Showing papers in "Public Health Reports in 2013"

Mortality rates and age at death from sickle cell disease: U.S., 1979-2005.

Abstract: Objectives.Improvements in survival for children with sickle cell disease (SCD) during the last 30 years have been well established. Whether similar improvements for adults with the disease have oc...

Socioeconomic Disadvantage as a Social Determinant of Teen Childbearing in the U.S.

Abstract: Objective.We reviewed the literature focused on socioeconomic influences on teen childbearing and suggested directions for future research and practice related to this important indicator of teen s...

PHS Guideline for Reducing Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis C Virus Transmission through Organ Transplantation:

Abstract: AND FULL-TEXT SCREENING To identify studies that were (1) relevant to one or more key questions; (2 ) primary research, systematic review, or meta-analysis; (3 ) written in English; and (4 ) inclusive of question-specific criteria DATA EXTRACTION AND SYNTHESIS Data abstracted into evidence tables; individual study quality assessed DRAFT RECOMMENDATIONS GRADE of evidence base evaluated, narrative summaries drafted, recommendations drafted from summaries, and recommendation strength assigned FINALIZE RECOMMENDATIONS Recommendations finalized; guideline published Figure 8. Evidence-based process used to develop guideline recommendations for reducing HIV, HBV, and HCV transmission through organ transplantation HIV 5 human immunodeficiency virus HBV 5 hepatitis B virus HCV 5 hepatitis C virus GRADE 5 Grading of Recommendations Assessment, Development, and Evaluation

Estimates of smoking before and during pregnancy, and smoking cessation during pregnancy: comparing two population-based data sources.

Abstract: Objectives.We compared three measures of maternal smoking status—prepregnancy, during pregnancy, and smoking cessation during pregnancy—between the Pregnancy Risk Assessment Monitoring System (PRAMS) questionnaire and the 2003 revised birth certificate (BC).Methods.We analyzed data from 10,485 women with live births in eight states from the 2008 PRAMS survey, a confidential, anonymous survey administered in the postpartum period that is linked to select BC variables. We calculated self-reported prepregnancy and prenatal smoking (last trimester only) prevalence based on the BC, the PRAMS survey, and the two data sources combined, and the percentage of smoking cessation during pregnancy based on the BC and PRAMS survey. We used two-sided t-tests to compare BC and PRAMS estimates.Results.Prepregnancy smoking prevalence estimates were 17.3% from the BC, 24.4% from PRAMS, and 25.4% on one or both data sources. Prenatal smoking prevalence estimates were 11.3% from the BC, 14.0% from PRAMS, and 15.2% on one or b...

Measuring what matters: development of standard HIV core indicators across the U.S. Department of Health and Human Services.

Abstract: Address correspondence to: Ronald O. Valdiserri, MD, MPH, U.S. Department of Health and Human Services, Office of HIV/AIDS and Infectious Disease, 200 Independence Ave. SW, HHH Building, Room 443-H, Washington, DC 20201; tel. 202-690-5560; fax 202-690-7560; e-mail . Ronald O. Valdiserri, MD, MPHa Andrew D. Forsyth, PhDa Vera Yakovchenko, MPHa Howard K. Koh, MD, MPHb “If you cannot measure it, you cannot improve it.” —Lord Kelvin

Health, Chronic Conditions, and Behavioral Risk Disparities among U.S. Immigrant Children and Adolescents:

Abstract: Objective.We examined differentials in the prevalence of 23 parent-reported health, chronic condition, and behavioral indicators among 91,532 children of immigrant and U.S.-born parents.Methods.We used the 2007 National Survey of Children's Health to estimate health differentials among 10 ethnic-nativity groups. Logistic regression yielded adjusted differentials.Results.Immigrant children in each racial/ethnic group had a lower prevalence of depression and behavioral problems than native-born children The prevalence of autism varied from 0.3% among immigrant Asian children to 1.3%–1.4% among native-born non-Hispanic white and Hispanic children Immigrant children had a lower prevalence of asthma, attention deficit disorder/attention deficit hyperactivity disorder; developmental delay; learning disability; speech, hearing, and sleep problems; school absence; and ≥1 chronic condition than native-born children, with health risks increasing markedly in relation to mother's duration of residence in the U.S. Imm...

Understanding sexual health and its role in more effective prevention programs.

Abstract: This supplemental issue of Public Health Reports (PHR) presents a variety of articles addressing the science and practical applications of sexual health, an important health promotion concept with the potential for improving population health in a broad range of areas related to sexual behavior, including human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), sexually transmitted diseases (STDs), viral hepatitis, teen and unintended pregnancy, and sexual violence. The focus of these articles is especially timely given the population burden of these conditions in the United States and other nations, and the growing recognition that, despite the sensitive nature of the topic, addressing the broad construct of sexual health can enhance the national dialogue in this area and increase the effectiveness of public health programs.1–4 The concept of sexual health has evolved since its initial articulation by the World Health Organization (WHO) in 1975,5 but it has generally emphasized wellbeing across a range of life domains (e.g., physical, mental, and emotional) rather than simply the absence of disease or other adverse outcomes.6 The definition of sexual health currently in most widespread use is that developed by WHO in 2002:

Electronic health information quality challenges and interventions to improve public health surveillance data and practice.

Abstract: ObjectiveWe examined completeness, an attribute of data quality, in the context of electronic laboratory reporting (ELR) of notifiable disease information to public health agenciesMethodsWe extracted more than seven million ELR messages from multiple clinical information systems in two states We calculated and compared the completeness of various data fields within the messages that were identified to be important to public health reporting processes We compared unaltered, original messages from source systems with similar messages from another state as well as messages enriched by a health information exchange (HIE) Our analysis focused on calculating completeness (i e, the number of nonmissing values) for fields deemed important for inclusion in notifiable disease case reportsResultsThe completeness of data fields for laboratory transactions varied across clinical information systems and jurisdictions Fields identifying the patient and test results were usually complete (97%–100%) Fields contain

From theory to action: applying social determinants of health to public health practice.

Abstract: Recent approaches to population health have encouraged public health practitioners and policy makers to consider the broader determinants of health as part of a more comprehensive approach to improving health, addressing health inequalities, and accelerating health impact.1–3 Implementing action on social determinants involves understanding the dynamic interaction among the behavioral, clinical, policy, systems, occupational, and environmental determinants of health; identifying synergisms and antagonisms; and employing costeffective strategies to achieve sufficient and sustainable population coverage and scale. In an era of health system transformation, greater attention is now being paid to access, utilization, and quality of health care and its influence on population health. Similarly, research highlighting the importance of poverty, residential segregation, stigma and discrimination, incarceration, and educational attainment on health outcomes provides a deeper understanding of the complex social and structural determinants of health and pinpoints additional opportunities for enhancing prevention and control efforts.4–8 Our expanded understanding of the wider determinants of health and disease suggests that significant advances in health could be achieved if policy makers, program developers, and implementers address these broader influences on health outcomes while maintaining excellence in traditional disease control approaches. This supplement is both timely and critical to continuing the momentum in incorporating the social determinants of health (SDH) into prevention programming. This supplement seeks to advance scientific knowledge and illustrate how public health professionals can address SDH across a range of public health activities that promote health equity among the populations most disproportionately impacted by infectious and chronic diseases. By focusing on the ways in which SDH approaches are being integrated into public health research, surveillance, communication, policy, program, capacity building, and partnership activities, we hope to highlight best practices in addressing SDH across a broad range of public health activities.

Hepatitis B Vaccination Coverage among Health-Care Personnel in the United States:

Abstract: Objectives.We compared self-reported hepatitis B (HepB) vaccine coverage among health-care personnel (HCP) with HepB vaccine coverage among the general population and determined trends in vaccinati...

Considerations for national public health leadership in advancing sexual health.

Abstract: Nations across the globe face significant public heath challenges in optimizing sexual health, including reducing human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), sexually transmitted infections (STIs), unintended pregnancies, and sexual violence, and mitigating the associated adverse social and economic impacts. In response, some countries have implemented national strategies and other efforts focused on promoting more holistic and integrated approaches for addressing these syndemics. This article describes opportunities for national leadership to use a more holistic approach to improve the sexual health of individuals and communities.

Integrating a Social Determinants of Health Approach Into Public Health Practice: A Five-Year Perspective of Actions Implemented by CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

Abstract: Hazel D. Dean, ScD, MPHa Kevin A. Fenton, MD, PhD, FFPHa In the United States, human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), viral hepatitis, sexually transmitted disease (STD), and tuberculosis (TB) infections are among the most prevalent and most commonly reported conditions—with STDs alone accounting for more than 19 million new infections per year and direct costs in excess of $15 billion.1,2 Their nonrandom distribution in the population is characterized by increasing disease concentration among the poor, those with poor access to curative services, populations with a high prevalence of risky or stigmatized behaviors, or the socially marginalized. Strong vertical programs that provide highly specialized technical approaches to disease control have been the mainstay of the domestic efforts during the past four decades, with a focus on scaling up screening, diagnosis, treatment, and partner notification efforts. However, our evolved understanding of the complex and overlapping (syndemic) nature of these conditions and their close interrelationship with social and structural determinants has necessitated the adoption of new approaches to enhance traditional disease control efforts. Scientific evidence shows that genetic predisposition and risk behaviors only partially explain why some people become sick and others do not.3 Many chronic and infectious diseases cluster in populations that experience social and economic constraints to good health.4,5 These constraints, often referred to as social determinants of health (SDH), are the economic and social conditions that influence the health of individuals and communities.5 They determine the extent to which a person possesses the physical, social, and personal resources to identify and achieve personal goals, satisfy needs, cope with the environment, and achieve optimal health. In 2008, the World Health Organization (WHO) published the final report of the Commission on Social Determinants of Health, entitled “Closing the Gap in a Generation—Health Equity through Action on the Social Determinants of Health.” In this report, the Commission issued a call for the “World Health Organization and all governments to lead global action on the social determinants of health with the aim of achieving health equity” and “closing

Fatalities of pedestrians, bicycle riders, and motorists due to distracted driving motor vehicle crashes in the U.S., 2005-2010.

Abstract: OBJECTIVE: Distracted driving is an increasingly deadly threat to road safety. This study documents trends in and characteristics of pedestrian, bicycle rider, and other victim deaths caused by distracted drivers on U.S. public roads. METHODS: We obtained data from the Fatality Analysis Reporting System database from 2005 to 2010 on every crash that resulted in at least one fatality within 30 days occurring on public roads in the U.S. Following the definition used by the National Highway Traffic Safety Administration, we identified distracted driving based on whether police investigators determined that a driver had been using a technological device, including a cell phone, onboard navigation system, computer, fax machine, two-way radio, or head-up display, or had been engaged in inattentive or careless activities. RESULTS: The rate of fatalities per 10 billion vehicle miles traveled increased from 116.1 in 2005 to 168.6 in 2010 for pedestrians and from 18.7 in 2005 to 24.6 in 2010 for bicyclists. Pedestrian victims of distracted driving crashes were disproportionately male, 25-64 years of age, and non-Hispanic white. They were also more likely to die at nighttime, be struck by a distracted driver outside of a marked crosswalk, and be in a metro location. Bicycling victims of distracted crashes were disproportionately male, non-Hispanic white, and struck by a distracted driver outside of a crosswalk. Compared with pedestrians, bicyclists were less likely to be hit in early morning. CONCLUSIONS: Distracted drivers are the cause of an increasing share of fatalities found among pedestrians and bicycle riders. Policies are needed to protect pedestrians and bicycle riders as they cross intersections or travel on roadways. Keywords: Driver distraction; Language: en

What can public health programs do to improve health equity

Abstract: Ritu Sadana, ScDa Erik Blas, DrPHb Health inequalities are disparities in health, reflecting either differences in access to a range of promotional, preventive, curative, or palliative health services or differences in outcomes including disability, morbidity, and mortality spanning physical, mental, and social health. The causes of inequalities in health are dynamic and reflect multiple determinants. Health inequities, however, are differences in health that are judged to be avoidable, unfair, and unjust.1 Health inequities are often revealed through systematic patterns or gradients in access or outcomes across populations with different levels of underlying social advantage or disadvantage—that is, wealth, power, prestige, or other markers of social stratification.2 Numerous reviews across low-, middle-, and high-income countries continue to document that health inequalities are related not only to biological or genetic factors, but also to social factors that are amenable to policy and are potentially avoidable given cross-group or cross-population comparisons. Studies most often document differential access to health services based on an individual’s socioeconomic position or place of residence, rather than on need,3–6 although other approaches exist.7 The place in the social hierarchy that individuals and groups occupy, combined with the epidemiological environment, then determines exposure and vulnerability to health-enhancing or health-damaging conditions in daily life (e.g., where people are born, grow, live, work, and age).8 The underlying causes are complex, often reflecting systematic social, political, historical, economic, and environmental factors that also interface with biological factors. The term “social determinants” is often used as shorthand for all of these factors and is relevant to communicable and non-communicable conditions alike.9 An added complexity is that negative or positive impacts of social determinants of health (SDH) can be accumulated during a lifetime, alter health trajectories across the life course, and be transferred across generations.10 Moreover, labeling an inequality as an inequity also reflects a value judgment. This labeling is sometimes made explicit by deliberating on facts, clarifying underlying values, and designing remedial actions. Often, however, there is no

Racial Differences in Age at First Sexual Intercourse: Residential Racial Segregation and the Black-White Disparity Among U.S. Adolescents

Abstract: Objectives.The age of adolescents at first sexual intercourse is an important risk factor for sexually transmitted diseases (STDs) and adolescent pregnancy. Black adolescents are at higher risk than white adolescents for first sexual intercourse at younger ages as well as STDs and pregnancy. Individual- and family-level factors do not fully explain this disparity. We examined whether five dimensions of black-white residential racial segregation can help explain the racial disparity in age at first sexual intercourse.Methods.Using the National Longitudinal Survey of Youth 1997 and U.S. Census 2000 data, we performed multiple hierarchical discrete time-to-event analyses on a nationally representative cohort of adolescents followed since 1997. Although the cohort study is ongoing, we used data from 1997 through 2005.Results.Concentration and unevenness significantly modified the association of race and age at first sexual intercourse. However, stratified results suggested differences in the effect of race on...

Assessing the validity and reliability of three indicators self-reported on the pregnancy risk assessment monitoring system survey.

Abstract: Objectives.We investigated the reliability and validity of three self-reported indicators from the Pregnancy Risk Assessment Monitoring System (PRAMS) survey.Methods.We used 2008 PRAMS (n=15,646) d...

Using GIS and secondary data to target diabetes-related public health efforts.

Abstract: Objectives.To efficiently help communities prevent and manage diabetes, health departments need to be able to target populations with high risk but low resources To aid in this process, we mapped county-level diabetes-related rates and resources/use using publicly available secondary data to identify Michigan counties with high diabetes prevalence and low or no medical and/or community resources.Methods.We collected county-level diabetes-related rates and resources from Web-based sources and mapped them using geographic information systems (GIS) software. Data included age-adjusted county diabetes rates, diabetes-related medical resource and resource use (i.e., the number of endocrinologists and percentage of Medicare patients with diabetes who received hemoglobin A1c testing in the past year), community resources (i.e., the number of certified diabetes self-management education and diabetes support groups), as well as population estimates and demographics (e.g., rural residence, education, poverty, and r...

Achieving pharmacy-based public health: a call for public health engagement.

Abstract: ©2013 Association of Schools of Public Health The evolution of pharmacy practice in the last 15 years has created expanded public health access. Community pharmacies now provide a range of public health services with promising improvements in health access and outcomes. The observed practice changes call our attention to systemic issues that remain in need of collective attention. As we strengthen our intersectoral public health system, we must focus on the pharmacy-public health partnership and establish collaborative policy and research agendas to guide this system change for maximum public health impact. Our collective effort to assure the health of communities depends upon our seeing opportunities across systems and sectors, and upon our success in shifting the policy environment to allow health system flexibility.

Obesity among chronically homeless adults: is it a problem?

Abstract: Objective. We examined rates of obesity and associated characteristics in the chronically homeless population to explore how a range of factors, including sociodemographics, housing, food source, physical and mental health, and health service use, were related to being overweight or obese. Methods. We conducted multivariate regression analyses on a community sample of 436 chronically homeless adults across 11 U.S. cities to examine the prevalence of obesity. results. The majority (57%) of chronically homeless adults were overweight or obese. Chronically homeless adults who were female or Hispanic appeared to be at particular risk for obesity. There were few differences on physical and mental health by weight group. Although overweight and obese chronically homeless adults were more likely to discuss exercise with a health-care provider, they reported engaging in less exercise than those who were underweight or normal weight. conclusion. These findings underscore the need for greater attention to obesity in chronically homeless adults and demonstrate a food insecurity-obesity paradox or poverty-obesity link.

Determinants of cervical cancer screening among women with intellectual disabilities: evidence from medical records.

Abstract: Objective.We examined receipt of cervical cancer screening and determinants of screening for women with intellectual disabilities in one Southeastern state.Methods.Using medical records data from 2...

Measurement of sexual health in the U.S.: an inventory of nationally representative surveys and surveillance systems.

Abstract: ObjectivesTo identify opportunities within nationally representative surveys and surveillance systems to measure indicators of sexual health, we reviewed and inventoried existing data systems that include variables relevant to sexual healthMethodsWe searched for US nationally representative surveys and surveillance systems that provided individual-level sexual health data We assessed the methods of each data system and catalogued them by their measurement of the following domains of sexual health: knowledge, communication, attitudes, service access and utilization, sexual behaviors, relationships, and adverse health outcomesResultsWe identified 18 US-focused, nationally representative data systems: six assessing the general population, seven focused on special populations, and five addressing health outcomes While these data systems provide a rich repository of information from which to assess national measures of sexual health, they present several limitations Most importantly, apart from dat

The recommended critical component elements of an undergraduate major in public health.

Abstract: Public Health Reports / September–October 2013 / Volume 128 11. Riegelman RK. Undergraduate public health education: past, present, and future. Am J Prev Med 2008;35:258-63. 12. Gebbie K, Merrill J, Hwang I, Gebbie EN, Gupta M. The public health workforce in the year 2000. J Public Health Manag Pract 2003;9:79-86. 13. Rosenstock L, Silver GB, Helsing K, Evashwick C, Katz R, Klag M, et al. Confronting the public health workforce crisis: ASPH statement on the public health workforce. Public Health Rep 2008;123:395-8. 14. Eyler J, Giles DE Jr. Where’s the learning in service-learning? San Francisco: Jossey-Bass; 1999. 15. Barry WA, Doherty RJ. Contemplatives in action: the Jesuit way. Mahwah (NJ): Paulist Press; 2002. 16. Association of Schools of Public Health, Association of American Colleges and Universities, Association for Prevention Teaching and Research, Centers for Disease Control and Prevention (US). Undergraduate public health learning outcomes model. Washington: ASPH; 2011. 17. Fleming ML, Parker E, Gould T, Service M. Educating the public health workforce: issues and challenges. Aust N Z Health Policy 2009;6:8.

In Their Own Words: Romantic Relationships and the Sexual Health of Young African American Women:

Abstract: OBJECTIVE: We assessed young African American womens understanding of "dual protection" (DP) (i.e. strategies that simultaneously protect against unintended pregnancies and sexually transmitted diseases [STDs]) and how relationship factors influence their use of DP methods. METHODS: We conducted 10 focus groups with African American women (n=51) aged 15-24 years in Atlanta Georgia to identify barriers to and facilitators of their DP use. Focus group participants also completed a brief self-administered questionnaire that assessed demographics and sexual behaviors. We analyzed focus group data by theme: relationships planning for sex pregnancy intentions STD worries the trade-off between pregnancy and STDs attitudes toward condoms and contraceptives and understanding of DP. RESULTS: From the questionnaire 51% of participants reported that an STD would be the "worst thing that could happen" and 26% reported that being pregnant would be "terrible." Focus group data suggested that most participants understood what DP was but thought it was not always feasible. Relationship factors (e.g. trust intimacy length of relationship and centrality) affected pregnancy intentions STD concerns and use of DP. Social influences (e.g. parents) and pregnancy and STD history also affected attitudes about pregnancy STDs and relationships. CONCLUSIONS: Although participants identified risks associated with sex a complex web of social and relationship factors influenced the extent to which they engaged in protective behavior. The extent to which relationship factors influence DP may reflect developmental tasks of adolescence and should be considered in any program promoting sexual health among young African American women.

Vibrio infections and surveillance in Maryland, 2002-2008.

Abstract: Objective Vibrio is a naturally occurring waterborne pathogen with potential occupational, recreational, and commercial impacts. During the last 15 years in the U.S. and in Maryland, the incidence of vibriosis has increased. Due to the increase in cases in Maryland, warming water temperatures, and public concern about human health effects resulting from exposure to the Chesapeake Bay, we reviewed cases of vibriosis and evaluated the Vibrio surveillance system in Maryland for timeliness and data quality, attributes necessary for successful outbreak investigation and illness prevention. Methods The evaluation included (1) informal qualitative surveys of state and local personnel who report and manage Vibrio cases and (2) a review of Vibrio surveillance data from 2002 through 2008 for data quality and timeliness of the system. Results From 2002 to 2008, 188 laboratory-confirmed cases of vibriosis were reported in Maryland with an annual average of 27 cases. The species of Vibrio that were most frequently responsible for infection, regardless of clinical presentation, were V. parahaemolyticus (43.6%), V. vulnificus (23.9%), V. alginolyticus (9.6%), and non-toxigenic V. cholerae (9.0%). The case fatality rate fluctuated during the study period, but the number of cases increased. Conclusions The surveillance system in Maryland is flexible and captures cases of vibriosis where specimens were collected for testing; however, the system may not adequately capture mild, self-limiting infections. Better integration of data collection for clinical, laboratory, and environmental information and improved completion of variables for shellfish harvest or water exposure locations could improve the system. Quarterly meetings comprising surveillance, public health laboratory, and food-control personnel could direct and ensure the success of improvement efforts.

Developing an educated citizenry: the undergraduate public health learning outcomes project.

Abstract: In its seminal 1988 report, “The Future of Public Health,” the Institute of Medicine (IOM) called public health “what we do as a society collectively to assure the conditions in which people can be healthy.”1 Public health interventions may occur in myriad institutions, through a variety of direct and indirect mechanisms in communities across the country. Yet, despite the many proven benefits of health approaches based on prevention and the well-being of populations, public health does not enjoy popular support and is poorly understood by most Americans.2 The dominance of medical solutions to health challenges, even in the face of overwhelming evidence regarding the effectiveness of community-based preventive approaches, is illustrative of this broad lack of understanding. In 2003, the IOM suggested that the nation’s health would benefit from a greater understanding of the profession’s potential. To promote this enhanced awareness among the public, the IOM report called for every undergraduate to have access to education in public health.3 This call for broader public health education led to the formation of the Educated Citizen and Public Health initiative led by the Association for Prevention Teaching and Research, the Council of Colleges of Arts and Sciences, the Association of Schools and Programs of Public Health (ASPPH), and the Association of American Colleges and Universities (AAC&U). The initiative intended to respond to growing demand in the field and bring leadership to the suddenly explosive growth of courses and programs. The initiative further intended to introduce undergraduate study of integrative public health to all institutions of higher education and to take an interdisciplinary and inter-professional approach to collaboration.4 In recognition of the growth in undergraduate public health programs at colleges and universities, many without schools or programs of public health, ASPPH determined that it should actively engage in defining the learning outcomes and design of undergraduate public health programs. Many questions immediately surfaced: Should the traditional liberal arts be the recommended framework? Should programs prepare associate and baccalaureate graduates to enter the workforce? Should curricula include an internship or apprenticeship? Should programs focus on lifelong learning? How would an undergraduate public health degree articulate to existing master’s degrees in public health? And what faculty development opportunities would be needed to support the integration of public health theory and content into other areas of inquiry in an undergraduate setting? In September 2009, ASPPH convened an Undergraduate Task Force to consider these issues and to develop a strategy for integrating public health knowledge and principles in undergraduate education.