bluuebunny/crossref_metadata_2025 huggingface dataset:
Rural Healthy People 2010—Evolving Interactive Practice
Authors: Gamm Larry , Hutchison Linnae
Published: December 2008

The objectives of the Rural Healthy People 2010 project are to employ a survey of state and local rural health leaders to identify rural health priorities, to synthesize available research and other publications on these priorities, to identify and describe models for practice employed by rural communities to address these priorities, and to disseminate this information to rural communities. We describe these priorities; the content of Rural Healthy People 2010 products, methods, and target audiences; and the continuing evolution of the program. Rural Healthy People 2010 encourages rural support of Healthy People 2010 goals and invites state and local rural health leaders to share their successful models with others.
Urban–Rural Shifts in Intentional Firearm Death: Different Causes, Same Results
Authors: Branas Charles C. , Nance Michael L. , Elliott Michael R. , Richmond Therese S. , Schwab C. William
Published: December 2008

Objectives. We analyzed urban–rural differences in intentional firearm death.

Methods. We analyzed 584629 deaths from 1989 to 1999 assigned to 3141 US counties, using negative binomial regressions and an 11-category urban–rural variable.

Results. The most urban counties had 1.03 (95% confidence interval [CI]=0.87, 1.20) times the adjusted firearm death rate of the most rural counties. The most rural counties experienced 1.54 (95% CI=1.29, 1.83) times the adjusted firearm suicide rate of the most urban. The most urban counties experienced 1.90 (95% CI=1.50, 2.40) times the adjusted firearm homicide rate of the most rural. Similar opposing trends were not found for nonfirearm suicide or homicide.

Conclusions. Firearm suicide in rural counties is as important a public health problem as firearm homicide in urban counties. Policymakers should become aware that intentional firearm deaths affect all types of communities in the United States.
The Christian Medical Commission and the Development of the World Health Organization’s Primary Health Care Approach
Authors: Litsios Socrates
Published: December 2008

The primary health care approach was introduced to the World Health Organization (WHO) Executive Board in January 1975. In this article, I describe the changes that occurred within WHO leading up to the executive board meeting that made it possible for such a radical approach to health services to emerge when it did. I also describe the lesser-known developments that were taking place in the Christian Medical Commission at the same time, developments that greatly enhanced the case for primary health care within WHO and its subsequent support by nongovernmental organizations concerned with community health.
Research and Development of New Vaccines Against Infectious Diseases
Authors: Kieny Marie Paule , Excler Jean-Louis , Girard Marc
Published: December 2008

Infectious diseases are responsible for approximately 25% of global mortality, especially in children aged younger than 5 years. Much of the burden of infectious diseases could be alleviated if appropriate mechanisms could be put in place to ensure access for all children to basic vaccines, regardless of geographical location or economic status. In addition, new safe and effective vaccines should be developed for a variety of infections against which no effective preventive intervention measure is either available or practical.

The public, private, and philanthropic sectors need to join forces to ensure that these new or improved vaccines are fully developed and become accessible to the populations in need as quickly as possible.
Prevalence of Chronic Diseases in Adults Exposed to Arsenic-Contaminated Drinking Water
Authors: Zierold Kristina M. , Knobeloch Lynda , Anderson Henry
Published: December 2008

Inorganic arsenic is naturally occurring in groundwaters throughout the United States. This study investigated arsenic exposure and self-report of 9 chronic diseases. We received private well-water samples and questionnaires from 1185 people who reported drinking their water for 20 or more years. Respondents with arsenic levels of 2 μg/L or greater were statistically more likely to report a history of depression, high blood pressure, circulatory problems, and bypass surgery than were respondents with arsenic concentrations less than 2 μg/L.
The Latina Paradox: An Opportunity for Restructuring Prenatal Care Delivery
Authors: McGlade Michael S. , Saha Somnath , Dahlstrom Marie E.
Published: December 2008

Latina mothers in the United States enjoy surprisingly favorable birth outcomes despite their social disadvantages. This “Latina paradox” is particularly evident among Mexican-born women.

The social and cultural factors that contribute to this paradox are maintained by community networks—informal systems of prenatal care that are composed of family, friends, community members, and lay health workers. This informal system confers protective factors that provide a behavioral context for healthy births. US-born Latinas are losing this protection, although it could be maintained with the support of community-based informal care systems.

We recommend steps to harness the benefits of informal systems of prenatal care in Latino communities to meet the increasing needs of pregnant Latina women.
Health Care Disparities and Cervical Cancer
Authors: Bradley Cathy J. , Given Charles W. , Roberts Caralee
Published: December 2008

Objectives. We compared cervical cancer incidence, stage at diagnosis, and survival in Medicaid-insured and non–Medicaid-insured populations.

Methods. We stratified the sample by age and used ordered logistic regression to predict stage at diagnosis and used Cox proportional hazards regression to predict survival.

Results. Medicaid insured nearly one quarter of women diagnosed with cervical cancer. The likelihood of late-stage disease was greatest for women who enrolled in Medicaid after diagnosis. Women younger than 65 years who enrolled in Medicaid after diagnosis were more likely to die from cervical cancer than were women who were not insured by Medicaid (hazard ratio=2.40, 95% confidence interval=1.49, 3.86).

Conclusions. Our study underscores the importance of cervical cancer screening programs targeted at low-income women.
Very Low Birthweight in African American Infants: The Role of Maternal Exposure to Interpersonal Racial Discrimination
Authors: Collins James W. , David Richard J. , Handler Arden , Wall Stephen , Andes Steven
Published: December 2008

Objectives. We determined whether African American women’s lifetime exposure to interpersonal racial discrimination is associated with pregnancy outcomes.

Methods. We performed a case–control study among 104 African American women who delivered very low birthweight (<1500 g) preterm (<37 weeks) infants and 208 African American women who delivered non–low-birthweight (>2500g) term infants in Chicago, Ill.

Results. The unadjusted and adjusted odds ratio of very low birthweight infants for maternal lifetime exposure to interpersonal racism in 3 or more domains equaled 3.2 (95% confidence intervals=1.5, 6.6) and 2.6 (1.2, 5.3), respectively. This association tended to persist across maternal sociodemographic, biomedical, and behavioral characteristics.

Conclusions. The lifelong accumulated experiences of racial discrimination by African American women constitute an independent risk factor for preterm delivery.
Reducing Social Disparities in Tobacco Use: A Social-Contextual Model for Reducing Tobacco Use Among Blue-Collar Workers
Authors: Sorensen Glorian , Barbeau Elizabeth , Hunt Mary Kay , Emmons Karen
Published: December 2008

In the United States in 1997, the smoking prevalence among blue-collar workers was nearly double that among white-collar workers, underscoring the need for new approaches to reduce social disparities in tobacco use. These inequalities reflect larger structural forces that shape the social context of workers’ lives.

Drawing from a range of social and behavioral theories and lessons from social epidemiology, we articulate a social-contextual model for understanding ways in which socioeconomic position, particularly occupation, influences smoking patterns. We present applications of this model to worksite-based smoking cessation interventions among blue-collar workers and provide empirical support for this model. We also propose avenues for future research guided by this model.
Public Health Under Attack: The American Stop Smoking Intervention Study (ASSIST) and the Tobacco Industry
Authors: White Jenny , Bero Lisa A.
Published: December 2008

We describe the tobacco industry’s response to the American Stop Smoking Intervention Study (ASSIST). Tobacco industry documents from the University of California, San Francisco/Legacy Tobacco Documents Library and industry Web sites were analyzed. LexisNexis and the Library of Congress’s Thomas Web site were searched for legislative history.

We found that the tobacco industry considered ASSIST a major threat because of its emphasis on policy and creation of local tobacco control infrastructures. The industry mobilized resources for a well-coordinated attack on ASSIST. Although industry executives were sometimes frustrated in their efforts, they ultimately had a chilling effect on ASSIST.

This evidence suggest that tobacco control advocates should expect a vigorous response from the tobacco industry to policy advocacy efforts, particularly at the local level.
Tobacco Industry Direct Mail Marketing and Participation by New Jersey Adults
Authors: Lewis M. Jane , Delnevo Cristine D. , Slade John
Published: December 2008

We examined adult participation in tobacco industry direct marketing: receipt of direct mail and use of coupons and brand reward programs. Participation was highest for direct mail; participation in all 3 forms differed by gender, age, and race/ethnicity; current smokers, Whites, and persons aged 25 to 64 years reported greater participation. Although tobacco industry direct marketing may influence smoking initiation, its potential to increase consumption and impede cessation is unquestionable.
Risk Factors Associated With Problem Use of Prescription Drugs
Authors: Simoni-Wastila Linda , Strickler Gail
Published: December 2008

We estimate the prevalence of and risk factors for the problem use of prescription drugs, overall and by therapeutic class. Applying logistic regression analysis to data from the National Household Survey on Drug Abuse, 1 we found that nearly 1.3 million Americans aged 12 years and older experience problem use of prescription drugs signifying physiological dependence or heavy daily use. Those at greatest risk include older adults, females, those in poor/fair health, and daily alcohol drinkers.
Effects of Tobacco Smoke Exposure on Asthma Prevalence and Medical Care Use in North Carolina Middle School Children
Authors: Sturm Jesse J. , Yeatts Karin , Loomis Dana
Published: December 2008

Objectives. We sought to determine the effects of exposure to environmental tobacco smoke (ETS) and childhood cigarette smoking on asthma symptoms among middle school children in North Carolina.

Methods. During 1999–2000, information was collected from a survey completed by the children. Outcomes of asthma symptom reporting were regressed on tobacco smoke exposures.

Results. Children who currently smoked or reported any exposure to ETS were at increased risk of reporting active asthma symptoms. Exposure to ETS and childhood cigarette smoking was responsible for 15% of the asthma cases observed in the study population and $1.34 million in excess medical expenditures.

Conclusions. Even at low levels of exposure, childhood cigarette smoking and ETS are independently associated with asthmatic symptoms.
Design and Analysis of Group-Randomized Trials: A Review of Recent Methodological Developments
Authors: Murray David M. , Varnell Sherri P. , Blitstein Jonathan L.
Published: December 2008

We review recent developments in the design and analysis of group-randomized trials (GRTs). Regarding design, we summarize developments in estimates of intraclass correlation, power analysis, matched designs, designs involving one group per condition, and designs in which individuals are randomized to receive treatments in groups. Regarding analysis, we summarize developments in marginal and conditional models, the sandwich estimator, model-based estimators, binary data, survival analysis, randomization tests, survey methods, latent variable methods and nonlinear mixed models, time series methods, global tests for multiple endpoints, mediation effects, missing data, trial reporting, and software.

We encourage investigators who conduct GRTs to become familiar with these developments and to collaborate with methodologists who can strengthen the design and analysis of their trials.
The Burden of Disease From Undernutrition and Overnutrition in Countries Undergoing Rapid Nutrition Transition: A View From Brazil
Authors: Monteiro Carlos A. , Conde Wolney L. , Popkin Barry M.
Published: December 2008

On the basis of 3 comparable population-based surveys conducted in Brazil, we identified clear changes in the relative magnitude of women’s undernutrition and overnutrition. In 1975, there were almost 2 cases of underweight to 1 case of obesity, whereas in 1997, there were more than 2 cases of obesity to 1 case of underweight. In 1997, Brazilian low-income women were significantly more susceptible than high-income women to both underweight and obesity.
A Population-Based Registry Study of Infant Mortality in the Arctic: Greenland and Denmark, 1973–1997
Authors: Friborg Jeppe , Koch Anders , Stenz Flemming , Wohlfahrt Jan , Melbye Mads
Published: December 2008

Objectives. We sought to determine precise estimates of infant mortality rates and to describe overall trends in infant mortality in Greenland and Denmark from 1973 to 1997.

Methods. We analyzed data from population-based registries of all live-born infants in Greenland and Denmark to calculate infant mortality rates from 1973 to 1997.

Results. Between the periods of 1973–1977 and 1993–1997, neonatal mortality rates in Greenland declined from 20.9 per 1000 live-born infants to 15.7, and postneonatal mortality rates declined from 20.9 per 1000 to 5.9. Infant mortality rates were significantly higher in Greenland than in Denmark, and the excess mortality was uniformly distributed over all birthweight percentiles. In Greenland, the risk of infant death was significantly lower if the mother was born outside Greenland.

Conclusions. Postneonatal mortality rates in Greenland have decreased significantly during the past 25 years, but little progress has been made in decreasing neonatal mortality rates. Disparities exist among children with different maternal origins.
Fruits, Vegetables, Milk, and Sweetened Beverages Consumption and Access to à la Carte/Snack Bar Meals at School
Authors: Cullen Karen Weber , Zakeri Issa
Published: December 2008

Objectives. We assessed the impact of access to school snack bars on middle school students’ fruit, vegetable, milk, and sweetened beverage consumption.

Methods. Five hundred ninety-four fourth- and fifth-grade students completed lunch food records 4 times during a 2-year period.

Results. The fourth-grade cohort consumed fewer fruits, regular (not fried) vegetables, and less milk and consumed more sweetened beverages and high-fat vegetables during year 2.

Conclusions. Middle school students who gained access to school snack bars consumed fewer healthy foods compared with the previous school year, when they were in elementary schools and only had access to lunch meals served at school. Healthy food choices and school policies that require healthier foods at school snack bars should be promoted.
Integrating the Environment, the Economy, and Community Health: A Community Health Center’s Initiative to Link Health Benefits to Smart Growth
Authors: McAvoy Peter V. , Driscoll Mary Beth , Gramling Benjamin J.
Published: December 2008

The Sixteenth Street Community Health Center (SSCHC) in Milwaukee, Wis, is making a difference in the livability of surrounding neighborhoods and the overall health of the families it serves. SSCHC is going beyond traditional health care provider models and working to link the environment, the economy, and community health through urban brownfield redevelopment and sustainable land-use planning.

In 1997, SSCHC recognized that restoration of local air and water quality and other environmental conditions, coupled with restoring family-supporting jobs in the neighborhood, could have a substantial impact on the overall health of families. Recent events indicate that SSCHC’s pursuit of smart growth strategies has begun to pay off.
Florida’s Motorcycle Helmet Law Repeal and Fatality Rates
Authors: Muller Andreas
Published: December 2008

On July 1 2000, the State of Florida exempted adult motorcyclist and moped riders from wearing helmets provided they have medical insurance of $10 000. Monthly time series of motorcycle occupant deaths are examined from 1/1994 to 12/2001. The interrupted time series analysis estimates a 48.6% increase in motorcycle occupant deaths the year after the law change. The impact estimate reduces to 38.2% and 21.3% when trends in travel miles and motorcycle registrations are controlled. Our findings suggest that the law’s age exemption should be revoked.
Asthma, Wheezing, and Allergies in Russian Schoolchildren in Relation to New Surface Materials in the Home
Authors: Jaakkola Jouni J. K. , Parise Helen , Kislitsin Victor , Lebedeva Natalia I. , Spengler John D.
Published: December 2008

In a cross-sectional study of 5951 Russian 8–12-year-old schoolchildren, risks of current asthma, wheezing, and allergy were related to recent renovation and the installation of materials with potential chemical emissions. New linoleum flooring, synthetic carpeting, particleboard, wall coverings, and furniture and recent painting were determinants of 1 or several of these 3 health outcomes. These findings warrant further attention to the type of materials used in interior design.
Community Violence and Asthma Morbidity: The Inner-City Asthma Study
Authors: Wright Rosalind J. , Mitchell Herman , Visness Cynthia M. , Cohen Sheldon , Stout James , Evans Richard , Gold Diane R.
Published: December 2008

Objectives. We examined the association between exposure to violence and asthma among urban children.

Methods. We obtained reports from caretakers (n = 851) of violence, negative life events, unwanted memories (rumination), caretaker-perceived stress, and caretaker behaviors (keeping children indoors, smoking, and medication adherence). Outcomes included caretaker-reported wheezing, sleep disruption, interference with play because of asthma, and effects on the caretaker (nights caretaker lost sleep because of child’s asthma).

Results. Increased exposure to violence predicted higher number of symptom days (P = .0008) and more nights that caretakers lost sleep (P = .02) in a graded fashion after control for socioeconomic status, housing deterioration, and negative life events. Control for stress and behaviors partially attenuated this gradient, although these variables had little effect on the association between the highest level of exposure to morbidity, which suggests there are other mechanisms.

Conclusions. Mechanisms linking violence and asthma morbidity need to be further explored.
Effects of WIC Participation on Children’s Use of Oral Health Services
Authors: Lee Jessica Y. , Rozier R. Gary , Norton Edward C. , Kotch Jonathan B. , Vann William F.
Published: December 2008

Objectives. We estimated the effects of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on dental services use by Medicaid children in North Carolina.

Methods. We used linked Medicaid claims and enrollment files, WIC files, and the area resource file to compare dental services use for children enrolled in WIC with those not enrolled. We used multivariate models that controlled for child clustering and employed 2-step methodology to control for selection bias.

Results. Children who participated in WIC had an increased probability of having a dental visit, were more likely to use preventive and restorative services, and were less likely to use emergency services.

Conclusions. Children’s WIC participation improved access to dental care services that should lead to improved oral health.
Delays and Unmet Need for Health Care Among Adult Primary Care Patients in a Restructured Urban Public Health System
Authors: Diamant Allison L. , Hays Ron D. , Morales Leo S. , Ford Wesley , Calmes Daphne , Asch Steven , Duan Naihua , Fielder Eve , Kim Sehyun , Fielding Jonathan , Sumner Gerald , Shapiro Martin F. , Hayes-Bautista David , Gelberg Lillian
Published: December 2008

Objectives. We estimated the prevalence and determinants of delayed and unmet needs for medical care among patients in a restructured public health system.

Methods. We conducted a stratified cross-sectional probability sample of primary care patients in the Los Angeles County Department of Health Services. Face-to-face interviews were conducted with 1819 adult patients in 6 languages. The response rate was 80%. The study sample was racially/ethnically diverse.

Results. Thirty-three percent reported delaying needed medical care during the preceding 12 months; 25% reported an unmet need for care because of competing priorities; and 46% had either delayed or gone without care.

Conclusions. Barriers to needed health care continue to exist among patients receiving care through a large safety net system. Competing priorities for basic necessities and lack of insurance contribute importantly to unmet health care needs.
Factors Associated With Colorectal Cancer Screening Among the US Urban Japanese Population
Authors: Honda Keiko
Published: December 2008

Objectives. The author examined the prevalence and predictors of colorectal cancer screening among the urban Japanese population of the United States.

Methods. A sample of Japanese residents of major US metropolitan areas completed a self-administered mailed survey.

Results. Physician recommendation, acculturation, and perceived psychological costs were consistent predictors of screening for colorectal cancer. Gender and marital status were related to screening via fecal occult blood testing; age, susceptibility, and health insurance were related to sigmoidoscopy/colonoscopy screening.

Conclusions. Colorectal cancer screening among the urban Japanese population could be increased with interventions seeking to promote physician recommendations for screening, alleviate perceived psychological costs among patients, and improve physician–patient communication.
The Limited Relevance of Drug Policy: Cannabis in Amsterdam and in San Francisco
Authors: Reinarman Craig , Cohen Peter D. A. , Kaal Hendrien L.
Published: December 2008

Objectives. We tested the premise that punishment for cannabis use deters use and thereby benefits public health.

Methods. We compared representative samples of experienced cannabis users in similar cities with opposing cannabis policies—Amsterdam, the Netherlands (decriminalization), and San Francisco, Calif (criminalization). We compared age at onset, regular and maximum use, frequency and quantity of use over time, intensity and duration of intoxication, career use patterns, and other drug use.

Results. With the exception of higher drug use in San Francisco, we found strong similarities across both cities. We found no evidence to support claims that criminalization reduces use or that decriminalization increases use.

Conclusions. Drug policies may have less impact on cannabis use than is currently thought.
Draw the Line/Respect the Line: A Randomized Trial of a Middle School Intervention to Reduce Sexual Risk Behaviors
Authors: Coyle Karin K. , Kirby Douglas B. , Marín Barbara V. , Gómez Cynthia A. , Gregorich Steven E.
Published: December 2008

Objectives. This study evaluated the long-term effectiveness of Draw the Line/Respect the Line, a theoretically based curriculum designed to reduce sexual risk behaviors among middle school adolescents.

Methods. The randomized controlled trial involved 19 schools in northern California. A cohort of 2829 sixth graders was tracked for 36 months.

Results. The intervention delayed sexual initiation among boys, but not girls. Boys in the intervention condition also exhibited significantly greater knowledge than control students, perceived fewer peer norms supporting sexual intercourse, had more positive attitudes toward not having sex, had stronger sexual limits, and were less likely to be in situations that could lead to sexual behaviors. Psychosocial effects for girls were limited.

Conclusions. The program was effective for boys, but not for girls.
Adolescents and Firearms: A California Statewide Survey
Authors: Sorenson Susan B. , Vittes Katherine A.
Published: December 2008

Objectives. We assessed the prevalence and correlates of adolescents’ reports regarding firearms in their homes, of their own, of close friends, and of same-aged peers.

Methods. Random-digit-dialed interviews were conducted with 5801 adolescents as part of the California Health Interview Survey.

Results. One fifth (19.6%) of California adolescents reported having a firearm in their homes; few (3.0%) reported having their own gun. Characteristics associated with having one’s own gun and with perceptions regarding others’ guns generally were consistent with characteristics associated with having a firearm in the home. The 2 exceptions were related to socioeconomic status and to ethnicity.

Conclusions. The source from which adolescents obtain guns, especially adolescents from less wealthy households, merits further investigation. Further research is needed to ascertain the accuracy of Black and Latino adolescents’ perceptions regarding handguns among their peers.
Overcoming Language Barriers in Health Care: Costs and Benefits of Interpreter Services
Authors: Jacobs Elizabeth A. , Shepard Donald S. , Suaya Jose A. , Stone Esta-Lee
Published: December 2008

Objectives. We assessed the impact of interpreter services on the cost and the utilization of health care services among patients with limited English proficiency.

Methods. We measured the change in delivery and cost of care provided to patients enrolled in a health maintenance organization before and after interpreter services were implemented.

Results. Compared with English-speaking patients, patients who used the interpreter services received significantly more recommended preventive services, made more office visits, and had more prescriptions written and filled. The estimated cost of providing interpreter services was $279 per person per year.

Conclusions. Providing interpreter services is a financially viable method for enhancing delivery of health care to patients with limited English proficiency.
Trends in Fruit and Vegetable Consumption Among Adults in the United States: Behavioral Risk Factor Surveillance System, 1994–2000
Authors: Serdula Mary K. , Gillespie Cathleen , Kettel-Khan Laura , Farris Rosanne , Seymour Jennifer , Denny Clark
Published: December 2008

Objectives. We examined trends in fruit and vegetable consumption in the United States.

Methods. A 6-item food frequency questionnaire was used to assess consumption among 434 121 adults in 49 states and the District of Columbia who were sampled in random-digit-dialed telephone surveys administered in 1994, 1996, 1998, and 2000.

Results. Although the geometric mean frequency of fruit and vegetable consumption declined slightly, the proportion of respondents consuming fruits and vegetables 5 or more times per day did not change. With the exception of the group aged 18 to 24 years, which experienced a 3-percentage-point increase, little change was seen among sociodemographic subgroups.

Conclusions. Frequency of fruit and vegetable consumption changed little from 1994 to 2000. If increases are to be achieved, additional efforts and new strategies will be needed.
Role of Health Insurance and a Usual Source of Medical Care in Age-Appropriate Vaccination
Authors: Dombkowski Kevin J. , Lantz Paula M. , Freed Gary L.
Published: December 2008

Objectives. We examined the associations of having health insurance and having a usual source of medical care with age-appropriate childhood vaccination.

Methods. Simulations were conducted with multivariate logistic regression models and a nationally representative sample of children to assess the likelihood of age-appropriate vaccination.

Results. Simulated provision of health insurance and a usual source of medical care produced substantial increases in the likelihood of doses being received age-appropriately. Increases in the likelihood of a child’s being up to date were also observed, but these increases typically were smaller than for age-appropriate vaccination.

Conclusions. Changes in childhood vaccination status should be assessed in age-appropriate terms, because measures of “up to date” status may not capture the effects of immunization interventions.
The Regional Immunization Registry as a Public Health Tool for Improving Clinical Practice and Guiding Immunization Delivery Policy
Authors: Kempe Allison , Beaty Brenda L. , Steiner John F. , Pearson Kellyn A. , Lowery N. Elaine , Daley Matthew F. , Crane Lori A. , Berman Stephen
Published: December 2008

Objectives. We assessed the distribution of immunization records among 3 health care delivery sectors and the impact of a regional immunization registry on “up to date” rates.

Methods. Immunization registry records in 2 regions were categorized as having originated in private practices, community health centers, or public health clinics. “Up to date” rates were calculated after we sequentially added immunization records from the 3 sectors.

Results. The percentage of children with immunizations documented in multiple sectors increased with age from 7 to 24 months, and children who were seen in multiple sectors were more likely to be up to date. There were relative increases in “up to date” rates of 50% for children aged 24 months.

Conclusions. The regional immunization registry is a powerful public health tool for increasing documented “up to date” rates and providing insights into patterns of immunization delivery.
Legal and Public Policy Responses of States to Bioterrorism
Authors: Martin William
Published: December 2008

In late 2001, during the aftermath of the anthrax letter attacks, model legislation was proposed to relevant state agencies to update their states’ public health laws to meet the threat of bioterrorism. This legislation was the Model State Emergency Health Powers Act.

A concern underlying this and related efforts to address future bioterrorism threats was the perceived inadequacy of state laws to respond effectively when such threats occur. We evaluated how 4 states—Utah, Maine, South Dakota, and Indiana—addressed this concern in the context of the model legislation.

The conclusion is that the model legislation generally served as an important catalyst for state action in the field of bioterrorism preparation.
Syphilis Testing in Association With Gonorrhea/Chlamydia Testing During a Syphilis Outbreak
Authors: Rosenman Marc B. , Kraft Stephanie K. , Harezlak Jaroslaw , Mahon Barbara E. , Katz Barry P. , Wang Jane , Arno Janet N.
Published: December 2008

We used an electronic medical records system retrospectively to evaluate how frequently, in a public hospital and its clinics, combined gonorrhea/chlamydia tests were accompanied by a syphilis test before and during a syphilis outbreak. Among 70 330 gonorrhea/chlamydia tests (1996–2000), the proportion with a syphilis test increased from 13% (preoutbreak) to 50% (intervention period) for men and from 6% to 13% for nonpregnant women. The increased syphilis testing coincided with a multifaceted public health intervention.
Changes in Sexual Behavior Among HIV-Infected Women After Initiation of HAART
Authors: Wilson Tracey E. , Gore Mary Elizabeth , Greenblatt Ruth , Cohen Mardge , Minkoff Howard , Silver Sylvia , Robison Esther , Levine Alexandra , Gange Stephen J.
Published: December 2008

Objectives. We assessed the association between initiation of highly active antiretroviral treatment (HAART) regimens and sexual risk behaviors among HIVinfected women.

Methods. We analyzed data from 724 women who initiated HAART between January 1996 and January 2001 and who had pre-HAART viral loads at or above 400 copies per milliliter.

Results. Sexually active women were less likely (odds ratio [OR] = 0.79) to report 2 or more partners during a 6-month period after HAART initiation than before HAART initiation. However, the risk for unprotected sex was higher after HAART initiation than before HAART initiation among all sexually active women (both those who reported 2 or more partners [OR = 1.84] and those who reported 1 partner [OR = 1.22]).

Conclusions. Sexual risk behaviors are associated with receipt of therapy but not with therapeutic response, indicating a risk for transmission among female HAART recipients.
Medically Eligible Women Who Do Not Use HAART: The Importance of Abuse, Drug Use, and Race
Authors: Cohen Mardge H. , Cook Judith A. , Grey Dennis , Young Mary , Hanau Lawrence H. , Tien Phyllis , Levine Alexandra M. , Wilson Tracey E.
Published: December 2008

Objectives. We investigated the prevalence and characteristics of HIV-positive women who do not report highly active antiretroviral therapy (HAART) use.

Methods. We analyzed HAART use among 1165 HIV-positive participants in the Women’s Interagency HIV Study.

Results. Between October 1, 2000, and March 31, 2001, 254 women with clinical indications for HAART reported not using it, 635 reported HAART use, and 276 had no clinical indications. In multivariate analysis, using crack/cocaine/heroin and a history of abuse decreased the likelihood of using HAART, whereas being White increased it.

Conclusions. One of 4 women for whom HAART was indicated reported not using HAART. Childhood sexual abuse prevention, more intensive abuse treatment, and continuing drug treatment may enhance HIV disease treatment of women.
Acceptability of a Microbicide Among Women and Their Partners in a 4-Country Phase I Trial
Authors: Bentley Margaret E. , Fullem Andrew M. , Tolley Elizabeth E. , Kelly Clifton W. , Jogelkar Neelam , Srirak Namtip , Mwafulirwa Liness , Khumalo-Sakutukwa Gertrude , Celentano David D.
Published: December 2008

Objectives. We analyzed qualitative and quantitative data for 98 HIV-negative, low-risk women in Malawi, Zimbabwe, India, and Thailand who participated in a safety and acceptability study of BufferGel, a vaginal microbicide to determine the across-country acceptability of vaginal microbicides among women and their partners.

Methods. Quantitative survey data were collected at 7 and 14 days after use among enrolled women, and exit interviews were conducted with women and their partners in separate focus group discussions.

Results. Acceptability was high in all sites (73% of women approved of the microbicide). Women in Africa, where HIV infection rates are highest, were virtually unanimous in their desire for such a product, suggesting that an individual’s perception of being at risk for HIV will outweigh concerns about side effects, problems applying a product, or other factors, when products are shown to be efficacious. But men and women reported that use, which was kept secret from an intimate partner, would be difficult and might “break the trust” of a relationship.

Conclusions. Acceptability research across diverse settings through all stages of microbicide research, development, and postlicensure dissemination can help maximize acceptability and use.
Effectiveness of HIV Prevention in Ontario, Canada: A Multilevel Comparison of Bisexual Men
Authors: Leaver Chad A. , Allman Dan , Meyers Ted , Veugelers Paul J.
Published: December 2008

Objectives. We examined the effectiveness of community-level HIV prevention programming for men who have sex with men.

Methods. We used multilevel methods to examine unprotected intercourse by bisexual men (n = 1016) with male and female partners in geographic regions with and without HIV prevention programming.

Results. Men living in geographic regions with HIV prevention programming had significantly less frequent unprotected homosexual intercourse with both casual and regular partners. In contrast, no differences were observed for unprotected heterosexual intercourse.

Conclusions. This study provides evidence supporting the effectiveness of community-level HIV prevention programming and the need for its broader implementation. The study also demonstrates the suitability of multilevel methods for examining the effectiveness of community-level public health programs.
Geographic Location of Commercial Plasma Donation Clinics in the United States, 1980–1995
Authors: James Robert C. , Mustard Cameron A.
Published: December 2008

Objective. We examined the location of commercial plasma donation centers in the United States over the period 1980 to 1995 relative to the geographic distribution of risk behaviors associated with transfusion-transmissible infections.

Methods. The census tract locations of commercial source plasma clinics were described by measures of neighborhood social disadvantage and the prevalence of illicit drug use and active local drug economies.

Results. Depending on the measure of social environment used, commercial plasma clinics were 5 to 8 times more likely to be located in census tracts designated high-risk than would be expected by chance.

Conclusions. Commercial source plasma clinics were overrepresented in neighborhoods with very active local drug economies. These patterns persisted after the links between human immunodeficiency virus and hepatitis C virus infections and plasma products had been established and may present risks to blood system safety.
Insurance Coverage of Smoking Cessation Treatment for State Employees
Authors: Burns Marguerite E. , Bosworth Timothy W. , Fiore Michael C.
Published: December 2008

Public health experts recommend that health insurance include coverage for smoking cessation treatment as an evidence-based strategy to reduce smoking. As employers, states can implement this policy for more than 5 million individuals nationwide. This study identified the extent to which states require smoking cessation treatment insurance coverage for their employees; of 45 states, 29 required coverage for at least 1 US Public Health Service (PHS)–recommended treatment, and only 17 of 45 provided coverage that was fully consistent with PHS recommendations.
Fertility and Parental Consent for Minors to Receive Contraceptives
Authors: Zavodny Madeline
Published: December 2008

Objectives. I examined the effect of imposing a requirement for parental consent before minors can receive medical contraceptives.

Methods. Birth and abortions among teens, relative to adults, in a suburban Illinois county that imposed a parental consent requirement in 1998 were compared with births and abortions in nearby counties during the period 1997–2000.

Results. The relative proportion of births to women under age 19 years in the county rose significantly compared with nearby counties, whereas the relative proportion of abortions to women under age 20 years declined insignificantly, with a relative increase in the proportion of pregnancies (births and abortions) to young women in the county.

Conclusions. Imposing a parental consent requirement for contraceptives, but not abortions, appears to raise the frequency of pregnancies and births among young women.
Trends in Prenatal Care Use and Low Birthweight in Southeast Brazil
Authors: Goldani Marcelo Z. , Barbieri Marco A. , Silva Antonio A. M. , Bettiol Heloisa
Published: December 2008

Objectives. We investigated trends in prenatal care use and its association with low birthweight in a developing country.

Methods. We examined data from 2 southeast Brazilian cohort surveys, 1 conducted in 1978–1979 and the other in 1994.

Results. Socioeconomic inequalities in prenatal care use increased during the 15-year period of 1979–1994. Although prenatal care use increases paralleled increases in low birthweight rate during this period, having no prenatal care was associated with higher risk of low birthweight in both surveys. Inadequate prenatal care use was also associated with higher risk of low birthweight in 1978–1979 only.

Conclusions. Increasing low birthweight rates among women who adequately used prenatal care may be causing a bias by reducing the estimates of the effect of inadequate prenatal care use on low birthweight rates.
Implications of Family Income Dynamics for Women’s Depressive Symptoms During the First 3 Years After Childbirth
Authors: Dearing Eric , Taylor Beck A. , McCartney Kathleen
Published: December 2008

Objectives. We examined within-person associations between changes in family income and women’s depressive symptoms during the first 3 years after childbirth.

Methods. Data were analyzed for 1351 women (mean baseline age = 28.13 years) who participated in the National Institute of Child Health and Human Development Study of Early Child Care. Nineteen percent of these women belonged to an ethnic minority, and 35% were poor at some time during the study.

Results. Changes in income and poverty status were significantly associated with changes in depressive symptoms. Effects were greatest for chronically poor women and for women who perceived fewer costs associated with their employment.

Conclusions. Given that women head most poor households in the United States, our findings indicate that reductions in poverty would have mental health benefits for women and families.
Feasibility and Benefits of a Parent-Focused Preschool Child Obesity Intervention
Authors: McGarvey Elizabeth , Keller Adrienne , Forrester Mena , Williams Erin , Seward Donna , Suttle David E.
Published: December 2008

Objectives. This field study tested the feasibility and benefits of a program to promote 6 targeted parental behaviors to prevent obesity in children served by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

Methods. Two WIC sites participated in a nonrandomized, controlled 1-year prospective study to assess parents’ self-reported behavior changes.

Results. Statistical analyses of preintervention and postintervention assessments of parental behavior demonstrated significant changes in 2 behaviors: frequency of offering the child water and frequency of engaging in active play with the child. In both cases, the intervention proved effective in increasing the desired behavior.

Conclusions. The findings demonstrate the feasibility of changing parental behaviors through multidimensional education in a WIC clinic setting.
An Environmental Intervention to Promote Lower-Fat Food Choices in Secondary Schools: Outcomes of the TACOS Study
Authors: French Simone A. , Story Mary , Fulkerson Jayne A. , Hannan Peter
Published: December 2008

Objectives. We evaluated an environmental intervention intended to increase sales of lower-fat foods in secondary school cafeterias.

Methods. Twenty secondary schools were randomly assigned to either an environmental intervention or a control group for a 2-year period. The intervention increased the availability of lower-fat foods and implemented student-based promotions.

Results. A steeper rate of increase in sales of lower-fat foods in year 1 (10% intervention vs −2.8% control, P = .002) and a higher percentage of sales of lower-fat foods in year 2 (33.6% intervention vs 22.1% control, P = .04) were observed. There were no significant changes in student self-reported food choices.

Conclusions. School-based environmental interventions to increase availability and promotion of lower-fat foods can increase purchase of these foods among adolescents.
Improvements in Heart Health Behaviors and Reduction in Coronary Artery Disease Risk Factors in Urban Teenaged Girls Through a School-Based Intervention: The PATH Program
Authors: Bayne-Smith Marcia , Fardy Paul S. , Azzollini Ann , Magel John , Schmitz Kathryn H. , Agin Denise
Published: December 2008

Objectives. We sought to assess the effects of a school-based intervention program on cardiovascular disease risk factors in urban girls.

Methods. We compared heart health knowledge, health behaviors, cardiovascular risk factors, and physical fitness among a group of 442 multiethnic teenaged girls (310 experimental participants vs 132 control participants). Testing was conducted before and after a 12-week program of vigorous exercises integrated with lectures and discussions on diet, exercise, stress, and smoking.

Results. Significant differences in body fat, systolic and diastolic blood pressure, heart health knowledge, and whether breakfast was eaten were observed between experimental participants and control participants.

Conclusions. An integrated program of exercise and heart health–related lectures and discussions had a beneficial effect on health knowledge, health behaviors, and onset of risk factors for coronary artery disease among urban girls.
Sociodemographic and Geographic Correlates of Meeting Current Recommendations for Physical Activity in Middle-Aged French Adults: the Supplémentation en Vitamines et Minéraux Antioxydants (SUVIMAX) Study
Authors: Bertrais Sandrine , Preziosi Paul , Mennen Louise , Galan Pilar , Hercberg Serge , Oppert Jean-Michel
Published: December 2008

Objective. We evaluated the characteristics of French subjects meeting current public health recommendations for physical activity.

Methods. We assessed leisure-time physical activity cross-sectionally in 7404 adults aged 45 to 68 years with applied logistic regression models.

Results. Meeting the recommended physical activity levels was more likely in subjects aged 60 years and older and in women with higher education levels or living in rural areas and was less likely in smokers. No association was found with time spent watching television. The contribution of vigorous activity to total time spent being active was approximately 2 times higher in subjects meeting recommendations.

Conclusions. Participation in some vigorous activity may be viewed as a “facilitator” to attain physical activity recommendations. Relationships with physical environment variables in Europe need further investigation.
Urban Sprawl and Risk for Being Overweight or Obese
Authors: Lopez Russ
Published: December 2008

Objectives. I examined the association between urban sprawl and the risk for being overweight or obese among US adults.

Methods. A measure of urban sprawl in metropolitan areas was derived from the 2000 US Census; individual-level data were obtained from the Behavioral Risk Factor Surveillance System. I used multilevel analysis to assess the association between urban sprawl and obesity.

Results. After I controlled for gender, age, race/ethnicity, income, and education, for each 1-point rise in the urban sprawl index (0–100 scale), the risk for being overweight increased by 0.2% and the risk for being obese increased by 0.5%.

Conclusions. The current obesity epidemic has many causes, but there is an association between urban sprawl and obesity.
A Potential Natural Treatment for Attention-Deficit/Hyperactivity Disorder: Evidence From a National Study
Authors: Kuo Frances E. , Faber Taylor Andrea
Published: December 2008

Objectives. We examined the impact of relatively “green” or natural settings on attention-deficit/hyperactivity disorder (ADHD) symptoms across diverse subpopulations of children.

Methods. Parents nationwide rated the aftereffects of 49 common after-school and weekend activities on children’s symptoms. Aftereffects were compared for activities conducted in green outdoor settings versus those conducted in both built outdoor and indoor settings.

Results. In this national, nonprobability sample, green outdoor activities reduced symptoms significantly more than did activities conducted in other settings, even when activities were matched across settings. Findings were consistent across age, gender, and income groups; community types; geographic regions; and diagnoses.

Conclusions. Green outdoor settings appear to reduce ADHD symptoms in children across a wide range of individual, residential, and case characteristics.