Race and sex differences in willingness to undergo total joint replacement: the Johnston County Osteoarthritis Project
Allen KD , Golightly YM , Callahan LF , Helmick CG , Ibrahim SA , Kwoh CK , Renner JB , Jordan JM . Arthritis Care Res (Hoboken) 2014 66 (8) 1193-202 OBJECTIVE: Using data from the community-based Johnston County Osteoarthritis Project, we examined race and sex variations in willingness to undergo, and perceptions regarding, total joint replacement (TJR). METHODS: Analyses were conducted for the total sample who participated in a followup measurement period from 2006-2010 (n = 1,522) and a subsample with symptomatic hip and/or knee osteoarthritis (sOA; n = 445). Participants indicated how willing they would be to have TJR (hip or knee) if their doctor recommended it; responses were categorized as "definitely" or "probably" willing versus "unsure," "probably not," or "definitely not" willing, or "don't know." Participants answered 7 questions regarding perceptions of TJR outcomes. Multivariable logistic regression models of willingness included participant characteristics (including socioeconomic status) and TJR perception variables that were associated with willingness at the P < 0.1 level in bivariate analyses. RESULTS: African Americans had lower odds of willingness to undergo TJR than whites in the total sample (adjusted odds ratio [OR] 0.47 [95% confidence interval (95% CI) 0.31-0.72]) and the sOA subsample (adjusted OR 0.42 [95% CI 0.25-0.69]). There were no sex differences in willingness. African Americans expected poorer TJR outcomes than whites, but sex differences were minimal; perceptions of TJR outcomes were not significantly associated with willingness. CONCLUSION: In this community sample, race differences in TJR willingness and perceptions were substantial, but sex differences were small. Perceptions of TJR did not appear to affect willingness or explain race differences in willingness. |
Relationship between employment characteristics and obesity among employed U.S. adults
Park S , Pan L , Lankford T . Am J Health Promot 2014 28 (6) 389-96 PURPOSE: This study examined associations between employment characteristics and obesity among a sample representing civilian noninstitutionalized U.S. adults. Design . Quantitative, cross-sectional study. SETTING: Workplace. SUBJECTS: The 2010 National Health Interview Survey data for 15,121 employed adults (≥18 years). MEASURES: The outcome variable was weight status, and exposure variables were employment characteristics (number of employees, work hours, paid by the hour, paid sick leave, and health insurance offered). ANALYSIS: Multivariate logistic regression was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for employment characteristics associated with obesity (body mass index [BMI] ≥ 30 kg/m(2)) after controlling for age, sex, race/ethnicity, education, family income, fruit/vegetable intake, physical activity, smoking, and occupations. RESULTS: Nationwide, 28% of employed adults were obese. From multivariate logistic regression, the odds of being obese was significantly greater among adults who worked at a company with 100 to 499 employees (OR = 1.19, 95% CI = 1.02-1.39) vs. with 1 to 24 employees and those who worked >50 hours/week (OR = 1.32, 95% CI = 1.05-1.65) vs. <30 hours/week. CONCLUSION: Approximately 3 out of 10 employees were obese and 6 out of 10 were overweight or obese. A better understanding of why these employment characteristics are associated with obesity could help employers better develop and target interventions for obesity prevention and treatment in the worksites. |
Use of the word "crisis" in sickle cell disease: the language of sickle cell
Savitt TL , Smith WR , Haywood Jr C , Creary MS . J Natl Med Assoc 2014 106 (1) 23-30 Language matters. The words used to name and describe disease phenomena are a reflection of society. The authors address the use of the word "crisis" in SCD from sociological, historical, medical, and patient perspectives. The term "crisis" became associated with sickle cell disease in the mid-1920s, more than a decade after the first description of the disease had been published. The term had been used for centuries in conjunction with fever and as a signifier of severe pain in certain diseases during the nineteenth century. The application of the term to this new disease in the 1920s resulted from physicians' observations of their patients' urgent situations. Though commonly used by health care providers and patients today, "crisis" may not be the appropriate term for sickle cell patients suffering severe pain, because people endure differing amounts of pain before stating they are "in crisis." The result can be undertreatment of the pain or mistrust between physicians and patients about use of strong (narcotic) pain-relievers. Some patients believe the term is useful in communicating the severity of their pain and the urgency of their need for relief from it, especially when seeking care at hospital emergency departments, while others believe "crisis" does not accurately reflect the severity or seriousness of their situation. |
Patient navigation in a colorectal cancer screening program
Escoffery C , Fernandez ME , Vernon SW , Liang S , Maxwell AE , Allen JD , Dwyer A , Hannon PA , Kohn M , DeGroff A . J Public Health Manag Pract 2014 21 (5) 433-40 CONTEXT: Colorectal cancer (CRC) is the second leading cause of cancer death among cancers affecting both men and women in the United States. The Centers for Disease Control and Prevention's Colorectal Cancer Control Program (CRCCP) supports both direct clinical screening services (screening provision) and activities to promote screening at the population level (screening promotion). OBJECTIVE: The purpose of this study was to characterize patient navigation (PN) programs for screening provision and promotion for the first 1 to 2 years of program funding. PARTICIPANTS: We conducted a cross-sectional survey of the 29 CRCCP grantees (25 states and 4 tribal organizations) and 14 in-depth interviews to assess program implementation. MAIN OUTCOME MEASURES: The survey and interview guide collected information on CRC screening provision and promotion activities and PN, including the structure of the PN program, characteristics of the navigators, funding mechanism, and navigators' activities. RESULTS: Twenty-four of 28 CRCCP grantees of the survey used PN for screening provision whereas 18 grantees used navigation for screening promotion. Navigators were often trained in nursing or public health. Navigation activities were similar for both screening provision and promotion, and common tasks included assessing and responding to patient barriers to screening, providing patient education, and scheduling appointments. For screening provision, activities centered on making reminder calls, educating patients on bowel preparation for colonoscopies, and tracking patients for completion of the tests. Navigation may influence screening quality by improving patients' bowel preparation for colonoscopies. CONCLUSIONS: Our study provides insights into PN across a federally funded CRC program. Results suggest that PN activities may be instrumental in recruiting people into cancer screening and ensuring completed screening and follow-up. |
Key informant interviews with coordinators of special events conducted to increase cancer screening in the United States
Escoffery C , Rodgers K , Kegler MC , Haardorfer R , Howard D , Roland KB , Wilson KM , Castro G , Rodriguez J . Health Educ Res 2014 29 (5) 730-9 Special events such as health fairs, cultural festivals and charity runs are commonly employed in the community to increase cancer screening; however, little is known about their effectiveness. The purpose of this study is to assess the activities, screening outcomes, barriers and recommendations of special events to increase breast, cervical and colorectal cancer screening. In-depth interviews were conducted nationally with 51 coordinators of events in June to September 2012. Health fairs and screening days were the most common events conducted, primarily for breast cancer education. Goals were to increase awareness of cancer screening and reach special populations. Evidence-based Community Guide strategies to increase cancer screening employed were: small media, reducing structural barriers, one-on-one education or group education. For each event that provided screening on-site or through referral, a mean of 35 breast, 28 cervical and 19 colorectal cancer screenings were reported. Coordinators made recommendations for further evaluation of special events, and most plan to conduct another special event. These data are novel and provide baseline documentation of activities and recommendations for a commonly used community-based cancer screening intervention that lacks evidence of effectiveness. Additional research to better understand the use of special events for increasing cancer screening is warranted. |
Assessing asthma control and associated risk factors among persons with current asthma - findings from the child and adult Asthma Call-Back Survey
Zahran HS , Bailey CM , Qin X , Moorman JE . J Asthma 2014 52 (3) 1-31 INTRODUCTION: Monitoring the level of asthma control is important in determining the effectiveness of current treatment which may decrease the frequency and intensity of symptoms and functional limitations. Uncontrolled asthma has been associated with decreased quality of life and increased health care use. The objectives of this study were to assess the level of asthma control and identify related risk factors among persons with current asthma. METHODS: Using the 2006 to 2010 BRFSS child and adult Asthma Call-back Survey, asthma control was classified as well-controlled or uncontrolled (not-well-controlled or very-poorly-controlled) using three impairment measures: daytime symptoms, nighttime symptoms, and taking short-acting beta2-agonists for symptom control. Multivariate logistic regression identified predictors of asthma control. RESULTS: Fifty percent of adults and 38.4% of children with current asthma had uncontrolled asthma. About 63% of children and 53% of adults with uncontrolled asthma were on long-term asthma control medications. Among children, uncontrolled asthma was significantly associated with being younger than 5 years, having annual household income < $15,000, and reporting cost as barriers to medical care. Among adults, it was significantly associated with being 45 years or older, having annual household income of < $25,000, being "other" race, having less than a 4-year college degree, being a current or former smoker, reporting cost as barriers, being obese, and having chronic obstructive pulmonary disease or depression. CONCLUSION: Identifying and targeting modifiable predictors of uncontrolled asthma (low educational attainment, low income, cigarette smoking, and co-morbid conditions including obesity and depression) could improve asthma control. |
Asthma prevalence among Hispanic adults in Puerto Rico and Hispanic adults of Puerto Rican descent in the United States - results from two national surveys
El Burai Felix S , Bailey CM , Zahran HS . J Asthma 2014 52 (1) 1-7 OBJECTIVE: To assess whether asthma prevalence differs between Hispanic adults living in Puerto Rico and Hispanic adults of Puerto Rican descent living in the United States. METHODS: We used 2008-2010 Behavioral Risk Factor Surveillance System data, administered in Puerto Rico for Hispanic adults living in Puerto Rico (Hispanics in Puerto Rico), and 2008-2010 National Health Interview Survey data for Hispanic adults of Puerto Rican descent living in the United States (Puerto Rican Americans). We used 95% confidence intervals (CIs) to compare asthma prevalence between corresponding subgroups; non-overlapping CIs indicate statistical significance. Chi-square test and multivariate logistic regression were used to assess the association between current asthma status and socio-demographic factors and health risk behaviors within each Puerto Rican population. RESULTS: Current asthma prevalence among Hispanics in Puerto Rico (7.0% [6.4%-7.7%]) was significantly lower than the prevalence among Puerto Rican Americans (15.6% [13.0%-18.1%]). The prevalence among almost all socio-demographic and health risk subgroups of Hispanics in Puerto Rico was significantly lower than the prevalence among the corresponding subgroups of Puerto Rican Americans. Adjusting for potential confounders did not alter the results. Asthma prevalence was significantly associated with obesity among Puerto Rican Americans (adjusted prevalence ratios [aPR] = 1.5 [1.1-2.0]), and among Hispanics in Puerto Rico was associated with obesity (aPR = 1.6 [1.3-1.9]), smoking (aPR = 1.4 [1.1-1.9]) and being female (aPR = 1.9 [1.5-2.4]). CONCLUSION: Asthma was more prevalent among Puerto Rican Americans than Hispanics in Puerto Rico. Although the observed associations did not explain all variations in asthma prevalence between these two populations, they may lay the foundation for future research. |
Risky behavior and correlates of HIV and Hepatitis C Virus infection among people who inject drugs in three cities in Afghanistan
Ruisenor-Escudero H , Wirtz AL , Berry M , Mfochive-Njindan I , Paikan F , Yousufi HA , Yadav RS , Burnham G , Vu A . Drug Alcohol Depend 2014 143 127-33 BACKGROUND: Injecting drug use is the primary mode of HIV transmission and acquisition in Afghanistan. People who inject drugs (PWID) in the country have been characterized by high risk injecting behavior and a high burden of HCV infection. We aimed to estimate the burden of HIV, HCV, and other infectious diseases and to identify the correlates of HIV and HCV infection among PWID living in three major Afghan cities in 2009. METHODS: Epidemiologic data was collected among PWID for the integrated biological and behavioral surveillance (IBBS) survey between May and August, 2009 in three Afghan cities. Data were collected using a structured questionnaire and biologic specimens to screen for HIV, HBV, HCV, syphilis, and HSV-2 using rapid testing kits. Multiple logistic regression models were constructed to identify correlates of infection. RESULTS: Among 548 participants, pooled HIV prevalence was 7.1% (Mazar-i-Sharif: 1.0%, Kabul: 3.1%, Herat: 18.4%) and HCV prevalence was 40.3%. Almost all participants with HIV infection were co-infected with HCV (94.9%). Pooled prevalence estimates for other diseases included 7.1% for HBV, 5.5% for syphilis; and 9.3% for HSV-2. Living in Herat, ever in prison and time injecting were independently associated with HIV infection. Living in Kabul, Herat and time injecting were independently associated with HCV infection. CONCLUSIONS: There is a high and heterogeneous burden of HIV and HCV among PWID in Afghan cities. Provision of comprehensive harm reduction services to PWID in Afghanistan is warranted to reduce exposures associated with HIV and HCV infection, especially in the city of Herat. |
Late diagnosis of hepatitis C virus infection in the Chronic Hepatitis Cohort Study (CHeCS): missed opportunities for intervention
Moorman AC , Xing J , Ko S , Rupp LB , Xu F , Gordon SC , Lu M , Spradling PR , Teshale EH , Boscarino JA , Vijayadeva V , Schmidt MA , Holmberg SD . Hepatology 2014 61 (5) 1479-84 To determine stage of liver disease at initial diagnosis of hepatitis C virus (HCV) infection, we analyzed data from the Chronic Hepatitis Cohort Study (CHeCS), a large US observational study. We examined the temporal relationships of initial HCV infection diagnosis with cirrhosis-- defined by liver biopsy or mean FIB-4 score >5.88--and time to onset of cirrhotic decompensation in electronic medical records. We determined time in health system prior to HCV diagnosis and rates of hospitalization and death following HCV diagnosis. Of 14,717 patients with chronic HCV seen during 2006-2011, 6,166 (42%) had a definable time of initial HCV diagnosis. Of these, 1,056 (17%) patients met our definition for "late diagnosis" with either cirrhosis concurrent with initial HCV diagnosis (n=550), a first diagnosis of hepatic decompensation before or within 12 months after initial HCV diagnosis (n=506), or both (n=314). Patients with late diagnosis had an average of 6 years in the health system before their HCV diagnosis. In a comparison with patients without late diagnosis, hospitalization (59% vs 35%) and death (33% vs 9%) were more frequent among patients with late diagnosis. Among all who died, mean (median) time from initial HCV diagnosis to death was 4.8 (4.2) years. CONCLUSION: Many CHeCS patients had advanced liver disease concurrent with their initial HCV diagnosis despite many years of engagement with the health care system, and these patients had high rates of hospitalization and mortality. |
Low prospects and high risk: structural determinants of health associated with sexual risk among young African American women residing in resource-poor communities in the South
Raiford JL , Herbst JH , Carry M , Browne FA , Doherty I , Wechsberg WM . Am J Community Psychol 2014 54 243-50 African American women at increased risk of HIV/sexually transmitted infection (STI) may engage in risky sex as a coping mechanism for depressed economic conditions. This study examines the association between high-risk sexual behavior and structural determinants of sexual health among a sample of young African American women. 237 young African American women (16-19 years old) from economically disadvantaged neighborhoods in North Carolina were enrolled into a randomized trial testing the efficacy of an adapted HIV/STI prevention intervention. Logistic regression analyses predicted the likelihood that young women reporting lack of food at home, homelessness and low future prospects would also report sexual risk behaviors. Young women reporting a lack of food at home (22 %), homelessness (27 %), and low perceived education/employment prospects (19 %) had between 2.2 and 4.7 times the odds as those not reporting these risk factors of reporting multiple sex partners, risky sex partners including older men and partners involved in gangs, substance use prior to sex, and exchange sex. Self-reported structural determinants of sexual health were associated with myriad sexual risk behaviors. Diminished economic conditions among these young women may lead to sexual risk due to hopelessness, the need for survival or other factors. |
Middle East respiratory syndrome coronavirus not detected in children hospitalized with acute respiratory illness in Amman, Jordan, March 2010 to September 2012
Khuri-Bulos N , Payne DC , Lu X , Erdman D , Wang L , Faouri S , Shehabi A , Johnson M , Becker MM , Denison MR , Williams JV , Halasa NB . Clin Microbiol Infect 2014 20 (7) 678-82 Hospitalized children < 2 years of age in Amman, Jordan, admitted for fever and/or respiratory symptoms, were tested for Middle East respiratory syndrome coronavirus (MERS-CoV): MERS-CoV by real-time RT-PCR (rRT-PCR). This was a prospective year-round viral surveillance study in children <2 years of age admitted with acute respiratory symptoms and/or fever from March 2010 to September 2012 and enrolled from a government-run hospital, Al-Bashir in Amman, Jordan. Clinical and demographic data, including antibiotic use, were collected. Combined nasal/throat swabs were collected, aliquoted, and frozen at -80 degrees C. Specimen aliquots were shipped to Vanderbilt University and the Centers for Disease Control and Prevention (CDC), and tested by rRT-PCR for MERS-CoV. Of the 2433 subjects enrolled from 16 March 2010 to 10 September 2012, 2427 subjects had viral testing and clinical data. Of 1898 specimens prospectively tested for other viruses between 16 March 2010 and 18 March 2012, 474 samples did not have other common respiratory viruses detected. These samples were tested at CDC for MERS-CoV and all were negative by rRT-PCR for MERS-CoV. Of the remaining 531 samples, collected from 19 March 2012 to 10 September 2012 and tested at Vanderbilt, none were positive for MERS-CoV. Our negative findings from a large sample of young Jordanian children hospitalized with fever and/or respiratory symptoms suggest that MERS-CoV was not widely circulating in Amman, Jordan, during the 30-month period of prospective, active surveillance occurring before and after the first documented MERS-CoV outbreak in the Middle East region. |
Primary care providers human papillomavirus vaccine recommendations for the medically underserved: a pilot study in U.S. Federally Qualified Health Centers
Roland KB , Benard VB , Greek A , Hawkins NA , Saraiya M . Vaccine 2014 32 (42) 5432-5 INTRODUCTION: In the United States, Federally Qualified Health Centers (FQHCs) are safety-net clinics that provide cervical cancer screening and human papillomavirus (HPV) vaccination to medically underserved women, some of whom may be at risk for developing cervical cancer. National guidelines recommend against using screening test results or sexual history to determine vaccine eligibility. Documenting HPV vaccine recommendations and beliefs of primary care providers in FQHCs may aid in promoting evidence-based practices and prioritizing health interventions for vulnerable populations. METHODS: Between 2009 and 2010, we collected data from 98 primary care providers in 15 FQHC clinics in IL, USA using a cross-sectional survey. Questions assessed provider and practice characteristics, HPV vaccine recommendations, and provider's belief about whether their screening and management procedures would change for women who were vaccinated. RESULTS: 93% of providers recommended the HPV vaccine, most frequently for females aged 13-26 years (98%). Some providers reported sometimes to always using HPV test results (12%), Pap test results (7%), and number of sexual partners (33%) to determine vaccine eligibility. More than half of providers (55%) reported they will not change their screening and management practices for vaccinated females, yet believe vaccination will yield fewer abnormal Pap tests (71%) and referrals for colposcopy (74%). CONCLUSION: Study providers routinely recommended the HPV vaccine for their patients. However, providers made fewer recommendations to vaccinate females ages 9-12 years (which includes the target age for vaccination) compared to older females, and used pre-vaccination assessments not recommended by U.S. guidelines, such as screening test results and number of sexual partners. In order to maximize the public health benefit of the HPV vaccine to prevent cervical cancer, adherence to guidelines is necessary, especially in settings that provide care to medically underserved women. |
Quality assurance of prevention of mother-to-child transmission of HIV in Botswana
Matambo S , Machakaire E , Motswere-Chirwa C , Legwaila K , Letsholathebe V , Dintwa E , Lu L , Voetsch AC , Glenshaw M . Afr J Midwifery Womens Health 2014 8 (3) 130-133 The HIV prevalence rate among pregnant women is 37% in Botswana. According to UNICEF (2011), maternal and under-5 mortality rates in Botswana were 160 per 100000 live births and 26 per 1000 live births, respectively. Therefore, this study sought to identify the effects of ongoing clinic audits of the prevention of mother-to-child transmission of HIV (PMTCT) in Francistown, Botswana for the period 2008–2012. | Methods: | Existing data for all women attending antenatal and postnatal clinics were collected and collated manually from monthly from clinic PMTCT registers. | Results: | There were 19 720 new antenatal clinic visits between 2008 and 2012 with an HIV prevalence of 35% among the women. Mother-to-child transmission of HIV decreased from 3% in 2008 to 1% in 2012. The decrease was due, in part, to the introduction of triple antiretroviral prophylaxis/antiretroviral therapy (TAP/ARV) (PMTCT Option B) in 2011. | Conclusions: | Audit results over a 5-year period showed a steady improvement in the cascade of PMTCT interventions. Clinic audits should be implemented nationally to reduce maternal and under-5 mortality. |
Ebola 2014 - new challenges, new global response and responsibility
Frieden TR , Damon I , Bell BP , Kenyon T , Nichol S . N Engl J Med 2014 371 (13) 1177-80 Since Ebola virus was first identified in 1976, no previous Ebola outbreak has been as large or persistent as the current epidemic, and none has spread beyond East and Central Africa. To date, more than 1000 people, including numerous health care workers, have been killed by Ebola virus disease (EVD) in 2014, and the number of cases in the current outbreak now exceeds the number from all previous outbreaks combined. Indirect effects include disruption of standard medical care, including for common and deadly conditions such as malaria, and substantial economic losses, insecurity, and social disruption in countries that were already struggling to recover from decades of war. |
The burden of influenza and RSV among inpatients and outpatients in rural Western Kenya, 2009-2012
Emukule GO , Khagayi S , McMorrow ML , Ochola R , Otieno N , Widdowson MA , Ochieng M , Feikin DR , Katz MA , Mott JA . PLoS One 2014 9 (8) e105543 BACKGROUND: In Kenya, detailed data on the age-specific burden of influenza and RSV are essential to inform use of limited vaccination and treatment resources. METHODS: We analyzed surveillance data from August 2009 to July 2012 for hospitalized severe acute respiratory illness (SARI) and outpatient influenza-like illness (ILI) at two health facilities in western Kenya to estimate the burden of influenza and respiratory syncytial virus (RSV). Incidence rates were estimated by dividing the number of cases with laboratory-confirmed virus infections by the mid-year population. Rates were adjusted for healthcare-seeking behavior, and to account for patients who met the SARI/ILI case definitions but were not tested. RESULTS: The average annual incidence of influenza-associated SARI hospitalization per 1,000 persons was 2.7 (95% CI 1.8-3.9) among children <5 years and 0.3 (95% CI 0.2-0.4) among persons ≥5 years; for RSV-associated SARI hospitalization, it was 5.2 (95% CI 4.0-6.8) among children <5 years and 0.1 (95% CI 0.0-0.2) among persons ≥5 years. The incidence of influenza-associated medically-attended ILI per 1,000 was 24.0 (95% CI 16.6-34.7) among children <5 years and 3.8 (95% CI 2.6-5.7) among persons ≥5 years. The incidence of RSV-associated medically-attended ILI was 24.6 (95% CI 17.0-35.4) among children <5 years and 0.8 (95% CI 0.3-1.9) among persons ≥5 years. CONCLUSIONS: Influenza and RSV both exact an important burden in children. This highlights the possible value of influenza vaccines, and future RSV vaccines, for Kenyan children. |
Factors associated with receiving treatment for dental decay among Medicaid-enrolled children younger than 12 years of age in Iowa, 2010
Zilversmit L , Kane DJ , Rochat R , Rodgers T , Russell B . J Public Health Dent 2014 75 (1) 17-23 OBJECTIVES: The Iowa Department of Public Health I-Smile program provides dental screening and care coordination to over 23,000 low-income and Medicaid-enrolled children per year. The purposes of this study were to evaluate I-Smile program effectiveness to ensure that Medicaid-enrolled children obtained dental treatment after having been screened and to determine the factors associated with failure to receive dental care after screening through the I-Smile program. METHODS: Based on I-Smile program priorities, we limited our sample to children younger than 12 years of age who screened positive for decay and who linked to a paid Medicaid claim for dental treatment (n = 1,816). We conducted bivariate analyses to examine associations between children's characteristics who screened positive for decay and received treatment within 6 months of their initial screening. We also performed multivariate logistic regression to assess the association of sociodemographic characteristics with receipt of treatment among children who screened positive for decay. RESULTS: Eleven percent of children screened positive for decay. Nearly 24 percent of children with decay received treatment based on a Medicaid-paid claim. Being 5 years or older [adjusted odds ratio (aOR): 1.48, confidence interval (CI): 1.17, 1.88] and not having a dental home (aOR: 1.90, CI: 1.41, 2.58) were associated with higher odds of not receiving dental treatment. CONCLUSIONS: Children 5 years and older and without a dental home were less likely to obtain dental treatment. Opportunities exist for the I-Smile program to increase the numbers of at-risk children with dental homes and who obtain dental care after screening. |
Variability and predictors of urinary concentrations of phthalate metabolites during early childhood
Watkins DJ , Eliot M , Sathyanarayana S , Calafat AM , Yolton K , Lanphear BP , Braun JM . Environ Sci Technol 2014 48 (15) 8881-90 The variability and predictors of urinary concentrations of phthalate metabolites in preschool-aged children have not been thoroughly examined. Additionally, the impact of temporal changes in the use and restriction of phthalates in children's products has not been assessed. Our objective was to identify demographic, behavioral, and temporal predictors of urinary phthalate metabolite concentrations in young children. Between 2004 and 2011, we collected up to five urine samples from each of 296 children participating in a prospective birth cohort during annual study visits at ages 1-5 years. We used linear mixed models to calculate intraclass correlation coefficients (ICCs), a measure of within-individual reproducibility, and identify demographic predictors of urinary phthalate metabolites. We used multivariable linear regression to examine cross-sectional relationships between food packaging or personal care product use and phthalate metabolites measured at age 5 years. Across annual measurements, monoethyl phthalate exhibited the least variation (ICC = 0.38), while di-2-ethylhexyl phthalate (SigmaDEHP) metabolites exhibited the most variation (ICC = 0.09). Concentrations changed with age, suggesting age-related changes in phthalate exposure and perhaps metabolism. Our findings suggest that fast food consumption may be a source of butylbenzyl phthalate and di-isononyl phthalate (DiNP) exposure, and some personal care products may be sources of diethyl phthalate exposure. Concentrations of SigmaDEHP metabolites decreased over the study period; however, concentrations of DiNP metabolites increased. This finding suggests that manufacturer practices and regulations, like the Consumer Product Safety Improvement Act of 2008, may decrease DEHP exposure, but additional work characterizing the nature and toxicity of replacements is critically needed. |
Assessment of chemical exposures: epidemiologic investigations after large- scale chemical releases
Duncan MA . J Environ Health 2014 77 (2) 36-38 ATSDR's Assessment of Chemical Exposures (ACE) program is available to help public health agencies respond to acute chemical releases. This month's column provides a history of the program. It also discusses the three focus areas of the ACE program: 1) assisting state, tribal, regional, and local health departments to perform epidemiologic assessments after large chemical incidents; 2) maintaining a toolkit of customizable surveys, databases, and other resources that can be used for epidemiologic assessments after chemical incidents and preparedness planning; and 3) instructing public health personnel in performing epidemiologic assessments after chemical incidents at ACE training courses, workshops, and conferences. |
Domestic exposure to fungal allergenic particles determined by halogen immunoassay using subject's serum versus particles carrying three non-fungal allergens determined by allergen-specific HIA
Sercombe JK , Liu-Brennan D , McKay KO , Green BJ , Tovey ER . Indoor Air 2014 24 (4) 438-45 Studies that estimate indoor aeroallergen exposure typically measure a pre-selected limited range of allergens. In this study, inhalable aeroallergen particles were quantified using the halogen immunoassay (HIA) to determine the contribution of fungal and non-fungal aeroallergens to total allergen exposure. Bioaerosols from 39 homes of fungal-allergic subjects were sampled using inhalable fraction samplers and immunostained by HIA using resident subject's immunoglobulin E (IgE) to detect allergen-laden particles. Fungal aerosols as well as particles carrying mite, cat, and cockroach allergens were identified and enumerated by HIA. Reservoir dust-mite (Der p 1), cat (Fel d 1), and cockroach (Bla g 1) allergen concentrations were quantified by ELISA. Fungal particles that bound subject's IgE in the HIA were 1.7 (bedroom)- and 1.4 (living room)-fold more concentrated than Der p 1, Fel d 1, and Bla g 1 allergen particles combined. Predominant fungal conidia that bound IgE were derived from common environmental genera including Cladosporium and other fungi that produce amerospores. Airborne mite, cat, and cockroach allergen particle counts were not associated with reservoir concentrations determined by ELISA. This study demonstrates that inhalable fungal aerosols are the predominant aeroallergen sources in Sydney homes and should be considered in future exposure assessments. |
Next-generation sequencing reveals large connected networks of intra-host HCV variants.
Campo DS , Dimitrova Z , Yamasaki L , Skums P , Lau DT , Vaughan G , Forbi JC , Teo CG , Khudyakov Y . BMC Genomics 2014 15 Suppl 5 S4 BACKGROUND: Next-generation sequencing (NGS) allows for sampling numerous viral variants from infected patients. This provides a novel opportunity to represent and study the mutational landscape of Hepatitis C Virus (HCV) within a single host. RESULTS: Intra-host variants of the HCV E1/E2 region were extensively sampled from 58 chronically infected patients. After NGS error correction, the average number of reads and variants obtained from each sample were 3202 and 464, respectively. The distance between each pair of variants was calculated and networks were created for each patient, where each node is a variant and two nodes are connected by a link if the nucleotide distance between them is 1. The work focused on large components having > 5% of all reads, which in average account for 93.7% of all reads found in a patient. CONCLUSIONS: Most intra-host variants are organized into distinct single-mutation components that are: well separated from each other, represent genetic distances between viral variants, robust to sampling, reproducible and likely seeded during transmission events. Facilitated by NGS, large components offer a novel evolutionary framework for genetic analysis of intra-host viral populations and understanding transmission, immune escape and drug resistance. |
Genetic history of hepatitis C virus in Pakistan.
Ur Rehman I , Vaughan G , Purdy MA , Xia GL , Forbi JC , Rossi LM , Butt S , Idrees M , Khudyakov YE . Infect Genet Evol 2014 27 318-24 Hepatitis C virus (HCV) genotype 3a accounts for approximately 80% of HCV infections in Pakistan, where approximately 10 million people are HCV-infected. Here, we report analysis of the genetic heterogeneity of HCV NS3 and NS5b subgenomic regions from genotype 3a variants obtained from Pakistan. Phylogenetic analyses showed that Pakistani genotype 3a variants were as genetically diverse as global variants, with extensive intermixing. Bayesian estimates showed that the most recent ancestor for genotype 3a in Pakistan was last extant in approximately 1896-1914 C.E. (range: 1851-1932). This genotype experienced a population expansion starting from approximately 1905 to approximately 1970 after which the effective population leveled. Death/birth models suggest that HCV 3a has reached saturating diversity with decreasing turnover rate and positive extinction. Taken together, these observations are consistent with a long and complex history of HCV 3a infection in Pakistan. |
High colonization rate and prolonged shedding of Clostridium difficile in pediatric oncology patients
Dominguez SR , Dolan SA , West K , Dantes RB , Epson E , Friedman D , Littlehorn CA , Arms LE , Walton K , Servetar E , Frank DN , Kotter CV , Dowell E , Gould CV , Hilden JM , Todd JK . Clin Infect Dis 2014 59 (3) 401-3 Surveillance testing for Clostridium difficile among pediatric oncology patients identified stool colonization in 29% of patients without gastrointestinal symptoms and in 55% of patients with prior C. difficile infection (CDI). A high prevalence of C. difficile colonization and diarrhea complicates the diagnosis of CDI in this population. |
Chikungunya virus: new risk to transfusion safety in the Americas
Petersen LR , Epstein JS . Transfusion 2014 54 (8) 1911-5 On December 5, 2013, the French National Reference Centre for Arboviruses confirmed autochthonous chikungunya virus (CHIKV) transmission on the Caribbean island of St. Martin.1,2 This mosquito-borne virus, so-named in the Makonde language for its ability to cause crippling arthralgia, has caused large outbreaks in multiple locations in Africa, Asia, and the Western Pacific in the last decade.3,4 Prior to its arrival in St. Martin, few doubted that CHIKV would eventually emerge and take hold in the Western Hemisphere given the widespread presence of competent mosquito vectors and opportunities for the virus to be introduced through travel and commerce.5–9 The virus’ subsequent swift spread from St. Martin throughout the Caribbean4 and onto South America have created considerable concern regarding its eventual extent and intensity of transmission in the Western Hemisphere, and hence its impact on transfusion safety. | Although transfusion-associated CHIKV transmission has not been reported, most likely due to the difficulty in identifying and proving CHIKV transfusion-associated transmission in the context of large-scale community mosquito-borne outbreaks, the AABB Transfusion Transmitted Diseases Committee deemed CHIKV a priority area of concern10,11 given its high-level viremia12–15 and high incidence during outbreaks.6,16–18 As with other arboviruses, four factors will determine the impact of CHIKV on transfusion medicine in the Americas: (1) prevalence of viremia among blood donors, (2) clinical impact on infected transfusion recipients, (3) availability of measures to reduce transfusion transmission when required, and (4) the cost and disruption incurred by those measures.19 |
Maternal determinants of timely vaccination coverage among infants in rural Bangladesh
Vasudevan L , Labrique AB , Mehra S , Wu L , Levine O , Feikin D , Klemm R , Christian P , West KP Jr . Vaccine 2014 32 (42) 5514-9 BACKGROUND: Timely vaccination, i.e., the receipt of all scheduled vaccinations in an age-appropriate fashion, is critical for the prevention of deadly diseases in infants and achievement of the UN Millennium Development Goal to reduce infant mortality. Infants, especially in rural or underprivileged settings often receive delayed vaccinations leaving them susceptible to vaccine-preventable illnesses early in the first year of life. In this study, we examined rates of timely vaccination among 24,435 infants born in Gaibandha and Rangpur rural districts of Bangladesh from 2001 to 2007. METHODS: Vaccinations due by 14 weeks of age and administered through routine government immunization services were assessed using interviews with enrolled mothers between 11 and 18 weeks postpartum. We created a Timely Vaccination (TV) score to classify infants as vaccinated fully and on schedule (TV=1) or not (TV=0), and used multivariable logistic regression to identify maternal characteristics associated with infant's timely vaccination status. RESULTS: Our results suggest that only 19% of infants in this cohort received scheduled vaccinations on time by 11-18 weeks postpartum. Mothers' engagement in paid employment [OR=1.13, 95% CI: 1.03-1.23], receipt of tetanus toxoid vaccination [OR=1.24, 95% CI: 1.11-1.38], history of antenatal care [OR=1.22, 95% CI: 1.12-1.32], or higher socioeconomic status [OR=1.07, 95% CI: 1.03-1.11] were positively associated with timely vaccination of their infants. Mother's perception of small infant size at birth was negatively associated with timely vaccination [OR=0.89, 95% CI: 0.82-0.97]. CONCLUSION: Timely vaccination coverage of infants in rural Gaibandha and Rangpur districts is extremely low. This analysis identifies important shortcomings associated with the 1-year vaccination benchmark of routine immunization performance and suggests the need for specific interventions based on potential maternal determinants as well as known system and programmatic barriers of timely vaccination among infants in rural Bangladesh. |
Effect of multiple, simultaneous vaccines on polio seroresponse and associated health outcomes
Broderick MP , Oberste MS , Moore D , Romero-Steiner S , Hansen CJ , Faix DJ . Vaccine 2014 33 (24) 2842-8 BACKGROUND: Administration of multiple simultaneous vaccines to infants, children, and military recruits is not uncommon. However, little research exists to examine associated serological and health effects, especially in adults. METHOD: We retrospectively examined 416 paired serum specimens from U.S. military subjects who had received the inactivated polio vaccine (IPV) alone or in combination with either 1 other vaccine (<3 group) or 4 other vaccines (>4 group). Each of the 2 groups was subdivided into 2 subgroups in which Tdap was present or absent. RESULTS: The >4 group was associated with a higher proportion of polio seroconversions than the <3 group (95% vs. 58%, respectively, p<0.01). Analysis of the <3 subgroup that excluded Tdap vs. the >4 subgroup that excluded Tdap showed no difference between them (p>0.1). However, the >4 subgroup that included Tdap had significantly more seroconversions than either the <3 subgroup that excluded Tdap or the >4 subgroup that excluded Tdap (p<0.01). Overall, at least 98% of subjects were at or above the putative level of seroprotection both pre- and post-vaccination, yet at least 81% of subjects seroconverted. In an analysis of 400 of the subjects in which clinic in- and outpatient encounters were counted over the course of 1 year following vaccinations, there was no significant difference between the 2 groups (p>0.1). CONCLUSION: A combination of >4 vaccines including IPV appeared to have an immunopotentiation effect on polio seroconversion, and Tdap in particular was a strong candidate for an important role. The dose of IPV we studied in our subjects, who already had a high level of seroprotection, acted as a booster. In addition, there appear to be no negative health consequences from receiving few versus more multiple simultaneous vaccinations. |
Chikungunya virus control: is a vaccine on the horizon?
Powers AM . Lancet 2014 384 (9959) 2008-9 Vector-borne diseases such as malaria and dengue are among the most prevalent and significant infectious diseases on a global scale. For example, the World Health Organization has estimated that 40% of the world's population is at risk of dengue infection and up to 100 million infections may occur annually. In the United States alone, West Nile virus and Lyme disease are prominent examples of vector-borne diseases with over 5,600 and 31,000 human cases estimated, respectively, in 2012.1, 2 Now, another arthropod-borne virus, chikungunya virus, which has caused over 2.5 million infections worldwide over the past decade, has been found spreading throughout the Americas and has just recently been reported in the United States.3 Ideally, for both public health and economic reasons, there would be options available for control of these agents before they caused large outbreaks. For chikungunya, on the single island of La Reunion, approximately 300,000 cases were reported during the course of the outbreak with an estimated economic impact of $43.9 million euros (in 2006 values).4, 5 Studies have demonstrated that the cost of a delayed response to the introduction of a novel arboviral disease could be as much as 346 times as high as the cost of preparedness through surveillance for the outbreak event.6 Additional preparedness efforts, including the availability of effective and safe vaccines, could further reduce the scope and impact of an eventual outbreak. | A single chikungunya virus vaccine candidate was developed in the US prior to the large outbreaks that started in 2004 in coastal Kenya. Phase 2 clinical trials were conducted on the live-attenuated vaccine candidate before further development was discontinued due to lack of funding and questions regarding the eventual use of the vaccine.7, 8 However, with the continued expansion of the chikungunya epidemic, Lee-Jah Chang and Vaccine Research Center (VRC) colleagues at the NIH have reinvigorated chikungunya virus vaccine development with the completion of a Phase 1 clinical trial on the VRC virus-like particle (VLP) vaccine candidate, VRC-CHKVLP059-00-VP. The dose-escalation, open-label clinical trial included 25 participants to evaluate the safety, tolerability, and immunogenicity of the candidate vaccine. This VLP vaccine, which had previously been shown to protect non-human primates against virus infection,9 was shown in a study in this issue of The Lancet, to elicit antibody development in all participants. Significantly, the authors demonstrated that the neutralizing antibodies persisted for at least 6 months in all subjects in all dose groups which indicates the vaccine could provide long-term protection against the virus. |
Racial and ethnic disparities in fatal unintentional drowning among persons less than 30 years of age - United States, 1999-2010
Gilchrist J , Parker EM . J Safety Res 2014 50 139-42 BACKGROUND: In the U.S., almost 4,000 persons die from drowning annually. Among those 0-29years, drowning is in the top three causes of unintentional injury death. METHODS: To describe racial/ethnic differences in drowning rates by age of decedent and drowning setting, CDC analyzed 12years of mortality data from 1999 through 2010 for those ≤29years. RESULTS: Compared to whites, American Indians/Alaska Natives were twice, and blacks were 1.4 times, as likely to drown. Disparities were greatest in swimming pool settings, with drowning rates among blacks aged 5-19years 5.5 times higher than those among whites. CONCLUSIONS: Drowning rates for black children and teens are higher than those of other race/ethnicities, especially in swimming pools. PRACTICAL APPLICATION: The practicality and effectiveness of current drowning prevention strategies varies by setting; however, basic swimming skills can be beneficial across all settings and may help reduce racial disparities. |
Trauma healing: a mixed methods study of personal and community-based healing
Todahl JL , Walters E , Bharwdi D , Dube SR . J Aggress Maltreat Trauma 2014 23 (6) 611-632 Trauma survivors’ beliefs are important toward a new social response to trauma-a response that reduces help-seeking barriers and invites and supports healing. This exploratory, mixed-methods study examined trauma survivors' perspectives about key elements of trauma healing. An online and paper-and-pencil survey (n= 82) asked participants to describe what hindered and what helped regarding how people in their lives, including mental health providers, responded to their abuse. Five central themes emerged: what hurt, what helped or would have helped, experience with the mental health system, recommendations to the mental health system, and what participants need in the mental health system. The majority of participants reported that they never or rarely received help or protection at the time of their abuse, and most were first abused early in childhood. This study supports the notion that trauma survivors’ insights should be central in the development of community-based healing models. |
Les lanternes rouges: the race for information about cycling-related female sexual dysfunction
Partin SN , Connell KA , Schrader SM , Guess MK . J Sex Med 2014 11 (8) 2039-47 INTRODUCTION: Cycling is growing in popularity among women. As in men, it is associated with genital neuropathies and decreased sensation in female riders. However, there is a gap in research and information addressing the relationship between cycling and female sexual dysfunction (FSD) in women. AIMS: To review the literature investigating pelvic floor injuries and sexual dysfunction in female cyclists. METHODS: Searches in several electronic databases were conducted, and relevant articles that met the inclusion criteria were identified for critical review. MAIN OUTCOME MEASURES: The main outcome measure to be determined was the strength of the current body of evidence in published literature of a correlation between cycling-related pelvic floor injuries and FSD. RESULTS: Data on FSD from cycling-related injuries in women are limited. Research indicates that bicycle setup and riding equipment may be contributing factors. Women's ergonomics and physiology interact differently with the bicycle than men's. Current evidence offers insufficient foundation to recommend various effect-mitigating equipment and products. CONCLUSIONS: While gender-specific cycling products offer a promising direction for protecting women riders, studies addressing FSD and pelvic floor injuries in women cyclists are inadequate to indicate clear etiology or provide treatment recommendations. Current evidence is also insufficient to recommend effect-mitigating equipment and products. |
A 10-year review of the Centers for Disease Control and Prevention's Heads Up initiatives: bringing concussion awareness to the forefront
Sarmiento K , Hoffman R , Dmitrovsky Z , Lee R . J Safety Res 2014 50 143-7 Children and adolescents are at increased risk for concussions, a type of mild traumatic brain injury (TBI) caused by a bump, blow, or jolt to the head or body that can change the way the brain normally works. While most children and adolescents no longer experience symptoms within two weeks of the injury, some—especially those who have a history of concussions—may have symptoms that last for months or even longer (Eisenberg, Andrea, Meehan, & Mannix, 2013). Concussions need to be addressed correctly to help reduce the risk for short- or long-term health problems that can affect a child’s or adolescent’s thinking, learning, behavior, and/or emotions (Brosseau-Lachaine, Gagnon, Forget, & Faubert, 2008; McClincy, Lovell, Pardini, Collins, & Spore, 2006; Moser, Schatz, & Jordan, 2005; Schatz, Moser, Covassin, & Karpf, 2011). | To help address this public health concern, the Children’s Health Act of 2000 (H.R. 4365) (Library of Congress, 1999–2000) charged the Centers for Disease Control and Prevention’s (CDC) National Center for Injury Prevention and Control to implement a public information campaign to broaden public awareness of the health consequences of TBI. In response, CDC developed and launched the Heads Up concussion education campaign. Over the last 10 years, CDC’s Heads Up campaign has grown into a cohesive suite of educational initiatives that share a common goal: to help protect children and adolescents from concussions and other serious brain injuries by raising awareness, enhancing knowledge, and informing action to improve prevention, recognition, and response to concussions. Each CDC Heads Up initiative fulfills these goals by (1) translating the latest concussion science into educational products tailored specifically for the target audiences, and (2) working with partner organizations to disseminate and integrate concussion educational materials and messages into their existing systems and programs. This report describes the process CDC employed to develop and carry out the Heads Up campaign. |
Limited utility of dried-blood- and plasma spot-based screening for antiretroviral treatment failure with Cobas Ampliprep/TaqMan HIV-1 version 2.0.
Sawadogo S , Shiningavamwe A , Chang J , Maher AD , Zhang G , Yang C , Gaeb E , Kaura H , Ellenberger D , Lowrance DW . J Clin Microbiol 2014 52 (11) 3878-83 The 2013 WHO antiretroviral therapy (ART) guidelines recommend dried blood spots (DBS) as an alternative specimen type for viral load (VL) monitoring. We assessed the programmatic utility of screening for ARV treatment failure (TF) at 5,000 and 1,000 copies/mL using DBS and dried plasma spots (DPS) with a commonly used VL assay, the Roche COBAS Ampliprep/COBAS TaqManV.2.0 (CAP/CTM). Plasma, DBS, and DPS were prepared from 839 whole-blood specimens collected from patients on ART ≥ six months at three public facilities in Namibia. VL was measured in plasma, DBS and DPS using the CAP/CTM and results were compared using plasma VL as the reference standard. The clinical sensitivity, specificity, Positive and Negative Predictive Value, (PPV and NPV) of DBS were 0.99, 0.55, 0.33 and 0.99, and 0.99, 0.26, 0.29 and 0.99 at ARV TF diagnostic thresholds of 5,000 copies/mL and 1,000 copies/mL, respectively; for DPS, they were 0.88, 0.98, 0.92 and 0.97, and 0.91, 0.96, 0.89, and 0.97 at TF diagnostic thresholds of 5,000 copies/mL and 1,000 copies/mL, respectively. TF prevalence in DBS was overestimated by 33% and 57% at the two thresholds, respectively. A high rate of false-positive results would occur if the CAP/CTM with DBS were used to screen for ARV TF. WHO recommendations for DBS-based VL monitoring should be specific to VL assay version and type. Despite the higher performance of DPS, the programmatic utility for TF screening may be limited by requirements for processing the whole blood at the collection site. |
Validation of an HPLC-MS/MS and wipe procedure for mitomycin C contamination
B'Hymer C , Connor T , Stinson D , Pretty J . J Chromatogr Sci 2014 53 (4) 619-24 A high-performance liquid chromatography-tandem mass spectrometric (HPLC-MS/MS) method was developed for the determination of mitomycin C, an anticancer drug, from contamination on various surfaces. Mitomycin C is often used in various forms of intraperitoneal chemotherapy, and operating room healthcare worker exposure to this drug is possible. The surface testing method consisted of a wiping procedure utilizing a solution of 20/45/35 (v/v/v) of acetonitrile-isopropanol-water made 0.01 M in ammonium citrate (apparent pH 7.0). The wipe solutions were analyzed by means of HPLC-MS/MS using a reversed-phase gradient system and electrospray ionization in positive ion mode with a triple-quadrupole MS detector. Accuracy and precision of this method were demonstrated by a series of recovery studies of both spiked solutions and extracted wipes from various surfaces (stainless steel, vinyl and Formica(R)) spiked with known levels of mitomycin C. Recoveries of spiked solutions containing the analyte demonstrate mean recoveries (accuracy) ranged from 93 to 105%. Precision as measured by the relative standard deviation (% RSD) of multiple samples (n= 10) at each concentration level demonstrated values of 7.5% or less. The recoveries from spiked surfaces varied from 30 to 99%. The limit of detection for this methodology is approximately 2 ng/100 cm2 equivalent surface area, and the limit of quantitation is approximately 6 ng/100 cm2. |
New NIOSH methods for sampling and analysis of airborne inorganic acids
Breuer D , Ashley K . J Occup Environ Hyg 2014 11 (11) 0 Mention of company names or products does not constitute endorsement by the Centers for Disease Control and Prevention. The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the National Institute for Occupational Safety and Health. |
Numerical investigation of sheath and aerosol flows in the flow combination section of a Baron fiber classifier
Dubey P , Ghia U , Turkevich LA . Aerosol Sci Technol 2014 48 (8) 896-905 The Baron fiber classifier is an instrument used to separate fibers by length. The flow combination section (FCS) of this instrument is an upstream annular region, where an aerosol of uncharged fibers is introduced along with two sheath flows; length separation occurs by dielectrophoresis downstream in the flow classification section. In its current implementation at NIOSH, the instrument is capable of processing only very small quantities of fibers. In order to prepare large quantities of length-separated fibers for toxicological studies, the throughput of the instrument needs to be increased, and hence, higher aerosol flow rates need to be considered. However, higher aerosol flow rates may give rise to flow separation or vortex formation in the FCS, arising from the sudden expansion of the aerosol at the inlet nozzle. The goal of the present investigation is to understand the interaction of the sheath and aerosol flows inside the FCS, using computational fluid dynamics (CFD), and to identify possible limits to increasing aerosol flow rates. Numerical solutions are obtained using an axisymmetric model of the FCS, and solving the Navier-Stokes equations governing these flows; in this study, the aerosol flow is treated purely aerodynamically. Results of computations are presented for four different flow rates. The geometry of the converging outer cylinder, along with the two sheath flows, is effective in preventing vortex formation in the FCS for aerosol-to-sheath flow inlet velocity ratios below ~50. For higher aerosol flow rates, recirculation is observed in both inner and outer sheaths. Results for velocity, streamlines, and shear stress are presented. |
Extension of the Legionella pneumophila sequence-based typing scheme to include strains carrying a variant of the N-acylneuraminate cytidylyltransferase gene
Mentasti M , Underwood A , Luck C , Kozak-Muiznieks NA , Harrison TG , Fry NK . Clin Microbiol Infect 2014 20 (7) O435-41 Sequence-based typing (SBT) combined with monoclonal antibody subgrouping of Legionella pneumophila isolates is at present considered to be the reference standard during epidemiological investigation of Legionnaires' disease outbreaks. In some isolates of L. pneumophila, the seventh allele of the standard SBT scheme, neuA, is not amplified, because a homologue that is refractory to amplification with the standard neuA primers is present. Consequently, a complete seven-allele profile, and hence a sequence type, cannot be obtained. Subsequently, primers were designed to amplify both neuA and the homologue, but these yielded suboptimal sequencing results. In this study, novel primers specific for the neuA homologue were designed and internationally validated by members of the ESCMID Study Group for Legionella Infections at national and regional Legionella reference laboratories with a modified version of the online L. pneumophila sequence quality tool. To date, the addition of the neuAh target to the SBT protocol has allowed full typing data to be obtained for 108 isolates of 11 different serogroups, namely 1, 2, 3, 4, 5, 6, 7, 8, 10, 13, and 14, which could not previously be typed with the standard SBT neuA primers. Further studies are necessary to determine why it is still not possible to obtain either a neuA or a neuAh allele from three serogroup 11 isolates. |
APRI and FIB-4 are good predictors of the stage of liver fibrosis in chronic hepatitis B: the Chronic Hepatitis Cohort Study (CHeCS)
Teshale E , Lu M , Rupp LB , Holmberg SD , Moorman AC , Spradling P , Vijayadeva V , Boscarino JA , Schmidt MA , Gordon SC . J Viral Hepat 2014 21 (12) 917-20 We aim to determine the predictive ability of APRI, FIB-4 and AST/ALT ratio for staging of liver fibrosis and to differentiate significant fibrosis (F2-F4) from none to minimal fibrosis (F0-F1) in chronic hepatitis B (CHB). Liver biopsy results were mapped to an F0-4 equivalent fibrosis stage. Mean APRI and FIB-4 scores were significantly higher for each successive fibrosis level from F1 to F4 (P < 0.05). Based on optimized cut-offs, the AUROCs in distinguishing F2-F4 from F0 to F1 were 0.81 (0.76-0.87) for APRI, 0.81 (0.75-0.86) for FIB-4 and 0.56 (0.49-0.64) for AST/ALT ratio. APRI and FIB-4 distinguished F2-F4 from F0 to F1 with good sensitivity and specificity and can be useful for treatment decisions and monitoring progression of fibrosis. |
Development and characterization of a resistance spot welding aerosol generator and inhalation exposure system
Afshari A , Zeidler-Erdely PC , McKinney W , Chen BT , Jackson M , Schwegler-Berry D , Friend S , Cumpston A , Cumpston JL , Donny Leonard H , Meighan TG , Frazer DG , Antonini JM . Inhal Toxicol 2014 26 (12) 1-12 Limited information exists regarding the health risks associated with inhaling aerosols that are generated during resistance spot welding of metals treated with adhesives. Toxicology studies evaluating spot welding aerosols are non-existent. A resistance spot welding aerosol generator and inhalation exposure system was developed. The system was designed by directing strips of sheet metal that were treated with an adhesive to two electrodes of a spot welder. Spot welds were made at a specified distance from each other by a computer-controlled welding gun in a fume collection chamber. Different target aerosol concentrations were maintained within the exposure chamber during a 4-h exposure period. In addition, the exposure system was run in two modes, spark and no spark, which resulted in different chemical profiles and particle size distributions. Complex aerosols were produced that contained both metal particulates and volatile organic compounds (VOCs). Size distribution of the particles was multi-modal. The majority of particles were chain-like agglomerates of ultrafine primary particles. The submicron mode of agglomerated particles accounted for the largest portion of particles in terms of particle number. Metal expulsion during spot welding caused the formation of larger, more spherical particles (spatter). These spatter particles appeared in the micron size mode and accounted for the greatest amount of particles in terms of mass. With this system, it is possible to examine potential mechanisms by which spot welding aerosols can affect health, as well as assess which component of the aerosol may be responsible for adverse health outcomes. |
Cardiometabolic risk assessments by body mass index z-score or waist-to-height ratio in a multiethnic sample of sixth-graders
Kahn HS , El Ghormli L , Jago R , Foster GD , McMurray RG , Buse JB , Stadler DD , Trevino RP , Baranowski T , Healthy Study Group . J Obes 2014 2014 421658 Convention defines pediatric adiposity by the body mass index z-score (BMIz) referenced to normative growth charts. Waist-to-height ratio (WHtR) does not depend on sex-and-age references. In the HEALTHY Study enrollment sample, we compared BMIz with WHtR for ability to identify adverse cardiometabolic risk. Among 5,482 sixth-grade students from 42 middle schools, we estimated explanatory variations (R (2)) and standardized beta coefficients of BMIz or WHtR for cardiometabolic risk factors: insulin resistance (HOMA-IR), lipids, blood pressures, and glucose. For each risk outcome variable, we prepared adjusted regression models for four subpopulations stratified by sex and high versus lower fatness. For HOMA-IR, R (2) attributed to BMIz or WHtR was 19%-28% among high-fatness and 8%-13% among lower-fatness students. R (2) for lipid variables was 4%-9% among high-fatness and 2%-7% among lower-fatness students. In the lower-fatness subpopulations, the standardized coefficients for total cholesterol/HDL cholesterol and triglycerides tended to be weaker for BMIz (0.13-0.20) than for WHtR (0.17-0.28). Among high-fatness students, BMIz and WHtR correlated with blood pressures for Hispanics and whites, but not black boys (systolic) or girls (systolic and diastolic). In 11-12 year olds, assessments by WHtR can provide cardiometabolic risk estimates similar to conventional BMIz without requiring reference to a normative growth chart. |
Safety and the diverse workforce: lessons from NIOSH's work with Latino immigrants
Flynn MA . Prof Saf 2014 59 (6) 52-57 The U.S. workforce is undergoing dramatic demographic shifts that are likely to continue in the coming decades. Increasing participation of men and women in previously gender-segregated fields (Sarkar, 2002), the aging workforce (National Research Council, 2012) and the integration of 2.4 million soldiers who have served in Iraq and Afghanistan since 2011 (Waterstone, 2010) are just a few characteristics of the emerging diverse workplace. Perhaps most noticeable is the country’s growing ethnic diversity as a result of immigration and higher birthrates; this trend has prompted estimates that no ethnic or racial majority will exist in the U.S. by 2042 (Johnson & Lichter, 2010). Each group brings unique experiences, assets and challenges to the workplace in general and occupational safety and health in particular. Effectively responding to this diversity will be increasingly important for public- and private-sector institutions alike. |
Workplace psychosocial factors associated with hypertension in the U.S. workforce: a cross-sectional study based on the 2010 National Health Interview Survey
Kaur H , Luckhaupt SE , Li J , Alterman T , Calvert GM . Am J Ind Med 2014 57 (9) 1011-21 OBJECTIVE: To explore associations between self-reported hypertension and workplace psychosocial factors that are common among U.S. workers and to identify industries and occupations (I&Os) that are associated with a high prevalence of hypertension, even after adjustment for common known risk factors. METHODS: Data from the 2010 National Health Interview Survey were used to examine relationships between the prevalence of self-reported hypertension and job insecurity, hostile work environment, work- family imbalance, work hours and I&O. RESULTS: Job insecurity (adjusted prevalence ratio (aPR): 1.11; 95% confidence interval (CI): 1.04-1.19)) and hostile work environment (aPR: 1.15; 95% CI: 1.03-1.29) were significantly associated with hypertension. Hypertension prevalence was significantly elevated among those employed in Healthcare Support occupations and Public Administration industries. CONCLUSION: Addressing hostile work environments and the stress associated with job insecurity may improve workers' health. Other occupational factors that contribute to the variation in prevalence of hypertension by I&O should be sought. |
Psychosocial work characteristics of personal care and service occupations: a process for developing meaningful measures for a multiethnic workforce
Hoppe A , Heaney CA , Fujishiro K , Gong F , Baron S . Ethn Health 2014 20 (5) 1-19 BACKGROUND AND OBJECTIVES: Despite their rapid increase in number, workers in personal care and service occupations are underrepresented in research on psychosocial work characteristics and occupational health. Some of the research challenges stem from the high proportion of immigrants in these occupations. Language barriers, low literacy, and cultural differences as well as their nontraditional work setting (i.e., providing service for one person in his/her home) make generic questionnaire measures inadequate for capturing salient aspects of personal care and service work. This study presents strategies for (1) identifying psychosocial work characteristics of home care workers that may affect their occupational safety and health and (2) creating survey measures that overcome barriers posed by language, low literacy, and cultural differences. DESIGN AND RESULTS: We pursued these aims in four phases: (Phase 1) Six focus groups to identify the psychosocial work characteristics affecting the home care workers' occupational safety and health; (Phase 2) Selection of questionnaire items (i.e., questions or statements to assess the target construct) and first round of cognitive interviews (n = 30) to refine the items in an iterative process; (Phase 3) Item revision and second round of cognitive interviews (n = 11); (Phase 4) Quantitative pilot test to ensure the scales' reliability and validity across three language groups (English, Spanish, and Chinese; total n = 404). Analysis of the data from each phase informed the nature of subsequent phases. This iterative process ensured that survey measures not only met the reliability and validity criteria across groups, but were also meaningful to home care workers. CONCLUSION: This complex process is necessary when conducting research with nontraditional and multilingual worker populations. |
Effects of acute inhalation of aerosols generated during resistance spot welding with mild-steel on pulmonary, vascular and immune responses in rats
Zeidler-Erdely PC , Meighan TG , Erdely A , Fedan JS , Thompson JA , Bilgesu S , Waugh S , Anderson S , Marshall NB , Afshari A , McKinney W , Frazer DG , Antonini JM . Inhal Toxicol 2014 26 (12) 1-11 Spot welding is used in the automotive and aircraft industries, where high-speed, repetitive welding is needed to join thin sections of metal. Epoxy adhesives are applied as sealers to the metal seams. Pulmonary function abnormalities and airway irritation have been reported in spot welders, but no animal toxicology studies exist. Therefore, the goal of this study was to investigate vascular, immune and lung toxicity measures after exposure to these metal fumes in an animal model. Male Sprague-Dawley rats were exposed by inhalation to 25 mg/m3 to either mild-steel spot welding aerosols with sparking (high metal, HM) or without sparking (low metal, LM) for 4 h/d for 3, 8 and 13 d. Shams were exposed to filtered air. Bronchoalveolar lavage (BAL), lung gene expression and ex vivo BAL cell challenge were performed to assess lung toxicity. Lung resistance (RL) was evaluated before and after challenge with inhaled methacholine (MCh). Functional assessment of the vascular endothelium in isolated rat tail arteries and leukocyte differentiation in the spleen and lymph nodes via flow cytometry was also done. Immediately after exposure, baseline RL was significantly elevated in the LM spot welding aerosols, but returned to control level by 24 h postexposure. Airway reactivity to MCh was unaffected. Lung inflammation and cytotoxicity were mild and transient. Lung epithelial permeability was significantly increased after 3 and 8 d, but not after 13 d of exposure to the HM aerosol. HM aerosols also caused vascular endothelial dysfunction and increased CD4+, CD8+ and B cells in the spleen. Only LM aerosols caused increased IL-6 and MCP-1 levels compared with sham after ex vivo LPS stimulation in BAL macrophages. Acute inhalation of mild-steel spot welding fumes at occupationally relevant concentrations may act as an irritant as evidenced by the increased RL and result in endothelial dysfunction, but otherwise had minor effects on the lung. |
Evaluating job demands and control measures for use in farm worker health surveillance
Alterman T , Gabbard S , Grzywacz JG , Shen R , Li J , Nakamoto J , Carroll DJ , Muntaner C . J Immigr Minor Health 2014 17 (5) 1364-73 Workplace stress likely plays a role in health disparities; however, applying standard measures to studies of immigrants requires thoughtful consideration. The goal of this study was to determine the appropriateness of two measures of occupational stressors ('decision latitude' and 'job demands') for use with mostly immigrant Latino farm workers. Cross-sectional data from a pilot module containing a four-item measure of decision latitude and a two-item measure of job demands were obtained from a subsample (N = 409) of farm workers participating in the National Agricultural Workers Survey. Responses to items for both constructs were clustered toward the low end of the structured response-set. Percentages of responses of 'very often' and 'always' for each of the items were examined by educational attainment, birth country, dominant language spoken, task, and crop. Cronbach's alpha, when stratified by subgroups of workers, for the decision latitude items were (0.65-0.90), but were less robust for the job demands items (0.25-0.72). The four-item decision latitude scale can be applied to occupational stress research with immigrant farm workers, and potentially other immigrant Latino worker groups. The short job demands scale requires further investigation and evaluation before suggesting widespread use. |
An evaluation of an aftermarket local exhaust ventilation device for suppressing respirable dust and respirable crystalline silica dust from powered saws
Garcia A , Jones E , Echt AS , Hall RM . J Occup Environ Hyg 2014 11 (11) 0 The objective of this study was to quantify the respirable dust and respirable silica exposures of roofing workers using an electric powered circular saw with an aftermarket local exhaust ventilation attachment to cut concrete roofing tiles. The study was conducted to determine whether the local exhaust ventilation attachment was able to control respirable dust and respirable silica exposure below occupational exposure limits (OEL). Time-integrated filter samples and direct reading respirable dust concentrations were evaluated. The local exhaust ventilation consisted of a shroud attached to the cutting plane of the saw; the shroud was then connected to a small electric axial fan, which is intended to collect dust at the point of generation. All sampling was conducted with the control in use. |
Flight attendant radiation dose from solar particle events
Anderson JL , Mertens CJ , Grajewski B , Luo LA , Tseng CY , Cassinelli RT . Aviat Space Environ Med 2014 85 (8) 828-832 INTRODUCTION: Research has suggested that work as a flight attendant may be related to increased risk for reproductive health effects. Air cabin exposures that may influence reproductive health include radiation dose from galactic cosmic radiation and solar particle events. This paper describes the assessment of radiation dose accrued during solar particle events as part of a reproductive health study of flight attendants. METHODS: Solar storm data were obtained from the National Oceanic and Atmospheric Administration Space Weather Prediction Center list of solar proton events affecting the Earth environment to ascertain storms relevant to the two study periods (1992-1996 and 1999-2001). Radiation dose from exposure to solar energetic particles was estimated using the NAIRAS model in conjunction with galactic cosmic radiation dose calculated using the CARI-6P computer program. RESULTS: Seven solar particle events were determined to have potential for significant radiation exposure, two in the first study period and five in the second study period, and over-lapped with 24,807 flight segments. Absorbed (and effective) flight segment doses averaged 6.5 mu Gy (18 mu Sv) and 3.1 mu Gy (8.3 mu Sv) for the first and second study periods, respectively. Maximum doses were as high as 440 mu Gy (1.2 mSv) and 20 flight segments had doses greater than 190 mu Gy (0.5 mSv). DISCUSSION: During solar particle events, a pregnant flight attendant could potentially exceed the equivalent dose limit to the conceptus of 0.5 mSv in a month recommended by the National Council on Radiation Protection and Measurements. |
Longitudinal outcomes in a cohort of Ugandan children randomized to artemether-lumefantrine versus dihydroartemisinin-piperaquine for the treatment of malaria
Wanzira H , Kakuru A , Arinaitwe E , Bigira V , Muhindo MK , Conrad M , Rosenthal PJ , Kamya MR , Tappero JW , Dorsey G . Clin Infect Dis 2014 59 (4) 509-16 BACKGROUND: Artemisinin-based combination therapy (ACT) has become the standard of care for the treatment of uncomplicated Plasmodium falciparum malaria. Although several ACT regimens are approved, data guiding optimal choices of ACTs are limited. We compared short- and long-term outcomes in a cohort of young Ugandan children randomized to 2 leading ACTs. METHODS: Overall, 312 children were randomized to artemether-lumefantrine or dihydroartemisinin-piperaquine (DP) at the time of the first episode of uncomplicated malaria (median age, 10.5 months). The same treatment was given for all subsequent episodes of uncomplicated malaria and children were followed until they reached 5 years of age. The cohort included a subgroup that was human immunodeficiency virus (HIV) infected (n = 44) or HIV exposed (n = 175) and prescribed trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis. Outcomes included time to recurrent malaria following individual treatments and the overall incidences of treatments for malaria, complicated malaria, and hospitalizations. RESULTS: Among children not prescribed TMP-SMX prophylaxis, 4443 treatments for malaria were given over 790 person-years following randomization. Treatment with DP was associated with a lower hazard of recurrent malaria over the 84 days after treatment (hazard ratio, 0.66; 95% confidence interval [CI], .61-.70; P < .001). Children randomized to DP had a lower incidence of all treatments for malaria (incidence rate ratio [IRR], 0.85; 95% CI, .75-.96; P = .01), complicated malaria (IRR, 0.12; 95% CI, .04-.39; P < .001), and hospitalizations (IRR, 0.31; 95% CI, .13-.77; P = .01). Among children prescribed TMP-SMX prophylaxis, there were no significant differences in longitudinal outcomes. CONCLUSIONS: Compared to artemether-lumefantrine, the use of DP to treat uncomplicated malaria delayed the time to recurrent malaria and reduced the incidences of treatments for malaria, complicated malaria, and hospitalizations. Clinical Trials Registration. NCT00527800. |
Artemisinin-based combination therapies are efficacious and safe for treatment of uncomplicated malaria in HIV-infected Ugandan children
Kakuru A , Achan J , Muhindo MK , Ikilezi G , Arinaitwe E , Mwangwa F , Ruel T , Clark TD , Charlebois E , Rosenthal PJ , Havlir D , Kamya MR , Tappero JW , Dorsey G . Clin Infect Dis 2014 59 (3) 446-53 BACKGROUND: Artemisinin-based combination therapies (ACTs) are highly efficacious and safe, but data from human immunodeficiency virus (HIV)-infected children concurrently receiving antiretroviral therapy (ART) and ACTs are limited. METHODS: We evaluated 28-day outcomes following malaria treatment with artemether-lumefantrine (AL) or dihydroartemisinin-piperaquine (DP) in 2 cohorts of HIV-infected Ugandan children taking various ART regimens. In one cohort, children <6 years of age were randomized to lopinavir/ritonavir (LPV/r) or nonnucleoside reverse transcriptase inhibitor-based ART and treated with AL for uncomplicated malaria. In another cohort, children <12 months of age were started on nevirapine-based ART if they were eligible, and randomized to AL or DP for the treatment of their first and all subsequent uncomplicated malaria episodes. RESULTS: There were 773 and 165 treatments for malaria with AL and DP, respectively. Initial response to therapy was excellent, with 99% clearance of parasites and <1% risk of repeat therapy within 3 days. Recurrent parasitemia within 28 days was common following AL treatment. The risk of recurrent parasitemia was significantly lower among children taking LPV/r-based ART compared with children taking nevirapine-based ART following AL treatment (15.3% vs 35.5%, P = .009), and those treated with DP compared with AL (8.6% vs 36.2%, P < .001). Both ACT regimens were safe and well tolerated. CONCLUSIONS: Treatment of uncomplicated malaria with AL or DP was efficacious and safe in HIV-infected children taking ART. However, there was a high risk of recurrent parasitemia following AL treatment, which was significantly lower in children taking LPV/r-based ART compared with nevirapine-based ART. |
Walking for transportation and leisure among U.S. adults - National Health Interview Survey 2010
Paul P , Carlson SA , Carroll DD , Berrigan D , Fulton JE . J Phys Act Health 2014 12 Suppl 1 S62-9 BACKGROUND: Walking, the most commonly reported physical activity among U.S. adults, is undertaken in various domains, including transportation and leisure. METHODS: This study examined prevalence, bout length, and mean amount of walking in the last week for transportation and leisure, by selected characteristics. Self-reported data from the 2010 National Health Interview Survey (N = 24,017) were analyzed. RESULTS: Prevalence of transportation walking was 29.4% (95% CI: 28.6%-30.3%) and of leisure walking was 50.0% (95% CI: 49.1%-51.0%). Prevalence of transportation walking was higher among men; prevalence of leisure walking was higher among women. Most (52.4%) transportation walking bouts were 10-15 minutes; leisure walking bouts were distributed more evenly (28.0%, 10-15 minutes; 17.1%, 41-60 minutes). Mean time spent in transportation walking was higher among men, decreased with increasing BMI, and varied by race/ethnicity and region of residence. Mean time spent leisure walking increased with increasing age and with decreasing BMI. CONCLUSION: Demographic correlates and patterns of walking differ by domain. Interventions focusing on either leisure or transportation walking should consider correlates for the specific walking domain. Assessing prevalence, bout length, and mean time of walking for transportation and leisure separately allows for more comprehensive surveillance of walking. |
What does a performance measurement system tell us about the National Comprehensive Cancer Control Program?
Townsend JS , Moore AR , Mulder TN , Boyd M . J Public Health Manag Pract 2014 21 (5) 449-58 CONTEXT: The National Comprehensive Cancer Control Program (NCCCP) performance measurement system seeks to understand both the processes that funded programs undertake with their respective coalitions to implement the objectives of their cancer plans and the outcomes of those efforts. OBJECTIVE: To identify areas of achievement and technical assistance needs of NCCCP awardees. DESIGN:: Program performance was assessed through surveys completed by program directors on performance indicators in 2009 and 2010 and queries from a Web-based management information system in 2011 and 2012. SETTING: Programs funded by the Centers for Disease Control and Prevention's NCCCP. PARTICIPANTS: Sixty-nine programs. MAIN OUTCOME MEASURE(S): The key performance measures assessed were inclusion of diverse partners and key sectors in cancer coalitions, partners' involvement in activities, receiving in-kind resources from partners, using evidence-based interventions and data for setting priorities, conducting program evaluation, using community- or organization-level strategies to address cancer control efforts, and demonstrating progress toward achieving health outcomes. RESULTS: Most programs reported having active coalitions that represent diverse organizational sectors. Nearly all programs routinely assess the burden of cancer. In-kind resources to implement activities peaked at $64716 in the second year of a 5-year funding cycle and declined in subsequent project years. By year 3, more than 70% of programs reported having an evaluation plan. While programs reported that nearly two-thirds of their interventions were evidence-based, some programs implemented non-evidence-based interventions. A majority of programs successfully used at least 1 community- or organization-level change strategy. However, many programs did not incorporate objectives linked to health outcomes as they reported progress in implementing interventions. CONCLUSIONS: While NCCCP programs were strong at building and maintaining infrastructure, some programs may need additional technical assistance to increase the adoption of evidence-based interventions, develop solid and responsive evaluation plans, and better link efforts to population-based measures that demonstrate impact toward reducing the burden of cancer. |
Analysis of the benefits and costs of a national campaign to promote colorectal cancer screening: CDC's Screen for Life-National Colorectal Cancer Action Campaign
Ekwueme DU , Howard DH , Gelb CA , Rim SH , Cooper CP . Health Promot Pract 2014 15 (5) 750-8 The Centers for Disease Control and Prevention's Screen for Life: National Colorectal Cancer Action Campaign (SFL) is one of the longest running national multimedia campaigns to promote colorectal cancer screening. Since its inception in 1999, no study has quantified the benefits and costs of SFL. We modeled the impact of SFL campaign on screening rates, assuming that the effect size would range from 0.5% to 10% of the unscreened population exposed to the campaign in the last 14 years. Given the estimated benefits of the campaign and costs, we calculated the cost per person screened (2012 dollars). We hypothesize that if 0.5% of the population exposed to campaign messages were screened for colorectal cancer, an additional 251,000 previously unscreened individuals would be screened. The average cost of SFL per person screened would be $2.44. On the other hand, if 10% of the population exposed to campaign messages were screened, an additional 5.01 million individuals would be screened. The average cost per person screened would be $0.12. Results indicate that SFL improves screening rates at a relatively low cost per person screened. The findings in this study provide an important starting point and benchmark for future research efforts to determine the benefits and costs of health communication campaigns to promote cancer prevention. |
Lessons learned while preparing a tailored, self-help, technology-driven intervention for national dissemination
Wilkes AL , Jones PL , Morales-Reid B , Ramos B , Vega MY , Scholes D , Farrell D , Edwards A , Polk L . AIDS Educ Prev 2014 26 (4) 281-95 Tailored health interventions have been found to be effective in various areas of health promotion because of their delivery of customized content, which focuses the prevention messages more closely on the individual's risk behavior. However, the use of tailored interventions in the prevention of STD/HIV has been limited, and there is a void in the literature on translating tailored interventions into practice. This paper discusses the process of translating a tailored, self-help, technology-driven STD/HIV prevention intervention from research-to-practice. Three agencies were selected during the translation process to test the intervention materials and provided valuable lessons learned for translating a tailored intervention into practice. A racially diverse group of more than 250 women in six states participated in the intervention during this pilot test. Lessons learned for research-to-practice efforts for tailored interventions are presented, including expanding the reach of such interventions by making them more compatible for mobile technology. |
Health care provider advice for adolescent tobacco use: results from the 2011 National Youth Tobacco Survey
Schauer GL , Agaku IT , King BA , Malarcher AM . Pediatrics 2014 134 (3) 446-55 BACKGROUND: Health care providers play an important role in promoting tobacco use abstinence among adolescents. This study aimed to provide nationally representative data on the prevalence of provider tobacco use screening and advice delivered to adolescents. Cessation behaviors and correlates of past year quit attempts among current smokers are also explored. METHODS: Data came from the 2011 National Youth Tobacco Survey, a nationally representative school-based survey of adolescents in grades 6 through 12 (n = 18 385). Provider screening and advice were assessed by smoking status and demographic characteristics. Logistic regression was used to assess the association between advice and past year quit attempt. RESULTS: The overall prevalence of current tobacco use was 16.6%; 10.8% were current cigarette smokers (3.6% were established smokers, 7.2% were nonestablished smokers); 17.3% were former smokers; and 71.9% were never smokers (22.6% high susceptibility, 77.4% low susceptibility). Among all respondents, the prevalence of being asked about tobacco use by a health care provider was 32.2%; the prevalence of being advised to quit or avoid tobacco was 31.4%. Established smokers were more likely than other groups to report provider assessment of tobacco use and advice. Receipt of advice was associated with a higher adjusted odds of having made a past year quit attempt (odds ratio: 1.47, 95% confidence interval: 1.18-1.82). CONCLUSIONS: Less than one-third of adolescents report being asked about tobacco use or being advised not to use tobacco. Increased tobacco use intervention by health care providers is needed to prevent initiation and increase cessation. |
Intentions to smoke cigarettes among never-smoking U.S. middle and high school electronic cigarette users, National Youth Tobacco Survey, 2011-2013
Bunnell RE , Agaku IT , Arrazola R , Apelberg BJ , Caraballo RS , Corey CG , Coleman B , Dube SR , King BA . Nicotine Tob Res 2014 17 (2) 228-35 INTRODUCTION: Electronic cigarette (e-cigarette) use is increasing rapidly and their impact on youth is unknown. We assessed associations between e-cigarette use and smoking intentions among U.S. youth who had never smoked conventional cigarettes. METHODS: We analyzed data from the nationally representative 2011, 2012, and 2013 National Youth Tobacco Surveys of students in grades 6-12. Youth reporting they would definitely not smoke in the next year or if offered a cigarette by a friend were defined as not having an intention to smoke, while all others were classified as having positive intention to smoke conventional cigarettes. Demographics, pro-tobacco advertisement exposure, ever use of e-cigarettes, and ever use of other combustibles (cigars, hookah, bidis, kreteks, and pipes) and non-combustibles (chewing tobacco, snuff, dip, snus, and dissolvables) were included in multivariate analyses assessing associations with smoking intentions among never-cigarette-smoking youth. RESULTS: Between 2011-2013, the number of never-smoking youth who used e-cigarettes increased three-fold, from 79,000 to over 263,000. Intention to smoke conventional cigarettes was 43.9% among ever e-cigarette users and 21.5% among never users. Ever e-cigarette users had higher adjusted odds of having smoking intentions than never users (Adjusted Odds Ratio: 1.70, 95% Confidence Interval: 1.24-2.32). Those who ever used other combustibles, ever used non-combustibles, or reported pro-tobacco advertisement exposure also had increased odds of smoking intentions. CONCLUSION: In 2013, over a quarter million never-smoking youth had used e-cigarettes. E-cigarette use was associated with increased intentions to smoke cigarettes. Enhanced prevention efforts for youth are important for all forms of tobacco, including e-cigarettes. |
Cancer-Related News from the CDC: Smokeless tobacco use among working adults
Mazurek JM , Syamlal G , King BA , Castellan RM . Oncol Times 2014 36 (14) 54-55 Smokeless tobacco causes cancers of the oral cavity, esophagus, and pancreas.1 CDC analyzed National Health Interview Survey (NHIS) data to estimate the proportion of U.S. working adults who used smokeless tobacco in 2005 and 2010, by industry and occupation. This report describes the results of that analysis, which showed no statistically significant change in the prevalence of smokeless tobacco use among workers from 2005 (2.7%) to 2010 (3.0%). | In 2010, smokeless tobacco use was highest among adults age 25 to 44 (3.9%), males (5.6%), non-Hispanic whites (4.0%), those with no more than a high school education (3.9%), and those living in the South (3.9%). | By industry, the prevalence of smokeless tobacco use ranged from 1.5 percent in education services to 18.8 percent in mining industries, and by occupation from 1.3 percent in office and administrative support to 10.8 percent in construction and extraction. These findings highlight opportunities for reducing the health and economic burdens of tobacco use among U.S. workers, especially those in certain industries and occupations where use of smokeless tobacco is especially common. | CDC recommends best practices for comprehensive tobacco-control programs, including effective employer interventions, such as providing employee health insurance coverage for proven cessation treatments, offering easily accessible help for those who want to quit, and establishing and enforcing tobacco-free workplace policies.2 |
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