bluuebunny/crossref_metadata_2025 huggingface dataset:
Vaccine Beliefs of Parents Who Oppose Compulsory Vaccination
Authors: Kennedy Allison M. , Brown Cedric J. , Gust Deborah A.
Published: July 2017

Objectives.

Our objectives were the following: ( 1) to describe the sociodemographic factors, vaccine beliefs, and behaviors that are associated with parental opposition to compulsory vaccination, and ( 2) to determine if the availability of a philosophical exemption in a parent's state of residence is associated with parental opposition to compulsory vaccination.

Methods.

Data from the 2002 HealthStyles survey were analyzed. Chi-square analysis was used to identify significant associations between belief and behavior questions and opposition to compulsory vaccination for school entry. Multivariate logistic regression was conducted using significant variables from the bivariate analysis to identify independent predictors of opposition to compulsory vaccination among surveyed parents.

Results.

Of respondents with at least one child aged ⩽18 years living in the household ( n = 1,527), 12% were opposed to compulsory vaccination. Survey results indicate that a parent's belief regarding compulsory vaccination for school entry is significantly associated with beliefs in the safety and utility of vaccines, as well as intention to have the youngest child fully vaccinated. Residence in a state that permits philosophical exemption to vaccination also was significantly associated with a parent's opposition to compulsory vaccination for school entry.

Conclusions.

Providing basic information to parents regarding vaccines and vaccine-preventable diseases may help reduce opposition to compulsory vaccination by reinforcing the safety and importance of routine childhood vaccinations.
Empirically Examining the Risk of Intimate Partner Violence: The Revised Domestic Violence Screening Instrument (DVSI-R)
Authors: Williams Kirk R. , Grant Stephen R.
Published: July 2017

Objective.

This study extends recent research on assessing the risk of intimate partner violence by determining the concurrent and predictive validity of a revised version of the Domestic Violence Screening Instrument (DVSI-R) and whether evidence of such validity is sustained independent of perpetrator demographic characteristics and forms of intimate violence. The analyses highlight violent incidents involving multiple victims as an indicator of “severe” violence. Previous research did not address these issues.

Methods.

Data were analyzed on 14,970 assessments conducted in the State of Connecticut from September 1, 2004 through May 2, 2005. Hierarchical regression and receiver operating characteristic analyses were used to address the objectives of this research.

Results.

The empirical findings support the concurrent and predictive validity of the DVSI-R and show that it is robust in its applicability. The findings further show that incidents involving multiple victims are highly associated with DVSI-R risk scores and recidivistic violence.

Conclusion.

Validating and demonstrating the robustness of a risk assessment instrument is only a first step in preventing violence involving intimate partners or others in family or family-like relationships. The challenge is to train professionals responsible for addressing the problem of such violence to link valid risk assessments to well-crafted strategies of supervision and treatment so that the victimized or other potential victims are protected and perpetrators are held accountable for their actions.
Assessing the Offending Activity of Criminal Domestic Violence Suspects: Offense Specialization, Escalation, and De-Escalation Evidence from the Spouse Assault Replication Program
Authors: Piquero Alex R. , Brame Robert , Fagan Jeffrey , Moffitt Terrie E.
Published: July 2017

Objective.

Over the past quarter century, intimate partner violence research has occupied an increasingly important position in the research agenda of criminology, public policy, and public health. Yet, a number of questions about the criminal careers of domestic violence offenders remain unresolved. This study attempts to determine ( 1) the extent to which criminal domestic violence offenders specialize in violence, and ( 2) whether the severity of an offender's attacks against the same victim increase, decrease, or stay about the same over time.

Methods.

Data from the Spouse Assault Replication Program (SARP) are used to address two questions corresponding to different features of the criminal careers of domestic violence offenders.

Results.

The specialization analysis reveals that the majority of domestic violence offenders with prior official criminal records have been involved in nonviolent forms of criminal behavior in addition to domestic violence. The escalation analysis identifies groups of escalators and de-escalators as well as individuals who engage in stable low-level aggression and stable high-level aggression.

Conclusions.

Few SARP domestic violence offenders have been specializing exclusively in violence. There is also a heterogeneous mix of offenders who escalate and de-escalate the severity of their attacks over the short-term follow-up periods. Few studies have presented data consistent with the present study's findings. A longitudinal analysis of the criminal careers of domestic violence offender subtypes is critical for future research.
Household and Neighborhood Contexts of Intimate Partner Violence
Authors: Fox Greer Litton , Benson Michael L.
Published: July 2017

Objectives.

Two sources of contextual risk on the prevalence and severity of intimate partner violence (IPV) are investigated: household economic condition and neighborhood disadvantage. There is debate about whether each context is an independent source of IPV risk and whether risks cumulate over contexts.

Methods.

Data from the second wave of the National Survey of Families and Households are combined with tract level data from the 1990 U.S. Census. A sub-sample of co-resident couples with a child aged 5–17 in the household was selected for analysis ( n=2,273). IPV is measured in three ways: as any physical violence reported by either partner in the year prior to the survey, as gendered violence in which both partners are identified as aggressors, and as severe violence in terms of injury and frequency.

Results.

Regardless of how IPV is assessed, couples with IPV are more likely to present a vulnerable economic risk profile and to live in neighborhoods of high disadvantage. When economically vulnerable couples living in advantaged versus disadvantaged neighborhoods are compared, there are no significant differences in rates of IPV, regardless of the measure of IPV that is used. Neighborhood context matters, however, in comparisons among economically advantaged couples: rates of IPV are significantly higher among those in disadvantaged neighborhoods.

Conclusions.

The consistency of effect for economic vulnerability and its invariance across neighborhood settings suggests that reducing economic vulnerability is likely to have beneficial effects in both disadvantaged and non-disadvantaged neighborhoods.
Injury Mortality Rates in Native and Non-Native Children: A Population-Based Study
Authors: Harrop A. Robertson , Brant Rollin F. , Ghali William A. , Macarthur Colin
Published: July 2017

Objectives.

To examine injury mortality rates in Native and non-Native children in the province of Alberta, Canada, over a 10-year period, temporal trends in injury mortality rates (Native vs. non-Native), as well as relative risks of injury mortality (Native vs. non-Native) by injury mechanism and intent, were calculated.

Methods.

An observational, population-based study design was used. Mortality data were obtained from provincial vital statistics, with injury deaths identified using external injury codes (E-codes). The relative risk (RR) of injury mortality (Native vs. non-Native) along with 95% confidence intervals (CIs) were calculated. Stratified analyses and Poisson regression modeling were used to calculate adjusted relative risk.

Results.

Injury mortality rates declined over the study period, with no difference in the rate of decline between Native and non-Native children. The adjusted relative risk for all-cause injury death (Native vs. non-Native) was 4.6 (95% CI 4.1 to 5.2). The adjusted relative risks (Native vs. non-Native) by injury intent categories were: unintentional injuries, 4.0 (95% CI 3.5 to 4.6); suicide, 6.6 (95% CI 5.2 to 8.5); and homicide, 5.1 (95% CI 3.0 to 8.5). Injury mortality rates were consistently higher for Native children across all injury mechanism categories. The largest relative risks (Native vs. non-Native) were pedestrian injury (RR=17.0), accidental poisoning (RR=15.4), homicide by piercing objects (RR=15.4), and suicide by hanging (RR=13.5).

Conclusion.

The burden of injury mortality is significantly greater in Native children compared with non-Native children. Therefore, injury prevention strategies that target both intentional and unintentional injuries are needed.
Racial Misidentification of American Indians/Alaska Natives in the HIV/AIDS Reporting Systems of Five States and One Urban Health Jurisdiction, U.S., 1984–2002
Authors: Bertolli Jeanne , Lee Lisa M. , Sullivan Patrick S. ,   AI/AN Race/Ethnicity Data Validation Workgroup
Published: July 2017

Objectives.

We examined racial misidentification of American Indians/Alaska Natives (AI/AN) reported to the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) Reporting Systems (HARS) of five U.S. states and one county.

Methods.

To identify AI/AN records with misidentified race, we linked HARS data from 1984 through 2002 to the Indian Health Service National Patient Information and Reporting System (NPIRS), excluding non-AI/AN dependents, using probabilistic matching with clerical review. We used chi-square tests to examine differences in proportions and logistic regression to examine the associations of racial misidentification with HARS site, degree of AI/AN ancestry, mode of exposure to HIV, and urban or rural location of residence at time of diagnosis.

Results.

A total of 1,523 AI/AN individuals was found in both NPIRS and HARS; race was misidentified in HARS for 459 (30%). The percentages of racially misidentified ranged from 3.7% (in Alaska) to 55% (in California). AI/AN people were misidentified as white (70%), Hispanic (16%), black (11%), and Asian/Pacific Islander (2%); for 0.9%, race was unspecified. Logistic regression results (data from all areas, all variables) indicated that urban residence at time of diagnosis, degree of AI/AN ancestry, and mode of exposure to HIV were significantly associated with racial misidentification of AI/AN people reported to HARS.

Conclusions.

Our findings add to the evidence that racial misidentification of AI/AN in surveillance data can result in underestimation of AI/AN HIV/AIDS case counts. Racial misidentification must be addressed to ensure that HIV/AIDS surveillance data can be used as the basis for equitable resource allocation decisions, and to inform and mobilize public health action.
An FQHC Research Network in Oral Health: Enhancing the Workforce and Reducing Disparities
Authors: Riedy Christine A. , Ly Kiet A. , Ybarra Vickie , Milgrom Peter
Published: July 2017

Federally Qualified Health Centers (FQHCs) contribute greatly to reducing health disparities by providing care to underserved communities. Yet these safety-net clinics face chronic manpower shortages and turnover. Practice-Based Research Networks aid in translating medical science from bench to clinical practice. These networks have been used to understand and improve health-care delivery and reduce disparities. Initiatives to strengthen lagging translational research in dentistry have begun, but there is no FQHC research network that addresses oral health.

This article reviews the potential for, and outlines a model of, an Oral Health FQHC Research Network. It characterizes the needs for an FQHC research network, describes a successful FQHC research-oriented program, and outlines an Oral Health FQHC Research Network conceptual model. It argues that strengthening FQHCs through involvement of their dental staff in clinical research may enhance their jobs, draw staff closer to the community, and strengthen their ability to reduce health disparities.
Potential Implications of Missing Income Data in Population-Based Surveys: An Example from a Postpartum Survey in California
Authors: Kim Soowon , Egerter Susan , Cubbin Catherine , Takahashi Eugene R. , Braveman Paula
Published: July 2017

Objectives.

Income data are often missing for substantial proportions of survey participants and these records are often dropped from analyses. To explore the implications of excluding records with missing income, we examined characteristics of survey participants with and without income information.

Methods.

Using statewide population-based postpartum survey data from the California Maternal and Infant Health Assessment, we compared the age, education, parity, marital status, timely prenatal care initiation, and neighborhood poverty characteristics of women with and without reported income data, overall, and by race/ethnicity/nativity.

Results.

Overall, compared with respondents who reported income, respondents with missing income information generally appeared younger, less educated, and of lower parity. They were more likely to be unmarried, to have received delayed or no prenatal care, and to reside in poor neighborhoods; and they generally appeared more similar to lower- than higher-income women. However, the patterns appeared to vary by racial/ethnic/nativity group. For example, among U.S.-born African American women, the characteristics of the missing-income group were generally similar to those of low-income women, while European American women with missing income information more closely resembled their moderate-income counterparts.

Conclusions.

Respondents with missing income information may not be a random subset of population-based survey participants and may differ on other relevant sociodemographic characteristics. Before deciding how to deal analytically with missing income information, researchers should examine relevant characteristics and consider how different approaches could affect study findings. Particularly for ethnically diverse populations, we recommend including a missing income category or employing multiple-imputation techniques rather than excluding those records.
Alaska Native Mortality Rates and Trends
Authors: Day Gretchen Ehrsam , Provost Ellen , Lanier Anne P.
Published: July 2017

Objectives.

This article compared mortality data (1999–2003) for Alaska Natives (AN), U.S. white residents (USW), and Alaska white residents (AKW), and examined changes in mortality rates from 1979 to 2003.

Methods.

We used SEERStat* software from the National Cancer Institute to calculate age-adjusted mortality rates.

Results.

The AN all-cause mortality rate was 40% higher (rate ratio [RR]=1.4) than the rate for both the USW and AKW populations. Based on comparisons with USW, the largest disparities in AN mortality were found for unintentional injuries (RR=3.0), suicide (RR=3.1), and homicide (RR=4.4). Disparities were also found for eight of the 10 leading causes of death, including cancer (AN/USW RR=1.3), cerebrovascular disease (RR=1.3), chronic obstructive pulmonary disease (RR=1.4), pneumonia/influenza (RR=1.6), and chronic liver disease (RR=2.0). In contrast, the mortality rate for heart disease among AN was significantly lower (RR=0.9) than for USW, and lower—though not significantly lower—for diabetes. Findings were quite similar when rates for AN were compared with AKW. AKW also had high rates of unintentional injury mortality and suicide compared with USW, but the magnitude of the difference was much less for AKW. From 1979 to 2003, mortality rates among AN declined 16% for all causes, similar to the USW decline of 15%.

Conclusions.

Monitoring mortality rates and their trends is essential not only to understand the health status of a population but also to target areas for prevention and evaluate the impact of policy change or the effect of interventions over time.
Hospital Readmissions for Childhood Asthma: The Role of Individual and Neighborhood Factors
Authors: Liu Sze Yan , Pearlman Deborah N.
Published: July 2017

Objectives.

This study used a Cox proportional hazards model to determine whether neighborhood characteristics are associated with risk of readmission for childhood asthma independently of individual characteristics.

Methods.

Rhode Island Hospital Discharge Data from 2001 to 2005 were used to identify children younger than 19 years of age at the time of the index (i.e., first) asthma admission, defined as a primary diagnosis of asthma or a primary diagnosis of respiratory illness with a secondary or tertiary diagnosis of asthma ( n=2,919). Hazard ratios of repeat hospitalizations for childhood asthma from 2001 to 2005 were estimated, controlling for individual- and neighborhood-level variables.

Results.

During the study period, 15% of the sample was readmitted for asthma ( n=451). In the unadjusted cumulative hazard curves, children residing in the census tracts with the highest proportion of crowded housing conditions, racial minority residents, or neighborhood-level poverty had higher cumulative hospital readmission rates as compared with children who resided in less disadvantaged neighborhoods. In the fully adjusted models, children insured by Medicaid at the time of their index admission had readmission rates that were 33% higher than children who were privately insured.

Conclusion.

Our findings suggest that differences in health-care coverage are associated with higher readmission rates for pediatric asthma, but the relationship between neighborhood inequality and repeat hospitalizations for pediatric asthma requires further exploration. Social indicators such as minority race, Medicaid health insurance, and neighborhood markers of economic disadvantage are tightly interwoven in the U.S. and teasing these relationships apart is important in asthma disparities research.
Partner Notification after STD and HIV Exposures and Infections: Knowledge, Attitudes, and Experiences of Massachusetts Men Who Have Sex with Men
Authors: Mimiaga Matthew J. , Reisner Sari L. , Tetu Ashley M. , Bonafide Katherine E. , Cranston Kevin , Bertrand Thomas , Novak David S. , Mayer Kenneth H.
Published: July 2017

Objectives.

We assessed Boston-area men who have sex with men (MSM) in terms of their knowledge of partner notification (PN)/partner counseling and referral services (PCRS) and intentions to use such services if exposed to/infected with a sexually transmitted disease (STD) or human immunodeficiency virus (HIV) in the future.

Methods.

The study used a convenience sample of STD clinic patients ( n=48) and a modified respondent-driven sampling method ( n=70) to reach a diverse sample of MSM (total sample n=118) in Massachusetts. Participants completed a one-on-one, open-ended, semistructured qualitative interview and quantitative survey.

Results.

Overall, white, HIV-infected MSM had the highest level of knowledge about PN activities. MSM who were unfamiliar with PN were disproportionately nonwhite and HIV-uninfected. Participants were more likely to notify past partners of HIV exposure than STD exposure. The preferred method of PN for the majority of MSM was direct person-to-person notification. Notably, nonwhite participants were more likely to endorse Massachusetts Department of Public Health PN services than white MSM, who preferred involvement of primary care providers.

Conclusions.

PN is an important public health strategy for treating and preventing STDs and HIV among at-risk populations, especially MSM who engage in sexual behavior with anonymous or otherwise non-notifiable sexual partners. Although many MSM had an understanding of the ethical desirability of informing exposed partners and recognized the value of preventative behaviors, they require further education to overcome barriers to PN as well as to gain knowledge of the various methods of both traditional and nontraditional notification, such as Internet PN.
Potentially Avoidable Hospitalizations in Tennessee: Analysis of Prevalence Disparities Associated with Gender, Race, and Insurance
Authors: Chang Cyril F. , Pope Rebecca A.
Published: July 2017

Objectives.

We determined ( 1) the relative rates of potentially avoidable hospitalizations (PAHs) in Tennessee; ( 2) relative rates of PAHs among gender, race, and insurance subgroups; and ( 3) adjusted population-based relative rates of PAHs, taking into account the influences of unobservable factors such as patient preferences, physician practice patterns, and availability of hospital beds that can also affect PAHs.

Methods.

We applied the Agency for Healthcare Research and Quality's definitions of ambulatory care sensitive conditions (ACSCs) to Tennessee hospitalization records to identify PAHs. Patient discharge records for 2002 came from Tennessee's Hospital Discharge Data System. Population estimates came from the U.S. Census Current Population Survey. Hospital discharges with a complete record from all nonfederal acute-care hospitals in Tennessee were considered.

Results.

The relative rates of PAHs in Tennessee were higher than the U.S. rates in each of the ACSC categories. The relative rates were sensitive to adjustment for unmeasured factors such as patient preferences, physician practice patterns, and the physician supply that were reflected implicitly in the hospitalization rates of each subgroup for all discharge conditions. Within Tennessee, the type of insurance each person held was the greatest determinant of the likelihood of having a PAH, particularly for a chronic condition.

Conclusions.

The results indicate poor health of the general population in Tennessee and suggest opportunities to improve the provision of primary care for specific ACSCs and population subgroups to reduce PAHs, particularly the uninsured and individuals enrolled in Tennessee's Medicaid managed care program.
A New Paradigm for Quarantine and Public Health Activities at Land Borders: Opportunities and Challenges
Authors: Waterman Stephen H. , Escobedo Miguel , Wilson Todd , Edelson Paul J. , Bethel Jeffrey W. , Fishbein Daniel B.
Published: July 2017

The Institute of Medicine (IOM) report Quarantine Stations at Ports of Entry: Protecting the Public's Health focused almost exclusively on U.S. airports and seaports, which served 106 million entries in 2005. IOM concluded that the primary function of these quarantine stations (QSs) should shift from providing inspection to providing strategic national public health leadership.

The large expanse of our national borders, large number of crossings, sparse federal resources, and decreased regulation regarding conveyances crossing these borders make land borders more permeable to a variety of threats. To address the health challenges related to land borders, the QSs serving such borders must assume unique roles and partnerships to achieve the strategic leadership and public health research roles envisioned by the IOM. In this article, we examine how the IOM recommendations apply to the QSs that serve the land borders through which more than 319 million travelers, immigrants, and refugees entered the U.S. in 2005.
Assessing and Quantifying High Risk: Comparing Risky Behaviors by Youth in an Urban, Disadvantaged Community with Nationally Representative Youth
Authors: Swahn Monica H. , Bossarte Robert M.
Published: July 2017

Objective.

This study examined whether youth who live in an urban, disadvantaged community are significantly more likely than youth representing the nation to engage in a range of health-compromising behaviors.

Methods.

Analyses were based on the Youth Violence Survey conducted in 2004 and administered to students ( n=4,131) in a high-risk school district. Students in ninth grade ( n=1,114) were compared with ninth-grade students in the 2003 national Youth Risk Behavior Survey ( n=3,674) and the National Longitudinal Study of Adolescent Health conducted in 1995/1996 ( n=3,523). Analyses assessed the differences in prevalence of risk and protective factors among ninth-grade students from the three studies using Chi-square tests.

Results.

The results showed that youth in this urban, disadvantaged community were significantly more likely than their peers across the country to report vandalism, theft, violence, and selling drugs. Youth in this community also reported significantly less support from their homes and schools, and less monitoring by their parents. Moreover, youth in this community were significantly less likely to binge drink or initiate alcohol use prior to age 13 than youth across the U.S.

Conclusions.

Youth who live in this urban, disadvantaged community reported significantly higher prevalence of some, but not all, risky behaviors than nationally representative U.S. youth. These findings highlight that some caution is justified when defining what might constitute high risk and that demographic and other characteristics need to be carefully considered when targeting certain high-risk behaviors.
The History of Ultraviolet Germicidal Irradiation for Air Disinfection
Authors: Reed Nicholas G.
Published: July 2017

Public health concerns such as multi- and extensive drug-resistant tuberculosis, bioterrorism, pandemic influenza, and severe acute respiratory syndrome have intensified efforts to prevent transmission of infections that are completely or partially airborne using environmental controls. One such control, ultraviolet germicidal irradiation (UVGI), has received renewed interest after decades of underutilization and neglect. With renewed interest, however, come renewed questions, especially regarding efficacy and safety. There is a long history of investigations concluding that, if used properly, UVGI can be safe and highly effective in disinfecting the air, thereby preventing transmission of a variety of airborne infections. Despite this long history, many infection control professionals are not familiar with the history of UVGI and how it has, and has not, been used safely and effectively. This article reviews that history of UVGI for air disinfection, starting with its biological basis, moving to its application in the real world, and ending with its current status.
The Occurrence of Rare Cancers in U.S. Adults, 1995–2004
Authors: Greenlee Robert T. , Goodman Marc T. , Lynch Charles F. , Platz Charles E. , Havener Lori A. , Howe Holly L.
Published: July 2017

Objective.

Rare cancers have been traditionally understudied, reducing the progress of research and hindering decisions for patients, physicians, and policy makers. We evaluated the descriptive epidemiology of rare cancers using a large, representative, population-based dataset from cancer registries in the United States.

Methods.

We analyzed more than 9 million adult cancers diagnosed from 1995 to 2004 in 39 states and two metropolitan areas using the Cancer in North America (CINA) dataset, which covers approximately 80% of the U.S. population. We applied an accepted cancer classification scheme and a published definition of rare (i.e., fewer than 15 cases per 100,000 per year). We calculated age-adjusted incidence rates and rare/non-rare incidence rate ratios using SEER*Stat software, with analyses stratified by gender, age, race/ethnicity, and histology.

Results.

Sixty of 71 cancer types were rare, accounting for 25% of all adult tumors. Rare cancers occurred with greater relative frequency among those who were younger, nonwhite, and of Hispanic ethnicity than among their older, white, or non-Hispanic counterparts.

Conclusions.

Collectively, rare tumors account for a sizable portion of adult cancers, and disproportionately affect some demographic groups. Maturing population-based cancer surveillance data can be an important source for research on rare cancers, potentially leading to a greater understanding of these cancers and eventually to improved treatment, control, and prevention.
Estimates of State-Level Health-Care Expenditures Associated with Disability
Authors: Anderson Wayne L. , Armour Brian S. , Finkelstein Eric A. , Wiener Joshua M.
Published: July 2017

Objectives.

We estimated state-level disability-associated health-care expenditures (DAHE) for the U.S. adult population.

Methods.

We used a two-part model to estimate DAHE for the noninstitutionalized U.S. civilian adult population using data from the 2002–2003 Medical Expenditure Panel Survey and state-level data from the Behavioral Risk Factor Surveillance System. Administrative data for people in institutions were added to generate estimates for the total adult noninstitutionalized population. Individual-level data on total health-care expenditures along with demographic, socioeconomic, geographic, and payer characteristics were used in the models.

Results.

The DAHE for all U.S. adults totaled $397.8 billion in 2006, with state expenditures ranging from $598 million in Wyoming to $40.1 billion in New York. Of the national total, the DAHE were $118.9 billion for the Medicare population, $161.1 billion for Medicaid recipients, and $117.8 billion for the privately insured and uninsured populations. For the total U.S. adult population, 26.7% of health-care expenditures were associated with disability, with proportions by state ranging from 16.9% in Hawaii to 32.8% in New York. This proportion varied greatly by payer, with 38.1% for Medicare expenditures, 68.7% for Medicaid expenditures, and 12.5% for nonpublic health-care expenditures associated with disability.

Conclusions.

DAHE vary greatly by state and are borne largely by the public sector, and particularly by Medicaid. Policy makers need to consider initiatives that will help reduce the prevalence of disabilities and disability-related health disparities, as well as improve the lives of people with disabilities.
Increasing Poisoning Mortality Rates in the United States, 1999–2006
Authors: Bohnert Amy S.B. , Fudalej Sylwia , Ilgen Mark A.
Published: July 2017

Objectives.

Poisoning mortality rates have increased dramatically in the United States since the 1970s. This trend has been mainly attributed to an increase in accidental medication overdose deaths. The aim of this study was to analyze recent trends in poisoning mortality among U.S. adults using the most recently available data, and to examine gender and age as risk factors.

Methods.

Data on injury-based mortality for the entire U.S. were obtained from the Web-based Injury Statistics Query and Reporting System (WISQARS™) for 1999–2006. We analyzed poisoning mortality rates by age group, gender, and intent. We modeled time trends in poisoning mortality using Poisson regression.

Results.

Although intentional and undetermined poisoning mortality rates remained relatively stable, accidental poisoning mortality rates increased 108.5% between 1999 and 2006, and were significantly higher in each successive year (incidence rate ratio = 1.12 per year increase). Unintentional poisoning mortality rates were higher in men than in women; however, the increase in rate overtime was higher in women than in men. The unintentional poisoning mortality rate was highest in individuals aged 40–49 years across all years studied, but we observed large increases in the rate for individuals aged 15–29 and 50–59 years during the study period.

Conclusions.

Despite recently raised awareness, rates of unintentional poisoning mortality in the U.S. continued to rise in 2006. Men are at increased risk, but this disparity has decreased over time.
A Comparative Analysis of Health-Related Quality of Life for Residents of U.S. Counties with and without Coal Mining
Authors: Zullig Keith J. , Hendryx Michael
Published: July 2017

Objectives.

We compared health-related quality of life (HRQOL) in mining and non-mining counties in and out of Appalachia using the 2006 Behavioral Risk Factor Surveillance System (BRFSS) survey.

Methods.

Dependent variables included self-rated health, the number of poor physical and mental health days, the number of activity limitation days (in the last 30 days), and the Centers for Disease Control and Prevention Healthy Days Index. Independent variables included the presence of coal mining, Appalachian region residence, metropolitan status, primary care physician supply, and BRFSS behavioral (e.g., smoking, body mass index, and alcohol consumption) and demographic (e.g., age, gender, race, and income) variables. We compared dependent variables across a four-category variable: Appalachia (yes/no) and coal mining (yes/no). We used SUDAAN® Multilog and multiple linear regression models with post-hoc least-squares means to test for Appalachian coal-mining effects after adjusting for covariates.

Results.

Residents of coal-mining counties inside and outside of Appalachia reported significantly fewer healthy days for both physical and mental health, and poorer self-rated health ( p<0.0005) when compared with referent U.S. non-coal-mining counties, but disparities were greatest for people residing in Appalachian coal-mining areas. Furthermore, results remained consistent in separate analyses by gender and age.

Conclusions.

Coal-mining areas are characterized by greater socioeconomic disadvantage, riskier health behaviors, and environmental degradation that are associated with reduced HRQOL.
Trends of Elevated PTSD Risk in Firefighters Exposed to the World Trade Center Disaster: 2001–2005
Authors: Berninger Amy , Webber Mayris P. , Cohen Hillel W. , Gustave Jackson , Lee Roy , Niles Justin K. , Chiu Sydney , Zeig-Owens Rachel , Soo Jackie , Kelly Kerry , Prezant David J.
Published: July 2017

Objectives.

We identified trends in the prevalence of elevated posttraumatic stress disorder (PTSD) risk as determined by the Fire Department of the City of New York (FDNY)-modified PTSD Checklist in World Trade Center (WTC)-exposed firefighters. We also examined trends in relation to WTC exposure, social support, change in recreational activities, and functional health.

Methods.

We analyzed 16,826 questionnaires from 10,074 firefighters in yearly intervals, from September 12, 2001, to September 11, 2005.

Results.

The prevalence of elevated PTSD risk increased over time, from 9.8% in year 1 to 10.6% in year 4 ( p<0.0001). Earliest arrival at the WTC site (odds ratio [OR] = 6.0; 95% confidence interval [CI] 4.4, 8.3), prolonged work at the site (OR=2.0; 95% CI 1.8, 2.3), providing supervision without previous supervisory experience (OR=4.1; 95% CI 2.8, 6.1), and retirement due to a WTC-related disability (OR=1.3; 95% CI 1.1, 1.5) were associated with ever having elevated PTSD risk. Difficulty functioning at home was strongly associated with elevated PTSD risk (ORs ranged from 17.0 [95% CI 14.5, 20.0] in year 1 to 26.7 [95% CI 20.3, 35.2] in year 3), as was difficulty functioning at work (ORs ranged from 12.1 [95% CI 10.2, 14.2] in year 1 to 23.0 [95% CI 14.6, 36.3] in year 2).

Conclusions.

Elevated PTSD risk was associated with exposure to the WTC site as well as functional impairment, and remained largely unabated during the first four years of the study. Screening for elevated PTSD risk may be useful in identifying those who could benefit from interventions during long-term follow-up, as well as in the immediate aftermath of disasters.
Disparities in Maternal Hypertension and Pregnancy Outcomes: Evidence from North Carolina, 1994–2003
Authors: Miranda Marie Lynn , Swamy Geeta K. , Edwards Sharon , Maxson Pamela , Gelfand Alan , James Sherman
Published: July 2017

Objectives.

To better understand disparities in pregnancy outcomes, we analyzed data from North Carolina to determine how the pattern of maternal hypertensive disorders differs among non-Hispanic white (NHW), non-Hispanic black (NHB), and Hispanic women across the range of maternal ages. In addition, we explored whether rates of poor birth outcomes, including low birthweight (LBW) and preterm birth (PTB), among hypertensive women differed by race.

Methods.

We restricted our analyses to births occurring between 1994 and 2003, constructing six five-year maternal age categories: 15–19 years, 20–24 years, 25–29 years, 30–34 years, 35–39 years, and 40–44 years. We used logistic regression to determine the relative contribution of race and age to incidence of maternal hypertension. All analyses controlled for the standard covariates of maternal education, marital status, and tobacco use. To assess the impact of maternal hypertension on birth outcomes, we limited the dataset to women with any hypertensive disorder and used linear regression to determine how particular race-age combinations affected outcomes. We also used logistic regression to find out how particular race-age combinations affected the likelihood of LBW and PTB.

Results.

The risk of hypertension differed by race, with NHB women exhibiting the highest risk and Hispanic women the lowest risk. Further, rates of hypertension increased with age. Among hypertensive women, pregnancy outcomes differed by race and age, with NHB women having the poorest outcomes (i.e., LBW and PTB) and age exhibiting a dose-response relationship in PTB and very PTB.

Conclusions.

Patterns of maternal hypertension and subsequent outcomes are important contributors to persistent disparities in pregnancy outcomes.
YOUR Blessed Health: An HIV-Prevention Program Bridging Faith and Public Health Communities
Authors: Griffith Derek M. , Campbell Bettina , Allen Julie Ober , Robinson Kevin J. , Stewart Sarah Kretman
Published: July 2017

African American faith-based institutions are not necessarily equipped to balance their moral and spiritual missions and interpretation of religious doctrine with complex health issues such as human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). YOUR Blessed Health (YBH) is a faith-based, six-month pilot project designed to increase the capacity of faith-based institutions and faith leaders to address HIV/AIDS and sexually transmitted infections (STIs) in 11- to 19-year-old African Americans. In addition to increasing the knowledge and skills of young people, the intervention seeks to change churches' norms to provide more open settings where young people can talk with faith leaders about sex, relationships, STIs, and HIV/AIDS. YBH expands the roles of adult faith leaders, particularly pastors' spouses, to include health education as they implement the intervention in their congregations and communities. The intervention includes a flexible menu of activities for faith leaders to select from according to their institutional beliefs, doctrines, and culture.
Male Circumcision in the United States for the Prevention of HIV Infection and other Adverse Health Outcomes: Report from a CDC Consultation
Authors: Smith Dawn K. , Taylor Allan , Kilmarx Peter H. , Sullivan Patrick , Warner Lee , Kamb Mary , Bock Naomi , Kohmescher Bob , Mastro Timothy D.
Published: July 2017

In April 2007, the Centers for Disease Control and Prevention (CDC) held a two-day consultation with a broad spectrum of stakeholders to obtain input on the potential role of male circumcision (MC) in preventing transmission of human immunodeficiency virus (HIV) in the U.S. Working groups summarized data and discussed issues about the use of MC for prevention of HIV and other sexually transmitted infections among men who have sex with women, men who have sex with men (MSM), and newborn males. Consultants suggested that ( 1) sufficient evidence exists to propose that heterosexually active males be informed about the significant but partial efficacy of MC in reducing risk for HIV acquisition and be provided with affordable access to voluntary, high-quality surgical and risk-reduction counseling services; ( 2) information about the potential health benefits and risks of MC should be presented to parents considering infant circumcision, and financial barriers to accessing MC should be removed; and ( 3) insufficient data exist about the impact (if any) of MC on HIV acquisition by MSM, and additional research is warranted. If MC is recommended as a public health method, information will be required on its acceptability and uptake. Especially critical will be efforts to understand how to develop effective, culturally appropriate public health messages to mitigate increases in sexual risk behavior among men, both those already circumcised and those who may elect MC to reduce their risk of acquiring HIV.
Costs of HIV Prevention among Out-of-Treatment Drug-Using Women: Results of a Randomized Controlled Trial
Authors: Ruger Jennifer Prah , Ben Abdallah Arbi , Cottler Linda
Published: July 2017

Objectives.

We developed a micro-costing methodology to estimate the real resource costs consumed by delivery of the National Institute on Drug Abuse (NIDA) Cooperative Agreement Standard Intervention (SI) for human immunodeficiency virus (HIV) prevention, plus two enhanced modules, in a three-arm randomized controlled trial (RCT) among drug-using women. To our knowledge, this is the first micro-costing study of the SI and enhanced modules and the first of its kind targeting drug-using women.

Methods.

We conducted a micro-costing study alongside a three-arm RCT to estimate costs of ( 1) the modified NIDA SI; ( 2) the SI and a well woman exam (SI+WWE); and ( 3) the SI, WWE, and four educational sessions (SI+WWE+4ES) to prevent HIV and sexually transmitted diseases in at-risk, drug-using women in St. Louis, Missouri.

Results.

The cost of the SI that all 501 participants received was approximately $227 per person. The additional costs for the WWE and 4ES were approximately $145 and $942 per person, respectively. Total program costs for the SI ( n=501) were $113,869; additional costs for the SI+WWE ( n=342) were $49,403 and for the SI+WWE+4ES ( n=170) were $160,189. The main cost component for the SI (64% of total costs) was testing costs, whereas building and facilities costs were the main cost component for the SI+WWE+4ES (75% of total costs).

Conclusions.

This study provides accurate estimates of the real costs for standard and enhanced HIV interventions for policy makers seeking to implement targeted HIV-prevention programs with scarce resources.
A Longitudinal Study of the Impact of an Emergency Preparedness Curriculum
Authors: Hoeppner Mary M. , Olson Debra K. , Larson Susan C.
Published: July 2017

Objective.

We conducted a longitudinal study to evaluate the impact of a curriculum designed to develop competency in emergency preparedness among public health professionals.

Methods.

At six and 12 months following completion of one or more courses in the areas of emergency preparedness, response, and recovery, or in food protection, course participants were contacted and asked to identify if their participation allowed them to develop targeted competencies, identify important knowledge or skills they had acquired, provide examples of application of learning, and describe the impact of changes. Over five years, 36 sets of data were collected.

Results.

The response rate of those who responded at either six or 12 months, or for both time periods, was 63%. At both six and 12 months, those who responded agreed that the learning activity helped them develop the competency associated with it in the curriculum plan. Respondents described multiple applications of learning and reported the development of reflective and systems-thinking abilities.

Conclusions.

The results provide compelling evidence that learners do develop competencies that impact their work activities as a result of competency-based educational programming and are able to apply these competencies in their work and organizational activities.
Public Health-Specific National Incident Management System Trainings: Building a System for Preparedness
Authors: Kohn Sivan , Barnett Daniel J. , Galastri Costanza , Semon Natalie L. , Links Jonathan M.
Published: July 2017

Local health departments (LHDs) are at the hub of the public health emergency preparedness system. Since the 2003 issuance of Homeland Security Presidential Directive-5, LHDs have faced challenges to comply with a new set of all-hazards, 24/7 organizational response expectations, as well as the National Incident Management System (NIMS). To help local public health practitioners address these challenges, the Centers for Disease Control and Prevention-funded Johns Hopkins Center for Public Health Preparedness (JH-CPHP) created and implemented a face-to-face, public health-specific NIMS training series for LHDs. This article presents the development, evolution, and delivery of the JH-CPHP NIMS training program. In this context, the article also describes a case example of practice-academic collaboration between the National Association of County and City Health Officials and JH-CPHP to develop public health-oriented NIMS course content.
An Academic/Government Partnership to Provide Technical Assistance with Pandemic Influenza Planning to Local Health Departments in North Carolina
Authors: Rosselli Richard T. , Davis Meredith K. , Simeonsson Kristina , Johnson Morgan , Goode Brant , Casani Julie , MacDonald Pia D.M.
Published: July 2017

In 2006, the North Carolina Division of Public Health (NC DPH) required all 85 local health departments (LHDs) in North Carolina to develop a pandemic influenza plan. Because few LHDs had experience in developing such plans, NC DPH engaged in a unique partnership with an academic center, the North Carolina Center for Public Health Preparedness (NCCPHP), to provide technical assistance to local planners. This article describes the technical assistance program implemented by NCCPHP, the use of technical assistance by local planners, subsequent completeness of local pandemic influenza plans, and lessons learned throughout the program. We discuss selected topic areas (surveillance, vaccine/antiviral, and vulnerable populations) observed within local pandemic influenza plans to highlight the variability in planning approaches and identify potential opportunities for state and local standardization.
Public Health Emergency Preparedness Exercises: Lessons Learned
Authors: Biddinger Paul D. , Savoia Elena , Massin-Short Sarah B. , Preston Jessica , Stoto Michael A.
Published: July 2017

The Harvard School of Public Health Center for Public Health Preparedness exercise program has two aims: ( 1) educating the public health workforce on key public health system emergency preparedness issues, and ( 2) identifying specific systems-level challenges in the public health response to large-scale events. Rigorous evaluation of 38 public health emergency preparedness (PHEP) exercises employing realistic scenarios and reliable and accurate outcome measures has demonstrated the usefulness of PHEP exercises in clarifying public health workers' roles and responsibilities, facilitating knowledge transfer among these individuals and organizations, and identifying specific public health systems-level challenges.