Survival on dialysis among American Indians and Alaska Natives with diabetes in the United States, 1995-2010
Burrows NR , Cho P , McKeever Bullard K , Narva AS , Eggers PW . Am J Public Health 2014 104 Suppl 3 S490-5 OBJECTIVES: We assessed survival in American Indians and Alaska Natives (AI/ANs) with end-stage renal disease attributed to diabetes who initiated hemodialysis between 1995 and 2009. METHODS: Follow-up extended from the first date of dialysis in the United States Renal Data System until December 31, 2010, kidney transplantation, or death. We used the Kaplan-Meier method to compute survival on dialysis by age and race/ethnicity and Cox regression analysis to compute adjusted hazard ratios (HRs). RESULTS: Our study included 510 666 persons-48% Whites, 2% AI/AN persons, and 50% others. Median follow-up was 2.2 years (interquartile range = 1.1-4.1 years). At any age, AI/AN persons survived longer on hemodialysis than Whites; this finding persisted after adjusting for baseline differences. Among AI/AN individuals, those with full Indian blood ancestry had the lowest adjusted risk of death compared with Whites (HR = 0.58; 95% confidence interval = 0.55, 0.61). The risk increased with declining proportion of AI/AN ancestry. CONCLUSIONS: Survival on dialysis was better among AI/AN than White persons with diabetes. Among AI/AN persons, the inverse relationship between risk of death and level of AI/AN ancestry suggested that cultural or hereditary factors played a role in survival. |
Trends and clustering of cardiovascular health metrics among U.S. adolescents 1988-2010
Yang Q , Yuan K , Gregg EW , Loustalot F , Fang J , Hong Y , Merritt R . J Adolesc Health 2014 55 (4) 513-20 PURPOSE: American Heart Association recently published a set of seven cardiovascular (CV) health metrics for adults and children, emphasizing importance of preventing CV risk factors. Although CV disease risk factors have generally improved in adults, there is concern that this has not been true among adolescents. The present study examined trends and disparities of CV health metrics among U.S. adolescents. METHODS: We used data from a series of National Health and Nutrition Examination Survey (1988-1994, 1999-2004, and 2005-2010) including 11,233 adolescents aged 12-17 years. We estimated prevalence and mean score of CV health metrics and examined the disparities in mean score by sex, race/ethnicity, educational attainment, and poverty-income ratio. RESULTS: The prevalence of nonsmoking and healthy diet increased from 1988 through 2010, while the prevalence of normal body mass index and physical activity decreased, resulting in an unchanged distribution of overall CV health scores since 1988. The prevalence of adolescents meeting all seven CV health metrics was low, 3.5% (95% confidence interval [CI] 2.2-5.4), 4.0% (95% CI 3.3-4.8), and 4.0% (95% CI 2.9-5.3) in National Health and Nutrition Examination Survey 1988-1994, 1999-2004, and 2005-2010, respectively. The disparities in adjusted mean scores persisted between non-Hispanic whites and non-Hispanic blacks, families/households with >12 versus <12 years of education, and poverty-income ratio of >3 versus <3 (p < .05). CONCLUSIONS: The proportion of adolescents achieving all seven CV health metrics was low and remained unchanged during 1988-2010. The disparities in mean CV health score persisted among adolescents. |
Trends and disparities in heart disease mortality among American Indians/Alaska Natives, 1990-2009
Veazie M , Ayala C , Schieb L , Dai S , Henderson JA , Cho P . Am J Public Health 2014 104 Suppl 3 S359-67 OBJECTIVES: We evaluated heart disease death rates among American Indians and Alaska Natives (AI/ANs) and Whites after improving identification of AI/AN populations. METHODS: Indian Health Service (IHS) registration data were linked to the National Death Index for 1990 to 2009 to identify deaths among AI/AN persons aged 35 years and older with heart disease listed as the underlying cause of death (UCOD) or 1 of multiple causes of death (MCOD). We restricted analyses to IHS Contract Health Service Delivery Areas and to non-Hispanic populations. RESULTS: Heart disease death rates were higher among AI/AN persons than Whites from 1999 to 2009 (1.21 times for UCOD, 1.30 times for MCOD). Disparities were highest in younger age groups and in the Northern Plains, but lowest in the East and Southwest. In AI/AN persons, MCOD rates were 84% higher than UCOD rates. From 1990 to 2009, UCOD rates declined among Whites, but only declined significantly among AI/AN persons after 2003. CONCLUSIONS: Analysis with improved race identification indicated that AI/AN populations experienced higher heart disease death rates than Whites. Better prevention and more effective care of heart disease is needed for AI/AN populations. |
Trends and disparities in stroke mortality by region for American Indians and Alaska Natives
Schieb LJ , Ayala C , Valderrama AL , Veazie MA . Am J Public Health 2014 104 Suppl 3 S368-76 OBJECTIVES: We evaluated trends and disparities in stroke death rates for American Indians and Alaska Natives (AI/ANs) and White people by Indian Health Service region. METHODS: We identified stroke deaths among AI/AN persons and Whites (adults aged 35 years or older) using National Vital Statistics System data for 1990 to 2009. We used linkages with Indian Health Service patient registration data to adjust for misclassification of race for AI/AN persons. Analyses excluded Hispanics and focused on Contract Health Service Delivery Area (CHSDA) counties. RESULTS: Stroke death rates among AI/AN individuals were higher than among Whites for both men and women in CHSDA counties and were highest in the youngest age groups. Rates and AI/AN:White rate ratios varied by region, with the highest in Alaska and the lowest in the Southwest. Stroke death rates among AI/AN persons decreased in all regions beginning in 2001. CONCLUSIONS: Although stroke death rates among AI/AN populations have decreased over time, rates are still higher for AI/AN persons than for Whites. Interventions that address reducing stroke risk factors, increasing awareness of stroke symptoms, and increasing access to specialty care for stroke may be more successful at reducing disparities in stroke death rates. |
Trends in the use, sociodemographic correlates, and undertreatment of prescription medications for chronic obstructive pulmonary disease among adults with chronic obstructive pulmonary disease in the United States from 1999 to 2010
Ford ES , Mannino DM , Wheaton AG , Presley-Cantrell L , Liu Y , Giles WH , Croft JB . PLoS One 2014 9 (4) e95305 BACKGROUND: The extent to which patients with COPD are receiving indicated treatment with medications to improve lung function and recent trends in the use of these medications is not well documented in the United States. The objective of this study was to examine trends in prescription medications for COPD among adults in the United States from 1999 to 2010. METHODS: We performed a trend analysis using data from up to 1426 participants aged ≥20 years with self-reported COPD from six national surveys (National Health and Nutrition Examination Survey 1999-2010). RESULTS: During 2009-2010, the age-adjusted percentage of participants who used any kind of medication was 44.2%. Also during 2009-2010, the most commonly used medications were short-acting agents (36.0%), inhaled corticosteroids (ICS) (18.3%), and LABAs (16.7%). The use of long-acting beta-2 agonists (LABAs) (p for trend <0.001), ICS (p for trend = 0.013) increased significantly over the 12-year period. Furthermore, the use of tiotropium increased rapidly during this period (p for trend <0.001). For the years 2005-2010, the use of LABAs, ICS and tiotropium increased with age. Compared with whites, Mexican Americans were less likely to use short-acting agents, LABAs, ICS, tiotropium, and any kind of COPD medication. Among participants aged 20-79 years with spirometry measurements during 2007-2010, the use of any medication was reported by 19.0% of those with a moderate/severe obstructive impairment and by 72.6% of those with self-reported COPD and any obstructive impairment. CONCLUSION: The percentages of adults with COPD who reported having various classes of prescription medications that improve airflow limitations changed markedly from 1999-2000 to 2009-2010. However, many adults with COPD did not report having recommended prescription medications. |
Lung cancer deaths among American Indians and Alaska Natives, 1990-2009
Plescia M , Henley SJ , Pate A , Underwood JM , Rhodes K . Am J Public Health 2014 104 Suppl 3 S388-95 OBJECTIVES: We examined regional differences in lung cancer among American Indians/Alaska Natives (AI/ANs) using linked data sets to minimize racial misclassification. METHODS: On the basis of federal lung cancer incidence data for 1999 to 2009 and deaths for 1990 to 2009 linked with Indian Health Service (IHS) registration records, we calculated age-adjusted incidence and death rates for non-Hispanic AI/AN and White persons by IHS region, focusing on Contract Health Service Delivery Area (CHSDA) counties. We correlated death rates with cigarette smoking prevalence and calculated mortality-to-incidence ratios. RESULTS: Lung cancer death rates among AI/AN persons in CHSDA counties varied across IHS regions, from 94.0 per 100 000 in the Northern Plains to 15.2 in the Southwest, reflecting the strong correlation between smoking and lung cancer. For every 100 lung cancers diagnosed, there were 6 more deaths among AI/AN persons than among White persons. Lung cancer death rates began to decline in 1997 among AI/AN men and are still increasing among AI/AN women. CONCLUSIONS: Comparison of regional lung cancer death rates between AI/AN and White populations indicates disparities in tobacco control and prevention interventions. Efforts should be made to ensure that AI/AN persons receive equal benefit from current and emerging lung cancer prevention and control interventions. |
Mortality caused by chronic liver disease among American Indians and Alaska Natives in the United States, 1999-2009
Suryaprasad A , Byrd KK , Redd JT , Perdue DG , Manos MM , McMahon BJ . Am J Public Health 2014 104 Suppl 3 S350-8 OBJECTIVES: We compared chronic liver disease (CLD) mortality from 1999 to 2009 between American Indian and Alaska Natives (AI/ANs) and Whites in the United States after improving CLD case ascertainment and AI/AN race classification. METHODS: We defined CLD deaths and causes by comprehensive death certificate-based diagnostic codes. To improve race classification, we linked US mortality data to Indian Health Service enrollment records, and we restricted analyses to Contract Health Service Delivery Areas and to non-Hispanic populations. We calculated CLD death rates (per 100 000) in 6 geographic regions. We then described trends using linear modeling. RESULTS: CLD mortality increased from 1999 to 2009 in AI/AN persons and Whites. Overall, the CLD death rate ratio (RR) of AI/AN individuals to Whites was 3.7 and varied by region. The RR was higher in women (4.7), those aged 25 to 44 years (7.4), persons residing in the Northern Plains (6.4), and persons dying of cirrhosis (4.0) versus hepatocellular carcinoma (2.5), particularly those aged 25 to 44 years (7.7). CONCLUSIONS: AI/AN persons had greater CLD mortality, particularly from premature cirrhosis, than Whites, with variable mortality by region. Comprehensive prevention and care strategies are urgently needed to stem the CLD epidemic among AI/AN individuals. |
Ovarian and uterine cancer incidence and mortality in American Indian and Alaska Native women, United States, 1999-2009
Singh SD , Ryerson AB , Wu M , Kaur JS . Am J Public Health 2014 104 Suppl 3 S423-31 OBJECTIVES: We examined geographic differences and trends in incidence and mortality of ovarian and uterine cancer in American Indian/Alaska Native (AI/AN) women. METHODS: We linked mortality data (1990-2009) and incidence data (1999-2009) to Indian Health Service (IHS) records. Death (and incidence) rates for ovarian and uterine cancer were examined for AI/AN and White women; Hispanics were excluded. Analyses focused on Contract Health Service Delivery Area (CHSDA) counties. RESULTS: AI/AN and White women had similar ovarian and uterine cancer death rates. Ovarian and uterine cancer incidence and death rates were higher for AI/ANs residing in CHSDA counties than for all US counties. We also observed geographic differences, regardless of CHSDA residence, in ovarian and uterine cancer incidence and death rates in AI/AN women by IHS region; Pacific Coast and Southern Plains women had higher ovarian cancer death rates and Northern Plains women had higher uterine cancer death rates. CONCLUSIONS: Regional differences in the incidence and mortality of ovarian and uterine cancers among AI/AN women in the United States were significant. More research among correctly classified AI/AN women is needed to understand these differences. |
Prevalence of psoriasis among adults in the U.S.: 2003-2006 and 2009-2010 National Health and Nutrition Examination Surveys
Helmick CG , Lee-Han H , Hirsch SC , Baird TL , Bartlett CL . Am J Prev Med 2014 47 (1) 37-45 BACKGROUND: A 2010 CDC-sponsored consultation of psoriasis, psoriatic arthritis, and public health experts developed a public health agenda for psoriasis and psoriatic arthritis indicating that additional population-based research is needed to better characterize psoriasis in the population. PURPOSE: To better characterize the burden of psoriasis in the U.S. using recent population-based, cross-sectional data in this 2012 analysis. METHODS: A subset of 10,676 adults aged 20-59 years from the 2003-2006 and 2009-2010 National Health and Nutrition Examination Surveys was used to examine psoriasis prevalence, severity, disparities, health-related quality of life, and selected comorbidities. RESULTS: The overall prevalence of psoriasis was 3.1% (95% CI=2.6, 3.6); extrapolating to older adults suggests that 6.7 million adults aged ≥20 years are affected. Psoriasis was significantly more prevalent among non-Hispanic whites than other race/ethnicity subgroups, as well as among those with arthritis. Approximately 82% reported no/little or mild disease; the impact of psoriasis on daily life increased with disease severity (p=0.0001 for trend). Those with psoriasis reported significantly more frequent mental distress or mild to severe depression than those without psoriasis. Psoriasis was also significantly associated with obesity and former smoking status. CONCLUSIONS: Psoriasis is a large public health problem. Further characterizing psoriasis from a public health perspective will require better survey questions and inclusion of these questions in national surveys. |
Prostate cancer deaths and incident cases among American Indian/Alaska Native men, 1999-2009
Hoffman RM , Li J , Henderson JA , Ajani UA , Wiggins C . Am J Public Health 2014 104 Suppl 3 S439-45 OBJECTIVES: We linked databases to improve identification of American Indians/Alaska Natives (AI/ANs) in determining prostate cancer death and incidence rates. METHODS: We linked prostate cancer mortality and incidence data with Indian Health Service (IHS) patient records; analyses focused on residents of IHS Contract Health Service Delivery Area (CHSDA) counties. We calculated age-adjusted incidence and death rates for AI/AN and White men for 1999 to 2009; men of Hispanic origin were excluded. RESULTS: Prostate cancer death rates were higher for AI/AN men than for White men. Death rates declined for White men (-3.0% per year) but not for AI/AN men. AI/AN men had lower prostate cancer incidence rates than White men. Incidence rates declined among Whites (-2.2% per year) and AI/ANs (-1.9% per year). CONCLUSIONS: AI/AN men had higher prostate cancer death rates and lower prostate cancer incidence rates than White men. Disparities in accessing health care could contribute to mortality differences, and incidence differences could be related to lower prostate-specific antigen testing rates among AI/AN men. |
Geographic variation in colorectal cancer incidence and mortality, age of onset, and stage at diagnosis among American Indian and Alaska Native people, 1990-2009
Perdue DG , Haverkamp D , Perkins C , Daley CM , Provost E . Am J Public Health 2014 104 Suppl 3 S404-14 OBJECTIVES: We characterized estimates of colorectal cancer (CRC) in American Indians/Alaska Natives (AI/ANs) compared with Whites using a linkage methodology to improve AI/AN classification in incidence and mortality data. METHODS: We linked incidence and mortality data to Indian Health Service enrollment records. Our analyses were restricted to Contract Health Services Delivery Area counties. We analyzed death and incidence rates of CRC for AI/AN persons and Whites by 6 regions from 1999 to 2009. Trends were described using linear modeling. RESULTS: The AI/AN colorectal cancer incidence was 21% higher and mortality 39% higher than in Whites. Although incidence and mortality significantly declined among Whites, AI/AN incidence did not change significantly, and mortality declined only in the Northern Plains. AI/AN persons had a higher incidence of CRC than Whites in all ages and were more often diagnosed with late stage CRC than Whites. CONCLUSIONS: Compared with Whites, AI/AN individuals in many regions had a higher burden of CRC and stable or increasing CRC mortality. An understanding of the factors driving these regional disparities could offer critical insights for prevention and control programs. |
Human papillomavirus genotype prevalence in invasive vaginal cancer from a registry-based population
Sinno AK , Saraiya M , Thompson TD , Hernandez BY , Goodman MT , Steinau M , Lynch CF , Cozen W , Saber MS , Peters ES , Wilkinson EJ , Copeland G , Hopenhayn C , Watson M , Lyu C , Unger ER . Obstet Gynecol 2014 123 (4) 817-821 OBJECTIVE: To describe the human papillomavirus (HPV) genotype distribution in invasive vaginal cancers diagnosed before the introduction of the HPV vaccine and evaluate if survival differed by HPV status. METHODS: Four population-based registries and three residual tissue repositories provided formalin-fixed, paraffin embedded tissue from microscopically confirmed primary vaginal cancer cases diagnosed between 1994 and 2005 that were tested by L1 consensus polymerase chain reaction with type-specific hybridization in a central laboratory. Clinical, demographic, and all-cause survival data were assessed by HPV status. RESULTS: Sixty cases of invasive vaginal cancer were included. Human papillomavirus was detected in 75% (45) and 25% (15) were HPV-negative. HPV 16 was most frequently detected (55% [33/60]) followed by HPV 33 (18.3% [11/60]). Only one case was positive for HPV 18 (1.7%) Multiple types were detected in 15% of the cases. Vaginal cancers in women younger than 60 years were more likely to be HPV 16- or HPV 18-positive (HPV 16 and 18) than older women, 77.3% compared with 44.7% (P5.038). The median age at diagnosis was younger in the HPV 16 and 18 (59 years) group compared with other HPV-positive (68 years) and no HPV (77 years) (P5.003). The HPV distribution did not significantly vary by race or ethnicity or place of residence. The 5-year unadjusted all-cause survival was 57.4% for women with HPV-positive vaginal cancers compared with 35.7% among those with HPV-negative tumors (P5.243). CONCLUSION: Three fourths of all vaginal cancers in the United States had HPV detected, much higher than previously found, and 57% could be prevented by current HPV vaccines. |
Kidney cancer incidence and mortality among American Indians and Alaska Natives in the United States, 1990-2009
Li J , Weir HK , Jim MA , King SM , Wilson R , Master VA . Am J Public Health 2014 104 Suppl 3 S396-403 OBJECTIVES: We describe rates and trends in kidney cancer incidence and mortality and identify disparities between American Indian/Alaska Native (AI/AN) and White populations. METHODS: To improve identification of AI/AN race, incidence and mortality data were linked with Indian Health Service (IHS) patient records. Analysis focused on residents of IHS Contract Health Service Delivery Area counties; Hispanics were excluded. We calculated age-adjusted kidney cancer incidence (2001-2009) and death rates (1990-2009) by sex, age, and IHS region. RESULTS: AI/AN persons have a 1.6 times higher kidney cancer incidence and a 1.9 times higher kidney cancer death rate than Whites. Despite a significant decline in kidney cancer death rates for Whites (annual percentage change [APC] = -0.3; 95% confidence interval [CI] = -0.5, 0.0), death rates for AI/AN persons remained stable (APC = 0.4; 95% CI = -0.7, 1.5). Kidney cancer incidence rates rose more rapidly for AI/AN persons (APC = 3.5; 95% CI = 1.2, 5.8) than for Whites (APC = 2.1; 95% CI = 1.4, 2.8). CONCLUSIONS: AI/AN individuals have greater risk of developing and dying of kidney cancers. Incidence rates have increased faster in AI/AN populations than in Whites. Death rates have decreased slightly in Whites but remained stable in AI/AN populations. Racial disparities in kidney cancer are widening. |
Breast cancer mortality among American Indian and Alaska Native women, 1990-2009
White A , Richardson LC , Li C , Ekwueme DU , Kaur JS . Am J Public Health 2014 104 Suppl 3 S432-8 OBJECTIVES: We compared breast cancer death rates and mortality trends among American Indian/Alaska Native (AI/AN) and White women using data for which racial misclassification was minimized. METHODS: We used breast cancer deaths and cases linked to Indian Health Service (IHS) data to calculate age-adjusted rates and 95% confidence intervals (CIs) by IHS-designated regions from 1990 to 2009 for AI/AN and White women; Hispanics were excluded. Mortality-to-incidence ratios (MIR) were calculated for 1999 to 2009 as a proxy for prognosis after diagnosis. RESULTS: Overall, the breast cancer death rate was lower in AI/AN women (21.6 per 100 000) than in White women (26.5). However, rates in AI/ANs were higher than rates in Whites for ages 40 to 49 years in the Alaska region, and ages 65 years and older in the Southern Plains region. White death rates significantly decreased (annual percent change [APC] = -2.1; 95% CI = -2.3, -2.0), but regional and overall AI/AN rates were unchanged (APC = 0.9; 95% CI = 0.1, 1.7). AI/AN women had higher MIRs than White women. CONCLUSIONS: There has been no improvement in death rates among AI/AN women. Targeted screening and timely, high-quality treatment are needed to reduce mortality from breast cancer in AI/AN women. |
Cervical cancer incidence and mortality among American Indian and Alaska Native women, 1999-2009
Watson M , Benard V , Thomas C , Brayboy A , Paisano R , Becker T . Am J Public Health 2014 104 Suppl 3 S415-22 OBJECTIVES: We analyzed cervical cancer incidence and mortality data in American Indian and Alaska Native (AI/AN) women compared with women of other races. METHODS: We improved identification of AI/AN race, cervical cancer incidence, and mortality data using Indian Health Service (IHS) patient records; our analyses focused on residents of IHS Contract Health Service Delivery Area (CHSDA) counties. Age-adjusted incidence and death rates were calculated for AI/AN and White women from 1999 to 2009. RESULTS: AI/AN women in CHSDA counties had a death rate from cervical cancer of 4.2, which was nearly twice the rate in White women (2.0; rate ratio [RR] = 2.11). AI/AN women also had higher incidence rates of cervical cancer compared with White women (11.0 vs 7.1; RR = 1.55) and were more often diagnosed with later-stage disease (RR = 1.84 for regional stage and RR = 1.74 for distant stage). Death rates decreased for AI/AN women from 1990 to 1993 (-25.8%/year) and remained stable thereafter. CONCLUSIONS: Although rates decreased over time, AI/AN women had disproportionately higher cervical cancer incidence and mortality. The persistently higher rates among AI/AN women compared with White women require continued improvements in identifying and treating cervical cancer and precancerous lesions. |
Diabetes-related mortality among American Indians and Alaska Natives, 1990-2009
Cho P , Geiss LS , Burrows NR , Roberts DL , Bullock AK , Toedt ME . Am J Public Health 2014 104 Suppl 3 S496-503 OBJECTIVES: We assessed diabetes-related mortality for American Indians and Alaska Natives (AI/ANs) and Whites. METHODS: Study populations were non-Hispanic AI/AN and White persons in Indian Health Service (IHS) Contract Health Service Delivery Area counties; Hispanics were excluded. We used 1990 to 2009 death certificate data linked to IHS patient registration records to identify AI/AN decedents aged 20 years or older. We examined disparities and trends in mortality related to diabetes as an underlying cause of death (COD) and as a multiple COD. RESULTS: After increasing between 1990 and 1999, rates of diabetes as an underlying COD and a multiple COD subsequently decreased in both groups. However, between 2000 and 2009, age-adjusted rates of diabetes as an underlying COD and a multiple COD remained 2.5 to 3.5 times higher among AI/AN persons than among Whites for all age groups (20-44, 45-54, 55-64, 65-74, and ≥ 75 years), both sexes, and every IHS region except Alaska. CONCLUSIONS: Declining trends in diabetes-related mortality in both AI/AN and White populations are consistent with recent improvements in their health status. Reducing persistent disparities in diabetes mortality will require developing effective approaches to not only control but also prevent diabetes among AI/AN populations. |
Disparities in cancer mortality and incidence among American Indians and Alaska Natives in the United States
White MC , Espey DK , Swan J , Wiggins CL , Eheman C , Kaur JS . Am J Public Health 2014 104 Suppl 3 S377-87 OBJECTIVES: We used improved data on American Indian and Alaska Native (AI/AN) ancestry to provide an updated and comprehensive description of cancer mortality and incidence among AI/AN populations from 1990 to 2009. METHODS: We linked the National Death Index and central cancer registry records independently to the Indian Health Service (IHS) patient registration database to improve identification of AI/AN persons in cancer mortality and incidence data, respectively. Analyses were restricted to non-Hispanic persons residing in Contract Health Service Delivery Area counties in 6 geographic regions of the United States. We compared age-adjusted mortality and incidence rates for AI/AN populations with White populations using rate ratios and mortality-to-incidence ratios. Trends were described using joinpoint analysis. RESULTS: Cancer mortality and incidence rates for AI/AN persons compared with Whites varied by region and type of cancer. Trends in death rates showed that greater progress in cancer control was achieved for White populations compared with AI/AN populations over the last 2 decades. CONCLUSIONS: Spatial variations in mortality and incidence by type of cancer demonstrated both persistent and emerging challenges for cancer control in AI/AN populations. |
Toward a county-level map of tuberculosis rates in the U.S.
Scales D , Brownstein JS , Khan K , Cetron MS . Am J Prev Med 2014 46 (5) e49-51 Active tuberculosis (TB) is a reportable communicable disease in all 50 states, but nationwide, county-level data are not released publicly. The CDC’s Online Tuberculosis Information System (OTIS) provides public surveillance data only by state. Owing to an agreement with the states, the CDC cannot publicly release TB data at the county level, precluding the development of publicly available, county-level maps of TB cases and incidence rates. | The lack of a more granular nationwide data set has limited the study of TB trends and socioeconomic risk factors to states,1 Metropolitan Statistical Areas,2 or census tracts within a single state.3 A nationwide county-level data set of TB rates provides opportunities to examine TB-related trends across multiple states, metropolitan areas, and across counties with similar demographic characteristics, such as the number of people deemed to be at high risk.4 |
Pneumonia and influenza mortality among American Indian and Alaska Native People, 1990-2009
Groom AV , Hennessy TW , Singleton RJ , Butler JC , Holve S , Cheek JE . Am J Public Health 2014 104 Suppl 3 S460-9 OBJECTIVES: We compared pneumonia and influenza death rates among American Indian/Alaska Native (AI/AN) people with rates among Whites and examined geographic differences in pneumonia and influenza death rates for AI/AN persons. METHODS: We adjusted National Vital Statistics Surveillance mortality data for racial misclassification of AI/AN people through linkages with Indian Health Service (IHS) registration records. Pneumonia and influenza deaths were defined as those who died from 1990 through 1998 and 1999 through 2009 according to codes for pneumonia and influenza from the International Classification of Diseases, 9th and 10th Revision, respectively. We limited the analysis to IHS Contract Health Service Delivery Area counties, and compared pneumonia and influenza death rates between AI/ANs and Whites by calculating rate ratios for the 2 periods. RESULTS: Compared with Whites, the pneumonia and influenza death rate for AI/AN persons in both periods was significantly higher. AI/AN populations in the Alaska, Northern Plains, and Southwest regions had rates more than 2 times higher than those of Whites. The pneumonia and influenza death rate for AI/AN populations decreased from 39.6 in 1999 to 2003 to 33.9 in 2004 to 2009. CONCLUSIONS: Although progress has been made in reducing pneumonia and influenza mortality, disparities between AI/AN persons and Whites persist. Strategies to improve vaccination coverage and address risk factors that contribute to pneumonia and influenza mortality are needed. |
Evidence-based HIV/STD prevention intervention for black men who have sex with men
Herbst JH , Painter TM , Tomlinson HL , Alvarez ME . MMWR Suppl 2014 63 (1) 21-7 This report summarizes published findings of a community-based organization in New York City that evaluated and demonstrated the efficacy of the Many Men, Many Voices (3MV) human immunodeficiency virus (HIV)/sexually transmitted disease (STD) prevention intervention in reducing sexual risk behaviors and increasing protective behaviors among black men who have sex with men (MSM). The intervention addressed social determinants of health (e.g., stigma, discrimination, and homophobia) that can influence the health and well-being of black MSM at high risk for HIV infection. This report also highlights efforts by CDC to disseminate this evidence-based behavioral intervention throughout the United States. CDC's Office of Minority Health and Health Equity selected the intervention analysis and discussion to provide an example of a program that might be effective for reducing HIV infection- and STD-related disparities in the United States. 3MV uses small group education and interaction to increase knowledge and change attitudes and behaviors related to HIV/STD risk among black MSM. Since its dissemination by CDC in 2004, 3MV has been used in many settings, including health department- and community-based organization programs. The 3MV intervention is an important component of a comprehensive HIV and STD prevention portfolio for at-risk black MSM. As CDC continues to support HIV prevention programming consistent with the National HIV/AIDS Strategy and its high-impact HIV prevention approach, 3MV will remain an important tool for addressing the needs of black MSM at high risk for HIV infection and other STDs. |
Hand contamination with human rhinovirus in Bangladesh
Luby SP , Lu X , Cromeans T , Sharker MA , Kadir MA , Erdman DD . J Med Virol 2014 86 (12) 2177-80 As one step in developing a measure of hand contamination with respiratory viruses, this study assessed if human rhinovirus (HRV) was detectable on hands in a low income non-temperate community where respiratory disease is a leading cause of child death. Research assistants observed residents in a low income community in Dhaka, Bangladesh. When they observed a resident sneeze or pick their nose, they collected a hand rinse and anterior nare sample from the resident. Samples were first tested for HRV RNA by real-time RT-PCR (rRT-PCR). A subset of rRT-PCR positive samples were cultured into MRC-5 and HeLa Ohio cells. Among 177 hand samples tested for HRV by real-time RT-PCR, 52 (29%) were positive. Among 15 RT-PCR positive hand samples that were cultured, two grew HRV. HRV was detected in each of the sampling months (January, February, June, July, November, and December). This study demonstrates in the natural setting that, at least after sneezing or nasal cleaning, hands were contaminated commonly with potentially infectious HRV. Future research could explore if HRV RNA is present consistently and is associated sufficiently with the incidence of respiratory illness in communities that it may provide a proxy measure of respiratory viral hand contamination. |
Increased susceptibility to vaginal SHIV transmission in pigtail macaques coinfected with Chlamydia trachomatis and Trichomonas vaginalis
Henning T , Butler K , Hanson D , Sturdevant G , Ellis S , Sweeney EM , Mitchell J , Deyounks F , Phillips C , Farshy C , Fakile Y , Papp J , Secor WE , Caldwell H , Patton D , McNicholl J , Kersh E . J Infect Dis 2014 210 (8) 1239-47 BACKGROUND: Sexually transmitted infections (STIs) are associated with increased HIV infection risk, but their biological effect on HIV susceptibility is not fully understood. METHODS: Female pigtail macaques, inoculated with C. trachomatis and T. vaginalis (n=9) or media (controls, n=7), were repeatedly intravaginally challenged with SHIVSF162p3. Virus levels were evaluated by real-time PCR, plasma and genital cytokine levels by Luminex assays, and STI clinical signs by colposcopy. RESULTS: SHIV susceptibility was enhanced in STI-positive macaques (p=0.04, log rank; 2.5-times as high relative risk of infection, 95% CI 1.1, 5.6). All STI-positive macaques were SHIV-infected, while n=3 (43%) of controls remained uninfected. Moreover, relative to non-STI, infections occurred earlier in the menstrual cycle in STI-positive macaques (p=0.01, Wilcoxon). Inflammatory cytokines were higher in STI-positive macaques during STI inoculation (IFN-gamma, IL-6, and G-CSF) and SHIV exposure periods (G-CSF) (p≤0.05, Wilcoxon). CONCLUSIONS: C. trachomatis and T. vaginalis increase susceptibility to SHIV, likely due to prolonged genital tract inflammation. These novel data demonstrate a biological link between these non-ulcerative STIs and (S)HIV risk, supporting epidemiological observations. This study establishes a macaque model for high-risk HIV transmission and prevention studies. |
Infectious disease mortality among American Indians and Alaska Natives, 1999-2009
Cheek JE , Holman RC , Redd JT , Haberling D , Hennessy TW . Am J Public Health 2014 104 Suppl 3 S446-52 OBJECTIVES: We described death rates and leading causes of death caused by infectious diseases (IDs) in American Indian/Alaska Native (AI/AN) persons. METHODS: We analyzed national mortality data, adjusted for AI/AN race by linkage with Indian Health Service registration records, for all US counties and Contract Health Service Delivery Area (CHSDA) counties. The average annual 1999 to 2009 ID death rates per 100 000 persons for AI/AN persons were compared with corresponding rates for Whites. RESULTS: The ID death rate in AI/AN populations was significantly higher than that of Whites. A reported 8429 ID deaths (rate 86.2) in CHSDA counties occurred among AI/AN persons; the rate was significantly higher than the rate in Whites (44.0; rate ratio [RR] = 1.96; 95% confidence interval [CI] = 1.91, 2.00). The rates for the top 10 ID underlying causes of death were significantly higher for AI/AN persons than those for Whites. Lower respiratory tract infection and septicemia were the top-ranked causes. The greatest relative rate disparity was for tuberculosis (RR = 13.51; 95% CI = 11.36, 15.93). CONCLUSIONS: Health equity might be furthered by expansion of interventions to reduce IDs among AI/AN communities. |
Knowledge, attitudes, and practices of nonpharmaceutical interventions following school dismissals during the 2009 influenza A H1N1 pandemic in Michigan, United States
Shi J , Njai R , Wells E , Collins J , Wilkins M , Dooyema C , Sinclair J , Gao H , Rainey JJ . PLoS One 2014 9 (4) e94290 BACKGROUND: Many schools throughout the United States reported an increase in dismissals due to the 2009 influenza A H1N1 pandemic (pH1N1). During the fall months of 2009, more than 567 school dismissals were reported from the state of Michigan. In December 2009, the Michigan Department of Community Health, in collaboration with the United States Centers for Disease Control and Prevention, conducted a survey to describe the knowledge, attitudes, and practices (KAPs) of households with school-aged children and classroom teachers regarding the recommended use of nonpharmaceutical interventions (NPIs) to slow the spread of influenza. METHODS: A random sample of eight elementary schools (kindergarten through 5th grade) was selected from each of the eight public health preparedness regions in the state. Within each selected school, a single classroom was randomly identified from each grade (K-5), and household caregivers of the classroom students and their respective teachers were asked to participate in the survey. RESULTS: In total, 26% (2,188/8,280) of household caregivers and 45% (163/360) of teachers from 48 schools (of the 64 sampled) responded to the survey. Of the 48 participating schools, 27% (13) experienced a school dismissal during the 2009 fall term. Eighty-seven percent (1,806/2,082) of caregivers and 80% (122/152) of teachers thought that the 2009 influenza A H1N1 pandemic was severe, and >90% of both groups indicated that they told their children/students to use NPIs, such as washing hands more often and covering coughs with tissues, to prevent infection with influenza. CONCLUSIONS: Knowledge and instruction on the use of NPIs appeared to be high among household caregivers and teachers responding to the survey. Nevertheless, public health officials should continue to explain the public health rationale for NPIs to reduce pandemic influenza. Ensuring this information is communicated to household caregivers and teachers through trusted sources is essential. |
Knowledge, beliefs and behaviours related to STD risk, prevention, and screening among a sample of African American men and women
Uhrig JD , Friedman A , Poehlman J , Scales M , Forsythe A . Health Educ J 2014 73 (3) 332-340 OBJECTIVE: Current data on sexually transmitted disease (STD) among African Americans show significant racial/ethnic disparities. The purpose of this study was to explore knowledge, attitudes, beliefs, and behaviours related to STD risk, prevention, and testing among African American adults to help inform the development of a health communication intervention to address the high rates of STDs in this community. DESIGN: Cross-sectional survey. SETTING: Four United States (US) communities with high cumulative incidence of STDs. Method: We administered a 44-item structured survey. RESULTS: Participants were 185 sexually active heterosexual African Americans aged 18 to 45. Most participants (84.2%) had been tested for an STD at least once. Most participants (75.8%) perceived STDs to be a problem in their community, and almost all (91.2%) felt that people needed education to learn how to avoid STDs. Nonetheless, only half of participants (49.5%) agreed that they should get tested for STDs because they may be at risk. Misconceptions related to STD prevention and testing were identified. Results suggest that STDs remain highly stigmatized with concerns related to social and interpersonal consequences. Participants’ perceived personal risk was low, despite acknowledging high STD rates in their communities. CONCLUSION: Findings suggest that health communication may play an important role in addressing STD disparities by increasing perceptions of personal risk, minimizing STD-associated stigma, and marketing STD prevention and testing behaviours. |
CD4 T-lymphocyte percentages corresponding to CD4 T-lymphocyte count thresholds in a new staging system for HIV infection
Selik RM , Gebo KA , Borkowf CB , Whitmore SK , Espinoza L . J Acquir Immune Defic Syndr 2014 66 (4) e92-4 For epidemiologic surveillance of HIV infection in the United States, until this year, the staging system for adults (published in 2008) had been separate from the classification system for children (published in 1994).1,2 To design a single staging system for both adults and children based primarily on absolute CD4 T-lymphocyte counts, we retained the age-specific CD4 count thresholds used to define the boundaries between stages 1, 2, and 3 (called “immunologic categories” rather than “stages” in the 1994 classification for children). Values greater than or equal to the upper threshold indicate stage 1, values less than the upper threshold but greater than or equal to the lower threshold indicate stage 2, and values less than the lower threshold indicate stage 3 (AIDS). For children aged <1 year, the lower and upper CD4 count thresholds are 750 and 1500 (cells/μL); for children aged 1 to <6 years, they are 500 and 1000; for children aged 6 to <13 and for adults and adolescents aged 13 or older, they are 200 and 500. | Those staging/classification systems used both the absolute CD4 count and the CD4 percentage of total lymphocytes to classify cases into stages; if the CD4 count and the CD4 percentage indicated different stages, the more advanced of the 2 stages was selected. If one of these measurements was not available, the classification was based solely on the other measurement. The lower and upper CD4 percentage thresholds in those staging/classification systems were 15% and 25% for all 3 age groups of children, and 14% and 29% for adults and adolescents.1,2 In developing an updated staging system, we reassessed the relationship between the CD4 counts and the CD4 percentages and selected the mean CD4 percentage corresponding to each CD4 count threshold. |
Community-based program to prevent HIV/STD infection among heterosexual black women
Painter TM , Herbst JH , Diallo DD , White LD . MMWR Suppl 2014 63 (1) 15-20 Heterosexual non-Hispanic black women in the United States are far more affected than women of other races or ethnicities by human immunodeficiency virus (HIV). SisterLove, Inc., a community-based organization in Atlanta, Georgia, responded to this disparity early in the epidemic by creating the Healthy Love HIV and sexually transmitted disease (STD) prevention intervention in 1989. Since then, SisterLove has been delivering the intervention to black women in metropolitan Atlanta. This report describes successful efforts by SisterLove, Inc., to develop, rigorously evaluate, and demonstrate the efficacy of Healthy Love, a 3-4-hour interactive, educational workshop, to reduce HIV- and sexually transmitted disease-related risk behaviors among heterosexual black women. On the basis of the evaluation findings, CDC packaged the intervention materials for use by service provider organizations in their efforts to reduce HIV disparities that affect black women in metropolitan Atlanta, the South, and the United States. This report also describes initiatives by SisterLove after the efficacy study to increase the potential effectiveness and reach of the Healthy Love intervention and further address HIV-related disparities that affect black women. CDC's Office of Minority Health and Health Equity selected the intervention analysis and discussion that follows to provide an example of a program that might be effective in reducing HIV-related disparities in the United States. The results of the randomized controlled efficacy trial highlight the potential of culturally tailored, interactive group intervention efforts to reduce health disparities. CDC's support for evaluating and packaging SisterLove's intervention materials, and making the materials available (www.effectiveinterventions.org) for use by service provider organizations, are important contributions toward efforts to address HIV-related disparities that affect black women. |
Comparing clinical characteristics between hospitalized adults with laboratory-confirmed influenza A and B virus infection
Su S , Chaves SS , Perez A , D'Mello T , Kirley PD , Yousey-Hindes K , Farley MM , Harris M , Sharangpani R , Lynfield R , Morin C , Hancock EB , Zansky S , Hollick GE , Fowler B , McDonald-Hamm C , Thomas A , Horan V , Lindegren ML , Schaffner W , Price A , Bandyopadhyay A , Fry AM . Clin Infect Dis 2014 59 (2) 252-5 We challenge the notion that influenza B virus infection is milder than influenza A virus infection by finding similar clinical characteristics and outcomes between adults hospitalized with these two types of influenza. Among patients treated with oseltamivir, length of stay and mortality did not differ by type of virus infection. |
Death rates from human immunodeficiency virus and tuberculosis among American Indians/Alaska Natives in the United States, 1990-2009
Reilley B , Bloss E , Byrd KK , Iralu J , Neel L , Cheek J . Am J Public Health 2014 104 Suppl 3 S453-9 OBJECTIVES: We used race-corrected data and comprehensive diagnostic codes to better compare HIV and tuberculosis (TB) mortality from 1999 to 2009 between American Indian/Alaska Natives (AI/ANs) and Whites. METHODS: National Vital Statistics Surveillance System mortality data were adjusted for AI/AN racial misclassification through linkage with Indian Health Service registration records. We compared average annual 1990 to 2009 HIV and TB death rates (per 100 000 people) for AI/AN persons with those for Whites; Hispanics were excluded. RESULTS: Although death rates from HIV in AI/AN persons were significantly lower than those in Whites from 1990 to 1998 (4.2 vs 7.0), they were significantly higher than those in Whites from 1999 to 2009 (3.6 vs 2.0). Death rates from TB in AI/AN persons were significantly higher than those in Whites, with a significant disparity during both 1990 to 1998 (3.3 vs 0.3) and 1999 to 2009 (1.5 vs 0.1). CONCLUSIONS: The decrease in death rates from HIV and TB was greater among Whites, and death rates remained significantly higher among AI/AN individuals. Public health interventions need to be prioritized to reduce the TB and HIV burden and mortality in AI/AN populations. |
Surveillance systems to track progress toward global polio eradication - worldwide, 2012-2013
Levitt A , Diop OM , Tangermann RH , Paladin F , Kamgang JB , Burns CC , Chenoweth PJ , Goel A , Wassilak SG . MMWR Morb Mortal Wkly Rep 2014 63 (16) 356-61 In 2012, the World Health Assembly of the World Health Organization (WHO) declared completion of polio eradication a programmatic emergency. Polio cases are detected through surveillance of acute flaccid paralysis (AFP) cases and subsequent testing of stool specimens for polioviruses (PVs) at WHO-accredited laboratories within the Global Polio Laboratory Network (GPLN). AFP surveillance is supplemented by environmental surveillance, testing sewage samples from selected sites for PVs. Virologic surveillance, including genomic sequencing to identify isolates by genotype and measure divergence between isolates, guides Global Polio Eradication Initiative (GPEI) activities by confirming the presence of PV, tracking chains of PV transmission, and highlighting gaps in AFP surveillance quality. This report provides AFP surveillance quality indicators at national and subnational levels during 2012-2013 for countries that experienced PV cases during 2009-2013 in the WHO African Region (AFR) and Eastern Mediterranean Region (EMR), the remaining polio-endemic regions. It also summarizes the results of environmental surveillance and reviews indicators assessing the timeliness of reporting of PV isolation and of virus strain characterization globally. Regional-level performance indicators for timely reporting of PV isolation were met in five of six WHO regions in 2012 and 2013. Of 30 AFR and EMR countries that experienced cases of PV (wild poliovirus [WPV], circulating vaccine-derived poliovirus [cVDPV], or both) during 2009-2013, national performance indicator targets for AFP surveillance and collection of adequate specimens were met in 27 (90%) countries in 2012 and 22 (73%) in 2013. In 17 (57%) countries, ≥80% of the population lived in subnational areas meeting both AFP performance indicators in 2012, decreasing to 13 (43%) in 2013. To achieve polio eradication and certify interruption of PV transmission, intensive efforts to strengthen and maintain AFP surveillance are needed at subnational levels, including in field investigation and prompt collection of specimens, particularly in countries with current or recent active PV transmission. |
Outbreaks attributed to cheese: differences between outbreaks caused by unpasteurized and pasteurized dairy products, United States, 1998-2011
Gould LH , Mungai E , Barton Behravesh C . Foodborne Pathog Dis 2014 11 (7) 545-51 INTRODUCTION: The interstate commerce of unpasteurized fluid milk, also known as raw milk, is illegal in the United States, and intrastate sales are regulated independently by each state. However, U.S. Food and Drug Administration regulations allow the interstate sale of certain types of cheeses made from unpasteurized milk if specific aging requirements are met. We describe characteristics of these outbreaks, including differences between outbreaks linked to cheese made from pasteurized or unpasteurized milk. METHODS: We reviewed reports of outbreaks submitted to the Foodborne Disease Outbreak Surveillance System during 1998-2011 in which cheese was implicated as the vehicle. We describe characteristics of these outbreaks, including differences between outbreaks linked to cheese made from pasteurized versus unpasteurized milk. RESULTS: During 1998-2011, 90 outbreaks attributed to cheese were reported; 38 (42%) were due to cheese made with unpasteurized milk, 44 (49%) to cheese made with pasteurized milk, and the pasteurization status was not reported for the other eight (9%). The most common cheese-pathogen pairs were unpasteurized queso fresco or other Mexican-style cheese and Salmonella (10 outbreaks), and pasteurized queso fresco or other Mexican-style cheese and Listeria (6 outbreaks). The cheese was imported from Mexico in 38% of outbreaks caused by cheese made with unpasteurized milk. In at least five outbreaks, all due to cheese made from unpasteurized milk, the outbreak report noted that the cheese was produced or sold illegally. Outbreaks caused by cheese made from pasteurized milk occurred most commonly (64%) in restaurant, delis, or banquet settings where cross-contamination was the most common contributing factor. CONCLUSIONS: In addition to using pasteurized milk to make cheese, interventions to improve the safety of cheese include limiting illegal importation of cheese, strict sanitation and microbiologic monitoring in cheese-making facilities, and controls to limit food worker contamination. |
Wild-type measles viruses with non-standard genome lengths.
Bankamp B , Liu C , Rivailler P , Bera J , Shrivastava S , Kirkness EF , Bellini WJ , Rota PA . PLoS One 2014 9 (4) e95470 The length of the single stranded, negative sense RNA genome of measles virus (MeV) is highly conserved at 15,894 nucleotides (nt). MeVs can be grouped into 24 genotypes based on the highly variable 450 nucleotides coding for the carboxyl-terminus of the nucleocapsid protein (N-450). Here, we report the genomic sequences of 2 wild-type viral isolates of genotype D4 with genome lengths of 15,900 nt. Both genomes had a 7 nt insertion in the 3' untranslated region (UTR) of the matrix (M) gene and a 1 nt deletion in the 5' UTR of the fusion (F) gene. The net gain of 6 nt complies with the rule-of-six required for replication competency of the genomes of morbilliviruses. The insertions and deletion (indels) were confirmed in a patient sample that was the source of one of the viral isolates. The positions of the indels were identical in both viral isolates, even though epidemiological data and the 3 nt differences in N-450 between the two genomes suggested that the viruses represented separate chains of transmission. Identical indels were found in the M-F intergenic regions of 14 additional genotype D4 viral isolates that were imported into the US during 2007-2010. Viral isolates with and without indels produced plaques of similar size and replicated efficiently in A549/hSLAM and Vero/hSLAM cells. This is the first report of wild-type MeVs with genome lengths other than 15,894 nt and demonstrates that the length of the M-F UTR of wild-type MeVs is flexible. |
Health behaviors and risk factors among American Indians and Alaska Natives, 2000-2010
Cobb N , Espey D , King J . Am J Public Health 2014 104 Suppl 3 S481-9 OBJECTIVES: We provided contextual risk factor information for a special supplement on causes of death among American Indians and Alaska Natives (AI/ANs). We analyzed 11 years of Behavioral Risk Factor Surveillance System (BRFSS) data for AI/AN respondents in the United States. METHODS: We combined BRFSS data from 2000 to 2010 to determine the prevalence of selected risk factors for AI/AN and White respondents residing in Indian Health Service Contract Health Service Delivery Area counties. Regional prevalence estimates for AI/AN respondents were compared with the estimates for White respondents for all regions combined; respondents of Hispanic origin were excluded. RESULTS: With some regional exceptions, AI/AN people had high prevalence estimates of tobacco use, obesity, and physical inactivity, and low prevalence estimates of fruit and vegetable consumption, cancer screening, and seatbelt use. CONCLUSIONS: These behavioral risk factors were consistent with observed patterns of mortality and chronic disease among AI/AN persons. All are amenable to public health intervention. |
Risk communication recommendations and implementation during emerging infectious diseases: a case study of the 2009 H1N1 influenza pandemic
Gesser-Edelsburg A , Mordini E , James JJ , Greco D , Green MS . Disaster Med Public Health Prep 2014 8 (2) 1-12 OBJECTIVE: To examine their implementation, we analyzed World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) guidelines from 2005 to 2008 for risk communication during an emerging infectious disease outbreak, WHO and CDC reports on implementing the guidelines worldwide after the 2009 H1N1 pandemic; and a case study of a member state. METHODS: A qualitative study compared WHO and CDC guidelines from 2005 to 2008 with WHO and CDC reports from 2009 to 2011, documenting their implementation during the H1N1 outbreak and assessed how these guidelines were implemented, based on the reports and Israeli stakeholders (n=70). RESULTS: Eight risk communication subthemes were identified: trust, empowerment, uncertainty, communicating the vaccine, inclusion, identification of subpopulations and at-risk groups, segmentation, and 2-way communication. The reports and case study disclosed a gap between international guidelines and their local-level implementation. The guidelines were mostly top-down communications, with little consideration for individual member-state implementation. The WHO and CDC recommendations were not always based on formative evaluation studies, which undermined their validity. CONCLUSIONS: In formulating effective communication strategies, the first step is to define the goal of a vaccination program. We recommend implementing conceptual elements from the most current theoretical literature when planning communication strategies and increasing organizational involvement in implementing guidelines in future health crises. |
Reduction of racial/ethnic disparities in vaccination coverage, 1995-2011
Walker AT , Smith PJ , Kolasa M . MMWR Suppl 2014 63 (1) 7-12 The Presidential Childhood Immunization Initiative was developed in 1993 to address major gaps in childhood vaccination coverage in the United States. Eliminating the cost of vaccines as a barrier to vaccination was one strategy of the Childhood Immunization Initiative; it led to Congressional legislation that authorized creation of the Vaccines for Children program (VFC) in 1994. CDC analyzed National Immunization Survey data for 1995-2011 to evaluate trends in disparities in vaccination coverage rates between non-Hispanic white children and children of other racial/ethnic groups. VFC has been effective in ireducing disparities in vaccination coverage among U.S. children. CDC's Office of Minority Health and Health Equity selected the intervention analysis and discussion that follows to provide an example of a program that has been effective in reducing childhood vaccination coverage-related disparities in the United States. At its inception in 1994, VFC was implemented in 78 Immunization Action Plan areas that covered the entire United States; within each area, concerted efforts were made to improve childhood vaccination coverage. The findings in this report demonstrate that there have been no racial/ethnic disparities in vaccine coverage for measles-mumps-rubella and poliovirus in the United States since 2005. Disparities in coverage for the diphtheria-tetanus-pertussis/diphtheria-tetanus-acellular pertussis vaccine were absent, declining, or inconsistent during this period, depending on the racial/ethnic group examined. The results in this report highlight the effectiveness of VFC. |
Rotavirus vaccines: current status and future considerations
Yen C , Tate JE , Hyde TB , Cortese MM , Lopman BA , Jiang B , Glass RI , Parashar UD . Hum Vaccin Immunother 2014 10 (6) 1436-48 Rotavirus is the leading cause of severe diarrhea among children<5 years worldwide. Currently licensed rotavirus vaccines have been efficacious and effective, with many countries reporting substantial declines in diarrheal and rotavirus-specific morbidity and mortality. However, the full public health impact of these vaccines has not been realized. Most countries, including those with the highest disease burden, have not yet introduced rotavirus vaccines into their national immunization programs. Research activities that may help inform vaccine introduction decisions include (1) establishing effectiveness, impact, and safety for rotavirus vaccines in low-income settings; (2) identifying potential strategies to improve performance of oral rotavirus vaccines in developing countries, such as zinc supplementation; and (3) pursuing alternate approaches to oral vaccines, such as parenteral immunization. Policy- and program-level barriers, such as financial implications of new vaccine introductions, should be addressed to ensure that countries are able to make informed decisions regarding rotavirus vaccine introduction. |
Prevaccine era human papillomavirus types 6, 11, 16 and 18 seropositivity in the USA, National Health and Nutrition Examination Surveys, 2003-2006
Introcaso CE , Dunne EF , Hariri S , Panicker G , Unger ER , Markowitz LE . Sex Transm Infect 2014 90 (6) 505-8 BACKGROUND: A vaccine is available to prevent human papillomavirus (HPV) 6, 11, 16 and 18; in the prevaccine era, seropositivity to vaccine types is a measure of natural exposure. METHODS: We describe HPV seropositivity in the USA among 14-59-year-olds using the 2003-2006 National Health and Nutrition Examination Surveys. RESULTS: Seropositivity to HPV 6, 11, 16 and 18 was 17.5%, 6.8%, 15.1% and 5.9%, respectively, among women, and 7.0%, 2.4%, 5.2% and 1.5%, respectively, among men. Overall in both sexes, seropositivity was 22.5% for any vaccine type (31.8% in women and 12.9% in men), but substantially lower for three or more types (1.7% overall, 2.8% in women and 0.6% in men). CONCLUSIONS: Almost a quarter of the participants were seropositive to any HPV vaccine type but few were seropositive to at least three vaccine HPV types in the prevaccine era. Further study is needed to assess if seropositivity would be useful as a biological marker of vaccination. |
Effect of the 13-valent pneumococcal conjugate vaccine on nasopharyngeal colonization by Streptococcus pneumoniae - Alaska, 2008-2012
Gounder PP , Bruce MG , Bruden DJ , Singleton RJ , Rudolph K , Hurlburt DA , Hennessy TW , Wenger J . J Infect Dis 2014 209 (8) 1251-8 BACKGROUND: In 2010, a 13-valent pneumococcal conjugate vaccine (PCV13) replaced a 7-valent vaccine (PCV7) that contained all PCV7 serotypes plus 6 additional serotypes (PCV6+). We conducted annual surveys from 2008 to 2012 to determine the effect of PCV13 on colonization by pneumococcal serotypes. METHODS: We obtained nasopharyngeal swabs for pneumococcal identification and serotyping from residents of all ages at 8 rural villages and children age <60 months at 2 urban clinics. We conducted interviews/medical records review for all participants. RESULTS: A total of 18 207 nasopharyngeal swabs (rural = 16 098; urban = 2109) were collected. From 2008 to 2012, 84% of rural and 90% of urban children age <5 years were age-appropriately vaccinated with a PCV. Overall pneumococcal colonization prevalence remained stable among rural (66%) and urban (35%) children age <5 years, and adults age ≥18 years (14%). Colonization by PCV6+ serotypes declined significantly among rural children age <5 years, urban children age <5, and adults age ≥18 over the course of the study (25%-5%, 22%-9%, 22%-6%, respectively). CONCLUSIONS: PCV13 was rapidly introduced into the Alaska childhood immunization schedule and reduced colonization by PCV6+ serotypes among children. Unvaccinated adults also experienced comparable reductions in vaccine serotype colonization indicating substantial indirect protection from PCV13. |
Age-specific strategies for immunization reminders and recalls: a registry-based randomized trial
Dombkowski KJ , Costello LE , Harrington LB , Dong S , Kolasa M , Clark SJ . Am J Prev Med 2014 47 (1) 1-8 BACKGROUND: Although previous studies have found reminder/recall to be effective in increasing immunization rates, little guidance exists regarding the specific ages at which it is optimal to send reminder/recall notices. PURPOSE: To assess the relative effectiveness of centralized reminder/recall strategies targeting age-specific vaccination milestones among children in urban areas during June 2008-June 2009. METHODS: Three reminder/recall strategies used capabilities of the Michigan Care Improvement Registry (MCIR), a statewide immunization information system: a 7-month recall strategy, a 12-month reminder strategy, and a 19-month recall strategy. Eligible children were randomized to notification (intervention) or no notification groups (control). Primary study outcomes included MCIR-recorded immunization activity (administration of ≥1 new dose, entry of ≥1 historic dose, entry of immunization waiver) within 60 days following each notification cycle. RESULTS: A total of 10,175 children were included: 2,072 for the 7-month recall, 3,502 for the 12-month reminder, and 4,601 for the 19-month recall. Immunization activity was similar between notification versus no notification groups at both 7 and 12 months. Significantly more 19-month-old children in the recall group (26%) had immunization activity compared to their counterparts that did not receive a recall notification (19%). CONCLUSIONS: Although recall notifications can positively affect immunization activity, the effect may vary by targeted age group. Many 7- and 12-month-olds had immunization activity following reminder/recall; however, levels of activity were similar irrespective of notification, suggesting that these groups were likely to receive medical care or immunization services without prompting. |
Benefits from immunization during the Vaccines for Children program era - United States, 1994-2013
Whitney CG , Zhou F , Singleton J , Schuchat A . MMWR Morb Mortal Wkly Rep 2014 63 (16) 352-5 The Vaccines for Children (VFC) program was created by the Omnibus Budget Reconciliation Act of 1993 and first implemented in 1994. VFC was designed to ensure that eligible children do not contract vaccine-preventable diseases because of inability to pay for vaccine and was created in response to a measles resurgence in the United States that resulted in approximately 55,000 cases reported during 1989-1991. The resurgence was caused largely by widespread failure to vaccinate uninsured children at the recommended age of 12-15 months. To summarize the impact of the U.S. immunization program on the health of all children (both VFC-eligible and not VFC-eligible) who were born during the 20 years since VFC began, CDC used information on immunization coverage from the National Immunization Survey (NIS) and a previously published cost-benefit model to estimate illnesses, hospitalizations, and premature deaths prevented and costs saved by routine childhood vaccination during 1994-2013. Coverage for many childhood vaccine series was near or above 90% for much of the period. Modeling estimated that, among children born during 1994- 2013, vaccination will prevent an estimated 322 million illnesses, 21 million hospitalizations, and 732,000 deaths over the course of their lifetimes, at a net savings of $295 billion in direct costs and $1.38 trillion in total societal costs. With support from the VFC program, immunization has been a highly effective tool for improving the health of U.S. children. |
Tribal motor vehicle injury prevention programs for reducing disparities in motor vehicle-related injuries
West BA , Naumann RB . MMWR Suppl 2014 63 (1) 28-33 A previous analysis of National Vital Statistics System data for 2003-2007 that examined disparities in rates of motor vehicle-related death by race/ethnicity and sex found that death rates for American Indians/Alaska Natives were two to four times the rates of other races/ethnicities. To address the disparity in motor vehicle-related injuries and deaths among American Indians/Alaska Natives, CDC funded four American Indian tribes during 2004-2009 to tailor, implement, and evaluate evidence-based road safety interventions. During the implementation of these four motor vehicle-related injury prevention pilot programs, seat belt and child safety seat use increased and alcohol-impaired driving decreased. Four American Indian/Alaska Native tribal communities-the Tohono O'odham Nation, the Ho-Chunk Nation, the White Mountain Apache Tribe, and the San Carlos Apache Tribe-implemented evidence-based road safety interventions to reduce motor vehicle-related injuries and deaths. Each community selected interventions from the Guide to Community Preventive Services and implemented them during 2004-2009. Furthermore, each community took a multifaceted approach by incorporating several strategies, such as school and community education programs, media campaigns, and collaborations with law enforcement officers into their programs. Police data and direct observational surveys were the main data sources used to assess results of the programs. Results included increased use of seat belts and child safety seats, increased enforcement of alcohol-impaired driving laws, and decreased motor vehicle crashes involving injuries or deaths. CDC's Office of Minority Health and Health Equity selected the intervention analysis and discussion as an example of a program that might be effective for reducing motor vehicle-related injury disparities in the United States. The Guide to Community Preventive Services recognizes these selected interventions as effective; this report examines the feasibility and transferability for implementing the interventions in American Indian/Alaska Native tribal communities. The findings in this report underscore the effectiveness of community interventions to reduce motor vehicle crashes among selected American Indian/Alaska Native communities. |
Unintentional injury mortality among American Indians and Alaska Natives in the United States, 1990-2009
Murphy T , Pokhrel P , Worthington A , Billie H , Sewell M , Bill N . Am J Public Health 2014 104 Suppl 3 S470-80 OBJECTIVES: We describe the burden of unintentional injury (UI) deaths among American Indian and Alaska Native (AI/AN) populations in the United States. METHODS: National Death Index records for 1990 to 2009 were linked with Indian Health Service registration records to identify AI/AN deaths misclassified as non-AI/AN deaths. Most analyses were restricted to Contract Health Service Delivery Area counties in 6 geographic regions of the United States. We compared age-adjusted death rates for AI/AN persons with those for Whites; Hispanics were excluded. RESULTS: From 2005 to 2009, the UI death rate for AI/AN people was 2.4 times higher than for Whites. Death rates for the 3 leading causes of UI death-motor vehicle traffic crashes, poisoning, and falls-were 1.4 to 3 times higher among AI/AN persons than among Whites. UI death rates were higher among AI/AN males than among females and highest among AI/AN persons in Alaska, the Northern Plains, and the Southwest. CONCLUSIONS: AI/AN persons had consistently higher UI death rates than did Whites. This disparity in overall rates coupled with recent increases in unintentional poisoning deaths requires that injury prevention be a major priority for improving health and preventing death among AI/AN populations. |
Prevalence of sexual violence against women in 23 states and two U.S. territories, BRFSS 2005
Black MC , Basile KC , Breiding MJ , Ryan GW . Violence Against Women 2014 20 (5) 485-499 Sexual violence (SV) is a significant public health problem. Using data from the 2005 Behavioral Risk Factor Surveillance System (BRFSS), this article provides state-specific 12-month SV prevalence data for women residing in 23 states and two territories. Overall, more than 500,000 women in the participating states experienced completed or attempted nonconsensual sex in the 12-month period prior to the survey. The collection of state-level data using consistent, uniform, and behaviorally specific SV definitions enables states to evaluate the magnitude of the problem within their state and informs the development and evaluation of state-level SV programs, policies, and prevention efforts. |
S-nitrosylation of FLICE inhibitory protein determines its interaction with RIP1 and activation of NF-kappaB
Talbott SJ , Luanpitpong S , Stehlik C , Azad N , Iyer AK , Wang L , Rojanasakul Y . Cell Cycle 2014 13 (12) 1948-57 Death receptor (DR) ligation can lead to divergent signaling pathways causing either caspase- mediated cell death or cell proliferation and inflammation. These variations in cellular fate are determined by adaptor proteins that are recruited to the DR signaling complex. FLICE inhibitory protein (FLIP) is an established inhibitor of caspase-8-mediated apoptosis, and it is also involved in NF-kappaB activation. However, the molecular mechanism that regulates FLIP within this complex is unknown. In this study, we provide new evidence for the regulation of NF-kappaB by FLIP through S-nitrosylation, which involves covalent modification of the protein's cysteine thiol by nitric oxide to form S-nitrosothiol. Point mutations of FLIP at cysteine residues 254 and 259 prevent FLIP S-nitrosylation and its ability to activate NF-kappaB. The mechanism by which FLIP nitrosylation regulates NF-kappaB activity involves RIP1 binding and redistribution, whereas TRAF2 binding and distribution are unaffected. We further show that FLIP processing and cleavage is dependent on its nitrosylation status. Collectively, our study reveals a novel pathway for FLIP regulation of NF-kappaB through protein S-nitrosylation, which is a key posttranslational mechanism controlling DR-mediated cell death and survival. Since increased expression of FLIP and nitric oxide are frequently observed in chemotherapy-resistant tumors, S-nitrosylation of FLIP could be a key mechanism of chemoresistance and tumor growth. |
A survey of liquid chromatographic-mass spectrometric analysis of mercapturic acid biomarkers in occupational and environmental exposure monitoring
Mathias PI , B'Hymer C . J Chromatogr B Analyt Technol Biomed Life Sci 2014 964 136-45 High-performance liquid chromatography/mass spectrometry (HPLC/MS) is sensitive and specific for targeted quantitative analysis and is readily utilized for small molecules from biological matrices. This brief review describes recent selected HPLC/MS methods for the determination of urinary mercapturic acids (mercapturates) which are useful as biomarkers in characterizing human exposure to electrophilic industrial chemicals in occupational and environmental studies. Electrophilic compounds owing to their reactivity are used in chemical and industrial processes. They are present in industrial emissions, are combustion products of fossil fuels, and are components in tobacco smoke. Their presence in both the industrial and general environments are of concern for human and environmental health. Urinary mercapturates which are the products of metabolic detoxification of reactive chemicals provide a non-invasive tool to investigate human exposure to electrophilic toxicants. Selected recent mercapturate quantification methods are summarized and specific cases are presented. The biological formation of mercapturates is introduced and their use as biomarkers of metabolic processing of electrophilic compounds is discussed. Also, the use of liquid chromatography/tandem mass spectrometry in simultaneous determinations of the mercapturates of multiple parent compounds in a single determination is considered, as well as future trends and limitations in this area of research. |
Physiologic doses of depot-medroxyprogesterone acetate do not increase acute plasma simian HIV viremia or mucosal virus shedding in pigtail macaques
Radzio J , Hanley K , Mitchell J , Ellis S , Deyounks F , Jenkins LT , Hanson D , Heneine W , Garcia-Lerma JG . AIDS 2014 28 (10) 1431-9 OBJECTIVE: Epidemiologic studies remain inconclusive on whether the injectable contraceptive depot-medroxyprogesterone acetate (DMPA) increases mucosal HIV shedding and transmissibility. Nonhuman primate models may help to determine the effects of DMPA on acute HIV replication. DESIGN: We defined a physiologic dose of DMPA in macaques and assessed the impact of DMPA on acute simian HIV (SHIV) replication. METHODS: Pigtail macaques received 1-30 mg of DMPA intramuscularly followed by measurements of progesterone and medroxyprogesterone acetate (MPA). Vaginal epithelial thickness, number of cell layers and density of intraepithelial CD3 cells were measured. The effect of DMPA on SHIV viremia and genital virus shedding was investigated in six pigtail macaques infected during monthly treatment cycles with 3 mg DMPA. Six DMPA-untreated macaques were controls. RESULTS: Plasma MPA concentrations directly correlated with changes in epithelial thickness (correlation = 0.84; P < 0.001) and density of intraepithelial CD3 cells (correlation = 0.41; P = 0.02). A 3 mg DMPA dose recapitulated plasma MPA concentrations and changes in vaginal epithelial thickness seen in women. DMPA-treated and untreated macaques showed similar peak plasma viremia and RNA area under the curve0-12wk values (P = 0.94), although treated macaques had higher odds of having virus being detected in plasma (odds ratio 6.6, P = 0.02). Rectal and vaginal virus shedding was similar between treated and untreated macaques (P = 0.72 and P = 0.53, respectively). CONCLUSION: In this pigtail macaque model of DMPA and vaginal SHIV infection, we found little or no effect of DMPA on plasma viremia and mucosal virus shedding during acute infection. These results do not support a role of DMPA in increasing mucosal virus shedding. |
An approach for modeling cross-immunity of two strains, with application to variants of Bartonella in terms of genetic similarity
Ahn KW , Kosoy M , Chan KS . Epidemics 2014 7 7-12 We developed a two-strain susceptible-infected-recovered (SIR) model that provides a framework for inferring the cross-immunity between two strains of a bacterial species in the host population with discretely sampled co-infection time-series data. Moreover, the model accounts for seasonality in host reproduction. We illustrate an approach using a dataset describing co-infections by several strains of bacteria circulating within a population of cotton rats (Sigmodon hispidus). Bartonella strains were clustered into three genetically close groups, between which the divergence is correspondent to the accepted level of separate bacterial species. The proposed approach revealed no cross-immunity between genetic clusters while limited cross-immunity might exist between subgroups within the clusters. |
Does tenofovir gel or do other microbicide products affect detection of biomarkers of semen exposure in vitro?
Snead MC , Kourtis AP , Melendez JH , Black CM , Mauck CK , Penman-Aguilar A , Chaney DM , Gallo MF , Jamieson DJ , Macaluso M , Doncel GF . Contraception 2014 90 (2) 136-41 OBJECTIVES: There is currently no information on whether products evaluated in HIV microbicide trials affect the detection of the semen biomarkers prostate-specific antigen (PSA) or Y chromosome DNA. STUDY DESIGN: We tested (in vitro) dilutions of tenofovir (TFV), UC781 and the hydroxyethylcellulose (HEC) placebo gels using the Abacus ABAcard and the quantitative (Abbott Architect total PSA) assays for PSA and Y chromosome DNA by real-time polymerase chain reaction. RESULTS: TFV gel and the HEC placebo adversely affected PSA detection using the ABAcard but not the Abbott Architect total PSA assay. UC781 adversely affected both the ABAcard and Abbott Architect total PSA assays. While there were some quantitative changes in the magnitude of the signal, none of the products affected positivity of the Y chromosome assay. CONCLUSIONS: The presence of TFV or HEC gels did not affect quantitative PSA or Y chromosome detection in vitro. Confirmation of these findings is recommended using specimens obtained following use of these gels in vivo. IMPLICATIONS: Researchers should consider the potential for specific microbicides or any products to affect the particular assay used for semen biomarker detection. The ABAcard assay for PSA detection should not be used with TFV UC781, or HEC. |
Universal newborn screening for congenital CMV infection: what is the evidence of potential benefit?
Cannon MJ , Griffiths PD , Aston V , Rawlinson WD . Rev Med Virol 2014 24 (5) 291-307 Congenital CMV infection is a leading cause of childhood disability. Many children born with congenital CMV infection are asymptomatic or have nonspecific symptoms and therefore are typically not diagnosed. A strategy of newborn CMV screening could allow for early detection and intervention to improve clinical outcomes. Interventions might include antiviral drugs or nonpharmaceutical therapies such as speech-language therapy or cochlear implants. Using published data from developed countries, we analyzed existing evidence of potential benefit that could result from newborn CMV screening. We first estimated the numbers of children with the most important CMV-related disabilities (i.e. hearing loss, cognitive deficit, and vision impairment), including the age at which the disabilities occur. Then, for each of the disabilities, we examined the existing evidence for the effectiveness of various interventions. We concluded that there is good evidence of potential benefit from nonpharmaceutical interventions for children with delayed hearing loss that occurs by 9 months of age. Similarly, we concluded that there is fair evidence of potential benefit from antiviral therapy for children with hearing loss at birth and from nonpharmaceutical interventions for children with delayed hearing loss occurring between 9 and 24 months of age and for children with CMV-related cognitive deficits. We found poor evidence of potential benefit for children with delayed hearing loss occurring after 24 months of age and for children with vision impairment. Overall, we estimated that in the United States, several thousand children with congenital CMV could benefit each year from newborn CMV screening, early detection, and interventions. |
Early-onset group B streptococcal disease in the United States: potential for further reduction
Verani JR , Spina NL , Lynfield R , Schaffner W , Harrison LH , Holst A , Thomas S , Garcia JM , Scherzinger K , Aragon D , Petit S , Thompson J , Pasutti L , Carey R , McGee L , Weston E , Schrag SJ . Obstet Gynecol 2014 123 (4) 828-837 OBJECTIVE: To describe lapses in adherence to group B streptococcus (GBS) prevention guidelines among cases of early-onset GBS disease in term and preterm neonates and to estimate the potential for further reduction in disease burden under current prevention strategies. METHODS: We reviewed labor and delivery and prenatal records of mothers of neonates with early-onset GBS disease (aged younger than 7 days with GBS isolated from a normally sterile site) identified at population-based surveillance sites in 2008-2009. We interviewed prenatal care providers about GBS screening practices and obtained relevant laboratory records. We evaluated the data for errors in prenatal screening, laboratory methods, communication of results, and intrapartum antibiotic prophylaxis. Using published data on screening sensitivity and intrapartum prophylaxis effectiveness, we estimated the potential reduction in cases under optimal prevention implementation. RESULTS: Among 309 cases, 179 (57.9%) had one or more implementation errors. The most common error type in term and preterm case-patients was prenatal screening (80 of 222 [36.0%]) and intrapartum prophylaxis (46 of 85 [54.1%]), respectively. We estimated that under optimal implementation, cases of early-onset GBS disease could be reduced by 26-59% with the largest benefit from a single intervention coming from improved use of intrapartum prophylaxis (16% decrease). CONCLUSION: Further reduction of early-onset GBS disease burden is possible under current prevention strategies, particularly with improved implementation of antibiotic prophylaxis. However, even with perfect adherence to recommended practices, the decline in cases may be modest. Therefore, novel prevention approaches such as improved intrapartum assays and vaccines are also needed. |
American Indian and Alaska Native infant and pediatric mortality, United States, 1999-2009
Wong CA , Gachupin FC , Holman RC , Macdorman MF , Cheek JE , Holve S , Singleton RJ . Am J Public Health 2014 104 Suppl 3 S320-8 OBJECTIVES: We described American Indian/Alaska Native (AI/AN) infant and pediatric death rates and leading causes of death. METHODS: We adjusted National Vital Statistics System mortality data for AI/AN racial misclassification by linkage with Indian Health Service (IHS) registration records. We determined average annual death rates and leading causes of death for 1999 to 2009 for AI/AN versus White infants and children. We limited the analysis to IHS Contract Health Service Delivery Area counties. RESULTS: The AI/AN infant death rate was 914 (rate ratio [RR] = 1.61; 95% confidence interval [CI] = 1.55, 1.67). Sudden infant death syndrome, unintentional injuries, and influenza or pneumonia were more common in AI/AN versus White infants. The overall AI/AN pediatric death rates were 69.6 for ages 1 to 4 years (RR = 2.56; 95% CI = 2.38, 2.75), 28.9 for ages 5 to 9 years (RR = 2.12; 95% CI = 1.92, 2.34), 37.3 for ages 10 to 14 years (RR = 2.22; 95% CI = 2.04, 2.40), and 158.4 for ages 15 to 19 years (RR = 2.71; 95% CI = 2.60, 2.82). Unintentional injuries and suicide occurred at higher rates among AI/AN youths versus White youths. CONCLUSIONS: Death rates for AI/AN infants and children were higher than for Whites, with regional disparities. Several leading causes of death in the AI/AN pediatric population are potentially preventable. |
Association of maternal body mass index, excessive weight gain, and gestational diabetes mellitus with large-for-gestational-age births
Kim SY , Sharma AJ , Sappenfield W , Wilson HG , Salihu HM . Obstet Gynecol 2014 123 (4) 737-744 OBJECTIVE: To estimate the percentage of large-for-gestational age (LGA) neonates associated with maternal overweight and obesity, excessive gestational weight gain, and gestational diabetes mellitus (GDM)-both individually and in combination-by race or ethnicity. METHODS: We analyzed 2004-2008 linked birth certificate and maternal hospital discharge data of live, singleton deliveries in Florida. We used multivariable logistic regression to assess the independent contributions of mother's prepregnancy body mass index (BMI), gestational weight gain, and GDM status on LGA (birth weight-for-gestational age 90th percentile or greater) risk by race and ethnicity while controlling for maternal age, nativity, and parity. We then calculated the adjusted population-attributable fraction of LGA neonates to each of these exposures. RESULTS: Large-for-gestational age prevalence was 5.7% among normal-weight women with adequate gestational weight gain and no GDM and 12.6%, 13.5% and 17.3% among women with BMIs of 25 or higher, excess gestational weight gain, and GDM, respectively. A reduction ranging between 46.8% in Asian and Pacific Islanders and 61.0% in non-Hispanic black women in LGA prevalence might result if women had none of the three exposures. For all race or ethnic groups, GDM contributed the least (2.0-8.0%), whereas excessive gestational weight gain contributed the most (33.3-37.7%) to LGA. CONCLUSION: Overweight and obesity, excessive gestational weight gain, and GDM all are associated with LGA; however, preventing excessive gestational weight gain has the greatest potential to reduce LGA risk. |
A comparison of family financial and employment impacts of fragile X syndrome, autism spectrum disorders, and intellectual disability
Ouyang L , Grosse SD , Riley C , Bolen J , Bishop E , Raspa M , Bailey DB Jr . Res Dev Disabil 2014 35 (7) 1518-1527 This study compares the family financial and employment impacts of having a child with fragile X syndrome (FXS), autism spectrum disorder (ASD), or intellectual disabilities (ID). Data from a 2011 national survey of families of children with FXS were matched with data from the National Survey of Children with Special Health Care Needs 2009-2010 to form four analytic groups: children with FXS (n=189), children with special health care needs with ASD only (n=185), ID only (n=177), or both ASD and ID (n=178). Comparable percentages of parents of children with FXS (60%) and parents of children with both ASD and ID (52%) reported that their families experienced a financial burden as a result of the condition, both of which were higher than the percentages of parents of children with ASD only (39%) or ID only (29%). Comparable percentages of parents of children with FXS (40%) and parents of children with both ASD and ID (46%) reported quitting employment because of the condition, both of which were higher than the percentages of parents of children with ID only (25%) or ASD only (25%). In multivariate analyses controlling for co-occurring conditions and functional difficulties and stratified by age, adjusted odds ratios for the FXS group aged 12-17 years were significantly elevated for financial burden (2.73, 95% CI 1.29-5.77), quitting employment (2.58, 95% CI 1.18-5.65) and reduced hours of work (4.34, 95% CI 2.08-9.06) relative to children with ASD only. Among children aged 5-11 years, the adjusted odds ratios for the FXS group were elevated but statistically insignificant for financial burden (1.63, 95% CI 0.85-3.14) and reducing hours of work (1.34, 95% CI 0.68-2.63) relative to children with ASD only. Regardless of condition, co-occurring anxiety or seizures, limits in thinking, reasoning, or learning ability, and more irritability were significantly associated with more caregiver financial and employment impacts. Proper management of anxiety or seizures and functional difficulties of children with FXS or other developmental disabilities may be important in alleviating adverse family caregiver impacts. |
Core state preconception health indicators - Pregnancy Risk Assessment Monitoring System and Behavioral Risk Factor Surveillance System, 2009
Robbins CL , Zapata LB , Farr SL , Morrow B , Ahluwalia I , D'Angelo DV , Barradas D , Cox S , Goodman D , Grigorescu V , Barfield WD . MMWR Surveill Summ 2014 63 Suppl 3 (3) 1-62 PROBLEM/CONDITION: Promoting preconception health can potentially improve women's health and pregnancy outcomes. Evidence-based interventions exist to reduce many maternal behaviors and chronic conditions that are associated with adverse pregnancy outcomes such as tobacco use, alcohol use, inadequate folic acid intake, obesity, hypertension, and diabetes. The 2006 national recommendations to improve preconception health included monitoring improvements in preconception health by maximizing public health surveillance (CDC. Recommendations to improve preconception health and health care-United States: a report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. MMWR 2006;55[No. RR-6]). REPORTING PERIOD COVERED: 2009 for 38 indicators; 2008 for one indicator. DESCRIPTION OF SURVEILLANCE SYSTEMS: The Pregnancy Risk Assessment Monitoring System (PRAMS) is an ongoing state- and population-based surveillance system designed to monitor selected self-reported maternal behaviors, conditions, and experiences that occur shortly before, during, and after pregnancy among women who deliver live-born infants. The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing state-based telephone survey of noninstitutionalized adults aged ≥18 years in the United States that collects state-level data on health-related risk behaviors, chronic conditions, and preventive health services. This surveillance summary includes PRAMS data from 29 reporting areas (n = 40,388 respondents) and BRFSS data from 51 reporting areas (n = 62,875 respondents) for nonpregnant women of reproductive age (aged 18-44 years). To establish a comprehensive, nationally recognized set of indicators to be used for monitoring, evaluation, and response, a volunteer group of policy and program leaders and epidemiologists identified 45 core state preconception health indicators, of which 41 rely on PRAMS or BRFSS as data sources. This report includes 39 of the 41 core state preconception health indicators for which data are available through PRAMS or BRFSS. The two indicators from these data sources that are not described in this report are human immunodeficiency virus (HIV) testing within a year before the most recent pregnancy and heavy drinking on at least one occasion during the preceding month. Ten preconception health domains are examined: general health status and life satisfaction, social determinants of health, health care, reproductive health and family planning, tobacco and alcohol use, nutrition and physical activity, mental health, emotional and social support, chronic conditions, and infections. Weighted prevalence estimates and 95% confidence intervals (95% CIs)for 39 indicators are presented overall and for each reporting area and stratified by age group (18-24, 25-34, and 35-44 years) and women's race/ethnicity (non-Hispanic white, non-Hispanic black, non-Hispanic other, and Hispanic). RESULTS: This surveillance summary includes data for 39 of 41 indicators: 2009 data for 23 preconception health indicators that were monitored by PRAMS and 16 preconception health indicators that were monitored by BRFSS (one BRFSS indicator uses 2008 data). For two of the indicators that are included in this report (prepregnancy overweight or obesity and current overweight or obesity), separate measures of overweight and obesity were reported. All preconception health indicators varied by reporting area, and most indicators varied significantly by age group and race/ethnicity. Overall, 88.9% of women of reproductive age reported good, very good, or excellent general health status and life satisfaction (BRFSS). A high school/general equivalency diploma or higher education (social determinants of health domain) was reported by 94.7% of non-Hispanic white, 92.9% of non-Hispanic other, 91.1% of non-Hispanic black, and 70.9% of Hispanic women (BRFSS). Overall, health-care insurance coverage during the month before the most recent pregnancy (health-care domain) was 74.9% (PRAMS). A routine checkup during the preceding year was reported by 79.0% of non-Hispanic black, 65.1% of non-Hispanic white, 64.3% of other, and 63.0% of Hispanic women (BRFSS). Among women with a recent live birth (2-9 months since date of delivery), selected PRAMS results for the reproductive health and family planning, tobacco and alcohol use, and nutrition domains included several factors. Although 43% of women reported that their most recent pregnancy was unintended (unwanted or wanted to be pregnant later), approximately half (53%) of those who were not trying to get pregnant reported not using contraception at the time of conception. Smoking during the 3 months before pregnancy was reported by 25.1% of women, and drinking alcohol 3 months before pregnancy was reported by 54.2% of women. Daily use of a multivitamin, prenatal vitamin, or a folic acid supplement during the month before pregnancy was reported by 29.7% of women. Selected BRFSS results included indicators pertaining to the nutrition and physical activity, emotional and social support, and chronic conditions domains among women of reproductive age. Approximately one fourth (24.7%) of women were identified as being obese according to body mass index (BMI) on the basis of self-reported height and weight. Overall, 51.6% of women reported participation in recommended levels of physical activity per U.S. Department of Health and Human Services physical activity guidelines. Non-Hispanic whites reported the highest prevalence (85.0%) of having adequate emotional and social support, followed by other races/ethnicities (74.9%), Hispanics (70.5%), and non-Hispanic blacks (69.7%). Approximately 3.0% of persons reported ever being diagnosed with diabetes, and 10.2% of women reported ever being diagnosed with hypertension. INTERPRETATION: The findings in this report underscore opportunities for improving the preconception health of U.S. women. Preconception health and women's health can be improved by reducing unintended pregnancies, reducing risky behaviors (e.g., smoking and drinking) among women of reproductive age, and ensuring that chronic conditions are under control. Evidence-based interventions and clinical practice guidelines exist to address these risks and to improve pregnancy outcomes and women's health in general. The results also highlight the need to increase access to health care for all nonpregnant women of reproductive age and the need to encourage the use of essential preventive services for women, including preconception health services. In addition, system changes in community settings can alleviate health problems resulting from inadequate social and emotional support and environments that foster unhealthy lifestyles. Policy changes can promote health equity by encouraging environments that promote healthier options in nutrition and physical activity. Finally, variation in the preconception health status of women by age and race/ethnicity underscores the need for implementing and scaling up proven strategies to reduce persistent health disparities among those at highest risk. Ongoing surveillance and research in preconception health are needed to monitor the influence of improved health-care access and coverage on women's prepregnancy and interpregnancy health status, pregnancy and infant outcomes, and health disparities. PUBLIC HEALTH ACTION: Public health decision makers, program planners, researchers, and other key stakeholders can use the state-level PRAMS and BRFSS preconception health indicators to benchmark and monitor preconception health among women of reproductive age. These data also can be used to evaluate the effectiveness of preconception health state and national programs and to assess the need for new programs, program enhancements, and policies. |
The relationship between state policies for competitive foods and school nutrition practices in the United States
Merlo CL , Olsen EO , Galic M , Brener ND . Prev Chronic Dis 2014 11 E66 INTRODUCTION: Most students in grades kindergarten through 12 have access to foods and beverages during the school day outside the federal school meal programs, which are called competitive foods. At the time of this study, competitive foods were subject to minimal federal nutrition standards, but states could implement additional standards. Our analysis examined the association between school nutrition practices and alignment of state policies with Institute of Medicine recommendations (IOM Standards). METHODS: For this analysis we used data from the Centers for Disease Control and Prevention's (CDC's) report, Competitive Foods and Beverages in US Schools: A State Policy Analysis and CDC's 2010 School Health Profiles (Profiles) survey to examine descriptive associations between state policies for competitive foods and school nutrition practices. RESULTS: Access to chocolate candy, soda pop, sports drinks, and caffeinated foods or beverages was lower in schools in states with policies more closely aligned with IOM Standards. No association was found for access to fruits or nonfried vegetables. CONCLUSION: Schools in states with policies more closely aligned with the IOM Standards reported reduced access to less healthful competitive foods. Encouraging more schools to follow these standards will help create healthier school environments and may help promote healthy eating among US children. |
Consumer sentiment on actions reducing sodium in processed and restaurant foods, ConsumerStyles 2010
Patel SM , Gunn JP , Tong X , Cogswell ME . Am J Prev Med 2014 46 (5) 516-24 BACKGROUND: Current recommendations target sodium reduction in the food supply and intake; however, information is limited on consumer readiness for these actions. PURPOSE: Prevalence and determinants of consumer agreement for government restriction of manufacturers and restaurants putting excess salt in food and support for policies limiting sodium content of quick service restaurant (QSR) foods were examined. METHODS: Data were analyzed from 9,579 adults aged ≥18 years who responded to consumer readiness for sodium reduction questions in the 2010 ConsumerStyles survey. Responses were collapsed into three categories. Consumer agreement was determined and logistic regression was used to estimate ORs. Analyses were conducted in 2012. RESULTS: The majority of consumers agree that it is a good idea for government to restrict food manufacturers (55.9%) from putting excess salt in foods. About half agreed that it is a good idea for government to restrict restaurants from putting excess salt in foods and 81.5% supported sodium reduction policies in QSRs. Odds of agreement/support were higher for non-Hispanic blacks compared with non-Hispanic whites, and those with incomes <$40,000 compared with ≥$60,000. Those reporting "neutral" or "yes" to wanting to eat a diet low in sodium were more likely to agree/support government action compared to those answering "no." CONCLUSIONS: Nearly half of consumers agree with government actions to reduce sodium in manufactured and restaurant foods, with even greater support for QSRs. These findings could inform industry and public health partners about consumer preferences to lower the sodium content of the food supply. |
Occupational ladder fall injuries - United States, 2011
Socias CM , Chaumont Menendez CK , Collins JW , Simeonov P . MMWR Morb Mortal Wkly Rep 2014 63 (16) 341-6 Falls remain a leading cause of unintentional injury mortality nationwide, and 43% of fatal falls in the last decade have involved a ladder. Among workers, approximately 20% of fall injuries involve ladders. Among construction workers, an estimated 81% of fall injuries treated in U.S. emergency departments (EDs) involve a ladder. To fully characterize fatal and nonfatal injuries associated with ladder falls among workers in the United States, CDC's National Institute for Occupational Safety and Health (NIOSH) analyzed data across multiple surveillance systems: 1) the Census of Fatal Occupational Injuries (CFOI), 2) the Survey of Occupational Injuries and Illnesses (SOII), and 3) the National Electronic Injury Surveillance System-occupational supplement (NEISS-Work). In 2011, work-related ladder fall injuries (LFIs) resulted in 113 fatalities (0.09 per 100,000 full-time equivalent [FTE] workers), an estimated 15,460 nonfatal injuries reported by employers that involved ≥1 days away from work (DAFW), and an estimated 34,000 nonfatal injuries treated in EDs. Rates for nonfatal, work-related, ED-treated LFIs were higher (2.6 per 10,000 FTE) than those for such injuries reported by employers (1.2 per 10,000 FTE). LFIs represent a substantial public health burden of preventable injuries for workers. Because falls are the leading cause of work-related injuries and deaths in construction, NIOSH, the Occupational Safety and Health Administration, and the Center for Construction Research and Training are promoting a national campaign to prevent workplace falls. NIOSH is also developing innovative technologies to complement safe ladder use. |
Indoor firing ranges and elevated blood lead levels - United States, 2002-2013
Beaucham C , Page E , Alarcon WA , Calver GM , Methner M , Schoonover TM . MMWR Morb Mortal Wkly Rep 2014 63 (16) 347-51 Indoor firing ranges are a source of lead exposure and elevated blood lead levels (BLLs) among employees, their families, and customers, despite public health outreach efforts and comprehensive guidelines for controlling occupational lead exposure. There are approximately 16,000-18,000 indoor firing ranges in the United States, with tens of thousands of employees. Approximately 1 million law enforcement officers train on indoor ranges. To estimate how many adults had elevated BLLs (≥10 microg/dL) as a result of exposure to lead from shooting firearms, data on elevated BLLs from the Adult Blood Lead Epidemiology and Surveillance (ABLES) program managed by CDC's National Institute for Occupational Safety and Health (NIOSH) were examined by source of lead exposure. During 2002-2012, a total of 2,056 persons employed in the categories "police protection" and "other amusement and recreation industries (including firing ranges)" had elevated BLLs reported to ABLES; an additional 2,673 persons had non-work-related BLLs likely attributable to target shooting. To identify deficiencies at two indoor firing ranges linked to elevated BLLs, the Washington State Division of Occupational Safety and Health (WaDOSH) and NIOSH conducted investigations in 2012 and 2013, respectively. The WaDOSH investigation found a failure to conduct personal exposure and biologic monitoring for lead and also found dry sweeping of lead-containing dust. The NIOSH investigation found serious deficiencies in ventilation, housekeeping, and medical surveillance. Public health officials and clinicians should ask about occupations and hobbies that might involve lead when evaluating findings of elevated BLLs. Interventions for reducing lead exposure in firing ranges include using lead-free bullets, improving ventilation, and using wet mopping or high-efficiency particulate air (HEPA) vacuuming to clean. |
Adherence to safe handling guidelines by healthcare workers who administer antineoplastic drugs
Boiano JM , Steege AL , Sweeney MH . J Occup Environ Hyg 2014 11 (11) 728-40 The toxicity of antineoplastic drugs is well-documented. Many are known or suspected human carcinogens where no safe exposure level exists. Authoritative guidelines developed by professional practice organizations and federal agencies for the safe handling of these hazardous drugs have been available for nearly three decades. As a means of evaluating the extent of use of primary prevention practices such as engineering, administrative and work practice controls, personal protective equipment (PPE) and barriers to using PPE, NIOSH conducted a web survey of healthcare workers in 2011. The study population primarily included members of professional practice organizations representing healthcare occupations which routinely use or come in contact with selected chemical agents. All respondents who indicated that they administered antineoplastic drugs in the past week were eligible to complete a hazard module addressing self-reported health and safety practices on this topic. Most (98%) of the 2,069 respondents of this module were nurses. Working primarily in hospitals, outpatient care centers and physician offices, respondents reported that they collectively administered over 90 specific antineoplastic drugs in the past week, with carboplatin, cyclophosphamide and paclitaxel the most common. Examples of activities which increase exposure risk, expressed as percent of respondents, included: failure to wear nonabsorbent gown with closed front and tight cuffs (42%); intravenous (I.V.) tubing primed with antineoplastic agent by respondent (6%) or by pharmacy (12%); potentially contaminated clothing taken home (12%); spill or leak of antineoplastic agent during administration (12%); failure to wear chemotherapy gloves (12%); and lack of hazard awareness training (4%). The most common reason for not wearing gloves or gowns was "skin exposure was minimal"; 4% of respondents, however, reported skin contact during handling and administration. Despite the longstanding availability of safe handling guidance, recommended practices are not always followed, underscoring the importance of training and education for employers and workers. |
Costs of occupational musculoskeletal disorders (MSDs) in the United States
Bhattacharya Anasua . Int J Ind Ergon 2014 44 (3) 448-451 BACKGROUND: For the years 1992-2010 musculoskeletal disorders (MSDs) accounted for 29-35% of all occupational injuries and illnesses involving days away from work in the United States (US) (AFL-CIO, 2012). According to the American Federation of Labor and Congress of Industrial Organizations (AFL-CIO) 2012 report 'Death on the Job', for the years 1992 through 2010 the percent of cases involving MSDs in private industry were highest in 2000 (35%) and lowest in 2007 (29%). In 2010, the median number of days away from work for MSDs was 11 compared to 8 for all occupational injury cases involving days away from work; the median number of days away from work for Carpal Tunnel Syndrome (CTS) was 25, more than three times as high as for all other BLS injuries involving days away from work (BLS, 2011). This study estimated the costs of work related MSDs, and given that the number of days lost due to CTS is very high, it also estimated the costs of CTS separately in the United States (US) for the years 2003 through 2007. METHODS: The costs of work related MSDs and CTS in the US were estimated using the cost-of-illness, human capital method (Leigh etal., 2000), using some of the costs from the literature. This method decomposes costs into direct and indirect categories. Estimates of total cost of MSDs and CTS were obtained from the product of average costs of MSDs and CTS and the number of MSDs and CTS. The number of MSDs and CTS were obtained from BLS data. RESULTS: The number of reported work-related MSDs declined from 435,180 in 2003 to 335,390 in 2007 and the reported number of CTS also declined from 22,110 in 2003 to 11,920 in 2007. The direct costs of MSDs and CTS were respectively $1.5 billion and $0.1 billion for the year 2007. The indirect costs were $1.1 billion and $0.1 billion for MSDs and CTS respectively for the year 2007. DISCUSSION: This study found that the total costs of work-related MSDs and CTS declined during the period 2003 through 2007 but the average costs per case went up signifying that medical costs and other associated costs increased during this period. RELEVANCE TO INDUSTRY: The costs of MSDs are important to the industries too as a significant part of these costs are borne by the employers. Industries with higher prevalence of MSDs are affected more in terms of lost productivities due to the employees' days away from work because of MSDs. In cases of MSDs causing permanent disabilities, new hiring and training costs are also a part of the losses experienced by the employers. |
Molecular characterization of Cryptosporidium spp. in children from Mexico.
Valenzuela O , Gonzalez-Diaz M , Garibay-Escobar A , Burgara-Estrella A , Cano M , Durazo M , Bernal RM , Hernandez J , Xiao L . PLoS One 2014 9 (4) e96128 Cryptosporidiosis is a parasitic disease caused by Cryptosporidium spp. In immunocompetent individuals, it usually causes an acute and self-limited diarrhea; in infants, infection with Cryptosporidium spp. can cause malnutrition and growth retardation, and declined cognitive ability. In this study, we described for the first time the distribution of C. parvum and C. hominis subtypes in 12 children in Mexico by sequence characterization of the 60-kDa glycoprotein (GP60) gene of Cryptosporidium. Altogether, 7 subtypes belonging to 4 subtype families of C. hominis (Ia, Ib, Id and Ie) and 1 subtype family of C. parvum (IIa) were detected, including IaA14R3, IaA15R3, IbA10G2, IdA17, IeA11G3T3, IIaA15G2R1 and IIaA16G1R1. The frequency of the subtype families and subtypes in the samples analyzed in this study differed from what was observed in other countries. |
Trypanosoma cruzi survival following cold storage: possible implications for tissue banking
Martin DL , Goodhew B , Czaicki N , Foster K , Rajbhandary S , Hunter S , Brubaker SA . PLoS One 2014 9 (4) e95398 While Trypanosoma cruzi, the etiologic agent of Chagas disease, is typically vector-borne, infection can also occur through solid organ transplantation or transfusion of contaminated blood products. The ability of infected human cells, tissues, and cellular and tissue-based products (HCT/Ps) to transmit T. cruzi is dependent upon T. cruzi surviving the processing and storage conditions to which HCT/Ps are subjected. In the studies reported here, T. cruzi trypomastigotes remained infective 24 hours after being spiked into blood and stored at room temperature (N = 20); in 2 of 13 parasite-infected cultures stored 28 days at 4 degrees C; and in samples stored 365 days at -80 degrees C without cryoprotectant (N = 28), despite decreased viability compared to cryopreserved parasites. Detection of viable parasites after multiple freeze/thaws depended upon the duration of frozen storage. The ability of T. cruzi to survive long periods of storage at +4 and -80 degrees C suggests that T. cruzi-infected tissues stored under these conditions are potentially infectious. |
The legacies of Eugene Jamot and La Jamotique
Mbopi-Keou FX , Belec L , Milleliri JM , Teo CG . PLoS Negl Trop Dis 2014 8 (4) e2635 Who remembers “l'éveilleur” (“the awakener”), Colonel Eugène Jamot (1879–1937) [2]? Many still, it would seem, judging from the constant stream of biographies and articles that have appeared over the century, commemorating his contributions to the control of sleeping sickness, otherwise known as human African trypanosomiasis (HAT) [1], [3]. There is even an association that has been established and dedicated to his life and achievements [4]. |
Medication-assisted therapies - tackling the opioid-overdose epidemic
Volkow ND , Frieden TR , Hyde PS , Cha SS . N Engl J Med 2014 370 (22) 2063-6 The rate of death from overdoses of prescription opioids in the United States more than quadrupled between 1999 and 2010 (see graph), far exceeding the combined death toll from cocaine and heroin overdoses.1 In 2010 alone, prescription opioids were involved in 16,651 overdose deaths, whereas heroin was implicated in 3036. Some 82% of the deaths due to prescription opioids and 92% of those due to heroin were classified as unintentional, with the remainder being attributed predominantly to suicide or "undetermined intent." |
Using a checklist to assess pregnancy in teenagers and young women
Whiteman MK , Tepper NK , Kottke M , Curtis KM , Goedken P , Mandel MG , Marchbanks PA . Obstet Gynecol 2014 123 (4) 777-784 OBJECTIVE: Health care providers should assess pregnancy in women seeking contraceptive services. Although urine pregnancy tests are available in most U.S. settings, their accuracy varies based on timing relative to missed menses, recent intercourse, or recent pregnancy. We examined the performance of a checklist based on criteria recommended in family planning guidance documents to assist health care providers in assessing pregnancy in a sample of U.S. teenagers and young women. METHODS: Study participants were a convenience sample of sexually active black females aged 14-19 years seeking care in an urban family planning clinic. Each participant provided a urine sample for pregnancy testing and was then administered the checklist in two formats, audio computer-assisted self-interview and in-person interview. We estimated measures of the checklist performance compared with urine pregnancy test as the reference standard, including negative predictive value, sensitivity, specificity, and positive predictive value. RESULTS: Of 350 participants, 31 (8.9%) had a positive urine pregnancy test. The audio computer-assisted selfinterview checklist indicated pregnancy was unlikely for 250 participants, of whom 241 had a negative urine pregnancy test (negative predictive value=96.4%). The sensitivity of the audio computer-assisted self-interview checklist was 71%, the specificity was 75.6%, and the positive predictive value was 22%. The in-person checklist yielded similar results. CONCLUSION: The checklist may be a valuable tool to assist in assessing pregnancy in teenagers and young women. Appropriate use of the checklist by family planning providers in combination with discussion and clinically indicated use of urine pregnancy tests may reduce unnecessary barriers to contraception in this population. |
Providing quality family planning services: recommendations of CDC and the U.S. Office of Population Affairs
Gavin L , Moskosky S , Carter M , Curtis K , Glass E , Godfrey E , Marcell A , Mautone-Smith N , Pazol K , Tepper N , Zapata L . MMWR Recomm Rep 2014 63 1-54 This report provides recommendations developed collaboratively by CDC and the Office of Population Affairs (OPA) of the U.S. Department of Health and Human Services (HHS). The recommendations outline how to provide quality family planning services, which include contraceptive services, pregnancy testing and counseling, helping clients achieve pregnancy, basic infertility services, preconception health services, and sexually transmitted disease services. The primary audience for this report is all current or potential providers of family planning services, including those working in service sites that are dedicated to family planning service delivery as well as private and public providers of more comprehensive primary care.The United States continues to face substantial challenges to improving the reproductive health of the U.S. population. Nearly one half of all pregnancies are unintended, with more than 700,000 adolescents aged 15-19 years becoming pregnant each year and more than 300,000 giving birth. One of eight pregnancies in the United States results in preterm birth, and infant mortality rates remain high compared with those of other developed countries. This report can assist primary care providers in offering family planning services that will help women, men, and couples achieve their desired number and spacing of children and increase the likelihood that those children are born healthy. The report provides recommendations for how to help prevent and achieve pregnancy, emphasizes offering a full range of contraceptive methods for persons seeking to prevent pregnancy, highlights the special needs of adolescent clients, and encourages the use of the family planning visit to provide selected preventive health services for women, in accordance with the recommendations for women issued by the Institute of Medicine and adopted by HHS. |
Mechanistic hierarchical Gaussian processes
Wheeler MW , Dunson DB , Pandalai SP , Baker BA , Herring AH . J Am Stat Assoc 2014 109 (507) 894-904 The statistics literature on functional data analysis focuses primarily on flexible black-box approaches, which are designed to allow individual curves to have essentially any shape while characterizing variability. Such methods typically cannot incorporate mechanistic information, which is commonly expressed in terms of differential equations. Motivated by studies of muscle activation, we propose a nonparametric Bayesian approach that takes into account mechanistic understanding of muscle physiology. A novel class of hierarchical Gaussian processes is defined that favors curves consistent with differential equations defined on motor, damper, spring systems. A Gibbs sampler is proposed to sample from the posterior distribution and applied to a study of rats exposed to non-injurious muscle activation protocols. Although motivated by muscle force data, a parallel approach can be used to include mechanistic information in broad functional data analysis applications. |
Publicized sobriety checkpoint programs: a Community Guide systematic review
Bergen G , Pitan A , Qu S , Shults RA , Chattopadhyay SK , Elder RW , Sleet DA , Coleman HL , Compton RP , Nichols JL , Clymer JM , Calvert WB . Am J Prev Med 2014 46 (5) 529-539 CONTEXT: Publicized sobriety checkpoint programs deter alcohol-impaired driving by stopping drivers systematically to assess their alcohol impairment. Sobriety checkpoints were recommended in 2001 by the Community Preventive Services Task Force for reducing alcohol-impaired driving, based on strong evidence of effectiveness. Since the 2001 review, attention to alcohol-impaired driving as a U.S. public health problem has decreased. This systematic review was conducted to determine if available evidence supports the effectiveness of publicized sobriety checkpoint programs in reducing alcohol-impaired driving, given the current context. The economic costs and benefits of the intervention were also assessed. EVIDENCE ACQUISITION: This review focused on studies that evaluated the effects of publicized sobriety checkpoint programs on alcohol-involved crash fatalities. Using Community Guide methods, a systematic search was conducted for studies published between July 2000 and March 2012 that assessed the effectiveness of publicized sobriety checkpoint programs. EVIDENCE SYNTHESIS: Fourteen evaluations of selective breath testing and one of random breath testing checkpoints met the inclusion criteria for the systematic review, conducted in 2012. Ten evaluations assessed the effects of publicized sobriety checkpoint programs on alcohol-involved crash fatalities, finding a median reduction of 8.9% in this crash type (interquartile interval=-16.5%, -3.5%). Five economic evaluations showed benefit-cost ratios ranging from 2:1 to 57:1. CONCLUSIONS: The number of studies, magnitude of effect, and consistency of findings indicate strong evidence of the effectiveness of publicized sobriety checkpoint programs in reducing alcohol-involved crash fatalities. Economic evidence shows that these programs also have the potential for substantial cost savings. |
Decreased smoking disparities among Vietnamese and Cambodian communities - Racial and Ethnic Approaches to Community Health (REACH) Project, 2002-2006
Zhou H , Tsoh JY , Grigg-Saito D , Tucker P , Liao Y . MMWR Suppl 2014 63 (1) 37-45 Since 1964, smoking prevalence in the United States has declined because of nationwide intervention efforts. However, smoking interventions have not been implemented uniformly throughout all communities. Some of the highest smoking rates in the United States have been reported among Southeast Asian men, and socioeconomic status has been strongly associated with smoking. To compare the effect in reducing racial and ethnic disparities between men in Southeast Asian (Vietnamese and Cambodian) communities and men residing in the same states, CDC analyzed 2002-2006 data from The Racial and Ethnic Approaches to Community Health (REACH) project. The prevalence of current smoking significantly decreased and the quit ratio (percentage of ever smokers who have quit) significantly increased in REACH Vietnamese and Cambodian communities, but changes were minimal among all men in California or all men in Massachusetts (where these communities were located). The smoking rate also declined significantly, and the quit ratio showed an upward trend in U.S. men overall; however, the changes were significantly greater in REACH communities than in the nation. Stratified analyses showed decreasing trends of smoking and increasing trends of quit ratio in persons of both high and low education levels in Vietnamese REACH communities. The relative disparities in the prevalence of smoking and in the quit ratio decreased or were eliminated between less educated Vietnamese and less educated California men and between Cambodian and Massachusetts men regardless of education level. Eliminating health disparities related to tobacco use is a major public health challenge facing Asian communities. The decline in smoking prevalence at the population level in the three REACH Vietnamese and Cambodian communities as described in this report might serve as a model for promising interventions in these populations. The results highlight the potential effectiveness of community-level interventions, such as forming community coalitions, use of local media, and enhancing communities' capacity for systems change. The Office of Minority Health and Health Equity selected this intervention analysis and discussion to provide an example of a program that might be effective for reducing tobacco use-related health disparities in the United States. |
Racial misclassification of American Indians and Alaska Natives by Indian Health Service Contract Health Service Delivery Area
Jim MA , Arias E , Seneca DS , Hoopes MJ , Jim CC , Johnson NJ , Wiggins CL . Am J Public Health 2014 104 Suppl 3 S295-302 OBJECTIVES: We evaluated the racial misclassification of American Indians and Alaska Natives (AI/ANs) in cancer incidence and all-cause mortality data by Indian Health Service (IHS) Contract Health Service Delivery Area (CHSDA). METHODS: We evaluated data from 3 sources: IHS-National Vital Statistics System (NVSS), IHS-National Program of Cancer Registries (NPCR)/Surveillance, Epidemiology and End Results (SEER) program, and National Longitudinal Mortality Study (NLMS). We calculated, within each data source, the sensitivity and classification ratios by sex, IHS region, and urban-rural classification by CHSDA county. RESULTS: Sensitivity was significantly greater in CHSDA counties (IHS-NVSS: 83.6%; IHS-NPCR/SEER: 77.6%; NLMS: 68.8%) than non-CHSDA counties (IHS-NVSS: 54.8%; IHS-NPCR/SEER: 39.0%; NLMS: 28.3%). Classification ratios indicated less misclassification in CHSDA counties (IHS-NVSS: 1.20%; IHS-NPCR/SEER: 1.29%; NLMS: 1.18%) than non-CHSDA counties (IHS-NVSS: 1.82%; IHS-NPCR/SEER: 2.56%; NLMS: 1.81%). Race misclassification was less in rural counties and in regions with the greatest concentrations of AI/AN persons (Alaska, Southwest, and Northern Plains). CONCLUSIONS: Limiting presentation and analysis to CHSDA counties helped mitigate the effects of race misclassification of AI/AN persons, although a portion of the population was excluded. |
Linkages to improve mortality data for American Indians and Alaska Natives: a new model for death reporting?
Anderson RN , Copeland G , Hayes JM . Am J Public Health 2014 104 Suppl 3 S258-62 Racial misclassification is a well-documented weakness of mortality data taken from death certificates. As a result, mortality statistics for American Indians and Alaska Natives (AI/ANs) present, at best, an inaccurate and misleading assessment of mortality in this population. Studies evaluating the quality of race/ethnicity reporting on death certificates have linked data from death certificates to other data sources collected when the decedent was still alive (e.g., Census, Current Population Survey). Such studies have shown substantial misclassification of AI/AN decedents. Despite limitations, linking mortality data from death certificates with data from other sources collected when decedents were living provides opportunities to evaluate and correct misclassification of populations such as AI/AN persons and facilitates the calculation and presentation of more accurate mortality statistics. |
Methods for improving the quality and completeness of mortality data for American Indians and Alaska Natives
Espey DK , Jim MA , Richards TB , Begay C , Haverkamp D , Roberts D . Am J Public Health 2014 104 Suppl 3 S286-94 OBJECTIVES: We describe methods used to mitigate the effect of race misclassification in mortality records and the data sets used to improve mortality estimates for American Indians and Alaska Natives (AI/ANs). METHODS: We linked US National Death Index (NDI) records with Indian Health Service (IHS) registration records to identify AI/AN deaths misclassified as non-AI/AN deaths. Analyses excluded decedents of Hispanic origin and focused on Contract Health Service Delivery Area (CHSDA) counties. We compared death rates for AI/AN persons and Whites across 6 US regions. RESULTS: IHS registration records merged to 176 137 NDI records. Misclassification of AI/AN race in mortality data ranged from 6.3% in the Southwest to 35.6% in the Southern Plains. From 1999 to 2009, the all-cause death rate in CHSDA counties for AI/AN persons varied by geographic region and was 46% greater than that for Whites. Analyses for CHSDA counties resulted in higher death rates for AI/AN persons than in all counties combined. CONCLUSIONS: Improving race classification among AI/AN decedents strengthens AI/AN mortality data, and analyzing deaths by geographic region can aid in planning, implementation, and evaluation of efforts to reduce health disparities in this population. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
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- Food Safety
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- Health Behavior and Risk
- Health Communication and Education
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