bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of Minority Status and Rural Residence on Actions to Control High Blood Pressure in the U.S.
Authors: Ellis Charles , Grubaugh Anouk L. , Egede Leonard E.
Published: July 2017

Objective.

We examined actions to control high blood pressure (HBP) and health-care provider recommendations for blood pressure control among adults by racial/ethnic group and rural/urban residence.

Methods.

We examined data from 45,024 participants with HBP in the 2007 Behavioral Risk Factor Surveillance System (BRFSS) survey. We used multiple logistic regression analyses to assess the independent association between current actions to control HBP and health-care provider recommendations for blood pressure control by race/ethnicity and rural/urban status after accounting for confounders.

Results.

Black people, regardless of rural or urban residence, were more likely to report reducing salt and alcohol intake, changing eating habits, and taking medications than both white urban and white rural adults. Black people, regardless of rural or urban status, were more likely to be advised to cut down on salt, reduce alcohol use, and change eating habits. Black rural adults were also more likely to report being advised to take medications than white urban adults, while white rural adults were less likely to be advised to exercise than white urban adults.

Conclusions.

Race/ethnicity and rural/urban status have a differential effect on actions to control HBP and provider advice to control HBP.
Racial/Ethnic Disparities in All-Cause Mortality in U.S. Adults: The Effect of Allostatic Load
Authors: Borrell Luisa N. , Dallo Florence J. , Nguyen Norma
Published: July 2017

Objective.

We investigated the association between a cumulative biological risk or allostatic score and all-cause mortality risk. We used 13,715 records of participants aged 25 years and older from the Third National Health and Nutrition Examination Survey (NHANES III) linked to the National Death Index.

Methods.

We specified all-cause mortality using the underlying cause of death in the death certificate. We calculated time to death from interview date through December 31, 2000, as person-years of follow-up using the NHANES III interview month and year. We used Cox proportional hazards regression to estimate hazard ratios (HRs) relating all-cause mortality risk for those with an allostatic score of 2 and ≥3 relative to those with an allostatic score of ≤1.

Results.

After controlling for age, gender, race/ethnicity, education, and income, mortality rates were 40% (HR=51.40, 95% confidence interval [CI] 1.11, 1.76) and 88% (HR=51.88, 95% CI 1.56, 2.26) higher for participants with an allostatic score of 2 and ≥3, respectively, compared with those with a score of ≤1. The death rate associated with allostatic score for each racial/ethnic group differed with age.

Conclusions.

The allostatic score increased the risk of all-cause mortality. Moreover, this increased risk was observed for adults younger than 65 years of age regardless of their race/ethnicity Thus, allostatic score may be a contributor to premature death in the U.S.
The National Asthma Survey—New York State: Association of the Home Environment with Current Asthma Status
Authors: Nguyen Trang , Lurie Melissa , Gomez Marta , Reddy Amanda , Pandya Kruti , Medvesky Michael
Published: July 2017

Objectives.

The National Asthma Survey—New York State (NYS), a telephone survey of NYS residents, was conducted in 2002–2003 to further understand the burden of asthma among adults and children and to identify health, socioeconomic, behavioral, and environmental factors associated with asthma.

Methods.

A total of 1,412 households with at least one member with current asthma and 2,290 control households answered questions about their home environment (e.g., presence of asthma triggers and practices that promote or reduce common asthma triggers).

Results.

For children younger than 18 years of age, we found statistically significant positive associations between current asthma and the presence of mold (adjusted odds ratio [AOR] = 2.1, 95% confidence interval [CI] 1.3, 3.3), air cleaners (AOR=1.5, 95% CI 1.1, 2.1), dehumidifiers (AOR=2.0, 95% CI 1.4, 2.7), and humidifiers (AOR=1.6, 95% CI 1.1, 2.3). For adults, there were statistically significant positive associations with the presence of mold (AOR=2.5, 95% CI 1.8, 3.4), air cleaners (AOR=2.2, 95% CI 1.7, 2.8), and humidifiers (AOR=1.4, 95% CI 1.1, 1.8). There were no statistically significant associations with the presence of cockroaches, pets, or tobacco smoke, while use of a wood-burning stove or fireplace was significantly more prevalent in control homes.

Conclusions.

Asthma guidelines emphasize the importance of reducing triggers in the home as part of a multifaceted approach to asthma control. Despite these guidelines, many asthma triggers (specifically, mold) were as prevalent or more so in the homes of New Yorkers with asthma as compared with control households. Public health interventions in NYS should focus on educating households about potential asthma triggers and their sources and teach methods to prevent, reduce, or eliminate them.
Federally Qualified Health Center Dental Program Finances: A Case Study
Authors: Beazoglou Tryfon , Bailit Howard , Maule Margaret Drozdowski
Published: July 2017

Objectives.

We analyzed the operation of one Connecticut federally qualified health center (FQHC) dental program with seven delivery sites. We assessed the financial operation of the different delivery sites and contrasted the overall performance of the FQHC with private practices.

Methods.

We obtained data from a pretested financial survey instrument, electronic patient visit records, and site visits. To assess clinic productivity, we used two output measures: patient visits and market value of services. For the latter, we estimated the implicit fee of each service provided in patient visits.

Results.

On average, these clinics were running a modest deficit, mainly due to startup costs of two new clinics. The primary factor that impacted net revenues was low reimbursement rates, including privately insured patients. When FQHC dental revenues were adjusted to market rates, revenues were close to expenses.

Conclusions.

FQHC dental clinics are major components of the dental safety net system. This case study suggests that the established clinics use resources as effectively as private practices.
Enhancing Surveillance for Hepatitis C through Public Health Informatics
Authors: Heisey-Grove Dawn M. , Church Daniel R. , Haney Gillian A. , DeMaria Alfred
Published: July 2017

Disease surveillance for hepatitis C in the United States is limited by the occult nature of many of these infections, the large volume of cases, and limited public health resources. Through a series of discrete processes, the Massachusetts Department of Public Health modified its surveillance system in an attempt to improve timeliness and completeness of reporting and case follow-up of hepatitis C. These processes included clinician-based reporting, electronic laboratory reporting, deployment of a Web-based disease surveillance system, automated triage of pertinent data, and automated character recognition software for case-report processing. These changes have resulted in an increase in the timeliness of reporting.
Evaluation of HIV Incidence Surveillance in New York City, 2006
Authors: Nair Hemanth P. , Torian Lucia V. , Forgione Lisa , Begier Elizabeth M.
Published: July 2017

In 2005, the New York City (NYC) Department of Health and Mental Hygiene implemented a standardized human immunodeficiency virus (HIV) incidence surveillance protocol based on the serologic testing algorithm for recent HIV seroconversion deployed nationwide by the Centers for Disease Control and Prevention (CDC). We evaluated four key attributes of NYC's HIV incidence surveillance system—simplicity, data quality, timeliness, and acceptability—using CDC's guidelines for surveillance system evaluation. The evaluation revealed that the system could potentially provide HIV incidence estimates stratified by borough and major demographic groups at about nine months after the period of interest. The system strengths include its relative simplicity and integration with routine HIV/acquired immunodeficiency syndrome surveillance. Weaknesses include lack of completeness of testing history information, a critical component of incidence estimation. Continued improvements in data completeness and timeliness will improve the currently available information to inform personnel who develop HIV-prevention programs and policy initiatives in NYC and nationally.
Prevalence of Health-Risk Behaviors among Asian American and Pacific Islander High School Students in the U.S., 2001–2007
Authors: Lowry Richard , Eaton Danice K. , Brener Nancy D. , Kann Laura
Published: July 2017

Objectives.

We provided national prevalence estimates for selected health-risk behaviors for Asian American and Pacific Islander high school students separately, and compared those prevalence estimates with those of white, black, and Hispanic students.

Methods.

We analyzed data from the Youth Risk Behavior Surveillance System. To generate a sufficient sample of Asian American and Pacific Islander students, we combined data from four nationally representative surveys of U.S. high school students conducted in 2001, 2003, 2005, and 2007 (total n=56,773).

Results.

Asian American students were significantly less likely than Pacific Islander, white, black, or Hispanic students to have drunk alcohol or used marijuana. Asian American students also were the least likely to have carried a weapon, to have been in a physical fight, to have ever had sexual intercourse, or to be currently sexually active. Once sexually active, Asian American students were as likely as most other racial/ethnic groups to have used alcohol or drugs at last sexual intercourse or to have used a condom at last sexual intercourse. Pacific Islander students were significantly more likely than Asian American, white, black, or Hispanic students to have seriously considered or attempted suicide.

Conclusions.

The prevalence estimates of health-risk behaviors exhibited by Asian American students and Pacific Islander students are very different and should be reported separately whenever feasible. To address the different health-risk behaviors exhibited by Asian American and Pacific Islander students, prevention programs should use culturally sensitive strategies and materials.
Incident Smoking during Pregnancy and the Postpartum Period in a Low-Income Urban Population
Authors: Webb David A. , Culhane Jennifer F. , Mathew Leny , Bloch Joan R. , Goldenberg Robert L.
Published: July 2017

Objectives.

We determined the prevalence of first lifetime use of cigarettes during pregnancy or in the early postpartum period (incident smoking) and identified sociodemographic and health-related characteristics of incident smokers.

Methods.

We used statistics based on data from a longitudinal study of a large cohort of pregnant, low-income, urban women ( n= 1,676) to describe the timing of first-time use and to compare incident smokers with those who had never smoked and those who had already smoked prior to pregnancy.

Results.

About one in 10 (10.2%) women who had not previously smoked initiated cigarette smoking during pregnancy or in the early postpartum period. Compared with those who had never smoked, incident smokers were more likely to report high levels of stress and to have elevated levels of depressive symptomatology, which may be rooted in relatively poor social and economic conditions.

Conclusion.

A significant number of women may be initiating smoking during pregnancy or in the early postpartum period. These women have characteristics that are consistent with the risk factors associated with smoking. Further research is warranted to determine prevalence in other populations, identify the risk factors for incident smoking, and assess the potential for primary prevention efforts designed to help women who had previously avoided cigarette use to remain smoke-free throughout pregnancy and in the postpartum period.
Statewide Estimation of Racial/Ethnic Populations of Men Who Have Sex with Men in the U.S.
Authors: Lieb Spencer , Fallon Stephen J. , Friedman Samuel R. , Thompson Daniel R. , Gates Gary J. , Liberti Thomas M. , Malow Robert M.
Published: July 2017

Objectives.

Men who have sex with men (MSM) bear the greatest burden of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) in every state in the U.S., but their populations are poorly defined. We estimated and compared populations of MSM in 2007 by region, state, and race/ethnicity.

Methods.

We averaged findings from two statistical models we had previously developed to estimate the total state-specific percentage and number of males who were MSM. The models were based, respectively, on state-specific rural/suburban/urban characteristics and an index using state-specific household census data on same-sex male unmarried partners. A third model, based on racial/ethnic ratios from a nationally representative behavioral survey, partitioned these statewide numbers by race/ethnicity.

Results.

Of an estimated 7.1 million MSM residing in the U.S. in 2007, 71.4% (5.1 million) were white, 15.9% (1.1 million) were Hispanic, 8.9% (635,000) were black, 2.7% (191,000) were Asian, 0.4% (26,000) were American Indian/Alaska Native, 0.1% (6,000) were Native Hawaiian/other Pacific Islander, and 0.6% (41,000) were of multiple/unknown race/ethnicity. The overall U.S. percentage of males who were MSM (6.4%) varied from 3.3% in South Dakota to 13.2% in the District of Columbia, which we treated as a state. Estimated numbers of MSM ranged from 9,612 in Wyoming to 1,104,805 in California.

Conclusions.

Plausible estimates of MSM populations by state and race/ethnicity can inform and guide HIV/AIDS surveillance, allocation of resources, and advocacy. They can help in the planning, implementation, and evaluation of HIV prevention programs and other services. Using MSM numbers as denominators, estimates of population-based MSM HIV incidence, prevalence, and mortality rates could help clarify national and state-level epidemic dynamics. Until corroborated by other modeling and/or empirical research, these estimates should be used with caution.
Heart Disease Mortality among Alaska Native People, 1981–2007
Authors: Johnston Janet M. , Day Gretchen Ehrsam , Veazie Mark A. , Provost Ellen
Published: July 2017

Objectives.

Historically, Alaska Native (AN) people have exhibited low overall rates of heart disease mortality compared with the U.S. white (USW) population. We compared AN and USW heart disease mortality rates during the 27-year period from 1981 through 2007.

Methods.

We compared AN and USW heart disease mortality rates overall and by gender, age, and disease subtype. We calculated age-adjusted rates for AN people for three nine-year periods from 1981 through 2007 and compared them with the rates for USW people.

Results.

AN people ≥35 years of age had a significantly lower rate of heart disease mortality compared with their USW counterparts (rate ratio [RR] = 0.80). The lower overall RR was due primarily to a lower ischemic heart disease mortality RR (RR=0.63). Overall heart disease mortality decreased during the 27–year study period for both the AN (33.1%) and USW (35.0%) populations. However, hypertensive heart disease mortality increased 155.2% for AN people and 13.7% for USW people. Age-specific heart disease mortality was about 30.0% lower for AN people ≥75 years of age compared with their USW counterparts, while it was virtually identical for the two racial/ethnic groups among people 35–74 years of age.

Conclusions.

The age-adjusted AN heart disease mortality rate was consistently about 20.0% lower than the USW rate from 1981 through 2007, with similar RRs for men and women. However, combining all ages and all heart disease subgroups into a single, age-adjusted statistic obscures many important differences across ages and disease subtypes.
Assessment of Epidemiology Capacity in State Health Departments, 2004–2009
Authors: Boulton Matthew L. , Hadler James , Beck Angela J. , Ferland Lisa , Lichtveld Maureen
Published: July 2017

Objectives.

To assess the number of epidemiologists and epidemiology capacity nationally, the Council of State and Territorial Epidemiologists surveyed state health departments in 2004, 2006, and 2009. This article summarizes findings of the 2009 assessment and analyzes five-year (2004–2009) trends in the epidemiology workforce.

Methods.

Online surveys collected information from all 50 states and the District of Columbia about the number of epidemiologists employed, their training and education, program and technologic capacity, organizational structure, and funding sources. State epidemiologists were the key informants; 1,544 epidemiologists provided individual-level information.

Results.

The number of epidemiologists in state health departments decreased approximately 12% from 2004 to 2009. Two-thirds or more states reported less than substantial (<50% of optimum) surveillance and epidemiology capacity in five of nine program areas. Capacity has diminished since 2006 for three of four epidemiology-related Essential Services of Public Health (ESPHs). Fewer than half of all states reported using surveillance technologies such as Web-based provider reporting systems. State health departments need 68% more epidemiologists to reach optimal capacity in all program areas; smaller states (<5 million population) have higher epidemiologist-to-population ratios than more populous states.

Conclusions.

Epidemiology capacity in state health departments is suboptimal and has decreased, as assessed by states' ability to carry out the ESPHs, by their ability to use newer surveillance technologies, and by the number of epidemiologists employed. Federal emergency preparedness funding, which supported more than 20% of state-based epidemiologists in 2006, has decreased. The 2009 Epidemiology Capacity Assessment demonstrates the negative impact of this decrease on states' epidemiology capacity.
Identification of Structural Interventions for HIV/AIDS Prevention: The Concept Mapping Exercise
Authors: Abdul-Quader Abu S. , Collins Charles
Published: July 2017

Structural interventions have been defined as those prevention interventions that include physical, social, cultural, organizational, community, economic, legal, and policy factors. In an effort to examine the feasibility, evaluability, and sustainability of structural interventions for HIV prevention, the Centers for Disease Control and Prevention implemented a project that involved asking experts in HIV prevention and other areas of public health—including injury and violence prevention, tobacco control, drug abuse, and nutrition—to provide input on the identification of structural interventions based on the aforementioned definition. The process resulted in a list of 123 interventions that met the definition. The experts were asked to group these interventions into categories based on similarity of ideas. They were also asked to rate these interventions in terms of impact they would have, if implemented, on reducing HIV transmission. The findings highlight the need for conducting further research on structural interventions, including feasibility of implementation and effectiveness of reducing HIV transmission risks.
Black-White Differences in Self-Reported Disability Outcomes in the U.S.: Early Childhood to Older Adulthood
Authors: Nuru-Jeter Amani M. , Thorpe Roland J. , Fuller-Thomson Esme
Published: July 2017

Objective.

We examined black-white differences in activities of daily living (ADLs), functional limitations (FLs), vision/hearing/sensory impairment, and memory/learning problems in a large, nationally representative sample of community-dwelling and institutionalized people across the lifespan.

Methods.

Data are from the 2006 American Community Survey ( n=2,288,800). We included data on non-Hispanic black respondents (125,985 males and 145,780 females) and non-Hispanic white respondents (977,792 males and 1,039,243 females) ≥5 years of age. We used logistic regression to examine the black-white odds for each disability outcome. The overall response rate was 97.5%.

Results.

For FLs, ADL limitations, and memory/learning problems, black people experienced higher odds of disability across the adult lifespan compared with white people. Black-white differences narrowed in older age. For vision/hearing problems, a black-white crossover was found in older age (≥85 years), where odds of vision/hearing problems were lower among black people than among white people. For all disability outcomes, black-white differences peaked in midlife (50–69 years of age), with black people having approximately 1.5 to two times the odds of disabilities as their white peers.

Conclusions.

The study findings suggest the need to address black-white disparities across a range of disability outcomes throughout the lifespan. Future work identifying the factors accounting for this pattern of disparities will help inform the development of appropriate prevention strategies.
Increased Fall-Related Mortality Rates in New Mexico, 1999–2005
Authors: Wendelboe Aaron M. , Landen Michael G.
Published: July 2017

Objective.

In 2000, fall injuries affected 30% of U.S. residents aged ≥65 years and cost $19 billion. In 2005, New Mexico (NM) had the highest fall-related mortality rate in the United States. We described factors associated with these elevated fall-related mortality rates.

Methods.

To better understand the epidemiology of fatal falls in NM, we used state and national (Web-based Injury Statistics Query and Reporting System) vital records data for 1999–2005 to identify unintentional falls that were the underlying cause of death. We calculated age-adjusted mortality rates, rate ratios (RRs), and 95% confidence intervals (CIs) by sex, ethnicity, race, and year.

Results.

For 1999–2005 combined, NM's fall-related mortality rate (11.7 per 100,000 population) was 2.1 times higher than the U.S. rate (5.6 per 100,000 population). Elevated RRs persisted when stratified by sex (male RR=2.0, female RR=2.2), ethnicity (Hispanic RR=2.5, non-Hispanic RR=2.1), race (white RR=2.0, black RR=1.7, American Indian RR=2.3, and Asian American/Pacific Islander RR=3.1), and age (≥50 years RR=2.0, <50 years RR=1.2). Fall-related mortality rates began to increase exponentially at age 50 years, which was 15 years younger than the national trend. NM non-Hispanic individuals had the highest demographic-specific fall-related mortality rate (11.8 per 100,000 population, 95% CI 11.0, 12.5). NM's 69.5% increase in fall-related mortality rate was approximately twice the U.S. increase (31.9%); the increase among non-Hispanic people (86.2%) was twice that among Hispanic people (43.5%).

Conclusions.

NM's fall-related mortality rate was twice the U.S. rate; exhibited a greater increase than the U.S. rate; and persisted across sex, ethnicity, and race. Fall-related mortality disproportionately affects a relatively younger population in NM. Characterizing fall etiology will assist in the development of effective prevention measures.
Incorporating Geospatial Capacity within Clinical Data Systems to Address Social Determinants of Health
Authors: Comer Karen Frederickson , Grannis Shaun , Dixon Brian E. , Bodenhamer David J. , Wiehe Sarah E.
Published: July 2017

Linking electronic health record (EHR) systems with community information systems (CIS) holds great promise for addressing inequities in social determinants of health (SDH). While EHRs are rich in location-specific data that allow us to uncover geographic inequities in health outcomes, CIS are rich in data that allow us to describe community-level characteristics relating to health. When meaningfully integrated, these data systems enable clinicians, researchers, and public health professionals to actively address the social etiologies of health disparities.

This article describes a process for exploring SDH by geocoding and integrating EHR data with a comprehensive CIS covering a large metropolitan area. Because the systems were initially designed for different purposes and had different teams of experts involved in their development, integrating them presents challenges that require multidisciplinary expertise in informatics, geography, public health, and medicine. We identify these challenges and the means of addressing them and discuss the significance of the project as a model for similar projects.
Use of Medicaid Data to Explore Community Characteristics Associated with HIV Prevalence among Beneficiaries with Schizophrenia
Authors: Walkup James , Akincigil Ayse , Hoover Donald R. , Siegel Michele J. , Amin Shahla , Crystal Stephen
Published: July 2017

Objective.

People with severe mental illness (SMI) may be at increased risk for several adverse health conditions, including HIV/AIDS. This disproportionate disease burden has been studied primarily at the individual rather than community level, in part due to the rarity of data sources linking individual information on medical and mental health characteristics with community-level data. We demonstrated the potential of Medicaid data to address this gap.

Methods.

We analyzed data on Medicaid beneficiaries with schizophrenia from eight states that account for 66% of cumulative AIDS cases nationally.

Results.

Across 44 metropolitan statistical areas (MSAs), the treated prevalence of HIV among adult Medicaid beneficiaries diagnosed with schizophrenia was 1.56% (standard deviation = 1.31%). To explore possible causes of variation, we linked claims files with a range of MSA social and contextual variables including local AIDS prevalence rates, area-based economic measures, crime rates, substance abuse treatment resources, and estimates of injection drug users (IDUs) and HIV infection among IDUs, which strongly predicted community infection rates among people with schizophrenia.

Conclusions.

Effective strategies for HIV prevention among people with SMI may include targeting prevention efforts to areas where risk is greatest; examining social network links between IDU and SMI groups; and implementing harm reduction, drug treatment, and other interventions to reduce HIV spread among IDUs. Our findings also suggest the need for research on HIV among people with SMI that examines geographical variation and demonstrates the potential use of health-care claims data to provide epidemiologic insights into small-area variations and trends in physical health among those with SMI.
Lead and other Heavy Metals in Dust Fall from Single-Family Housing Demolition
Authors: Jacobs David E. , Cali Salvatore , Welch Alison , Catalin Bogdan , Dixon Sherry L. , Evens Anne , Mucha Amy P. , Vahl Nicole , Erdal Serap , Bartlett John
Published: July 2017

Objective.

We measured lead and other heavy metals in dust during older housing demolition and effectiveness of dust suppression.

Methods.

We used American Public Housing Association Method 502 and U.S. Environmental Protection Agency Methods SW3050B and SW6020 at 97 single-family housing demolition events with intermittent (or no) use of water to suppress dust at perimeter, non-perimeter, and locations without demolition, with nested mixed modeling and tobit modeling with left censoring.

Results.

The geometric mean (GM) lead dust fall during demolition was 6.01 micrograms of lead per square foot per hour (μg Pb/ft2/hour). GM lead dust fall was 14.18 μg Pb/ft2/hour without dust suppression, but declined to 5.48 μg Pb/ft2/hour ( p=0.057) when buildings and debris were wetted. Significant predictors included distance, wind direction, and main street location. At 400 feet, lead dust fall was not significantly different from background. GM lead concentration at demolition (2,406 parts per million [ppm]) was significantly greater than background (GM = 579 ppm, p=0.05). Arsenic, chromium, copper, iron, and manganese demolition dust fall was significantly higher than background ( p<0.001). Demolition of approximately 400 old housing units elsewhere with more dust suppression was only 0.25 μg Pb/ft2/hour.

Conclusions.

Lead dust suppression is feasible and important in single-family housing demolition where distances between houses are smaller and community exposures are higher. Neighbor notification should be expanded to at least 400 feet away from single-family housing demolition, not just adjacent properties. Further research is needed on effects of distance, potential water contamination, occupational exposures, and water application.
Barriers to Care and Comorbidities along the U.S.-Mexico Border
Authors: De Heer Hendrik Dirk , Balcazar Hector Guillermo , Morera Osvaldo F. , Lapeyrouse Lisa , Heyman Josiah Mcc. , Salinas Jennifer , Zambrana Ruth E.
Published: July 2017

Objective.

While limited access to care is associated with adverse health conditions, little research has investigated the association between barriers to care and having multiple health conditions (comorbidities). We compared the financial, structural, and cognitive barriers to care between Mexican-American border residents with and without comorbidities.

Methods.

We conducted a stratified, two-stage, randomized, cross-sectional health survey in 2009–2010 among 1,002 Mexican-American households. Measures included demographic characteristics; financial, structural, and cognitive barriers to health care; and prevalence of health conditions.

Results.

Comorbidities, most frequently cardiovascular and metabolic conditions, were reported by 37.7% of participants. Controlling for demographics, income, and health insurance, six financial barriers, including direct measures of inability to pay for medical costs, were associated with having comorbidities (odds ratios [ORs] ranged from 1.7 to 4.1, p<0.05). The structural barrier of transportation (OR=3.65, 95% confidence interval [CI] 1.91, 6.97, p<0.001) was also associated with higher odds of comorbidities, as were cognitive barriers of difficulty understanding medical information (OR=1.71, 95% CI 1.10, 2.66, p=0.017), being confused about arrangements (OR=1.82, 95% CI 1.04, 3.21, p=0.037), and not being treated with respect in medical settings (OR=1.63, 95% CI 1.05, 2.53, p=0.028). When restricting analyses to participants with at least one health condition (comparing one condition vs. having ≥2 comorbid conditions), associations were maintained for financial and transportation barriers but not for cognitive barriers.

Conclusion.

A substantial proportion of adults reported comorbidities Given the greater burden of barriers to medical care among people with comorbidities, interventions addressing these barriers present an important avenue for research and practice among Mexican-American border residents.
A Systematic Evaluation of Different Methods for Calculating Adolescent Vaccination Levels Using Immunization Information System Data
Authors: Gowda Charitha , Dong Shiming , Potter Rachel C. , Dombkowski Kevin J. , Stokley Shannon , Dempsey Amanda F.
Published: July 2017

Objective.

Immunization information systems (IISs) are valuable surveillance tools; however, population relocation may introduce bias when determining immunization coverage We explored alternative methods for estimating the vaccine-eligible population when calculating adolescent immunization levels using a statewide IIS.

Methods.

We performed a retrospective analysis of the Michigan State Care Improvement Registry (MCIR) for all adolescents aged 11–18 years registered in the MCIR as of October 2010. We explored four methods for determining denominators: (1) including all adolescents with MCIR records, (2) excluding adolescents with out-of-state residence, (3) further excluding those without MCIR activity ≥10 years prior to the evaluation date, and (4) using a denominator based on U.S. Census data. We estimated state- and county-specific coverage levels for four adolescent vaccines.

Results.

We found a 20% difference in estimated vaccination coverage between the most inclusive and restrictive denominator populations. Although there was some variability among the four methods in vaccination at the state level (2%–11%), greater variation occurred at the county level (up to 21%). This variation was substantial enough to potentially impact public health assessments of immunization programs. Generally, vaccines with higher coverage levels had greater absolute variation, as did counties with smaller populations.

Conclusion.

At the county level, using the four denominator calculation methods resulted in substantial differences in estimated adolescent immunization rates that were less apparent when aggregated at the state level. Further research is needed to ascertain the most appropriate method for estimating vaccine coverage levels using IIS data.
Vibrio Infections and Surveillance in Maryland, 2002–2008
Authors: Jones Erin H. , Feldman Katherine A. , Palmer Amanda , Butlera Erin , Blythe David , Mitchell Clifford S.
Published: July 2017

Objective.

Vibrio is a naturally occurring waterborne pathogen with potential occupational, recreational, and commercial impacts. During the last 15 years in the U.S. and in Maryland, the incidence of vibriosis has increased. Due to the increase in cases in Maryland, warming water temperatures, and public concern about human health effects resulting from exposure to the Chesapeake Bay, we reviewed cases of vibriosis and evaluated the Vibrio surveillance system in Maryland for timeliness and data quality, attributes necessary for successful outbreak investigation and illness prevention.

Methods.

The evaluation included (1) informal qualitative surveys of state and local personnel who report and manage Vibrio cases and (2) a review of Vibrio surveillance data from 2002 through 2008 for data quality and timeliness of the system.

Results.

From 2002 to 2008, 188 laboratory-confirmed cases of vibriosis were reported in Maryland with an annual average of 27 cases The species of Vibrio that were most frequently responsible for infection, regardless of clinical presentation, were V. parahaemolyticus (43.6%), V. vulnificus (23.9%), V. alginolyticus (9.6%), and non-toxigenic V. cholerae (9.0%). The case fatality rate fluctuated during the study period, but the number of cases increased.

Conclusions.

The surveillance system in Maryland is flexible and captures cases of vibriosis where specimens were collected for testing; however, the system may not adequately capture mild, self-limiting infections. Better integration of data collection for clinical, laboratory, and environmental information and improved completion of variables for shellfish harvest or water exposure locations could improve the system. Quarterly meetings comprising surveillance, public health laboratory, and food-control personnel could direct and ensure the success of improvement efforts.
Hospitalization Rates of People Living with HIV in the United States, 2009
Authors: Bachhuber Marcus A. , Southern William N.
Published: July 2017

Objectives.

We determined hospitalization rates and disparities among people with HIV, which may have been underestimated in previous studies, as only those in medical care were included.

Methods.

We estimated the hospitalization rate of people with diagnosed HIV infection in the U.S. in 2009 using two nationally representative datasets. We took the number of hospitalizations from the Nationwide Inpatient Sample and searched each discharge for International Classification of Diseases, Ninth Revision codes for HIV infection and opportunistic infections (OIs). We divided the number of hospitalizations by the number of prevalent diagnosed HIV cases estimated by CDC to produce hospitalization rates, and then compared those rates using Z-tests.

Results.

The estimated nationwide hospitalization rate was 26.6 per 100 population. Women had a 51% higher rate than men (35.5 vs. 23.5 per 100 population, p=0.002). Black people (31.2 per 100 population, p=0.01) had a 42% higher rate, and Hispanic people (18.2 per 100 population, p=0.23) had an 18% lower rate than white people (22.1 per 100 population) of hospitalization for any illness. Of hospitalizations with an OI, females with HIV had a 50% higher rate than males with HIV (5.0 vs. 3.4 per 100 population, p=0.003). Black people with HIV (4.7 per 100 population, p<0.001) had a 72% higher rate and Hispanic people with HIV (2.9 per 100 population, p=0.78) had a similar rate of hospitalization with an OI compared with white people with HIV (2.7 per 100 population).

Conclusions.

Hospitalization rates among people living with HIV in the U.S. are higher than have been previously estimated. Substantial gender and racial/ethnic disparities in hospitalization rates exist, suggesting that the benefits of antiretroviral therapy have not been realized across all groups equally.
Hepatitis C Seroprevalence among Prison Inmates since 2001: Still High but Declining
Authors: Varan Aiden K. , Mercer Daniel W. , Stein Matthew S. , Spaulding Anne C.
Published: July 2017

Objectives.

Although the hepatitis C epidemic in the United States disproportionately affects correctional populations, the last national estimates of seroprevalence and disease burden among these populations are more than a decade old. We investigated routine hepatitis C surveillance conducted in state prison systems and updated previous estimates.

Methods.

We surveyed all U.S. state correctional departments to determine which state prison systems had performed routine hepatitis C screening since 2001. Using seroprevalence data for these prison systems, we estimated the national hepatitis C seroprevalence among prisoners in 2006 and the share of the epidemic borne by correctional populations.

Results.

Of at least 12 states performing routine testing from 2001 to 2012, seroprevalences of hepatitis C ranged from 9.6% to 41.1%. All but one state with multiple measurements demonstrated declining seroprevalence. We estimated the national state prisoner seroprevalence at 17.4% in 2006. Based on the estimated total U.S. correctional population size, we projected that 1,857,629 people with hepatitis C antibody were incarcerated that year. We estimated that correctional populations represented 28.5%–32.8% of the total U.S. hepatitis C cases in 2006, down from 39% in 2003.

Conclusions.

Our results provide an important updated estimate of hepatitis C seroprevalence and suggest that correctional populations bear a declining but still sizable share of the epidemic. Correctional facilities remain important sites for hepatitis C case finding and therapy implementation. These results may also assist future studies in projecting the societal costs and benefits of providing new treatment options in prison systems.
Simulation study of a quick-service take-out restaurant
Authors: Thomas George R.
Published: July 2017

This study illustrates the use of discrete simulation models as tools to assist in the analysis of an existing system--a quick-service take-out restaurant with 8 employees. Comparisons made between a model of the real-world system and models of proposed changes to the system's configuration assist in formulating minimal-risk decisions affecting

1. Levels of service

2. Cost of operation

3. Tradeoffs between volume of business and service offered to customers

4. Service time

In this study three alternatives involving the loca tion of the cash registers and the staffing level (8 or 10 employees) are examined. The study shows that the level of services could be increased with the same number of employees and with half as many cash registers. Queues would generally be shorter, and fewer customers would be lost during peak hours of business. The results of the simulation were tested and found to be statistically significant.
Macroeconomics of Unbalanced Productivity Growth and Urban Crisis: a Simulation
Authors: Peterson Richard E. , Seo K.K.
Published: July 2017

The "theory of unbalanced productivity growth and urban crisis" was developed by the economist William Baumol. It is based on a macroeconomic model of a region which is characterized by a progressive sector where technology is steadily advancing and a nonprogressive sec tor where it is not. In the progressive sector wages rise to match gains in productivity and in the nonprogressive sec tor they rise by "wage diffusion." A major component of the nonprogressive sector consists of municipal and other government services. When, under certain conditions, more and more workers enter the nonprogressive sector, municipal fiscal crises are a likely result.

The macroeconomic model used in this study is a 19- equation system with eight difference equations for which analytical solutions are not available at this time. A FORTRAN computer program, however, is developed for simulations covering a 50-year period. The results of these simulations are the basis for seven propositions. The worst case (the one most conducive to urban crisis) occurs when the demand for the output of the nonprogressive sector increases at a faster rate than income (i.e., this sector is "in come elastic") and is insensitive to price increases (i. e., is "price inelastic"). In this case the nonprogressive sector absorbs a growing percentage of total employment, and the year-by-year real output of the economy decreases.
Modeling and Simulations of Multicast Routing Algorithms for Advanced Network Applications
Authors: Jia Xiaohua , Pissinou Niki , Makki Kia
Published: July 2017

Multicast has become an important service in modern network applications. Multicast routing is a difficult issue, particularly under delay or bandwidth constraints. This paper discusses Steiner trees in the modeling of multicast routings and various routing constraints required by applications. It also discusses the existing multicast routing algorithms, especially the routings under constraints, such as delay constraint, limited available bandwidth, and traffic load balancing. Extensive simulations have been conducted to reveal the relationships between the network cost of the routing and each of the discussed constraints.
Trace-Driven Simulation of Document Caching Strategies for Internet Web Servers
Authors: Arlitt Martin F. , Williamson Carey L.
Published: July 2017

Given the continued growth of the World-Wide Web, performance of Web sewers is becoming increasingly important. File caching can be used to reduce the time that it takes a Web server to respond to client requests, by storing the most popular files in the main memory of the Web sewer, and by reducing the volume of data that must be transferred between secondary storage and the Web server. In this paper, we use trace-driven simulation to evaluate the effects of various replacement, threshold, and partitioning policies on the performance of a Web sewer. The workload traces for the simulations come from Web server access logs, from six different Internet Web sewers. The traces represent three different orders of magnitude in sewer activity and two different orders of magnitude in time duration. The results from our simulation study show that frequency-based caching strategies, using a variation of the Least Frequently Used (LFU) replacement policy, perform the best for the Web sewer workload traces considered. Thresholding policies and cache partitioning policies for Internet Web servers do not appear to be effective.
Proper Starching Technique
Authors: Kaswell Ernest R.
Published: July 2017

In view of the widespread application of starches for the sizing of yarns and fabrics, and, in particular, the pres ent scarcity of starch, it is imperative that a maximum economy be attained in the use of this important raw ma terial.

The following study was made for the specific pur pose of improving the technique in laundry practice. However, it is believed that disclosure of the relationship between certain variables and fabric stiffness will be of assistance to textile men in general. It was found in this study that a linear relationship between the amount of starch and weight of material such as is frequently used in determining the proper amount of starch does not hold. By proper use of graphs the correct amount of starch for any given weight may be determined.
The Loyal Traveler: Examining a Typology of Service Patronage
Authors: Pritchard Mark P. , Howard Dennis R.
Published: July 2017

The first goal of this study was to determine whether Day's (1969) measure of loyalty could be extended to better understand travel service patronage. Findings provide clear support that this composite measure, of repeat purchase and loyal attitude, is an effective approach to distinguishing the loyal traveler. A cluster analysis that combined scores on the composite measure from 428 travelers supported a two-dimensional matrix that identified four types of loyalty: true, spurious, latent, and low. This accomplished the study's second purpose by confirming that the four distinct levels of loyalty exist in a variety of service settings. Discriminant analysis was used to achieve the third objective — To identify those characteristics that differentiate the truly loyal patron. The resulting profile found this traveler to be a highly satisfied, symbolically involved consumer drawn to those services that exhibit an empathetic, caring concern for their patrons. These findings generate a much clearer understanding of how service providers can measure and manage their returning patrons.
Affective Images of Tourism Destinations
Authors: Baloglu Seyhmus , Brinberg David
Published: July 2017

The destination image and positioning studies in tourism have been limited to those dealing with the image's perceptual or cognitive component. This study examined the applicability of Russel and his colleagues' proposed affective space structure to large-scale environments (i.e., tourism destination countries) as well as its potential as a positioning structure to study affective images of tourism destinations. The multidimensional scaling analysis of 11 Mediterranean countries along with proposed affective space structure indicated that Russel and his colleagues' proposed affective space can also be applied to places that are not perceived directly. It also showed potential for studying the affective image positioning of tourism destinations. The article concludes with some theoretical and practical implications and future research areas regarding tourism destination images.
Applying Importance-Performance Analysis to Beijing as an International Meeting Destination
Authors: Go Frank , Zhang Wei
Published: July 2017

A customer survey was conducted among meeting planners to analyze the importance-performance of Beijing as an international meeting destination and to determine to which factors the city should devote its attention and resources to attract international meetings. The results suggest that Beijing provides a satisfactory environment for the staging of meetings, but it should improve its performance in meeting industry attributes that meeting planners consider important.
An Applied Model of Airline Revenue Management
Authors: Hamzaee Reza G. , Vasigh Bijan
Published: July 2017

Demand and revenue management are critical to achieving financial success in the competitive airline industry. This article examines the optimal allocation of available seats to different classes of airfare and provides hypothetical and numerical examples that illustrate the mathematical models.