017

Objective.

The purpose of this study was to describe the prevalence of asthma among children using alternative case definitions applied to administrative claims data, and to assess year-to-year classification concordance.

Methods.

This study was a retrospective cohort analysis of 357,729 children 0–18 years using 2001–2002 Michigan Medicaid claims. Asthma cases were classified using six alternative definitions based on outpatient, emergency department, inpatient, and pharmacy claims for asthma, including the Health Plan Employer Data Information Set (HEDIS) persistent asthma criteria commonly used for assessments of asthma health care quality: at least one asthma inpatient admission or emergency department visit, four or more asthma medications events, or four asthma outpatient visits and two asthma medication events.

Results.

Overall, asthma prevalence varied widely between alternative case definitions, ranging from 14.9% based on claims evidence of any type of asthma utilization to 3.7% when restricted to those with four or more asthma medication dispensing events. Among cases meeting HEDIS persistent asthma criteria in 2001, 55.5% met these criteria in 2002. Those with four or more asthma medication dispensing events had the best overall classification concordance between 2001 and 2002. Utilization of asthma services and prevalence estimates were highest among children younger than 5 years old, but year-to-year classification concordance was poorest among these cases (p<0.0001), irrespective of case definition.

Conclusions.

While overall asthma prevalence may remain relatively stable from year to year, individuals may not be classified consistently as cases over time, regardless of case definition. Studies that identify asthma cases in one year and assess asthma outcomes in a subsequent year may introduce substantial bias as a result of case misclassification. Among the case definitions considered in this study, our findings suggest that this bias is minimized among cases classified using the four or more asthma medication dispensing events criterion.
Measuring the Public's Health
Authors: Thacker Stephen B. , Stroup Donna F. , Carande-Kulis Vilma , Marks James S. , Roy Kakoli , Gerberding Julie L.
Published: January 2017

Allocation of public health resources should be based, where feasible, on objective assessments of health status, burden of disease, injury, and disability, their preventability, and related costs. In this article, we first analyze traditional measures of the public's health that address the burden of disease and disability and associated costs. Second, we discuss activities that are essential to protecting the public's health but whose impact is difficult to measure. Third, we propose general characteristics of useful measures of the public's health. We contend that expanding the repertoire of measures of the public's health is a critical step in targeting attention and resources to improve health, stemming mounting health care costs, and slowing declining quality of life that threatens the nation's future.
Surveillance Programs for Chronic Viral Hepatitis in Three Health Departments
Authors: Fleming Douglas T. , Zambrowski Amy , Fong Felicia , Lombard Andrea , Mercedes Lynne , Miller Claudia , Poujade Jan , Roome Aaron , Sullivan Amy , Finelli Lyn
Published: January 2017

Although chronic hepatitis B and chronic hepatitis C are diseases of public health importance, only a few health departments nationally have chronic viral hepatitis under surveillance; these programs rely primarily on direct reporting by medical laboratories. We conducted an evaluation to determine if lessons from these programs can guide other health departments.

Between December 2002 and February 2003, we visited the Connecticut Department of Public Health, the Multnomah County Health Department in Portland, Oregon, and the Minnesota Department of Health to determine the capacity of their chronic hepatitis registries to monitor trends and provide case management.

We found that the registries facilitated investigations of potentially acute cases by identifying previously known infections, and aided prevention planning by pinpointing areas where viral hepatitis was being diagnosed. For chronic cases, case management (defined as the process of ensuring that infected individuals and their partners receive medical evaluation, counseling, vaccination, and referral to specialists for treatment when indicated) was provided for hepatitis B in Multnomah County, but was limited in other programs; barriers included resource constraints, difficulties confirming chronic infection, and privacy concerns. Finding innovative ways to overcome these barriers and improve case management is important if chronic hepatitis surveillance is to realize its full potential.
Validity of Self-Assessment of Skin Reaction after Smallpox Vaccination
Authors: Huerta Michael , Balicer Ran D. , Mimouni Daniel , Goldberg Avi , Furman Moshe , Klement Eyal , Hourvitz Ariel , Grotto Itamar
Published: January 2017

Methods.

We conducted a prospective, double-blinded, paired-measurement validation study of 174 non-naive adult vaccinees and their physician evaluators. Subjects provided paired, blinded, independent assessments of take 7–9 days after vaccination.

Results.

Overall, vaccinees and evaluators agreed on 157 of 174 (90.2%) take assessments. Sensitivity of the tool was 99.1%, and specificity was 75%. The positive predictive value of self-assessment was 87.2% and the negative predictive value was 98%. Specificity of the tool and measures of agreement were significantly modified by age, education, and occupation. When adjusted for the expected take rate among a population including naive vaccinees, positive predictive value and overall agreement increased significantly.

Conclusions.

Self-assessment may be a feasible option for evaluation of take in the event of mass smallpox vaccination. The predictive values and overall agreement of the tool are satisfactory, and can be expected to increase when used in a largely naive population.
The Pregnancy Risk Assessment Monitoring System (PRAMS): Current Methods and Evaluation of 2001 Response Rates
Authors: Shulman Holly B. , Gilbert Brenda Colley , Lansky Amy
Published: January 2017

Objectives.

Our objectives were to describe the methodology of the Pregnancy Risk Assessment Monitoring System (PRAMS), examine recent response rates, determine characteristics associated with response, and track response patterns over time.

Methods.

PRAMS is a mixed-mode surveillance system, using mail and telephone surveys. Rates for response, contact, cooperation, and refusal were computed for 2001. Logistic regression was used to examine the relationship between maternal and infant characteristics and the likelihood of response. Response patterns from 1996 to 2001 were compared for nine states.

Results.

The median response rate for the 23 states in 2001 was 76% (range: 49% to 84%). Cooperation rates ranged from 86% to 97% (median 91%); contact rates ranged from 58% to 93% (median 82%). Response rates were higher for women who were older, white, married, had more education, were first-time mothers, received early prenatal care, and had a normal birthweight infant. Education level was the most consistent predictor of response, followed by marital status and maternal race. From 1996 to 2001, response to the initial mailing decreased in all states compared, but the decrease was offset by increases in mail follow-up and telephone response rates. Overall response rates remained unchanged.

Conclusions.

The PRAMS mail/telephone methodology is an effective means of reaching most recent mothers in the 23 states examined, but some population subgroups are more difficult to reach than others. Through more intensive follow-up efforts, PRAMS states have been able to maintain high response rates over time despite decreases in response to the initial mailing.
Reducing Levels of Toxic Chemicals in Cigarette Smoke: A New Healthy People 2010 Objective
Authors: Richter Patricia , Pechacek Terry , Swahn Monica , Wagman Victoria
Published: January 2017

We developed and implemented a national surveillance system to monitor and reduce the levels of toxic chemicals in tobacco smoke. A developmental Healthy People 2010 (HP 2010) objective was revised to report on levels of three categories of chemicals—tobacco-specific nitrosamines, polyaromatic hydrocarbons, and volatile organic compounds—in the smoke of leading U.S. cigarette brands. Unit-based sales-weighted average levels were calculated for each chemical category. The target for the new HP 2010 objective is a 10% reduction in unit-based sales-weighted average levels of each chemical category. The Centers for Disease Control and Prevention provided the baseline, target data, and laboratory analyses.

A national data source, national baseline data, and target were presented to the Healthy People Steering Committee during 2005 Midcourse Review. Approval of the revised objective initiated the surveillance of three major classes of toxic chemicals in cigarette smoke. The approved objective provides a feasible, innovative approach for monitoring and supporting measurable population-based reductions in levels of toxic and carcinogenic chemicals in tobacco smoke.
A Comparison of Health-Related Quality of Life for Individuals with Mental Health Disorders and Common Chronic Medical Conditions
Authors: Cook Erica L. , Harman Jeffrey S.
Published: January 2017

Objectives.

The purpose of this study was to compare the burden of disease experienced by people with mental health conditions with people who have common medical disorders. Three prevalent medical disorders—the burden of disease of back/neck problems, diabetes, and hypertension—were compared with the mental health category of depression, anxiety, or emotional problem.

Methods.

This study used data from the nationally representative 2003–2004 National Health and Nutrition Examination Survey for respondents aged 18 or older (n=4,833). The measurement of health-related quality of life (HRQOL) used was the Healthy Days Measures developed by the Centers for Disease Control and Prevention. Unadjusted and adjusted HRQOL were compared for individuals reporting each of the four conditions. Adjusted HRQOL was assessed using ordinary least squares regression, which controlled for gender, age, race/ethnicity, education, marital status, comorbidity, and income.

Results.

Individuals with mental health conditions experienced 17.6 total unhealthy days per month, while those with back and neck problems and those with hypertension experienced 12.2 total unhealthy days per month, and those with diabetes experienced 12.3 total unhealthy days per month. After adjusting for socioeconomic and demographic characteristics as well as comorbid conditions, mental health conditions were responsible for a 6.8-day decrease in healthy days per month compared with average adults ( p<0.001). Mental health conditions resulted in significantly lower HRQOL than back or neck problems ( p=0.053), diabetes, ( p=0.002), and hypertension ( p=0.012).

Conclusions.

There were significant differences between the HRQOL found in mental and medical conditions, with mental health conditions being responsible for significantly greater impairment of HRQOL. An efficient health-care system should consider the relative disease burden of specific conditions when allocating public health resources.
Safety of Upper-Room Ultraviolet Germicidal Air Disinfection for Room Occupants: Results from the Tuberculosis Ultraviolet Shelter Study
Authors: Nardell Edward A. , Bucher Scott J. , Brickner Philip W. , Wang Charles , Vincent Richard L. , Becan-McBride Kathleen , James Mark A. , Michael Max , Wright James D.
Published: January 2017

Objectives.

We evaluated the safety of room occupants in the Tuberculosis Ultraviolet Shelter Study (TUSS), a double-blind, placebo-controlled field trial of upper-room ultraviolet germicidal irradiation (UVGI) at 14 homeless shelters in six U.S. cities from 1997 to 2004.

Methods.

Data collection involved administering questionnaires regarding eye and skin irritation to a total of 3,611 staff and homeless study subjects.

Results.

Among these subjects, there were 223 reports of eye or skin symptoms. During the active UV period, 95 questionnaires (6%) noted such symptoms, and during the placebo period, 92 questionnaires (6%) did so. In the 36 remaining cases, either the UV period when symptoms took place was unknown or the symptoms spanned both periods. There was no statistically significant difference in the number of reports of symptoms between the active and placebo periods. One definite instance of UV-related keratoconjunctivitis occurred, resulting from a placement of a bunk bed in a dormitory where a single bed had been used when the UV fixtures were first installed.

Conclusions.

These findings demonstrate that careful application of upper-room UVGI can be achieved without an apparent increase in the incidence of the most common side effects of accidental UV overexposure.
Prevalence of Obesity among Children in Six Chicago Communities: Findings from a Health Survey
Authors: Margellos-Anast Helen , Shah Ami M. , Whitman Steve
Published: January 2017

Objectives.

We analyzed data from a community health survey to assess levels of obesity and overweight among children in some Chicago communities compared with national U.S. estimates.

Methods.

Data came from the Sinai Improving Community Health Survey, which was conducted via face-to-face interviews with people living in six racially and ethnically diverse Chicago communities during 2002 and 2003. A stratified, three-stage probability study design was employed to obtain a representative sample from each community. Height and weight data reported by the primary caretakers of 501 randomly selected children aged 2–12 years were used to determine age- and gender-specific body mass index (BMI), which was then used to classify weight status (obese ≥95th percentile for age and gender).

Results.

Compared with 16.8% for the U.S., the prevalence of obesity was 11.8% in a non-Hispanic white community on Chicago's north side, 34.0% in a Mexican American community on the west side, and 56.4% in a non-Hispanic black community on the south side.

Conclusions.

Surveillance of the childhood obesity epidemic at the local level is limited. Findings describe the extent of disparities in childhood overweight and obesity within one city and how local-level data can shape new initiatives for improved health, one community at a time.
Vaccination Coverage Estimates for Selected Counties: Achievement of Healthy People 2010 Goals and Association with Indices of Access to Care, Economic Conditions, and Demographic Composition
Authors: Smith Philip J. , Singleton James A.
Published: January 2017

Objectives.

We provided vaccination coverage estimates for 181 counties; evaluated the extent to which Healthy People 2010 (HP 2010) vaccination coverage objectives were achieved; and examined how variations in those estimates depend on access to care and economic conditions.

Methods.

We analyzed data for 24,031 children aged 19 to 35 months sampled from the 2004 and 2005 National Immunization Survey.

Results.

Children living in the 181 counties represented 49% of all the 19- to 35-month-old children living in the U.S. None of the 181 counties had coverage for the polio, measles-mumps-rubella, Haemophilus influenzae type B, and hepatitis B vaccines that was significantly lower than the HP 2010 objective of 90% coverage. However, as many as 30.4% of the counties did not achieve the HP 2010 objective for diphtheria, tetanus toxoids, and acellular pertussis or diphtheria and tetanus toxoids and pertussis (DtaP/DTP), and as many as 6.6% did not achieve the goal for varicella (VAR). If children who received three doses of DTaP/DTP had received a final fourth dose, and if all children had received one dose of VAR, all of the 181 counties would have achieved the HP 2010 vaccination coverage target of 80% for the entire 4:3:1:3:3:1 vaccination series. Factors found to be associated with low county-level vaccination coverage rates were correlates of poverty, and factors found to be associated with high county-level vaccination coverage rates were correlates of access to pediatric services.

Conclusions.

HP 2010 vaccination coverage goals for all 181 counties can be achieved by improving vaccination coverage for only two vaccines. Those goals may be achieved most efficiently by targeting interventions in counties where indices of poverty are high or where access to pediatric services is low.
Service Learning within the University of Connecticut Master of Public Health Program
Authors: Gregorio David I. , DeChello Laurie M. , Segal Joan
Published: January 2017

Since 2005, the University of Connecticut Master of Public Health Program has administered its required service-learning practicum through coordinated activities of second-year students assigned to examine a pressing public health issue in Connecticut. The initiative underscores our program's commitment to preparing students for careers as leaders in applied practice and our emphasis on collaboration. Our thematic approach links content across the core curriculum, provides a venue where students demonstrate mastery of academic principles, and affirms values of public responsibility and common purpose. Projects have focused on public health concerns associated with childhood obesity, health literacy, and living with disabilities. Working together and with community-based preceptors, students estimate service needs, assess available program/service capacity, and recommend policy options. Results are compiled within a written report that accompanies a state legislative hearing. This article presents the rationale and organization of our service-learning practicum, and describes how the experience affects the education and personal growth of students and contributes positively to the community at large.
Lifelong Learning for Public Health Practice Education: A Model Curriculum for Bioterrorism and Emergency Readiness
Authors: Olson Debra , Hoeppner Mary , Larson Susan , Ehrenberg Anne , Leitheiser Agnes T.
Published: January 2017

In 2002, the University of Minnesota School of Public Health (UMNSPH) adopted an approach that supports basic, advanced, and continuing education curricula to train current and future public health workers. This model for lifelong learning for public health practice education allows for the integration of competency domains from the Council on Linkages Between Academia and Public Health Practice's core public health workforce competency levels and the Centers for Disease Control and Prevention's Bioterrorism and Emergency Readiness Competencies.

This article describes how UMNSPH has implemented the model through coordination with state planning efforts and needs assessments in the tristate region of Minnesota, North Dakota, and Wisconsin. In addition, we discuss methods used for credentialing practitioners who have achieved competency at various levels of performance to enhance the capacity of the public health preparedness systems.
Reducing Exposure to Environmental Toxicants before Birth: Moving from Risk Perception to Risk Reduction
Authors: Grason Holly A. , Misra Dawn P.
Published: January 2017

In this study, we considered approaches to reducing maternal exposure to hazardous environmental toxicants, focusing on risk communication to pregnant women and providers, but also considering identification of environmental toxicants in the community and reduction of environmental toxicants. We addressed the following questions: ( 1) What do pregnant women and their providers know about environmental toxicants and perinatal health? and ( 2) What policy strategies are needed (should be considered) to move forward in risk reduction in this area? We reviewed the literature on knowledge of pregnant women and providers regarding these issues.

While there is limited research on what pregnant women and their providers know about environmental toxicants and perinatal health, there is evidence of reproductive and perinatal toxicity. This article describes a wide range of policy strategies that could be implemented to address environmental toxicants in the context of perinatal health. Effective leadership in this area will likely require collaboration of both environmental health and maternal and child health leaders and organizations.
Self-Reported Diabetes in Hispanic Subgroup, Non-Hispanic Black, and Non-Hispanic White Populations: National Health Interview Survey, 1997–2005
Authors: Borrell Luisa N. , Crawford Natalie D. , Dallo Florence J. , Baquero Maria C.
Published: January 2017

Objectives.

We estimated the prevalence of self-reported diabetes in Hispanic subgroup (Puerto Rican, Mexican, Mexican American, Cuban, Dominican, Central and South American, and other Hispanic), non-Hispanic black, and non-Hispanic white populations aged 20 years and older.

Methods.

Using the National Health Interview Survey 1997–2005, we limited these analyses to 272,041 records of adults aged 20 years and older, including 46,749 records for Hispanic respondents. We used logistic regression to assess the strength of the association between race/ethnicity and self-reported diabetes before and after adjusting for selected characteristics.

Results.

Compared with non-Hispanic white respondents, Mexican American (odds ratio [OR] = 2.02; 95% confidence interval [CI] 1.75, 2.34), Mexican (OR=1.52; 95% CI 1.31, 1.91), Puerto Rican (OR=1.53; 95% CI 1.23, 1.91), other Hispanic (OR=2.08; 95% CI 1.68, 2.58), and non-Hispanic black (OR=1.47; 95% CI 1.35, 1.61) respondents had greater odds of reporting diabetes. When compared with non-Hispanic white respondents, Mexican American respondents with less than a high school diploma had the lowest odds of reporting diabetes, while those with at least a college degree had greater odds of reporting diabetes. However, Puerto Rican respondents with less than a high school education, Mexican respondents with at least some college education, and other Hispanic respondents with at least a high school diploma/general equivalency diploma had greater odds of reporting diabetes.

Conclusions.

Although Hispanic respondents bear a greater burden of diabetes than non-Hispanic white respondents, this burden is unevenly distributed across subgroups. These findings call attention to data disaggregation whenever possible for U.S. racial/ethnic populations classified under categories considered homogeneous.
Excess Hispanic Fetal-Infant Mortality in a Midwestern Community
Authors: Hoff Gerald L. , Cai Jinwen , Okah Felix A. , Dew Paul C.
Published: January 2017

Objective.

We assessed excess fetal-infant mortality for Hispanic, non-Hispanic white, and non-Hispanic black populations in five contiguous counties of Missouri and Kansas.

Methods.

We conducted a perinatal periods of risk (PPOR) assessment of fetal-infant mortality using electronic linked birth-death record files from 2001 through 2005. We generated an internal reference group in accordance with established PPOR protocol. We used Kitagawa analysis to determine whether excess deaths were due to birthweight distribution (a higher frequency of prematurity or growth retardation) or to higher mortality rates once born at that birthweight (birthweight-specific mortality).

Results.

We found the excess fetal-infant death rates for Hispanic and non-Hispanic white populations to be similar and considerably lower than that for non-Hispanic black populations. Among Hispanic children, we judged 21.6% of fetal-infant mortality to be excess in relation to the reference population. Within the PPOR matrix, Hispanic excess mortality rates were distributed differently from those of non-Hispanic white and non-Hispanic black populations. Among Hispanic children, 93.6% of the excess mortality could be explained by low birthweight and birthweight-specific mortality, with the greatest contribution attributable to low birthweight.

Conclusion.

The excess fetal-infant mortality experience of Hispanic people in the five-county region was similar to that of the non-Hispanic white population, but was distributed differently in the PPOR model, which has significance regarding interventions targeting reductions in fetal-infant mortality.
The Accuracy of a Death Certificate Checkbox for Diabetes: Early Results from New Jersey
Authors: Hempstead Katherine
Published: January 2017

Objectives.

The rapid growth in diabetes prevalence has increased interest in measuring the burden of this disease. One response has been to add a checkbox for diabetes status to the death certificate, which New Jersey did in 2004. This study assessed the accuracy of the diabetes checkbox and its effect on cause-of-death coding. We analyzed whether a diabetes checkbox is a useful addition to the death certificate.

Methods.

We examined the trend in cause-of-death coding for diabetes as an underlying and contributing cause of death by analyzing New Jersey mortality data between 1990 and 2005. We assessed the accuracy of the checkbox by examining inconsistencies between cause-of-death coding and checkbox status, and assessed sensitivity by analyzing linked hospital and death data for a cohort of decedents with diabetes.

Results.

Between 2003 and 2005, there was approximately a 15% increase in the number of deaths listing diabetes as a contributing cause. The number of deaths where diabetes was listed as an underlying cause changed little. Approximately 10% of death certificates had an inconsistency between cause of death and checkbox status. The sensitivity analysis showed that approximately 40% of diabetic decedents had the appropriate checkbox status.

Conclusion.

The addition of the checkbox was accompanied by a change in the reporting of diabetes as a contributing cause of death. Results from the sensitivity analysis raise questions about the accuracy of the checkbox as a measure of the diabetic status of decedents.
Creating an Online “Promising Practices” Clearinghouse for Pandemic Influenza
Authors: LaFrance Amy Becker , Vestin Natalie , Moore Kristine , Collison Elaine , McClure Elizabeth , DeBoer Jill
Published: January 2017

This article describes efforts to create, share, and sustain an online clearinghouse of expert-reviewed “promising practices” in pandemic influenza preparedness from September 2006 to December 2008. This project involved six activities: ( 1) determining focus areas, ( 2) defining a promising practice, ( 3) collecting practices, ( 4) establishing an expert-review process for accepting practices, ( 5) disseminating the practices, and ( 6) evaluating the project. By December 31, 2008, materials and descriptions for 181 expert-reviewed practices had been posted in a public online database. Practices were available in four areas: models for care, communication, mitigation, and at-risk groups. The database has been used by international agencies and a variety of U.S. organizations. The challenges and constraints facing the U.S. public health system underscore the need to maximize resources. We believe that the Promising Practices Project demonstrates a useful approach in pandemic preparedness and response and may serve as a valuable model for other areas of public health.
An Outbreak of Hepatitis A among Primary and Secondary Contacts of an International Adoptee
Authors: Pelletier Andrew R. , Mehta Puja J. , Burgess Donald R. , Bondeson Lisa M. , Carson Patty J. , Rea Vicki E. , Sharapov Umid M. , Hu Dale J.
Published: January 2017

The Advisory Committee on Immunization Practices recommends that susceptible people traveling to developing countries receive hepatitis A vaccine or immune globulin prior to departure. Until 2009, the recommendations did not address non-traveling family members or other close contacts of international adoptees. We report an outbreak of hepatitis A in 2008 that occurred in Maine.

Eight members of an extended family developed hepatitis A following the arrival of an asymptomatic infant from Ethiopia who was brought to the United States by an adoption agency. Two children in the family attended an elementary school where five additional cases of hepatitis A were subsequently identified. Only three (1%) of 208 students at the school had previously been immunized against hepatitis A. This outbreak highlights the need to immunize household members and other close contacts of families adopting children from countries where hepatitis A is endemic, as well as all children at one year of age.
Geographic Variation in Medicaid Claims for Dental Procedures in New York State: Role of Fluoridation under Contemporary Conditions
Authors: Kumar Jayanth V. , Adekugbe Olubunmi , Melnik Thomas A.
Published: January 2017

Objective.

We conducted an evaluation to determine if the number of claims reimbursed for caries-related procedures for children in the New York State Medicaid program varied by county fluoridation coverage.

Methods.

We calculated the mean number of claims per recipient for children in each county separately for the treatment of caries and all other procedures not related to caries using the 2006 Medicaid claims data.

Results.

Compared with the predominantly fluoridated counties, the mean number of restorative, endodontic, and extraction procedures per recipient was 33.4% higher in less fluoridated counties. The mean number of claims per child for caries-related services was inversely correlated with the extent of fluoridtion in a county (Spearman's correlation coefficient = −0.54, p<0.0001), but claims for non-caries related services were not.

Conclusions.

These findings, when added to the already existing weight of evidence, have implications for promoting policies at the federal and state levels to strengthen the fluoridation program.
The State of Science, Microbiology, and Vaccines Circa 1918
Authors: Eyler John M.
Published: January 2017

The influenza pandemic of 1918–1919 dramatically altered biomedical knowledge of the disease. At its onset, the foundation of scientific knowledge was information collected during the previous major pandemic of 1889–1890.

The work of Otto Leichtenstern, first published in 1896, described the major epidemiological and pathological features of pandemic influenza and was cited extensively over the next two decades. Richard Pfeiffer announced in 1892 and 1893 that he had discovered influenza's cause. Pfeiffers bacillus ( Bacillus influenzae) was a major focus of attention and some controversy between 1892 and 1920. The role this organism or these organisms played in influenza dominated medical discussion during the great pandemic.

Many vaccines were developed and used during the 1918–1919 pandemic. The medical literature was full of contradictory claims of their success; there was apparently no consensus on how to judge the reported results of these vaccine trials. The result of the vaccine controversy was both a further waning of confidence in Pfeiffer's bacillus as the agent of influenza and the emergence of an early set of criteria for valid vaccine trials.
The 1918 Influenza Epidemic in New York City: A Review of the Public Health Response
Authors: Aimone Francesco
Published: January 2017

New York City approached the 1918 influenza epidemic by making use of its existing robust public health infrastructure. Health officials worked to prevent the spread of contagion by distancing healthy New Yorkers from those infected, increasing disease surveillance capacities, and mounting a large-scale health education campaign while regulating public spaces such as schools and theaters. Control measures, such as those used for spitting, were implemented through a spectrum of mandatory and voluntary measures. Most of New York City's public health responses to influenza were adapted from its previous campaigns against tuberculosis, suggesting that a city's existing public health infrastructure plays an important role in shaping its practices and policies during an epidemic.
“It's as Bad as Anything Can Be”: Patients, Identity, and the Influenza Pandemic
Authors: Bristow Nancy K.
Published: January 2017

Americans were stunned when pandemic influenza hit the United States in 1918. Recent advances in bacteriology and public health allowed Americans to imagine a future free of infectious disease, even as their familiarity with influenza tempered their fears of it. They soon realized this influenza was something unprecedented, as it shocked them with its pace, virulence, mortality patterns, and symptoms. Patients endured and frequently succumbed to a miserable illness, their suffering often made worse by the chaotic circumstances the epidemic produced in families and communities and shaped in significant and sometimes discriminatory ways by their gender, class, and race. While the nation's public culture soon forgot the epidemic, it lived on in lives changed irrevocably by its consequences. As they face present and future influenza pandemics, Americans can learn from this earlier experience, guarding against identity-based discrimination and acknowledging and remembering the grief and loss fellow citizens suffered.
The Social Determinants of HIV Serostatus in Sub-Saharan Africa: An Inverse Relationship between Poverty and HIV?
Authors: Fox Ashley M.
Published: January 2017

Contrary to theories that poverty acts as an underlying driver of human immunodeficiency virus (HIV) infection in sub-Saharan Africa (SSA), an increasing body of evidence at the national and individual levels indicates that wealthier countries, and wealthier individuals within countries, are at heightened risk for HIV. This article reviews the literature on what has increasingly become known as the positive-wealth gradient in HIV infection in SSA, or the counterintuitive finding that the poor do not have higher rates of HIV. This article also discusses the programmatic and theoretical implications of the positive HIV-wealth gradient for traditional behavioral interventions and the social determinants of health literature, and concludes by proposing that economic and social policies be leveraged as structural interventions to prevent HIV in SSA.
Epidemiologic Differences between Native-Born and Foreign-Born Black People Diagnosed with HIV Infection in 33 U.S. States, 2001–2007
Authors: Johnson Anna Satcher , Hu Xiaohong , Dean Hazel D.
Published: January 2017

Objective.

Few studies have examined the extent to which foreign-born people contribute to the human immunodeficiency virus (HIV) epidemic among non-Hispanic black people in the U.S. We sought to determine differences in the epidemiology of HIV infection among native- and foreign-born black people, using data from the national HIV surveillance system of the Centers for Disease Control and Prevention.

Methods.

We estimated the number of HIV infections among black adults and adolescents diagnosed from 2001 to 2007 in 33 U.S. states. We compared annual HIV diagnosis rates, distributions of demographic characteristics and HIV-transmission risk factors, late diagnoses of HIV infection, and survival after an acquired immunodeficiency syndrome (AIDS) diagnosis for native- and foreign-born black people.

Results.

From 2001 to 2007, an estimated 100,013 black adults and adolescents were diagnosed with HIV infection in 33 U.S. states, for which country-of-birth information was available. Of these, 11.7% were foreign-born, with most from the Caribbean (54.1%) and Africa (41.5%). Annual HIV diagnoses decreased by 5.5% per year (95% confidence interval [CI] −5.9, −5.0) among native-born black people. Decreases were small among foreign-born black people (–1.3%; 95% CI −2.6, −0.1), who were more likely to be female, have HIV infection attributable to high-risk heterosexual contact, be diagnosed with AIDS within 12 months of HIV diagnosis, and survive one year and three years after an AIDS diagnosis.

Conclusions.

The epidemiology of HIV infection differs for foreign-born black individuals compared with their native-born counterparts in the U.S. These data can be used to develop culturally appropriate and relevant HIV-prevention interventions.
Effectiveness of Pregnancy Check Boxes on Death Certificates in Identifying Pregnancy-Associated Mortality
Authors: Horon Isabelle L. , Cheng Diana
Published: January 2017

Objectives.

Information that would allow the identification of women who were pregnant at the time of death or within the year preceding death has historically been underreported on death certificates. As a result, the magnitude of the problem of pregnancy-associated mortality is underestimated. To improve the identification of these deaths, check boxes for reporting pregnancy status have been added to death certificates in a number of states. We used multiple external data sources to determine whether check boxes have been effective in identifying pregnancy-associated deaths.

Methods.

We collected data on deaths occurring among pregnant or recently pregnant women residing in Maryland during the years 2001–2008 using multiple data sources. We determined the percentage of these deaths that could be identified through check boxes placed on death certificates.

Results.

Overall, 64.5% of pregnancy-associated deaths were identified through pregnancy check boxes on death certificates, including 98.1% of maternal deaths—defined as deaths occurring during pregnancy or within 42 days of delivery from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes—and 46.7% of deaths from nonmaternal causes, such as homicide, suicide, accidents, and substance abuse.

Conclusions.

Check boxes on death certificates are effective in identifying pregnancy-associated deaths resulting from maternal causes. However, they are far less effective in identifying deaths resulting from nonmaternal causes, such as homicide, accidental death, and substance abuse, which represent three of the four leading causes of pregnancy-associated death in Maryland.
Evaluating Risk Factors and Possible Mediation Effects in Posttraumatic Depression and Posttraumatic Stress Disorder Comorbidity
Authors: Chiu Sydney , Niles Justin K. , Webber Mayris P. , Zeig-Owens Rachel , Gustave Jackson , Lee Roy , Rizzotto Linda , Kelly Kerry J. , Cohen Hillel W. , Prezant David J.
Published: January 2017

Objectives.

On September 11, 2001 (9/11), attacks on the World Trade Center (WTC) killed 341 Fire Department of the City of New York (FDNY) firefighters and injured hundreds more. Previous WTC-related studies reported high rates of comorbid depression and posttraumatic stress disorder (PTSD), identifying disability retirement, alcohol use, and early arrival at the WTC site as correlates. However, those studies did not evaluate risk factors that could have mediated the observed comorbidity. We identified unique risk factors for each condition in an effort to better understand comorbidity.

Methods.

We screened retired WTC-exposed firefighters using self-administered questionnaires including the Center for Epidemiologic Studies Depression Scale, the Post Traumatic Stress Disorder Checklist, and the Alcohol Use Disorders Identification Test. We performed regression analyses to compare independent predictors of elevated depression and PTSD risk, and also tested a mediation hypothesis.

Results.

From December 2005 to July 2007, 23% and 22% of 1,915 retirees screened positive for elevated depression and PTSD risk, respectively, with comorbidity >70%. Controlling for comorbidity, we identified unique risk factors for (7) depression: problem alcohol use and (2) PTSD: early arrival at the WTC site.

Conclusions.

Our data support the premise that PTSD and depression are different responses to trauma with unique risk factors. The data also suggest a hypothesis that PTSD mediates the relationship between early WTC arrival and depression, while depression mediates the relationship between alcohol use and PTSD, a more complex relationship than shown in previous studies. Clinicians should consider these factors when evaluating patients for depression and PTSD.
Review of Unintentional Non-Fire-Related Carbon Monoxide Poisoning Morbidity and Mortality in Florida, 1999–2007
Authors: Harduar-Morano Laurel , Watkins Sharon
Published: January 2017

Objective.

Previous Florida evaluations of carbon monoxide (CO) poisoning have been disaster focused. The majority of prevention messages and risk-factor identification efforts have revolved around hurricane season (June-November). We evaluated the prevalence, risk factors, and causes of CO poisoning within Florida throughout the year to produce a more complete presentation of the burden of CO poisoning.

Methods.

We obtained data from death certificates, hospital discharge records, and emergency department records. We limited our analysis to unintentional poisonings, calculating rates for age, gender, race, and ethnicity, and reviewing poisoning chronology, location, and exposure situation.

Results.

From 1999 to 2007, 493 people were hospitalized, and 230 individuals died as a result of non-fire-related CO poisoning. From 2005 to 2007, 781 people visited emergency departments for non-fire-related CO poisoning. Rates of severe poisoning resulting in hospitalization or death were highest among the elderly (0.56 visits and 0.63 deaths per 100,000 Floridians). Acute poisoning rates were highest among people 25–34 years of age (2.48 visits per 100,000 Floridians). Poisonings were primarily due to motor vehicle exhaust (21%–69%) and generator exposure (12%–33%), and the majority (50%–70%) occurred within the home. A large number of poisonings (25%–29%) occurred during the winter months, outside of hurricane season.

Conclusion.

The findings of this study indicate a need for additional prevention strategies in conjunction with current activities to more effectively reduce the number of CO poisonings in Florida. Prevention activities should be conducted year-round, and additional strategies should include public awareness of the hazards of motor vehicle exhaust.
Mortality Reductions for Older Adults Differ by Race/Ethnicity and Gender since the Introduction of Adult and Pediatric Pneumococcal Vaccines
Authors: Soneji Samir , Metlay Joshua
Published: January 2017

Objective.

We determined the effectiveness of a 23-valent-polysaccharide pneumococcal vaccine (PPV-23) and pneumococcal conjugate vaccine (PCV-7) in reducing adult pneumococcal mortality by comparing historically predicted declines in pneumococcal disease mortality with observed patterns since the introduction of PPV-23 and PCV-7, including analyses of age, gender, and racial/ethnic subgroups.

Methods.

We analyzed all deaths registered on U.S. death certificates reporting any site of pneumococcal infection (e.g., meningitis, sepsis, pneumonia, bacteremia, and peritonitis) from 1968 to 2006. We used time-series dynamic linear regression on annual pneumococcal mortality rates to determine the percentage reduction in post-1983 mortality rates for a given increase in PPV-23 vaccination rates and post-2000 mortality rates for a given increase in PCV-7 vaccination rates.

Results.

Pneumococcal mortality decreased well before the introduction of PPV-23 in 1983 and again before the introduction of PCV-7 in 2000. The level of PPV-23 vaccination was associated with a direct and significant reduction in adult mortality, especially white female adults ≥65 years of age. In contrast, the level of PCV-7 vaccination in the population was not associated with an indirect and significant reduction in pneumococcal mortality beyond the historical pace of decline.

Conclusions.

PPV-23 introduction was associated with a reduction in pneumococcal mortality among older adults ≥65 years of age beyond levels predicted by secular trends, whereas PCV-7 introduction was not. Mortality reduction was not uniformly experienced across the population, revealing the need for additional strategies to reduce pneumococcal mortality in older adults.
Healthy Homes University: A Home-Based Environmental Intervention and Education Program for Families with Pediatric Asthma in Michigan
Authors: Largo Thomas W. , Borgialli Michele , Wisinski Courtney L. , Wahl Robert L. , Priem Wesley F.
Published: January 2017

Environmental conditions within the home can exacerbate asthmatic children's symptoms. To improve health outcomes among this group, we implemented an in-home environmental public health program—Healthy Homes University—for low-income families in Lansing, Michigan, from 2005 to 2008. Families received four visits during a six-month intervention. Program staff assessed homes for asthma triggers and subsequently provided products and services to reduce exposures to cockroaches, dust mites, mold, tobacco smoke, and other triggers. We also provided asthma education that included identification of asthma triggers and instructions on specific behaviors to reduce exposures. Based on self-reported data collected from 243 caregivers at baseline and six months, the impact of asthma on these children was substantially reduced, and the proportion who sought acute unscheduled health care for their asthma decreased by more than 47%.