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There is a strong relationship between experiencing violence and participating in behaviors that increase the risk of contracting sexually transmitted infections. Sexual health education (SHE) tailored to the unique needs of female survivors of violence is needed. This paper presents findings from 40 surveys and 33 accompanying interviews with stakeholders representing 31 agencies in the violence advocacy community in Arkansas to investigate the feasibility, acceptability, and perceived need of a SHE program for female survivors of violence. Data also explore the role and preferences of community agencies in the design and implementation of such a program. Interviews with stakeholders revealed three themes: intervention concerns, content, and structure.

Background: Epidemic increases in childhood obesity and associated health risks are resulting in efforts to implement school policies related to nutrition and physical activity (NPA). With multicomponent policy efforts, challenges exist in characterizing the extent of policy change across the breadth of NPA policies. Methods: Aggregated policy indices were created to characterize NPA policy implementation in Arkansas public schools from 2004 through 2009. Index scores are presented by year, domain, and school level. Results: Both mean and median index scores increased over time, with greater changes seen in nutrition than in physical activity policy scores. The composite index score was heavily dependent on the nutrition index score and, thus, is relatively less useful for the purposes of our evaluation. Policy index scores varied by school level, rurality, enrollment size, and percentage of students eligible for federal meal programs. Conclusions: The policy index approach facilitates the consideration of the effect of school policy change in a holistic, aggregated way. School characteristics influence policy adoption, and thus, should be taken into consideration in the promotion of policy change. (Contains 4 tables and 1 figure.)

Background: Foods provided in schools represent a substantial portion of US children's dietary intake; however, the school food environment has proven difficult to describe due to the lack of comprehensive, standardized, and validated measures. Methods: As part of the Arkansas Act 1220 evaluation project, we developed the School Cafeteria Nutrition Assessment (SCNA) measures to assess food availability in public school cafeterias (n = 113). The SCNA provides a measure to evaluate monthly school lunch menus and to observe foods offered in school cafeterias during the lunch period. These measures provide information on the availability of fruit, vegetables, grains (whole or white), chips (reduced fat or regular), side dishes, main dishes, beverages, a la carte selections, and desserts, as well as information on healthier preparation of these items. Using independent raters, the inter-rater reliability of the measure was determined among a subsample of these schools (n = 32). Results: All food categories assessed, with the exception of the side dish and chip categories, had inter-rater reliability rates of 0.79 or greater, regardless of school type. The SCNA scores encompassed the majority of the possible scores, indicating the ability for the measures to differentiate between school cafeterias in the availability of healthier options. Conclusion: These measures allow comprehensive, rapid measurement of school cafeteria food availability with high inter-rater reliability for public health and school health professionals, communities, and school personnel. These measures have the potential to contribute to school health efforts to evaluate cafeteria offerings and/or the impact of policy changes regarding school foods. (Contains 5 tables.)

Background Delivery of a macrosomic fetus can be linked with significant maternal and perinatal morbidity. Detection of the macrosomic fetus prior to delivery could have a significant impact on reducing that morbidity. Aims The purpose of this study was to determine the likelihood of detection of macrosomia at the time of labour and delivery admission using ultrasound. Methods Retrospective review using the electronic medical record and delivery room logs to identify women admitted to labour and delivery with a birthweight of ≥4000 g. Results There were 272 macrosomic neonates delivered between January 2010 and December 2012, of which, 91 (33.46%) were identified as macrosomic by ultrasound. Using Spearman correlation, the association between the estimated fetal weight by ultrasound and birthweight was r = 0.214 (95% CI: 0.098-0.325; P = 0.0004). In bivariate analyses, only White race was significant for macrosomia detection with 59 of 149 (39.6%) identified compared with 32 of 123 (26.02%) ( P = 0.020) non-White people. In the multivariate model, race remained significant. The odds of being labelled macrosomia for White people was 2.051 (95% CI: 1.188-3.542) compared with non-White people ( P = 0.010). Conclusions Only 33% of fetuses whose birthweight was ≥4000 g were identified by a labour and delivery ultrasound. White race was the only significant factor that increased the odds of having a correct diagnosis of macrosomia by ultrasound. [ABSTRACT FROM AUTHOR]

Breast cancer continues to be among the most common cancers affecting women in the United States. Researchers investigating the area are turning their attention to novel prevention, detection, and treatment options. Recent molecular epidemiology research has highlighted the effects of both genetic and environmental exposures on an individual's risk of developing breast cancer and predicted response to treatment. Cohort designs are a potentially powerful tool that researchers can utilize to investigate the genetic and environmental factors affecting breast cancer risk and treatment options. This paper describes the recruitment of a community-based cohort of women in a southern state. The Spit for the Cure Cohort (SFCC), being developed by researchers at the University of Arkansas for Medical Sciences (Little Rock, AR), is designed to be representative of the female population of the state with oversampling of women with a history of breast cancer and women of color. To date, the SFCC includes more than 14,000 women recruited from all 75 counties of Arkansas and six neighboring states. Methods used to recruit and maintain the cohort and collect both questionnaire data and genetic material are described, as are the demographic characteristics of the cohort as it currently exists. The recruitment methods utilized for the SFCC are rapidly building a breast cancer cohort and providing a large biorepository for molecular epidemiology research. [ABSTRACT FROM AUTHOR]

In response to a nationwide rise in obesity, several states have passed legislation to improve school health environments. Among these was Arkansas's Act 1220 of 2003, the most comprehensive school-based childhood obesity legislation at that time. We used the Multiple Streams Framework to analyze factors that brought childhood obesity to the forefront of the Arkansas legislative agenda and resulted in the passage of Act 1220. When 3 streams (problem, policy, and political) are combined, a policy window is opened and policy entrepreneurs may advance their goals. We documented factors that produced a policy window and allowed entrepreneurs to enact comprehensive legislation. This historical analysis and the Multiple Streams Framework may serve as a roadmap for leaders seeking to influence health policy. [ABSTRACT FROM AUTHOR]

Changes in school nutrition and physical activity policies and environments are important to combat childhood obesity. Arkansas Act 1220 of 2003 was among the first and most comprehensive statewide legislative initiatives to combat childhood obesity through school-based change. Annual surveys of principals and superintendents have been analyzed to document substantial and important changes in school environments, policies, and practices. For example, results indicate that schools are more likely to require that healthy options be provided for student parties (4.5% in 2004, 36.9% in 2008; P ≤ 0.0001) and concession stands (1.6% in 2004, 19.6% in 2008; P ≤ 0.0001), ban commercial advertising by food or beverage companies (31.7% in 2005, 42.6% in 2008; P ≤ 0.0001), and offer skim milk options for students in cafeterias (white milk: 26.1% in 2004, 41.0% in 2008, P ≤ 0.0001; chocolate milk: 9.0% in 2004, 24.0% in 2008, P ≤ 0.0001). They are less likely to have vending machines available during the lunch period (72.3% in 2004, 37.2% in 2008; P ≤ 0.0001) and to include sodas in vending machines (83.8% in 2004, 73.5% in 2008; P ≤ 0.0001). Other changes were noted in foods and beverages offered in the cafeteria, in classrooms, and at school events, as well as in fund-raising and physical activity practices. A significant number of school districts have modified physical education requirements for elementary schools and developed policies prohibiting the use of physical activity as a punishment. We conclude that Arkansas Act 1220 of 2003 is associated with a number of changes in school environments and policies, resulting from both statewide and local initiatives spawned by the Act. [ABSTRACT FROM AUTHOR]

Arkansas was among the first states to pass comprehensive legislation to combat childhood obesity, with Arkansas Act 1220 of 2003. Two distinct but complementary evaluations of the process, impact, and outcomes of Act 1220 are being conducted: first, surveillance of the weight status of Arkansas children and adolescents, using the statewide data amassed from the required measurements of students' body mass indexes (BMIs); and second, an independent evaluation of the process, impact, and outcomes associated with Act 1220. Various stakeholder groups initially expressed concerns about the Act, specifically concerns related to negative social and emotional consequences for students and an excessive demand on health care. Evaluation data, however, suggest that few adverse effects have occurred either in these areas of concern or in other concerns which have emerged over time. Schools are changing environments and implementing policies and programs to promote healthy behaviors and BMI levels have not increased since the implementation of Act 1220 in 2004. The Arkansas experience to date may serve to inform the efforts of other states to adopt policies to address the epidemic of childhood obesity.Journal of Public Health Policy (2009) 30, S124–S140. doi:10.1057/jphp.2008.54 [ABSTRACT FROM AUTHOR]