bluuebunny/crossref_metadata_2025 huggingface dataset:
Health Department Collaboration with Emergency Departments as a Model for Public Health Programs among at-Risk Populations
Authors: Lyons Michael S. , Lindsell Christopher J. , Ledyard Holly K. , Frame Peter T. , Trott Alexander T.
Published: July 2017

Objectives.

Accessing at-risk and underserved populations for intervention remains a major obstacle for public health programs. Emergency departments (EDs) care for patients not otherwise interacting with the health care system, and represent a venue for such programs. A variety of perceived and actual barriers inhibit widespread implementation of ED-based public health programs. Collaboration between local health departments and EDs may overcome such barriers. The goal of this study was to assess the effectiveness of a health department-funded, ED-based public health program in comparison with other similar community-based programs through analysis of data reported by health department-funded HIV counseling and testing centers in one Ohio county.

Method.

Data for HIV counseling and testing at publicly funded sites in southwestern Ohio from January 1999 through December 2002 were obtained from the Ohio Department of Health. Demographic and risk-factor profiles were compared between the counseling and testing program located in the ED of a large, urban teaching hospital and the other publicly funded centers in the same county.

Results.

A total of 26,382 patients were counseled and tested; 5,232 were ED patients, and 21,150 were from community sites. HIV positivity was 0.86% (95% confidence interval [CI] 0.64%, 1.15%) in the ED and 0.65% (95% CI 0.55%, 0.77%) elsewhere. The ED program accounted for 19.8% of all tests and 24.7% of all positive results. The ED notified 77.3% of individuals testing positive and 84.4% of individuals testing negative. At community program centers, 88.3% of patients testing positive and 63.8% of patients testing negative were notified of results. All ED patients notified of positive status were successfully referred to infectious disease specialists.

Conclusions.

Public health programs can operate effectively in the ED. EDs should have a rapidly expanding role in the national public health system.
Querying of Death Certificates in the United States
Authors: Hoyert Donna L. , Lima Ann R.
Published: July 2017

Objective.

Data from death certificates are often used in research; however, little has been published on the processing of vague or incomplete information reported on certificates. The goal of this study was to examine the querying efforts in the United States used to clarify such records.

Methods.

The authors obtained data on the querying efforts of the 50 states, New York City, and the District of Columbia. Descriptive statistics are presented for two units of analysis: registration area and death record. Using data from a single registration area, Washington State, the authors compared the percent change in age-adjusted death rates for data from before and after querying to analyze the effect of querying on selected causes of death.

Results.

Fifty-one of the 52 registration areas queried either demographic or cause-of-death information. Almost 90% of queries were returned; the underlying cause of death changed in approximately 68% of these records. This data translates into about 3% of total U.S. death records, given that 4% of total U.S. death records were queried about cause of death. The impact of queries on age-adjusted death rates varied by cause of death. Generally, the effect is most obvious for cause-of-death categories that are specific and relatively homogenous.

Conclusion.

Querying continues to be widely practiced. In the case of cause-of-death queries, this method refines the assigned underlying cause of death for records reported with vague or incomplete information.
Screening Housing to Prevent Lead Toxicity in Children
Authors: Lanphear Bruce P. , Hornung Richard , Ho Mona
Published: July 2017

Objective.

Screening children to identify those with blood lead levels ⩾10 μg/d fails to protect children from lead-associated cognitive deficits and behavioral problems. To broaden our efforts at primary prevention, screening criteria are needed to identify lead-contaminated housing before children are unduly exposed. The purpose of this study was to identify and validate housing characteristics associated with children having elevated blood lead levels (⩾10 μg/dl).

Methods.

Two existing studies were used to examine housing characteristics linked with undue lead exposure: a cross-sectional study of 205 children aged 12 to 31 months, and a random sample from a longitudinal study of 276 children followed from 6 to 24 months of age. Logistic regression analysis was conducted to examine the association of children's blood lead levels >10 μg/dl.

Results.

The mean age of the 481 children was 17.8 months; 99 (20.6%) had a blood lead concentration of 10 μg/dl or higher. The following characteristics were associated with blood lead concentration >10 μg/dl: floor lead loading >15 μg/ft2 (odds ratio [OR]=2.2; 95% confidence interval [CI] 1.3, 3.8); rental housing (OR=3.2; 95% CI 1.3, 7.6); poor housing condition (OR=2.1; CI 1.2, 3.6); African American race (OR=3.3; CI 1.9, 6.1); paint chip ingestion (OR=5.8; CI 1.3, 26.5); and soil ingestion (OR=2.2; CI 1.1, 4.2). Housing characteristics including rental status, lead-contaminated floor dust, and housing condition had a range of sensitivity from 47% to 92%; specificity from 28% to 76%; a positive predictive value from 25% to 34%; and a negative predictive value of 85% to 93%.

Conclusions.

Housing characteristics and floor dust lead levels can be used to screen housing to identify lead hazards prior to occupancy, before purchasing a home, or after renovation to prevent children's exposure to lead hazards.
Cost of Child Lead Poisoning to Taxpayers in Mahoning County, Ohio
Authors: Stefanak Matthew , Diorio Joe , Frisch Larry
Published: July 2017

Lead poisoning in children imposes both immediate and long-term financial burdens on taxpayers. The District Board of Health of Mahoning County, Ohio, quantified some of the direct costs to taxpayers of providing medical care and public health services to the 279 children diagnosed with lead poisoning in the county in 2002, using methods described by Katrina Korfmacher at the University of Rochester. The Board of Health also attempted to quantify the longer-term costs of special education and juvenile justice services attributable to lead exposure. The realization that lead poisoning costs local government on the order of $0.5 million each year has mobilized community leaders in education and juvenile justice to demand more aggressive action against rental property owners who fail to remediate lead hazards.
Infant Mortality Reviews in the Aberdeen Area of the Indian Health Service: Strategies and Outcomes
Authors: EagleStaff Mary Lynn , Klug Marilyn G. , Burd Larry
Published: July 2017

Objective.

To determine cause and manner of death for consecutive infant deaths in the Aberdeen Area of the Indian Health Service (AAIHS) from 1998 to 2002 and to identify risk markers for infant mortality.

Methods.

Infant deaths in the AAIHS were identified from four data sources: death certificates from the four states in the AAIHS, deaths reported by local IHS Service Units, from obituaries in local and regional newspapers, and deaths reported by area hospitals. Each infant death is then sent to the local IHS service unit for review, where data from the infant and mother's chart is extracted and recorded. Local community factors, birth and death certificates, and autopsy reports are collected. The case is then reviewed at the Perinatal Infant Mortality Review (PIMR) meeting and a cause and manner of death is assigned. Summary data for the cohort was examined and then compared by mortality category and three age-at-death groups.

Results.

Sudden infant death syndrome accounted for 33% of all infant deaths in the AAIHS. Prematurity was the second most prevalent cause-specific mortality category, accounting for 22% of all infant deaths. The authors found that infant mortality was surprisingly recurrent, with 32% of mothers of this infant having had a previous infant death.

Conclusions.

The PIMR committee requires substantial resources to support a review committee with appropriate expertise and their travel. Participation of local IHS staff and tribal members provides an important cultural and community perspective for the review process. Quality improvement changes are currently being implemented. These include increasing data on substance use, mental health needs, and reviews of fetal deaths. The process of mortality review has been very helpful in public education in the AAIHS.
Parental Perspectives on Influenza Vaccination among Children with Asthma
Authors: Gnanasekaran Sangeeth K. , Finkelstein Jonathan A. , Hohman Katherine , O'Brien Megan , Kruskal Benjamin , Lieu Tracy A.
Published: July 2017

Objectives.

The objectives of this study were to: ( 1) identify modifiable factors influencing receipt of influenza vaccination among children with asthma, and ( 2) to evaluate the effect of heightened media attention on vaccination rates.

Methods.

During November and December 2003, we interviewed parents of children with asthma about their experiences with and beliefs about influenza vaccination. We randomly selected 500 children from a study population of 2,140 children identified with asthma in a managed care organization in Massachusetts. We obtained data on influenza vaccination status from computerized medical records and determined significant factors influencing receipt of influenza vaccination.

Results.

Children were more likely to be vaccinated if their parent recalled a physician recommendation (odds ratio [OR] 2.6; 95% confidence interval [CI] 1.5, 4.5), believed the vaccine worked well (OR 2.0; 95% CI 1.4, 2.8), or expressed little worry about vaccine adverse effects (OR 1.3; 95% CI 1.0, 1.6), or if the child was younger (OR 1.1 per year of age; 95% CI 1.0, 1.2). During the study period, there was heightened media attention about influenza illness and the vaccine. The influenza vaccination rate for children with asthma was 43% in 2003–04 compared with 27% in 2002–03. Comparison of weekly influenza vaccination rates in 2003–04 and 2002–03 suggested that the media attention was associated with the increase in vaccination rates.

Conclusions.

Physician recommendations and parental education about influenza vaccine availability, effectiveness, and adverse effects are potentially important influences on influenza vaccination. Our findings suggest that media coverage of the risks of influenza was associated with a significant increase in vaccination rates.
Human Rabies Exposures and Postexposure Prophylaxis in South Carolina, 1993–2002
Authors: O'Bell Susan A. , McQuiston Jennifer , Bell Linda J. , Ferguson Sue C. , Williams L.A.
Published: July 2017

Objectives.

South Carolina mandates reporting of animal bites and manages distribution of biologics for rabies postexposure prophylaxis (PEP). Incidence and epidemiologic characteristics of potential human rabies exposures and preventive treatment in South Carolina from 1993 through 2002 were examined to help assess the burden of PEP in the state and determine if the incidence of rabies exposures has changed over time.

Methods.

Data on animal exposure investigations and PEP administration at the state and county level were examined, and the annual incidences of potential rabies exposures and human PEP courses were calculated.

Results.

The incidence of animal exposures for which investigations were initiated was 297.9 per 100,000 population per year, and the incidence of PEP was 10.6 per 100,000 population per year. At the county level, the incidence of PEP appeared inversely correlated with the population density. Most courses of PEP were administered following exposures to domestic species, although these animals accounted for only a small proportion of rabid animals in the state. The annual PEP incidence was similar throughout the study period, but it was markedly higher than estimates from 1981 (<5/100,000 population per year).

Conclusions.

The incidence of PEP in South Carolina is higher than previously thought, and these findings suggest that incidence extrapolations for other states and at the national level may be underestimated. An accurate estimation of the incidence of PEP and an understanding of rabies epidemiology is important at the state level to allow for better public health planning.
Changing Marital Status and Desistance from Intimate Assault
Authors: Wooldredge John , Thistlethwaite Amy
Published: July 2017

Objectives.

This study examined whether the odds of subsequent domestic violence by married men are reduced when women file for divorce, and whether these odds are further influenced by the timing of divorce proceedings.

Methods.

The sample included 703 married men arrested for misdemeanor assaults on spouses in Hamilton County (Cincinnati), Ohio. Logistic regression models were estimated to determine whether men with divorces filed against them (after entry into the study) were less likely to be re-arrested during a fixed 24-month follow-up period. A survival analysis of differences in time to re-arrest for men with filed divorces versus those without was also conducted, as well as an analysis of the speed of divorce filings and re-arrest.

Results.

Only 24% of all offenders had divorce papers filed in court during the study period. Divorce filings coincided with ( 1) lower likelihoods of re-arrest for intimate assault, ( 2) lower likelihoods of re-arrest during each month of follow-up, and ( 3) longer delays to re-arrest (for those who ultimately re-offended). Shorter delays to divorce filings (after initial arrest) were more effective for reducing likelihoods of subsequent assault, particularly within the first 11 months after entry into the study.

Conclusions.

Findings have implications for victim support services offered through domestic violence courts. Evidence from this and future studies may provide additional incentives for support personnel to identify and overcome the barriers preventing many women from successfully filing for divorce. However, the study should be seen as offering preliminary findings on a potentially important issue.
Intimate Partner Violence and Minor Psychiatric Morbidity of Aboriginal Taiwanese Women
Authors: Yang Mei-Sang , Yang Ming-Jen , Chang Shun-Jen , Chen Shu-Chuan , Ko Ying-Chin
Published: July 2017

Objectives.

Experiences of abuse increase the risk of psychiatric morbidity in women. This study assesses the prevalence of intimate partner violence and minor psychiatric morbidity and analyzes their association among aboriginal women in Taiwan.

Methods.

Using system random sampling, 840 aboriginal women between the ages of 18 and 50 years old were recruited from four townships with aboriginal communities in southern Taiwan. Trained primary care nurses interviewed the participants at home by structured questionnaire.

Results.

One hundred twenty-six of 840 (15%) of the aboriginal women had experienced physical abuse perpetrated by an intimate partner (her husband or cohabitant) during their lifetime; 10.1% had experienced it during the past 12 months; 4.0% had experienced sexual abuse by the partner; and 6.3% had experienced physical abuse during childhood at the hands of one or both parents. Multiple logistic regression revealed that after adjusting for women's age, alcohol and drug use, religious activity and husband's employment status, the experience of abuse (including partner physical abuse, partner sexual abuse, and childhood physical abuse) was significantly associated with suicidal ideation and depression.

Conclusions.

Health care professionals need to provide adequate support and health education, develop interventions, and use referrals in primary care in the community in order to reduce and prevent domestic violence against aboriginal women in Taiwan.
Survey of State Practices during the 2004–2005 Influenza Vaccine Shortage
Authors: Shimabukuro Tom T. , Wortley Pascale M. , Bardenheier Barbara , Bresnitz Eddy A. , DeBlois Anna M. , Hahn Christine G. , Mangione Ellen J.
Published: July 2017

To describe state-level actions and policies during the 2004–2005 influenza vaccine shortage and determine whether these or other factors were related to vaccination coverage, we surveyed all state health departments (including the District of Columbia). We included 2004–2005 Behavioral Risk Factor Surveillance System data to examine whether state-level actions, policies, or other factors like vaccine supply were related to changes in vaccination coverage in adults aged ≥65 years from the previous non-shortage year. We found that 96% ( n=49) of states reported adopting or recommending adherence to the initial national interim influenza vaccination recommendations. Of these, at some point during the season, 22% ( n=11) reported local public health agencies issued prioritization recommendations that differed from the state health department's guidance. Eighty percent ( n=41) initiated at least one emergency response activity and 43% ( n=22) referred to or implemented components of their pandemic influenza plans. In 35% ( n=18), emergency or executive orders were issued or legislative action occurred.

In a multivariable linear regression model, the availability and use of practitioner contact lists and having a relatively high vaccine supply in early October 2004 were associated with smaller decreases in coverage for adults aged ≥65 years from the previous non-shortage season ( p=0.003, r2=0.26). States overwhelmingly followed national vaccination prioritization guidelines and used a range of activities to manage the 2004–2005 vaccine shortage. The availability and use of practitioner contact lists and having a relatively high vaccine supply early in the season were associated with smaller decreases in coverage from the previous non-shortage season.
Perceived Discrimination among Severely Disadvantaged People with HIV Infection
Authors: Sohler Nancy , Li Xuan , Cunningham Chinazo
Published: July 2017

Objectives.

Studies continue to document that people with human immunodeficiency virus (HIV) experience discrimination in their interactions with the health-care system, which can have negative implications for maintaining continuity in care and outcomes. We explored the patient characteristics associated with perceived discrimination and whether these experiences are associated with health-care system quality ratings in a survey of severely disadvantaged people with HIV who are at great risk of inconsistent access to appropriate health care.

Methods.

Five hundred and twenty-three participants were recruited from temporary housing facilities for people with HIV in the New York City area and administered a survey using audio computer-assisted self-interviewing technology.

Results.

Of the 207 participants (39.6%) who reported experiencing discrimination in the health-care system, the most common attributions were HIV infection ( n=122, 59.8%), drug use ( n=100, 49.8%), homelessness ( n=71, 34.6%), and race/ethnicity ( n=69, 35.2%). Length of time HIV infected, use of non-prescription opioids, white race, higher education, female gender, younger age, and poorer self-reported health status were all significantly associated with greater odds of perceived discrimination. After adjusting for participant characteristics, perceived discrimination was significantly associated with poorer participant ratings of quality of health care.

Conclusions.

Members of this vulnerable population commonly report experiences of discrimination from within the health-care system and these experiences are associated with poor health-care ratings. These findings support the need for closer examination of the adequacy of cultural competency training within the HIV health-care delivery system to improve access to appropriate care for disadvantaged people.
Exposure to West Nile Virus during the 2002 Epidemic in Cuyahoga County, Ohio: A Comparison of Pediatric and Adult Behaviors
Authors: LaBeaud Angelle Desirée , Kile Jeffery R. , Kippes Christopher , King Charles H. , Mandalakas Anna M.
Published: July 2017

Objectives.

Emerging evidence suggests that children are at higher risk for West Nile virus (WNV) exposure, but may have a lower risk for infection-related morbidity and mortality. Limited data exist regarding risk determinants of childhood WNV infection. We conducted a survey to analyze the differences between pediatric and adult behavior relevant to WNV exposure.

Methods.

Residents of participating sampled households responded to a questionnaire that measured knowledge, attitudes, personal protective behaviors, and clinical history to evaluate the association between personal behavior and exposure to WNV.

Results.

Children were more likely to have high levels of outdoor exposure compared to adults (83% vs. 70%). Children were less likely to avoid going outdoors (4% vs. 13%) and to wear long sleeves or pants compared to adults (8% vs. 19%). Both groups were highly educated about WNV. Television, not health-care provider education, was the most common source of WNV information. Participants were more concerned about WNV infection than pesticide usage.

Conclusions.

Our study demonstrates that children exhibit behaviors that could put them at greater risk for WNV infection and suggests that children could benefit from greater education about practices that can decrease WNV exposure to limit their risk for infection.
Investigating Asthma Deaths among Children and Young Adults: Michigan Asthma Mortality Review
Authors: Rosenman Kenneth D. , Hanna Elizabeth A. , Lyon-Callo Sarah K. , Wasilevich Elizabeth A.
Published: July 2017

Objective.

We developed a surveillance system to investigate asthma deaths in children and young adults.

Methods.

A rapid asthma death notification and investigation system for Michigan was developed to identify interventions to prevent future deaths among people aged 2–34 years. Multidisciplinary panels to determine causal factors and recommend preventative actions reviewed information from death certificates, autopsies, next-of-kin interviews, and medical records. An annual report was disseminated to public health workers, health-care providers, insurers, and others.

Results.

Eighty-six asthma deaths in Michigan residents, aged 2–34, occurred from 2002–2004. Sixty-one next of kin were interviewed and medical records were obtained for 84 of the deceased. Summaries were prepared on each of the deceased and were reviewed by expert panels, which reached consensus on causal factors and potential preventive action for each death. Each year an annual report, which summarized the causal factors and potential preventive activity, was prepared.

Conclusion.

This review has informed and catalyzed interventions to improve asthma care and management in Michigan. Factors leading to the review's success and future activities are discussed.
Can the Health-Care System Meet the Challenge of Pandemic Flu? Planning, Ethical, and Workforce Considerations
Authors: Levin Peter J. , Gebbie Eric N. , Qureshi Kristine
Published: July 2017

The federal pandemic influenza plan predicts that 30% of the population could be infected. The impact of this pandemic would quickly overwhelm the public health and health-care delivery systems in the U.S. and throughout the world. Surge capacity for staffing, availability of drugs and supplies, and alternate means to provide care must be included in detailed plans that are tested and drilled ahead of time. Accurate information on the disease must be made available to health-care staff and the public to reduce fear. Spokespersons must provide clear, consistent messages about the disease, including actions to be taken to contain its spread and treat the afflicted. Home care will be especially important, as hospitals will be quickly overwhelmed. Staff must be prepared ahead of time to assure their ability and willingness to report to work, and public health must plan ahead to adequately confront ethical issues that will arise concerning the availability of treatment resources. The entire community must work together to meet the challenges posed by an epidemic. Identification and resolution of these challenges and issues are essential to achieve adequate public health preparedness.
Race/Ethnicity and Self-Reported Diabetes among Adults in the National Health Interview Survey: 2000–2003
Authors: Borrell Luisa N. , Crawford Natalie D. , Dallo Florence J.
Published: July 2017

Objective.

We investigated the effect of race among Hispanic and non-Hispanic people on self-reported diabetes after adjusting for selected individual characteristics and known risk factors.

Methods.

Using the National Health Interview Survey 2000–2003, these analyses were limited to Hispanic and non-Hispanic people who self-identified as white or black/African American for a final sample of 117,825 adults, including 17,327 Hispanic people (with 356 black and 16,971 white respondents).

Results.

The overall prevalence of diabetes was 7.2%. After adjusting for selected covariates, Hispanic white and black respondents were 1.56 (95% confidence interval [CI] 1.32, 1.83) and 2.64 (95% CI 1.10, 6.35) times more likely to report having diabetes than non-Hispanic white respondents. The estimate for non-Hispanic black respondents was 1.45 (95% CI 1.29, 1.64). When compared to low-income non-Hispanic white respondents, low-income Hispanic white respondents (odds ratio [OR] 1.64; 95% CI 1.26, 2.19) and non-Hispanic black respondents (OR 1.71; 95% CI 1.38, 2.11) were more likely to report having diabetes. Hispanic black people born in the U.S. were 3.54 (95% CI 1.27, 9.82) times more likely to report having diabetes when compared to Hispanic white people born in the U.S. In comparison to non-Hispanic white respondents, the odds of reporting diabetes decreased for non-Hispanic black respondents, while the odds remained constant for Hispanic white respondents ( p-value for interaction between survey year and race/ethnicity = 0.03).

Conclusions.

This study suggests that race may be a proxy for unmeasured exposures among non-Hispanic and Hispanic people. Thus, given the importance of race on health and the racial heterogeneity among Hispanic people, race among Hispanic people should be investigated whenever the data allow it.
Computer Use and Habitual Spinal Posture in Australian Adolescents
Authors: Straker Leon M. , O'Sullivan Peter B. , Smith Anne , Perry Mark
Published: July 2017

Objective.

Computer use is common in adolescents, and there is evidence that adolescent spinal posture alters during computer use. However, it is unknown if computer use and habitual postures are associated. The objective of this study was to evaluate associations between adolescent computer use and habitual postures.

Methods.

Eight hundred eighty-four adolescents (408 females, 476 males, mean age, 14.0 years, standard deviation, 0.2) completed a questionnaire assessing weekly computer use. Habitual spinal posture was assessed by photographic analysis while standing and sitting.

Results.

Computer use was associated with adolescent habitual postures. In males, increased computer use was associated with increased head flexion and neck flexion. In females, increased computer use was associated with increased lumbar lordosis.

Conclusions.

The amount of weekly computer use was associated with changes in habitual spinal postures, and these depended on gender. These associations may result from temporary computer postures leading to adaptive neuromusculoskeletal changes, though further multivariate and longitudinal studies are needed to confirm causality. As some habitual posture changes may place a greater strain on the musculoskeletal system, computer use by adolescents should be viewed as a possible health concern.
Economic Impact of Regulating the Use of Amalgam Restorations
Authors: Beazoglou Tryfon , Eklund Stephen , Heffley Dennis , Meiers Jonathan , Brown L. Jackson , Bailit Howard
Published: July 2017

Objective.

This article estimates the financial impact of a ban on amalgam restorations for selected population groups: the entire population, children, and children and women of childbearing age.

Methods.

Using claim and enrollment data from Delta Dental of Michigan, Ohio, and Indiana and the American Dental Association Survey of Dental Services Rendered, we estimated the per capita use and annual rate of change in amalgam restorations for each age, gender, and socioeconomic subgroup. We used population projections to obtain national estimates of amalgam use, and the dental component of the Consumer Price Index to estimate the annual rate of change in fees. We then calculated the number of dental amalgams affected by the regulation, and the fees for each of the years 2005 to 2020.

Results.

If amalgam restorations are banned for the entire population, the average price of restorations before 2005 and after the ban would increase $52 from $278 to $330, and total expenditures for restorations would increase from $46.2 billion to $49.7 billion. As the price of restorations increases, there would be 15,444,021 fewer restorations inserted per year. The estimated first-year impact of banning dental amalgams in the entire population is an increase in expenditures of $8.2 billion.

Conclusions.

An amalgam ban would have a substantial short- and long-term impact on increasing expenditures for dental care, decreasing utilization, and increasing untreated disease. Based on the available evidence, we believe that state legislatures should seriously consider these effects when contemplating possible restrictions on the use of amalgam restorations.
Hospitality Workers' Attitudes and Exposure to Secondhand Smoke, Hazardous Chemicals, and Working Conditions
Authors: Pearson Dave , Angulo Antoinette , Bourcier Emily , Freeman Elizabeth , Valdez Roger
Published: July 2017

Objective.

Compelling reasons exist for labor and public health to collaborate. For example, compared to white-collar workers, blue-collar and service workers are much more likely to be targeted by the tobacco industry and become smokers. The purpose of this descriptive study was to assess if there were ways public health and labor could collaborate to document the health attitudes and needs of hospitality industry workers.

Methods.

Eligible union members were identified through an electronic enrollment file consisting of 3,659 names maintained by the union. The mail survey instrument covered exposure to secondhand smoke, exposure to hazardous chemicals and materials, time pressure and job demands, and work-related pain/disability. Additional questions related to age, gender, race/ethnicity, level of education, employment history, English proficiency, and self-reported health status.

Results.

Study results demonstrated that important health information could be successfully collected on unionized workers. Survey data showed that union members were a very diverse group who were exposed to secondhand smoke and supported working in clean-air settings. Workers, especially housekeeping staff, characterized their work as being chaotic and demanding, while almost half of workers reported work-related pain.

Conclusions.

Key to the successful collaboration was establishing trust between the parties and emphasizing data collection that served the information needs of both organizations. Opportunities exist to improve the health and working conditions of this population. Health interventions need to be designed to take into consideration the very diverse, mostly female, and limited English proficiency of this group of workers.
Comparison of Health and Social Characteristics of People Leaving New York City Jails by Age, Gender, and Race/Ethnicity: Implications for Public Health Interventions
Authors: Freudenberg Nicholas , Moseley Jeanne , Labriola Melissa , Daniels Jessie , Murrill Christopher
Published: July 2017

Objectives.

We compared health and social needs by gender, age, and race/ethnicity of people leaving New York City jails and assessed the implication of these differences for the development of jail reentry programs.

Methods.

Surveys were completed with 1,946 individuals (536 men, 704 women, and 706 adolescent males) between 1997 and 2004. Structured questionnaires captured data on demographic, criminal justice, substance use, and health characteristics. Bivariate comparisons were performed to determine variations between men and women, men and male adolescents, and non-Latino black and Hispanic/Latino respondents.

Results.

The majority of participants were black and Hispanic/Latino, reported high levels of substance use, had high rates of recidivism, and experienced difficult living circumstances. Compared with men, women were more likely to be homeless, use illicit drugs, report drug charges at index arrest, have health problems, and be parents. Adolescent males were more likely than men to rely on illegal activities for income and to have used marijuana and alcohol recently, and were less likely to report homelessness or health problems. Ethnic/racial differences between black and Hispanic/Latino respondents within gender and age groups were smaller than differences among these groups.

Conclusions.

Jails concentrate individuals with multifaceted health and social problems, providing opportunities to engage at-risk populations in comprehensive reentry programs. Gender, age, and ethnic/racial differences among incarcerated populations require that interventions be tailored to the specific needs of these different groups.
Panel Classification of Self-Reported Exposure Histories: A Useful Exposure Index after a Mass-Casualty Event
Authors: Van Sickle David , Wenck Mary Anne , Belflower Amy , Drociuk Dan , Ferdinands Jill
Published: July 2017

Objective.

Although rapid epidemiologic investigations of toxic exposures require estimates of individual exposure levels, objective measures of exposure are often unavailable. We investigated whether self-reported exposure histories, when reviewed and classified by a panel of raters, provided a useful exposure metric.

Methods.

A panel reviewed exposure histories as reported by people who experienced a chlorine release. The panelists received no information about health-care requirements or specific health effects. To each exposure case, each panelist assigned one of five possible exposure severity ratings. When assigned ratings were not in initial agreement, the panelists discussed the case and assigned a consensus rating. Percent agreement and kappa statistics assessed agreement among panelists, Kendall's W measured agreement among panelists in their overall ordering of the exposure histories, and Spearman's rho compared the resultant rankings with individual health outcome.

Results.

In 48% of the cases, the panelists' initial ratings agreed completely. Overall, initial ratings for a given case matched the consensus rating 69% to 89% of the time. Pair-wise comparisons revealed 85% to 95% agreement among panelists, with weighted kappa statistics between 0.69 and 0.83. In their overall ranking of the exposure histories, the panelists reached significant agreement (W50.90, p<0.0001). Disagreement arose most frequently regarding probable chlorine concentration and duration of exposure. This disagreement was most common when panelists differentiated between adjacent categories of intermediate exposure. Panel-assigned exposure ratings significantly correlated with health outcome (Spearman's rho=0.56; p<0.0001).

Conclusion.

Epidemiologists and public health practitioners can elicit and review self-reported exposure histories and assign exposure severity ratings that predict medical outcome. When objective markers of exposure are unavailable, panel-assigned exposure ratings may be useful for rapid epidemiologic investigations.
Rapid Assessment of Exposure to Chlorine Released from a Train Derailment and Resulting Health Impact
Authors: Wenck Mary Anne , Van Sickle David , Drociuk Daniel , Belflower Amy , Youngblood Claire , Whisnant M. David , Taylor Richard , Rudnick Veleta , Gibson James J.
Published: July 2017

Objectives.

After a train derailment released approximately 60 tons of chlorine from a ruptured tanker car, a multiagency team performed a rapid assessment of the health impact to determine morbidity caused by the chlorine and evaluate the effect of this mass-casualty event on health-care facilities.

Methods.

A case was defined as death or illness related to chlorine exposure. Investigators gathered information on exposure, treatment received, and outcome through patient questionnaires and medical record review. An exposure severity rating was assigned to each patient based on description of exposure, distance from derailment, and duration of exposure. A case involving death or hospitalization ≥3 nights was classified as a severe medical outcome. Logistic regression was used to examine factors associated with severe medical outcomes.

Results.

Nine people died, 72 were hospitalized in nine hospitals, and 525 were examined as outpatients. Fifty-one people (8%) had a severe medical outcome. Of 263 emergency department visits within 24 hours of the incident, 146 (56%) were in Augusta, Georgia; at least 95 patients arrived at facilities in privately owned vehicles. Patients with moderate-to-extreme exposure were more likely to experience a severe medical outcome (relative risk: 15.2; 95% confidence interval 4.8, 47.8) than those with a lower rating.

Conclusions.

The rapid investigation revealed significant morbidity and mortality associated with an accidental release of chlorine gas. Key findings that should be addressed during facility, community, state, and regional mass-casualty planning include self-transport of symptomatic people for medical care and impact on health-care facilities over a wide geographic area.
Identifying Infants at Increased Risk for Late Initiation of Immunizations: Maternal and Provider Characteristics
Authors: Feemster Kristen A. , Spain C. Victor , Eberhart Michael , Pati Susmita , Watson Barbara
Published: July 2017

Objective.

We identified maternal, provider, and community predictors among infants for late initiation of immunizations.

Methods.

We performed a retrospective cohort study of infants born between January 1, 2002, and December 31, 2004, in Philadelphia, Pennsylvania. Primary outcomes were age in days at first office-based immunization and status as a late starter (i.e., initiating office-based immunizations after 90 days of age). Candidate predictors included sociodemographic and prenatal characteristics, immunization provider practice type and size, and neighborhood factors. We performed hierarchical logistic regression and Cox regression models to identify independent predictors for being a late starter and prolonged time to first immunization.

Results.

Of the 65,519 infants from this birth cohort in Philadelphia's immunization registry, 54,429 (88.1%) were included in analysis and 12.6% of these were late starters. Infants whose mothers were younger, received less than five prenatal visits, had less than a high school education, had more than two children, and who smoked cigarettes prenatally were significantly more likely to be late starters. Receiving care at hospital/university-based or public health clinics was also significantly associated with likelihood of being a late starter. Neither distance between infant's residence and practice nor neighborhood socioeconomic indicators was independently associated with the outcomes. Common risk factor profiles based on practice type and four maternal characteristics were found to reliably identify infant risk.

Conclusions.

Maternal receipt of fewer prenatal care visits, younger maternal age, higher birth order, and receiving care at public health clinics were the strongest predictors of being a late starter and time to first immunization. Risk factor profiles based on information already collected at birth can be used to identify higher-risk infants. Early intervention and potentially partnering with prenatal care providers may be key strategies for preventing underimmunization.
Assessing Cancer Stage and Screening Disparities among Native American Cancer Patients
Authors: Guadagnolo B. Ashleigh , Cina Kristin , Helbig Petra , Molloy Kevin , Reiner Mary , Cook E. Francis , Petereit Daniel G.
Published: July 2017

Objective.

Disparities in cancer-related health outcomes exist among Native Americans. This article assesses barriers to timely and effective cancer care among Native American cancer patients.

Methods.

We conducted a community-based participatory survey of newly diagnosed cancer patients to assess their basic knowledge of cancer screening and their beliefs about cancer management. Sociodemographic and cancer-related information was obtained from medical records. Mean scores for correct answers to the screening knowledge battery were tabulated and analyzed by race/ethnicity and sociodemographic characteristics. Multivariable regression models were used to adjust for sociodemographic characteristics in evaluating the association between screening knowledge and race/ethnicity.

Results.

The survey response rate was 62%. Of 165 patients, 52 were Native American and 113 were white. Native Americans with cancers for which a screening test is available presented with significantly higher rates of advanced-stage cancer ( p=0.04). Native Americans scored lower on the cancer screening knowledge battery ( p=0.0001). In multivariable analyses adjusting for age, gender, income, education level, employment status, and geographic distance from the cancer center, Native American race/ethnicity was the only factor significantly predictive of lower screening knowledge. Native Americans expressed more negative attitudes toward cancer treatment in some of the items regarding impacts and burden of cancer treatment.

Conclusions.

Native American cancer patients presented with higher rates of advanced-stage disease for screening-detectable cancers, lower levels of basic cancer screening knowledge, and more negative attitudes about cancer treatment than white patients. Public health interventions regarding screening and cancer education are needed.
Developing Summary Scores of Health-Related Quality of Life for a Population-Based Survey
Authors: Horner-Johnson Willi , Krahn Gloria , Andresen Elena , Hall Trevor ,   RRTC Expert Panel on Health Status Measurement
Published: July 2017

Objective.

Health-related quality of life (HRQOL) is an important indicator of public health. The Centers for Disease Control and Prevention's (CDC's) Behavioral Risk Factor Surveillance System (BRFSS) includes nine HRQOL items that can be used to monitor the health status of the nation. The objective of this study was to examine the numerical relationships among these HRQOL items to develop summary scores by combining items.

Methods.

Using 2001 and 2002 BRFSS data from states that included all nine HRQOL questions, factor analyses were performed to determine whether the items would group together into multi-item scales.

Results.

Two factors emerged, corresponding conceptually to a physical health construct and a mental health construct. The resulting scales demonstrated acceptable internal consistency and ability to distinguish between population subgroups known to differ on HRQOL.

Conclusions.

This study provides support for condensing the BRFSS core and optional HRQOL questions into two scales. These scales provide more complete information about physical and mental HRQOL than is available from single items, while limiting the number of individual variables required for a given analysis. However, the four core HRQOL questions focus primarily on physical health. Thus, the five supplemental questions should be included when measuring mental health is of interest.
Hepatocellular Carcinoma Prevalence and Mortality in a Male State Prison Population
Authors: Baillargeon Jacques , Snyder Ned , Soloway Roger D. , Paar David , Baillargeon Gwen , Spaulding Anne C. , Pollock Brad H. , Arcari Christine M. , Williams Brie A. , Raimer Ben G.
Published: July 2017

Objectives.

The incidence of hepatocellular carcinoma (HCC) in the United States has increased dramatically over the last two decades, largely because of an increase in the number of people with advanced hepatitis C virus (HCV) infection. U.S. prisoners are at high risk for HCC, given their elevated rates of HCV infection, comorbid hepatitis B virus (HBV) infection, and alcoholic liver disease. The purpose of our study was to examine the prevalence and mortality of HCC in the nation's largest state prison system.

Methods.

The study population consisted of 325,477 male Texas Department of Criminal Justice (TDCJ) inmates who were incarcerated between January 1, 2003, and July 31, 2006. Information on medical conditions and demographic characteristics was obtained from an institution-wide medical information system.

Results.

During the 3.5-year study period, 176 male TDCJ inmates (54 per 100,000) were diagnosed with HCC and 108 (33 per 100,000) died as a result of HCC. Inmates who were Hispanic, older, and infected with HCV, HBV, or human immunodeficiency virus had elevated rates of both HCC prevalence and mortality. After adjusting for all study covariates, HCC prevalence, but not mortality, was modestly elevated among inmates with diabetes.

Conclusions.

Our study showed that the Texas male prison population had a sevenfold higher prevalence of HCC than the general U.S. male population and a fourfold higher death rate from HCC. These findings likely reflect the high concentration of HCC-related risk factors, particularly HCV, among prisoners.
Assessing Public Health Capabilities during Emergency Preparedness Tabletop Exercises: Reliability and Validity of a Measurement Tool
Authors: Savoia Elena , Testa Marcia A. , Biddinger Paul D. , Cadigan Rebecca O. , Koh Howard , Campbell Paul , Stoto Michael A.
Published: July 2017

Objectives.

Improving the ability of local public health agencies to respond to large-scale emergencies is an ongoing challenge. Tabletop exercises can provide an opportunity for individuals and groups to practice coordination of emergency response and evaluate performance. The purpose of this study was to develop a valid and reliable self-assessment performance measurement tool for tabletop exercise participants.

Methods.

The study population comprised 179 public officials who attended three tabletop exercises in Massachusetts and Maine between September 2005 and November 2006. A 42-item questionnaire was developed to assess five public health functional capabilities: ( 1) leadership and management, ( 2) mass casualty care, ( 3) communication, ( 4) disease control and prevention, and ( 5) surveillance and epidemiology. Analyses were undertaken to examine internal consistency, associations among scales, the empirical structure of the items, and inter-rater agreement.

Results.

Thirty-seven questions were retained in the final questionnaire and grouped according to the original five domains. Alpha coefficients were 0.81 or higher for all scales. The five-factor solution from the principal components analysis accounted for 60% of the total variance, and the factor structure was consistent with the five domains of the original conceptual model. Inter-rater agreement ranged from good to excellent.

Conclusions.

The resulting 37-item performance measurement tool was found to reliably measure public health functional capabilities in a tabletop exercise setting, with preliminary evidence of a factor structure consistent with the original conceptualization and of criterion-related validity.