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The emergence of the International Social Marketing Association (iSMA) and its affiliated regional associations is a key indicator that social marketing is maturing, both as a community of practice and as a profession. Through these associations, the international social marketing community has developed a consensus definition of the discipline and a consensus list of basic competencies for social marketing certificate programs. The associations are currently working on certification programs and a code of ethics. Continued movement toward professionalization can help social marketers be recognized and valued more highly for their relevant skills, knowledge, expertise, trustworthiness and altruism. At the same time, the discipline must address a number of key challenges and opportunities, to stay relevant and thrive.

Background: The purpose of this review was to examine and chart the “scope” of strategies reported in ED-SBIRT (emergency department-based screening, brief intervention and referral to treatment) studies that employ non–face-to-face (nFtF) modalities for high-risk alcohol use (i.e., risk for alcohol-related injury, medical condition, use disorder) and to identify research gaps in the scientific literature. Methods: The scoping review population included study participants with high-risk alcohol use patterns as well as study participants targeted for primary public health prevention (e.g., adolescent ED patients). Core concepts included SBIRT components among intervention studies that incorporated some form of nFtF modality (e.g., computer-assisted brief intervention). The context encompassed ED-based studies or trauma center studies, regardless of geographic location. After screening a total of 1526 unique references, reviewers independently assessed 58 full-text articles for eligibility. Results: A total of 30 full-text articles were included. Articles covered a period of 14 years (2003–2016) and 19 journal titles. Authors reported the use of a wide range of nFtF modalities across all 3 ED-SBIRT components: “screening” (e.g., computer tablet screening), “brief intervention” (e.g., text message–based brief interventions), and “referral to treatment” (e.g., computer-generated feedback with information about alcohol treatment services). The most frequently used nFtF modality was computerized screening and/or baseline assessment. The main results were mixed with respect to showing evidence of ED-SBIRT intervention effects. Conclusions: There is an opportunity for substance use disorder researchers to explore the specific needs of several populations (e.g., ED patients with co-occurring problems such as substance use disorder and violence victimization) and on several methodological issues (e.g., ED-SBIRT theory of change). Substance use disorder researchers should take the lead on establishing guidelines for the reporting of ED-SBIRT studies—including categorization schemes for various nFtF modalities. This would facilitate both secondary research (e.g., meta-analyses) and primary research design.

Objective: The Emergency Department (ED) Geriatric Readmission Assessment (ED-GRAY) is a 16-item questionnaire we developed that can be used to evaluate the prognostic ability to determine if geriatric patients will recidivate to the ED, be admitted or die within 30 days. Methods: We conducted an observational prospective cohort study at a single academic urban university-affiliated hospital. Subjects (n=250) were consenting, non-critically ill, English-speaking Original Research Article Post et al.; BJMMR, 14(1): 1-8, 2016; Article no.BJMMR.23877 2 adults older than 65 years and receiving care in the ED. Multivariable logistic regression and receiver operating characteristic (ROC) curves were used to evaluate the ability to accurately predict the likelihood of a 30-day event: subsequent ED visit, hospitalization, or death. Results: 56 participants (22%) experienced at least one 30-day return visit or death. Greater disability as measured by the ED GRAY global disability was associated with an increased likelihood of an event (OR=1.7 for each 1-point worsening in severity; 95% CI 1.2, 2.5). In the multivariable model, prior ED visits (OR=2.7, 95% CI=1.4, 5.2), ED GRAY global score (OR=1.4, 95% CI=1.0, 2.1), and age (OR=1.03, 95% CI=0.99, 1.07) were associated with a greater likelihood of a 30-day event. The fit of the multivariable model was good (Hosmer-Lemeshow Goodness of Fit test, p=0.85) and it provided good discrimination between those having and not having a 30-day event (AUROC=0.70). The predicted probability of a return visit ranged from 3–56%. Conclusions: ED GRAY demonstrated good predictive validity when combined with prior ED visits, poly-pharmacy and age.

Objective: Our primary objective was to develop a reliable, valid, and efficient screening tool that measures recovery disability among geriatric patients for the Department of Emergency Medicine (ED) Geriatric Readmission Assessments (GRAY). Methods: We conducted a retrospective medical chart review and prospective data analysis of geriatric patients admitted to hospital from the emergency department that were discharged, admitted, or died at a single academic urban university-affiliated hospital to identify items for ED GRAY. Rasch analysis was then used to reduce items and construct an interval/ratio scale of physical and cognitive disabilities. Patients consisted of a cohort of consenting, non-critically ill, English-speaking adults older than 65 years and receiving care in the ED to reduce the number of items. Original Research Article Post et al.; BJMMR, 14(1): 1-14, 2016; Article no.BJMMR.23875 2 Results: Rasch analyses resulted in infit and outfit statistics that eliminated redundant items or items that did not fit a unidimensional disability construct. From the 158 original items, sixteen items comprise the ED GRAY global health questionnaire, representing five sub-constructs: physical disability, cognitive disability, stress, depression, and isolation. All infit and outfit statistics for the global recovery disability score ranging from 1 (least healthy) to 5 (most healthy) were consistent with forming a unidimensional scale. Conclusions: Our study resulted in an objective measurement tool of physical and cognitive disability using Rasch analyses. This screening tool allows healthcare providers the ability to screen older ED patients on a continuum of risk, with high-risk patients being most likely to benefit from indepth evaluation—e.g., comprehensive geriatric assessment—followed by intervention (when necessary).

Introduction Several studies have measured health outcomes in the United States, but none have provided a comprehensive assessment of patterns of health by state. Objective To use the results of the Global Burden of Disease Study (GBD) to report trends in the burden of diseases, injuries, and risk factors at the state level from 1990 to 2016. Design and Setting A systematic analysis of published studies and available data sources estimates the burden of disease by age, sex, geography, and year. Main Outcomes and Measures Prevalence, incidence, mortality, life expectancy, healthy life expectancy (HALE), years of life lost (YLLs) due to premature mortality, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 333 causes and 84 risk factors with 95% uncertainty intervals (UIs) were computed. Results Between 1990 and 2016, overall death rates in the United States declined from 745.2 (95%UI, 740.6 to 749.8) per 100 000 persons to 578.0 (95%UI, 569.4 to 587.1) per 100 000 persons. The probability of death among adults aged 20 to 55 years declined in 31 states and Washington, DC from 1990 to 2016. In 2016, Hawaii had the highest life expectancy at birth (81.3 years) and Mississippi had the lowest (74.7 years), a 6.6-year difference. Minnesota had the highest HALE at birth (70.3 years), andWest Virginia had the lowest (63.8 years), a 6.5-year difference. The leading causes of DALYs in the United States for 1990 and 2016 were ischemic heart disease and lung cancer, while the third leading cause in 1990 was low back pain, and the third leading cause in 2016 was chronic obstructive pulmonary disease. Opioid use disorders moved from the 11th leading cause of DALYs in 1990 to the 7th leading cause in 2016, representing a 74.5%(95%UI, 42.8%to 93.9%) change. In 2016, each of the following 6 risks individually accounted for more than 5%of risk-attributable DALYs: tobacco consumption, high body mass index (BMI), poor diet, alcohol and drug use, high fasting plasma glucose, and high blood pressure. Across all US states, the top risk factors in terms of attributable DALYs were due to 1 of the 3 following causes: tobacco consumption (32 states), high BMI (10 states), or alcohol and drug use (8 states). Conclusions and Relevance There are wide differences in the burden of disease at the state level. Specific diseases and risk factors, such as drug use disorders, high BMI, poor diet, high fasting plasma glucose level, and alcohol use disorders are increasing and warrant increased attention. These data can be used to inform national health priorities for research, clinical care, and policy.

Please cite this paper as: August E, Salihu H, Weldeselasse H, Biroscak B, Mbah A, Alio A. Infant mortality and subsequent risk of stillbirth: a retrospective cohort study. BJOG 2011;118:1636–1645. Objective To examine the association between infant mortality in a first pregnancy and risk for stillbirth in a second pregnancy. Design Population-based, retrospective cohort study. Setting Maternally linked cohort data files for the state of Missouri. Population Women who had two singleton pregnancies in Missouri during the period 1989–2005 (n = 320 350). Methods Women whose first pregnancy resulted in infant death were compared with those whose infant from the first pregnancy survived the first year of life. The Kaplan–Meier product limit estimator was employed to compare probabilities for stillbirth in the second pregnancy between both groups of women. Adjusted hazard ratios (AHRs) and 95% confidence intervals (95% CIs) were generated to assess the association between infant mortality in the first pregnancy and stillbirth in the second pregnancy. Main outcome measures Exposure was defined as infant mortality in the first pregnancy, and the outcome was defined as stillbirth in the second pregnancy. Results Women with prior infant deaths were about three times as likely to experience stillbirth in their subsequent pregnancy (AHR 2.91; 95% CI 2.02–4.18). White women with a previous infant death were nearly twice as likely to experience a subsequent stillbirth, compared with white women with a surviving infant (AHR 1.96; 95% CI 1.13–3.39). Black women with a previous infant death were more than four times as likely to experience subsequent stillbirth, compared with black women with a surviving infant (AHR 4.28; 95% CI 2.61–6.99). Conclusions Previous infant mortality results in an elevated risk for subsequent stillbirth, with the most profound increase observed among black women. Interconception care should consider prior childbearing experiences to avert subsequent fetal loss.

BackgroundLittle is known about “new media” use, defined as media content created or consumed on demand on an electronic device, by patients in emergency department (ED) settings. The application of this technology has the potential to enhance health care beyond the index visit. ObjectiveThe objectives are to determine the prevalence and characteristics of ED patients’ use of new media and to then define and identify the potential of new media to transcend health care barriers and improve the public’s health. MethodsFace-to-face, cross-sectional surveys in Spanish and English were given to 5,994 patients who were sequentially enrolled from July 12 to August 30, 2012. Data were collected from across a Southern Connecticut health care system’s 3 high-volume EDs for 24 hours a day, 7 days a week for 6 weeks. The EDs were part of an urban academic teaching hospital, an urban community hospital, and an academic affiliate hospital. ResultsA total of 5,994 (89% response rate) ED patients reported identical ownership of cell phones (85%, P.05) and personal health records (P

Objectives. Articles describing the epidemiology of intimate partner homicide (IPH) have often been positioned as one-time research projects utilizing a single data source for case identification. However, researchers without access to centralized repositories for data pertinent to IPH can ascertain cases by using multiple extant data sources. The authors describe a surveillance system that can serve as a model for state health departments and others seeking to quantify and characterize violent deaths related to intimate partner relationships on an ongoing basis. Methods. Retrospective surveillance was conducted to identify and characterize deaths related to intimate partnerships by linking the following data sources: death certificates, newspaper articles, law enforcement reports, and medical examiners' records. Results. The authors identified at least 34% more IPHs using multiple data sources than would have been recognized solely using Supplementary Homicide Reports—the most frequently cited data source for IPH case ascertainment—and 22% more cases than newspaper data alone would have allowed for. Conclusions. While it was discovered that at least 181 IPHs—and at least 128 other deaths related to intimate partnerships—occurred in Michigan from 1999–2001, this frequency of occurrences is probably conservative. This limitation is due, in part, to the researchers not having access to information from all possible data source contributors. However, in the absence of statewide data systems, the authors demonstrate the utility of using multiple data sources for violent death surveillance to address incomplete case ascertainment.

To assess the association between bariatric surgery and pregnancy-related outcomes among obese and non-obese women in the state of Florida. We conducted a population-based, retrospective cohort analysis using vital records and hospital discharge data in Florida during 2004–2007. Women were categorized based on prior bariatric surgery and pre-pregnancy obesity status. Maternal complications (i.e., anemia, pre-eclampsia, gestational diabetes, chronic hypertension, endocrine disorders, cesarean section, prolonged hospital stay) and fetal morbidities [macrosomia, preterm birth, small for gestational age (SGA)] were the outcomes of interest. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were computed. Mothers with a prior history of bariatric surgery, regardless of obesity status, were more likely to have anemia, chronic hypertension, endocrine disorders, and SGA infants. Classification based on prior history of bariatric surgery and obesity status showed that non-obese mothers with prior bariatric surgery were more likely to have anemia, chronic hypertension, endocrine disorders, and SGA infants, whereas obese mothers without prior bariatric surgery were at greater risk of having gestational diabetes, chronic hypertension, macrosomic infants (AOR = 1.69, 95% CI = 1.65–1.73), and prolonged hospital stay as compared to non-obese mother without prior bariatric surgery. Although prior bariatric surgery is associated with multiple negative maternal and fetal outcomes, it is protective against infant macrosomia in obese mothers. Our findings support the need for preconception/interconception services tailored for former bariatric surgery patients to improve maternal and feto-infant health outcomes.