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Context The US government manages a large number of data sets, including federally funded data collection activities that examine infectious and chronic conditions, as well as risk and protective factors for adverse health outcomes. Although there currently is no mature, comprehensive metadata repository of existing data sets, US federal agencies are working to develop and make metadata repositories available that will improve discoverability. However, because these repositories are not yet operating at full capacity, researchers must rely on their own knowledge of the field to identify available data sets. Program or policy We sought to identify and consolidate a practical and annotated listing of those data sets. Implementation and/or dissemination Creative use of data resources to address novel questions is an important research skill in a wide range of fields including public health. This report identifies, promotes, and encourages the use of a range of data sources for health, behavior, economic, and policy research efforts across the life span. Evaluation We identified and organized 28 federal data sets by the age-group of primary focus; not all groups are mutually exclusive. These data sets collectively represent a rich source of information that can be used to conduct descriptive epidemiologic studies. Discussion The data sets identified in this article are not intended to represent an exhaustive list of all available data sets. Rather, we present an introduction/overview of the current federal data collection landscape and some of its largest and most frequently utilized data sets.

Introduction Rapid growth of the older adult population requires greater epidemiologic characterization of dementia. We developed national prevalence estimates of diagnosed dementia and subtypes in the highest risk United States (US) population. Methods We analyzed Centers for Medicare & Medicaid administrative enrollment and claims data for 100% of Medicare fee-for-service beneficiaries enrolled during 2011–2013 and age ≥68 years as of December 31, 2013 (n = 21.6 million). Results Over 3.1 million (14.4%) beneficiaries had a claim for a service and/or treatment for any dementia subtype. Dementia not otherwise specified was the most common diagnosis (present in 92.9%). The most common subtype was Alzheimer's (43.5%), followed by vascular (14.5%), Lewy body (5.4%), frontotemporal (1.0%), and alcohol induced (0.7%). The prevalence of other types of diagnosed dementia was 0.2%. Discussion This study is the first to document concurrent prevalence of primary dementia subtypes among this US population. The findings can assist in prioritizing dementia research, clinical services, and caregiving resources.

Objectives. We explored how changes in insurance coverage contributed to recent nationwide decreases in newborn circumcision. Methods. Hospital discharge data from the 2000–2010 Nationwide Inpatient Sample were analyzed to assess trends in circumcision incidence among male newborn birth hospitalizations covered by private insurance or Medicaid. We examined the impact of insurance coverage on circumcision incidence. Results. Overall, circumcision incidence decreased significantly from 61.3% in 2000 to 56.9% in 2010 in unadjusted analyses (P for trend = .008), but not in analyses adjusted for insurance status (P for trend = .46) and other predictors (P for trend = .55). Significant decreases were observed only in the South, where adjusted analyses revealed decreases in circumcision overall (P for trend = .007) and among hospitalizations with Medicaid (P for trend = .005) but not those with private insurance (P for trend = .13). Newborn male birth hospitalizations covered by Medicaid increased from 36.0% (2000) to 50.1% (2010; P for trend Conclusions. Shifts in insurance coverage, particularly toward Medicaid, likely contributed to decreases in newborn circumcision nationwide and in the South. Barriers to the availability of circumcision should be revisited, particularly for families who desire but have less financial access to the procedure.

In this commentary, we review definition frameworks for community health and examine factors having core relevance to shaping the meaning of this term and growing field. We conclude by suggesting a potential framework for conceptualizing and advancing this field of public health practice through improved understanding of the meaning, scope, and science of community health.

What characteristics are associated with a Day 5 embryo transfer?The use of the Day 5 embryo transfer has increased over time, with clinicians allowing women with typically 'poorer' prognostic characteristics to undergo a Day 5 embryo transfer. The mean number of embryos per Day 5 transfer decreased from 2001 to 2009, although the prevalence of the Day 5 single embryo transfer remains low and the rate of multiple births remains substantial.Day 5 embryo transfer may reduce the rate of multiple gestation pregnancy. US trends over time in the prevalence of the Day 5 transfer, changes in characteristics of patients receiving Day 5 transfer, and number of embryos transferred are unknown.We used 2001-2009 US National assisted reproductive technology (ART) Surveillance System (NASS) data on 620,295 fresh IVF cycles derived from autologous oocytes with a Day 3 or 5 embryo transfer. Trends in the mean number of embryos transferred from 2001 to 2009 were assessed by the day of transfer. For 349,947 cycles from clinics performing both Days 3 and 5 embryo transfers, multivariable logistic regression was used to determine the characteristics associated with the Day 5 embryo transfer. We also compared the characteristics of the Day 5 embryo cycles in 2001 and 2009.Overall, the proportion of ART cycles using the Day 5 embryo transfer increased from 12% in 2001 to 36% in 2009 (P0.0001), while the mean number of embryos transferred decreased from 2.4 to 2.1 (P0.0001). Among Day 5 transfers, the rate of the single embryo transfer tripled from 4.5% in 2001 to 14.8% in 2009 (P0.0001); and the rate of multiple births decreased from 44.8 to 41.1% (P0.0001). In cycles initiated after 2001, maternal age35 years, no prior ART cycles, ≥1 prior pregnancies, baseline follicle stimulating hormone10 international units and ≥10 oocytes retrieved were associated with the Day 5 embryo transfer. Compared with 2001, in 2009, a broader range of candidates received the Day 5 transfer. BIAS Women undergoing multiple ART cycles over time are not linked.We ran multivariable logistic regression to lessen the effects of the confounding factors. Cycle cancelation rates by the day of embryo transfer are unknown.Generalizable to ART clinics included in NASS.This study was funded by the Centres for Disease Control. The authors have no competing interests to declare.

Objective.To compare frequencies of complications among HIV-infected and-uninfected women undergoing common gynecological surgical procedures in inpatient settings.Methods.We used 1994–2007 data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project, a nationally representative sample of inpatient hospitalizations. Our analysis included discharge records of women aged ≥15 undergoing hysterectomy, oophorectomy, salpingectomy for ectopic pregnancy, bilateral tubal sterilization, or dilation and curettage. Associations between HIV infection status and surgical complications were evaluated in multivariable logistic regression models, adjusting for key covariates.Results.For each surgery, HIV infection was associated with experiencing ≥1 complication. Adjusted ORs ranged from 2.0 (95% confidence interval (CI): 1.7, 2.2) for hysterectomy with oophorectomy to 3.1 (95% CI: 2.4, 4.0) for bilateral tubal sterilization with no comorbidity present. HIV infection was positively associated with extended length of stay and infectious complications of all of the surgeries examined. For some surgeries, it was positively associated with transfusion and anemia due to acute blood loss. Among HIV-infected women, the odds of infectious and other complications did not decrease between 1994–2000 and 2001–2007.Conclusion.HIV infection was associated with elevated frequencies of complications of gynecologic surgeries in the US, even in the era of HAART.

This study investigated changes in cesarean delivery rate and cesarean indications in 3 county-level hospitals in rural China. Hospital delivery records in 1997 and 2003 were used to examine the reasons behind the changes. In Chengde County Hospital, the cesarean delivery rate increased from 28% in 1997 to 54% in 2003. The rate increased from 43% in 1997 to 65% in 2003 in Anxian County Hospital and Anxian Maternal and Child Health Hospital. The dramatic increase in cesarean delivery in the study hospitals was associated with a shift from more severe to mild or no clinical indications. The ratio of mild to moderate to severe hypertension increased substantially. More than half of the cephalopelvic disproportion cases were diagnosed prior to labor. The majority of nuchal cord cases were diagnosed without fetal distress. Maternal/family request was the number one cesarean indication in Anxian County Hospital and Anxian MCH Hospital in 2003. Ultrasound evidence of nuchal cord moved from the ninth ranked indication in 1997 to the second in 2003 in Chengde County Hospital.

OBJECTIVE To examine trends in the prevalence of diabetes among delivery hospitalizations in the U.S. and to describe the characteristics of these hospitalizations. RESEARCH DESIGN AND METHODS Hospital discharge data from 1994 through 2004 were obtained from the Nationwide Inpatient Sample. Diagnosis codes were selected for gestational diabetes mellitus (GDM), type 1 diabetes, type 2 diabetes, and unspecified diabetes. Rates of delivery hospitalization with diabetes were calculated per 100 deliveries. RESULTS Overall, an estimated 1,863,746 hospital delivery discharges contained a diabetes diagnosis, corresponding to a rate of 4.3 per 100 deliveries over the 11-year period. GDM accounted for the largest proportion of delivery hospitalizations with diabetes (84.7%), followed by type 1 (7%), type 2 (4.7%), and unspecified diabetes (3.6%). From 1994 to 2004, the rates for all diabetes, GDM, type 1 diabetes, and type 2 diabetes significantly increased overall and within each age-group (15–24, 25–34, and ≥35 years) (P < 0.05). The largest percent increase for all ages was among type 2 diabetes (367%). By age-group, the greatest percent increases for each diabetes type were among the two younger groups. Significant predictors of diabetes at delivery included age ≥35 years vs. 15–24 years (odds ratio 4.80 [95% CI 4.72–4.89]), urban versus rural location (1.14 [1.11–1.17]), and Medicaid/Medicare versus other payment sources (1.29 [1.26–1.32]). CONCLUSIONS Given the increasing prevalence of diabetes among delivery hospitalizations, particularly among younger women, it will be important to monitor trends in the pregnant population and target strategies to minimize risk for maternal/fetal complications.

Psychiatric illnesses commonly co-occur with HIV infection and such illnesses have been linked to women's poorer medication adherence and suicide. Using hospital discharge data from the 1994-2004 Nationwide Inpatient Sample, we conducted this study to describe hospitalizations with psychiatric diagnoses from 1994 through 2004 and evaluate the association of specific psychiatric disorders among hospitalized HIV-infected women in the USA with their lack of adherence to medical treatment and suicide attempt. Multivariable logistic regression analyses were used to examine trends in hospitalizations with psychiatric diagnoses among nonpregnant HIV-infected women and the association between specific disorders and women's lack of adherence to medical treatment and suicide attempt. Between 1994 and 2004, the estimated number of all hospitalizations among nonpregnant HIV-infected women increased by 8%, while the number of hospitalizations with a psychiatric diagnosis in this population increased by 73%. After adjusting for demographic factors and alcohol/substance abuse, we found that HIV-infected women were more likely to be hospitalized for mood (odds ratio (OR): 2.35; 95% confidence interval (CI): 1.93-2.88), anxiety (OR: 2.24, 95%CI: 1.74-2.88), and psychotic (OR: 1.45, 95%CI: 1.10-1.90) disorders in 2004 than in 1994. There was a significant association of alcohol/substance abuse with mood, adjustment, anxiety, personality, and psychotic disorders. Noncompliance with medical treatment was significantly associated with psychotic disorders, whereas suicide attempt/self-inflicted injury was significantly associated with mood, adjustment, anxiety, personality, and psychotic disorders. The number of hospitalizations with a psychiatric diagnosis among HIV-infected women in the USA has increased substantially. As HIV-infected women live longer, these results highlight the need for targeted public health interventions to address mental health issues in this population.

The purpose of this study was to describe trends in the prevalence of eating disorders among delivery hospitalizations in the United States from 1994 to 2004 and to compare hospital, demographic, and obstetrical outcomes among women with and without eating disorders.Hospital discharge data for 1994 to 2004 from the Nationwide Inpatient Sample (NIS) were used to assess the relationship between eating disorders (anorexia nervosa and bulimia nervosa) and obstetrical complications. Analyses were limited to delivery-related hospitalizations.There were an estimated 1,668 delivery hospitalizations with an eating disorder diagnosis in the United States in the 11-year period, resulting in an overall rate of 0.39 per 10,000 deliveries. After adjustment for hospital and demographic characteristics, delivery hospitalizations with an eating disorder were significantly more likely than those without an eating disorder to have fetal growth restriction (odds ratio [OR] 9.08, 95% confidence interval [CI] 6.45-12.77), preterm labor (OR 2.78, 95% CI 2.10-3.69), anemia (OR 1.73, 95% CI 1.25-2.38), genitourinary tract infections (OR 1.66, 95% CI 1.03-2.68), and labor induction (OR 1.32, 95% CI 1.01-1.73).Although the prevalence of eating disorders among delivery hospitalizations is lower than in the general population, the fact that women with eating disorders are at increased risk of adverse pregnancy outcomes highlights the importance of screening for and appropriate clinical care of eating disorders in pregnancy.

Objectives The accuracy of maternal morbidity estimates from hospital discharge data may be influenced by incomplete identification of deliveries. In maternal/infant health studies, obstetric deliveries are often identified only by the maternal outcome of delivery code (International Classification of Diseases code = V27). We developed an enhanced delivery identification method based on additional delivery-related codes and compared the performance of the enhanced method with the V27 method in identifying estimates of deliveries as well as estimates of maternal morbidity. Methods The enhanced and standard V27 methods for identifying deliveries were applied to data from the 1998–2004 Healthcare Cost and Utilization Project Nationwide Inpatient Sample, an annual nationwide representative survey of U.S. hospitalizations. Odds ratios (ORs) and 95% confidence intervals (CIs) from logistic regression were used to examine predictors of deliveries not identified using the V27 method. Results The enhanced method identified 958,868 (3.4%) more deliveries than the 27,128,539 identified using the V27 code alone. Severe complications including major puerperal infections (OR = 3.1, 95% CI 2.8–3.4), hysterectomy (OR = 6.0, 95% CI 5.3–6.8), sepsis (OR = 11.9, 95% CI 10.3–13.6) and respiratory distress syndrome (OR = 16.6, 95% CI 14.4–19.2) were strongly associated with deliveries not identified by the V27 method. Nationwide prevalence rates of severe maternal complications were underestimated with the V27 method compared to the enhanced method, ranging from 9% underestimation for major puerperal infections to 40% underestimation for respiratory distress syndrome. Conclusion Deliveries with severe obstetric complications may be more likely to be missed using the V27 code. Researchers should be aware that selecting deliveries from hospital stay records by V27 codes alone may affect the accuracy of their findings.

OBJECTIVE. The objective of this study was to describe trends in hospital use by HIV-infected children and adolescents in the United States in the 10 years from 1994 (before highly active antiretroviral therapy) to 2003 (widespread use of highly active antiretroviral therapy). METHODS. Data from the Nationwide Inpatient Sample database were used. The most frequent diagnoses were evaluated by year, and trends in hospitalizations for selected diagnoses and procedures were examined by multivariate logistic regression. RESULTS. In 2003, there were an estimated 3419 hospitalizations of HIV-infected children who were 18 years or younger, compared with 11785 such hospitalizations in 1994 (a 71% decrease). This decrease was more marked among infants and children who were younger than 5 years (94% for boys and 92% for girls) than among adolescents (decrease of 47% for boys and increase of 23% for girls 15–18 years of age). The inpatient fatality rate among HIV-infected children decreased from 5.0% in 1994 to 1.8% in 2003. The number of hospitalizations among HIV-infected children in the highly active antiretroviral therapy era decreased significantly compared with before highly active antiretroviral therapy (1994–1996) for Pneumocystis jiroveci, bacterial infection, or sepsis; fungal infection; encephalopathy; failure to thrive; and lymphocytic interstitial pneumonia. No significant change in the number of hospitalizations for Pneumococcus or cytomegalovirus was observed. CONCLUSIONS. Dramatic decreases in the number of hospitalizations among HIV-infected children occurred since the advent of highly active antiretroviral therapy in the United States. However, this trend is not seen in hospitalizations of adolescents, particularly girls. Hospitalizations for several HIV-related conditions are less frequent in the highly active antiretroviral therapy era, but for certain other conditions, the hospitalization burden remains high.

Background: The purpose of this study was to describe hospital use patterns of children with sickle cell disease (SCD) and human immunodeficiency virus type-1 (HIV) infection in the United States. Methods: Hospital discharges of children with 1 or both of the 2 conditions (SCD and HIV infection) were analyzed using nationally weighted data from the 1994 to 2003 Nationwide Inpatient Databases of the Healthcare Cost and Utilization Project. Demographic and hospital characteristics, length of stay, charges and the most frequent diagnoses and procedures performed during the hospitalization were compared. Multivariate logistic regression was used to analyze the effects of age, sex and HIV infection on number of hospitalizations for selected conditions. Results: There were an estimated 686 hospitalizations of children with SCD and HIV infection in the United States in the 10-year period 1994–2003; these hospitalizations aggregated in the South (78.2%) and their expected payer was mostly Medicaid/Medicare (82.0%). Their average length of stay was longer than that of children with SCD alone (8.0 days vs. 4.3 days, respectively), and the mean charges associated with the hospitalization were also higher ($18,291 vs. $9584). Compared with patients with SCD without HIV, HIV infection conferred a higher risk for hospitalizations for bacterial infections and sepsis (odds ratio 2.75; 95% CI, 1.66–4.6), but less of a risk for vaso-occlusive crises (odds ratio 0.32; 95% CI, 0.22–0.48). Inpatient case-fatality rate of children with SCD and HIV was no different from that of children with SCD alone, but lower than that of the rest of children with HIV infection. Conclusions: Hospitalized children with SCD and HIV infection have higher odds of infection than those with SCD alone. Their inpatient case-fatality rate is lower than that of children with HIV infection alone. These findings should be considered in designing appropriate interventions for this population.

Objective To describe trends in hospitalizations with a diagnosis of substance abuse among reproductive-age women from 1998–2003. Methods Data were obtained from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample. Hospitalizations with a diagnosis of substance abuse were categorized into subgroups by age, primary expected payer, substance-specific diagnoses, concomitance, and hospital location. Trends in hospitalization rates per 100,000 women aged 15–44 were tested using a weighted least-squares method. Results From 1998–2003, there was no change in the overall rate of hospitalization with a diagnosis of substance abuse among women aged 15–44. Alcohol abuse was the most common substance-specific diagnosis. The rate of hospitalization with a diagnosis of cocaine abuse decreased 22%; for a diagnosis of cannabis abuse, the rate increased 35%. The rate of hospitalization with a diagnosis of amphetamine abuse doubled from 1998–2003. Among women aged 15–24, the rate of hospitalization with a diagnosis of substance abuse increased 23%. Conclusion Although we did not observe a change in the overall rate of substance-abuse hospitalization among reproductive-age women, there were dramatic changes in the rate of substance-specific diagnoses. These data may be used to quantify emerging trends in substance abuse and promote the use of hospital-based interventions.

Purpose This study assessed the contraceptive outcomes of the Partners Against Risk-Taking: A Networking, Evaluation and Research Study (PARTNERS). The PARTNERS project developed and evaluated a 3-session intervention to help young women and their male partners reduce their risk for unintended pregnancies, and HIV and other STDs. Methods Participating couples were randomly assigned to the 3-session intervention or a 1-session information session for couples. Changes in psychosocial factors related to women's motivation to use contraception and relationship factors were assessed using analysis of variance with repeated measures. Changes in contraceptive outcomes were assessed using logistic regression with generalized estimating equations. Results Comparison of changes from baseline to 6 months among women who participated in the 3-session intervention with those who participated in the information session showed no significant intervention effect on reports of contraceptive use. Instead, contraceptive use increased in both conditions. Both groups exhibited similar changes in the psychosocial variable measuring the importance of avoiding pregnancy and in the relationship variable measuring women's participation in contraceptive decision making. Members of the intervention group, however, showed greater improvement in the psychosocial variable measuring positive expectations pertaining to partner's support for contraception. Conclusion These findings raise questions for further investigation to better understand couples behavior, and whether and how to intervene with couples.

One of the great pleasures of being the Editor in Chief of Preventing Chronic Disease: Public Health Research, Practice, and Policy (PCD) is to read the papers submitted by the next generation of public health professionals for the annual PCD Student Contest. This year was no exception. We received 59 papers on a range of critical public health topics that used novel analytic methods. In collaboration with members of the Editorial Board, it is my pleasure to announce that Nelly Mejia at the Pardee RAND Graduate School has won the 2015 PCD Student Contest. In this paper, Mejia and colleagues describe their analysis of the association between living in a food desert and eating fruits and vegetables (1). Understanding the influence of food deserts on public health is critical to designing, implementing, and evaluating the impact of policy and environmental changes to improve access to nutritious foods. Much of the published literature has documented both the prevalence of food deserts and disparities in access to nutritious foods (2–5). In the past several years, there has been a substantial effort to place farmers markers in areas considered to be food deserts (4–6). These interventions have documented some success; however, there are a number remaining challenges. Access to healthier foods is necessary but not sufficient to improve nutrition and mitigate the short-term and long-term health effects of suboptimal nutritional intake. Interventions must also address issues of preparation of these healthier foods for consumption. Access and purchasing behavior are first steps in changing dietary intake. Mejia and colleagues conducted an analysis of the association of living in a food desert on consumption of fruits and vegetables in Los Angeles County. Their findings question current evidence about outlet density, access, healthy behaviors, and health status. In this setting, they found no consistent evidence that consumption of healthier foods or body mass index (BMI) were associated with density of food outlets commonly reported to carry less healthful foods. The finding was especially convincing because of the number of comparisons and the lack of any statistical associations detected. The findings of this study do not definitively answer the question of the relationship between access, intake, and BMI. No study will have sufficient sample size to “prove” there is no association. There are contextual variables that potentially mediate the findings here that may not be relevant in other settings. Los Angeles County has a population of approximately 10 million; the county is highly diverse economically, socially, and culturally (7). Although Los Angeles County is known for urban and suburban sprawl, parts of the northeast portion of the county are remote and sparsely populated. This diversity makes the findings of this study relevant to one of the most populous regions of the country but may not easily translate to other settings. Nonetheless, the findings of this study are important to the field, because they point to the importance of contextual factors that can mediate the associations that we are most interested in studying. Health status and health behaviors do not often have simple and direct relationships. Mejia and colleagues demonstrate the changes in measurement and analytic techniques that can lead to different conclusions. In this case the results were surprisingly consistent given the number of permutations and analytic approaches. Geographic boundaries can either highlight or mask important findings. In this study, there was little variation in the findings regardless of size or shape of unit of geographic analysis. Looking at both more proximal outcomes of consumption and distal measures of BMI also produced little difference in the conclusions. Rarely in chronic disease prevention are interventions straightforward and rarely do they consistently impact health behavior and health status in a multitude of settings. This work represents some of the best of the up-and-coming generation of public health professionals. PCD is proud to be able to contribute to the career development of the next generation of researchers and practitioners. The changes faced in chronic disease prevention and health promotion are complex and not always as they appear at first glance. As with any study, this one does not provide a definitive answer on how food deserts are related to consumption patterns and BMI. Objectively conducting analysis and using data to understand the burden of disease, especially when the results may not be consistent with the current understanding, is how science progresses. Mejia and colleagues have done exactly that and helped advance the understanding of the relationship between access to healthier foods and intermediate outcome measures of diet and nutrition.

BACKGROUND: The literature on whether HIV infection and its complex antiretroviral treatments confer a higher risk for adverse pregnancy outcomes is controversial. OBJECTIVE: We compared rates of hospitalization for select morbidities among HIV-infected and uninfected pregnant women in the USA. DESIGN AND METHODS: Using data from the 1994-2003 Nationwide Inpatient Sample, we used descriptive statistics and multivariate logistic regression to examine socio-demographic characteristics, morbidity outcomes and time trends. RESULTS: There were approximately 6000 hospitalizations per year of HIV-infected pregnant women in the USA. HIV-infected women were more likely to be hospitalized in urban hospitals, in the South, have Medicaid as the expected payer, have longer hospitalizations and incur higher charges than uninfected women. Hospitalizations for major puerperal sepsis, genitourinary infections, influenza, bacterial infections, preterm labor/delivery, and liver disorders were more frequent among pregnant HIV-infected women than their uninfected counterparts. However, rates of pre-eclampsia and antepartum hemorrhage were not significantly different. While rates of inpatient mortality and various infectious conditions decreased between 1994 and 2003, the rate of gestational diabetes increased among HIV-infected pregnant women. CONCLUSIONS: HIV-infected pregnant women in the USA continue to be at higher risk for morbidity and adverse obstetric outcomes. With the introduction of antiretroviral therapy, rates of most of the conditions examined have either decreased or remained stable, hence current antiretroviral regimens do not seem to be associated with major adverse pregnancy outcomes on a population basis. The increase in gestational diabetes among HIV-infected women may be associated, in part, with antiretroviral therapy and merits further attention.

OBJECTIVES. The purpose of this research was to describe hospital use patterns of HIV-infected children in the United States.STUDY DESIGN. We analyzed a nationwide, stratified probability sample of 2.5 million hospital discharges of children and adolescents during the year 2000, weighted to 7.3 million discharges nationally. We excluded discharges after hospitalizations related to pregnancy/childbirth and their complications and discharges of neonates 18 years of age. Diagnoses were identified through the use of the Clinical Classification Software with grouping of related diagnoses.RESULTS. We estimated that there were 4107 hospitalizations of HIV-infected children in 2000 and that these hospitalizations accounted for ∼$100 million in hospital charges and >30000 hospital days. Infections, including sepsis and pneumonia, were among the most frequent diagnoses in such hospitalizations, followed by diagnoses related to gastrointestinal conditions, nutritional deficiencies and anemia, fluid/electrolyte disorders, central nervous system disorders, cardiovascular disorders, and respiratory illnesses. Compared with hospitalizations of non-HIV-infected children, hospitalizations of HIV-infected ones were more likely to be in urban areas, in pediatric/teaching hospitals, and in the Northeast, and the expected payer was more likely to be Medicaid (77.6% vs 37.2%). Compared with children without HIV, those with HIV tended to be older (median age: 9.5 years vs 5.2 years), to have been hospitalized longer (mean: 7.8 days vs 3.9 days), and to have incurred higher hospital costs (mean: $23221 vs $11215); HIV-associated hospitalizations ended in the patient's death more frequently than non-HIV ones (1.8% vs 0.4%), and complications of medical care were also more common (10.8% vs 6.2%).CONCLUSIONS. Infections account for the majority of hospitalizations of HIV-infected children in the United States, although nutritional deficiencies, anemia and other hematologic disorders, gastrointestinal and renal disorders, and complications of medical care are also more common among hospitalized children with HIV than among those without HIV.

Information regarding the type and scope of preconception care programs in the United States is scant. We evaluated State Title V measurement and indicator data and abstracts presented at the National Summit on Preconception Care (June 2005) in order to identify existing programs and innovative strategies for preconception health promotion.We used the web-based Title V Information System to identify state Performance Measures and Priority Needs pertaining to preconception health as reported for the 2005-2010 Needs Assessment Cycle. We also present a detailed summary of the abstracts presented at the National Summit on Preconception Care.A total of 23 states reported a Priority Need that focused on preconception health and health care. Forty-two states and jurisdictions identified a Performance Measure associated with preconception health or a related indicator (e.g., folic acid, birth spacing, family planning, unintended pregnancy, and healthy weight). Nearly 60 abstracts pertaining to preconception care were presented at the National Summit and included topics such as research, programs, patient or provider toolkits, clinical practice strategies, and public policy.Strategies for improving preconception health have been incorporated into numerous programs throughout the United States. Widespread recognition of the benefits of preconception health promotion is evidenced by the number of states identifying related indicators.

OBJECTIVE: To examine hospitalizations with respiratory illness among pregnant women in the United States during periods of influenza activity. METHODS: Data were obtained from the Healthcare Cost and Utilization Project National Inpatient Sample (NIS), the largest publicly available all-payer hospital discharge database. Hospitalizations for respiratory illness and pregnancy were classified with International Classification of Diseases, 9th Revision, Clinical Modification codes. Analyses were stratified by delivery status. Discharge characteristics, length of stay, and complications of delivery among hospitalized pregnant women with and those without respiratory illness were compared. RESULTS: During the 1998–2002 influenza seasons, 3.4 per 1,000 hospitalizations of pregnant women included diagnoses of respiratory illness. Characteristics of pregnancy hospitalizations associated with higher odds of respiratory illness were presence of a high-risk condition for which influenza vaccination is recommended (adjusted odds ratio [OR] 3.2, 95% confidence interval [CI] 3.0–3.5 and OR 6.0, 95% CI 5.2–6.9 for nondelivery and delivery, respectively), Medicaid/Medicare as primary expected payer of care (OR 1.2, 95% CI 1.1–1.3 and OR 1.9, 95% CI 1.7–2.2 for nondelivery and delivery, respectively), and hospitalization in a rural area (OR 1.2, 95% CI 1.1–1.4 for nondelivery). During influenza season, hospitalized pregnant women with respiratory illness had significantly longer lengths of stay and higher odds of delivery complications than hospitalized pregnant women without respiratory illness. CONCLUSION: Hospitalizations with respiratory illness among pregnant women during influenza season are associated with increased burden for patients and the health care system. Intervention efforts to decrease influenza-related respiratory morbidity among pregnant women should be encouraged. (Obstet Gynecol 2006;107:1315–22) LEVEL OF EVIDENCE: III

The 2 articles by Urban and colleagues published this week in Preventing Chronic Disease report 15-year trends in sodium, trans fat, and saturated fat, 3 food components associated with increased risk for cardiovascular disease and obesity, in frequently ordered meal items (French fries, cheeseburgers, grilled chicken sandwiches, and regular cola) from leading US national fast food chain restaurants (1,2). These longitudinal findings track these 3 food components in foods that are frequently consumed by Americans. In recent surveys, almost half of Americans report eating fast food at least weekly (http://www.gallup.com/poll/163868/fast-food-major-part-diet.aspx), and similarly, nearly half report drinking soda daily (http://www.gallup.com/poll/156116/Nearly-Half-Americans-Drink-Soda-Daily.aspx). The findings by Urban et al confirm a substantial reduction in the content of trans fat and saturated fat in French fries but not in cheeseburgers or chicken sandwiches. Changes were inconsistent in sodium, saturated fat, and calories among food products, with the exception of sodas, where there was an increase in portion size. The authors conclude that, unlike the reduction observed in artificial trans fat in French fries, the content of sodium, saturated fat, and calories in the selected foods did not change much. Taken together, these findings indicate that little improvement has been made in the quality or energy density of popular fast food products and suggest the need for interventions to improve population health. It is important to consider these findings in the larger context as public health researchers, practitioners, and policy makers develop and implement interventions to reduce intake of excessive calories, saturated fat, and artificial trans fat. Cheeseburgers, French fries, and a soda represent a quintessential part of American culture. Banter about them was central to the Saturday Night Live skit made famous by the late John Belushi. Similarly, songs made popular by performers such as Jimmy Buffett, Charlie Pride, the Gang of Four, and the Village People are all about having a cheeseburger, French fries, and a soda. These staples of the American diet are unlikely to disappear. However, central to American food choices is an unacceptably high prevalence of diet-related risk factors that compromise the health of Americans and contribute to the high costs of chronic disease. During the period examined by Urban and colleagues, the late 1990s through 2013, the US prevalence of chronic disease risk factors such as overweight, obesity, and hypertension have remained high, cardiovascular disease remains the leading cause of death, and prevalence of prediabetes and diabetes continues to increase (3). The continued popularity of fast food restaurants and continued high prevalence of diet-related risk factors remind public health researchers, practitioners, and policy makers that there is much that needs to be done. The findings of the 2 studies by Urban and colleagues present concrete evidence on an issue that many may consider obvious: the paradigmatic meal of a cheeseburger with French fries and a soda still contains components whose consumption is associated with increased risk of adverse health outcomes. Changes in portion size can change the amount of these components consumed, as with the increasing portion size observed for regular soda, which can increase energy density. In the past several years, increased public health efforts have sought to implement and evaluate interventions to increase access to healthy food options through farmers markets, community gardens, and other venues that make the healthier choice the easier choice whenever possible (4–6). Changes in subsidy programs and other structural changes have been implemented to remove access barriers, such as remediation of food deserts or placement of farmers markets in high-traffic areas, such as near subway stops. Many evaluation efforts have focused on measuring consumer awareness and purchasing behavior as surrogates for consumption (5–7). Few studies have evaluated changes in key outcomes, including consumption patterns, changes in risk factors, or changes in health outcomes. These 3 outcomes are challenging to study because they are hard to measure, the time horizon to document an effect is long, and the attribution to a specific intervention is difficult to make. Researchers, practitioners, and policy makers need to work together to develop creative methods to study these important outcomes. Evaluating effect and return on investment of these interventions is critical to identify which interventions will make a lasting difference in the health of the population. The experience with trans fat suggests that regulatory interventions, including menu labeling in restaurants and vending machines, to be implemented in 2015 (http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm423952.htm), will improve the food environment. New federal nutrition policy, including the 2015 update of the Dietary Guidelines for Americans, will help shape the environment to support healthier choices. At the same time, there is increased public concern about the healthfulness of fast food and growing support for efforts to increase access to healthy food options, particularly in schools. Taken together, expanded policy levers in concert with increased consumer awareness and demand for healthy food products will accelerate improvement in the US diet and food environment and support reductions in the population’s cardiometabolic risk.

Context: Hormonal contraceptive users may be at increased risk for HIV and other STDs. An understanding of their decisions and abilities to use condoms is needed to focus intervention programs aimed at improving their protective behaviors. Methods: Between 1999 and 2001 426 new users of depot medroxyprogesterone acetate (DMPA) and oral contraceptives were recruited from public clinics providing family planning services to low-income women and surveyed when they began their method and again three months later. Bivariate analyses examined the consistency of condom use across subgroups and multivariate analyses assessed associations between consistent use and various characteristics. Results: Among women who had used condoms consistently before starting on DMPA or the pill 54% discontinued consistent use after taking these contraceptives. Overall 20% of women consistently used condoms with their hormonal method and such use did not vary significantly by contraceptive type. Seventy-five percent of women in nonmonogamous relationships were inconsistent users though nearly a third had been consistent users prior to beginning a hormonal method. Factors associated with an elevated likelihood of consistent use were the male partner’s positive opinion of condoms (odds ratio 3.3) and the woman’s strong belief that condom use is important for vaginal intercourse (3.5) and even if the couple is using another form of birth control (4.1). Conclusions: Many women at highest risk for disease have a decreased likelihood of using condoms and disease prevention programs should be customized to target these women. Educational efforts focusing on women’s attitudes and negotiation skills may be the best means of increasing dual method use. (authors)

In Zimbabwe, adult HIV prevalence is over 25% and acceptable prevention methods are urgently needed. Sixty-eight Zimbabwean women who had completed a barrier-methods study and 34 of their male partners participated in focus group discussions and in-depth interviews to qualitatively explore acceptability of male condoms, female condoms and diaphragms. Most men and about half of women preferred diaphragms because they are female-controlled and do not detract from sexual pleasure or carry stigma. Unknown efficacy and reuse were concerns and some women reported feeling unclean when leaving the diaphragm in for six hours following sex. Nearly half of women and some men preferred male condoms because they are effective and limit women's exposure to semen, although they reportedly detract from sexual pleasure and carry social stigma. Female condoms were least preferred because of obviousness and partial coverage of outer-genitalia that interfered with sexual pleasure.

Background: Women who are the most vulnerable to sexually transmitted diseases/HIV are often unable to consistently use condoms. One potential alternative method currently under investigation is the diaphragm. Goals: The goals of this study were to assess diaphragm uptake and use over time in Zimbabwe and to identify factors associated with self-reported consistent diaphragm use. Study: Women attending family planning clinics who were inconsistent condom users received a diaphragm intervention and were followed for 6 months. Results: Of the 186 participants, 99% ever reported using the diaphragm, and, at study exit, 96% had used it in the previous 2 months. Consistent diaphragm use since the previous visit was reported by 13% to 16% of the women, and in multivariate regression analysis, it was significantly associated with never using condoms (adjusted odds ratio, 24.08; 95% confidence interval, 6.71–86.34). Other factors included discreet use, preferring diaphragms to condoms, timing of insertion, domestic violence, and contraception. Conclusion: Diaphragms were well accepted among women at risk for sexually transmitted diseases/HIV.

Background: Prenatal screening for chromosomalabnormalities is routinely offered to allpregnant women who present for care by their20th gestational week. Not all women,however, choose to undergo one of these tests,and choice of which test(s) to undergo alsovary. The reasons for variation in screeningtest behavior have not been fully explored.Methods: We examined the psychometricproperties of scales developed to measurefactors related to prenatal screening usingdata collected as part of a survey of 448racial/ethnically diverse pregnant women. These women were consecutively recruited fromprenatal care clinics when they were betweentheir 12th and 20th week ofpregnancy. The Theory of Reasoned Action wasused to develop to measures of attitudes towardand beliefs about prenatal screening. All itemswere subjected to factor analysis. Scalesidentified in the factor analysis were thensubjected to reliability analysis. Allanalysis was conducted for the entire studygroup as well as separately for eachracial/ethnic group.Results: Six scales emerged: who makes medicaldecisions, fatalism, health care trust, valueof screening, fear of screening and value ofpregnancy. All scales had adequate reliabilitywhen the analysis was conducted for the entirestudy group; however there were differences inreliability across racial/ethnic group.Conclusions: Because of these between groupdifferences comparisons of racial/ethnic groupmay be difficult to interpret and potentiallylead to erroneous conclusions.

Through a posttranslational processing mechanism, pro-growth hormone releasing hormone (proGHRH) gives rise to an amidated GHRH molecule, which in turn stimulates the synthesis and release of growth hormone. We have previously proposed a model for the biochemical processing of proGHRH [Nillni et al. (1999), Endocrinology 140, 5817-5827]. We demonstrated that the proGHRH peptide (10.5 kDa, 104 aa) is first processed to an 8.8 kDa intermediate form that is later cleaved to yield two products: the 5.2 kDa GHRH and the 3.6 kDa GHRH-RP. However, the proteolytic enzymes involved in this process are unknown. Therefore, in this study we determined which proconverting enzymes are involved in this process. We transfected different constructs in cell lines carrying different PC enzymes followed by analysis of the peptide products after metabolic labeling or Western blots. We found that in the absence of furin (LoVo cells) or CHO cells treated with BFA, only one moiety was observed, and that corresponds to the same electrophorectic mobility to the GHRH precursor. This finding strongly supports an initial role for furin in the processing of proGHRH. The results from transfections with preproGHRH alone or double or triple transfections with PC1 and PC2 in AtT-20, GH3, and GH4C1 cells indicated that PC1 is the primary enzyme involved in the generation of GHRH peptide from the 8.8 kDa intermediate form. We found that AtT-20 cells (high PC1, very low PC2) were able to generate GHRH. However, GH3 cells (high PC2, but not PC1) were able to process the 8.8 kDa peptide to GHRH only after the cotransfection with the PC1 enzyme. Transfections with preproGHRH-GFP and preproGHRH-V5 provided similar results in all the cell lines analyzed. These data support the hypothesis that proGHRH is initially cleave by furin at preproGHRH29-30, followed by a second cleavage at preproGHRH74 primarily by PC1 to generate GHRH and GHRH-RP peptides, respectively.

This study assessed hypotheses that measures of power and control over male condom (MC) use would predict use of the female condom (FC) among women with main partners from two public STD clinics (n = 616). The women (mean age 24 years, 87% African American) were enrolled in an intervention study to promote barrier contraceptive use and were interviewed at baseline and at 6 monthly follow-up visits. Seven baseline predictor variables were assessed: her having requested MC use, his having objected, her having wanted a MC used but not asking, percentage of MC use, perceived control over MC use, anticipated consequences of refusing unprotected sex, and physical violence. In the first Poisson regression analysis, none of the hypothesized predictors was significantly associated with FC use during follow up. In the second regression analysis, which assessed the influence of the hypothesized set of predictors on follow-up FC use in situations when MCs were not used, we found two effects. Either no or inconsistent MC use before study entry was associated with less subsequent FC use; women who reported, at study entry, having more control over MC use were more likely to use FCs during follow up. We found no evidence of adoption of the FC by women in relationships marked by history of conflict over the MC, circumstances in which alternatives are most needed. On the contrary, we found that women with a history of control and consistent use of MCs were the most likely users of FCs when MCs were not used.

The authors reflect on aging in the U.S. They suggest that with an increase which has been seen in the number of consumers who are over the age of 65 in the U.S. the challenge to medical professionals is to help them stay healthy and maintain a high quality of life at every age. They argue that U.S. public health policies and preparedness initiatives need to be altered to adapt to an increasing population of older citizens.

OBJECTIVE: To evaluate the effect of a low-intensity behavioral therapy program on urinary incontinence in older women. METHODS: A randomized clinical trial for community-dwelling women at least 55 years reporting at least one urinary incontinent episode per week was conducted. Women were randomly assigned to a behavioral therapy group (n = 77) or a control group (n = 75). The treatment group had six weekly instructional sessions on bladder training and followed individualized voiding schedules. The control group received no instruction but kept urinary diaries for 6 weeks. After this period, the control group underwent the behavioral therapy protocol. Using per-protocol analyses, t and χ2 tests were used to compare the treatment and control groups, and paired t tests were used to evaluate the efficacy of behavioral therapy for all women (treatment and control groups before and after behavioral therapy). RESULTS: Women in the treatment group experienced a 50% reduction in mean number of incontinent episodes recorded on a 7-day urinary diary compared with a 15% reduction for controls (P = .001). After behavioral therapy, all women had a 40% decrease in mean weekly incontinent episodes (P = .001), which was maintained over 6 months (P < .004). Thirty (31%) women were 100% improved (dry), 40 (41%) were at least 75% improved, and 50 (52%) at least 50% improved. There were no differences in treatment efficacy by type of incontinence (stress, urge, mixed) or group assignment (treatment, control). CONCLUSION: A low-intensity behavioral therapy intervention for urinary incontinence was effective and should be considered as a first-line treatment for urinary incontinence in older women.

This article describes the frequency of initial difficulty inserting the female condom and identifies predictors of insertion difficulty among women at risk of sexually transmitted diseases (STDs). Female STD clinic patients (n = 1144) were taught how to insert the female condom by using an anatomic model, then given an opportunity for self-insertion practice. Correct placement of the condom was verified by a nurse clinician, and the number of attempts required for correct insertion was recorded. Sociodemographic and psychosocial predictors of refusing the insertion practice and of difficulty inserting the female condom were evaluated using logistic regression. Only 5% of study participants refused the self-insertion practice. Women who never had a Papanicolaou smear test, did not use tampons, never used an inserted method of STD prevention/birth control, and disliked the insertion features of intravaginal barrier methods were more likely to refuse the self-insertion practice. Of those who attempted self-insertion, 25% were unable to insert the female condom correctly on the first attempt. Women who never expressed their sexual likes and were indifferent to the positive features of intravaginal contraceptive methods were more likely to experience difficulty their first insertion attempt. Other variables associated with insertion difficulty included longer fingernails. Insertion refusal and difficulty affect use of the female condom for a sizable proportion of women. Women in this study who refused the self-insertion practice had greater aversion to inserting intravaginal barrier methods. Women who had initial difficulty inserting the female condom had a different profile from those who refused and can benefit from intensive skills training that includes supervised self-insertion practice.

Each year since 2011 Preventing Chronic Disease (PCD) has issued a special call for student papers for our Student Research Paper Contest. This year PCD received 67 submissions from students throughout the world. We are very excited to recognize Kathleen Li and colleagues as the winners of the 2014 contest for their paper entitled “Evaluation of the Placement of Mobile Fruit and Vegetable Vendors to Alleviate Food Deserts in New York City” (1). Ms Li is currently a medical student at the University of California, San Francisco, School of Medicine, and she conducted the study described in her paper with Dr Carol Horowitz and colleagues at the Icahn School of Medicine at Mount Sinai’s Department of Health Evidence and Policy. In their paper Ms Li and colleagues described their investigation of how the placement of mobile fruit and vegetable vendors affects access to fresh fruit and vegetables in areas that have been designated food deserts. Evidence suggests that people in neighborhoods with access to supermarkets are more likely to have healthier diets and lower levels of obesity than those in food deserts (2). A substantial investment in promotion of mobile fruit and vegetable vendors in the past several years has been at least partially effective in increasing access in areas that lack retail outlets with healthful selections (3–5). The strategic placement of these vendors has been central to the New York City licensing program. In addition to placement, efforts have been made to facilitate the vendor acceptance of Electronic Benefit Transfer (EBT) cards from the Supplemental Nutrition Assistance Program and other assistance programs. An important aspect of any public health intervention is determining whether the policy is having the intended effect. The New York City program has resulted in issuance of several permits, suggesting that the Green Cart program is changing the landscape in terms of where healthful foods are available. However, looking only at the number of permits does not fully evaluate the intervention. Li and colleagues report that, although Carts were in the streets, they were not in areas designated as food deserts. They were often on the borders of food deserts and in areas where there was already access to healthful foods. These vendors were often in high-traffic areas, close to subway stops and large employers. From a business perspective it is logical to locate in a setting with sufficient traffic so that the enterprise can be profitable. However, from a public health perspective such placement does not fulfill the intent of the intervention. Areas identified as food deserts before the intervention remain deserts with limited access to healthful foods. Green Carts may increase access to healthful foods to the extent that people who live in food deserts go into these high-traffic areas because the carts are on the streets so that they do not have to go into stores. One of the concerns identified by Li and her colleagues is that people who are not mobile may not travel out of their neighborhoods into these higher traffic areas and thus may still have limited access to healthful foods. Data on licenses suggest that access to healthful foods has increased in food deserts. Li et al’s geographic analysis suggests that New York City Green Carts are mostly on the edges of food deserts and not in the areas of highest need. The data presented in this article are an important component of an evaluation of the Green Cart program; however, the data do not fully answer the question of whether the program is having the desired effect. At least 4 measures remain to be assessed. First, do people who live in these food deserts have access to Green Carts? Access is only the first step. The second measure is purchasing behavior. Data from investigations have shown that vouchers from the EBT and other assistance programs are being used by consumers at Green Carts (3–5). The third area of measurement is consumption of more healthful foods, that is, whether foods purchased are consumed and whether foods are being prepared in healthful ways. The fourth area of measurement is health status of people purchasing from the mobile vendors, because the ultimate goal of these interventions is to improve the health status of the population. One of the biggest challenges of public health interventions in the field of chronic disease prevention is measuring the intermediate outcomes as well as the health outcomes. This is especially true when evaluating interventions that focus on systems or environmental change. Measuring the number of Green Cart licenses issued is easy. Determining whether the population at high risk is being served requires more sophisticated geographic analysis. Measures of uptake, consumption, and health outcomes can be obtained from surveys and population surveillance; however, without linking exposure, behavior, and outcome, interventions are limited in their ability to answer the question we need answered, that is, does an intervention change the health of the population? As public health interventions focus more and more on systems and environmental change, evaluations are becoming more complicated and take more time. In the submissions for this year’s Student Research Paper Contest, many of the papers investigated different aspects of systems or environmental interventions. Li and colleagues presented a very interesting and elegant evaluation of one component of the New York City mobile food vendors intervention. However, just as the number of licenses alone doesn’t tell the story, their investigation does not provide a definitive answer to the question of how the intervention is affecting population health. Full understanding of the effect of systems interventions requires the measurement of many processes and intermediate outcomes as well as health outcomes. These health outcomes often take years to be observed. Rarely is there a simple yes or no answer to the effectiveness of a systems intervention. We need to keep in mind that we are trying to change population health outcomes and that these steps along the way are necessary to measure change in that outcome. However, evaluations alone cannot answer all our questions. One of the challenges in reviewing the papers in this set of contest submissions was that no one study can fully answer the questions we are asking. Li and colleagues are to be congratulated for their innovative and outstanding work and are encouraged to do more to document meaningful changes in intermediate outcomes of interventions and health outcomes. The Student Research Paper Contest is a great opportunity to recognize the outstanding work being done by the next generation of public health researchers and their mentors. In addition to the 67 students who submitted manuscripts, hundreds of mentors and colleagues supported these young investigators, and we want to recognize them. Without their contributions PCD would not have received the number of high-quality papers that it did. Having nearly 70 papers arrive in one day is no small accomplishment. We want to recognize the hard work of PCD staff members Sasha Ruiz and Tawni Wold who worked with the authors to make sure that the papers met submission requirements and that the papers were processed in a timely manner. Members of the PCD Editorial Board who helped with the initial review (Drs Barbara Bowman and Rachel Kaufman) and with the multiple rounds of review of the top 15 papers (Drs Ana Diez-Roux, Patrick Remington, Sara L Huston, and Eugene J Lengrich) also contributed countless hours reviewing and commenting on these manuscripts. I especially want to recognize Dr Deesha Patel, our 2013 student winner, who served as a reviewer this year. Congratulations and thank you for making the student contest a success!

Mixed-method designs are increasingly used in sexually transmitted infection (STI) and HIV prevention research. The authors designed a mixedmethod approach and applied it to estimate and evaluate a predictor of continued female condom use (6+ uses, among those who used it at least once) in a 6-month prospective cohort study. The analysis included 402 women who received an intervention promoting use of female and male condoms for STI prevention and completed monthly quantitative surveys; 33 also completed a semistructured qualitative interview. The authors identified a qualitative theme (couples' female condom enjoyment [CFCE]), applied discriminant analysis techniques to estimate CFCE for all participants, and added CFCE to a multivariable logistic regression model of continued female condom use. CFCE related to comfort, naturalness, pleasure, feeling protected, playfulness, ease of use, intimacy, and feeling in control of protection. CFCE was associated with continued female condom use (adjusted odds ratio: 2.8, 95% confidence interval: 1.4-5.6) and significantly improved model fit (p.001). CFCE predicted continued female condom use. Mixed-method approaches for "scaling up" qualitative findings from small samples to larger numbers of participants can benefit HIV and STI prevention research.

Previous research has identified factors associated with condom use. However less information exists on the impact that a history of sexually transmitted disease (STD) has on condom use. The aim was to identify factors associated with self-reported male condom use that relate to history of STD. Women attending STD clinics completed a survey that assessed sexual behavior STD history and psychosocial characteristics. Binomial regression was used to estimate the association between these factors and condom use. Of the 12 factors included in the regression model 11 were significant for all women. When the analysis was stratified by STD history high condom use self-efficacy high convenience of condom use and high frequency of condom use requests were significantly associated with increased condom use among women with or without a history of STD. Factors such as greater perceived condom use norms higher perceived level of risk and greater need for condom use in long-term relationships were significantly associated with increased condom use among women with history of STD. Factors such as shorter duration of a relationship less violence in the relationship and lifetime drug use were associated with increased condom use among women with no history of STD. The pattern of psychosocial factors determining condom use is modified by a positive history of STD. These findings suggest that a history of STD could be an important factor in targeting condom use interventions. (authors)

Establishing comparable measurement properties across different populations or in different population subgroups is a crucial yet often neglected step in instrument development. Failure to have comparable factor structures across groups makes any comparison between groups suspect. Previous analyses of the measurement structure of the Center for Epidemiologic Studies Depression Scale (CES-D) in diverse racial/ethnic populations have resulted in conflicting results. In the present analysis, data from three studies of urban Latinos (N = 1,403) were analyzed using structural equation modeling techniques to (1) fit the original four-factor solution separately in men and women; (2) evaluate configural and metric invariance between men and women; and (3) evaluate the mediating effects of age and acculturation on the fit of this model to the data. Results indicated that the four-factor model proposed by Radloff provided adequate fit to the data for Latina women when age and acculturation were included in the model. The four-factor model did not fit the data for Latino men; thus tests of configural and metric invariance across these two groups failed. We conclude that the CES-D may not measure the same constructs in Latino men and women and that further evaluation of the use of this measure in diverse populations is needed. Additionally, prior to comparison with other groups in which the four-factor solution is observed, the effects of age and acculturation should be controlled in Latinas.

Recently a new method for the analysis of survival data using a structural equation modeling approach has been suggested by Pickles and colleagues using twin data they demonstrated the application of this model to study the correlation in age of onset. The purpose of the current research is twofold: 1) to evaluate the statistical performance of the model as presented by Pickles and colleagues, and 2) to expand and evaluate the model in more applications, including both genetically informative data and other multivariate examples. Results evaluated from this study involve three areas of method performance: Type-I error rates, power, and parameter estimates under four different distributions (normal, Gamma-2, Gamma-6 and g-and-h) and four different sample sizes (n = 125, 250, 500 and 750). Results based on the original Pickles model indicated that in all sample size and distribution conditions the Type-I error rate was adequate, in fact below the nominal level of .05. Additionally, power was greater than .80 for sample sizes of 500 or more for all distribution conditions. Parameter estimates were upwardly biased when the population value was ρ = .20. This bias varied across distributions; the g-and-h distribution showed the largest bias. Results from the expanded model indicated that Type-I error rates were adequate. Power results were not affected by distribution type; sample sizes of 500 were above the .80 level. Parameter estimates continued to be upwardly biased in this more general model, although the degree of bias was smaller.

Women aged 35 or older who wish to undergo prenatal diagnosis for chromosomal disorders are typically offered a choice between chorionic villus sampling or amniocentesis. These two tests are performed at different times and impose differing miscarriage risks. In deciding which test to use, therefore, women need to consider both short-term consequences (e.g. timing of pregnancy loss, should it occur) and long-term consequences (e.g. whether a pregnancy loss is followed by a future birth). We examined how women seeking prenatal diagnostic services value the outcomes of testing. We conducted a cross-sectional study of 72 women seeking genetic counselling at the University of California at San Francisco or Kaiser San Francisco. We measured preferences for outcomes (utilities) of prenatal diagnosis using the standard gamble metric. We also assessed demographics and attitudes via questionnaire. We observed no differences in mean utilities assigned to first- versus second-trimester pregnancy losses with similar long-term sequelae. Utilities for losses followed by future birth, however, were significantly higher than utilities for losses without future birth (range 0.91 to 0.93 versus 0.84 to 0.86, p

Objective: To determine the prevalence of stress, urge, and mixed urinary incontinence and associated risk factors in postmenopausal women. Methods: Before enrollment in a 4-year, randomized trial of combination hormone therapy to prevent coronary heart disease, 2763 participants completed questionnaires on prevalence and type of incontinence. We measured factors potentially associated with incontinence including demographics, reproductive and medical histories, height, weight, and waist-to-hip circumference ratio. We used multivariate logistic models to determine independent associations between those factors and weekly incontinence by type. Results: The mean (± standard deviation [SD]) age of the participants was 67 ± 7 years; 89% were white and 8% were black. Fifty-six percent reported weekly incontinence. In multivariate analyses, the prevalence of weekly stress incontinence was higher in white than black women (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.6, 5.1), in women with higher body-mass index (BMI) (OR 1.1 per 5 units, 95% CI 1.0, 1.3), and higher waist-to-hip ratio (OR 1.2 per 0.1 unit, 95% CI 1.0, 1.4). The prevalence of weekly urge incontinence was higher in older women (OR 1.2 per 5 years, 95% CI 1.1, 1.3), diabetic women (OR 1.5, 95% CI 1.1, 2.0) and women who had reported two or more urinary tract infections in the prior year (OR 2.0, 95% CI 1.1, 3.6). Conclusion: Stress and urge incontinence are common in postmenopausal women and have different risk factors, suggesting that approaches to risk-factor modification and prevention also might differ and should be specific to types of incontinence.

The primary objective of this study was to estimate the survival function for time to onset of dementia in initially unaffected twins from when their partner (index proband) was diagnosed with dementia of the Alzheimer's type. Survival functions generated by life table analyses were compared by zygosity and gender. Sixty-one twin pairs where at least one member had been diagnosed with dementia of Alzheimer's type were included in the analyses. Additionally, both members of the twin pair had to be alive at the time the index proband was diagnosed with dementia. The probability of remaining cognitively intact within the first three years after the proband was diagnosed was high (0.93, 95% CI 0.89, 1.0), but after 15 years the probability of remaining intact was low (0.34, 95% CI 0.16, 0.52). Age of onset of the index proband was a significant covariate in the survival functions. There were significant differences in the survival functions for monozygotic (MZ) and dizygotic (DZ) co-twins (χ2 = 3.86, 1, P < 0.05), evidencing a genetic component for age of onset for dementia, but there were no significant differences between men and women. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 88:207–210, 1999. © 1999 Wiley-Liss, Inc.

Urge incontinence has a profound effect on the day-to-day lives of women. The purpose of this study was to identify specific aspects of functioning and well-being affected by urge incontinence or mixed incontinence with a primary urge component. We conducted six focus groups of 65 racially and age diverse, community-dwelling women with urge incontinence. Transcripts of the focus groups were quantitatively analyzed for word use frequency with QSR NUD*IST software. Demographics, symptomatology, and the impact of incontinence on daily activities and feelings were assessed by questionnaire. Participants in the focus groups were on average 62 years of age; 52% were nonwhite, and 26% had a high school or less education. In the three identified broad domains, 52% of domain-related words were associated with feelings, 40% with activities, and 8% with relationships. Frequently identified references were bathroom availability (24%), loss of control (14%), anxiety (11%), and sleep disturbance (10%). Women under the age of 70 compared with older women more commonly identified feeling unattractive and low self-esteem (12% versus 2%, p < 0.007) and adverse effects on dating and sexual activity (45% versus 0%, p < 0.02). The effect of incontinence on quality of life correlated with frequency, nocturia, and pad use (Kendall's tau beta 0.02-0.32, p < 0.05). Urge incontinence affects many quality of life issues and contributes to limitation of activities, loss of control, and negative self-perception. Focus groups of diverse women with urge incontinence symptomatology are useful in understanding these effects.

Objective: To determine if awareness of methods to reduce vertical transmission of human immunodeficiency virus (HIV) is associated with HIV test acceptance and to clarify patients’ attitudes toward routine versus elective prenatal HIV testing. Methods: In a cross-sectional study, 247 antenatal patients were surveyed regarding HIV knowledge, self-perceived HIV risk, and willingness to learn a positive test result. This information, along with demographic and risk factor data, was related to HIV test acceptance. Patients also indicated their attitudes toward routine versus elective prenatal testing for HIV and other common prenatal screening tests. Results: Seventy-two percent of antenatal patients accepted HIV testing. Test acceptance was not associated with the presence of risk factors, self-perceived HIV risk, or demographic factors, including race and ethnicity. Test acceptance was associated positively with patients’ knowledge of a medical intervention to reduce vertical transmission and their willingness to learn a positive HIV test result. Only 24% of patients knew that the risk of vertical transmission could be reduced using medication. Sixty-nine percent of patients said that prenatal HIV testing should be routine, whereas 27% said that it should be done only after specific written consent. As a group, our patients viewed HIV screening no differently from screening for other infections in pregnancy. Conclusion: Interventions aimed at increasing HIV testing rates among pregnant women should focus on educating patients about vertical transmission reduction and promising new therapies for HIV infection. Proponents of elective testing should re-evaluate the assumption that patients view HIV testing differently from other prenatal tests for which separate written consent is not required.

Women in later stages of pregnancy are at increased risk for serious influenza-related morbidity; thus, universal influenza vaccination of pregnant women is recommended. However, vaccine uptake in the United States has been suboptimal. We previously described the burden of severe influenza-related morbidity during pregnancy in the United States by examining hospitalizations of pregnant women with respiratory illness during influenza season. Nondelivery hospitalizations with respiratory illness had significantly longer lengths of stay than those without respiratory illness. Hospitalization characteristics associated with greater likelihood of respiratory illness were the presence of a high-risk condition for which influenza vaccination is recommended, Medicaid/Medicare as primary expected payer, and hospitalization in a rural area. These findings may be explained by these women being at higher risk of influenza-related morbidity or reflect disparities in receipt of influenza immunization. Universal vaccination of pregnant women to decrease influenza-related morbidity should be encouraged.

Current trends in US population growth, age distribution, and disease dynamics foretell rises in the prevalence of chronic diseases and other chronic conditions. These trends include the rapidly growing population of older adults, the increasing life expectancy associated with advances in public health and clinical medicine, the persistently high prevalence of some risk factors, and the emerging high prevalence of multiple chronic conditions. Although preventing and mitigating the effect of chronic conditions requires sufficient measurement capacities, such measurement has been constrained by lack of consistency in definitions and diagnostic classification schemes and by heterogeneity in data systems and methods of data collection. We outline a conceptual model for improving understanding of and standardizing approaches to defining, identifying, and using information about chronic conditions in the United States. We illustrate this model's operation by applying a standard classification scheme for chronic conditions to 5 national-level data systems. Although the literature does not support a single uniform definition for chronic disease, recurrent themes include the non-self-limited nature, the association with persistent and recurring health problems, and a duration measured in months and years, not days and weeks--Thrall. So far, many different approaches have been used to measure the prevalence and consequences of chronic diseases and health conditions in children, resulting in a wide variability of prevalence estimates that cannot be readily compared--van der Lee et al.

Introduction Public health and clinical strategies for meeting the emerging challenges of multiple chronic conditions must address the high prevalence of lifestyle-related causes. Our objective was to assess prevalence and trends in the chronic conditions that are leading causes of disease and death among adults in the United States that are amenable to preventive lifestyle interventions. Methods We used self-reported data from 196,240 adults aged 25 years or older who participated in the National Health Interview Surveys from 2002 to 2009. We included data on cardiovascular disease (coronary heart disease, angina pectoris, heart attack, and stroke), cancer, chronic obstructive pulmonary disease (emphysema and chronic bronchitis), diabetes, and arthritis. Results In 2002, an unadjusted 63.6% of participants did not have any of the 5 chronic conditions we assessed; 23.9% had 1, 9.0% had 2, 2.9% had 3, and 0.7% had 4 or 5. By 2009, the distribution of co-occurrence of the 5 chronic conditions had shifted subtly but significantly. From 2002 to 2009, the age-adjusted percentage with 2 or more chronic conditions increased from 12.7% to 14.7% (P < .001), and the number of adults with 2 or more conditions increased from approximately 23.4 million to 30.9 million. Conclusion The prevalence of having 1 or more or 2 or more of the leading lifestyle-related chronic conditions increased steadily from 2002 to 2009. If these increases continue, particularly among younger adults, managing patients with multiple chronic conditions in the aging population will continue to challenge public health and clinical practice.

In 2003, Drs James Marks and Lynne Wilcox began developing a plan to realize their vision of creating a scholarly journal that would strengthen the links connecting public health research, practice, and policy with regard to chronic diseases. Their vision resulted in the publication the following year of Preventing Chronic Disease: Public Health Research, Practice, and Policy (PCD). As we start our 10th year of publication, we can reflect on what has been accomplished and what might be on the horizon. In the accompanying editorial, Dr Wilcox describes the importance of the journal’s focus on chronic disease in 2004 and highlights some of the early milestones in the journal’s development (1). One of the core drivers for starting PCD was the recognition that the field of public health would benefit from an open access forum for sharing successes and lessons learned in order to increase the quality, relevance, and effectiveness of our efforts and to improve their efficiency. The journal’s focus on chronic conditions and its commitment to providing a forum for sharing best practices and innovations is just as important today as it was a decade ago, and will increasingly be so in the future. PCD has grown and changed with advances in technology and public health science to meet the changing demands of the field. In 2004, the journal was among the first to be published only in electronic format. The landscape of e-publishing has dramatically changed since then. In a world of increasing demand and constricting resources, there is an increasing push to use these resources effectively and efficiently. Since its inception, the journal has evolved to meet these challenges. PCD will continue to build on its solid foundation and expand its efforts by increasing its quality, relevance, impact, and efficiency. The changes and developments at the journal in 2012 demonstrate our continued commitment to the field by incorporating the best of science, practice, policy, and publishing technology in our publication processes and content. Some of these innovations are more visible to the reader than others; however, all affect our ability to be of service to the field. First, we have increased our efficiency by redesigning our production workflow, incorporating new software that facilitates document formatting on the journal’s Web pages. Second, accompanying this change in production schedules, we can now make PCD articles available as soon as they are produced, without holding them to be bundled into an issue. These 2 changes have dramatically reduced the amount of time from acceptance to publication, a metric important to authors who want to see their work published more quickly and to the field to speed the process of translating research and experience into practice. In addition to these publishing innovations, we have implemented technological innovations to increase our reach, access, and efficiency of distribution. PCD content is now available on multiple technology platforms through the development of the Centers for Disease Control and Prevention’s iPad application and the PCD-specific iPad application, both of which are available through the iTunes store under the Medical category (https://itunes.apple.com/us/app/preventing-chronic-disease/id560556547?mt=8). Additionally, the PCD-specific application is available for the iPhone. Journal content is also available through the CDC Content Syndication service, allowing our content to be easily placed on external websites (http://www.cdc.gov/pcd/subscriptions/syndication.htm). These advancements increase the reach of PCD, as do the increased distribution of summaries and content to media outlets, Facebook, and Twitter, and the continued promotion of the RSS feed; for example, our monthly Web views went from approximately 102,000 to 160,000 from January to June of 2012. The recognition and stature of PCD have increased steadily since the first issue in 2004. The journal’s commitment to excellence in content and delivery is evidenced by the recognition of a growing number of ranking organizations and indexing services. Ratings of PCD’s impact, according to SCImago Journal Rank indicators (2), document a continual increase in our ranking from 2004 through 2010, the most recent year with complete data available. PCD is now indexed by a number of services including PubMed, PubMed Central, Web of Science, EBSCOhost, PsycINFO, and DOAJ (Directory of Open Access Journals), with full text content available in many of these systems. In 2012 PCD received a Thomson Reuters impact factor, debuting with a score of 1.819, which placed the journal in the top half of public health and environmental journals. We have also made efforts to increase PCD’s reach through offering continuing medical education credits, thanks to our partnership with Medscape. The quantitative data on journal ranking and use of the educational offerings are strong demonstrations of our relevance and impact in the field. If past experience is any indication of future performance, PCD will continue to achieve its mission of promoting an open exchange of information for all those working to reduce the burden of chronic diseases and improve health. Publishing PCD is a community effort that involves researchers, reviewers, readers, and staff. Over the past several years the quality of submissions has consistently increased, as has the number, by 20%. This increase reflects the increased reach and impact of the journal in the field. In addition to contributing authors, our volunteer peer reviewers are critical to our success. The 46,000 subscribers and other readers who use the results of these efforts to implement change and improve the health of the population are critical to the success of the journal. With the guidance of the editorial board and dedication of the staff, PCD continues to develop from the vision of Drs Marks and Wilcox and to reflect the state of public health programs, policy, and research. It is rewarding to work with the PCD community, which is dedicated to efficiency in publishing processes and technology and to making the latest in evidence-based practice and practice-based evidence available to all who are working to prevent and minimize the burden of chronic diseases. The accomplishments in 2012 exemplify PCD’s commitment to serving the field and provide a firm foundation for development over the next 10 years and beyond. The field of chronic disease prevention and health promotion is becoming more complex as more people have multiple chronic conditions (both physical and mental) and the once seemingly clear distinction between communicable and noncommunicable diseases becomes blurred. Furthermore, the burden of chronic diseases is increasing globally, and PCD is committed to being of service to researchers, practitioners, and policy makers around the world. Thank you to all who contribute to, review, read, and produce PCD for continuing to move the journal forward.

Introduction This longitudinal study examined the prevalence and demographic correlates of unprotected insertive and receptive anal intercourse among HIV-positive gay and bisexual men who were aware of their serostatus. Methods Participants (n = 395), sampled randomly at two HIV outpatient clinics in Los Angeles, completed two waves of self-administered questionnaires (separated by approximately 7-9 months) that measured sexual behaviors in the previous 60 days. Results The cross-sectional prevalence of unprotected insertive anal intercourse was 11.2% at time 1 and 7.1% at time 2. Longitudinal analyses indicated that nearly 15% of the participants had engaged in that high-risk behavior either at time 1 or time 2 and approximately 4% had engaged in the behavior at each time period. Similar rates of unprotected receptive anal intercourse were observed. These high-risk activities were more prevalent with seropositive and unknown serostatus partners than with seronegative partners. The rate of anal intercourse risk behaviors was higher among asymptomatic men and among those who were exclusively gay. conclusion The findings demonstrate considerable differences in the prevalence of stable and occasional high-risk sexual behaviors among HIV-positive gay and bisexual men. Simple cross-sectional analyses cannot capture the stability or variation in behavior across time and, thus, may generate misleading conclusions about disease transmission, especially if the partner’s HIV serostatus is not considered in the analysis. The findings indicate a need for focused safer-sex interventions for seropositive men. The HIV outpatient clinic is an ideal setting for such interventions.

BACKGROUND To determine whether patient race was associated with timeliness of follow-up after abnormal screening mammography, a retrospective record review of diagnostic tests for women with abnormal screening mammography from a Northern California mobile van program was conducted. METHODS The study included 317 women between the ages of 33 and 85 who were reported to have abnormal screening mammography between July 1993 and May 1994. Measurements included patient demographics, screening mammography interpretation, follow-up diagnostic tests, and dates of diagnostic evaluation. RESULTS Women with abnormal screening mammography underwent a wide variety of diagnostic evaluations. Nonwhite women had significantly longer time (median time, 19 days) from date of index abnormal screening mammography to final disposition compared with white women (median time, 12 days). This racial difference was primarily due to the longer interval between index abnormal screening mammography and first diagnostic test (median time, 15 days for nonwhite women versus 7 days for white women, P < 0.001). The difference persisted when adjusting for patient age, family history of breast cancer, report of palpable mass, and income. The racial difference was similarly significant for each nonwhite subgroup (African American, Latina, and Asian) when compared with white women (P < 0.01). CONCLUSIONS Reasons for less timely follow-up of abnormal mammography among nonwhite women need to be identified. Delays that may be instigated by the patient or be due to her physician or system of care need to be explored further. Cancer 1996;78:1395-402.