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This paper examines the extent to which parent and grandparent smoking influences adolescent smoking and its quantitative implications for tobacco control. It extends similar prior studies by investigating the effects on the probability of becoming a smoker and on the number of cigarettes smoked. Count regressions were used to assess the intergenerational transmission of smoking across three cohabitant generations, simultaneously, using data from the 2010 survey 'Encuesta Estatal Sobre Uso De Drogas en Estudiantes de Enseñanzas Secundarias'. This survey, of 32,234 students, constitutes a representative sample of Spanish students between 14 and 18 years of age. Living with a mother who smokes, a father who smokes, or a grandparent who smokes reduces the odds of being a non-smoker by 36.1 % (OR 0.639), 26.1 % (OR 0.739) and 20.3 % (OR 0.797), respectively. Parental smoking increases cigarette consumption levels among adolescents. Having a cohabitant mother who smokes increases the number of cigarettes smoked by children by around 18.7 % (IRR 1.187), while having a cohabitant father who smokes increases the number by around 12.1 % (IRR 1.121). Estimates support the hypothesis that visibility of smoking among parents and grandparents is a strong predictor of smoking among adolescents. Accordingly, quitting smoking by parents and grandparents before children become adolescents appears to be a powerful means to both reduce smoking rates among adolescents and the number of cigarettes smoked by smokers; such decisions appear to exert a stronger influence on the prevalence of smoking and consumption levels than exposure to smoking prevention campaigns at school. [ABSTRACT FROM AUTHOR]

Improving survival rates for out of hospital cardiac arrest (OHCA) at the neighborhood level is increasingly seen as priority in US cities. Since wide disparities exist in OHCA rates at the neighborhood level, it is necessary to locate neighborhoods where people are at elevated risk for cardiac arrest and target these for educational outreach and other mitigation strategies. This paper describes a GIS-based methodology that was used to identify communities with high risk for cardiac arrests in Franklin County, Ohio during the period 2004-2009. Prior work in this area used a single criterion, i.e., the density of OHCA events, to define the high-risk areas, and a single analytical technique, i.e., kernel density analysis, to identify the high-risk communities. In this paper, two criteria are used to identify the high-risk communities, the rate of OHCA incidents and the level of bystander CPR participation. We also used Local Moran's I combined with traditional map overlay techniques to add robustness to the methodology for identifying high-risk communities for OHCA. Based on the criteria established for this study, we successfully identified several communities that were at higher risk for OHCA than neighboring communities. These communities had incidence rates of OHCA that were significantly higher than neighboring communities and bystander rates that were significantly lower than neighboring communities. Other risk factors for OHCA were also high in the selected communities. The methodology employed in this study provides for a measurement conceptualization of OHCA clusters that is much broader than what has been previously offered. It is also statistically reliable and can be easily executed using a GIS. [ABSTRACT FROM AUTHOR]

This paper investigates the relationship between socio-economic status and emotional well-being of orphans in Mangaung, South Africa. Five hundred orphans aged 7-11 years participated in the cross-sectional study between 2009 and 2012. Data was collected by trained fieldworkers, who conducted face-to-face interviews and questionnaires with the orphans, their teachers and caregivers, and the heads of the households where the orphans resided. The caregivers, children and teachers all completed the Strengths and Difficulties Questionnaire in order to measure the orphans' mental health, while heads of household provided information about socio-economic indicators. STATA version 12 was used to perform multivariate data analyses to identify socio-economic factors associated with the mental health of orphans. Food security, access to medical services and a male caregiver were factors associated with better emotional well-being of orphans, whereas other variables such as household asset index and monthly household expenditure were not linked with the orphans' mental health. Two of the three variables (food security and access to medical services) associated with better emotional well-being of orphans are also government interventions to assist orphans. Further research is needed to determine whether other government programs also impact the emotional well-being of orphans. [ABSTRACT FROM AUTHOR]

Cardiovascular disease (CVD) is the leading cause of death for Hispanic women in the United States. In 2001, the Illinois Department of Public Health received funding from the Centers for Disease Control and Prevention to implement the enhanced WISEWOMAN program (IWP) to address the disproportionate CVD risk among uninsured and underinsured women enrolled in the Illinois Breast and Cervical Cancer Early Detection Program. This paper presents the results of the Spanish-language arm of the IWP. Spanish speaking IWP participants were recruited from two sites, and randomized into either the minimum intervention (MI) or the enhanced intervention (EI) group. Both groups received CVD risk factor screening and educational handouts. The EI group also received an integrated 12-week nutrition and physical activity lifestyle change intervention. Of the 180 Spanish-speaking immigrants in this sample, 90 (50 %) received the EI and 90 (50 %) received the MI. At baseline there were no significant differences between group demographics or clinical values. At post-intervention, the EI group showed improvements in fat intake, fiber intake, moderate intensity physical activity, and total physical activity. At 1 year only the change in fiber intake remained. A significant improvement was also seen in body mass index (BMI) at the 1-year follow-up. The IWP Spanish-language arm was moderately successful in addressing risk factors for CVD in this population. The behavior changes that sustained up to a year were an increase in fiber intake and a decrease in BMI. [ABSTRACT FROM AUTHOR]

Drowning, a largely preventable problem, continues to be a serious issue worldwide, with young men particularly at risk. Alcohol and drugs are often present among young males and, particularly for males aged 18-34 years, alcohol is considered to be a significant risk factor for drowning. The current study aimed to understand the motivations guiding the intentions of young Australian men to engage in drinking and swimming, a behaviour not yet examined systematically. A cross-sectional correlational design was adopted to investigate the ability of the theory of planned behaviour (TPB) and additional variables to predict males' intentions to drink and swim. Males ( N = 211) aged 18-34 years ( Mage = 23.93, SD = 4.01) completed a survey either on-line or paper-based. The survey assessed the TPB constructs of attitude, subjective norm, and perceived behavioural control (PBC); and additional variables of group norms, anticipated regret, objective (i.e. swimming ability) and perceived (i.e. perceived severity and perceived susceptibility) risk perceptions, and past behaviour. Support was found for the TPB constructs of attitude and subjective norm, but not PBC, as well as the additional constructs of group norm, anticipated regret, objective risk, and past behaviour in predicting males' intentions to drink and swim; explaining an overall 76 % of variance. Knowledge gained from this study will help to inform resultant interventions designed to discourage alcohol use in, on, or around water and, thus, prevent drownings in this at risk group. [ABSTRACT FROM AUTHOR]

American Indian/Alaska Natives comprise a small portion of the general college student population, but often have the poorest health and wellness, as well as the highest dropout rates compared to any other race or ethnicity. Despite the well-documented issues this group faces in higher education, they are often ignored in studies due to their status as the minority within the minority, comprising only 0.8 % of all college students in the US. This study examines the differences in college students' overall ratings of health across racial and ethnic groups, focusing specifically on the health and wellness of AI/AN students compared to their counterparts. This paper also investigates the physical health issues students experienced in the past 12 months and the health issues' impact on their academic achievement. Results showed that AI/AN students reported the lowest overall health ratings and the most health issues in the past year. [ABSTRACT FROM AUTHOR]

The current study aimed to (1) offer a large-scale enumeration of college students' lifetime sexual behaviors and sexual behaviors at last event, and (2) apply a gender discrepancy lens to college students' sexual behaviors in order to examine potential gender differences in heterosexual college students' experiences. Nine-hundred and seventy college students between the ages of 18 and 27 from two large universities in the United States participated in the current study. Participants filled out a paper-pencil questionnaire during the last 30 min of class. Measures of lifetime sexual behaviors and engagement in behaviors at last sexual event were replicated from the National Survey of Sexual Health Behavior. Most college students engaged in some form of sexual behavior (manual, oral, vaginal-penile, anal). Men more frequently reported engaging in receptive sexual behaviors (e.g., receiving oral sex) where as women were more likely to engage in performative sexual behaviors (e.g., performing oral sex). At most recent sexual event, men were more likely than women to report being the sexual initiator. Findings highlight gender differences in sexual behavior and provide a foundation for social norms interventions. Holistic sexual health promotion for young adults includes acknowledging and discouraging sites of disparity in equity and pleasure. Therefore, college-level sexual health educators should pay attention to the potential pleasure gap between men and women in heterosexual encounters, and to see pleasure as an important part of sexual health that should be included in social norms campaigns. [ABSTRACT FROM AUTHOR]

Many veterans receive care from both the Veterans Health Administration (VHA) and the non-VHA health system, or dual care. Non-federal physicians practicing in Nebraska were surveyed to examine their perspectives on the organization and delivery of dual care provided to veterans. A paper-based survey was mailed to all 1,287 non-federal primary care physicians (PCPs) and a purposive sample of 765 specialist physicians practising in Nebraska. Rural physicians are more likely to incorporate care coordination practices in their clinical practice, compared to urban physicians. More rural physicians report difficulties in patient transfers, and referrals to the VHA, in prescribing for veteran patients, and in contacting a VHA provider in an emergent situation regarding their veteran patient. More PCPs also report difficulties in referrals to the VHA. However, more rural and primary care physicians follow up with their veteran patients post referral to the VHA. There was agreement among the physicians that the current dual care system needed improvements to provide timely, efficient, coordinated and high quality care to veterans. The specific areas identified for improvement were coordination of care, information sharing, medication management, streamlining of patient transfers, reimbursement for care provided outside the VA, and better delineation and clarity of the boundaries of each system and roles and responsibilities of VA and non-VA providers in the care of veterans. [ABSTRACT FROM AUTHOR]

The purpose of this study is to evaluate the health status of the homeless population who utilize a free clinic. The study specifically aims to compare the prevalence of asthma, diabetes, tuberculosis, mental health disorders, sexually transmitted diseases, sinus problems, and hepatitis among the homeless population. Investigators collected data from paper medical records during patient visits from 2004 to 2009. Diagnosed health conditions among the homeless population were compared to the general clinic users using logistic regression. There were several similarities between the general clinic and homeless population, however, the homeless population had statistically significant ( p < 0.05) outcomes for diagnosed cases of tuberculosis, hepatitis, anxiety, and bipolar disorders. Prevalence of diabetes, sinus problems, asthma, diabetes, and depression were similar among both populations. The odds ratios among hepatitis, tuberculosis, STDs, bipolar disorder and anxiety disorder indicated the homeless had a significantly greater risk of developing hepatitis, tuberculosis, and bipolar disorder. This study adds to the literature by illustrating the characteristics of the homeless population who utilize the free health clinic and their medical conditions. Previous studies have shown the free clinic clients have a lower level of health than the general population. This study finds that the homeless clients of a free clinic have an even worse level of health than the general clinic clients. This research can contribute to the improvement of the healthcare delivery system in providing access to needed health care services for the homeless population. [ABSTRACT FROM AUTHOR]

Health and social disparities are widespread among men who have sex with men (MSM). Although literature indicates that Black MSM (BMSM) are no more likely than other MSM to report sexual risk behaviors, such as unprotected anal intercourse, studies have reported that buying and trading sex appear to be important risk factors for BMSM. Substance use generally is not significantly greater among BMSM than other MSM, studies have found that BMSM report more powder and crack cocaine use than other MSM. The lack of adequate coping skills and social support for BMSM has also been documented. This paper examines differences in substance use, sexual risk behaviors and social support among Black and non-black MSM, in a sample of 515 men participating in a randomized intervention trial. BMSM reported higher rates of substance dependence (72.2 vs. 59.5 %, P = .015) and buying sex (49.1 vs. 17.4 %, P < .000) than non-Black MSM. BMSM also reported lower levels of social support than other MSM on all measures included in the study; e.g., getting help and emotional support from others (38.0 vs. 52.8 %, P < .006). Mediation analyses showed that BMSM's higher rates of substance dependence and buying sex are partially mediated by lower levels of social support. Our data appear to show that lack of social support is an important influence on risk behaviors among BMSM. Qualitative data also supported these findings. Sexual risk and substance use prevention interventions should address BMSM's capacity to build adequate and supportive relationships. [ABSTRACT FROM AUTHOR]

We conducted a 2-year pilot randomized controlled trial (N = 105) in a high HIV-prevalence area in rural western Kenya to test whether providing young orphan adolescents with uniforms, school fees, and community visitors improves school retention and reduces HIV risk factors. The trial was a community intervention, limited to one community. In this paper, we examined intervention implementation and its association with outcomes using longitudinal data. We used both quantitative and qualitative methods to evaluate the community-based model for orphan HIV prevention, with recommendations for future studies. Despite promising effects after 1 year, GEE analyses showed null effects after 2 years. Volunteer community visitors, a key element of the intervention, showed little of the expected effect although qualitative reports documented active assistance to prevent orphans' school absence. For future research, we recommend capturing the transition to high school, a larger sample size, and biomarker data to add strength to the research design. We also recommend a school-based intervention approach to improve implementation and reduce infrastructure costs. Finally, we recommend evaluating nurses as agents for improving school attendance and preventing dropout because of their unique ability to address critical biopsychosocial problems. [ABSTRACT FROM AUTHOR]

This study explored the economic costs and response rate of mail and web-based surveys with practicing dentists. A random sample of 6,000 practicing dentists was randomly assigned into three groups of 2,000: choice (mail or web-based), postal mail, or web-based. The Florida Tobacco Control Survey 2009, which is composed of 28 questions (including subject demographic questions), served as the survey instrument. A total of 1,232 surveys were returned by the three different groups (21% overall response rate). Response rates were best for the mail (26%) with the worst response rate coming from the Web group (11%). However, a cost-effectiveness analysis revealed that web surveys were 2.68 times more cost effective. [ABSTRACT FROM AUTHOR]

The Building Healthy Communities (BHC) initiative addresses inadequate physical activity in Michigan using a population-based approach to prevent chronic disease. Eighteen local health departments through 2010 received $1,505,179 to plan and implement community-based interventions to increase physical activity among low-income and minority populations. This paper examines park user demographics, compares park user demographics to the demographic characteristics and examines physical activity behaviors of park users in these parks. BHC Park usage was examined from 2008 to 2010 using the System for Observing Play and Recreation in Communities (SOPARC). One sample binomial tests were used to examine if the proportion of male and female park users was different than the proportion of males and females in Michigan and to examine if the proportion of white and other park users was different than the proportion of whites and others in Michigan. A chi-square goodness-of-fit test was used to examine whether the observed proportions for age groups observed using the park differed from the actual proportions for age groups in Michigan. The majority of BHC park users were white. More children were observed than other age groups. Park users were most often observed engaging in walking or vigorous activity rather than sedentary activities. When comparing the proportion of whites (54.7%) and others (42.8%) observed using the parks to the proportion of whites (79%) and others (21%) residing in Michigan, there was a significant difference ( P < 0.001) with a greater proportion of whites and smaller proportion of persons of other ethnicities expected to be observed using the parks. This chi square goodness of fit test showed a significant difference in the observed and expected number of persons observed using the trail in each age group (χ = 4,897.707, df = 3, P < 0.001) with a greater number of children (n = 1,939) and teens (n = 1,116) observed than the number of children (n = 828) and teens (n = 305) expected based on 2010 Michigan census data. A greater proportion of non-whites (compared to whites) were observed using the park than would be expected. In Michigan, 60% of blacks, 37% of Hispanics, and 53% of other minority groups do not meet national physical activity recommendations. Perhaps developing additional parks in Michigan can increase physical activity behaviors among minorities. [ABSTRACT FROM AUTHOR]

Community Health Workers (CHWs) have gained national recognition for their role in addressing health disparities and are increasingly integrated into the health care delivery system. There is a lack of consensus, however, regarding empirical evidence on the impact of CHW interventions on health outcomes. In this paper, we present results from the 2010 National Community Health Worker Advocacy Survey (NCHWAS) in an effort to strengthen a generalized understanding of the CHW profession that can be integrated into ongoing efforts to improve the health care delivery system. Results indicate that regardless of geographical location, work setting, and demographic characteristics, CHWs generally share similar professional characteristics, training preparation, and job activities. CHWs are likely to be female, representative of the community they serve, and to work in community health centers, clinics, community-based organizations, and health departments. The most common type of training is on-the-job and conference training. Most CHWs work with clients, groups, other CHWs and less frequently community leaders to address health issues, the most common of which are chronic disease, prevention and health care access. Descriptions of CHW activities documented in the survey demonstrate that CHWs apply core competencies in a synergistic manner in an effort to assure that their clients get the services they need. NCHWAS findings suggest that over the past 50 years, the CHW field has become standardized in response to the unmet needs of their communities. In research and practice, the field would benefit from being considered a health profession rather than an intervention. [ABSTRACT FROM AUTHOR]

Youth in urban environments are exposed to community violence, yet some do well and continue on a positive developmental trajectory. This study investigated the relationships between lifetime community violence exposure (including total, hearing about, witnessing, and victimization), family functioning, and positive youth development (PYD) among 110 urban youth ages 10-16 years (54% female) using a paper and pen self-report survey. This cross-sectional study was part of an interdisciplinary community-based participatory research effort in West/Southwest Philadelphia. Almost 97% of the sample reported some type of community violence exposure. Controlling for presence of mother in the home and presence of father in the home, separate linear regression models for PYD by each type of community violence exposure indicated that gender and family functioning were significantly associated with PYD. None of the types of community violence exposure were significant in the models. Significant interactions between gender and presence of mother in the home and gender and family functioning helped better explain these relationships for some of the types of community violence exposure. Presence of mother was associated with higher PYD for girls, but not for boys. Boys with poor family functioning had lower PYD than girls with poor family functioning. This study helps to better delineate relationships between CVE and PYD by adding new knowledge to the literature on the role of family functioning. Points of intervention should focus on families, with attention to parental figures in the home and overall family functioning. [ABSTRACT FROM AUTHOR]

This study aimed to compare the tobacco-related knowledge, attitudes and smoking behavior among Chinese medical and non-medical students across three grades from freshmen to juniors. Survey data were collected among 8,138 students using a paper-and-pencil questionnaire. Study findings indicate that compared to non-medical students, medical students in the sophomore and junior years reported significantly higher levels of knowledge regarding tobacco toxicants and tobacco-related diseases, and had stronger attitudes against smoking as personal rights and stronger attitudes in favor of smoking ban. The differences between medical and non-medical students remained after controlling for a number of covariates. However the prevalence rates of cigarette smoking were similar between medical and non-medical students across grades even after adjusted smoking initiation before entering college. Despite increases in tobacco related knowledge, approximately 40% of junior-year medical students did not recognize carbon monoxide as a toxicant from tobacco, and 30-40% of them were unknown of tobacco smoking as a risk factor for several diseases, including hypertension, stroke, and gastric ulcer. Findings of this study suggest the need for immediate action to enhance tobacco-related education in formal medical training in China to prepare future doctors for smoking prevention and to assist millions of smokers to quit. [ABSTRACT FROM AUTHOR]

This paper examines changes in the interval between first heroin smoking and onset of injection in a large, out-treatment sample of male heroin users in Hanoi, Vietnam (n = 1,115). Mean age at initiation of heroin use (smoking) was 18.4 and mean age of onset of heroin injection was 20.9 years. Full multivariate analysis indicates that the interval between first heroin use (smoking) and first heroin injection has been significantly attenuated among more recent heroin initiates ( P = 0.0043), suggesting that heroin users in Vietnam may be at increased risk for exposure to HIV relatively soon after onset of heroin use, highlighting the need for behavioral interventions that target heroin smokers. Critical intervention goals include delaying the onset of injection and improved education about safer drug sharing and drug injection practices. [ABSTRACT FROM AUTHOR]

Rwanda still faces major hurdles in its effort to achieve universal access to health care for all. Even though there is an improvement in overall population health status and community-based funding of insurance coverage, a large percentage of women still deliver their babies at home assisted by unskilled birth attendants or unassisted. This paper examines the relationship between being insured and delivery at home and delivery by an unskilled attendant/unassisted. It is evident that uninsured women are significantly more likely to deliver their babies at home by an unskilled birth attendant/unassisted. Moreover, taking other factors into consideration, women who delivered at home are more likely to have no formal education, reside in a rural area, work in the agricultural sector, and are in the poorest household quintile. Findings from this study suggest that being insured may lift financial barriers and encourage women to deliver their babies in a health facility by a skilled birth attendant. Nonetheless, when health insurance status is controlled in multivariate models, certain socioeconomic inequalities do exist for women giving birth in a health facility and by a skilled birth attendant. These inequalities should decline when the insured population increases. [ABSTRACT FROM AUTHOR]

Lead is still seen as one of the most harmful environmental toxins for young children, with the predominant source being deteriorating lead-based paint. Those at continued risk include those living in homes built before 1978, renovators and remodelers, and especially those with limited access to proper healthcare and diets. Proper training on lead-safe work practices focused on preventing and reducing the spread of lead dust can help reduce lead exposure. Presented in this paper are experiences in delivering lead-safe work practices training in six Arkansas cities, and results from pre- and post- surveys delivered before and immediately after the training. Pre- and post-surveys assess strong and weak areas of training. Participants demonstrated positive shifts in attitude and behavior towards lead-safe work practices following training. However, our research found that more emphasis should be focused on clarifying current lead exposure sources and routes for children. [ABSTRACT FROM AUTHOR]

The public health workforce is diverse and encompasses a wide range of professions. For tribal communities, the Community Health Representative (CHR) is a public health paraprofessional whose role as a community health educator and health advocate has expanded to become an integral part of the health delivery system of most tribes. CHRs possess a unique set of skills and cultural awareness that make them an essential first responder on tribal land. As a result of their distinctive qualities they have the capability of effectively mobilizing communities during times of crisis and can have a significant impact on the communities' response to a local incident. Although public health emergency preparedness training is a priority of federal, state, local and tribal public health agencies, much of the training currently available is not tailored to meet the unique traits of CHRs. Much of the emergency preparedness training is standardized, such as the Federal Emergency Management Agency (FEMA) Training Programs, and does not take into account the inherent cultural traditions of some of the intended target audience. This paper reports on the use of the Native American Talking Circle format as a culturally appropriate method to teach the Incident Command System (ICS). The results of the evaluation suggest the talking format circle is well received and can significantly improve the understanding of ICS roles. The limitations of the assessment instrument and the cultural adaptations at producing changes in the understanding of ICS history and concepts are discussed. Possible solutions to these limitations are provided. [ABSTRACT FROM AUTHOR]

We aimed to determine the relationship between neighborhood characteristics (walkability, cohesion/safety) and recommended activity levels among community-dwelling middle-aged and older adults. Subjective and objective data on 394 individuals aged ≥50 years were used to assess the likelihood of walking ≥150 min/week. Environmental factors associated with a greater likelihood of any walking ≥150 min/week included living in a neighborhood with high perception of cohesion/safety versus low, living in walkable areas versus car-dependent, and living in an area with a low-moderate median income versus the lowest. Middle-aged and older adults were more likely to walk ≥150 min/week in a walkable, perceived safe/cohesive neighborhood. Identifying neighborhood factors associated with promoting walking among this population can enable stakeholders (e.g., researchers, planners, and policy makers) to direct interventions focusing on the built environment. [ABSTRACT FROM AUTHOR]

This community health needs assessment-the second part of a mixed-methods project-sought to quantitatively determine the impact of the closure of St. Vincent's Medical Center, a large not-for-profit hospital in NYC on individuals who used its services. Findings from a community survey disseminated to the broader community affected by the closure of this hospital are described. The questions covered topics including demographics, health status, experiences accessing health care pre- and post-hospital closure, access to medical records, prescriptions, etc. The majority of respondents are from the community immediately surrounding the hospital. Almost 50% report having a physical or mental health condition requiring regular care; roughly 64% had a doctor affiliated with St. Vincent's and 68% currently see the same doctor as before the hospital closed. With regard to service utilization, 74% reported having sought services at St. Vincent's in the past 5 years. Of these, the emergency department was the most commonly used service (75%), followed by specialty tests (32%), inpatient care (30%), and outpatient services (22%). The majority of ratings of services at St. Vincent's were 'excellent' or 'very good.' Conversely, 65% of former St. Vincent's users reported more difficulty obtaining health care post closure. Of the 11% who have tried to access their medical records, 30% have not been able to obtain their records and 42% report their attempt as being 'somewhat difficult' or 'very difficult.' Over 50% report spending more time traveling or traveling further to get to their healthcare provider; and over one third report waiting longer to get an appointment, or to be seen when at an appointment. Bivariate analyses revealed that certain subgroups of respondents had significantly worse negative experiences associated with the closure of the hospital. Specifically, individuals with a health condition were more likely to have visited an ER since St. Vincent's closed, and now travel further and spend more time traveling to their health care provider, compared to those without a physical and/or mental health condition. Similarly, a greater proportion of respondents who had a doctor affiliated with St. Vincent's reported greater challenges accessing care since the closing, compared to those who did not have a doctor affiliated with St. Vincent's (e.g., waiting longer to get an appointment). Finally, the same health care challenges were being experienced by those who are not seeing the same doctor as prior to the closing. [ABSTRACT FROM AUTHOR]

Several personal protective measures (PPMs) are recommended to prevent tick-borne diseases (TBD). We aimed to quantify the strength of seven PPMs and self-reported TBD diagnosis associations and to understand what variables modify these associations. In June–July 2018, with a cross-sectional study design, we surveyed a sample of adult Indiana state residents. Overall, 2927 participants were eligible for this analysis. All data were self-reported. We used the double robust approach of stabilized inverse probability weighting and propensity score adjustment to obtain ORs. Approximately 5% of participants (n = 142) self-reported TBD diagnosis. Practicing different PPMs ranged from 48% for treating outdoor clothing with special bug-spray to 83% for walking on established trails. Using insect repellent on exposed skin was protective against TBD diagnosis [OR (95% CI): 0.55 (0.35, 0.88)]. A thorough body/clothes check after being outdoors was also protective against TBD diagnosis [OR (95% CI): 0.40 (0.25, 0.67)]. In stratified analyses, TBD knowledge, safety worry because of ticks, avoiding outdoors because of ticks, and pet TBD risk modified the associations between different PPMs and self-reported TBD diagnosis. In the state of Indiana, thorough body/clothes check after being outdoors and use of insect repellent on exposed skin might be strongly effective in preventing TBD. The protective effect of different PPMs might be stronger among people with high TBD knowledge, high safety worry because of ticks, high avoidance of being outdoors because of ticks, and low pet TBD risk. These results might be useful in the design of intervention programs. [ABSTRACT FROM AUTHOR]

HIV pre-exposure prophylaxis (PrEP) is underutilized among Hispanics, women, and low-income individuals. To better understand PrEP barriers in this population, questionnaires were administered to 500 patients attending public health clinics in southern Arizona which provide family planning and sexually transmitted infections care. Sixty-three percent believed that they had no risk of HIV infection. When asked "Before today, did you know that there was a pill that can prevent HIV infection?" 80% of persons answered no. Among women, 88% answered no to this question. As expected, individuals with a higher perceived HIV risk (OR 1.76) or one HIV risk factor (OR 5.85) had a higher probability of knowledge. Among survey participants 87% would take a daily pill, 91% would visit a health-care provider every 3 months, and 92% would have laboratory testing every 3 months. Fifty-four percent would not be afraid or embarrassed if friends or family knew they were taking PrEP. Seventy-two percent would take PrEP despite temporary nausea. Sixty-two percent would pay ≥ $40 every 3 months for PrEP. Lack of knowledge, rather than patient attitudes, is the more important barrier to wider utilization of PrEP among individuals, especially women, attending public health clinics in Southern Arizona. Future efforts need to focus on education and access to PrEP in underserved populations including women and Hispanics. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the eating behaviors and social cognitive factors that affect fruit and vegetable consumption. Strategies to change, pros & cons, enjoyment, family support, and peer influence were measured in children ages 8–10 years both pre- and post- Zest Quest® program (pre: n = 82; post: n = 80). Children for a comparison group were selected from comparable elementary schools and pre- and post- measures were evaluated (pre: n = 92; post: n = 87). Chi-squared analyses were conducted on individual measures and Spearman correlations & linear regression were used for composite variables with fruit and vegetable consumption as the dependent variable. Results from the study demonstrated significant moderate correlations for fruit change strategies pre- (rs = 0.39) and post-intervention (rs = 0.33) and vegetable change strategies pre-intervention (rs = 0.42) in the Zest Quest® group. Peer influence (rs = 0.33) and enjoyment (rs = 0.38) showed significant moderate correlations with fruit intake in the comparison group. The regression analysis showed pros (β = 0.24, p value 0.05) and cons (β = 0.14, p value 0.05) to be significant predictors for fruit intake post-intervention in the Zest Quest® group. Prior to the intervention, strategies to change (β = 0.10, p value 0.02) was a significant predictor for fruit intake and cons (β = 0.15, p value = 0.03) for vegetable intake in this group. Family support and peer influence were not significant in the regression models, but demonstrated significance in the crude model. Eating behaviors and social cognitive factors may have an effect on fruit and vegetable consumption, but these measures are difficult to capture. Future research should continue exploring the impact of family support and peer influence on fruit and vegetable intake. [ABSTRACT FROM AUTHOR]

The aims of this study were to explore the differences in (1) the perception of severity towards ZIKV infection and dengue fever, and (2) mosquito control practices before and after the ZIKV outbreak were declared a Public Health Emergency of International Concern (PHEIC). Data were collected between Feb to May 2016 using a computer-assisted telephone interviewing system. The median scale score for perceived severity of ZIKV was 3 (interquartile range [IQR] 1-5) versus 4 (IQR 3-5) for dengue (P < 0.001). The scores for mosquito control practices before and after ZIKV was declared a PHEIC were similar, at 4 (IQR 3-5). Multivariate analysis revealed that participants with a higher score for perception of severity of ZIKV were more likely to report greater mosquito control practices after the declaration of the PHEIC (OR 1.822 [95% CI 1.107-2.998]). The emerging ZIKV pandemic requires concerted efforts to enhance mosquito control practices among the Malaysian public. Efforts to improve public mosquito control practices should focus on enhancing the perception of the severity of ZIKV. [ABSTRACT FROM AUTHOR]

Approximately one-quarter of human papillomavirus (HPV) infections are acquired by adolescents, with a higher burden among racial/ethnic minorities. However, racial/ethnic minorities have been underrepresented in previous HPV vaccine trials. Ongoing and future HPV vaccine optimization trials would benefit from racially- and ethnically-diverse sample of adolescent trial participants. This study examined factors influencing parental willingness to consent to their adolescents' participation in HPV vaccine clinical trials and tested for possible racial differences. A convenience sample of parents of adolescents (N = 256) completed a cross-sectional survey. Chi square analyses were used to assess racial differences in parental HPV vaccine awareness and intentions and willingness to consent to their child participating in an HPV vaccine clinical trial. Ordinal logistic regression was used to identify factors associated with willingness. Approximately 47% of parents were willing to allow their adolescent to participate in HPV vaccine clinical trials (30.7% African American and 48.3% Caucasian, p = .081). African Americans had lower HPV vaccine awareness ( p = .006) but not lower intentions to vaccinate ( p = .086). Parental willingness was positively associated with the following variables: Child's age ( p < .039), Perceived Advantages of HPV Vaccination for Adolescents ( p = .002), Parental Trust in Medical Researchers ( p < .001), and Level of Ease in Understanding Clinical Trial Information ( p = .010). Educating parents about the advantages of HPV vaccines for younger adolescents using low-literacy educational materials and building trust between parents and researchers may increase parental willingness to consent to adolescent participation in HPV vaccine clinical trials. [ABSTRACT FROM AUTHOR]

Little is known about how neighborhood noise influences cardiovascular disease (CVD) risk among low-income populations. The aim of this study was to investigate associations between neighborhood noise complaints and body mass index (BMI) and blood pressure (BP) among low-income housing residents in New York City (NYC), including the use of global positioning system (GPS) data. Data came from the NYC Low-Income Housing, Neighborhoods and Health Study in 2014, including objectively measured BMI and BP data (N = 102, Black = 69%), and 1 week of GPS data. Noise reports from 'NYC 311' were used to create a noise complaints density (unit: 1000 reports/km) around participants' home and GPS-defined activity space neighborhoods. In fully-adjusted models, we examined associations of noise complaints density with BMI (kg/m), and systolic and diastolic BP (mmHg), controlling for individual- and neighborhood-level socio-demographics. We found inverse relationships between home noise density and BMI (B = −2.7 [kg/m], p = 0.009), and systolic BP (B = −5.3 mmHg, p = 0.008) in the fully-adjusted models, and diastolic BP (B = −3.9 mmHg, p = 0.013) in age-adjusted models. Using GPS-defined activity space neighborhoods, we observed inverse associations between noise density and systolic BP (B = −10.3 mmHg, p = 0.019) in fully-adjusted models and diastolic BP (B = −7.5 mmHg, p = 0.016) in age-adjusted model, but not with BMI. The inverse associations between neighborhood noise and CVD risk factors were unexpected. Further investigation is needed to determine if these results are affected by unobserved confounding (e.g., variations in walkability). Examining how noise could be related to CVD risk could inform effective neighborhood intervention programs for CVD risk reduction. [ABSTRACT FROM AUTHOR]

The purpose of this project was to determine the effect of diet, physical activity, and access to fruits, vegetables on weight status of children who reside in a low-income rural area. 153 3rd-6th graders were assessed for physical activity, sedentary behavior, fruit and vegetable consumption and access to physical activity, fruits and vegetables. Physical activity and sedentary behavior was objectively assessed via accelerometery. Fruit and vegetable consumption was assessed by direct observation and a recall questionnaire. Access was assessed by a questionnaire. Regression analysis was used to determine relationships with weight status as measured by BMI. On average children met physical activity requirements (71 min of MVPA) per day which significantly related to children's weight status ( p = .016). Sedentary behavior was also related to weight status ( p = < 0.001). Participants' access to physical activity opportunities near the home was not significantly related to their physical activity levels or weight status. Fruit and vegetable consumption was not related to BMI or access to fruits and vegetables. The results of this study suggested that children's physical activity and sedentary behavior impacts weight status of children residing in a rural environment. [ABSTRACT FROM AUTHOR]

Sexual violence, a global concern, has far reaching consequences for individuals and communities. This survey of South African high school students, reported baseline prevalence and factors associated with forced sex. Data collected among 434 adolescents (54.4% boys; 45.6% girls) used a questionnaire developed using the I-Change Model conceptual framework. Forced sex prevalence was 14.2% (95% CI 9.1, 21.5) with a non-significant difference between females (15.0%) and males (13.6%) (p = 0.781). After multivariable adjustment, urban location (39%), low socio-economic status (15%) and discordant mother/father vital status (20%) remained significant risk factors for forced sex. South African high school students are still at risk of experiencing forced sex with a higher prevalence in females. Interventions to address socio-economic and structural constructs contributing to the forced sex prevalence in this population are required. [ABSTRACT FROM AUTHOR]

Shared decision making has been shown to improve patients experience and satisfaction with care within the health care setting but it is not clear that all patients want to play an active role in health care decisions. The aim of this study is to describe general decision control preferences among a predominantly Spanish speaking Hispanic population. This is a cross-sectional study using the Control Preference Scale to assess decision-making preference. A total of 780 subjects completed the survey (response rate 89.9%). The majority preferred a collaborative role (53.3%) compared to a passive (26.4%) or active role (20.3%). We observed that individuals who were married or living with a partner were more likely to prefer an active or collaborative role than their unmarried counterparts (RRR 1.78 P value 0.017; RRR 1.56 p value 0.012). Less acculturated individuals (i.e. more Spanish speaking at home were less likely to prefer an active vs. passive role) (RRR 0.296, P value 0.029). Our predominantly Spanish speaking Hispanic population showed a preference for collaborative versus active or passive roles. There are several demographic factors that are associated with this preference but it remains important to determine individual's preference for decision making in health care settings. [ABSTRACT FROM AUTHOR]

Alzheimer's disease (AD) is the fourth leading cause of death in Puerto Rico. Using multi-media resources and in-person education may be an effective approach to improve knowledge and awareness of AD. The Un Café por el Alzheimer program in Puerto Rico incorporates an education component at coffee shops and a social media campaign using Facebook. The current study evaluates this initiative through an analysis of pre/post education survey results and social media content and use. Surveys contained close-ended and open-ended questions to understand participants' perceptions and knowledge about AD. Post-education surveys also included questions related to program satisfaction. Social media analysis of the Facebook community page examined posts from March 1 to September 30, 2015. Descriptive statistics were used to analyze survey and Facebook data. Four education sessions were conducted with a total of 212 participants. Fifty-one of the participants completed both pre- and post-surveys. Following the education program participants reported improved knowledge of risk and protective factors. All participants reported learning new information from the program. There were a total of 250 posts on the Un Café por el Alzheimer community Facebook page; 168 posts related to AD. The Facebook page reached 294,109 people, with 9963 page likes, 610 comments, 17,780 post clicks, and 3632 shares. There was an average increase of 64.8 % in number of people reached by the Facebook page following the education sessions. The approach of combining social media resources and in-person education is beneficial to increase public awareness of AD and disseminate health information. [ABSTRACT FROM AUTHOR]

As people living with HIV/AIDS (PLWHA) live longer, and HIV incidence declines, health systems are transitioning from vertical-only care delivery to horizontal integration with social and other services. This is essential to responding to the chronic nature of the disease, and health systems must respond to full-breadth of socio-economic conditions facing PLWHA. We use excellent self-rated health as a referent, and assess the role of non-biomedical conditions in mediating HIV+ status and excellent overall health among a large community sample of Kenyan women. After controlling for age and wealth, we found significant mediation by social support, partner HIV status, meaningfulness of life, family functioning, food sufficiency, and monthly income. If the goal of health systems is to help all people attain the highest level of health, integrating vertical HIV services with socio-economic support and empowerment may be required. Further investigation of the relative contribution of social support, family functioning, food and financial sufficiency should be conducted longitudinally, ideally in collaboration with HIV clinical services. [ABSTRACT FROM AUTHOR]

Tobacco use is common among homeless adults, yet few homeless shelters offer tobacco dependence treatment. Using a pre-intervention and post-intervention study design, we pilot tested the feasibility of a capacity building intervention that consisted of a 3.5-h training for shelter staff to provide cessation counseling. Staff (n = 12) and homeless clients (n = 46) completed questionnaires at pre-intervention, post-intervention (6 weeks), and at 12-weeks follow-up. Staff completed a questionnaire on tobacco-related knowledge, attitudes toward and practices around treating tobacco dependence, and self-efficacy in providing cessation counseling (score range 1-5). Clients completed a questionnaire on tobacco-related knowledge, attitudes toward tobacco dependence, and receipt of tobacco-related services from the program (score range 1-5). We used repeated measures linear regression analysis to examine change in scores over time. From pre-intervention to post-intervention, staff knowledge (β coefficient 0.4, 95 % CI 0.1-0.8) and efficacy (β coefficient 0.4, 95 % CI 0.2-0.7) in treating tobacco dependence increased. Client receipt of tobacco-related program services increased significantly from post-intervention to follow-up (β coefficient 0.3, 95 % CI 0.1-0.5). A brief capacity building intervention has the potential to increase tobacco-related interventions among clients in homeless shelters. [ABSTRACT FROM AUTHOR]

Latinos are a diverse population comprised of multiple countries of origin with varying cultural profiles. This study examines differences in colonoscopy completion across place of birth and migration-related factors in a sample of predominantly Dominican and Puerto Rican Latinos living in New York City after receiving a recommendation for colonoscopy screening and navigation services. The sample included 702 Latinos recruited for two cancer screening projects targeting Latinos eligible for colonoscopy who seek healthcare in New York City. Participants completed a survey that included sociodemographic, health-related questions, psychosocial assessments and cancer screening practices, in Spanish or English. Migration, acculturation, and language factors were found to predict colonoscopy completion. The results indicated that Latinos born in the Dominican Republic and Central America were more likely to complete a screening colonoscopy than their counterparts born in the US. Further, those who emigrated at an older age, who have resided in the US for less than 20 years, preferred Spanish and those with lower US acculturation levels were also more likely to complete a screening colonoscopy. The findings suggest that Latinos who are less acculturated to the US are more likely to complete a screening colonoscopy after receiving a physician recommendation for colonoscopy screening. The results provide important information that can inform clinical practice and public health interventions. Continued attention to cultural and migration influences are important areas for cancer screening intervention development. [ABSTRACT FROM AUTHOR]

Physicians tend to treat their own illnesses differently than the general population, sometimes continuing to come to work when ill. To assess whether family physicians continue to work when ill. A cross-sectional study with a convenience sample. A self-administered, anonymous questionnaire, that included socio-demographic data, questions relating to illness, and reasons for work absenteeism, was completed by family physicians in the Negev region of Israel. 107 physicians participated in the study including 46 women (43 %). The mean age was 45.1 ± 11.4. Forty physicians (37.4 %) said they come to work with an acute illness, 47 (43.9 %) answered that they do so some of the time, and 19 (17.8 %) said that they did not come to work ill. On a scale from 1 to 10 the mean score for the question as to whether physicians are liable to infect their patients was 7.4, with a higher score meaning more likely to infect. Older physicians were more likely to say that the decision to stay away from work was related to the lack of available physicians ( P = 0.002), while board certified physicians were more likely than residents to stay away from work due to an acute illness ( P = 0.023). Family physicians in the Negev sometimes work when they are ill. This finding has positive sides related to dedication to patients and the work place, but one cannot ignore the fact that patients may be infected by their physicians. Behavioral guidelines, including social, legal, and ethical aspects, should be formulated on this issue. [ABSTRACT FROM AUTHOR]

Maternal depression, including antepartum and postpartum depression, is a neglected public health issue with potentially far-reaching effects on maternal and child health. We aimed to measure the burden of antepartum depression and identify risk factors among women in a peri-urban community in Swaziland. We conducted a cross-sectional study within the context of a community outreach peer support project involving 'Mentor Mothers'. We used of the Edinburgh Postnatal Depression Scale (EPDS) to screen women for depression during the third trimester of pregnancy, using a cut-off score of ≥13 to indicate depression. We also collected demographic and socioeconomic factors, and assessed the association of these factors with EPDS score using logistic regression models. A total of 1038 pregnant women were screened over a period of 9 months. Almost a quarter (22.7 %) had EPDS scores ≥13 and 41.2 % were HIV positive. A fifth, 17.5 % were teenagers and 73.7 % were unemployed. Depression was not associated with HIV status, age or employment status. However, women with multiple socioeconomic stressors were found to be more likely to score highly on the EPDS. Depression was common among pregnant women in the peri-urban areas of Swaziland. Screening for depression using the EPDS is feasible and can be included in the community health worker standard tool box as a way to improve early detection of depression and to highlight the importance of maternal mental health as a core public health concern. [ABSTRACT FROM AUTHOR]

In the past, several enteric outbreaks in 1996, 1998, 1999, and 2003 caused by Salmonella typhi, a Gram-negative bacterium, have occurred in Armenia. This study describes the demographic, epidemiological, and clinical characteristics of febrile hospitalized patients with intestinal infections in Armenia. Using a chart review study design, medical data from adult patients who were hospitalized at the Nork hospital during 2010-2012 were reviewed. A total of 600 medical charts were reviewed. Of these, 51 % were diagnosed with intestinal infections. Among these patients, 59 % had an intestinal infection of known etiology, with three main pathogens identified: Salmonella sp. (32 %), Shigella sp. (32 %), and Staphylococcus aureus (18 %). After controlling for the calendar year, age in years, and gender, patients detected with Salmonella sp. were more likely to reported the presence of a family member with similar signs or symptoms [odds ratio (OR) 9.0; 95 % CI 2.4-33.7] and the lack of a water tap at home (OR 3.9; 95 % CI 1.7-9.5). Evidence indicates that Salmonella sp., Shigella sp., and S. aureus as the most common etiologies reported among febrile hospitalized patients. A high percentage of patients had intestinal infections of unknown etiology; thus, improvement in laboratory capacity (enabling more advanced tests, such as polymerase chain reaction) would increase the identification of the enteropathogens causing disease in Armenia. [ABSTRACT FROM AUTHOR]

To answer the call for more systematic surveillance, analysis and evaluation of tobacco news coverage, a 6-year content analysis of newspaper stories from Missouri was conducted to evaluate the presence of public health facts and characteristics of stories framed for or against tobacco control. The method was a content analysis of all Missouri newspapers (N = 381) from September 2006 to November 2011 for a total sample of 4711. Results were connected to the larger, societal context within which newspaper stories reside, i.e., towns that passed or did not pass a smoke-free ordinance during the project intervention. Results showed the majority of news stories were about tobacco control, which were mostly written at the local level, were episodic, and carried a positive slant toward tobacco control. However, there were more negative than positive headlines, and more negative editorials than non-editorials. Tobacco control stories used fewer public health facts than non-tobacco control stories. Towns with existing smoke-free ordinances had more tobacco control stories, and towns without smoke-free ordinances had fewer tobacco control stories and more non-tobacco control stories, suggesting a connection between news media coverage and the passage of smoke-free policies. We conclude that the tobacco industry may have had success in impacting news stories in no-ordinance cities by diverting attention from tobacco control to secondary topics, such as youth smoking, which meant stories had fewer public health facts and fewer positive health benefits in towns that may have needed these details most. [ABSTRACT FROM AUTHOR]

As HIV treatment becomes more widely available and efficacious, and persons with HIV live longer, considerations for the financial and healthcare impact are of important. The best interval for routine HIV monitoring has been identified as area in which gaps in knowledge exist. The goal of this study is to determine the impact of changing scheduled follow up care for persons with HIV from a 4 to 6 months interval. HIV infected adults with a CD4 count ≥250 cells/μl, and an undetectable HIV viral load (VL) by an ultrasensitive assay for at least 1 year were randomized to routine HIV care at either a 4 or 6 months interval. Subjects were monitored for virological failure, adherence and quality of life (QOL). 142 subjects were enrolled and completed study protocol. Two subjects in the 6 months arm developed virological failure, p value = 0.5. There was no difference in adherence, or QOL scores. Subjects in the 4 months arm had higher rates of HIV visits (8.5/100 vs. 5.2/100 person months, p = 0.01) and non-HIV related visits (9.4/100 vs. 6.0/100 person months, p = 0.01) and were more likely to change antiretroviral regimen (34.8 vs. 15.8 %, p = 0.01). Despite strict inclusion criteria in this relatively short follow up time, 2/142 (1.4 %) subjects developed virological failure and many more had transient detectable VL. While not statistically significant a larger study with longer follow up is needed. [ABSTRACT FROM AUTHOR]

The aim of the present study was to assess oral health literacy (OHL) in pregnant women and its association with social determinants and knowledge regarding eating habits and oral hygiene in infants. This cross-sectional study assessed 175 pregnant women in a hospital in southern Brazil. Socioeconomic and demographic data were obtained using a questionnaire, and OHL was determined by the Brazilian Rapid Estimate of Adult Literacy in Dentistry (BREALD-30). Eating habits and oral hygiene knowledge were assessed by statements on a 3-point Likert scale. The data were analyzed using Spearman correlations and the Mann-Whitney U test (α = 0.05). The mean (SD) age was 26.2 (6.17) years. Most of the participants had up to 8 years of education (60.0 %) and belonged to socioeconomic class 'C' or lower (56.0 %). The mean (SD) score on the BREALD-30 was 22.4 (4.66). A positive correlation was found between BREALD-30 scores and knowledge (r = 0.370, p < 0.001), income (r = 0.374, p < 0.001), and the age at which infants first consumed sugar in their diets (r = 0.370, p < 0.001). A negative correlation was found between BREALD-30 scores and domicile agglomeration (r = −0.237, p = 0.020). BREALD-30 scores were higher among pregnant women who had more than 8 years of education ( p < 0.001), who belonged to higher socioeconomic classes ( p < 0.001), and who were employed ( p = 0.025). A significant correlation was found between OHL and knowledge. Lower social determinants were associated with lower OHL. Oral health literacy should be considered in health education practices to facilitate adherence to health recommendations in pregnant women. [ABSTRACT FROM AUTHOR]

Data regarding HIV among men having sex with men (MSM) in Burundi are scarce. In a context where same-sex practices are illegal, national recommendations including MSM have been issued in 2012. However, no study has been conducted to evaluate MSM's health needs, which would be useful to adapt recommendations and implement evidence-based interventions. This study aimed at identifying health needs expressed by MSM. A cross-sectional study was conducted in Bujumbura in 2014, in collaboration with the National Association for HIV positive people and AIDS patients. Fifty-one MSM, recruited during HIV prevention activities, self-completed a questionnaire. A descriptive analysis was conducted. Participants had a median age of 23 years, over 60 % declared being a member of an LGBT organisation and 76 % lived their homosexuality secretly or discretely. Over the last month, 67 % declared having had sex with a man and 32 % with a woman. In the previous 6 months, 40 % declared having systematically used a condom during sexual intercourse. In terms of health needs, 22 % did not use the services offered by HIV providers. Participants expressed needs in terms of prevention (access to rapid HIV tests, in a confidential setting, with counselling) and care (listening centre, free treatment, confidentiality). Medical expertise and being a good listener were the predominant healthcare staff qualities desired by participants. Results suggest that Burundian MSM represent an at-risk population, with low access to HIV services, in need of a comprehensive approach for HIV prevention, with community-based activities (HIV testing, counselling, prevention tools), psychological and social support. [ABSTRACT FROM AUTHOR]

New York City (NYC) Latinos are disproportionately affected by obesity. However, little information is available on demographic and behavioral factors linked to body mass index (BMI) in this population. A community-based survey was conducted in the inner-city Bronx community of NYC to evaluate these factors among Latino New Yorkers. 738 Latinos completed the survey. 241 (32.7 %) participants were obese (BMI > 30 kg/m) and 302 (41 %) individuals were overweight (BMI 25-30 kg/m). Adjusted regression analyses show that Latinos who are overweight or obese were found at greater odds of being men, residing in the US for >10 years, in early stages 1-3 of change of physical activity behavior, and at lower odds of being young adults aged <35 years or with college education. Analysis of factors associated stages of change (SOC) revealed that subjects in these preliminary SOC related to physical activity were at greater odds of speaking Spanish alone, in the same SOC with respect to diet, and at lower odds of living >10 years in the US. With respect to diet, subjects in preliminary stages were at greater odds of being young adults <35 years of age or in early SOC of physical activity and at lower odds of low income <20 dollars per year. The survey shows that Latino New-Yorkers in the Bronx with high prevalence of overweight status and obesity have unique demographic, socio-economic, behavioral and cultural factors that can be linked to excessive body weight. [ABSTRACT FROM AUTHOR]

Despite the availability of HPV prophylactic vaccines, uptake has been suboptimal in the US. In the state of Hawaii, HPV vaccine coverage has decreased among females and remains low among males aged 13-17. The reasons for low uptake are unknown and may indicate the existence of critical barriers to HPV vaccination. The purpose of this investigation was to identify policy, system and environmental barriers and promoters of pediatric HPV vaccination in Hawaii. An online 86-item survey addressing knowledge, attitudes, beliefs, practices, and barriers to HPV vaccination was distributed to practicing physicians in Hawaii specializing in Pediatrics, Family Medicine, and Obstetrics-Gynecology. Survey responses were received from a total of 120 physicians. Private practice physicians reported more concerns with vaccine ordering and stocking costs ( p < 0.0001), reimbursement levels ( p < 0.0001), and insurance coverage ( p < 0.0001) compared to physicians in large group practices. Eighty-three percent of providers cited lack of parent knowledge and understanding of HPV infection as a barrier. Over half of physicians (58 %) reported that completion of the 3-dose schedule was a barrier. Most physicians did not use tracking or reminder systems to ensure dose completion. A majority (58 %) of providers cited the lack of school-based vaccination requirements as a barrier. Uptake of HPV vaccination in Hawaii may be impeded by physician perception of parent knowledge and attitudes. Cost-related system barriers are particular barriers among those in private practice. Completion of the 3-dose schedule also remains a challenge. [ABSTRACT FROM AUTHOR]

Human papillomavirus (HPV) is a contemporary public health concern because of its association with cervical cancer. Despite evidence about HPV vaccination benefits, debate surrounds whether or not to vaccinate American youth. While no nationwide mandate exists, understanding the behaviors and intentions of future parents may provide insight about our ability to protect the next generation of school-aged youth. The purposes of this study were to examine factors associated with unmarried college students' intentions to: (1) vaccinate their daughters against HPV and (2) give their daughters the choice about whether or not to be vaccinated. Data were analyzed from 1606 college students aged 18-26 using an internet-delivered questionnaire. Two binary logistic regression analyses were performed identifying predictor variables associated with participants' intentions when having daughters in the future to vaccinate them against HPV and whether or not they would let their daughters decide to get the vaccination. Relative to those who did not intend to vaccinate their daughters against HPV, participants who were female (OR 1.55, P = 0.018), sexually active (OR 1.62, P = 0.001), diagnosed with HPV (OR 2.64, P < 0.001), received a flu shot in the past 12 months (OR 1.63, P = 0.002), perceived the HPV vaccine to be safe (OR 1.19, P < 0.001), and supported HPV vaccination mandates for school-aged youth (OR 2.58, P < 0.001) were more likely to report intentions of vaccinating their daughters against HPV. Participants who were sexually active (OR 1.45, P = 0.002) and perceived the HPV vaccine to be safe (OR 1.05, P = 0.012) were more likely to report they would allow their daughters to choose whether to be vaccinated against HPV. Until HPV vaccination mandates are enacted, parental support of vaccines are among the most effective way of increasing vaccine uptake. Identifying HPV vaccination support among future parents has potential to inform parent vaccination education programs related and advocacy for HPV vaccination policies. [ABSTRACT FROM AUTHOR]

Breast cancer screening combined with follow-up and treatment reduces breast cancer mortality. However, in the study clinic, only 12 % of eligible women ≥40 years received a mammogram in the previous year. The objective of this project was to implement patient navigation, in our partner health clinic to (1) identify women overdue for a mammogram; and (2) increase mammography utilization in this population over a 2-year period. Women overdue for a mammogram were identified. One patient navigator made navigation attempts over a 2-year period (2009-2011). Navigation included working around systems- and individual-level barriers to receive a mammogram as well as the appropriate follow-up post screening. Women were contacted up to three times to initiate navigation. The proportion of women navigated and who received a mammogram during the study period were compared to women who did not receive a mammogram using Chi square tests for categorical variables and t tests for continuous variables with an α = 0.05. Barriers to previous mammography were also assessed. With 94.8 % of eligible women navigated and 94 % of these women completing mammography, the implementation project reached 89 % of the target population. This project was a successful implementation of an evidence-based patient navigation program that continues to provide significant impact in a high-need area. Cost was the most commonly cite barrier to mammography. Increasing awareness of resources in the community for mammography and follow-up care remains a necessary adjunct to removing structural and financial barriers to accessing preventive services. [ABSTRACT FROM AUTHOR]

Factors that might account for the probability of children being exposed to secondhand smoke compared to those who are unexposed and characteristics associated with the urinary cotinine level (UCL) of those who are exposed were investigated. All households in a German region with a child aged 3 years or younger (n = 3,570) were invited to participate in a study that tested the efficacy of an intervention for reducing secondhand smoke exposure. In 1,282 households, at least one parent reported daily smoking. Among these, 915 (71.3 %) participated in the study. For data analyses, we used a two-part model. Characteristics of the households associated with SHSE of the youngest child were analyzed, as well as characteristics associated with UCL among those exposed. Exposure to secondhand smoke was defined using a UCL ≥ 10 ng/ml. Secondhand smoke exposure was detected in 57.1 % of the samples. Nursery attendance was associated with secondhand smoke exposure, in addition to the number of smokers living in the household, extent of home smoking ban and parental education. Among children exposed, nursery attendance, season of urine collection and age of the child were associated with UCL. Consideration of seasonal smoking behavior and a child's age at the time of intervention may increase attention to the adverse health effects of secondhand smoke exposure. [ABSTRACT FROM AUTHOR]

The purpose of our study was to describe the relationship between office-based provider visits and emergency department (ED) utilization by adult Medicaid beneficiaries. Data were extracted from the publicly-available Medical Expenditure Panel Survey, a nationally representative sample of the civilian non-institutionalized population in the United States. The sample included 1,497 respondents who had full year Medicaid coverage in 2009. Study variables included insurance coverage type, usual source of care, chronic illnesses, and beneficiary demographics. Multivariate analyses were conducted to describe associations between individual characteristics and (a) likelihood of any ED utilization, and (b) number of ED visits by those who utilized the ED at least once in the study year. The analysis was adjusted for demographic characteristics and chronic health conditions. A greater number of office-based provider visits was associated with a higher likelihood of ED utilization. Among those with at least one ED visit, a greater number of office-based visits was associated with a higher number of ED visits. A respondent's age, history of hypertension or myocardial infarction, and Hispanic/Latino ethnicity were associated with having one or more ED visits; age and Hispanic/Latino ethnicity were associated with total number of ED visits among those with at least one. In this representative sample of adult Medicaid beneficiaries, there was no evidence that office-based provider visits reduced ED utilization. Office visits were associated with higher ED utilization, as were certain chronic conditions, older age, and Hispanic/Latino ethnicity. Findings do not support efforts to reduce ED utilization by increasing office-based visits alone. [ABSTRACT FROM AUTHOR]

The Advisory Committee on Immunization Practices (ACIP) recommends that certain children under 9 years of age receive two influenza vaccine doses in a season for optimal protection. Recent data indicate that many of these children fail to receive one or both of these needed doses. Contributing factors to under-vaccination of this population remain unclear. Caregivers of children aged 6 months-8 years requiring two influenza vaccine doses in the 2010-2011 season were identified from households enrolled in four urban Head Start programs. Recruitment and survey administration were conducted between March and June 2011. The impact of caregiver, provider, and practice-based factors on influenza vaccine receipt was assessed using bivariate and multivariable logistic regression analyses. Caregivers (n = 128) were predominantly mothers, Latina, Spanish-speaking, and non-U.S. born. Few children received one (31 %) or both (7 %) influenza vaccine doses. Caregivers who discussed influenza vaccination with providers were more likely to know their child needed two doses (55 vs. 35 %, p < 0.05) and have a fully vaccinated child (11 vs. 0 %, p < 0.05). Among caregivers whose child received the first dose, those who reported being told when to return for the second dose were also more likely to have a fully vaccinated child (35 vs. 0 %, p = 0.05). Belief in influenza vaccine effectiveness was positively associated with vaccination ( p < 0.001), while safety concerns were negatively associated ( p < 0.05). This study highlights the importance of provider-family communication about the two-dose regimen as well as influenza vaccine effectiveness and safety. [ABSTRACT FROM AUTHOR]

Use of community-based participatory research (CBPR) approaches is increasing with the goal of making more meaningful and impactful advances in eliminating cancer-related health disparities. While many reports have espoused its advantages, few investigations have focused on comparing CBPR-oriented recruitment and retention. Consequently, the purpose of this analysis was to report and compare two different CBPR approaches in two cancer prevention studies. We utilized frequencies and Chi-squared tests to compare and contrast subject recruitment and retention for two studies that incorporated a randomized, controlled intervention design of a dietary and physical activity intervention among African Americans (AA). One study utilized a de-centralized approach to recruitment in which primary responsibility for recruitment was assigned to the general AA community of various church partners whereas the other incorporated a centralized approach to recruitment in which a single lay community individual was hired as research personnel to lead recruitment and intervention delivery. Both studies performed equally well for both recruitment and retention (75 and 88 % recruitment rates and 71 and 66 % retention rates) far exceeding those rates traditionally cited for cancer clinical trials (~5 %). The de-centralized approach to retention appeared to result in statistically greater retention for the control participants compared to the centralized approach (77 vs. 51 %, p < 0.01). Consequently, both CBPR approaches appeared to greatly enhance recruitment and retention rates of AA populations. We further note lessons learned and challenges to consider for future research opportunities. [ABSTRACT FROM AUTHOR]