bluuebunny/crossref_metadata_2025 huggingface dataset:
A Two-Stage Sampling Method for Clinical Surveillance of Individuals in Care for HIV Infection in the United States
Authors: Sullivan Patrick S. , Karon John M. , Malitz Faye E. , Broyles Stephanie , Mokotoff Eve D. , Buskin Susan E. , Fleming Patricia L.
Published: July 2017

Objectives.

The goals of this study were two-fold: ( 1) to describe methods for drawing a population-based sample of individuals in care for HIV infection and ( 2) to compare data from the sample with data from existing surveillance systems that describe care for HIV.

Methods.

The authors implemented a two-stage sampling method, using local HIV/AIDS surveillance data as a sampling frame of HIV care providers in three states. At selected providers, medical records of a random sample of patients were abstracted.

Results.

The medical records of a number of patients, ranging from 253 to 374 individuals per state, were abstracted. The demographics of sampled individuals and of individuals reported to the local HIV/AIDS surveillance program were similar; however, differences existed in the proportion of individuals receiving HIV care consistent with treatment guidelines between the sample and a contemporary facility-based supplemental surveillance project. The median design effect for outcomes collected in the sample was 1.8 (range=0.5–29.6).

Conclusions.

This survey method is feasible for collecting population-based data on patients in care for HIV. Sample size and some design elements should be changed in future studies to increase precision of estimates and usefulness of data for local planning and evaluation.
The Relationship between Blood Lead Levels and Neurobehavioral Test Performance in NHANES III and Related Occupational Studies
Authors: Krieg Edward F. , Chrislip David W. , Crespo Carlos J. , Brightwell W. Stephen , Ehrenberg Richard L. , Otto David A.
Published: July 2017

Objectives.

The goals of this study were two-fold: ( 1) to assess the relationship between blood lead levels and neurobehavioral test performance in a nationally representative sample of adults from the third National Health and Nutrition Evaluation Survey and ( 2) to analyze the results from previously published studies of occupational lead exposure that used the same neurobehavioral tests as those included in the survey.

Methods.

Regression models were used to test and estimate the relationships between measurements of blood lead and performance on a simple reaction time, a symbol-digit substitution, and a serial digit learning test in adults aged 20–59 years who participated the survey. Mixed models were used to analyze the data from the occupational studies.

Results.

The blood lead levels of those participating in the survey ranged from 0.7 to 41.8 μg/dl. The estimated geometric mean was 2.51 μg/dl, and the estimated arithmetic mean was 3.30 μg/dl. In the survey, no statistically significant relationships were found between blood lead concentration and performance on the three neurobehavioral tests when adjusted for covariates. In the occupational studies, the groups exposed to lead consistently performed worse than control groups on the simple reaction time and digit-symbol substitution tests.

Conclusions.

The results from the survey and the occupational studies do not provide evidence for impairment of neurobehavioral test performance at levels below 25 μg/dl, the concentration that the Centers for Disease Control and Prevention define as elevated in adults. The average blood lead level of the exposed groups in the occupational studies was 41.07 μg/dl, less than 50 μg/dl, the minimum concentration that the Occupational Safety and Health Administration requires for medical removal from the workplace. Given the evidence of impaired neurobehavioral performance in these groups, the 50 μg/dl limit should be reevaluated.
Trends in Total Knee Replacement Surgeries and Implications for Public Health, 1990–2000
Authors: Mehrotra Chetna , Remington Patrick L. , Naimi Timothy S. , Washington William , Miller Richard
Published: July 2017

Objectives.

Total joint replacements are important surgical interventions for treating severe arthritis of weight-bearing joints. The most common indication for total knee replacement (TKR) is osteoarthritis of the knee joint. The goals of this study were to assess the trend in rate of TKR in Wisconsin and to describe the economic impact of these surgical procedures on the health care system.

Method.

A population-based cross-sectional study of TKR surgeries was conducted among Wisconsin residents aged ⩾45 years. The Wisconsin inpatient hospital discharge data from 1990 through 2000 were used. Rates were age-adjusted to the 2000 U.S. population, and charges for TKR were adjusted for inflation.

Results.

From 1990 through 2000, the age-adjusted rate for TKR increased by 81.5% (from 162 to 294 per 100,000; p<0.001). The rate increased the most among the youngest age group (45–49 years), rate ratio 5.1 for men, 4.2 for women. The total charges for TKR increased from $69.4 million to $148 million (109.2% inflation-adjusted increase). Medicare received the highest proportion of charges for TKR procedures, but throughout the study period, the proportion of charges covered by private insurance increased by 39%.

Conclusions.

The rate and costs of TKR procedures among Wisconsin residents increased substantially from 1990 through 2000, especially among younger age groups. Changes in medical practices probably accounted for some of this increase, but these trends also may reflect an increased prevalence of osteoarthritis, which in turn may be related to dramatic increases in the number of individuals who are overweight.
Reducing Lead Exposure from Drinking Water: Recent History and Current Status
Authors: Maas Richard P. , Patch Steven C. , Morgan Diane M. , Pandolfo Tamara J.
Published: July 2017

This article discusses the issue of lead contamination of drinking water, noting the various regulatory-driven measures that have been adopted in the U.S. since 1986 to address this public health issue. The article summarizes the literature on the dynamics of tap water lead contamination and discusses this widespread source of lead exposure in the context of the latest research evidence.
Use of a Prospective Space-Time Scan Statistic to Prioritize Shigellosis Case Investigations in an Urban Jurisdiction
Authors: Jones Roderick C. , Liberatore Monica , Fernandez Julio R. , Gerber Susan I.
Published: July 2017

Objective.

A prospective space-time scan statistic was applied to Chicago's 2002 shigellosis surveillance data to evaluate its utility in objectively describing clusters and assisting in the prioritization of investigations.

Methods.

The prospective space-time module of SaTScan, a free software available online, was used to identify “live” clusters of disease, meaning cases that were current as of the date of the analysis and strongly associated in place and time. Fifty-two separate space-time analyses were run, one simulation for each week of 2002. Identified clusters were described in terms of space, time, risk factors reported by involved case-patients, and cases' links to venue-associated outbreaks.

Results.

Twelve live clusters were detected at the p<0.05 significance level: two single-household clusters and 10 community clusters. The community clusters ranged in size from 194 to 367 census tracts (median = 294), and in disease burden from 21 to 41 cases (median = 29). Geographically, all of the community clusters were located in the west-central part of the city and had a temporal span of 28 days. Within the 10 community clusters, 15 different day care centers were identified as potential exposure settings for case-patients or their close contacts.

Conclusions.

The prospective space-time scan statistic offers local health departments an objective way of describing clusters of shigellosis cases. The method used in this study could help prioritize the assignment and investigation of cases, particularly when overall shigellosis incidence exceeds expected numbers or when an agency's resources are stressed by other events, such as outbreaks.
Income, Housing, and Fire Injuries: A Census Tract Analysis
Authors: Shai Donna
Published: July 2017

Objectives.

This study investigates the social and demographic correlates of nonfatal structural fire injury rates for the civilian population for Philadelphia census tracts during 1993–2001.

Methods.

The author analyzed 1,563 fire injuries by census tract using the 1990 census (STF 3) and unpublished data from the Office of the Fire Marshal of the Philadelphia Fire Department. Injury rates were calculated per 1,000 residents of a given census tract. Multiple regression was used to determine significant variables in predicting fire injuries in a given census tract over a nine-year period and interaction effects between two of these variables—age of housing and income.

Results.

Multiple regression analysis indicates that older housing (prior to 1940), low income, the prevalence of vacant houses, and the ability to speak English have significant independent effects on fire injury rates in Philadelphia. In addition, the results show a significant interaction between older housing and low income.

Conclusions.

Given the finding of very high rates of fire injuries in census tracts that are both low income and have older housing, fire prevention units can take preventative measures. Fire protection devices, especially smoke alarms, should be distributed in the neighborhoods most at risk. Multiple occupancy dwellings should have sprinkler systems and fire extinguishers. Laws concerning the maintenance of older rental housing need to be strictly enforced. Vacant houses should be effectively boarded up or renovated for residential use. Fire prevention material should be distributed in a number of languages to meet local needs.
The Role of Reported Primary Race on Health Measures for Multiple Race Respondents in the National Health Interview Survey
Authors: Parker Jennifer D.
Published: July 2017

Objectives.

As data for multiple race groups have only recently been collected and tabulated, the current understanding of the health of multiple race groups is not well developed. In the National Health Interview Survey (NHIS), survey respondents who report more than one race are asked to identify a primary race. This report compares selected health and demographic measures by the response to the primary race question and compares estimates for specific primary race groups to corresponding estimates for single race groups.

Methods.

Using 1997–2003 NHIS data, several demographic and health measures were compared by reported primary race within the four largest multiple race groups. Then estimates by primary race for these four multiple race groups were compared to those for their single race counterparts.

Results.

There were few statistically significant associations between reported primary race and health or demographic variables within the four multiple race groups. This lack of association may be due to the small number of multiple race respondents (which results in large standard errors) rather than similarity of point estimates among the subgroups. A greater number of differences between estimates for single race groups and for multiple race respondents who reported the same single race as their primary race were identified.

Conclusions.

The apparent lack of association between primary race within a multiple race group and health outcomes suggests that tabulating multiple race responses by primary race is unnecessary for valid health estimates for multiple race groups, at least with available statistical power. However, differences between single race and primary race estimates within a multiple race group suggest that inferences for multiple race respondents using single race estimates may be imprecise for some outcomes.
Behavioral Health in Multiracial Adolescents: The Role of Hispanic/Latino Ethnicity
Authors: Whaley Arthur L. , Francis Kimberly
Published: July 2017

Objectives.

The purpose of the present study was twofold: ( 1) to determine whether adolescents who self-identify as multiracial have more adverse health behaviors than their monoracial counterparts, and ( 2) to examine whether the health behaviors of adolescents who are multiracial and Hispanic are more similar to those who identify as monoracial Hispanic or those who are multiracial and non-Hispanic.

Methods.

Secondary analyses of data in a subsample from the Youth Risk Behavior Survey of 3,704 (27.2%) adolescents who identified as Hispanic/Latino only, multiracial Hispanic, or multiracial non-Hispanic were conducted. Regression analyses were conducted using SUDAAN for the complex sampling to test for differences in health behaviors (i.e., smoking, exercise, substance abuse, and suicide risk) among the three ethnicity/race groups.

Results.

Each health behavior scale yielded significant between-group differences according to ethnic/racial identity: Hispanic/Latino adolescents scored significantly lower than both multiracial groups on the measure of cigarette smoking, lower than multiracial Hispanic adolescents on the substance abuse scale, and lower than multiracial non-Hispanic adolescents on the measure of exercise. The multiracial Hispanic group was also at marginally increased risk for suicide compared to the Hispanic/Latino group.

Conclusions.

The results support the hypothesis that multiracial Hispanic adolescents have more behavioral health problems than monoracial Hispanic adolescents. The second hypothesis—that multiracial Hispanic adolescents are more similar to multiracial non-Hispanic adolescents—was also supported. The implications of these findings for the classification of Hispanic adolescents in terms of ethnicity and race in relation to health behaviors are discussed.
Patterns of Intimate Partner Violence and Their Associations with Physical Health, Psychological Distress, and Substance Use
Authors: Carbone-López Kristin , Kruttschnitt Candace , Macmillan Ross
Published: July 2017

Objectives.

The purpose of this work is to formally model patterns of intimate partner violence (IPV) separately for males and females and to assess the unique contributions of different types of violence exposure to health related outcomes.

Methods.

Using data from the National Violence Against Women Survey—a national probability sample of U.S. men and women—latent class analyses produced a map of the underlying structure of IPV for both males and females that is defined by specific types of violent acts. Multivariable logistic regression analyses assessed the differential physical health, mental health, and substance use consequences of exposure to IPV by gender.

Results.

Women and men experience similar types of IPV, although the prevalence of the different types of violence is much greater for women than men. Second, exposure to IPV for both women and men is associated with a range of negative health outcomes including increased odds of poor physical health and physical disability, psychological distress and mental illness, and heightened recreational and non-recreational substance use. Finally, there is some evidence that experiences with IPV have stronger and broader associations with negative health outcomes among women, likely reflecting differences in the severity of violence experienced by men and women.

Conclusions.

More attention to the ways in which interpersonal violence is conceptualized, measured, and screened for is crucial. Specifically, while women have greater exposure to IPV, and subsequently a greater range of health problems, the effects on men should not be ignored.
A Practical Approach to Public Health Surveillance of Violent Deaths Related to Intimate Partner Relationships
Authors: Biroscak Brian J. , Smith Patricia K. , Post Lori A.
Published: July 2017

Objectives.

Articles describing the epidemiology of intimate partner homicide (IPH) have often been positioned as one-time research projects utilizing a single data source for case identification. However, researchers without access to centralized repositories for data pertinent to IPH can ascertain cases by using multiple extant data sources. The authors describe a surveillance system that can serve as a model for state health departments and others seeking to quantify and characterize violent deaths related to intimate partner relationships on an ongoing basis.

Methods.

Retrospective surveillance was conducted to identify and characterize deaths related to intimate partnerships by linking the following data sources: death certificates, newspaper articles, law enforcement reports, and medical examiners' records.

Results.

The authors identified at least 34% more IPHs using multiple data sources than would have been recognized solely using Supplementary Homicide Reports—the most frequently cited data source for IPH case ascertainment—and 22% more cases than newspaper data alone would have allowed for.

Conclusions.

While it was discovered that at least 181 IPHs—and at least 128 other deaths related to intimate partnerships—occurred in Michigan from 1999–2001, this frequency of occurrences is probably conservative. This limitation is due, in part, to the researchers not having access to information from all possible data source contributors. However, in the absence of statewide data systems, the authors demonstrate the utility of using multiple data sources for violent death surveillance to address incomplete case ascertainment.
Changes in Driver Fatality Rates and Vehicle Incompatibility Concurrent with Changes in the Passenger Vehicle Fleet
Authors: Braitman Keli A. , Ferguson Susan A. , Elharam Kamal
Published: July 2017

Objective.

With more sport utility vehicles (SUVs) on the road, public concern has been expressed about their influence on traffic safety. The present study examined changes in the mix of passenger vehicles between 1988 and 2004 and concurrent changes in driver fatality rates and vehicle incompatibility.

Method.

Vehicle registrations and driver deaths per registered vehicle were examined using data from R.L. Polk and Company and the Fatality Analysis Reporting System.

Results.

Between 1988 and 2004, SUVs comprised an increasingly larger proportion of registered passenger vehicles (5% of one- to three-year-old vehicles in 1988 vs. 22% in 2004), yet driver deaths per registered vehicle decreased 43% to 47% for all passenger vehicle types. Reductions in driver fatality rates were greater for two-vehicle crashes than for single-vehicle crashes and greater for two-vehicle frontal crashes than for two-vehicle side-impact crashes. Driver death rates declined more on rural roads than on urban roads, and this difference was most pronounced for SUVs. Among cars struck by other vehicles, driver death rates in front-to-front and front-to-side impacts decreased more when the striking vehicle was an SUV than a pickup or car.

Conclusions.

Factors likely contributing to the overall reductions in fatality rates include advances in occupant protection, increases in average vehicle weight, increased availability of SUVs with car-based designs, and reductions in alcohol-impaired driving. Reductions of driver death rates in two-vehicle collisions between 1988 and 2004 are encouraging, but SUVs and pickups continue to pose a substantially higher risk to drivers of cars than when the striking vehicle is another car.
Development of a Survey Instrument to Measure Connectivity to Evaluate National Public Health Preparedness and Response Performance
Authors: Dorn Barry C. , Savoia Elena , Testa Marcia A. , Stoto Michael A. , Marcus Leonard J.
Published: July 2017

Objective.

Survey instruments for evaluating public health preparedness have focused on measuring the structure and capacity of local, state, and federal agencies, rather than linkages among structure, process, and outcomes. To focus evaluation on the latter, we evaluated the linkages among individuals, organizations, and systems using the construct of “connectivity” and developed a measurement instrument.

Methods.

Results from focus groups of emergency preparedness first responders generated 62 items used in the development sample of 187 respondents. Item reduction and factors analyses were conducted to confirm the scale's components.

Results.

The 62 items were reduced to 28. Five scales explained 70% of the total variance (number of items, percent variance explained, Cronbach's alpha) including connectivity with the system (8, 45%, 0.94), coworkers (7, 7%, 0.91), organization (7, 12%, 0.93), and perceptions (6, 6%, 0.90). Discriminant validity was found to be consistent with the factor structure.

Conclusion.

We developed a Connectivity Measurement Tool for the public health workforce consisting of a 34-item questionnaire found to be a reliable measure of connectivity with preliminary evidence of construct validity.
Assessment of Missing Immunizations and Immunization-Related Barriers among WIC Populations at the Local Level
Authors: Ghosh Tista S. , Patnaik Jennifer L. , Bennett Anne , Trefren Lynn , Vogt Richard L.
Published: July 2017

Objective.

Low childhood immunization rates have been a challenge in Colorado, an issue that was exacerbated by a diphtheria-tetanus-acellular pertussis (DTaP) vaccine shortage that began in 2001. To combat this shortage, the locally based Tri-County Health Department conducted a study to assess immunization-related barriers among children in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), a population at risk for undervaccination.

Methods.

This study assessed characteristics and perceptions of WIC mothers in conjunction with their children's immunization status in four clinics.

Results.

Results indicated poor immunization rates, which improved with assessment and referral. The uninsured were at higher risk for undervaccination. DTaP was the most commonly missing vaccine, and discrepancies existed between the children's perceived and actual immunization status, particularly regarding DTaP. Targeted interventions were initiated as a result of this study.

Conclusion.

Local health departments should target immunization-related interventions by assessing their own WIC populations to identify unique vaccine-related deficiencies, misperceptions, and high-risk subpopulations.
Fetal Death Certificates as a Source of Surveillance Data for Stillbirths with Birth Defects
Authors: Duke C. Wes , Alverson C.J. , Correa Adolfo
Published: July 2017

Objective.

We assessed fetal death certificates (FDCs) as a source of surveillance for stillbirths with birth defects by linkage with data from the Metropolitan Atlanta Congenital Defects Program (MACDP), a population-based birth defects surveillance system.

Methods.

Stillbirths with defects in MACDP were identified from 1994 through 2002 and linked to FDCs. Sensitivity of FDCs for capturing stillbirths with defects was estimated, and predictors for a case being reported were assessed. Concordance for selected variables from each data source was evaluated.

Results.

Two hundred twenty-four of 257 stillbirths with birth defects in MACDP were linked to an FDC (linkage rate 5 87.2%; 95% confidence interval [CI] 82.4, 91.0). Stillbirths of non-Hispanic black and Hispanic/other mothers were more likely to be issued an FDC (odds ratio [OR] 5 5.6 [95% CI 1.9, 17.0] and 14.0 [95% CI 1.7, 114.0], respectively). Cases undergoing autopsy were more likely to be issued an FDC (OR53.2; 95% CI 1.1, 8.7). Performance of an amniocentesis was poorly recorded on FDCs. The sensitivity and positive predictive value of FDCs for selected classes of defects ranged from 10% to 70% and 25% to 93%, respectively.

Conclusions.

Compared to FDCs, MACDP's active case identification improves the ascertainment of stillbirths with birth defects and the quality of certain recorded data.
Evaluation Findings from the Institute for Public Health and Faith Collaborations
Authors: Kegler Michelle Crozier , Kiser Mimi , Hall Sarah M.
Published: July 2017

Objective.

The Institute for Public Health and Faith Collaborations sought to cultivate boundary leadership to strengthen collaboration across religious and health sectors to address health disparities. This article presents findings from an evaluation of the Institute and its impact on participating teams of faith and public health leaders.

Methods.

Self-administered surveys were completed by participating team members ( n=243) immediately post-Institute. Semistructured telephone interviews were conducted with at least one health and one faith leader per team six to eight months after the Institute.

Results.

Significant self-reported improvement occurred for all short-term outcomes assessed, with the largest increases in describing organizational frames and why they are important for community change, and understanding the role of boundary leaders in community systems change. Six months after the Institute, participants spoke of inspiration, team building, and understanding their own leadership strengths as important outcomes. Leadership growth centered on functioning in groups, making a change in their work, a renewed faith in self, and a renewed focus on applying themselves to faith/health work. Top team accomplishments included planning or implementing a program or event, or solidifying or sustaining a collaborative structure. The majority felt they were moving in the right direction to reduce health disparities, but had not yet made an impact.

Conclusions.

Results suggest the Institute played a role in helping to align faith and health assets in many of the participating teams.
Identifying Challenges to the Integration of Computer-Based Surveillance Information Systems in a Large City Health Department: A Case Study
Authors: Jennings Jacky M. , Stover Jeffrey A. , Bair-Merritt Megan H. , Fichtenberg Caroline , Munoz Mary Grace , Maziad Rafiq , Ketemepi Sherry Johnson , Zenilman Jonathan
Published: July 2017

Objective.

Integrated infectious disease surveillance information systems have the potential to provide important new surveillance capacities and business efficiencies for local health departments. We conducted a case study at a large city health department of the primary computer-based infectious disease surveillance information systems during a 10-year period to identify the major challenges for information integration across the systems.

Methods.

The assessment included key informant interviews and evaluations of the computer-based surveillance information systems used for acute communicable diseases, human immunodeficiency virus/acquired immunodeficiency syndrome, sexually transmitted diseases, and tuberculosis. Assessments were conducted in 1998 with a follow-up in 2008. Assessments specifically identified and described the primary computer-based surveillance information system, any duplicative information systems, and selected variables collected.

Results.

Persistent challenges to information integration across the information systems included the existence of duplicative data systems, differences in the variables used to collect similar information, and differences in basic architecture.

Conclusions.

The assessments identified a number of challenges for information integration across the infectious disease surveillance information systems at this city health department. The results suggest that local disease control programs use computer-based surveillance information systems that were not designed for data integration. To the extent that integration provides important new surveillance capacities and business efficiencies, we recommend that patient-centric information systems be designed that provide all the epidemiologic, clinical, and research needs in one system. In addition, the systems should include a standard system of elements and fields across similar surveillance systems.
Sexual and Drug Use Risk Behaviors of Long-Haul Truck Drivers and Their Commercial Sex Contacts in New Mexico
Authors: McCree Donna Hubbard , Cosgrove Shannon , Stratford Dale , Valway Sarah , Keller Nick , Vega-Hernandez Jaime , Jenison Steven A.
Published: July 2017

Objectives.

Long-haul truck drivers and their commercial sex contacts (CCs) have been associated with the spread of sexually transmitted infections (STIs) in the developing world. However, there is a paucity of information about the STI risk behaviors of these populations in the U.S. We conducted a qualitative phase of a two-phase study to gather information about STI-related risk behaviors in drivers and their CCs in New Mexico.

Methods.

Between July and September 2004, we conducted face-to-face unstructured and semistructured qualitative interviews at trucking venues, health department facilities, and a community-based organization to solicit information on sexual behavior and condom and illicit drug use. The interviews were audiotaped, transcribed, reviewed for quality control, and then coded and analyzed for emerging themes using NVivo® software.

Results.

Thirty-three long-haul truck drivers and 15 CCs completed the interview. The truck drivers were mostly male and non-Hispanic white with a mean age of 41 years. The majority of the CCs were female, the largest percentage was Hispanic, and the mean age was 36 years. Data suggested risky sexual behavior and drug use (i.e., inconsistent condom use, illicit drug use including intravenous drug use, and the exchange of sex for drugs) that could facilitate STI/human immunodeficiency virus (HIV) and hepatitis virus transmission. Results also showed a low knowledge about STIs and lack of access to general health care for both populations.

Conclusions.

Additional studies are needed to further assess risk and inform the development of prevention interventions and methods to provide STI/HIV and other medical services to these populations.
Assessing Health Status, Behavioral Risks, and Health Disparities in American Indians Living on the Northern Plains of the U.S.
Authors: Holm Jeffrey E. , Vogeltanz-Holm Nancy , Poltavski Dmitri , McDonald Leander
Published: July 2017

Objective.

We assessed health status and behavioral risks in American Indians (AIs) from rural, northern plains reservation communities.

Methods.

AI interviewers from the communities administered the core and optional modules of the Behavioral Risk Factor Surveillance System (BRFSS) to 404 AI adults randomly selected from housing lists from four AI tribal communities located on the northern plains of the U.S. The BRFSS interview assessed several health functioning areas including medical conditions, preventive screenings, and behavioral risks. We measured health disparities by comparing the AI sample data with a northern plains statewide (North Dakota) sample and a U.S. national sample. We compared outcomes with BRFSS statewide (North Dakota) and U.S. national data from telephone-based interviews.

Results.

AI participants showed a significantly greater prevalence of diabetes, coronary heart disease, myocardial infarction, smoking, obesity, and heavy alcohol use than either the regional or national samples. They also reported being less likely to engage in leisure-time physical activity and to have had age-appropriate preventive screenings for several diseases including colorectal cancer, prostate cancer, breast cancer, and cardiovascular disease.

Conclusions.

Face-to-face interviews conducted by AI community members are an effective means of gathering health information about AIs living in rural, reservation communities. AIs living in these communities on the northern plains have a much higher prevalence of many health-risk behaviors and some medical conditions than are found in the general population. Improved health-care access, better preventive screenings, and culturally appropriate community-based health promotion programs and policies should be examined as possible ways to reduce health disparities.
Understanding People Who Have Never Received HIV Medical Care: A Population-Based Approach
Authors: Fagan Jennifer L. , Bertolli Jeanne , McNaghten A.D.
Published: July 2017

A substantial number of people living with human immunodeficiency virus (HIV) have never received HIV medical care despite the benefits of early entry to care. The United States has no population-based system that can be used to estimate the number of people who have never received HIV care or to monitor the reasons that care is delayed. Although local efforts to describe unmet need and barriers to care have been informative, nationally representative data are needed to increase the number of people who enter care soon after diagnosis.

Legal requirements to report all CD4 counts and all HIV viral load levels (indicators of HIV care) in most states now make national estimates of both care entry and non-entry feasible. The Centers for Disease Control and Prevention (CDC) and five state and local health department jurisdictions are testing and evaluating methods for a standardized supplemental HIV surveillance system to characterize HIV-infected people across the U.S. who have not entered HIV care after their diagnosis. This article reviews the context, rationale, and potential contributions of a nationally representative surveillance system to monitor delays in receiving HIV care, and provides data from the formative phase of the CDC pilot project.
Collaboration for the Integration of HIV Prevention at Title X Family Planning Service Delivery Sites
Authors: Tran Nhan T. , Hallerdin Jule M. , Flowers-Maple Charon , Moskosky Susan B.
Published: July 2017

Since 2001, the U.S. Department of Health and Human Services' Office of Family Planning (OFP), in collaboration with the Minority AIDS Initiative, has provided supplemental grant funds to Title X-funded family planning service delivery sites to expand the availability of human immunodeficiency virus (HIV) prevention services. This work has resulted in three major outcomes: ( 1) increased institutional capacity for the delivery of HIV-prevention services at Title X family planning service delivery sites, ( 2) the successful implementation of HIV-prevention services at these sites, and ( 3) the identification of HIV-positive individuals who were referred to care services. These efforts resulted in a total of 539,667 unduplicated individuals being tested for HIV. These tests resulted in the identification of 1,692 HIV-positive individuals who otherwise may not have been tested for HIV. More than 85% of the HIV-positive cases were detected among clients who self-identified as members of racial/ethnic minority groups. The integration of HIV-prevention services is a feasible and effective strategy for detecting HIV infection among women, including women in racial/ethnic minority groups.
Implementing Packaged HIV-Prevention Interventions for HIV-Positive Individuals: Considerations for Clinic-Based and Community-Based Interventions
Authors: Collins Charles B. , Hearn Kimberly D. , Whittier David N. , Freeman Anne , Stallworth JoAna D. , Phields Miriam
Published: July 2017

Providing efficacious human immunodeficiency virus (HIV) prevention services to HIV-positive individuals is an appropriate strategy to reduce new infections. The Centers for Disease Control and Prevention (CDC) has identified interventions with evidence of efficacy for prevention with positives (PwP). Through its process of disseminating evidence-based interventions (EBIs), CDC has attempted to diffuse four of these interventions into practice. One of these interventions has been diffused to community-based organizations, whereas another has been diffused to medical clinics serving HIV-positive people. A third intervention was originally developed with HIV-positive individuals using methadone, but uptake by methadone clinics has not occurred. A fourth intervention for HIV-positive adolescents and young adults has had disappointing adoption levels. Unique implementation challenges have been encountered in various intervention settings. Lessons learned in the dissemination of the first four PwP interventions will facilitate implementation of three new PwP EBIs currently being packaged for dissemination.
Origins and Development of the National Laboratory System for Public Health Testing
Authors: Astles J. Rex , White Vanessa A. , Williams Laurina O.
Published: July 2017

Although not recognized as such, a National Laboratory System (NLS) has existed since the inception of public health laboratory (PHL) testing more than a century ago. The NLS has always relied upon the participation of clinical laboratories, both to report test results that represent public health threats and to submit specimens and isolates to PHLs for additional or confirmatory testing. Historically, a number of factors have hindered the strengthening of the relationships between clinical laboratories and PHLs, but the reality of bioterrorism and subsequent focus on strengthening public-private relationships has stimulated the development of a more robust NLS.

Since 2002, there has been substantial strengthening of the NLS through the sharing of lessons learned from several demonstration projects. There is a growing emphasis on defining critical elements of the NLS, including the State Public Health Laboratory System (SPH Laboratory System) and the functions of the Laboratory Program Advisor, a position that every state should have at the center of its laboratory system's capacity-building. Additional strengthening of the NLS is occurring through ( 1) national biennial measurement of state PHLs' abilities to meet the Core Functions and Capabilities of State PHLs, ( 2) the new Laboratory System Improvement Program (L-SIP) for the SPH Laboratory System, and ( 3) sharing ideas to integrate and improve the SPH Laboratory System (e.g., using the L-SIP Online Resource Center). Public health emergencies, such as the recent H1N1 epidemic, illustrate and reinforce the need for a strong NLS within which federal, public health, and clinical (i.e., hospital and private reference) laboratories function in close collaboration.
Community-Driven Standards-Based Electronic Laboratory Data-Sharing Networks
Authors: Zarcone Patina , Nordenberg Dale , Meigs Michelle , Merrick Ulrike , Jernigan Daniel , Hinrichs Steven H.
Published: July 2017

Public health laboratories (PHLs) are critical components of the nation's healthcare system, serving as stewards of valuable specimens, delivering important diagnostic results to support clinical and public health programs, supporting public health policy, and conducting research. This article discusses the need for and challenges of creating standards-based data-sharing networks across the PHL community, which led to the development of the PHL Interoperability Project (PHLIP). Launched by the Association of Public Health Laboratories and the Centers for Disease Control and Prevention in September 2006, PHLIP has leveraged a unique community-based collaborative process, catalyzing national capabilities to more effectively share electronic laboratory-generated diagnostic information and bolster the nation's health security. PHLIP is emerging as a model of accelerated innovation for the fields of laboratory science, technology, and public health.
Implementing Routine Testing for Severe Combined Immunodeficiency within Wisconsin's Newborn Screening Program
Authors: Baker Mei Wang , Laessig Ronald H. , Katcher Murray L. , Routes John M. , Grossman William J. , Verbsky James , Kurtycz Daniel F. , Brokopp Charles D.
Published: July 2017

Severe combined immunodeficiency (SCID) is the result of genetic defects that impair normal T-cell development. SCID babies typically appear normal at birth, but acquire multiple life-threatening infections within a few months. Early diagnosis and treatment with a bone-marrow transplant markedly improves long-term outcomes.

On January 1, 2008, the newborn screening (NBS) program in Wisconsin became the first in the world to routinely test all newborns for SCID. A realtime quantitative polymerase chain reaction assay measures T-cell receptor excision circles (TRECs), which are formed during the maturation of normal T-cells. A lack or very low number of TRECs is consistent with T-cell lymphopenia. The development and validation of the TREC assay and the results of the first year of screening have been published. This article describes the process used to add SCID to the NBS panel, the establishment of follow-up capacity, and the integration of SCID screening into routine NBS workflows. The development of this expanded NBS program is described so that other states might benefit from the processes used in Wisconsin.
Leadership Principles for Developing a Statewide Public Health and Clinical Laboratory System
Authors: Marshall Steven A. , Brokopp Charles D. , Size Tim
Published: July 2017

In 1999, the Centers for Disease Control and Prevention (CDC), the Association of Public Health Laboratories (APHL), and the Federal Bureau of Investigation established the national Laboratory Response Network (LRN) for bioterrorism readiness. A more broad application of the LRN is the National Laboratory System (NLS), an effort to promote the 10 Essential Public Health Services and the Core Functions and Capabilities of State Public Health Laboratories (hereafter, Core Functions). State public health laboratories (PHLs) are responsible for leading the development of both the LRN and the NLS in their jurisdictions. Based on the experience of creating a laboratory network in Wisconsin, leadership principles are provided for developing and strengthening statewide laboratory networks of PHLs and clinical laboratories, which can also include point-of-care testing sites. Each state PHL, in the context of these Core Functions and leadership principles, sets its priorities, budgets, and strategic plans. For a limited investment of personnel and funds that will yield a large benefit to public health, a robust state laboratory system can be established.
A Brief History and Overview of CDC's Centers for Public Health Preparedness Cooperative Agreement Program
Authors: Richmond Alyson , Hostler Liane , Leeman Gregg , King Wanda
Published: July 2017

The Centers for Disease Control and Prevention (CDC) funded the Centers for Public Health Preparedness (CPHP) Cooperative Agreement program from 2004 through 2010. CDC gave approximately $134 million to 27 CPHPs within accredited schools of public health to enhance the relationship between academia and state and local health agencies to strengthen public health preparedness. Over the course of the program, CPHPs provided education and training services that met public health preparedness and response needs throughout the United States. The passage of the Pandemic and All-Hazards Preparedness Act in 2006 has had broad implications for the Department of Health and Human Services' future preparedness and response activities. Guidelines were established giving accredited schools of public health eligibility to receive federal grants to carry out the continual development and delivery of core curricula and training that responds to the needs of state, local, and tribal public health authorities.
Training the Public Health Workforce from Albany to Zambia: Technology Lessons Learned along the Way
Authors: Waltz Edward C. , Maniccia Dayna M. , Bryde Regina L. , Murphy Kristin , Harris Brett R. , Waldenmaier Mark N.
Published: July 2017

This article describes lessons learned by the University at Albany Center for Public Health Preparedness (UA-CPHP) in using three technologies to deliver preparedness training for public health professionals in New York State. These three technologies are: Audience response system (ARS, or the “clicker” system)—Purchased to improve engagement of all participants in heterogeneous training audiences, it also markedly reduces staff time while improving training evaluation (cost: $4,500). Satellite broadcast programs—UA-CPHP produced more than 50 broadcasts, which remain available as videostreams and/or podcasts. Viewership of archived programs sometimes surpasses that of the live event (cost estimate: $23,000 to $39,000). Interactive online courses—Seventeen courses have registered more than 44,000 learners worldwide. The Pandemic Influenza course alone has reached more than 16,000 registrants from all 50 U.S. states and at least 56 other countries (cost estimate: $30,000 to $65,000).

UA-CPHP's experience as a preparedness training center has confirmed that contemporary technology can be employed to improve and increase the reach of these training efforts. An additional finding was that, quite unintentionally, the intensive use of distance-based educational modalities designed to reach public health practitioners in New York State has afforded UA-CPHP a substantial national and international audience as well, and at no additional cost.
Review of the UNC Team Epi-Aid Graduate Student Epidemiology Response Program Six Years after Implementation
Authors: MacDonald Pia D.M. , Davis Meredith K. , Horney Jennifer A.
Published: July 2017

Service learning is one way that academia can contribute to assuring the public's health. The University of North Carolina's Team Epi-Aid service-learning program started in 2003. Since then, 145 graduate student volunteers have contributed 4,275 hours working with the state and local health departments during 57 activities, including outbreak investigations, community health assessments, and emergency preparedness and response. Survey data from student participants and public health partners indicates that the program is successful in meeting its goal of creating effective partnerships among the university, the North Carolina Center for Public Health Preparedness, and state and local health departments; supplying needed surge capacity to health departments; and providing students with applied public health experience and training. In this article, we discuss the programmatic lessons learned around administration, maintaining student interest, program sustainability, and challenges since program implementation.
Mapping Student Response Team Activities to Public Health Competencies: Are We Adequately Preparing the Next Generation of Public Health Practitioners?
Authors: Montgomery Jolynn P. , Durbeck Heidi , Thomas Dana , Beck Angela J. , Sarigiannis Amy N. , Boulton Matthew L.
Published: July 2017

This article compares activities of the University of Michigan School of Public Health Public Health Action Support Team (PHAST) to the Centers for Disease Control and Prevention/Council of State and Territorial Epidemiologists Applied Epidemiology Competencies (AECs) to determine the utility of using the competencies to assess extracurricular student training. We mapped the activities from eight PHAST trips occurring from 2006 to 2009 to the 34 AECs for Tier 1 epidemiologists by examining project activities to determine how closely they aligned with the AECs. PHAST trips provided students with opportunities to address 65% of the AECs; 29% of the AECs were addressed by all eight trips. The domains of AECs most often addressed by PHAST trips were leadership and systems thinking, cultural competency, and community dimensions of practice. Mapping PHAST trips to the AECs was useful for all public health students, not just epidemiologists in training.
A Public Health Academic-Practice Partnership to Develop Capacity for Exercise Evaluation and Improvement Planning
Authors: Wright Kate S. , Thomas Michael W. , Durham Dennis P. , Jackson Lillie M. , Porth Leslie L. , Buxton Mark
Published: July 2017

In December 2006, Congress passed the Pandemic and All-Hazards Preparedness Act to improve the nation's public health preparedness and response capabilities. It includes the role of Centers for Public Health Preparedness (CPHPs) to establish a competency-based core curriculum and perform evaluation of impact on newly developed materials. The Heartland Center for Public Health Preparedness (HCPHP) at the Saint Louis University School of Public Health is part of the Centers for Disease Control and Prevention national CPHP network and is engaged with state and regional partners in workforce development, preparedness planning, evaluation, and multi-year exercise and training cycles. This includes development, implementation, and evaluation of the HCPHP Exercise Evaluation Training Program to improve the competence and capacity for exercise evaluation and improvement planning. This program is designed to enhance quality improvement and performance measurement capabilities to identify increase of workforce competence over time (maturity).