bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing the Impact of the Health Center Growth Initiative on Health Center Patients
Authors: Shi Leiyu , Lebrun Lydie A. , Tsai Jenna 
Published: July 2017

Objectives. In 2001, the Health Center Growth Initiative was launched to increase access to primary health-care services through the expansion of the health center program. We examined the impact this initiative had on the number and types of patients seen by health centers, as well as the health center characteristics significantly associated with service expansions. Methods. We conducted secondary and time-trend analyses of the Uniform Data System, an annual dataset submitted to the Bureau of Primary Health Care by all federally qualified health centers. We performed trend and multi-variable analyses to examine the impact of the initiative on health center performance. Results. Health centers that received both new access points and expanded medical capacity funding saw the most rapid growth in patients. These centers experienced a 58% increase in total number of patients and a 60% increase in total number of encounters, compared with 10% and 8%, respectively, for centers receiving no funding at all. Conclusions were unchanged even after controlling for other health center characteristics. Conclusions. Public funding is critical to sustaining and expanding health center services to the nation's vulnerable populations.
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.
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.
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.