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Introduction Latino adolescents may face numerous barriers) to recommended vaccinations. There is little research on the association between Latino adolescent-mother preferred language concordance and vaccination completion and if it varies by neighborhood. To better understand the social/family factors associated with Latino adolescent vaccination, we studied the association of adolescent-mother language concordance and neighborhood social deprivation with adolescent vaccination completion. Methods We employed a multistate, electronic health record (EHR) based dataset of community health center patients to compare three Latino groups: (1) English-preferring adolescents with English-preferring mothers, (2) Spanish-preferring adolescents with Spanish-preferring mothers, and (3) English-preferring adolescents with Spanish-preferring mothers with non-Hispanic white adolescent-mother pairs for human papilloma virus (HPV), meningococcal, and influenza vaccinations. We adjusted for mother and adolescent demographics and care utilization and stratified by the social deprivation of the family's neighborhood. Results Our sample included 56,542 adolescent-mother dyads. Compared with non-Hispanic white dyads, all three groups of Latino dyads had higher odds of adolescent HPV and meningococcal vaccines and higher rates of flu vaccines. Latino dyads with Spanish-preferring mothers had higher vaccination odds/rates than Latino dyads with English-preferring mothers. The effects of variation by neighborhood social deprivation in influenza vaccination rates were minor in comparison to differences by ethnicity/language concordance. Conclusion In a multistate analysis of vaccinations among Latino and non-Latino adolescents, English-preferring adolescents with Spanish-preferring mothers had the highest completion rates and English-preferring non-Hispanic white dyads the lowest. Further research can seek to understand why this language dyad may have an advantage in adolescent vaccination completion., Author(s): John Heintzman [sup.1] , Rachel Springer [sup.1] , Miguel Marino [sup.1] , Jorge Kaufmann [sup.1] , Sophia Giebultowicz [sup.2] , Nathaniel Warren [sup.2] , Jennifer Devoe [sup.1] , Shuling [...]

Community-based health interventions have emerged as a growing focus for anthropological research. The application of ethnographic approaches in clinical practice settings reveals that community-based interventions must grapple with 'noise,' or unanticipated factors such as patients' own perceptions of illness and treatment, primary care providers' nonadherence to guidelines-based treatment, the social dynamics of the clinic site itself, and incomplete understanding and acceptance of an intervention by a clinic's staff members. Such noise can influence the implementation and quality of treatment. Thus, identifying clinic-based noise is critical in assessments of fidelity to intervention protocols as well as outcomes of community-based interventions. This paper highlights findings from an evaluation of a mental health intervention focusing on the role of promotoras (briefly trained, non-professional community health workers) as mental health practitioners in two urban New Mexico, USA, community health centers. Our research identified three areas of clinic-based noise: the clinics' physical ability to 'absorb' the intervention, the challenges of co-worker instability and interpersonal relationships, and balancing extra workplace demands. The findings demonstrate the value of ethnographic approaches in community-based intervention research. Keywords: USA; Promotoras; Ethnographic methods; Community-based intervention; Primary care; Health disparities; Mental health

Objective. Although privately owned practices provide the majority of primary care for children, little is known about the organizational characteristics of these practices or how these characteristics affect the quality of care for children. The purpose of this study was to describe selected organizational characteristics and preventive service delivery features that might affect the quality of primary care for children in private practices. Methods. A cross-sectional study of 44 private pediatric and family medicine practices in 2 regions of North Carolina was performed. Preventive service performance was assessed through chart abstraction for 60 randomly selected children between 24 and 30 months of age, for evaluation of immunizations and anemia, tuberculosis, and lead screening delivery by 2 years of age. Organizational characteristics were determined through surveys of all physicians and staff members. We used descriptive statistics and scatter plots to describe variations in organizational characteristics and preventive services. Results. Overall, practices demonstrated low levels of preventive service performance, with substantial variation among practices. Only 39% of children received 3 of the 4 recommended preventive services measured (practice range: 2-88%). Few practices demonstrated evidence of a systematic approach to prevention. For example, only 12 (27%) of the 44 practices used >1 of 5 recommended preventive service delivery strategies. Furthermore, practices varied greatly with respect to many of the measured organizational characteristics, which were consistent with organizational stress in some cases. For example, turnover of clinicians and staff members was remarkably high, with practices losing an average of 27% of their clinicians every 4 years (range: 0-170%) and 39% of their office staff members every 2 years (range: 0-170%). Conclusions. Private practices caring for children in North Carolina demonstrated low overall performance for the 4 recommended preventive services examined, with large variations among practices. Few practices had evidence of comprehensive systems for prevention. There was also evidence of substantial variation in many organizational characteristics. Some organizational characteristics were at levels that might impede delivery of high-quality primary care for children. These findings suggest a growing need for research that examines the impact of organizational characteristics on the quality of care in private practices. Pediatrics 2005;115:1704-1711; private practices, preventive services, organizational management. ABBREVIATIONS. FTE, full-time equivalent; RCT, randomized, controlled trial; OSI, Office Systems Index., In a recent report on health care quality, the Institute of Medicine recommended fundamental change in the US health care system, citing remarkable variation as well as shortcomings in many [...]

Objective: Understanding prevention program risks and the contextual factors associated with negative program outcomes is critical to assisting the development of public policy that is aimed at avoiding future prevention-related harm while maximizing prevention success. The purpose of this review was to systematically analyze published studies evaluating substance use prevention programs, to determine whether iatrogenic effects have occurred, and if so, what types of harmful effects resulted and under what circumstances. Method: A search of electronic bibliographic databases in allied health, education, medicine, psychology and general literature was conducted, spanning the years from 1980 to the present. Results: Evidence of negative program effects was found in 17 evaluation studies for which 43 negative outcomes were documented. The most common type of negative outcome resulting from prevention programs was behavioral effects consisting primarily of increases in consumption, especially alcohol use. Drug prevention programs resulted in greater increases in alcohol use, cigarette use, marijuana use and multiple drug use than did alcohol prevention programs. Negative program outcomes appear to exist as three possible scenarios, described in this article. Conclusions: Researchers, publishers and practitioners should pay special attention to measuring, monitoring and reporting negative outcomes of prevention programs in the future, so that we might learn more about which program elements interact with which contextual factors to cause harm to which groups of youth., A CONSIDERABLE AMOUNT of media attention was recently paid to an Institute of Medicine report (Kohn et al., 2000) indicating that medical errors may result in 44,000 to 98,000 deaths [...]

This article investigates the relationship between self-efficacy, behavioral intervention, and the effectiveness of preventive health services.

The authors examine the use of preventive health services to lower morality rates among Australian aborigines and Torres Strait Islanders. Topics include health care facilities, ambulatory services, and health care finance.

A group of 30 community physicians who practiced in northeastern United States and who participated in the Cancer Prevention in Community Practice project in 1988 were interviewed five years later. The aim of the interviews was to assess the long-term impact of the preventive services office system which had been introduced by the project. The qualitative analysis of interviews revealed three distinct physician philosophies about the provision of preventive services: * a Request Only focus, responding to specific patient inquiries about prevention but taking no initiative to recommend indicated services; * a Health Maintenance Visit focus, providing indicated services only during visits specifically scheduled for preventive care; and * an Opportunistic Prevention focus, providing indicated preventive services at every chance. Physicians demonstrated these philosophies in their overall view of disease prevention, perceived obstacles to delivery of preventive care, as well as in their continued use of flow sheets and their impression of the value of the Cancer Prevention in Community Practice project. The long-term impact of the office system was most apparent in the Opportunistic Prevention group. We conclude that the durability of a preventive services office system is influenced by a physician's preventive care philosophy. Key words - preventive health services, interviews semi-structured, qualitative research, durability, physicians' practice patterns, cancer prevention and early detection.

The aim of this study was to find out whether there is any relation between the use of preventive health services provided for by municipalities under the Japanese Health Services for the Elderly Act and the demands for in-patient and out-patient care by insured residents aged 40 or older who were covered by the National Health Insurance, eligible for preventive health services under the act, in nine cities within the same catchment area in Osaka Prefecture. Main outcome measures were correlation coefficients between the use of in-patient and out-patient care, and (1) the rate of use of health check-ups, and (2) the cost for preventive health services per resident. Hospital admission rate per 1000 insured persons had a strong negative correlation with the rate of use of health check-ups. The rate of long stay, 180 days or more, per 1000 insured persons was also negatively correlated with the rate of use of health check-ups. There were negative correlations between the rate of use of health check-ups and both the in-patient cost per insured person, and the rate of high in-patient cost, 600,000 Yen or more, per 1000 insured persons. On the other hand, out-patient utilization rate per 1000 insured persons had a positive correlation with the rate of use of health check-ups. However, there was a negative relation between the rate of use of health check-ups and the out-patient cost per insured person because of negative associations between the rate of use of health check-ups and the out-patient days, and cost per case. The rate of high out-patient cost, 60,000 Yen or more, was negatively correlated with out-patient utilization rate per 1000 insured persons. Negative relations were also shown between the cost for preventive health services per resident and the in-patient and out-patient cost per case and per insured person, except out-patient utilization rate per 1000 insured persons. The correlation coefficient between the cost for preventive health services per resident and the total medical cost per insured person was r = -0.779 (P = 0.007). Provision of preventive health services under the Health Services for the Elderly Act may possibly improve health management in the early stage of diseases by detecting abnormalities in health, and that investing in prevention might contribute to reducing the subsequent total demand for medical care. Key words - health check-ups, preventive health services, use of medical care

The additional benefits of direct community intervention in lowering health risk factors may be small, but such community-based studies may have other value. Three studies funded by the National Heart, Lung, and Blood Institute were designed to test community-based disease prevention programs. The focus was on risk factors for cardiovascular diseases. The three studies are the Stanford Five-City Project in California, the Minnesota Heart Health Program and the Pawtucket Heart Health Program in Rhode Island and Massachusetts. Early reports show significant improvements in the US population in general in changing behaviors related to cardiovascular disease. The specific efforts of these projects have not added much additional improvement. This may be in part because so many factors that cannot be controlled or even measured operate in a community. These studies add information on designing and managing community-based health projects. Many educational materials are produced and tested by these studies. These studies also do a thorough job of measuring the change that has occurred and may do well as part of combined approaches to public health interventions.

Continued public support for the design, implementation, and dissemination of preventive interventions depends on achievement of four major criteria: (a) Reductions in the incidence or prevalence rates of diagnosable emotional and behavioral disorders, (b) reductions in the need for mental health services through effective primary and secondary interventions, (c) enhancement of the effectiveness of obtained services as screening and early detection efforts are implemented, and (d) reductions in the nation's health care costs associated with emotional and behavioral dysfunctions. Strategies including risk reduction, risk avoidance, health promotion, empowerment, and resource development are preventive insofar as they contribute to achievement of the aforementioned outcomes.

The design, conduct, and analysis of prevention research efforts present formidable challenges, but as the papers in this volume illustrate, the problems of prevention research are probably not altogether intractable; they simply require the best of our thinking and the firmest of our commitments. The papers included in this issue represent some of the best thinking likely to be available, and, in aggregate, they give reason for some optimism about prevention research. Which is fortunate, because it is by now abundantly clear that treatment of all the assorted personal and social maladies that afflict us individually and as a society, is impossibly intrusive and expensive, even if we were certain we knew what to do, and we are not. Treatment research is only a step or two ahead of prevention research in nearly any field.

Recently there has been resurgence in the number of cases of measles, mumps, and rubella (German measles). Many of these cases are occurring not in the young child, as in the past, but in teenagers and young adults. A study was undertaken to determine the level of immunity of young adults, in an effort to provide information to those who make national and military immunization policy decisions. There were 1,547 US army recruits included in the study; the recruits were given a questionnaire and blood samples were obtained. Blood samples were evaluated for antibody status (presence of antibodies indicates immunity) against measles, mumps, rubella, and varicella (chicken pox), as well as poliovirus types 1, 2, and 3. The results of the blood analysis revealed that 20.7 percent of recruits were without antibodies against measles; 15.6 percent, against mumps; 17.6 percent against rubella; and 6.9 percent against varicella. Susceptibility to measles, mumps, and rubella was less in women, blacks, and college-educated recruits; women and backs were more susceptible to varicella. Older recruits (those born before 1970) more often had immunity to measles, mumps and rubella than did younger recruits. A total of 2.3 percent of the recruits lacked immunity to polio type 1; 0.6 percent to type 2; and 14.6 percent to type 3. It is concluded that immunity to measles, mumps, and rubella is unevenly distributed among young Americans. These findings support the national objective of improving immunization in school children and young adults. Results support legislation which would require those entering college to present evidence of at least two measles vaccinations, one of which having been given at or after admission to elementary school. (Consumer Summary produced by Reliance Medical Information, Inc.)

The quality of program delivery and reception or program integrity as factors that may play an important moderating function in the effectiveness of alcohol prevention programs is evaluated. It was found that program integrity significantly moderates outcomes for three of seven mediating variables. These were knowledge of peer pressure resistance strategies, behavioral pressure resistance skills and perceived self-efficacy. Trained observers and program specialists who taught the programs to students were utilized to judge program integrity.

This paper compares the cost per completed maternal tetanus immunization and an estimate of the cost per death averted in the routine EPI program with similar results from an experimental mass campaign in Aceh Province, Indonesia. The cost-effectiveness of the mass campaign in achieving complete immunization is similar to the routine program. However, the mass campaign is probably less cost-effective in averting neonatal tetanus deaths, due to its broader targetting. Factors affecting efficiency, coverage, and financing of tetanus immunization programs are assessed. While expansion of the routine EPI program is the preferred goal, mass campaigns are judged to be a reasonable part of the multi-year strategy for tetanus control in the province. Recent experiments with an accelerated routine program may provide further alternatives.

Acute illnesses are expected events in life, but even minor infections may put patients with diabetes at risk for decompensation and potential hospitalization. It has even been suggested that all [...]

Dietary intakes of police department employees in a wellness program (1) Americans have become more cognizant of healthy lifestyles. Corporations such as Tenneco, AT&T, Campbell Soup Company, and General Motors [...]