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Objectives: We used treatment for alcohol withdrawal syndrome as an objective surrogate marker to investigate the relationship between alcohol-related health outcomes and home neighborhood alcohol outlet density and alcohol advertising density. Methods: Mixed effects logistic regression examined whether alcohol outlet density or alcohol advertisement density within either one-quarter mile or one-half mile of individuals' home address was associated with treatment for alcohol withdrawal. Results: Adjusted models showed outlet and advertising density, particularly off-sale outlet density within one-quarter mile of the home, increased the risk of hospital admission for alcohol withdrawal syndrome (AOR = 1.15). Conclusion/impact: These data inform public policy initiatives to reduce the harmful effects of alcohol by regulating the neighborhood alcohol environment. [ABSTRACT FROM AUTHOR]

ABSTRACT: BACKGROUND: Louisiana has one of the highest rates of overweight and obese children in the United States. The Healthy School Food Collaborative (HSFC) was created to allow New Orleans's schools to select their own healthy school Food Service Provider (FSP) with requirements for higher nutritional standards than traditional options. The goal of this cross‐sectional study was to examine whether HSFC membership was associated with lunch consumption rates in elementary school children. METHODS: An 8‐week plate waste study examining 18,070 trays of food among fourth and fifth graders was conducted. Participants included 7 schools and the 3 FSPs (2 HSFC and 1 non‐HSFC member) that serviced them. Mixed models analysis examined whether consumption rates of food items differed among FSPs. RESULTS: On average, students consumed 307 cal during lunch. Analyses showed significant differences in consumption rates of entrée, vegetables, fruit, and milk between the 3 FSPs (p < .01). The highest consumption rate was among entrées at 65%. One HSFC provider had consumption levels consistent with the non‐HSFC FSP. CONCLUSIONS: Overall, students consumed less than 60% of the US Department of Agriculture recommended calories for school lunch. While overall caloric consumption was higher among the non‐HSFC schools, interventions to increase lunch consumption across all schools are needed. [ABSTRACT FROM AUTHOR]

Background: The relationship between mental health status and smoking is complicated and often confounded by bi-directionality, yet most research on this relationship assumes exogeneity. Objectives: The goal of this article is to implement an instrumental variable approach to (1) test the exogeneity assumption and (2) report on the association between mental health status and smoking post-disaster. Methods: This analysis utilizes the 2006 and 2007 Louisiana Behavioral Risk Factor Surveillance Survey to examine the link between mental distress and smoking in areas affected by Hurricanes Katrina and Rita. Residence in a hurricane-affected parish (county) was used as an instrumental variable for mental distress. Results: Just over 22% of the sample resided in a hurricane-affected parish. Residents of hurricane-affected parishes were significantly more likely to report occasional and frequent mental distress. Residence in a hurricane-affected parish was not significantly associated with smoking status. With residence established as a salient instrumental variable for mental distress, the exogeneity assumption was tested and confirmed in this sample. A dose-response relationship existed between mental distress and smoking, with smoking prevalence increasing directly (and non-linearly) with mental distress. Conclusions: In this sample, the relationship between mental distress and smoking status was exogenous and followed a dose-response relationship, suggesting that the disasters did not result in an uptake of smoking initiation, but that the higher amounts of mental distress may lead to increased use among smokers. The findings suggest that tobacco control programs should devise unique strategies to address mentally distressed populations. [ABSTRACT FROM AUTHOR]

Despite the presence of tobacco control policies, Louisiana continues to experience a high smoking burden and elevated smoking-attributable deaths. The SimSmoke model provides projections of these health outcomes in the face of existing and expanded (simulated) tobacco control polices. The SimSmoke model utilizes population data, smoking rates, and various tobacco control policy measures from Louisiana to predict smoking prevalence and smoking-attributable deaths. The model begins in 1993 and estimates are projected through 2054. The model is validated against existing Louisiana smoking prevalence data. The most powerful individual policy measure for reducing smoking prevalence is cigarette excise tax. However, a comprehensive cessation treatment policy is predicted to save the most lives. A combination of tobacco control policies provides the greatest reduction in smoking prevalence and smoking-attributable deaths. The existing Louisiana excise tax ranks as one of the lowest in the country and the legislature is against further increases. Alternative policy measures aimed at lowering prevalence and attributable deaths are: cessation treatments, comprehensive smoke-free policies, and limiting youth access. These three policies have a substantial effect on smoking prevalence and attributable deaths and are likely to encounter more favor in the Louisiana legislature than increasing the state excise tax. [ABSTRACT FROM AUTHOR]

Background: Mapping of the human genome and technological advancements allowing storage and rapid retrieval of healthcare data have heralded a new phase in clinical medicine and have served as a catalyst for the advent of personalized medicine. The use of health information databases provides a unique opportunity to investigate questions of great complexity and real-world application in a way that is most useful in providing high quality, safe, and cost-effective clinical care to patients. Methods: The Louisiana Clinical Data Research Network (LACDRN) aims to streamline the workflow of multiinstitutional clinical studies and to dramatically expand the clinical research resources available to local investigators. The LACDRN contains health information for more than 1 million patients in Southeast Louisiana and is a rich resource for researchers to conduct retrospective or observational trials and to recruit patients for prospective studies. Results: The LACDRN is part of a large-scale initiative by the Patient-Centered Outcomes Research Institute to create a national electronic health record network that enables the timely initiation and completion of comparative effectiveness research in a coordinated effort. For the first time, network research will be guided in part by input from patients and caregivers, increasing their engagement in the research process. Conclusion: The establishment of the LACDRN is a unique opportunity for clinicians to take part in an innovative national initiative designed to offer new clinical research options for patients and to carry out cutting-edge translational, clinical, and health services research. [ABSTRACT FROM AUTHOR]

Abstract: In spring 2009, students in six New Orleans public high schools were surveyed in order to evaluate the effectiveness of School Based Health Centers (SBHCs) in increasing access to and utilization of essential health services, promoting healthy lifestyles, and facilitating good decision-making skills in a complex urban environment. A quasi-experimental research design was utilized, involving three intervention schools with SBHCs and three comparison schools slated to eventually contain SBHCs. Propensity score matching was used to estimate the effects of SBHCs on indicators of adolescent utilization of health services and risky behaviors. Results indicate that adolescents with access to SBHCs report higher rates of utilization of essential health services, particularly vital mental health services, but they are also less likely to engage in behaviors that put their health at risk, including drug use, risky sexual activity, violence, smoking, unhealthy eating habits and lack of exercise. Sensitivity testing using Rosenbaum bounds confirms that the results are relatively insensitive to selection bias arising from unobservable school- or student-level confounders. [Copyright &y& Elsevier]

Background While school foods have become healthier under the Healthy, Hunger Free Kids Act, research suggests there is still substantial food waste in cafeterias. It is therefore necessary to study factors that can impact food consumption, including holding recess before lunch (“reverse recess”) and starting lunch periods very early or very late. Objective This study examined the association between the timing of recess (pre-lunch vs post-lunch recess), the timing of the lunch period, and food consumed by students at lunch. Design We conducted a secondary data analysis from a repeated cross-sectional design. Participants/setting An 8-week plate waste study examining 20,183 trays of food was conducted in New Orleans, LA, in 2014. The study involved 1,036 fourth- and fifth-grade students from eight public schools. Main outcome measures We measured percent of entrées, fruit, vegetables, and milk consumed by students at lunch. Statistical analyses performed We used mixed-model analyses, controlling for student sex, grade, and the timing of the lunch period, and examined the association between reverse recess and student lunch consumption. Mixed-model analyses controlling for student sex, grade, and recess status examined whether the timing of the lunch period was associated with student lunch consumption. Results On average, students with reverse recess consumed 5.1% more of their fruit than students with post-lunch recess ( P =0.009), but there were no significant differences in entrées, vegetables, or milk intake. Compared to students with “midday” lunch periods, on average students with “early” lunch periods consumed 5.8% less of their entrées ( P <0.001) and 4.5% less of their milk ( P =0.047). Students with “late” lunch periods consumed 13.8% less of their entrées ( P <0.001) and 15.9% less of their fruit ( P <0.001). Conclusions Reverse recess was associated with increased fruit consumption. “Early” lunch periods were associated with decreased entrée and milk consumption, and “late” lunch periods were associated with decreased entrée and fruit consumption. Additional research is recommended to determine whether these associations are causal. [ABSTRACT FROM AUTHOR]

Context: Electronic health records (EHRs) are an emerging chronic disease surveillance data source and facilitating this data sharing is complex., Program: Using the experience of the Multi-State EHR-Based Network for Disease Surveillance (MENDS), this article describes implementation of a governance framework that aligns technical, statutory, and organizational requirements to facilitate EHR data sharing for chronic disease surveillance., Implementation: MENDS governance was cocreated with data contributors and health departments representing Texas, New Orleans, Louisiana, Chicago, Washington, and Indiana through engagement from 2020 to 2022. MENDS convened a governance body, executed data-sharing agreements, and developed a master governance document to codify policies and procedures., Results: The MENDS governance committee meets regularly to develop policies and procedures on data use and access, timeliness and quality, validation, representativeness, analytics, security, small cell suppression, software implementation and maintenance, and privacy. Resultant policies are codified in a master governance document., Discussion: The MENDS governance approach resulted in a transparent governance framework that cultivates trust across the network. MENDS's experience highlights the time and resources needed by EHR-based public health surveillance networks to establish effective governance., Competing Interests: The authors declare no conflicts of interest.

Background: African Americans have nearly double the rate of posttraumatic stress disorder (PTSD) compared with other racial/ethnic groups., Objective: To understand whether trauma-informed collaborative care (TICC) is effective for improving PTSD among African Americans in New Orleans who receive their care in Federally Qualified Health Centers (FQHCs)., Design and Method: In this pilot randomized controlled trial, we assigned patients within a single site to either TICC or to enhanced usual care (EUC). We performed intent to treat analysis by nonparametric exact tests for small sample sizes., Participants: We enrolled 42 patients from October 12, 2018, through July 2, 2019. Patients were eligible if they considered the clinic their usual source of care, had no obvious physical or cognitive obstacles that would prevent participation, were age 18 or over, self-identified as African American, and had a provisional diagnosis of PTSD., Measures: Our primary outcome measures were PTSD measured as both a symptom score and a provisional diagnosis based on the PTSD Checklist for DSM-5 (PCL-5)., Key Results: Nine months following baseline, both PTSD symptom scores and provisional PTSD diagnosis rates decreased substantially more for patients in TICC than in EUC. The decreases were by 26 points in EUC and 36 points in TICC for symptoms (P=0.08) and 33% in EUC and 57% in TICC for diagnosis rates (P=0.27). We found no effects for mediator variables., Conclusions: TICC shows promise for addressing PTSD in this population. A larger-scale trial is needed to fully assess the effectiveness of this approach in these settings., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

The Louisiana Tobacco Control Initiative (TCI), a multidisciplinary program specializing in helping tobacco users quit, assisted health care providers in Louisiana's public hospitals with integrating evidence-based treatment of tobacco use into clinical practice. Our study compared smoking behavior, provider adherence to the 5 A's tobacco cessation intervention (ask, advise, assess, assist, and arrange), cessation assistance awareness, quit attempts, and treatment preference among respondents to a TCI survey with a sample of respondents from the National Adult Tobacco Survey (NATS) and a sample from the Louisiana Adult Tobacco Survey (LATS). In 2010, more TCI respondents were asked if they smoked, advised to quit, helped to set a quit date, counseled, and arranged to be contacted for follow-up than respondents to NATS or LATS. Fewer TCI respondents received self-help material or were prescribed medication to assist in quitting than NATS and LATS respondents. In 2010 and 2013, TCI participants reported more quit attempts when 4 or more of the 5 A's were received. Thus, public health systems can promote treatment of tobacco use.