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Little work has been done to explore the use of shade for skin cancer prevention in the context of the built environment. In an effort to address this gap and draw attention to the intersection between architectural and public health practice, we reviewed research on shade design, use, and policies published from January 1, 1996, through December 31, 2017. Our findings indicate that various features influence the sun-protective effects of shade, including the materials, size, shape, and position of the shade structure; the characteristics of the surrounding area; and weather conditions. Limited research suggests that shade provision in outdoor spaces may increase shade use. Shade audit and design tools are available to inform shade planning efforts. Shade policies to date have mostly been setting specific, and information on the implementation and effects of such policies is limited. Integrating shade planning into community design, planning, and architecture may have a substantial impact and will require a multidisciplinary approach. [ABSTRACT FROM AUTHOR]

Objectives. To evaluate the impact of the Southern Public Health Regions’ (Regions IV and IV) Collaborative Improvement and Innovation Network (CoIIN) to Reduce Infant Mortality, supported by the US Health Resources and Services Administration. Methods. We examined pre–post change (2011–2014) for CoIIN strategies with available outcome data from vital records (early elective delivery, smoking) and the Pregnancy Risk Assessment Monitoring System (safe sleep) as well as preterm birth and infant mortality for Regions IV and VI relative to all other regions. Results. For most outcomes, CoIIN improvements were greater in Regions IV and VI than in other regions. For example, early elective delivery decreased by 22% versus 14% in other regions, smoking cessation during pregnancy increased by 7% versus 2%, and back sleep position increased by 5%versus 2%. Preterm birth decreased by 4%, twice that observed in other regions, but infant mortality reductions did not differ significantly. Conclusions. The CoIIN approach to public health improvement shows promise in accelerating progress in intermediate outcomes and preterm birth. Impact on infant mortality may require additional strategies and sustained efforts. [ABSTRACT FROM AUTHOR]

Objectives. To evaluate whether the effects of the Communities That Care (CTC) prevention system, implemented in early adolescence to promote positive youth development and reduce health-risking behavior, endured through age 21 years. Methods. We analyzed 9 waves of prospective data collected between 2004 and 2014 from a panel of 4407 participants (grade 5 through age 21 years) in the community-randomized trial of the CTC system in Colorado, Illinois, Kansas, Maine, Oregon, Utah, and Washington State. We used multilevel models to evaluate intervention effects on sustained abstinence, lifetime incidence, and prevalence of past-year substance use, antisocial behavior, and violence. Results. The CTC system increased the likelihood of sustained abstinence from gateway drug use by 49% and antisocial behavior by 18%, and reduced lifetime incidence of violence by 11%through age 21 years. In male participants, the CTC system also increased the likelihood of sustained abstinence from tobacco use by 30% and marijuana use by 24%, and reduced lifetime incidence of inhalant use by 18%.No intervention effects were found on past-year prevalence of these behaviors. Results. Implementation of the CTC prevention system in adolescence reduced lifetime incidence of health-risking behaviors into young adulthood. [ABSTRACT FROM AUTHOR]

Health professionals, including social workers, community health workers, public health workers, and licensed health care providers, share common interests and responsibilities in promoting health equity and improving social determinants of health—the conditions in which people live,work, play, and learn. We summarize the underlying causes of health inequity and comparatively poor health outcomes in the United States. We describe barriers to realizing the hope embedded in the 2010 Patient Protection and Affordable Care Act, that moving away from fee-for-service payments will naturally drive care upstream as providers respond to greater financial risk by undertaking greater prevention efforts for the health of their patients. We assert that health equity should serve as the guiding framework for achieving the Triple Aim of health care reform and outline practical opportunities for improving care and promoting stronger efforts to address social determinants of health. These proposals include developing a dashboard of measures to assist providers committed to health equity and community-based prevention and to promote institutional accountability for addressing socioeconomic factors that influence health. [ABSTRACT FROM AUTHOR]

More than 3 decades since its emergence in the United States, HIV continues to spread and disproportionately affect socially marginalized groups. Preexposure prophylaxis (PrEP), a highly effective prevention strategy federally approved since 2012, could fundamentally alter the course of the epidemic. However, PrEP’s potential has not been fully realized, in part because health care providers have been slow to adopt PrEP in clinical practice and have been selective in their discussion of PrEP with patients. This nonstandardized approach has constrained PrEP access. PrEP access has not only been inadequate but also inequitable, with several groups in high need showing lower rates of uptake than do their socially privileged counterparts. Recognizing these early warning signs that current approaches to PrEP implementation could exacerbate existing HIV disparities, we call on health professionals to integrate PrEP into routine preventive health care for adult patients—particularly in primary care, reproductive health, and behavioral health settings. Drawing on the empirical literature, we present 4 arguments for why doing so would improve access and access equity, and we conclude that the benefits clearly outweigh the challenges. [ABSTRACT FROM AUTHOR]

Objectives. To compare changes in food-purchasing knowledge, self-efficacy, and behavior after viewing nutrition education videos among Los Angeles, California Latinas responsible for household grocery shopping. Methods. From February to May 2015, a convenience sample of 113 Latinas watched 1 video (El Carrito Saludable) featuring MyPlate guidelines applied to grocery shopping (1-video intervention) and another convenience sample of 105 Latinas watched 2 videos (El Carrito Saludable and Ser Consciente), the latter featuring mindfulness to support attention and overcome distractions while grocery shopping (2-video intervention). We administered questionnaires before and after intervention. A preselected sample in each intervention condition (n = 72) completed questionnaires at 2-months after intervention and provided grocery receipts (before and 2-months after intervention). Results. Knowledge improved in both intervention groups (P < .001). The 2-video group improved more in self-efficacy and use of a shopping list (both P < .05) and purchased more healthy foods (d = 0.60; P < .05) at 2 months than did the 1-video group. Conclusions. Culturally tailored videos that model food-purchasing behavior and mindfulness show promise for improving the quality of foods that Latinas bring into the home. [ABSTRACT FROM AUTHOR]

Objectives. To assess state-level progress on eliminating racial disparities in infant mortality. Methods. Using linked infant birth-death files from 1999 to 2013, we calculated state-level 3-year rolling average infant mortality rates (IMRs) and Black-White IMR ratios. We also calculated percentage improvement and a projected year for achieving equality if current trend lines are sustained. Results. We found substantial state-level variation in Black IMRs (range = 6.6-13.8) and Black-White rate ratios (1.5-2.7), and also in percentage relative improvement in IMR (range = 2.7% to 36.5% improvement) and in Black-White rate ratios (from 11.7% relative worsening to 24.0% improvement). Thirteen states achieved statistically significant reductions in Black-White IMR disparities. Eliminating the Black-White IMR gap would have saved 64 876 babies during these 15 years. Eighteen states would achieve IMR racial equality by the year 2050 if current trends are sustained. Conclusions. States are achieving varying levels of progress in reducing Black infant mortality and Black-White IMR disparities. Public Health Implications. Racial equality in infant survival is achievable, but will require shifting our focus to determinants of progress and strategies for success. [ABSTRACT FROM AUTHOR]

Objectives. To examine civil legal needs among people experiencing homelessness and the extent to which medical-legal partnerships exist in homeless service sites, which promote the integration of civil legal aid professionals into health care settings. Methods. We surveyed a national sample of 48 homeless service sites across 26 states in November 2015. The survey asked about needs, attitudes, and practices related to civil legal issues, including medical-legal partnerships. Results. More than 90% of the homeless service sites reported that their patients experienced at least 1 civil legal issue, particularly around housing, employment, health insurance, and disability benefits. However, only half of all sites reported screening patients for civil legal issues, and only 10% had a medical-legal partnership. The large majority of sites reported interest in receiving training on screening for civil legal issues and developing medical-legal partnerships. Conclusions. There is great need and potential to deploy civil legal services in health settings to serve unstably housed populations. Training homeless service providers how to screen for civil legal issues and how to develop medical-legal partnerships would better equip them to provide comprehensive care. [ABSTRACT FROM AUTHOR]

Objectives. To determine the impact of Positive Prevention PLUS, a school-based adolescent pregnancy prevention program on delaying sexual intercourse, birth control use, and pregnancy. Methods. I randomly assigned a diverse sample of ninth grade students in 21 suburban public high schools in California into treatment (n = 2483) and control (n = 1784) groups that participated in a clustered randomized controlled trial. Between October 2013 and May 2014, participants completed baseline and 6-month follow-up surveys regarding sexual behavior and pregnancy. Participants in the treatment group were offered Positive Prevention PLUS, an 11-lesson adolescent pregnancy prevention program. Results. The program had statistically significant impacts on delaying sexual intercourse and increasing the use of birth control. However, I detected no program effect on pregnancy rates at 6-month follow-up. Conclusions. The Positive Prevention PLUS program demonstrated positive impacts on adolescent sexual behavior. This suggests that programs that focus on having students practice risk reduction skills may delay sexual activity and increase birth control use. [ABSTRACT FROM AUTHOR]

Objectives. To evaluate the impacts of an enhanced version of the Family Life and Sexuality Module of the HealthTeacher middle school curriculum. Methods. We conducted a cluster randomized trial of Chicago, Illinois, middle schools. We randomly assigned schools to a treatment group that received the intervention during the 2010-2011 school year or a control group that did not. The primary analysis sample included 595 students (7 schools) in the treatment group and 594 students (7 schools) in the control group. Results. Students in the treatment schools reported greater exposure to information on reproductive health topics such as sexually transmitted infections (STIs; 78% vs 60%; P< .01), abstinence (64% vs 37%; P< .01), and birth control (45% vs 29%; P< .01). They also reported higher average scores on an index of knowledge of contraceptive methods and STI transmission (0.5 vs 0.3; P= .02). We found no statistically significant differences in rates of sexual intercourse (12%vs12%;P= .99),oral sex (12%vs9%;P= .18), or other intermediateoutcomes. Results. Students in the treatment schools reported greater exposure to information on reproductive health topics such as sexually transmitted infections (STIs; 78% vs 60%; P< .01), abstinence (64% vs 37%; P< .01), and birth control (45% vs 29%; P< .01). They also reported higher average scores on an index of knowledge of contraceptive methods and STI transmission (0.5 vs 0.3; P= .02). We found no statistically significant differences in rates of sexual intercourse (12%vs12%;P= .99),oral sex (12%vs9%;P= .18), or other intermediateoutcomes. [ABSTRACT FROM AUTHOR]

Objectives. To evaluate the effectiveness of Pono Choices, a culturally responsive adolescent pregnancy and sexually transmitted infection (STI) prevention program targeting middle school youths in Hawai'i. Methods. We conducted a cluster randomized controlled trial with the school as the unit of randomassignment over 3 semesters between 2012 and 2013.The sample consisted of 36middle schools and 2203 students. We administered student surveys to collect baseline outcomes, student demographic data, and outcomes at 12 months after baseline. Results. We found statistically significant effects for the knowledge assessment, which focused on basic understanding of adolescent pregnancy and STI prevention. The average percentage of correct responses was 73.6 for the treatment group and 60.4 for the control group (P < .001). We did not find statistically significant effects on behavioral outcomes (initiation of sexual activity or engagement in high-risk sexual behavior) or on other nonbehavioral outcomes (attitudes, skills, intentions). Conclusions. Pono Choices had a statistically significant impact on knowledge of adolescent pregnancy and STI prevention among middle school students at 12 months after baseline, though it did not lead to detectable changes in behavioral outcomes within the 1-year observation period. These results call for an exploration of longer-term outcomes to assess effects on knowledge retention and behavioral changes. [ABSTRACT FROM AUTHOR]

Objectives.To evaluate the Teen Outreach Program, a pregnancy prevention program, in 2 community-based settings. Methods. We evaluated the Teen Outreach Program, a 9-month positive youth development program, in 3 cohorts of youths from 2012 to 2015 in 2 states. In Louisiana, 7 agencies participated in an individualized randomized controlled trial, with youths randomly assigned to a treatment or control condition. Fourteen agencies in Rochester, New York, participated in a cluster randomized controlled trial. Results. We found no differences between the intervention and control youths on delay of sexual onset in Louisiana (adjusted odds ratio [AOR] = 0.80; 95% confidence interval [CI] = 0.62, 1.03) or in Rochester, New York (AOR = 0.89; 95% CI = 0.45, 1.77), or for sex with no effective means of birth control (Louisiana, AOR = 1.18; 95% CI = 0.78, 1.78; Rochester, AOR = 0.41; 95% CI = 0.13, 1.27) after controlling for relevant covariates. Conclusions. We found no short-term effects for the offer of the intervention. Research might be needed for the long-term and intermediate impacts of youth development programs on these and other adolescent risk behaviors. [ABSTRACT FROM AUTHOR]

An editorial is presented which addresses the author's views about the expert peer review process in relation to the adverse effects of environmental and occupational agents such as talcum powder and the herbicide glyphosate, and it mentions the possibility that these products and talc could be causing cancer in human beings. The World Health Organization's International Agency for Research on Cancer (IARC) is assessed, along with ovarian cancer risks and IARC Monographs.

The article discusses the 40th anniversary of the Nurses' Health Study (NHS) as of 2016 in relation to the author's views about public health interventions and methods for eliminating bias that is attributable to measurement error and misclassification. Controversies involving longitudinal cohort studies that use food frequency questionnaires to assess dietary intake over time are examined, along with various American epidemiological research methodologies.

Examining previously underused corporate documents, we revisit the story of the Asbestos Information Association/North America, an industry trade group that sought in the early 1970s to counteract the growing public attention to, and government regulation of, asbestos as a serious threat to workers and consumers. From the mid-1960s through the early 1970s, according to its own spokesperson, asbestos was exposed as "probably the most hazardous industrial material ever unleashed on an unsuspecting world." In retrospect, thousands of lives may have been saved if the Asbestos Information Association had publicly acknowledged this earlier. [ABSTRACT FROM AUTHOR]

We employed the research-to-practice consensus workshop (RTP; workshops held in New York City and Tompkins County, New York, in 2013) model to merge researcher and practitioner views of translational research priorities in palliative care. In the RTP approach, a diverse group of frontline providers generates a research agenda for palliative care in collaboration with researchers. We have presented the major workshop recommendations and contrasted the practice-based research priorities with those of previous consensus efforts. We uncovered notable differences and found that the RTP model can produce unique insights into research priorities. Integrating practitioner-identified needs into research priorities for palliative care can contribute to addressing palliative care more effectively as a public health issue. [ABSTRACT FROM AUTHOR]

Objectives. We sought to learn how employees reacted to changes in the corporate narrative of Philip Morris Companies (PMC) in the late 1990s and early 2000s. Methods. We analyzed archival internal tobacco industry documents about PMC's creation of a new corporate story. Results. In response to litigation and public opprobrium, PMC replaced its market success-oriented corporate narrative with a new one centered on responsibility. Although management sought to downplay inconsistencies between the old and new narratives, some employees reportedly had difficulty reconciling them, concerned that the responsibility focus might affect company profitability. However, others embraced the new narrative, suggesting radical ideas to prevent youth smoking. These ideas were not adopted. Conclusions. PMC's new narrative was unconvincing to many of its employees, who perceived it either as a threat to the company's continued profits or as incongruous with what they had previously been told. As it had done with the public, PMC misled its employees in explaining a narrative repositioning that would help the company continue business as usual. Moving toward a tobacco endgame will require ongoing discursive and symbolic efforts to disrupt this narrative. [ABSTRACT FROM AUTHOR]

Objectives. We sought to understand incarcerated youths' perspectives on the role of protective factors and risk factors for juvenile offending. Methods. We performed an in-depth qualitative analysis of interviews (conducted October-December 2013) with 20 incarcerated youths detained in the largest juvenile hall in Los Angeles. Results. The adolescent participants described their homes, schools, and neighborhoods as chaotic and unsafe. They expressed a need for love and attention, discipline and control, and role models and perspective. Youths perceived that when home or school failed to meet these needs, they spent more time on the streets, leading to incarceration. They contrasted the path through school with the path to jail, reporting that the path to jail felt easier. All of them expressed the insight that they had made bad decisions and that the more difficult path was not only better but also still potentially achievable. Conclusions. Breaking cycles of juvenile incarceration will require that the public health community partner with legislators, educators, community leaders, and youths to determine how to make success, rather than incarceration, the easier path for disadvantaged adolescents. [ABSTRACT FROM AUTHOR]

An epidemic of drug overdose deaths has led to calls for programs and policies to limit misuse and diversion of opioid medications. Any parallel call to consider the risk of iatrogenic addiction when treating pain has been muted in comparison. We have moved beyond questions of nonmedical use, abuse, and diversion to highlight the role of prescription opioids in causing addiction even when prescribed and used appropriately. Unfortunately, current evidence is insufficient, and a rapid expansion of longitudinal research is urgently needed to guide clinicians in balancing the need for opioids with the risk of adverse consequences. Meanwhile, medical education should place greater emphasis on the abuse liability of prescription opioids, and providers should endeavor to attenuate risk when possible. [ABSTRACT FROM AUTHOR]

Public health professionals and educators have developed effective school-based interventions to reduce prejudice and stigma against lesbian, gay, bisexual, and transgender (LGBT) students. Such interventions can reduce the harm caused to sexual minority youths by stigma and can improve health outcomes. However, critics have warned that these interventions attempt to control speech and religious beliefs protected by the First Amendment. We review this critique and assess the legal and ethical arguments. We conclude that, both legally and ethically, there is great leeway for schools to implement LGBT-affirmative interventions. Still, we recommend that interventionists attend critics' concerns using principles of community-based participatory research (CBPR). Using CBPR approaches, interventionists can achieve better community acceptance and cooperation and more successful interventions. [ABSTRACT FROM AUTHOR]

The invention of AIDS activism came soon after the AIDS epidemic emerged in gay communities in the United States in the early 1980s. AIDS activism by and for people with AIDS, distinct from gay activism responding to the threat of AIDS on the behalf of the whole community, started as a way of resisting the phenomenon of social death. Social death, in which people are considered "as good as dead" and denied roles in community life, posed a unique threat to people with AIDS. An organized political response to AIDS began among gay men with AIDS in San Francisco, California, and New York, New York, formalized in a foundational document later called the Denver Principles. The ideas and language of these first people with AIDS influenced later AIDS activism movements. They also help to illustrate the importance of considering an epidemic from the point of view of people with the disease. [ABSTRACT FROM AUTHOR]

Provider-initiated conversations with people living with HIV about reproductive plans are lacking. Providers must know whether their patients want to bear children to tailor treatment and refer for HIV preconception counseling to help achieve patients' reproductive goals while minimizing transmission to partners and children. The early focus on men who have sex with men largely excluded consideration of the epidemic's impact on reproductive health. We used a historical review of the US epidemic to describe the problem's scope and understand if this legacy underlies the current neglect of reproductive planning. Drawing on peer-reviewed literature, we discuss key themes relevant to assessing and understanding attention to desires for children among HIV-positive people. We conclude with recommendations for addressing persistent stigma and enhancing patient-provider communication about reproductive intentions. [ABSTRACT FROM AUTHOR]

Objectives. We assessed public support for a potential Food and Drug Administration (FDA)-mandated reduction in cigarette nicotine content. Methods. We used nationally representative data from a June 2010 cross-sectional survey of US adults (n = 2649) to obtain weighted point estimates and correlates of support for mandated nicotine reduction. We also assessed the potential role of political ideology in support of FDA regulation of nicotine. Results. Nearly 50% of the public supported mandated cigarette nicotine reduction, with another 28% having no strong opinion concerning this potential FDA regulation. Support for nicotine reduction was highest among Hispanics, African Americans, and those with less than a high school education. Among smokers, the odds of supporting FDA nicotine regulation were 2.77 times higher among smokers who intended to quit in the next 6 months than among those with no plans to quit. Conclusions. Mandating nicotine reduction in cigarettes to nonaddictive levels may reduce youth initiation and facilitate adult cessation. The reasons behind nicotine regulation need to be communicated to the public to preempt tobacco industry efforts to impede such a regulation. [ABSTRACT FROM AUTHOR]

In 2004, the US Preventive Services Task Force called for an end to scoliosis screening in US public schools. However, screening endures, although most nations have ended their screening programs. Why? Explanations range from America's unique fee-for service health care system and its encouragement of high-cost medical specialism to the nation's captivation with new surgeries and technologies. I highlight another, more historical, reason: the persistence of the belief that spinal curvature is a sign of a progressive disease or disability. Despite improved health and the mid-20th-century discovery of antibiotics and vaccines that all but eradicated the diseases historically associated with scoliosis (e.g., polio and tuberculosis), the health fears associated with spinal curvature never fully dissipated. Scoliosis is still seen as a "dangerous curve," although the exact nature of the health risk remains unclear. [ABSTRACT FROM AUTHOR]

Mobile food vending is a component of the food environment that has received little attention in the public health literature beyond concerns about food sanitation and hygiene issues. However, several features of mobile food vending make it an intriguing venue for food access. We present key components of mobile vending regulation and provide examples from12 US cities to illustrate the variation that can exist surrounding these regulations. Using these regulatory features as a framework, we highlight existing examples of "healthy vending policies" to describe how mobile food vending can be used to increase access to nutritious food for vulnerable populations. [ABSTRACT FROM AUTHOR]

American Indian and Alaska Native (AIAN) governments are sovereign entities with inherent authority to establish and administer public health programs within their communities and will be critical partners in national efforts to prepare for pandemic influenza. Within AIAN communities, some subpopulations will be particularly vulnerable during an influenza pandemic because of their underlying health conditions, whereas others will be at increased risk because of limited access to prevention or treatment interventions. We outline potential issues to consider in identifying and providing appropriate services for selected vulnerable populations within tribal communities. We also highlight pandemic influenza preparedness resources available to tribal leaders and their partners in state and local health departments, academia, community-based organizations, and the private sector. (Am J Public Health. 2009; 99:S271-S278. doi:10.2105/ AJPH.2008.157453) [ABSTRACT FROM AUTHOR]

Food insecurity is a serious public health problem associated with poor cognitive and emotional development in children and with depression and poor health in adults. Despite sizable continued investments in federal food assistance, food insecurity still affects 11.1% of US households — almost the same rate as in 1995, when annual measurement began. As a fresh approach to solving the problem of food insecurity, we suggest adoption of a human rights framework. This approach could actively engage those affected and would ensure that food security monitoring would be compared to benchmarks in national action plans. We describe key elements of a right-to-food approach, review challenges to implementing it, and suggest actions to foster its adoption. (Am J Public Health. 2009;99:1203-1211. doi:10.2105/AJPH.2007.130229) [ABSTRACT FROM AUTHOR]

Objectives. We examined the cognitive and behavioral effects of the National Youth Anti-Drug Media Campaign on youths aged 12.5 to 18 years and report core evaluation results. Methods. From September 1999 to June 2004, 3 nationally representative cohorts of US youths aged 9 to 18 years were surveyed at home 4 times, Sample size ranged from 8117 in the first to 5126 in the fourth round (65% first-round response rate, with 86%-93% of still eligible youths interviewed subsequently). Main outcomes were self-reported lifetime, past-year, and past-30-day marijuana use and related cognitions. Results. Most analyses showed no effects from the campaign. At one round, however, more ad exposure predicted less intention to avoid marijuana use (γ= -0.07; 95% confidence interval [Cl]=-0.13, -0.01) and weaker antidrug social norms (γ=-0.05; 95% Cl=-0.08, -0.02) at the subsequent round. Exposure at round 3 predicted marijuana initiation at round 4 (γ = 0.11; 95% Cl=0.00, 0.22). Conclusions. Through June 2004, the campaign is unlikely to have had favorable effects on youths and may have had delayed unfavorable effects. The evaluation challenges the usefulness of the campaign. (Am J Public Health. 2008;98:2229-2236. doi:10.2105/AJPH.2007.125849) [ABSTRACT FROM AUTHOR]

Objectives. We studied the effect of local approval of syringe exchange programs in California (through Assembly AB136) on program availability and performance. Methods. We determined the number of active syringe exchange programs in California by conducting Internet searches and obtaining information from the state and from local programs. To track changes in program availability and performance between 2000 and 2002, we interviewed 24 program directors annually for 3 years about program characteristics, syringe exchange policies, law enforcement contact, and other issues. We conducted multivariate analyses to determine whether AB136 approval status was associated with changes in performance. Results. Fifteen local governments (13 counties and 2 cities) enacted the new law by 2002, and operating syringe exchange programs increased from 24 to 35. The proportion of these programs that were not locally approved declined from 54% to 40%. No new approved programs were started in high-need counties. Total syringes exchanged increased by more than 1 million per year, average annual budgets increased by more than 50%, and police harassment of the program volunteers, clients, and operators declined. Improvements at approved syringe exchange programs accounted for these changes. Conclusions. Statewide approval and funding appears necessary to further syringe exchange availability in California. (Am J Public Health. 2008;98:278-283. doi:10.2105/AJPH.2005.080770) [ABSTRACT FROM AUTHOR]

Objectives. The Centers for Disease Control and Prevention's HIV/AIDS Prevention Research Synthesis Team conducted a systematic review of US-based HIV behavioral intervention research literature from 2000 through 2004 to identify interventions demonstrating best evidence of efficacy for reducing HIV risk. Methods. Standard systematic review methods were used. Each eligible study was reviewed on the basis of Prevention Research Synthesis Team efficacy criteria that focused on 3 domains: study design, implementation and analysis, and strength of evidence. Results. Eighteen interventions met the criteria for best evidence. Four targeted HIV-positive individuals. Of those targeting populations at risk for HIV, 4 targeted drug users, 6 targeted adults at risk because of heterosexual behaviors only, 2 targeted men who have sex with men, and 2 targeted youths at high risk. Eight interventions focused on women, and 13 had study samples with more than 50% minority participants. Significant intervention effects included increased condom use and reductions in unprotected sexual intercourse, number of sexual partners, injection drug use or needle sharing, and newly acquired sexually transmitted infections. Conclusions. Most of the best-evidence interventions are directly applicable for populations in greatest need of effective prevention programs; however, important gaps still exist. [ABSTRACT FROM AUTHOR]

Background and Purpose: A description of passive smoking during the first year of life might assist planning preventive efforts. Methods: Changes in the ecology of passive smoking were investigated in a sample of infants in central North Carolina followed from birth to one year of age. Results: The prevalence of tobacco smoke absorption, indicated by excretion of cotinine, increased from 53 percent to 77 percent (95% CI of difference: 14, 35) during the first year of life. Most infants (92 percent) excreting confine at three weeks of age were also excreting it at one year. Moreover, 61 percent of infants not excreting cotinine at age three weeks were excreting it at one war. This increase reflected an increased exposure to household and, particularly, nonhousehold sources of smoke; the proportion of infants exposed to nonhousehold smokers increased from 14 percent to 36 percent Conclusions: These findings suggest that prevention of the onset passive smoking should begin very early. [ABSTRACT FROM AUTHOR]

Abstract: We evaluated the effectiveness of a community-based injury prevention program designed to reduce the incidence of bums, falls in the home, motor vehicle occupant injuries, and poisonings and suffocations among children ages 0-5 years. Between September 1980 and June 1982, we implemented five injury prevention projects concurrently in nine Massachusetts cities and town; five sites, matched on selected demographic characteristics, were control communities. An estimated 42 percent of households with children ages 0-5 years were exposed to one or more of the interventions over the two-year period in the nine communities. Participation in safety programs increased three-fold in the intervention communities and two-fold in the control communities. Safety knowledge and practices increased in both intervention and control communities. Households that reported participatory exposure to the interventions had higher safety knowledge and behavior scores than those that received other community exposure or no exposure to intervention activities. We found a distinct reduction in motor vehicle occupant injuries among children ages 0-5 years in the intervention compared with control communities, associated with participatory exposure of about 55 percent of households with children ages 0-5 years. We have no evidence that the coordinated intervention programs reduced the other target injuries--although exposure to prevention messages was associated with safety behaviors for burns and poisonings. [ABSTRACT FROM AUTHOR]

We report the results of a population-based randomized clinical trial that tested the effectiveness of a prenatal self-help smoking cessation program. The intervention consisted predominantly of printed materials received through the mail. The population (n = 242) consisted of a socioeconomically and ethnically diverse group of pregnant women enrolled in a large health maintenance organization (HMO) who reported they were smoking at the time of their first prenatal visit. Biochemical confirmation of continuous abstinence achieved prior to the 20th completed week of pregnancy and lasting through delivery revealed 22.2 per cent of the women in the eight-week serialized program quit versus 8.6 per cent of controls with usual care. The adjusted odds ratio was 2.80 (95 per cent CI = 1.17, 6.69). We conclude that a low-cost prenatal self-help intervention can significantly affect the public health problem of smoking during pregnancy and its associated risks for maternal and child health. [ABSTRACT FROM AUTHOR]

Various physical and social effects of noise exposure were used to formulate five possible criteria. The five are presented and discussed, and the authors conclude that these are sufficient data to develop some of the quantitative criteria for community programs to control noise. [ABSTRACT FROM AUTHOR]

Abstract: Twelve per ¢ of the 847 women who delivered in one hospital prior to implementation of the North Carolina Prematurity Prevention Program had low-birthweight births compared with 9.5 per ¢ of the 748 women who delivered during the program. Controlling for known risk factors, both low- and very-low birthweight births among Whites (Odds Ratio 2.0 and 3.7 respectively) and very-low-birthweight births among Blacks (OR 2.9) were reduced. [ABSTRACT FROM AUTHOR]

Abstract: Cases of rubella continue to occur among adults in the United States because 10-20 per ¢ of persons in this age group remain susceptible. To evaluate the potential preventability of these cases, we present a method for assessing missed opportunities for rubella immunization, based on immunization recommendations of the Immunization Practices Advisory Committee (ACIP) of the US Public Health Service (PHS). Immunization programs Faced with limited resources can use analysis of missed opportunities to focus on those gaps in implementation contributing most to the remaining rubella cases. (Am J Public Health 1987: 77:1347-1349.) [ABSTRACT FROM AUTHOR]

The authors argue that researchers and developers need to revisit the theory of planned behavior, social cognitive theory, and the social, psychological theories that are predictive of sexual behavior, and it mentions innovations and research involving adolescent pregnancy prevention programs in America. Funding from the U.S. Department of Health and Human Services' Office of Adolescent Health is examined, along with the efforts to reduce adolescent sexual risk behaviors.

We examined trends in US public health expenditures by analyzing historical and projected National Health Expenditure Accounts data. Per-capita public health spending (inflation-adjusted) rose from $39 in 1960 to $281 in 2008, and has fallen by 9.3% since then. Public health's share of total health expenditures rose from 1.36% in 1960 to 3.18% in 2002, then fell to 2.65% in 2014; it is projected to fall to 2.40% in 2023. Public health spending has declined, potentially undermining prevention and weakening responses to health inequalities and new health threats. [ABSTRACT FROM AUTHOR]

The article highlights the "perinatal paradox" and the incongruity between the superb ability to care for the individual patient and the dismal failure to address the problems of the larger society. It is agreed that the problems of the larger society has not been adequately addressed. It is felt that socially based assistance should be a component of programs to benefit children. It is felt that attention to the social and economic needs of women may contribute more than additional medical care to reducing infant mortality in the United States.