bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hospitality Workers' Attitudes and Exposure to Secondhand Smoke, Hazardous Chemicals, and Working Conditions
Authors: Pearson Dave , Angulo Antoinette , Bourcier Emily , Freeman Elizabeth , Valdez Roger 
Published: July 2017

Objective. Compelling reasons exist for labor and public health to collaborate. For example, compared to white-collar workers, blue-collar and service workers are much more likely to be targeted by the tobacco industry and become smokers. The purpose of this descriptive study was to assess if there were ways public health and labor could collaborate to document the health attitudes and needs of hospitality industry workers. Methods. Eligible union members were identified through an electronic enrollment file consisting of 3,659 names maintained by the union. The mail survey instrument covered exposure to secondhand smoke, exposure to hazardous chemicals and materials, time pressure and job demands, and work-related pain/disability. Additional questions related to age, gender, race/ethnicity, level of education, employment history, English proficiency, and self-reported health status. Results. Study results demonstrated that important health information could be successfully collected on unionized workers. Survey data showed that union members were a very diverse group who were exposed to secondhand smoke and supported working in clean-air settings. Workers, especially housekeeping staff, characterized their work as being chaotic and demanding, while almost half of workers reported work-related pain. Conclusions. Key to the successful collaboration was establishing trust between the parties and emphasizing data collection that served the information needs of both organizations. Opportunities exist to improve the health and working conditions of this population. Health interventions need to be designed to take into consideration the very diverse, mostly female, and limited English proficiency of this group of workers.
Comparison of Health and Social Characteristics of People Leaving New York City Jails by Age, Gender, and Race/Ethnicity: Implications for Public Health Interventions
Authors: Freudenberg Nicholas , Moseley Jeanne , Labriola Melissa , Daniels Jessie , Murrill Christopher 
Published: July 2017

Objectives. We compared health and social needs by gender, age, and race/ethnicity of people leaving New York City jails and assessed the implication of these differences for the development of jail reentry programs. Methods. Surveys were completed with 1,946 individuals (536 men, 704 women, and 706 adolescent males) between 1997 and 2004. Structured questionnaires captured data on demographic, criminal justice, substance use, and health characteristics. Bivariate comparisons were performed to determine variations between men and women, men and male adolescents, and non-Latino black and Hispanic/Latino respondents. Results. The majority of participants were black and Hispanic/Latino, reported high levels of substance use, had high rates of recidivism, and experienced difficult living circumstances. Compared with men, women were more likely to be homeless, use illicit drugs, report drug charges at index arrest, have health problems, and be parents. Adolescent males were more likely than men to rely on illegal activities for income and to have used marijuana and alcohol recently, and were less likely to report homelessness or health problems. Ethnic/racial differences between black and Hispanic/Latino respondents within gender and age groups were smaller than differences among these groups. Conclusions. Jails concentrate individuals with multifaceted health and social problems, providing opportunities to engage at-risk populations in comprehensive reentry programs. Gender, age, and ethnic/racial differences among incarcerated populations require that interventions be tailored to the specific needs of these different groups.
Panel Classification of Self-Reported Exposure Histories: A Useful Exposure Index after a Mass-Casualty Event
Authors: Van Sickle David , Wenck Mary Anne , Belflower Amy , Drociuk Dan , Ferdinands Jill 
Published: July 2017

Objective. Although rapid epidemiologic investigations of toxic exposures require estimates of individual exposure levels, objective measures of exposure are often unavailable. We investigated whether self-reported exposure histories, when reviewed and classified by a panel of raters, provided a useful exposure metric. Methods. A panel reviewed exposure histories as reported by people who experienced a chlorine release. The panelists received no information about health-care requirements or specific health effects. To each exposure case, each panelist assigned one of five possible exposure severity ratings. When assigned ratings were not in initial agreement, the panelists discussed the case and assigned a consensus rating. Percent agreement and kappa statistics assessed agreement among panelists, Kendall's W measured agreement among panelists in their overall ordering of the exposure histories, and Spearman's rho compared the resultant rankings with individual health outcome. Results. In 48% of the cases, the panelists' initial ratings agreed completely. Overall, initial ratings for a given case matched the consensus rating 69% to 89% of the time. Pair-wise comparisons revealed 85% to 95% agreement among panelists, with weighted kappa statistics between 0.69 and 0.83. In their overall ranking of the exposure histories, the panelists reached significant agreement (W50.90, p<0.0001). Disagreement arose most frequently regarding probable chlorine concentration and duration of exposure. This disagreement was most common when panelists differentiated between adjacent categories of intermediate exposure. Panel-assigned exposure ratings significantly correlated with health outcome (Spearman's rho=0.56; p<0.0001). Conclusion. Epidemiologists and public health practitioners can elicit and review self-reported exposure histories and assign exposure severity ratings that predict medical outcome. When objective markers of exposure are unavailable, panel-assigned exposure ratings may be useful for rapid epidemiologic investigations.
Rapid Assessment of Exposure to Chlorine Released from a Train Derailment and Resulting Health Impact
Authors: Wenck Mary Anne , Van Sickle David , Drociuk Daniel , Belflower Amy , Youngblood Claire , Whisnant M. David , Taylor Richard , Rudnick Veleta , Gibson James J. 
Published: July 2017

Objectives. After a train derailment released approximately 60 tons of chlorine from a ruptured tanker car, a multiagency team performed a rapid assessment of the health impact to determine morbidity caused by the chlorine and evaluate the effect of this mass-casualty event on health-care facilities. Methods. A case was defined as death or illness related to chlorine exposure. Investigators gathered information on exposure, treatment received, and outcome through patient questionnaires and medical record review. An exposure severity rating was assigned to each patient based on description of exposure, distance from derailment, and duration of exposure. A case involving death or hospitalization ≥3 nights was classified as a severe medical outcome. Logistic regression was used to examine factors associated with severe medical outcomes. Results. Nine people died, 72 were hospitalized in nine hospitals, and 525 were examined as outpatients. Fifty-one people (8%) had a severe medical outcome. Of 263 emergency department visits within 24 hours of the incident, 146 (56%) were in Augusta, Georgia; at least 95 patients arrived at facilities in privately owned vehicles. Patients with moderate-to-extreme exposure were more likely to experience a severe medical outcome (relative risk: 15.2; 95% confidence interval 4.8, 47.8) than those with a lower rating. Conclusions. The rapid investigation revealed significant morbidity and mortality associated with an accidental release of chlorine gas. Key findings that should be addressed during facility, community, state, and regional mass-casualty planning include self-transport of symptomatic people for medical care and impact on health-care facilities over a wide geographic area.
Identifying Infants at Increased Risk for Late Initiation of Immunizations: Maternal and Provider Characteristics
Authors: Feemster Kristen A. , Spain C. Victor , Eberhart Michael , Pati Susmita , Watson Barbara 
Published: July 2017

Objective. We identified maternal, provider, and community predictors among infants for late initiation of immunizations. Methods. We performed a retrospective cohort study of infants born between January 1, 2002, and December 31, 2004, in Philadelphia, Pennsylvania. Primary outcomes were age in days at first office-based immunization and status as a late starter (i.e., initiating office-based immunizations after 90 days of age). Candidate predictors included sociodemographic and prenatal characteristics, immunization provider practice type and size, and neighborhood factors. We performed hierarchical logistic regression and Cox regression models to identify independent predictors for being a late starter and prolonged time to first immunization. Results. Of the 65,519 infants from this birth cohort in Philadelphia's immunization registry, 54,429 (88.1%) were included in analysis and 12.6% of these were late starters. Infants whose mothers were younger, received less than five prenatal visits, had less than a high school education, had more than two children, and who smoked cigarettes prenatally were significantly more likely to be late starters. Receiving care at hospital/university-based or public health clinics was also significantly associated with likelihood of being a late starter. Neither distance between infant's residence and practice nor neighborhood socioeconomic indicators was independently associated with the outcomes. Common risk factor profiles based on practice type and four maternal characteristics were found to reliably identify infant risk. Conclusions. Maternal receipt of fewer prenatal care visits, younger maternal age, higher birth order, and receiving care at public health clinics were the strongest predictors of being a late starter and time to first immunization. Risk factor profiles based on information already collected at birth can be used to identify higher-risk infants. Early intervention and potentially partnering with prenatal care providers may be key strategies for preventing underimmunization.
Assessing Cancer Stage and Screening Disparities among Native American Cancer Patients
Authors: Guadagnolo B. Ashleigh , Cina Kristin , Helbig Petra , Molloy Kevin , Reiner Mary , Cook E. Francis , Petereit Daniel G. 
Published: July 2017

Objective. Disparities in cancer-related health outcomes exist among Native Americans. This article assesses barriers to timely and effective cancer care among Native American cancer patients. Methods. We conducted a community-based participatory survey of newly diagnosed cancer patients to assess their basic knowledge of cancer screening and their beliefs about cancer management. Sociodemographic and cancer-related information was obtained from medical records. Mean scores for correct answers to the screening knowledge battery were tabulated and analyzed by race/ethnicity and sociodemographic characteristics. Multivariable regression models were used to adjust for sociodemographic characteristics in evaluating the association between screening knowledge and race/ethnicity. Results. The survey response rate was 62%. Of 165 patients, 52 were Native American and 113 were white. Native Americans with cancers for which a screening test is available presented with significantly higher rates of advanced-stage cancer ( p=0.04). Native Americans scored lower on the cancer screening knowledge battery ( p=0.0001). In multivariable analyses adjusting for age, gender, income, education level, employment status, and geographic distance from the cancer center, Native American race/ethnicity was the only factor significantly predictive of lower screening knowledge. Native Americans expressed more negative attitudes toward cancer treatment in some of the items regarding impacts and burden of cancer treatment. Conclusions. Native American cancer patients presented with higher rates of advanced-stage disease for screening-detectable cancers, lower levels of basic cancer screening knowledge, and more negative attitudes about cancer treatment than white patients. Public health interventions regarding screening and cancer education are needed.
Developing Summary Scores of Health-Related Quality of Life for a Population-Based Survey
Authors: Horner-Johnson Willi , Krahn Gloria , Andresen Elena , Hall Trevor ,   RRTC Expert Panel on Health Status Measurement
Published: July 2017

Objective. Health-related quality of life (HRQOL) is an important indicator of public health. The Centers for Disease Control and Prevention's (CDC's) Behavioral Risk Factor Surveillance System (BRFSS) includes nine HRQOL items that can be used to monitor the health status of the nation. The objective of this study was to examine the numerical relationships among these HRQOL items to develop summary scores by combining items. Methods. Using 2001 and 2002 BRFSS data from states that included all nine HRQOL questions, factor analyses were performed to determine whether the items would group together into multi-item scales. Results. Two factors emerged, corresponding conceptually to a physical health construct and a mental health construct. The resulting scales demonstrated acceptable internal consistency and ability to distinguish between population subgroups known to differ on HRQOL. Conclusions. This study provides support for condensing the BRFSS core and optional HRQOL questions into two scales. These scales provide more complete information about physical and mental HRQOL than is available from single items, while limiting the number of individual variables required for a given analysis. However, the four core HRQOL questions focus primarily on physical health. Thus, the five supplemental questions should be included when measuring mental health is of interest.
Hepatocellular Carcinoma Prevalence and Mortality in a Male State Prison Population
Authors: Baillargeon Jacques , Snyder Ned , Soloway Roger D. , Paar David , Baillargeon Gwen , Spaulding Anne C. , Pollock Brad H. , Arcari Christine M. , Williams Brie A. , Raimer Ben G. 
Published: July 2017

Objectives. The incidence of hepatocellular carcinoma (HCC) in the United States has increased dramatically over the last two decades, largely because of an increase in the number of people with advanced hepatitis C virus (HCV) infection. U.S. prisoners are at high risk for HCC, given their elevated rates of HCV infection, comorbid hepatitis B virus (HBV) infection, and alcoholic liver disease. The purpose of our study was to examine the prevalence and mortality of HCC in the nation's largest state prison system. Methods. The study population consisted of 325,477 male Texas Department of Criminal Justice (TDCJ) inmates who were incarcerated between January 1, 2003, and July 31, 2006. Information on medical conditions and demographic characteristics was obtained from an institution-wide medical information system. Results. During the 3.5-year study period, 176 male TDCJ inmates (54 per 100,000) were diagnosed with HCC and 108 (33 per 100,000) died as a result of HCC. Inmates who were Hispanic, older, and infected with HCV, HBV, or human immunodeficiency virus had elevated rates of both HCC prevalence and mortality. After adjusting for all study covariates, HCC prevalence, but not mortality, was modestly elevated among inmates with diabetes. Conclusions. Our study showed that the Texas male prison population had a sevenfold higher prevalence of HCC than the general U.S. male population and a fourfold higher death rate from HCC. These findings likely reflect the high concentration of HCC-related risk factors, particularly HCV, among prisoners.
Assessing Public Health Capabilities during Emergency Preparedness Tabletop Exercises: Reliability and Validity of a Measurement Tool
Authors: Savoia Elena , Testa Marcia A. , Biddinger Paul D. , Cadigan Rebecca O. , Koh Howard , Campbell Paul , Stoto Michael A. 
Published: July 2017

Objectives. Improving the ability of local public health agencies to respond to large-scale emergencies is an ongoing challenge. Tabletop exercises can provide an opportunity for individuals and groups to practice coordination of emergency response and evaluate performance. The purpose of this study was to develop a valid and reliable self-assessment performance measurement tool for tabletop exercise participants. Methods. The study population comprised 179 public officials who attended three tabletop exercises in Massachusetts and Maine between September 2005 and November 2006. A 42-item questionnaire was developed to assess five public health functional capabilities: ( 1) leadership and management, ( 2) mass casualty care, ( 3) communication, ( 4) disease control and prevention, and ( 5) surveillance and epidemiology. Analyses were undertaken to examine internal consistency, associations among scales, the empirical structure of the items, and inter-rater agreement. Results. Thirty-seven questions were retained in the final questionnaire and grouped according to the original five domains. Alpha coefficients were 0.81 or higher for all scales. The five-factor solution from the principal components analysis accounted for 60% of the total variance, and the factor structure was consistent with the five domains of the original conceptual model. Inter-rater agreement ranged from good to excellent. Conclusions. The resulting 37-item performance measurement tool was found to reliably measure public health functional capabilities in a tabletop exercise setting, with preliminary evidence of a factor structure consistent with the original conceptualization and of criterion-related validity.
Do Traditional Measures of Water Quality in Swimming Pools and Spas Correspond with Beneficial Oxidation Reduction Potential?
Authors: Bastian Tiana , Brondum Jack 
Published: July 2017

Objectives. Oxidation reduction potential (ORP) is a more direct measure of water quality in swimming pools and spas than free chlorine. However, ORP is not considered in some state pool codes, including Minnesota's. This study examined whether compliance with the Minnesota Pool Code assured an ORP ≥650 millivolts (mV), a value defined in the literature as adequate to kill viral and bacterial pathogens within seconds. We also examined predictors of ORP. Methods. Water samples from public swimming pools and spas in Hennepin County, Minnesota, were collected during routine health inspections from May through August 2004 and assessed for compliance with the state pool code. ORP values were also recorded. A Chi-square test was used to evaluate the association between code compliance and ORP. Analysis of covariance (ANCOVA) and logistic regression models were used to determine predictors of ORP. Results. The study included 132 pools and 30 spas. Compliance with the Minnesota Pool Code did not assure an ORP≥650 mV ( p<0.01). Outdoor pools had significantly lower ORP values than indoor pools ( p<0.001). ANCOVA and logistic regression models showed that ORP decreased with increasing cyanuric acid, increasing pH, and decreasing free chlorine. Conclusions. Compliance with the Minnesota Pool Code did not coincide with adequate ORP values, particularly for outdoor pools and spas. Therefore, it may be appropriate for states to include a minimum ORP standard of ≥650 mV in their swimming pool regulations. Doing so would likely benefit the health of swimmers.
A Pilot Asthma Incidence Surveillance System and Case Definition: Lessons Learned
Authors: Trepka Mary Jo , Martin Pilar , Mavunda Kunjana , Rodriguez Diana , Zhang Guoyan , Brown Clive 
Published: July 2017

Objectives. Surveillance for incident asthma in the general population could provide timely information about asthma trends and new, emerging etiologic factors. We sought to determine the feasibility of an asthma incidence surveillance system using voluntary reporting of asthma by outpatient clinics and emergency departments (EDs). Methods. Voluntary reporting occurred from July 2002 through June 2006. We classified reported asthma based on a case definition adapted from one developed by the Council of State and Territorial Epidemiologists. We validated the case definition by having pulmonologists review data from participant interviews, medical record abstractions, and pulmonary function test (PFT) results. Results. The positive predictive value (PPV) of meeting any of the case definition criteria for asthma was 80% to 82%. The criterion of taking at least one rescue and one controller medication had the highest PPV (97% to 100%). Only 7% of people meeting the incident case definition had a PFT documented in their medical record, limiting the usefulness of PFT results for case classification. Compared with pediatric participants, adult participants were more likely to be uninsured and to obtain asthma care at EDs. The surveillance system cost $5,129 per enrolled person meeting the incident case definition and was difficult to implement in participating clinics and EDs because asthma reporting was not mandatory and informed consent was necessary. Conclusions. The project was useful in evaluating the case definition's validity and in describing the participants' characteristics and health-care use patterns. However, without mandatory reporting laws, reporting of incident asthma in the general population by clinicians is not likely to be a feasible method for asthma surveillance.
Resource Allocation on the Frontlines of Public Health Preparedness and Response: Report of a Summit on Legal and Ethical Issues
Authors: Barnett Daniel J. , Taylor Holly A. , Hodge James G. , Links Jonathan M. 
Published: July 2017

Objectives. In the face of all-hazards preparedness challenges, local and state health department personnel have to date lacked a discrete set of legally and ethically informed public health principles to guide the distribution of scarce resources in crisis settings. To help address this gap, we convened a Summit of academic and practice experts to develop a set of principles for legally and ethically sound public health resource triage decision-making in emergencies. Methods. The invitation-only Summit, held in Washington, D.C., on June 29, 2006, assembled 20 experts from a combination of academic institutions and nonacademic leadership, policy, and practice settings. The Summit featured a tabletop exercise designed to highlight resource scarcity challenges in a public health infectious disease emergency. This exercise served as a springboard for Summit participants' subsequent identification of 10 public health emergency resource allocation principles through an iterative process. Results. The final product of the Summit was a set of 10 principles to guide allocation decisions involving scarce resources in public health emergencies. The principles are grouped into three categories: obligations to community; balancing personal autonomy and community well-being/benefit; and good preparedness practice. Conclusions. The 10 Summit-derived principles represent an attempt to link law, ethics, and real-world public health emergency resource allocation practices, and can serve as a useful starting framework to guide further systematic approaches and future research on addressing public health resource scarcity in an all-hazards context.