Public Health Commons^™

Frontiers Of The New Social Marketing, R. Craig Lefebvre

GW Health Communication and Marketing Symposium Series

No abstract provided.

Reassessing Google Flu Trends Data For Detection Of Seasonal And Pandemic Influenza: A Comparative Epidemiological Study At Three Geographic Scales, Donald R. Olson, Kevin J. Konty, Marc Paladini, Cecile G. Viboud, Lone Simonsen

Global Health Faculty Publications

The goal of influenza-like illness (ILI) surveillance is to determine the timing, location and magnitude of outbreaks by monitoring the frequency and progression of clinical case incidence. Advances in computational and information technology have allowed for automated collection of higher volumes of electronic data and more timely analyses than previously possible. Novel surveillance systems, including those based on internet search query data like Google Flu Trends (GFT), are being used as surrogates for clinically-based reporting of influenza-like-illness (ILI). We investigated the reliability of GFT during the last decade (2003 to 2013), and compared weekly public health surveillance with search query …

The Commission On Long-Term Care: Background Behind The Mission, Carol O'Shaughnessy

National Health Policy Forum

The American Taxpayer Relief Act of 2012 (ATRA, P.L. 112-240) created a Commission on Long-Term Care charged with developing a plan for financing of long-term services and supports (LTSS) and issuing a report in September 2013. Significant research and advocacy have been devoted to LTSS financing issues and perceived inadequacies of the delivery system over the past several decades, but the most recent comprehensive review of financing options was in 1990 by the Pepper Commission. This publication presents brief background behind the mission of the Commission, including a time line of selected federal and national activities on LTSS financing and …

Assessing The Potential Impact Of The Affordable Care Act On Uninsured Community Health Center Patients: A Nationwide And State-By-State Analysis, Peter Shin, Jessica Sharac, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

In this brief, we estimate the number of uninsured community health center (CHC) patients who would gain coverage under the Affordable Care Act using data from the 2009 HRSA Survey of CHC patients and 2011 Uniform Data System. We find that were all states to implement the Affordable Care Act Medicaid expansion, an estimated 5 million uninsured health center patients – or two-thirds of all uninsured patients served by CHCs nationally – would be eligible for coverage. However, over one million uninsured patients – 72% of whom live in southern states – who would have been eligible for coverage will …

Adolescents And Parents' Perceptions Of Best Time For Sex And Sexual Communications From Two Communities In The Eastern And Volta Regions Of Ghana: Implications For Hiv And Aids Education, Emmanuel Asampong, Joseph Osafo, Jeffrey Bingenheimer, Clement Ahiadeke

Prevention and Community Health Faculty Publications

Background

Adolescents and parents’ differ in their perceptions regarding engaging in sexual activity and protecting themselves from pregnancy and sexually transmitted infections (STIs). The views of adolescents and parents from two south-eastern communities in Ghana regarding best time for sex and sexual communications were examined.

Methods

Focus Group interviews were conducted with parents and adolescents (both In-school and Out-of school) from two communities (Somanya and Adidome) in the Eastern and Volta regions of Ghana with epidemiological differentials in HIV infection.

Results

Findings showed parents and adolescents agree that the best timing for sexual activity amongst adolescents is determined by socioeconomic …

Providing Outreach And Enrollment Assistance: Lessons Learned From Community Health Centers In Massachusetts, Julia Paradise, Sara J. Rosenbaum, Peter Shin, Jessica Sharac, Carmen Alvarez, Julia Zur, Leighton Ku

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

In 2006, major health care reform legislation was enacted in Massachusetts. In many ways a prototype for the Affordable Care Act (ACA), the Massachusetts law required nearly all state residents to obtain health insurance, and made insurance accessible and affordable by reforming the health insurance market and providing subsidies for coverage through expansions of Medicaid and CHIP and a new program for low-income adults who are not eligible for Medicaid, known as Commonwealth Care. The law also created the “Connector,” which, like the ACA’s health insurance Marketplaces, is designed to facilitate and simplify access to insurance for individuals, families, and …

Determining Who Responds Better To A Computer Vs. Human-Delivered Physical Activity Intervention: Results From The Community Health Advice By Telephone (Chat) Trial, Eric B. Hekler, Matthew P. Buman, Jennifer Otten, Cynthia M. Castro, Lauren Grieco, Bess Marcus, Robert H. Friedman, Melissa A. Napolitano, Abby C. King

Prevention and Community Health Faculty Publications

Background

Little research has explored who responds better to an automated vs. human advisor for health behaviors in general, and for physical activity (PA) promotion in particular. The purpose of this study was to explore baseline factors (i.e., demographics, motivation, interpersonal style, and external resources) that moderate intervention efficacy delivered by either a human or automated advisor.

Methods

Data were from the CHAT Trial, a 12-month randomized controlled trial to increase PA among underactive older adults (full trial N = 218) via a human advisor or automated interactive voice response advisor. Trial results indicated significant increases in PA in both …

Epidemiology Of Esophageal Cancer, Yuwei Zhang

Environmental and Occupational Health Faculty Publications

Esophageal cancer (EsC) is one of the least studied and deadliest cancers worldwide because of its extremely aggressive nature and poor survival rate. It ranks sixth among all cancers in mortality. In retrospective studies of EsC, smoking, hot tea drinking, red meat consumption, poor oral health, low intake of fresh fruit and vegetables, and low socioeconomic status have been associated with a higher risk of esophageal squamous cell carcinoma. Barrett’s esophagus is clearly recognized as a risk factor for EsC, and dysplasia remains the only factor useful for identifying patients at increased risk, for the development of esophageal adenocarcinoma in …

Does Comorbidity Increase The Risk Of Mortality Among Children Under 3 Years Of Age?, Christa L. Fischer Walker, Jamie Perin, Jodi L. Liu, Joanne Katz, James M. Tielsch, Robert Black

Global Health Faculty Publications

Objectives Diarrhoea and pneumonia remain leading causes of morbidity and mortality in children under 5 years of age. Little data is available to quantify the burden of comorbidity and the relationship between comorbid diarrhoea and pneumonia infections and mortality. We sought to quantify the relationship between comorbidity and risk of mortality among young children in two community-based studies conducted among South Asian children.

Design Secondary data analysis of two cohort studies.

Participants We identified two cohort studies of children under 3 years of age with prospective morbidity at least once every 2 weeks and ongoing mortality surveillance.

Outcome measures We …

Plasma S-Adenosylmethionine, Dnmt Polymorphisms, And Peripheral Blood Line-1 Methylation Among Healthy Chinese Adults In Singapore, Maki Inoue-Choi, Heather H. Nelson, Kim Robien, Erland Arning, Teodoro Bottiglieri, Woon-Puay Koh, Jian-Min Yuan

Epidemiology Faculty Publications

Background

Global hypomethylation of repetitive DNA sequences is believed to occur early in tumorigenesis. There is a great interest in identifying factors that contribute to global DNA hypomethylation and associated cancer risk. We tested the hypothesis that plasma S-adenosylmethionine (SAM) level alone or in combination with genetic variation in DNA methyltransferases (DNMT1, DNMT3A andDNMT3B) was associated with global DNA methylation extent at long interspersed nucleotide element-1 (LINE-1) sequences.

Methods

Plasma SAM level and LINE-1 DNA methylation index were measured using stored blood samples collected from 440 healthy Singaporean Chinese adults during 1994-1999. Genetic polymorphisms of …

Allostatic Load Amplifies The Effect Of Blood Lead Levels On Elevated Blood Pressure Among Middle-Aged U.S. Adults: A Cross-Sectional Study, Ami R. Zota, Edmond R. Shenassa, Rachel Morello-Frosch

Environmental and Occupational Health Faculty Publications

Background

Scientists and regulators have sought to understand whether and how physiologic dysregulation due to chronic stress exposure may enhance vulnerability to the adverse health effects of toxicant exposures. We conducted a cross-sectional study to determine whether allostatic load (AL), a composite measure of physiologic response to chronic exposure to stress, amplifies the effect of lead exposure on blood pressure among middle-aged adults.

Methods

We analyzed associations between blood lead levels and blood pressure in a nationally representative sample of 8,194 U.S. adults (aged 40-65 years) participating in the National Health and Nutritional Examination Survey, 1999--2008. Outcomes were elevated systolic …

Is Health Diplomacy Keeping Pace With Global Health Developments? Implications For Access To Medicines Strategies In The Post-2015 Mdg Framework, Samantha Ski, Rachel Kiddell-Monroe, James M. Sherry

Global Health Faculty Publications

As the 2015 deadline to achieve the Millennium Development Goals (MDGs) draws near, efforts to ensure access to essential medicines face new challenges in light of new resource constraints. To help assess those challenges, a summary analysis of published data was undertaken to examine the increasing discontinuity between the geographic focus of donor-country programs on low-income countries (LICs) and the geographic location of the increasing majority of the poor and the global burden of preventable disease within middle-income countries (MICs). This disconnect has put new pressure on both donor and government resources for essential medicines, prompting greater consideration of strategies …

Correlates Of Hiv Acquisition In A Cohort Of Black Men Who Have Sex With Men In The United States: Hiv Prevention Trials Network (Hptn) 061, Beryl A. Koblin, Kenneth H. Mayer, Susan H. Eshleman, Lei Wang, Sharon B. Mannheimer, Carlos Del Rio, Steve Shoptaw, Manya Magnus, Susan Buchbinder, Leo Wilton, Ting-Yuan Liu, Vanessa Cummings, Estelle Piwowar-Manning, Sheldon D. Fields, Sam Griffith, Vanessa Elharrar, Darrell Wheeler

Epidemiology Faculty Publications

Background

Black men who have sex with men (MSM) in the United States (US) are affected by HIV at disproportionate rates compared to MSM of other race/ethnicities. Current HIV incidence estimates in this group are needed to appropriately target prevention efforts.

Methods

From July 2009 to October 2010, Black MSM reporting unprotected anal intercourse with a man in the past six months were enrolled and followed for one year in six US cities for a feasibility study of a multi-component intervention to reduce HIV infection. HIV incidence based on HIV seroconversion was calculated as number of events/100 person-years. Multivariate proportional …

Medicare Advantage Update: Benefits, Enrollment, And Payments After The Aca, Kathryn Linehan

National Health Policy Forum

In 2012, the Medicare program paid private health plans $136 billion to cover about 13 million beneficiaries who received Part A and B benefits through the Medicare Advantage (MA) program rather than traditional fee-for-service (FFS) Medicare. Private plans have been a part of the program since the 1970s. Debate about the policy goals—Should they cost less per beneficiary than FFS Medicare? Should they be available to all beneficiaries? Should they be able to offer additional benefits?—has long accompanied Medicare's private plan option. This debate is reflected in the history of Medicare payment policy, and policy decisions over the …

Livestock-Associated Methicillin And Multidrug Resistant Staphylococcus Aureus Is Present Among Industrial, Not Antibiotic-Free Livestock Operation Workers In North Carolina, Jessica L. Rinsky, Maya Nadimpalli, Steve Wing, Devon Hall, Dothula Baron, Lance B. Price, Jesper Larsen, Marc Stegger, Jill Stewart, Christopher D. Heaney

Environmental and Occupational Health Faculty Publications

Objectives

Administration of antibiotics to food animals may select for drug-resistant pathogens of clinical significance, such as methicillin-resistant Staphylococcus aureus (MRSA). In the United States, studies have examined prevalence of MRSA carriage among individuals exposed to livestock, but prevalence of multidrug-resistant S. aureus (MDRSA) carriage and the association with livestock raised with versus without antibiotic selective pressure remains unclear. We aimed to examine prevalence, antibiotic susceptibility, and molecular characteristics of S. aureus among industrial livestock operation (ILO) and antibiotic-free livestock operation (AFLO) workers and household members in North Carolina.

Methods

Participants in this cross-sectional study were interviewed and provided a …

Role Of Environment And Sex Differences In The Development Of Autoimmune Diseases: A Roundtable Meeting Project, Monica P. Mallampalli, Erika Davies, Debra Wood, Hillary Robinson, Federica Polato, Christine L. Carter

Prevention and Community Health Faculty Publications

Autoimmune diseases (ADs) impose substantial health and financial burdens in the United States and in many parts of the world. Women are disproportionately affected by many of these disorders, which often contribute to lifelong disabilities. While the number of patients with some ADs appears to be rising, the complexities of conducting epidemiological studies prevent a thorough understanding of the prevalence and incidence of these various conditions. Research on environmental influences of these illnesses is limited, although they are generally hypothesized to result from the interaction of environmental agents in genetically susceptible individuals. Further, there is little known regarding the role …

Racial Disparities In The Use Of Cardiac Revascularization: Does Local Hospital Capacity Matter?, Suhui Li, Arnold Chen, Katherine H. Mead

Health Policy and Management Faculty Publications

Objective: To assess the extent to which the observed racial disparities in cardiac revascularization use can be explained by the variation across counties where patients live, and how the within-county racial disparities is associated with the local hospital capacity.

Data Sources: Administrative data from Pennsylvania Health Care Cost Containment Council (PHC4) between 1995 and 2006.

Study Design: The study sample included 207,570 Medicare patients admitted to hospital for acute myocardial infarction (AMI). We identified the use of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) procedures within three months after the patient’s initial admission for AMI. Multi-level hierarchical …

School-Centered Approaches To Improve Community Health: Lessons From School-Based Health Centers, Olga Acosta Price

Center for Health and Health Care in Schools

No abstract provided.

Cardiovascular Outcome Trials In Type 2 Diabetes And The Sulphonylurea Controversy: Rationale For The Active-Comparator Carolina Trial, Julio Rosenstock, Nikolaus Marx, Steven E. Kahn, Bernard Zinman, John J. Kastelein, John M. Lachin, Erich Bluhmki, Sanjay Patel, Odd-Erik Johansen, Hans-Jurgen Woerle

Epidemiology Faculty Publications

Sulphonylureas (SUs) are widely used glucose-lowering agents in type 2 diabetes mellitus (T2DM) with apparent declining efficacy over time. Concerns have been raised from observational retrospective studies on the cardiovascular (CV) safety of SUs but there are few long-term data on CV outcomes from randomized controlled trials (RCTs) involving the use of this class of agents. Most of the observational studies and registry data are conflicting and vary with study population and methodology used for analyses. To address the SU controversy, we reviewed the recently published literature (until end of the year 2011) to evaluate the impact of SUs on …

Smoking Behaviours And Cessation Services Among Male Physicians In China: Evidence From A Structural Equation Model, Cheng Huang, Chaoran Gao, Shaohua Yu, Yan Feng, Julia Song, Michael Erikson, Pam Redmon, Jeffrey Koplan

Global Health Faculty Publications

Objective To investigate smoking prevalence and cessation services provided by male physicians in hospitals in three Chinese cities.

Methods Data were collected from a survey of male physicians employed at 33 hospitals in Changsha, Qingdao and Wuxi City (n=720). Exploratory factor analysis was performed to identify latent variables, and confirmatory structural equation modelling analysis was performed to test the relationships between predictor variables and smoking in male physicians, and their provision of cessation services.

Results Of the sampled male physicians, 25.7% were current smokers, and 54.0% provided cessation services by counselling (18.8%), distributing self-help materials (17.1%), and providing traditional remedies …

National And Regional Estimates Of Term And Preterm Babies Born Small For Gestational Age In 138 Low-Income And Middle-Income Countries In 2010, Anne C.C. Lee, Joanne D. Katz, Hannah Blencowe, Simon Cousens, Naoko Kozuki, James M. Tielsch, +30 Additional Authors

Global Health Faculty Publications

Background

National estimates for the numbers of babies born small for gestational age and the comorbidity with preterm birth are unavailable. We aimed to estimate the prevalence of term and preterm babies born small for gestational age (term-SGA and preterm-SGA), and the relation to low birthweight (<2500 >g), in 138 countries of low and middle income in 2010.

Methods

Small for gestational age was defined as lower than the 10th centile for fetal growth from the 1991 US national reference population. Data from 22 birth cohort studies (14 low-income and middle-income countries) and from the WHO Global Survey on Maternal …

The Relevance Of Social Contexts And Social Action In Reducing Substance Use And Victimization Among Women Participating In An Hiv Prevention Intervention In Cape Town, South Africa, Elizabeth Reed, Andrea N. Emanuel, Bronwyn Myers, Kim Johnson, Wendee M. Wechsberg

Prevention and Community Health Faculty Publications

Objectives: To examine qualitatively how women's social context and community mobilization (eg, mobilizing women to take social action and engaging their community in social change) influence substance use abstinence and victimization among women participating in a human immunodeficiency virus (HIV) intervention in Cape Town, South Africa.
Methods: Thirty women who had participated in a randomized controlled trial of a group-delivered intervention to address substance use, gender-based violence, and associated risk for HIV (The Women's Health CoOp) were selected to participate in semi-structured interviews about their perceived impact of the intervention on their substance use and exposure to victimization. The Women's …

Cms's Proposed Rule Implementing The Aca-Mandated Medicaid Dsh Reductions, Kathryn Linehan

National Health Policy Forum

State Medicaid programs make Medicaid disproportionate share hospital (DSH) payments to hospitals to help offset costs of uncompensated care for Medicaid and uninsured patients. Unlike most Medicaid spending, annual DSH allotments for each state are capped. Under the Patient Protection and Affordable Care Act of 2010 (ACA), DSH payments will decrease starting in fiscal year (FY) 2014 and continuing through FY 2020. This paper describes the proposed rule for reducing these federal allotments, which was released on May 15, 2013, by the Centers for Medicare & Medicaid Services (CMS). Comments on the proposed rule are due July 12, 2013.

2014 …

When To Start Antiretroviral Therapy: The Need For An Evidence Base During Early Hiv Infection, James D. Lundgren, Abdel G. Babiker, Fred M. Gordin, Alvaro H. Borges, James D. Neaton

Epidemiology Faculty Publications

Background

Strategies for use of antiretroviral therapy (ART) have traditionally focused on providing treatment to persons who stand to benefit immediately from initiating the therapy. There is global consensus that any HIV+ person with CD4 counts less than 350 cells/μl should initiate ART. However, it remains controversial whether ART is indicated in asymptomatic HIV-infected persons with CD4 counts above 350 cells/μl, or whether it is more advisable to defer initiation until the CD4 count has dropped to 350 cells/μl. The question of when the best time is to initiate ART during early HIV infection has always been vigorously debated. The …

Quality Of Care In Community Health Centers And Factors Associated With Performance, Peter Shin, Jessica Sharac, Sara J. Rosenbaum, Julia Paradise

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Federally funded community health centers are a key source of comprehensive primary care for medically underserved communities, serving more than 20 million patients in 2011. The Affordable Care Act (ACA) expanded the health center program significantly to help meet the increased demand for health care that is expected as millions of the uninsured gain health coverage, beginning in 2014. Especially given health centers’ growing role, evidence of the quality of care they provide is of keen interest. Most research shows high performance by health centers relative to various standards, but some gaps have also been found, and suitable benchmarks for …

The Role Of Issue Familiarity And Social Norms: Findings On New College Students' Alcohol Use Intentions, Rajiv N. Rimal, Saar Mollen

Prevention and Community Health Faculty Publications

Background. Scholars in a variety of disciplines are interested in understanding the conditions under which social norms affect human behavior. Following the distinction made between descriptive and injunctive norms by the focus theory of normative conduct, the theory of normative social behavior predicts that the influence of descriptive norms on behavior is moderated by injunctive norms, outcome expectations, and group identity. We extended the theory by testing the proposition that the influence of descriptive norms on behavior would be greater under conditions of greater issue familiarity, defined as the ease with which one can cognitively access the behavior or …

Diarrhea As A Risk Factor For Acute Lower Respiratory Tract Infections Among Young Children In Low Income Settings, Christa L. Fischer Walker, Jamie Perin, Joanne D. Katz, James M. Tielsch, Robert Black

Global Health Faculty Publications

Background

Diarrhea and acute lower respiratory tract infections (ALRI) are leading causes of morbidity and mortality among children under 5 years of age. We sought to quantify the correlation of diarrhea and respiratory infections within an individual child and to determine if infection with one illness increases the risk of infection with the other during the same time period.

Methods

We quantified the likelihood of an ALRI and a diarrhea episode occurring during the same week compared to the likelihood of each occurring independently in two cohorts of children under 3 years of age using a bivariate probit regression model. …

Hospital Ships Adrift? Part 1: A Systematic Literature Review Characterizing Us Navy Hospital Ship Humanitarian And Disaster Response, 2004-2012., Derek J. Licina

Global Health Faculty Publications

Background: United States foreign policy is tied extensively to health initiatives, many related to the use of military assets. Despite substantial resource investment by the US Department of Defense (DoD) in hospital ship humanitarian assistance and disaster response missions, the impact of this investment is unclear.

Methods: A systematic literature review of both peer-reviewed and grey literature using eight databases representing the international community and multiple sectors was conducted. Data on the characteristics of missions directly related to US Navy hospital ship humanitarian assistance and disaster response from 2004-2012 were extracted and documented.

Results: Of the 1445 sources reviewed, a …

Principles To Consider For The Implementation Of A Community Health Needs Assessment Process, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

No abstract provided.

Exploring Changes In Open Defecation Prevalence In Sub-Saharan Africa Based On National Level Indices, Deise I. Galan, Seung-Sup Kim, Jay P. Graham

Environmental and Occupational Health Faculty Publications

Background

In sub-Saharan Africa, it is estimated that 215 million people continue to engage in open defecation. This practice facilitates the transmission of diarrheal diseases – one of the leading causes of mortality in children under 5 in sub-Saharan Africa. The main purpose of this study is to: estimate changes in open defecation prevalence between 2005 and 2010 across countries in sub-Saharan Africa; examine the association between national level indices and changes in open defecation prevalence; and assess how many countries can achieve ‘open defecation free status’ by 2015.

Methods

After applying selection criteria, this study analyzed country-level data for …