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The purpose of this paper is to characterize investigative structures and investigator characteristics for each APS office in all 50 states and the District of Columbia. Through mailed questionnaires and follow-up telephone calls, 1,409 questionnaires were completed for a return rate of 80%. The mean age of respondents was 46.4 years and ninety-nine percent of the respondents worked full-time and has been in his or her current position for an average of nine years. Half of the respondents reported using abuse screen or risk factor instruments when investigating an alleged elder abuse report. Seventy-three percent reported that they investigate only adult and elder allegations. Sixty percent of the respondents reported that a formal training program for elder abuse evaluations was in place for employees with an average length of two to four days. Sixty-nine percent of the investigators consider an elder to be "better off" most of the time following intervention, and that this improved status was a direct result of the resources provided. Nearly three-fourths of investigators reported that elder abuse was under reported in their area. Those on the front lines, the APS investigators, provide valuable insights regarding the systems in which they work. [ABSTRACT FROM AUTHOR]

Reports that Washington, D.C.-based American Forest and Paper Association released its Fiber Consumption Report that was included in its annual Capacity Survey. Decrease in total fiber consumption at U.S. paper and paperboard mills.

Cervical cancer screening and human papillomavirus (HPV) vaccination are critical for those immunocompromised due to human immunodeficiency virus (HIV). Health education programs, including text messaging, can effectively improve knowledge of cervical cancer and recommended screening. This paper describes the data-driven development of a 4-week text-messaging intervention to improve HPV and cervical cancer knowledge among women living with HIV (WLH). This study reports data from surveys (n  = 81; January 2020 to September 2021) and focus group discussions (FGDs, n  = 39; April–June 2020) conducted among WLH in the DC area. While most WLH revealed that their usual sources of health information were through in-person group sessions, they pointed out that these were impractical options due to the coronavirus 2019 pandemic. They noted that a text-messaging intervention was feasible and acceptable. FGD participants' responses structured around the Protection Motivation Theory constructs informed the text-messaging library, covering topics such as (I) understanding of cervical cancer and HPV, (II) cervical cancer prevention and (III) HPV self-sampling. The utilization of low-cost and easily accessible health education interventions, such as mobile-based text messaging, can effectively increase knowledge and awareness of cervical cancer in populations that have been historically difficult to access and during times when health services are disrupted such as during a global pandemic or public health emergency. [ABSTRACT FROM AUTHOR]

This paper examines to what extent household surveys and censuses in low- and middle-income countries include disability questions and the types of questions under use. We found that only 31% of 734 datasets between 2009 and 2018 from 133 low- and middle-income countries have at least one disability-related question. Of the surveys reviewed, 15% of the datasets have functional difficulty questions that meet international standards, i.e. Washington Group short set or other functional difficulty questions. Meanwhile, the most asked disability question "Do you have a disability?" is problematic as it does not produce meaningful and internationally comparable data. We recommend the adoption of functional difficulty questions for all surveys and censuses to track the progress of the implementation of the 2030 Agenda for Sustainable Development as well as the Convention on the Rights of Persons with Disabilities. [ABSTRACT FROM AUTHOR]

Many of the more than 1 million military veterans who identify as lesbian, gay, bisexual, and/or transgender (LGBT) have encountered "rejecting experiences in the military" and stigma from prior "Don't Ask Don't Tell" policies. Associated minority stress and social isolation have been linked to a disproportionate risk for depression and suicide, as well as a reluctance to seek medical care at Veterans Health Administration (VHA) facilities. This paper describes feasibility and preliminary outcomes of the newly developed, Pride in All Who Served Health Education Group created to meet the unique needs of sexual and gender minority veterans. The 10-week, closed, health education group (e.g., continuums of identity, military culture) enables open dialogue, fosters social connectedness, and empowers veterans to be more effective self-advocates within the healthcare system. Feedback from formative evaluations (n = 29 LGBT veterans and n = 25 VHA stakeholders) was incorporated before conducting a small scale, non-randomized pilot. Preliminary pre-post surveys (n = 18) show promise (i.e., Cohen's d range ± 0.40 to 1.59) on mental health symptoms (depression/anxiety, suicidal ideation), resilience indicators (identity affirmation, community involvement, problem-focused coping), and willingness to access care within the VA system (satisfaction with VA services, perception of staff competence). Results suggest that the 10-week Pride Group may be an effective tool for addressing minority-related stress in LGBT veterans. A full-scale, randomized clinical trial of this intervention is needed to determine short and long-term impacts on clinical and healthcare access-related outcomes. [ABSTRACT FROM AUTHOR]

This paper presents a performance-based methodology for the assessment of seismic vulnerability and capacity of buildings. The vulnerability assessment methodology is based on the HAZUS methodology and the improved capacitydemand-diagram method. The spectral displacement ( S d) of performance points on a capacity curve is used to estimate the damage level of a building. The relationship between S d and peak ground acceleration (PGA) is established, and then a new vulnerability function is expressed in terms of PGA. Furthermore, the expected value of the seismic capacity index (SCev) is provided to estimate the seismic capacity of buildings based on the probability distribution of damage levels and the corresponding seismic capacity index. The results indicate that the proposed vulnerability methodology is able to assess seismic damage of a large number of building stock directly and quickly following an earthquake. The SCev provides an effective index to measure the seismic capacity of buildings and illustrate the relationship between the seismic capacity of buildings and seismic action. The estimated result is compared with damage surveys of the cities of Dujiangyan and Jiangyou in the M8.0 Wenchuan earthquake, revealing that the methodology is acceptable for seismic risk assessment and decision making. The primary reasons for discrepancies between the estimated results and the damage surveys are discussed. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to characterize investigative structures and investigator characteristics for each APS office in all 50 states and the District of Columbia. Through mailed questionnaires and follow-up telephone calls, 1,409 questionnaires were completed for a return rate of 80%. The mean age of respondents was 46.4 years and ninety-nine percent of the respondents worked full-time and has been in his or her current position for an average of nine years. Half of the respondents reported using abuse screen or risk factor instruments when investigating an alleged elder abuse report. Seventy-three percent reported that they investigate only adult and elder allegations. Sixty percent of the respondents reported that a formal training program for elder abuse evaluations was in place for employees with an average length of two to four days. Sixty-nine percent of the investigators consider an elder to be "better off" most of the time following intervention, and that this improved status was a direct result of the resources provided. Nearly three-fourths of investigators reported that elder abuse was under reported in their area. Those on the front lines, the APS investigators, provide valuable insights regarding the systems in which they work. [ABSTRACT FROM AUTHOR]

A primary goal of the paper is to provide an example of an evaluation design and analytic method that can be used to strengthen causal inference in nonexperimental prevention research. We used this method in a nonexperimental multisite study to evaluate short-term outcomes of a preventive intervention, and we accounted for effects of two types of selection bias: self-selection into the program and differential dropout. To provide context for our analytic approach, we present an overview of the counterfactual model (also known as Rubin's causal model or the potential outcomes model) and several methods derived from that model, including propensity score matching, the Heckman two-step approach, and full information maximum likelihood based on a bivariate probit model and its trivariate generalization. We provide an example using evaluation data from a community-based family intervention and a nonexperimental control group constructed from the Washington State biennial Healthy Youth Survey (HYS) risk behavior data (HYS n = 68,846; intervention n = 1,502). We identified significant effects of participant, program, and community attributes in self-selection into the program and program completion. Identification of specific selection effects is useful for developing recruitment and retention strategies, and failure to identify selection may lead to inaccurate estimation of outcomes and their public health impact. Counterfactual models allow us to evaluate interventions in uncontrolled settings and still maintain some confidence in the internal validity of our inferences; their application holds great promise for the field of prevention science as we scale up to community dissemination of preventive interventions. [ABSTRACT FROM AUTHOR]

The article presents a paper that summarizes the present status of output measurement in urban government--the state of the art as well as the use being made of it--and discusses briefly prospects for its use and further development in the immediate future. The paper is concerned with measurement of both the quantitative and qualitative aspects of local government services. Two services, solid waste collection and recreation, are used to illustrate problems of measuring output and how they are being resolved. An important quality factor of solid waste collection is the resulting cleanliness. To measure this output the Washington D.C. government has implemented a method of inspector ratings of street and alley litter conditions. Three general conclusions regarding the present state of output measurement in local governments emerge from the two surveys. First, most governments collect some data on quantitative outputs. Second, some local governments collect data on qualitative aspects of output. And third, the state of measurements varies dramatically by service or program area.

Pre-exposure prophylaxis (PrEP) for HIV is highly effective, yet uptake has been limited. We measured PrEP knowledge, eligibility, and referral willingness among patients receiving emergency or acute care in Washington, DC. We surveyed HIV-negative patients with STI-related complaints on HIV risk behaviors, PrEP knowledge, eligibility, and willingness for PrEP referral. Among 174 participants, 70% were PrEP unaware and 33% were PrEP eligible. Most participants (81%) supported learning more, 64% would consider taking PrEP, and 28% agreed to immediate referral. Willingness to learn more about PrEP suggests referral from non-traditional settings may increase uptake. Further evaluation of this approach is warranted. [ABSTRACT FROM AUTHOR]

Objectives: To reduce the number of new HIV infections and improve HIV health care outcomes, the social conditions in which people live and work should be assessed. The objective of this study was to describe linkage to HIV medical care by selected demographic characteristics and social determinants of health (SDH) among US adults with HIV at the county level. Methods: We used National HIV Surveillance System data from 42 US jurisdictions and data from the American Community Survey to describe differences in linkage to HIV medical care among adults aged ≥18 with HIV infection diagnosed in 2017. We categorized SDH variables into higher or lower levels of poverty (where <13% or ≥13% of the population lived below the federal poverty level), education (where <13% or ≥13% of the population had

Recent uprisings have led to calls to defund police and invest in Black and Brown communities. This article explores the lessons learned about community safety from a four-year effort to reduce crime and improve safety in a predominately Latinx suburb of Washington, DC. It shows that programs that invested in building trust and rapport between police and community had little impact. Alternatively, efforts that built community, resourced and engaged residents, and invested in neighborhood infrastructure were more effective. The case highlights the critical role of community-based organizations in helping residents imagine and execute programs that improve community safety without relying on police. [ABSTRACT FROM AUTHOR]

Objectives: The Accreditation Council for Graduate Medical Education has guidelines on assessing surgical qualifications based on experience. Attending surgeons have various assumptions on how their trainees learn and acquire surgical skills. This study primarily investigates the resident's perspective on gaining experience and achieving competency in thyroid surgical procedures. Methods: A qualitative study using semi-structured interviews was designed to derive themes that discuss the acquisition of competency in thyroid surgery. After IRB approval, data was collected from 2012 to 2014 at 4 academic centers in the Washington, DC area. Fourteen chief residents specializing in either general surgery or otolaryngology were interviewed until saturation was achieved. These semi-structured interviews were transcribed and broken up into codes utilizing Moustakas' analysis. A comprehensive list of master themes in regards to achieving competency in thyroid surgery was developed. A follow up survey of the surgeons was undertaken at 5 years to determine if the perceptions during residency persisted in practice. Results: Surgical specialty residents experience and learn thyroid surgery in 5 learning themes: 1. Self—directed learning is significant during residency. 2. Repetition with graduated autonomy is key. 3. Effective mentors are competent surgeons who challenge residents and use positive teaching techniques. 4. Residents employ active learning through the "see one, do one, teach one" philosophy. 5. Learning from complexity is of importance to residency training. After several years in practice, the most important theme in learning after residency was repetition of cases. Conclusions: This study demonstrates how residents progress in approaching competency in thyroid surgery. Adult learning strategies are preferred, and programs should incorporate tailored techniques to meet the individual needs of the residents. Perceptions of what is most important shifted in long-term follow up. Further study is needed to assure competency in residency and in practice. [ABSTRACT FROM AUTHOR]

The article focuses on the issue of the victimization and crime in a ghetto community. Field Surveys I collected data on 511 randomly selected adults in three police districts in Washington, D.C. Forty percent of those interviewed said they had never been victimized. The respondents in Washington saw crime as serious, and 75% thought it was getting worse. Field Surveys II focuses on a national, random sample of 10,000 persons, 2,100 of whom were victimized. Despite high crime rates in the police precincts sampled, a majority of the respondents thought their neighborhoods were no worse than most other areas in the city. Respondents were asked whether they had ever been victimized in any of nine possible ways; those who replied affirmatively were asked whether this had happened during the last twelve months. The pattern of victimization by age is different for each race-ethnic group, although the differences by age within each race-ethnic group are small. Long-time residents of the community are more likely to be victimized, in all four race-ethnic groups, than are newcomers, except among blacks, among whom those of medium- and long-term residence are more likely to be victimized.

Breastfeeding is something that many new mothers aspire to do, but also something that many struggle with in the days following birth. Nursing support in the hospital can make a huge difference in the success of this endeavor for many patients. It is important for nurse educators that work with the obstetric population, and the nurses that care for them, to understand what drives nurses to be supportive of patients who have recently given birth in their breastfeeding efforts. This will allow for appropriate interventions to be implemented to increase the level of support. This study seeks to determine if a relationship exists between nurses' level of education and specialty certification, and their intent to provide support to new mothers in their efforts to breastfeed their babies. [ABSTRACT FROM AUTHOR]

Bullying is a serious public health issue among children and adolescents in the United States. The purpose of this study was to estimate the prevalence of bullying victimization (defined as a child being bullied, picked on, or excluded by children) in the 50 states and the District of Columbia. We used data on bullying victimization from the 2016-2017 National Survey of Children's Health (NSCH). We stratified the sample by age: children aged 6-11 years (n = 21 142) and adolescents aged 12-17 years (n = 29 011). We conducted bivariate analyses to determine the prevalence of bullying victimization by state for each age group. In the survey, parents/caregivers responded to a question about whether it was "definitely true," "somewhat true," or "not true" that their child "is being bullied, picked on, or excluded by other children." We combined "definitely true" and "somewhat true" responses to create a dichotomous variable for bullying victimization. Parents reported 22.4% of children aged 6-11 years and 21.0% of adolescents aged 12-17 years as experiencing bullying victimization during 2016-2017. The prevalence of bullying victimization among children ranged from 16.5% in New York State to 35.9% in Wyoming and among adolescents ranged from 14.9% in Nevada to 31.6% in Montana. The prevalence of bullying victimization among children or adolescents was >30% in 7 states: Arkansas, Kentucky, Maine, Montana, North Dakota, South Dakota, and Wyoming. These data can be used to inform state programs and policies to support bullying prevention efforts and services for children and adolescents who experience bullying. NSCH will continue to collect data on bullying victimization to track annual trends in national and state-level prevalence rates among children and adolescents. [ABSTRACT FROM AUTHOR]

Lower wage workers, known to seek more care in the emergency department (ED), may encounter more barriers to timely outpatient primary care. This study aimed to identify differences in self-reported delays in care related to 4 modifiable barriers (phone availability, appointment wait time, in-clinic wait time, and limited service hours) across self-reported wage and to examine the relationship between these care delays and self-reported ED use. The authors examined data from the 2011–2015 National Health Interview Surveys for 58,298 self-identified full-time workers. Multivariable logistic models with geographical region and year fixed effects were used to test the association of wage group and barriers to care. In addition, the multiplicative and additive interaction effects upon self-reported ED use were tested. No association was observed between wage level and barrier to timely care. Lower wage workers (<$25,000 vs. >$75,000/yr.; OR 1.53, 95% CI 1.20–1.94, P = 0.001) and those reporting any of the 4 barriers to care (OR 1.99, 95% CI 1.71–1.94, P < 0.001) were more likely to report 2 or more ED visits in the past year. Multiplicative effects were not statistically significant. Additive interaction effects of wage and barriers were only significant among workers with wages $35,000–$44,999 annually (vs. >$75,000: relative excess risk coef. 1.23, 95% CI 0.07–2.38, P = 0.037) for 2 or more ED visits in past year. Although these modifiable barriers may explain the differences in repeat ED use for workers earning $35,000–$44,999 annually, these barriers do not explain disparities in ED use between highest and lowest wage workers. [ABSTRACT FROM AUTHOR]

Objective: We sought to assess the frequency, content, and quality of shared decision making (SDM) in the emergency department (ED), from patients' perspectives. Methods: Utilizing a cross‐sectional, multisite approach, we administered an instrument, consisting of two validated SDM assessment tools—the CollaboRATE and the SDM‐Q‐9—and one newly developed tool to a sample of ED patients. Our primary outcome was the occurrence of SDM in the clinical encounter, as defined by participants giving "top‐box" scores on the CollaboRATE measure, and the ability of patients to identify the topic of their SDM conversation. Secondary outcomes included the content of the SDM conversations, as judged by patients, and whether patients were able to complete each of the two validated scales included in the instrument. Results: After exclusions, 285 participants from two sites completed the composite instrument. Just under half identified as female (47%) or as white (47%). Roughly half gave top‐box scores (i.e., indicating optimal SDM) on the CollaboRATE scale (49%). Less than half of the participants were able to indicate a decision they were involved in (44%), although those who did gave high scores for such conversations (73/100 via the SDM‐Q‐9 tool). The most frequently identified decisions discussed were admission versus discharge (19%), medication options (17%), and options for follow‐up care (15%). Conclusions: Fewer than half of ED patients surveyed reported they were involved in SDM. The most common decision for which SDM was used was around ED disposition (admission vs. discharge). When SDM was employed, patients generally rated the discussion highly. [ABSTRACT FROM AUTHOR]

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Background: The expectation to remain in the labor force is a powerful indicator of long-term employment outcomes for people with multiple sclerosis (MS), and it is determined in part by perceived current job performance. Objective: This study identified correlates of perceived job performance among working adults with MS. Method: Participants included 611 members of nine National Multiple Sclerosis Society chapters representing 21 states and Washington, DC. Participants were employed, and primarily female (81%), older (average age of 48 years), and White (77%). Results: Hierarchical multiple regression analysis revealed that males, Whites, people without or with low levels of cognitive impairment, and those who reported stronger job/person matches and higher levels of job satisfaction were more likely than other participants to positively evaluate their own job performance. The aggregated predictors explained 20% of the variability in participants' job performance self-ratings. Implications: Findings show the complexity in predicting how satisfied employed people with MS are with their overall job performance, which in turn shapes their expectations and intentions about staying in or disengaging from the workforce. The implications of the findings for rehabilitation counseling interventions and for identifying adults with MS who would benefit from early intervention are discussed. [ABSTRACT FROM AUTHOR]

Healthy People 2020 targets high vaccination coverage among children. Although reductions in coverage disparities by race/ethnicity have been described, data by nativity are limited. The National Immunization Survey is a random-digit-dialed telephone survey that estimates vaccination coverage among U.S. children aged 19-35 months. We assessed coverage among 52,441 children from pooled 2010-2012 data for individual vaccines and the combined 4:3:1:3*:3:1:4 series (which includes ≥4 doses of diphtheria, tetanus, and acellular pertussis vaccine/diphtheria and tetanus toxoids vaccine/diphtheria, tetanus toxoids, and pertussis vaccine, ≥3 doses of poliovirus vaccine, ≥1 dose of measles-containing vaccine, ≥3 or ≥4 doses of Haemophilus influenzae type b vaccine (depending on product type of vaccine; denoted as 3* in the series name), ≥3 doses of hepatitis B vaccine, ≥1 dose of varicella vaccine, and ≥4 doses of pneumococcal conjugate vaccine). Coverage estimates controlling for sociodemographic factors and multivariable logistic regression modeling for 4:3:1:3*:3:1:4 series completion are presented. Significantly lower coverage among foreign-born children was detected for DTaP, hepatitis A, hepatitis B, Hib, pneumococcal conjugate, and rotavirus vaccines, and for the combined series. Series completion disparities persisted after control for demographic, access-to-care, poverty, and language effects. Substantial and potentially widening disparities in vaccination coverage exist among foreign-born children. Improved immunization strategies targeting this population and continued vaccination coverage monitoring by nativity are needed. [ABSTRACT FROM AUTHOR]

Vietnamese Americans have high rates of hepatitis B virus (HBV) infection but low rates of knowledge and screening. A population-based survey conducted in 2011 of Vietnamese Americans in two geographic areas (n = 1666) was analyzed. The outcome variables were having heard of HBV and a score summarizing knowledge of HBV transmission. Most respondents (86.0%) had heard of HBV. Correct knowledge of transmission ranged from 59.5% for sex, 68.1% for sharing toothbrushes, 78.6% for during birth, and 85.0% for sharing needles. In multivariable analyses, factors associated with having heard of HBV and higher knowledge included Northern California residence, longer U.S. residence, higher education, family history of HBV, and discussing HBV with family/friends. Higher income was associated with having heard of HBV. English fluency and being U.S.-born were associated with higher knowledge. Interventions to increase knowledge of HBV transmission are needed to decrease this health disparity among Vietnamese Americans. [ABSTRACT FROM AUTHOR]

Cultural issues tied to race/ethnicity are important aspects in delivering medical home services to children with neurodevelopmental disabilities and their families. To better understand family satisfaction with family centered care (FCC) in medical homes of children with disabilities, this study investigated whether family race/ethnicity, in addition to parent and child characteristics, significantly influenced family perceptions of FCC in three areas: family-provider partnership, care setting practices and policies, and community coordination and follow-up. Based on the life course theory for optimizing children's developmental trajectories, examining connections between family race/ethnicity and satisfaction with health care allows for identification of strengths and weaknesses in medical home services delivery, and offers opportunities for family support and improvement in outcomes for children with disabilities. This study developed an original empirical survey using a structured questionnaire developed by Family Voices, a national advocacy organization dedicated to promoting the well-being of children with disabilities and their families. The study collected data for 122 families in a large urban area in the northeastern United States. Multivariate analyses revealed that family race/ethnicity significantly contributed to the prediction of parental satisfaction with medical homes of children with disabilities, and to families' perceptions of FCC in care setting practices and policies, and community coordination and followup, but not to family provider partnership. Non-White families reported significantly lower satisfaction. Discussion emphasizes that health care providers need to become more vigilant in providing culturally sensitive care. To enhance FCC practices and policies, the study advances a checklist of ten essential areas that promote culturally sensitive interactions between families of children with disabilities and their medical and non-medical health care providers. [ABSTRACT FROM AUTHOR]

The study of conflict processes often focuses on the manner in which disagreements are resolved, such that relationship deterioration is a product of the failure to negotiate. However, conflict management tactics may not be the most salient feature of parent-adolescent conflicts because these relationships are obligatory, with power unevenly distributed, and negotiated resolutions unanticipated. Instead, parent-adolescent relationships may be more sensitive to the affective tenor of the interchange than the manner in which the dispute is resolved. In two studies, we examined the premise that relationship damage arising from disagreements between mothers and adolescent children is a product of negative affect and failure to compromise. Concurrent analyses involved reports from 101 (33 boys, 68 girls) adolescents (M = 13.89 years old) about conflict with mothers. Longitudinal analyses involved reports from 271 (112 boys, 159 girls) adolescents (M = 11.6 years old at the outset) about conflict with mothers at two time points 1 year apart. Compromise and youth negative affect were moderately correlated; when both were included as predictors of adverse relationship consequences arising from conflict, negative affect accounted for almost all of the variance, concurrently and prospectively. Scholars and practitioners who advise families that negotiated resolutions to disagreements help to avoid relationship disruption may be discouraged in their efforts unless a similar emphasis is placed on minimizing negative affect. [ABSTRACT FROM AUTHOR]

Aims: A potential unintended consequence of legalizing recreational marijuana is increased marijuana-related driving impairment. Some states where recreational marijuana is legal have begun implementing interventions to mitigate driving under the influence (DUI) of marijuana, including media campaigns to increase knowledge about DUI laws. However, little is known about the associations between knowledge of DUI laws and marijuana DUI behavior. In this study, we provide new data from a survey of marijuana users in Colorado and Washington to examine associations between marijuana drugged driving and two potential behavioral precursors of marijuana DUI. We also explore other factors that may influence marijuana DUI. Methods: Data are from an online survey of marijuana users in Colorado and Washington. Respondents who reported any marijuana use in the past 30 days (n = 865) served as the analytic sample. We examined prevalence of two behavioral outcomes: (1) any driving of a motor vehicle while high in the past year and (2) driving a motor vehicle within 1 hour of using marijuana 5 or more times in the past month. Additional outcomes measuring willingness to drive while high were also assessed. Logistic regressions were used to estimate each outcome as a function of two multi-item scales measuring knowledge of the legal consequences of driving high and perceptions that driving while high is not safe. Additional covariates for potential confounders were included in each model. Results: Prevalence of past-year driving while under the influence of marijuana was 43.6% among respondents. The prevalence of driving within 1 hour of using marijuana at least 5 times in the past month was 23.9%. Increased perception that driving high is unsafe was associated with lower odds of past-year marijuana DUI (OR = 0.31, P < 0.01) and lower past-month odds of driving 5 or more times within 1 hour of using marijuana (OR = 0.26, P < 0.01). Increased knowledge of marijuana DUI laws was also associated with lower odds of each of these outcomes (OR = 0.63, P < 0.01, OR = 0.69, P = 0.02, respectively). Post-estimation Wald tests confirmed the negative associations with marijuana DUI were greater in magnitude for safety perceptions than knowledge of DUI laws. Increased perceptions that driving while high is unsafe was associated with significantly lower willingness to drive after using marijuana while increased knowledge of marijuana DUI laws was not associated with these outcomes. Conclusions: Despite recent interventions targeting public awareness of the legal consequences of marijuana DUI, our results suggest that knowledge of these laws is a weaker predictor of DUI behavior than perceptions that driving high is unsafe. In addition, safety perceptions predict decreased openness to driving high while knowledge of DUI laws was not associated with openness. These findings suggest that interventions for reducing the incidence of marijuana DUI are likely to be more successful by targeting safety perceptions related to marijuana DUI rather than knowledge of DUI laws. We caution that because these data are limited to an online convenience sample, results may not be generalizable beyond our sample. [ABSTRACT FROM AUTHOR]

Objective. This study assessed the usefulness of the Healthy Weight Disparity Index (HWDI) to evaluate income disparities related to obesity. We compared state based body mass index (BMI) rankings with HWDI rankings. Methods. National data from the 2010 Behavioral Risk Factor Surveillance System were used to estimate mean BMI levels in each of the 50 states (plus Washington, D.C.) by income level. Income-related disparities were described with the HWDI. Kappa statistics analyzed the concordance between the two rankings. Results. State-based BMI and the HWDI rankings were not concordant. For example, Washington, D.C. was ninth for lowest mean BMI yet ranked 49th on the HWDI. West Virginia ranked 42nd and 5th, and Mississippi ranked 51st on both the BMI and HWDI, respectively. Discussion. State-based BMI and HWDI rankings present divergent perspectives on the obesity crisis. We recommend adding HWDI rankings to BMI rankings to reflect fully patterns of obesity and subgroup differences. [ABSTRACT FROM AUTHOR]

The National Postbaccalaureate Collaborative (NPBC) is a partnership of Postbaccalaureate Programs (PBPs) dedicated to helping promising college graduates from disadvantaged and underrepresented backgrounds get into and succeed in medical school. This study aims to determine long-term program outcomes by looking at PBP graduates, who are now practicing physicians, in terms of health care service to the poor and underserved and contribution to health care workforce diversity. Methods. We surveyed the PBP graduates and a randomly drawn sample of non-PBP graduates from the affiliated 10 medical schools stratified by the year of medical school graduation (1996-2002). Results. The PBP graduates were more likely to be providing care in federally designated underserved areas and practicing in institutional settings that enable access to care for vulnerable populations. Conclusion. The NPBC graduates serve a critical role in providing access to care for underserved populations and serve as a source for health care workforce diversity. [ABSTRACT FROM AUTHOR]

Rates of sleep-related infant deaths have remained stagnant in recent years. Although most parents are aware of safe sleep recommendations, barriers to adherence, including lack of access to a safe crib, remain. The objective of this study was to describe parental knowledge and practices regarding infant sleep position, bedsharing, pacifier use, and feeding practices before and after receipt of a free crib and safe sleep education. Bedtime Basics for Babies (BBB) enrolled high-risk families in Washington, Indiana, and Washington, DC and provided them with cribs and safe sleep education. Parents completed surveys before ('prenatal' and 'postnatal') and 1-3 months after crib receipt ('follow-up'). Descriptive and bivariate analyses were completed. 3,303 prenatal, 1,483 postnatal, and 1,729 follow-up surveys were collected. Parental knowledge of recommended infant sleep position improved from 76 % (prenatal) and 77 % (postnatal) to 94 % after crib receipt ( p < 0.001). Intended use of supine positioning increased from 84 % (prenatal) and 80 % (postnatal) to 87 % after the intervention ( p < 0.001). Although only 8 % of parents intended to bedshare when asked prenatally, 38 % of parents receiving the crib after the infant's birth reported that they had bedshared the night before. This decreased to 16 % after the intervention. Ninety percent reported that the baby slept in a crib after the intervention, compared with 51 % postnatally ( p < 0.01). BBB was successful in changing knowledge and practices in the majority of high-risk participants with regards to placing the infant supine in a crib for sleep. Crib distribution and safe sleep education positively influence knowledge and practices about safe sleep. [ABSTRACT FROM AUTHOR]

Resident physicians receive little training designed to help them develop an understanding of the health literacy and health concerns of laypersons. The purpose of this study was to assess whether residents improve their understanding of health concerns of community members after participating in the Lay Health Educator Program, a health education program provided through a medical-religious community partnership. The impact was evaluated via pre-post surveys and open-ended responses. There was a statistically significant change in the residents' ( n = 15) understanding of what the public values as important with respect to specific healthcare topics. Findings suggest participation in a brief, formal community engagement activity improved medical residents' confidence with community health education. [ABSTRACT FROM AUTHOR]

Chinese Americans underutilize colorectal cancer screening. This study evaluated a physician-based intervention guided by social cognitive theory (SCT) to inform future research involving minority physicians and patients. Twenty-five Chinese-speaking primary care physicians were randomized into intervention or usual care arms. The intervention included two 45-minute in-office training sessions paired with a dual-language communication guide detailing strategies in addressing Chinese patients' screening barriers. Physicians' feedback on the intervention, their performance data during training, and pre-post intervention survey data were collected and analyzed. Most physicians (-85%) liked the intervention materials but -84% spent less than 20 minutes reading the guide and only 46% found the length of time for in-office training acceptable. Despite this, the intervention increased physicians' perceived communication self-efficacy with patients (p<.01). This study demonstrated the feasibility of enrolling and intervening with minority physicians. Time constraints in primary care practice should be considered in the design and implementation of interventions. [ABSTRACT FROM AUTHOR]

Objectives. We assessed how nonmedical exemption (NME) laws and annual uptake of vaccines required for school or daycare entry affect annual incidence rates for 5 vaccine-targeted diseases: pertussis, measles, mumps, Haemophilus influenzae type B, and hepatitis B. Methods. We employed longitudinal mixed-effects models to examine 2001- 2008 vaccine-targeted disease data obtained from the National Notifiable Disease Surveillance System. Key explanatory variables were state-level vaccine-specific uptake rates from the National Immunization Survey and a state NME law restrictiveness level. Results. NME law restrictiveness and vaccine uptake were not associated with disease incidence rate for hepatitis B, Haemophilus influenzae type B, measles, or mumps. Pertussis incidence rate, however, was negatively associated with NME law restrictiveness (b = -0.20; P = .03) and diphtheria-pertussis-tetanus vaccine uptake (b = -0.01; P = .05). Conclusions. State NME laws and vaccine uptake rates did not appear to influence lower-incidence diseases but may influence reported disease rates for higher-incidence diseases. If all states increased their NME law restrictiveness by 1 level and diphtheria-pertussis-tetanus uptake by 1%, national annual pertussis cases could decrease by 1.14% (171 cases) and 0.04% (5 cases), respectively. [ABSTRACT FROM AUTHOR]

By drawing from theoretical perspectives suggesting that unfair conditions threaten fundamental psychological needs, perceived unfairness at work was proposed and tested as a predictor of resting blood pressure. As part of the Midlife Development in the United States Biomarkers project, participants completed questionnaires measuring perceived unfairness, self-esteem and coworker support. Resting blood pressure readings were also recorded as part of a larger physical examination. Results indicate that perceived unfairness at work was associated with higher resting diastolic and systolic blood pressure. Perceived unfairness was most strongly related to diastolic and systolic blood pressure among women with low levels of coworker support. Contrary to predictions, self-esteem did not moderate the association between perceived unfairness and blood pressure. These results suggest that high blood pressure may be a mechanism linking unfairness to negative health outcomes and point to coworker support as a moderator of the perceived unfairness-blood pressure relationship among women. Further research is needed exploring the mediating mechanisms linking unfair treatment at work to blood pressure and health. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

In the U.S., cigar use doubled from 5.0 to 10.6 billion cigars consumed annually between 1997 and 2007, driven in large part by increased sales of cigarette-sized "little cigars" and narrow, mid-sized "cigarillos." The present study examined prevalence of cigarillo use as well as attitudes, knowledge and behaviors related to cigarillo use among a sample of predominantly urban African American young adults 18-24 not in school and not employed. Survey data were collected from 131 young adults attending education and job training centers in Baltimore, Maryland and from 78 young adults attending education, job training, or recreational programs in Washington, D.C. In Baltimore, 22% of young adults had smoked a cigarillo in the past 30 days, compared with nearly 63% in D.C. Both populations were heavily exposed to cigarillo advertising and marketing. Cigarillo use in this urban young adult population is a growing public health problem and undermines the progress made in decreasing cigarette use. [ABSTRACT FROM AUTHOR]

People of Hispanic origin, including monolingual Spanish speakers, have experienced difficulty identifying with a race category on U.S. demographic surveys. As part of a larger research effort by the U.S. Census Bureau to improve race and Hispanic origin questions for the 2020 Census, we tested experimental versions of race and Hispanic origin questions in Spanish. About half of the versions asked about race and Hispanic origin in separate questions, while the rest asked about these constructs in a combined question format. Cognitive interviews with 33 monolingual Spanish-speaking participants indicated that (a) most participants affirmatively claimed Hispanic origin on the separate and combined formats, but had difficulty selecting or declined to select a race category on the separate question formats and (b) most participants perceived few differences between Hispanic origin and race. In comparison with the separate race and Hispanic origin questions, the combined question facilitated more satisfactory self-identifications. [ABSTRACT FROM PUBLISHER]

Abstract: Catch and distribution of grooved Tanner crab (Chionoecetes tanneri Rathbun, 1893) from the Northwest Fisheries Science Center''s bottom trawl survey (55–1280m) were examined along the U.S. west coast (lat. 32°30′N–48°30′N). Grooved Tanner crabs were present in 28% of tows and occurred primarily at depths from 300 to 1280m. Annual biomass (metric tons, mt) indices and density (kgkm−2) estimates for the population varied significantly throughout the study area and within five International North Pacific Fisheries Commission (INPFC) statistical areas. Highest estimates occurred in the Monterey INPFC area (lat. 36°N–40°30′N) and within the 601–800m depth interval. Depth distribution varied by year and coast-wide catch-weighted average depths (m) were significantly correlated with average annual Pacific Decadal Oscillation (PDO) indices (2003–2010), a measure of Pacific climate variability. Annual mean carapace widths (CW), measured from 2005 to 2010, were always greater for males (96.9–113.9mm) relative to females (85.3–95.8mm). Size frequency distributions varied by year with strong recruitment for both sexes apparent in 2010. Grooved Tanner crabs were partially segregated by depth and stage. Males and females were found in all depth intervals but the average depth of adult females was significantly shallower (756m) than adult males (837m); adults were significantly shallower than subadult female (907m) and subadult male (927m) crabs. [Copyright &y& Elsevier]

Purpose: To gain an understanding of practice patterns for infant diagnostic hearing services at pediatric audiology facilities. Method: The authors used a cross-sectional survey design. From August to November of 2009, surveys were mailed to 1,091 facilities in 28 states and the District of Columbia. One survey was completed per facility, and responses were anonymous. Results: The return rate was 33% (356 surveys). The results revealed that the comprehensiveness of the test batteries used varied among facilities. Over half of the respondents, 146 (55%), reported using a limited test battery, 94 facilities reported using a comprehensive test battery but lacked at least 1 component recommended by the Joint Committee on Infant Hearing, and 25 facilities reported using a test battery that met Joint Committee on Infant Hearing recommendations. The wait time for an appointment varied between facilities (range = 3 days-5 months) and was affected by the test condition (i.e., natural sleep, sedation, or operating room). Conclusions: The results suggest that it is difficult for stakeholders to identify pediatric audiology facilities that serve infants less than 6 months of age and that there is variability among facilities in test batteries and wait times for an appointment. Implications exist for diagnostic accuracy and timeliness of diagnosis. [ABSTRACT FROM AUTHOR]

Visitor perceptions of the impacts of cetacean-based tourism from land-based and boat-based platforms are not well understood. Data from on-site surveys ( n = 633) and observational data were obtained at boat and land-based whale viewing platforms in the San Juan Islands, USA during the summer of 2000. Whale watchers at both platforms expressed concerns regarding adverse impacts on whales due to whale watching activities. Land-based whale watchers, however, were significantly more concerned about the presence of boats disturbing not only the whales, but also their own experiences. In particular, the noise and maneuvering of whale-watching boats were identified as issues of concern. The findings suggest that site-specific strategies for managing whale watching are necessary. Possible strategies include limiting the number of boats and the frequency and duration of boat interactions with whales. Furthermore, platform-specific visitor education programs may be useful for helping to address viewers' concerns. [ABSTRACT FROM AUTHOR]

This study examined the relationship of volume of alcohol consumed to the occurrence of alcohol-related problems among male and female college students to develop a gender-specific measure of heavy episodic or binge drinking by college students for public health research. A self-administered survey was mailed to a national representative sample of students at 140 4-year colleges in 40 states and the District of Columbia. A total of 17 592 college students completed the survey. Women who typically drink four drinks in a row were found to have roughly the same likelihood of experiencing drinking-related problems as men who typically drink five drinks in a row. Use of the same standard for both sexes underestimates binge drinking and the negative health risks for women. [ABSTRACT FROM AUTHOR]

We surveyed laboratories to assess their capacity to perform T-lymphocyte immunophenotyping. Of the 1026 respondents, 279 located in 41 states and the District of Columbia performed this type of testing. Most laboratories were located in hospitals, reported a low weekly test volume, and indicated that it took 6-24 weeks for flow cytometer operators to become proficient. Many laboratories appear to have the capacity to perform additional CD4+ cell testing, but training additional operators may be necessary. The paucity of laboratories performing T-lymphocyte immunophenotyping in the public sector may affect referral patterns from that setting. [ABSTRACT FROM AUTHOR]

Abstract: A prospective survey of maternal employment and breast-feeding initiation and duration was conducted among 668 Black and 511 White women who delivered their first child in Washington, DC. Ninety-one percent of White women (n = 511) and 80 percent of Black women (n = 668) reported working during pregnancy. Black women who planned to return to work part time vs full time were more likely to breast-feed rather than formula-feed (adjusted odds ratio, 2.3; 95% confidence intervals (CI) = 1.4, 3.7). Using Cox regression, Black women who returned to work had a shorter duration of breast-feeding than those not returning to work (hazard ratio = 0.5 (CI = 0.3, 0.9)). Black and White women returning to professional occupations had a longer duration of breast-feeding compared to women returning to sales or technical positions (hazard ratio for Black women = 2.4 (CI = 1.4, 4.4); hazard ratio for White women = 1.6 (CI = 1.0, 2.5)). In addition, White women in professional occupations had a longer duration of breastfeeding than women in clerical positions (hazard ratio = 1.7 (CI = 1.1, 2.6)). Until employers in the United States develop a maternity policy which does not discourage breast-feeding, the recommended six months of breast-feeding will be difficult to achieve for most employed women. (Am J Public Health 1989; 79:1247-1250). [ABSTRACT FROM AUTHOR]

The article presents information on the results of a psychosocial study of student peace demonstrators in Washington D.C. The sample consisted of 247 participants, which represented approximately 6 per cent of the total number of registered demonstrators. Two hundred and eighteen demonstrators filled out short-answer questionnaires, and twenty-nine other subjects were interviewed in depth for periods of 1% to 2 hours each. The questionnaires were distributed by a group of medical student research assistants who were instructed to choose subjects randomly at various times and in various areas of activity. Most questionnaires were filled out in the registration and resting area in the church which was serving as demonstration headquarters. Some forms were completed by demonstrators in or near actual picketing locations. The research assistants stood near the respondents during the 15 to 30 minutes, which it took to complete the forms, in order to discourage formation of informal groups making collective responses to the individual questionnaires. Subjects for interviews were selected at the headquarters area by the five interviewers who then conducted private interviews utilizing an outline prepared in advance. The authors also did some group interviewing under fairly informal circumstances. The whole research team met subsequently to discuss and compare various observations and data on group phenomena.

What are the main determinants of public attitudes toward the Supreme Court? Do they stem from the fact that one's political party controls the White House? The authors find the answers from Gallup surveys, from questions asked by the Michigan and Berkeley Survey Research Cena and from a comprehensive study by the Wisconsin Survey Research Laboratory in 1966. [ABSTRACT FROM AUTHOR]