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The novel coronavirus, also known as COVID-19, has moved rapidly across the world in 2020. This article reports on the recent consequences of the pandemic for early childhood education in Sweden, Norway, and the United States. The authors illustrate the effects of the pandemic on preschools in their countries, against a backdrop of frequent changes in infection and mortality rates, epidemiological understandings, government strategies, and mitigation strategies regarding preschool closures. Teachers report their experiences and actions in specific early childhood education settings, across the three national contexts. These experiential snapshots identify program priorities, parents' and children's reactions, and the commitment and concerns of teachers. The conversations reveal culturally situated similarities of early childhood educational practices but also differences across contexts. Teachers report on the challenges of their experiences but also benefits for their practice and how they engage with children and their families. Ideas about future preparedness for such pandemics are also discussed.

Background: It is important that systematic reviews (SRs) are up-to-date, otherwise they cannot be relied upon to guide decision-making in practice and policy. Our aim was to investigate epidemiological, descriptive and reporting characteristics of a cross-section of recently published updates of SRs. Methods: A SR update was defined as a new edition of a SR, either published by the same or new authors. We searched PubMed for SR updates published from January 01, 2016 to January 22, 2018 and included a random sample of n = 100 non-Cochrane updates of SRs on interventions reported in English. Results: Most SR updates had a corresponding author from the United Kingdom, United States, or Canada (in total 48/100) and dealt with nonpharmacological interventions (63/100). The SR updates were published a median of 5 years (interquartile range [IQR] 3-7) after the previous SR and included a median of 19 (IQR 9-28) studies. 31/100 SR updates reported that the conclusion had changed since the previous version. Only 51/100 SR updates used the term "update" in the title and none reported having based the decision to update the previous SR on an existing method/decision tool. The number of newly included studies and participants and the number of studies and participants included in/from the previous SR were often not reported. Conclusions: The included non-Cochrane updates were frequently missing important information that would be expected to be present in a SR update. Thus, structured and detailed reporting guidance specific to SR updates is needed. It should focus particularly on appropriate labeling and justification of updates, and how to incorporate information regarding the previous SR.

Americans' perceptions of childhood disability have changed dramatically over the past century, as have their ideas about health and illness, medical developments, threats to children's health and development, and expectations for child functioning. Neal Halfon, Amy Houtrow, Kandyce Larson, and Paul Newacheck examine how these changes have influenced the risk of poor health and disability and how recent policies to address the needs of children with disabilities have evolved. The authors examine the prevalence in the United States of childhood disability and of the conditions responsible for impairment, as well as trends in the prevalence of chronic conditions associated with disability. They find that childhood disability is increasing and that emotional, behavioral, and neurological disabilities are now more prevalent than physical impairments. They stress the importance of, and lack of progress in, improving socioeconomic disparities in disability prevalence, as well as the need for better measures and greater harmonization of data and data sources across different child-serving agencies and levels of government. They call on policy makers to strengthen existing data systems to advance understanding of the causes of childhood disabilities and guide the formulation of more strategic, responsive, and effective policies, programs, and interventions.The authors offer a new and forward-looking definition of childhood disability that reflects emerging and developmentally responsive notions of childhood health and disability. They highlight the relationship between health, functioning, and the environment; the gap in function between a child's abilities and the norm; and how that gap limits the child's ability to engage successfully with his or her world. Their definition also recognizes the dynamic nature of disability and how the experience of disability can be modified by the child's environment. (Contains 70 endnotes, 4 tables and 1 figure.)

Autism has gained the attention of policy makers and public administrators in recent years. The surge in prevalence, in tandem with a growing social preference for community inclusion of individuals with disabilities, strains a variety of policy infrastructures. Autism and related disorders, which were first described in 1943, were originally thought to be extremely low incidence and usually coincident with mental retardation. In accordance with the disability policy paradigm of the era, public services for autism were provided predominantly in institutional settings. Since then, however, autism and related disorders have come to be understood as more common than was originally thought and more rarely associated with mental retardation. In this article, shift-share analysis is used to gain insight into how the growth in autism incidence is being differentially experienced and recorded within a single arena of policy across the United States. The challenges associated with a sudden growth in supply (that is the number of children with autism), while unique to autism in some respects, include aspects that are similar for other disabilities and in policy challenges in other arenas. Especially since the implementation of the Government Performance Results Act of 1996, there is increased pressure to create public policy infrastructures that are anchored by clearly cut categorical service delivery. If the categories themselves leave significant room for interpretation and their use actually has a shaping effect on the target population, then it is important to administration and policy evaluation to understand how the effect is playing out. (Contains 3 tables.)

The International Collaboration for Autism Registry Epidemiology (iCARE) is the first multinational research consortium (Australia, Denmark, Finland, Israel, Norway, Sweden, USA) to promote research in autism geographical and temporal heterogeneity, phenotype, family and life course patterns, and etiology. iCARE devised solutions to challenges in multinational collaboration concerning data access security, confidentiality and management. Data are obtained by integrating existing national or state-wide, population-based, individual-level data systems and undergo rigorous harmonization and quality control processes. Analyses are performed using database federation via a computational infrastructure with a secure, web-based, interface. iCARE provides a unique, unprecedented resource in autism research that will significantly enhance the ability to detect environmental and genetic contributions to the causes and life course of autism.

With the persistence of microbiological foodborne illness and anticipated future shortage of scientists with agricultural and food science expertise in the United States, it is imperative to educate youth on microbiological food safety and enhance their awareness of opportunities to become engaged in finding solutions to food safety challenges. To help integrate food science education across the high school curriculum, new educational materials on microbiological food safety were developed and then disseminated to and evaluated by educators of secondary basic and applied sciences. The materials present food safety concepts in the context of foodborne illness outbreaks to introduce basic concepts of food microbiology, epidemiology, and food safety strategies as well as their broad impact on economics, communication, and regulations. The ready-to-implement educational materials support educational content standards and various learning styles and encourage critical thinking skills. The materials include a presentation on food microbiology and foodborne illness surveillance, case studies on foodborne illness outbreaks, a video on the laboratory investigation of foodborne illness, interactive web-based activities, and supporting materials for teachers and classroom display. Exposure to the materials in a 1-d workshop positively impacted educator familiarity with general microbiology, food safety strategies, regulatory requirements, and associated terminology as measured by a test administered prior to and after use of the materials. Teachers of biology, chemistry, family and consumer sciences, and related sciences rated the materials favorably on applicability, anticipated ease of implementation, and anticipated reception by students. (Contains 4 tables and 3 figures.)

This article articulates a contextualized understanding of gender and ethnicity as interacting social determinants of HIV risk and acquisition, with special focus on African Americans and Hispanics/Latinos--2 ethnic groups currently at most risk for HIV/AIDS acquisition in the United States. First, sex and gender are defined. Second, a conceptual model of gender, ethnicity, and HIV risk and resilience is presented. Third, a historical backdrop of gender and ethnic disparities is provided, with attention to key moments in history when notions of the intersections between gender, ethnicity, and HIV have taken important shifts. Finally, new frontiers in psychology are presented, with recommendations as to how psychology as a discipline can better incorporate considerations of gender and ethnicity as not only HIV risk factors but also as potential avenues of resilience in ethnic families and communities. Throughout the article, we promulgate the notion of a syndemic intersectional approach, which provides a critical framework for understanding and building the conditions that create and sustain overall community health by locating gendered lived experiences and expectations within the layered conceptual model ranging from the biological self to broader societal structures that define and constrain personal decisions, behaviors, actions, resources, and consequences. For ethnic individuals and populations, health disparities, stress and depression, substance abuse, and violence and trauma are of considerable concern, especially with regard to HIV risk, infection, and treatment. The conceptual model poses new frontiers for psychology in HIV policy, research, interventions, and training. (Contains 1 figure.)

The HIV epidemic continues to disproportionately affect ethnic minority youth. These disconcerting health disparities indicate that although existing HIV preventive strategies for ethnic minority youth have been efficacious, they have not significantly reduced the impact of the epidemic in this population. Macro-level interventions, such as structural or policy interventions, have the potential to impact the HIV epidemic at a population level, and thus reduce the HIV health disparities that exist among ethnic minority youth and other segments of the U.S. population. This article calls for a paradigm shift to develop, evaluate, and disseminate interventions that target upstream/macro-level factors or that, at a minimum, integrate both a macro and individual level perspective. The article also discusses the challenges in developing and evaluating such interventions. Psychologists and other behavioral scientists can play a critical role in reducing the impact of HIV on ethnic minority youth by integrating macro-level approaches to future HIV prevention strategies.

Despite advances in HIV prevention and care, African Americans and Latino Americans remain at much higher risk of acquiring HIV, are more likely to be unaware of their HIV-positive status, are less likely to be linked to and retained in care, and are less likely to have suppressed viral load than are Whites. The first National HIV/AIDS Strategy (NHAS) has reducing these disparities as one of its three goals by encouraging the implementation of combination high-impact HIV intervention strategies. Federal agencies have expanded their collaborations in order to decrease HIV-related disparities through better implementation of data-driven decision making; integration and consolidation of the continuum of HIV care; and the reorganization of relationships among public health agencies, researchers, community-based organizations, and HIV advocates. Combination prevention, the integration of evidence-based and impactful behavioral, biomedical, and structural intervention strategies to reduce HIV incidence, provides the tools to address the HIV epidemic. Unfortunately, health disparities exist at every step along the HIV testing-to-care continuum. This provides an opportunity and a challenge to everyone involved in HIV prevention and care to understand and address health disparities as an integral part of ending the HIV epidemic in the United States. To further reduce health disparities, successful implementation of NHAS and combination prevention strategies will require multidisciplinary teams, including psychologists with diverse cultural backgrounds and experiences, to successfully engage groups at highest risk for HIV and those already infected with HIV. In order to utilize the comprehensive care continuum, psychologists and behavioral scientists have a role to play in reconceptualizing the continuum of care, conducting research to address health disparities, and creating community mobilization strategies.

The U.S. HIV/AIDS epidemic has evolved over the past 30 years and is now concentrated in socially marginalized and disenfranchised communities. The health disparities in this epidemic are striking, with most HIV infections occurring in sexual minorities and communities of color. While widely recognized, the health disparities in HIV and AIDS are not often discussed. In this article, we examine the factors underlying health disparities in the U.S. HIV epidemic. We first discuss the interlocking relationships between biological, social, and behavioral factors that drive HIV/AIDS epidemics. Guided by a well-established conceptual model of health disparities, we then describe the social positions of those most affected by HIV and AIDS, particularly racial and gender groups. Structural and economic conditions--including environmental resources, constraints, access to care, and psychosocial influences--are examined in relation to HIV disease trajectories. Greater attention to contextual factors and comorbidities is needed to reduce the health disparities in HIV/AIDS. (Contains 2 figures.)

Gay, bisexual, and other men who have sex with men (MSM) have been disproportionately affected by HIV and AIDS since the beginning of the epidemic in the United States and in many other parts of the world. The HIV epidemic is inextricably tied to other health problems that disproportionately affect gay, bisexual, and other MSM including psychological comorbidities, substance use, sexual victimization, stigmatization, and multiple forms of discrimination. These interrelated health problems and social issues can be characterized as a syndemic of mutually reinforcing conditions or epidemics. Moreover, the syndemic is directed by biological, behavioral, psychosocial, and structural determinants. Addressing HIV within the context of a larger syndemic will require a more holistic approach to HIV prevention and treatment that recognizes the interplay between biological, behavioral, psychosocial, and structural factors that affect the health and well-being of sexual minority men. (Contains 1 figure.)

Racial/ethnic disparities in HIV infection, with minority groups typically having higher rates of infection, are a formidable public health challenge. In the United States, among both men and women who inject drugs, HIV infection rates are elevated among Hispanics and non-Hispanic Blacks. A meta-analysis of international research concluded that among persons who inject drugs, racial and ethnic minorities were twice as likely to acquire an HIV infection, though there was great variation across the individual studies. To examine strategies to reduce racial/ethnic disparities among persons who inject drugs, we reviewed studies on injection drug use and its role in HIV transmission. We identified four sets of evidence-based interventions that may reduce racial/ethnic disparities among persons who inject drugs: HIV counseling and testing, risk reduction services, access to antiretroviral therapy, and drug abuse treatment. Implementation of these services, however, is insufficient in many countries, including the United States. Persons who inject drugs appear to be changing drug use norms and rituals to reduce their risks. The challenges are to (a) develop a validated model of how racial/ethnic disparities in HIV infection arise, persist, and are reduced or eliminated over time and (b) implement evidence-based services on a sufficient scale to eliminate HIV transmission among all persons who inject drugs.

Objective: The current study examined the sex- and age-specific structure and comorbidity of lifetime anxiety disorders among U.S. adolescents. Method: The sample consisted of 2,539 adolescents (1,505 females and 1,034 males) from the National Comorbidity Survey-Adolescent Supplement who met criteria for "Diagnostic and Statistical Manual of Mental Disorders" (4th ed., text rev. ["DSM-IV-TR"]) lifetime anxiety disorders (American Psychiatric Association, 2000). Adolescents ranged in age from 13 to 18 years (M = 15.2 years, SE = 0.08 years) and were 39% non-White. Multiple-group latent class analysis was conducted by adolescent sex and age to identify subgroups of adolescents with similar anxiety disorder profiles. Developmental and clinical correlates of empirically derived classes were also examined to assess the nomological validity of identified subgroups. Results: A 7-class solution provided the best fit to the data, with classes defined primarily by one rather than multiple anxiety disorders. Results also indicated that classes displayed similar diagnostic profiles across age, but varied by sex. Classes characterized by multiple anxiety disorders were consistently associated with a greater degree of persistence, clinical severity, impairment, and comorbidity with other "DSM-IV-TR" psychiatric disorders. Conclusions: The presentation of lifetime anxiety disorders among adolescents and the observation of unique correlates of specific classes provide initial evidence for the utility of individual "DSM-IV-TR" anxiety disorder categories. Although findings of the present study should be considered preliminary, results emphasize the potential value of early intervention and gender-specific conceptualization and treatment of anxiety disorders. (Contains 3 footnotes, 4 tables, and 1 figure.)

In the recent years there has been a ten-fold increase in the incidence of autism in the USA. It is also estimated that approximately 67 million people are affected by autism worldwide. This worldwide epidemic has led to an increased interest in the identification and use of evidence-based interventions for individuals with autism. Interventions with children with autism can be broadly categorized into two primary types: (a) discrete trial training and (b) naturalistic interventions. This article provides an overview of the various components of evidence-based promising naturalistic interventions and their effectiveness with young children with autism. Naturalistic interventions that are reviewed in this article include pivotal response training, incidental teaching, and naturalistic language teaching paradigm. The evidence base for the interventions, limitations, and implications for practice are discussed. (Contains 2 tables.)

Intimate partner violence against women (IPV) affects all populations, but significant variations among these groups have been suggested. However, research results on racial differences in IPV are not only inconclusive, they are also limited--particularly with regard to racial minorities. As a result, it has been challenging for practitioners and service providers in many communities to serve an increasing number of racial minority clients. This study used the Collaborative Psychiatric Epidemiology Surveys (CPES) to examine differences in the prevalence of IPV, and associated factors, among major race groups in the U.S. Included variables were age, race, financial security, employment, education, social network, IPV perpetration and victimization, and severity of IPV. The results showed that Blacks were victimized the most, followed by Whites and Latinos, and Asians were victimized the least. Asians were the least likely to be victimized by IPV, even when controlling for sociodemographic variables. The odds of victimization for Blacks and Latinos were not significantly different from Whites. Financial security and age affected IPV victimization. Those who perceived themselves as financially secure were less likely to be victimized than those who did not. The older were less likely to be victimized than the younger. Employment, education, and social networks did not affect victimization. Race was not a significant predictor of perpetration, when controlling for other variables. Age was the only predictor of perpetration: the older were less likely to perpetrate IPV than the younger. (Contains 3 tables and 2 notes.)

This study examined effects of type of and cumulative burden of childhood adversities on bullying and cruelty to animals in the United States. Data were derived from Waves I and II of the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative sample of U.S. adults. Structured psychiatric interviews were completed by trained lay interviewers between 2001-2002 and 2003-2004. Although the effects of childhood adversity diminished with the inclusion of confounding variables, several adversities remained significant. For bullying, these included being made to do chores that were too difficult or dangerous, threatening to hit or throw something, pushing, shoving, slapping, or hitting, and hitting that left bruises, marks, or injuries. With respect to cruelty to animals, swearing and saying hurtful things, having a parent or other adult living within the home that went to jail or prison, and adult/other person fondling/touching in a sexual way were significant. The final models indicated that the cumulative burden of childhood adversities had strong effects on the increased likelihood of bullying behavior but not cruelty to animals. (Contains 3 tables.)

Keeping children safe and healthy is one of the main concerns of parents and child care providers. SIDS (Sudden Infant Death Syndrome) is the leading cause of death in infants 1 month to 12 months of age. Over 2,000 infants die from SIDS every year in the United States, and almost 15% of these deaths occur in child care settings. A targeted educational training was developed to teach child care providers about SIDS and the importance of safe sleep environments in child care. Statistical analyses indicated significant differences in participant knowledge and self-reported practices on pre- and post-tests. (Contains 2 tables.)

This project is one of four that were issued to first semester sophomore undergraduates at the United States Military Academy as part of an integrated learning experience at the end of their Calculus II course work. This project was used during a short, seven lesson block of instruction that was intended to capitalize on their recent academic decision--the student body had just selected their majors. Given that the students had only seven days to "solve" the problem, the focus was not on the details of developing the mathematical model. Instead, students were instructed to include several specified assumptions in a model that they would develop using a provided flow diagram. A computer algebra system was used to determine a numerical solution to the resulting system of differential equations. After completing this simplified approach to modeling a complicated biological problem, the focus shifted to the connection between the "math" and the "real world solution." The specific objectives of this experience were to develop student awareness of the role of mathematics in all disciplines as well as the effect of other disciplines on the development of mathematical models and solutions of "real world" situations. (Contains 2 figures.)

This article presents material that has been used as a classroom activity in a calculus-based probability and statistics course. The application was used in the first few lessons of this course. Students had three previous semesters of math, including calculus (single and multivariable), differential equations, and a course in mathematical modeling. No previous science courses are prerequisites for the course. (Contains 5 tables and 7 figures.)

This systematic review of population based studies of homicide followed by suicide was conducted to examine the associations between rates of homicide-suicide, rates of other homicides and rates of suicide. The review analysed 64 samples, including the case of an outlier (Greenland) that were reported in 49 studies. There was a significant association between the rates of homicide-suicide and those of other homicides in studies from the U.S.A. Outside the U.S.A. there was no clear association between homicide-suicide and other homicide but there was modest but significant association between rates of suicide and homicide-suicide. Homicide-suicide appears to be closer in epidemiological terms to homicide than suicide in regions with high rates of homicide and measures to reduce homicide in these regions may also reduce homicide-suicide.

Researching the epidemiology and estimating the prevalence of fetal alcohol syndrome (FAS) and other fetal alcohol spectrum disorders (FASD) for mainstream populations anywhere in the world has presented a challenge to researchers. Three major approaches have been used in the past: surveillance and record review systems, clinic-based studies, and active case ascertainment methods. The literature on each of these methods is reviewed citing the strengths, weaknesses, prevalence results, and other practical considerations for each method. Previous conclusions about the prevalence of FAS and total FASD in the United States (US) population are summarized. Active approaches which provide clinical outreach, recruitment, and diagnostic services in specific populations have been demonstrated to produce the highest prevalence estimates. We then describe and review studies utilizing in-school screening and diagnosis, a special type of active case ascertainment. Selected results from a number of in-school studies in South Africa, Italy, and the US are highlighted. The particular focus of the review is on the nature of the data produced from in-school methods and the specific prevalence rates of FAS and total FASD which have emanated from them. We conclude that FAS and other FASD are more prevalent in school populations, and therefore the general population, than previously estimated. We believe that the prevalence of FAS in typical, mixed-racial, and mixed-socioeconomic populations of the US is at least 2 to 7 per 1,000. Regarding all levels of FASD, we estimate that the current prevalence of FASD in populations of younger school children may be as high as 2-5% in the US and some Western European countries. (Contains 6 tables.)

The alarming prevalence of suicidal behaviors in Native American communities remains a major concern in the 21st-century United States. Recent reviews have demonstrated that prevention programs and intervention efforts using transactional-ecological models have effectively reduced suicidal behaviors in the American Indian and Alaska Native populations sampled. As a result, this article adopts a transactional-ecological framework for conceptualizing suicidality and identifying points of intervention. Drawing on the most current empirical reports, the epidemiology of Native American suicidal behaviors is reviewed, while situating risk and protective factors within a biopsychosocial framework. Opportunities for intervention are discussed with a focus on the interactions between individuals and their environments, and the antecedent conditions leading to zones of heightened suicide risk.

Rates of mental health problems in mothers and children in families affected by maternal HIV as compared to those not affected by maternal HIV but living in similar inner-city, low-SES, primarily ethnic-minority neighborhoods were examined. In addition, correspondence between mother and child mental health was explored. Interviews were conducted with 220 mother/child dyads regarding symptoms of depression and anxiety. Participants included HIV-negative early adolescents (ages 10 through 14 years) and their mothers, approximately half of whom were HIV-positive. Overall, mothers with HIV exhibited more depressive symptomatology than uninfected mothers. There were no significant differences, however, in depressive symptomatology between children of mothers who were HIV-positive and children of mothers who were HIV-negative. Among families directly affected by HIV, mothers who disclosed their status to their children endorsed greater depressive symptomatology than those who did not disclose and children who had been disclosed to were more likely to score in the clinically depressed range on the Child Depression Inventory than those who did not know. Latina mothers and their children were at increased risk for both depression and anxiety symptoms, particularly in families where the mother was not born in the United States. The results corroborate previous findings with HIV-infected women that highlight the mental health needs of HIV-infected mothers and their children, particularly children that know their mothers' status. (Contains 7 tables.)

Current widespread use of the same youth assessment measures and scales across different nations assumes that youth psychopathology syndromes do not differ meaningfully across nations. By contrast, the authors' syndromal sensitivity model posits 3 processes through which cultural differences can lead to cross-national differences in psychopathology syndromes. The authors tested this model in a comparison of Child Behavior Checklist syndromes for adolescents in Thailand and the United States. In support of the model, about half of the Thai-U.S. syndrome comparisons showed poor agreement (kappa = 0.40), and distinctive Thai syndromes emerged reflecting 3 prominent themes in Thai research literature: delayed maturation, indirect aggression and/or delinquency, and sex problems in boys. Such syndromal dissimilarity carries significant implications for assessment, diagnosis, epidemiology, and intervention across national boundaries.

The absence of validated U.S. rates of nonfatal suicidal behavior places risk management and injury prevention programs at danger of being poorly informed and inadequately conceptualized. In this study we compare estimated rates of intentional self-harm from two ongoing surveys (National Electronic Injury Surveillance System-All Injury Program-NEISS-AIP; National Hospital Ambulatory Medical Care Survey-NHAMCS) to data from the Toxic Exposure Surveillance System. Results suggest that, for every 2002-2003 suicide, there were 12 (NEISSAIP) or 15 (NHAMCS) self-harm--related emergency department visits, and for every intentional self-poisoning death there were 33 intentional overdoses reported to poison control centers, of which two ultimately went untreated.

Since the release of former Secretary Margaret Heckler's "Secretary's Task Force Report on Black and Minority Health" more than two decades ago, excess death from chronic diseases and other conditions between African Americans and Whites have increased. The conclusion of that report emphasized excess death and thus clinical care, paying little attention to the sociocultural environment and its effects on risk of disease. The authors of this article contend that eliminating health disparities between the African American and White populations in the United States requires a focus on improving the social environment of African Americans. They examine the interface of culture, gender, and power and how those are central to analysis of the root causes of health disparities. The REACH 2010 project of the Centers for Disease Control offers examples on how a coalition of community and research organizations can infuse community interventions with informed considerations of culture, gender, and power to eliminate health disparities.

While much of the industrialized world struggles for clues to the growing rise in obesity in their respective countries, researchers and service providers involved in understanding the health characteristics and health behaviors of persons with intellectual disability (ID) struggle with their own issues regarding the increased prevalence of obesity in this segment of the population. What is particularly alarming is that adults with ID residing in the United States in smaller, less supervised settings (e.g., group homes and family households) have a significantly higher rate of obesity compared to other countries and those living in larger and more supervised settings (e.g., institutions). These differences support the theory that the environment appears to exert a powerful influence on obesity in this population. Obesity presents a substantial threat to the livelihood of persons with ID and may have an effect on community participation, independent living, and healthy years of life. The lack of research on successful weight reduction strategies for obese persons with ID makes this an important and greatly needed area of research. (Contains 1 table and 4 figures.)

Although the percentage of overall AIDS diagnoses remains low among Asian and Pacific Islanders (APIs) in the United States compared with other racial/ethnic groups, research on API risk behaviors and health status suggest that the low number of AIDS cases may not provide a full picture of the epidemic and issues faced by this understudied and underserved population. Data from national HIV/AIDS surveillance systems and the Behavioral Risk Factor Surveillance System (BRFSS) were examined to delineate the magnitude and course of the HIV/AIDS epidemic among APIs in the United States. Same-sex sexual activity is the main HIV risk for API men, whereas heterosexual contact is for API women. APIs are significantly less likely to report being tested for HIV despite the fact that a similar proportion of APIs and other racial/ethnic groups reported having HIV risk in the past 12 months. Given the enormous diversity among APIs in the United States it is important to collect detailed demographic information to improve race/ethnicity and HIV risk classification, conduct better behavioral and disease monitoring for informing prevention planning, and addressing cultural, linguistic, economic and legal barriers to HIV prevention among APIs.

Objective: To review the past 10 years of published research on human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in the United States, including psychosocial and psychiatric risk factors, epidemiology, biology, neurocognitive and psychiatric sequelae, disclosure issues, prevention strategies, and biological and behavioral treatments. Method: Researchers reviewed the English-language literature with a focus on child and adolescent risk factors associated with HIV/AIDS, prevention, and treatment. Results: Substantial scientific advances have occurred over the past two decades leading to decreased morbidity and mortality in the United States from AIDS-related opportunistic infections. At the same time, rates of HIV infection are increasing in teenagers, young women, and minorities, and growing numbers of youths are living with an infected family member. Understanding HIV risk behavior requires a broad theoretical framework. Comprehensive HIV prevention programs have led to reduced risk behavior among HIV-affected youths and teens at risk of infection. Biological and behavioral treatments of HIV infection continue to evolve and have led to longer life span, improved quality of life, and fewer psychiatric problems. Conclusions: HIV/AIDS has significant mental health implications, and psychiatry can play a critical role in curbing the epidemic. With minimal effort, mental health professionals can adapt and apply the strategies that they use to treat psychiatric symptoms to prevent HIV transmission behaviors.

Most days, Cynthia Davis is an exasperated trooper who can always be found teaching and preaching from the frontline of the AIDS epidemic in Los Angeles. The very disease that's crippling and killing those she's trying to save with prevention, education and intervention is also what fuels her resolve to return day after day to a place where burnout is high, death is an almost everyday event and where the community's concerns about HIV/AIDS often get lost in the daily struggle to survive. Still this community services administrator and assistant professor at Charles R. Drew University of Medicine and Science in Los Angeles keeps on pushing for clinical care for those living with HIV/AIDS. Results from the federal governments National Health and Nutrition Examination Survey are discussed in this document. According to the survey, the HIV infection rate among Blacks ages 18 to 59 was 1.1 percent in 1991, or about five times higher than that found in Whites. By 2001, the rate was 2.14 percent, or 13 times greater than the rate seen in Whites.

A course on AIDS presents many interdisciplinary opportunities as well as interactive pedagogies. In an AIDS course at Whittier College, students learn about the biological basis and epidemiology of the disease, tackle current policy issues in the United States, and study the effect of the disease in Africa.

Composed of all or a portion of 13 states, Appalachia is a heterogeneous, economically disadvantaged region of the eastern United States. While mortality from cancer in Appalachia has previously been reported to be elevated, rates of cancer incidence in Appalachia remain unreported. Purpose:To estimate Appalachian cancer incidence by stage and site and to determine if incidence was greater than that in the United States. Using 1994-1998 data from the central registries of Kentucky, Pennsylvania, and West Virginia, age-adjusted incidence rates were calculated for the rural and nonrural regions of Appalachia. These state rates were compared to rates from the Surveillance, Epidemiology, and End Results (SEER) program for the same years by calculating the adjusted rate ratio (RR) and a 95% confidence interval (CI). Findings: Both the entire and rural Appalachian regions had an adjusted incidence rate for all cancer sites similar to the SEER rate (RR = 1.00 [95% CI, 1.00-1.01] and RR = 0.99 [95% CI, 0.99-1.00], respectively). However, incidence of cancer of the lung/ bronchus, colon, rectum, and cervix in Appalachia was significantly elevated (RR = 1.22 [95% CI, 1.20-1.23], 1.13 [95% CI, 1.11-1.14], 1.19 [95% CI, 1.16-1.22], and 1.12 [95% CI, 1.07-1.17], respectively). Incidence of cancer of the lung/bronchus and cervix in rural Appalachia was even more elevated (RR = 1.34 [95% CI, 1.31-1.36] and 1.29 [95% CI, 1.21-1.38], respectively). Incidence of unstaged disease for all cancer sites in Appalachia (RR = 1.06 [95% CI, 1.05-1.08]), particularly rural Appalachia (RR = 1.28 [95%CI, 1.25-1.30]), was elevated. Cancer incidence in Appalachia was not found to be elevated. However, incidence of cancer of the lung/bronchus, colon, rectum, and cervix was elevated in Appalachia. The rates of unstaged cancer of every examined site were elevated in rural Appalachia, suggesting a lack of access to cancer health care.

Objective: To critically review cannabis research during the past 10 years in relation to rates of use, behavioral problems, and mental disorders in young people. Method: Studies published in English between 1994 and 2004 were identified through systematic searches of literature databases. The material was selectively reviewed focusing on child and adolescent data. Results: In the 27 years between 1976 and 2002, approximately half of all 12th graders had been exposed to cannabis in the United States. There is growing evidence that early and regular marijuana use is associated with later increases in depression, suicidal behavior, and psychotic illness and may bring forward the onset of schizophrenia. Most of the recent data reject the view that marijuana is used to self-medicate psychotic or depressive symptoms. Research on treatment is very limited. Conclusions: Research on the mental health effects of cannabis has increased dramatically. Although doubts still remain about the role of cannabis in the causation of juvenile psychiatric disorder, the weight of the evidence points in the direction of early and regular cannabis use having substantial negative effects on psychosocial functioning and psychopathology.

The Ohio Substance Abuse Monitoring Network (OSAM) is designed to provide accurate, timely, qualitatively-oriented epidemiologic descriptions of substance abuse trends and emerging problems in the state's major urban and rural areas. Use of qualitative methods in identifying and assessing substance abuse practices in local communities is one of the main assets of OSAM Network. Qualitative methods are sensitive to local contextual variability, flexible enough to capture emergent trends, and can be implemented with limited financial resources. This paper describes how qualitative epidemiologic methods, like those used by the OSAM Network, could be applied to inform substance abuse prevention activities, particularly those directed at adolescents.

In teaching middle school students about diseases and microbes, it is surprising to discover how little they know about transmission. Misconceptions range from the idea that "giving a disease to someone" actually means "giving it away so you didn't have it anymore yourself" to a lack of understanding that tiny living things, and not dirt, are generally the cause of illness. This article describes a unit that would teach students about the microbes in their world with an emphasis on those that cause sickness. Anything that might be considered "disgusting" (and that includes gastrointestinal illness) generally appeals to middle school students. Additionally, this activity was designed to introduce students to careers in epidemiology by allowing them to investigate an outbreak themselves. (Contains 3 figures.)

In the United States, the incidence of type 2 diabetes mellitus (DM) in children and adolescents has been increasing at an alarming rate. Early recognition and intervention can delay the onset of type 2 DM and prevent the long-term complications. School nurses have an essential role in implementing the American Diabetes Association (ADA) recommended screening guidelines to identify youth at high risk for type 2 DM and in implementing student health programs that focus positively on the importance of physical activity and healthy eating habits. The purpose of this article is to present an overview of the epidemiology, pathophysiology, complications, diagnosis, and treatment, as well as the recommended screening guidelines for type 2 DM in the pediatric age group. The information provided will enhance awareness, promote screening, and empower the school nurse to more effectively promote healthy lifestyle education. (Contains 4 tables and 1 figure.)

Even on paper three decades ago, HIV, the virus that causes AIDS, invoked fear and loathing. Despite increased public awareness and billions spent in search of a cure, the disease still generates fear today. As the disease has morphed into a global pandemic that is still without a cure, Black America battles the highest rate of new HIV infections and new AIDS diagnoses compared to any other racial group. Even in the early days of the disease in the United States--first largely identified as a disease of gay White men--Blacks constituted a disproportionate number of new AIDS cases reported between 1981 and 1983. By the late 1980s, Blacks led Whites in the number of new HIV infections. By 2006, Blacks were 7.3 times more likely than Whites to be infected, according to the Black AIDS Institute. "Diverse" shares conversations and reflections from some HBCU stakeholders working on the front line of HIV/AIDS, both in the classroom and in the community. This article presents the views of AIDS experts who reflect on efforts to eradicate the disease and create awareness about how it is transmitted.

The Advisory Committee on Immunization Practices (ACIP) at the Center for Disease Control and Prevention (CDC) will be considering a new vaccination recommendation for the prevention of invasive "N. meningitidis" infection when meningococcal conjugate vaccines are licensed in the United States. The CDC has also updated the Working Group in the epidemiology of meningococcal disease. Although the rates of disease are highest among infants, the rates among adolescents and young adults are double those of the general population, and case fatality rates are 3- to 4-fold higher among teens. The risk among college freshmen living in dormitories is higher than that among dormitory residents, freshmen in general, college students in general, and the general population of persons aged 18 to 23 years. The Working Group and the ACIP also reviewed cost-effective studies. The CDC has conducted an extensive cost-effectiveness analysis, and the bottom line is that there are no cost savings to society for vaccinating adolescents against meningococcal disease. In this article, the author offers his views concerning ACIP's and CDC's stance on the cost-effectiveness of vaccinating adolescents against this disease.

Summarizes the epidemiology of AIDS in children in the United States reported cumulatively from 1982 through September 1996, presenting rates for 1995, and discussing HIV surveillance and reporting for children. The data show that the incidence of perinatally acquired AIDS has declined, a trend that probably reflects the effect of perinatal ZDV therapy. (SM)

Reviews epidemiological studies on the prevalence of maternal depression in the general population and the social etiology of behavioral and psychiatric disorders in early childhood. Also reports an original study conducted in Martha's Vineyard and points out avenues for much-needed further research in this area. (BB)

Suicide, and its particularly disturbing rise in the last three decades, is a major public health concern. Prevention efforts must be multifaceted, and include the refinement of epidemiological methods in the study of suicide; development of health education, information, and intervention programs dealing with suicide; and increased community awareness of and participation in all suicide prevention efforts. (Author/KS)

A questionnaire developed and mailed to administrators of all accredited U.S., Canadian, and Puerto Rican medical schools, asked for information on courses offered in epidemiology, statistics, evaluation of medical literature, and research design. Future research should evaluate the effectiveness of such courses. (Author/MLW)

Nearly 30 years ago, renowned immunologist James E.K. Hildreth, M.D., Ph.D., was compelled to start researching the virus that causes AIDS. He marveled at its enigma and was pressed into action by its ability to cut lives short and devastate communities. The disease set him on a course of medical inquiry that has included biomedical breakthroughs in understanding its transmission. In this conversation, Dr. Hildreth discusses his latest move to UC Davis, his tenure at Meharry Medical College, why he's frightened for Black women and what makes him hopeful about HIV/AIDS 30 years after the first AIDS cases were reported in the United States.

For years, New York health-care providers have treated Asian-Americans afflicted by serious, even life-threatening illnesses with ever-increasing frequency. Many doctors in the nation's largest city agreed that Asians seemed particularly at risk for specific health problems, but there was neither research nor statistics supporting physician observations. In this article, the author describes a pioneering center at New York University that employs a community-based approach to addressing illnesses disproportionately affecting Asian-Americans. Established in 2003, the Center for the Study of Asian American Health (CSAAH) is the only center of its kind at a U.S. academic medical center dedicated solely to evaluating public health issues of this racial group. Soon after CSAAH's inception, which was financed by a National Institutes of Health grant, its scientific efforts began exploring the relationship between viral and bacterial infections and cancer, as well as the risk for cardiovascular disease, among different Asian ethnic groups.

If a flu pandemic breaks out in the United States, as many as 4 in 10 school-age children will become sick, according to the U.S. Department of Health and Human Services, which released a comprehensive plan on how it would deal with such an outbreak. The nearly 400-page plan says the department would consider measures such as closing schools early in a pandemic to combat flu pandemic and to help control its spread, especially before a vaccine was available or while it was in short supply. School closings would accompany other measures, such as restricting travel, screening people from affected areas, and isolating infected persons. Though school health experts caution against overreaction, they agree that preparedness is paramount. They say that districts need to begin work now to ensure they are not caught sleeping. The federal plan, issued amid worries about avian flu, places children low on the list of groups that would have priority for receiving vaccines, because they generally have been at a low risk for hospitalization and death in prior pandemics and during the annual flu season. Anecdotal reports suggest the spread of a pandemic can be better controlled when schools are closed early in an outbreak. School districts are advised to come up with their own plans on how to respond to an influenza pandemic.