|| Assessing the health benefits from nationwide reductions of ozone air pollution
|| Do women change their diet after breast cancer diagnosis? An exploratory analysis
||Association between bully victimization and suicide behaviors among youth in Massachusetts
||Oxidative DNA damage and human esophageal cancer risk in Huaian, China
||Public health impact of community health screening and education programs on knowledge of coronary heart disease risk factors and health-promoting behaviors
||Calibration and validation of a dynamic model that projects population outcomes from methylmercury exposure from local fish consumption
||Park usage, physical activity, and social economic status: A study on the behaviors of females in Honolulu parks
||Dental residents' knowledge, perceptions and confidence of screening for and educating patients about alcohol, tobacco and illicit drug use
|| Changes in asthma, COPD, and ischemic heart disease, and heart failure rehospitalizations after iimplementation of smoke-free laws in Kentucky counties
||Increasing the rates of voluntary testing using youth-produced HIV messages: Intervention research on a school-based program in Dakar
||More than health care reform: Examining the health insurance disparity among college students at two-year institutions
||Seasonal and pandemic influenza vaccination of pregnant women: An economic simulation model
||Factors associated with Type I and Type II endometrial cancer in a large cohort of cases
||Estimating the global burden of aflatoxin -attributed hepatocellular carcinoma - A risk assessment
||Understanding racial disparities in low birthweight in Pittsburgh, PA: The role of area-level socioeconomic position and individual-level factors
||Impact of introducing the rotavirus vaccine into the Expanded Program on Immunization in Niger
||Ethnic differences in HPV knowledge and intentions among Hispanic and Non-Hispanic males
||Pre-operative breast MRI and treatment outcomes: A cost-effectiveness analysis
||Ambient air pollution and respiratory diseases in children in Jefferson County, Alabama
Assessing the health benefits from nationwide reductions of ozone air pollution
Jesse Berman , Johns Hopkins Bloomberg School of Public Health
Tropospheric ozone is a criteria air pollutant correlated with significant negative health effects, including increased mortality and cardiopulmonary/respiratory morbidity. The current EPA ozone standard is 75ppb, but measured ambient values often exceed this level. Using the BenMAP software, we quantified the prevented morbidities and mortalities from “rolling back” ozone concentrations to attain three 8-hr NAAQS: 75, 70, and 60 ppb; where the two lower alternatives reflect the upper and lower-bound range of EPA Clean Air Scientific Advisory Committee recommended values and are proposed targets for a revised ozone standard. Using a suite of short-term ozone risk estimates, the annual avoided cases of all-cause premature mortality range from 290-410 at 75ppb to 1,890-2,660 at 60ppb. Attaining the 75ppb standard prevents 290 emergency room visits, 250 hospital admissions, 550,250 acute respiratory symptoms, and 237,100 lost school days. Rollbacks to the 70 and 60 ppb 8-hr maximum levels yield additional health benefits. Mapping of scenario results display regional variations in benefits, with the greatest positive impact observed in New York, Los Angeles, Philadelphia, and Riverside, California.
Do women change their diets after breast cancer diagnosis? An exploratory analysis
Manleen Kaur, University of North Texas School of Public Health
Objective: To investigate whether the dietary patterns differ among women newly diagnosed with breast cancer and among long-term survivors.
Methods: Factor analysis was used to identify dietary patterns based on daily consumptions of 19 food groups. Women were categorized into different groups according to the interval between date of breast cancer diagnosis and date of dietary assessment. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI).
Results: Two dietary patterns were identified: the “prudent” dietary pattern characterized by a high intake of fruits and vegetables and the “western” dietary pattern characterized by a high intake of energy-dense foods. The prudent diet was associated with a reduced breast cancer risk among women with diet assessed ≤ 1 year of cancer diagnosis (OR=0.89, 95% CI: 0.62-1.28) but an increased risk among women with diet assessed ≥ 3 years after diagnosis (OR=1.70, 95% CI: 1.04-2.77). The western diet was associated with an increased breast cancer risk among women with diet assessed ≤ 1 year of cancer diagnosis (OR=1.73, 95% CI: 1.12-2.65) but a reduced risk among women with diet assessed at 2 years after diagnosis (OR=0.69, 95% CI: 0.44-1.10). However, the western diet resumed a positive association with breast cancer among women with diet assessed ≥ 3 years after cancer diagnosis (OR=1.84, 95% CI: 1.05 -3.22).
Conclusion: Women with newly diagnosed breast cancer tend to consume a healthy diet one or two years after cancer diagnosis but this trend did not continue among long-term cancer survivors.
Association between bully victimization and suicide behaviors among youth in Massachusetts
Shane Fernando, University of North Texas School of Public Health
Background: Bullying and dating violence are on the rise and are found to be linked to depression and self-harm. Research is sparse recognizing the association between bully victimization and suicidal behaviors.
Methods: The Massachusetts Youth Risk Behavior Survey, which surveyed 1,598 students between the ages of 12 and 18, was used. Bullying was assessed over the past year, and risk behaviors were assessed over the past 30 days. Using four suicidal behaviors questions, we classified students into three levels: No Risk (did not think or attempt suicide), Low Risk (Thought about committing suicide, planned suicide), and High Risk (attempted suicide, and attempted suicide with injury). Data were weighted and multilogistic regression models were run.
Results: Bully victims are twice as likely to be in either Low or High risk groups compared to those who were not victims (Low Risk OR 2.1, 95% CI 1.7-2.6, High Risk OR 1.83, 95% CI 1.3-2.7). Those who had been physically hurt by a date had a higher chance of being in the Low or High risk group than those who were not (Low Risk OR 1.44, 95% CI 0.9-2.4, High Risk OR 2.63, 95% CI 1.7-4.1), with similar results for those who had a sexual experience against their will (Low Risk OR 1.42, 95% CI 1-2.1, High Risk OR 2.04, 95% CI 1.2-3.5).
Conclusions: The findings confirm that bully victimization is a significant predictor of suicidal behaviors. School-based interventions for bullying and dating violence can be adjusted for suicide potential, reducing overall suicide events.
Oxidative DNA damage and human esophageal cancer risk in Huaian China
Li Xu, University of Georgia College of Public Health
Oxidative DNA damage plays important role in carcinogenesis and 8-hydroxy-2'-deoxyguanosine (8-OHdG), the most common oxidative DNA damage biomarker, has been shown to associate with formation of several cancer sites, while its role in esophageal cancer remains unclear. Therefore, we conducted a population-based case-control study, with 189 esophageal squamous cell carcinoma (ESCC) cases and 524 age-, gender-, and residency-matched healthy controls recruited from Huaian, China, a high risk area of ESCC. Levels of 8-OHdG in morning urine was determined by solid-phase extraction coupled with HPLC- electrochemical detection and adjusted by urinary creatinine. hOGG1 is responsible for repairing oxidative DNA damage and its single nucleotide polymorphism (Ser326Cys) was determined by PCR/RFLP. The average urinary 8-OHdG level in case group was 49.56 ± 235.66 ng/mg creatinine (mean±SD; range: 1.28 – 3210.23, median: 22.04). The average urinary 8-OHdG level in the control group was 23.30 ± 47.32 ng/mg creatinine (range: 0.71 – 817.22, median: 13.71). Levels of 8-OHdG were significantly higher in cases than controls (p <0.0001), and the difference remained significant (p <0.001) after adjusted by age and gender. A marginal significant difference was observed in comparison of distribution of hOGG1 genotypes in cases and controls (p=0.07) with wild type (ser/ser) 38 (20.88%) in cases vs. 70 (14.46%) in controls, heterozygote (ser/cys) 79 (43.41%) in cases vs. 251 (51.86%) in controls, and mutant type (cys/cys) 65 (35.71%) in cases vs. 163 (33.68%) in controls. These results support the role of oxidative DNA damage in the development to esophageal cancer in this high-risk population.
Public health impact of community health screening and education programs on knowledge of coronary heart disease risk factors and health-promoting behaviors
Leslie Mooney, University of Arkansas for Medical Sciences Boozman College of Public Health
Coronary heart disease (CHD) is the leading cause of death in the United States. Despite widespread prevalence, there is a disparity in patient knowledge regarding the role of CHD risk factors in the development and progression of CHD. Community-based public health interventions may be effective strategies for increasing knowledge and awareness of CHD risk factors. This study sought to determine the effects of community health screening and education programs on knowledge of CHD risk factors and participation in health-promoting behaviors. Participants of free health screenings completed a pre-screening written questionnaire to determine baseline knowledge of CHD risk factors. Participants underwent risk factor screening (lipid profile, blood glucose, body mass index, and blood pressure) and received appropriately tailored education. A follow-up telephone questionnaire was administered 4 to 8 weeks later. Pre- and post-screening responses were compared using McNemar's test to determine differences in participants' knowledge and participation in health-promoting behaviors. Of the 56 participants enrolled, 45 (80%) completed the post-screening telephone survey. Compared to pre-screening responses, participants showed significantly greater post-screening knowledge of “healthy” values for CHD risk factors, including blood pressure (p=0.02), fasting blood glucose (p=0.03), fasting total cholesterol (p<0.01), and body mass index (p<0.01). Following the screening, 20 (44%) participants had consulted their primary care provider, and 31 (69%) made at least one healthy behavior change. These results demonstrate that community-based health screening and education programs may effectively promote public health knowledge and empower participants to engage in health-promoting behaviors.
Calibration and validation of a dynamic model that projects population outcomes from methylmercury exposure from local fish consumption
Caroline Chan, University of Louisville School of Public Health and Information Sciences
Contamination of fish has led to unacceptable levels of exposure to methylmercury for many regions of the US. Within highly exposed populations such as subsistence fishers, the developing fetus is at particular risk for adverse effects. Regulatory agencies continue to consider how best to protect these populations. As a tool for these agencies, a dynamic model was developed to project mercury concentrations in common biomarkers of exposure in response to mercury concentrations in predatory fish from local waters. The model projects blood methylmercury, hair mercury, and cord blood concentrations for intake rates representing the mean, 90th, 95th, and 99th percentiles of populations of interest. For calibration and validation, chi-squared techniques were used to evaluate if the values from the model were similar to predicted values from the literature. There were no significant differences between model output and the literature values (all p-values > 0.05). While still not significantly different, the model slightly overestimates biomarker concentrations at the highest ingestion rates. The model predicts risk by comparing the projected biomarkers of exposure to levels deemed protective by the EPA. Decision makers can use the model to determine the portion of a population at risk and the degree of reduction in fish tissue that is necessary for the desired level of protection.
Park usage, physical activity, and social economic status: A study on the behaviors of females in Honolulu parks
Elise Davis, University of Hawaii Manoa
Physical inactivity contributes to many types of diseases including heart disease, diabetes, and osteoporosis. Parks, which are often free to use and closely located to residences, should be promoted for physical activity (PA). This study observed park users and coded their PA level, using System of Observing Play and Recreation in Communities (SOPARC), in six Honolulu public parks. Parks were categorized into lower, middle, or upper income categories based upon median income recorded for each respective surrounding census tract. Females were found to underutilize parks, especially in low-income neighborhoods. A total of 6,477 parks users were observed with 2,338 (36.1%) females and 4,139 (63.9%) males. Of females, 12.7% were observed in parks of low-income neighborhoods, 38.5% in parks of middle-income neighborhoods, and 48.8% in parks of high-income neighborhoods. Females in high-income neighborhoods are almost four times more likely to use parks than females in low-income neighborhoods. Furthermore, park users were coded into PA levels of sedentary, walking, or vigorous. Overall for females, 64.1% of PA was coded as sedentary, followed by 23.8% walking, and 12.1% vigorous. Within the parks located in low-income neighborhoods, females were most likely to be coded as vigorous (16.2%) compared to other parks and were least likely to be coded as sedentary (49.5%) compared to other parks. This may be the result of females not wanting to linger in parks that are perceived as less pleasant or safe; such perceptions might also explain underutilization of parks in low-income communities and are a good target for interventions.
Dental residents' knowledge, perceptions and confidence of screening for and educating patients about alcohol, tobacco and illicit drug use
Courtney Butler (right) and Nani Crashley Phillips (left), University of Connecticut
Alcohol, tobacco, and illicit drug use (ATOD) are three leading causes of preventable morbidity and premature mortality in the United States; however, their effects on oral health are largely neglected in discussions of the public health impact of substance abuse. ATOD misuse contributes to a wide range of damage within the craniofacial complex. Despite the serious implications that ATOD use has on oral health, current literature suggests that dental providers do not routinely screen their patients for ATOD use. A self-administered questionnaire was given to dental residents (n=23) at the University of Connecticut Health Center. Questions explored dental residents' knowledge, perceptions, and confidence levels of asking and educating patients about their substance use. Thirty-five percent were unable to identify a person in their clinic who screens for health risks behaviors. Fifty-four percent of residents report always educating their patients about smoking. For alcohol, 59% routinely provide advice and education, while 36% sometimes do, and 5% never discuss alcohol as a risk behavior. Dental residents are least comfortable discussing illicit drug use, with 36% providing education sometimes, and 23% reporting never addressing the issue. Building confidence and increasing the frequency of screening for health risk behaviors by dental residents is important because of their ability to serve as frontline public health providers and to help reduce preventable morbidity associated with substance use. After the implementation of an educational seminar, changes in dental residents' knowledge, perceptions, and confidence levels in asking and educating their patients about ATOD will be assessed and reported.
Changes in asthma, COPD, and ischemic heart disease, and heart failure related hospitalizations after implementation of smoke-free laws in Kentucky
Naomi Hudson, University of Kentucky College of Public Health
Background: The prevalence of smoking among adults in Kentucky (25.3% in 2007) is among the highest in the U.S. Annual Medicaid expenditures attributable to smoking are $22.95 billion for the US and $390 million for Kentucky. Hospitalizations for primary or any diagnosis of asthma, COPD, ischemic heart disease, and heart failure between January 2001 and June 2008 were assessed for all 120 Kentucky counties to compare counties with and without smoke-free laws.
Methods: County level hospital discharge data was obtained for each of the 120 Kentucky counties. Negative binomial regressions were used to estimate the rate ratio for asthma, COPD, ischemic heart disease, and heart failure comparing counties with and without smoke-free laws, controlling for demographic factor and baseline smoking per county, and seasonality. Fayette and Jefferson counties and Northern Kentucky were evaluated separately to determine effects of smoke-free laws in specific counties.
Results: Current smoking laws had a significant instantaneous effect (RR 0.93, CI: 0.88, 0.99) for any diagnosis of ischemic heart disease-related hospitalizations. The estimated interaction parameter was significant for primary diagnosis of COPD (RR 0.98, CI: 0.97, 0.99) and heart failure (RR 0.99, CI: 0.98, 0.99). There was a downward trend in hospitalizations over time for all health outcomes when comparing a county with a smoke-free law to an otherwise similar county without a smoke-free law.
Conclusion: These data suggests that smoke-free laws have both short and long-term benefits and could reduce the economic burden of asthma, COPD, ischemic heart disease, and heart failure over time.
Increasing the rates of voluntary testing using youth-produced HIV messages: Intervention research on a school-based program in Dakar
Philip Massey, University of California, Los Angeles School of Public Health
A concerning rise in HIV prevalence among Senegalese youth was observed between 2005 and 2007; estimates indicate that among youth aged 15-24 years, HIV prevalence has increased from 0.1 percent to 0.3 percent in males and 0.5 percent to 0.8 percent in females. This intervention research tests whether a school-based social media intervention can impact Senegalese adolescents' knowledge, attitudes, and behavior concerning HIV/AIDS stigma, discrimination, and voluntary testing. The Réseau Africain d'Éducation pour la Santé (RAES), an NGO located in Dakar, addressed this issue by training Senegalese adolescents to become the next generation of peer-to-peer educators through the use of Information and Communication Technology (ICT). To accomplish this, youth formed clubs at three schools and designed, wrote, and produced content concerning HIV/AIDS. RAES partnered with Dakar-based human rights and AIDS-advocacy organizations to accomplish this work. All youth-produced content, including videos, songs, radio shows, and journalism news, is posted on the social media website “Sunukaddu” – meaning ‘Our Voice' in Wolof. To measure the impact of the intervention, we sampled 2,400 students from three intervention schools and one comparison school, all located in Dakar. Baseline data collected in 2008 will be compared to data collected in 2010 and used to assess adolescents' changes in knowledge, attitudes and behavior. Of particular interest is increasing the percent of students who have been tested for HIV/AIDS. The second wave of data collection will also collect information on the level of exposure and participation in the clubs, lending to a dose-response analysis.
More than health care reform: Examining the health insurance disparity among college students at two-year institutions
India Rose, University of South Carolina Arnold School of Public Health
Introduction: With the media's recent coverage of healthcare reform, it is important to understand the current healthcare climate in our country, particularly among college students. More than 40 million Americans are without health insurance coverage, including over 5 million college students. There is limited research about health insurance coverage among college students at two-year institutions. The purpose of this study is to examine the health insurance disparity among college students at two-year institutions and examine their healthcare seeking behaviors as it relates to the prevention of sexually transmitted infections (STI).
Methods: Data were collected via self-reported questionnaire from 224 students.
Results: Descriptive statistics and chi-squares analyses were conducted. Fifty-two percent of the participants were female and 67% were White. Mean age of participants was 22.5 years. Eighty six percent of participants reported having health insurance coverage. Of those insured, only 19% were African American. Sixty-nine percent of Whites had visited a physician in the past year in comparison to 21% of African Americans. Chi-square analyses indicated that Whites were more likely to have health insurance coverage than African American students, χ2 (12)=21.12, p<.05. Those students with health insurance coverage were more likely to have been tested for STI, χ2Conclusions: Though healthcare reform passed, a major disparity still exists between African American and Caucasian students as it relates to health insurance coverage. This study found that health insurance coverage is associated with STI testing which has major implications for colleges and health insurance providers.
Seasonal and pandemic influenza vaccination of pregnant women: An economic simulation modelRachel Bailey, University of Pittsburgh Graduate School of Public Health
Objectives/Research Questions: Evaluate the cost-effectiveness of seasonal and pandemic vaccination strategies (single and two-dose) for immunizing pregnant women against laboratory-confirmed influenza.
Methods: Comparisons were made between not vaccinating and vaccinating all pregnant women in the U.S. for influenza using a decision analytic computer simulation model. Monte Carlo probabilistic sensitivity analyses were performed to determine the robustness of results by varying influenza prevalence, maternal influenza-attributable mortality, vaccine efficacy for both mother and neonate, and number of doses required. Incremental cost-effectiveness ratios (ICERs) were the main outcomes measure.
Results: Single and two-dose influenza vaccination strategies are cost-effective (ICER<$0,000) when influenza prevalence ≥7.5% and influenza-attributable mortality is ≥1.05%. Incremental value of vaccination increases as the prevalence and/or the severity of the outbreak increases. A single-dose strategy is dominant, (i.e. less costly and prevents more adverse clinical outcomes), when influenza prevalence is ≥25% and maternal probability of influenza-attributable mortality ≥2.1% (twice the baseline risk).
Conclusions: Immunization of pregnant women is a highly cost-effective intervention at both seasonal and pandemic scenarios. This suggests the optimization of maternal vaccination efforts, which often have low vaccine coverage. Even in seasonal scenarios, maternal immunization is cost-effective.
Implications for Public Health: Historically, seasonal and pandemic influenza have disproportionately affected pregnant women and neonates. Determining the cost-effectiveness of maternal immunization is important because public health dollars and doses of vaccines can both be limited.
Factors associated with Type I and Type II endometrial cancer in a large cohort of cases
Ashley Felix, University of Pittsburgh Graduate School of Public Healthh
Objective: The goal of this study was to evaluate risk factor differences between two endometrial cancer (EC) subtypes in a large cohort of patients.
Methods: We conducted a retrospective study comparing Type I (N=1,576) and Type II (N=176) EC cases treated at Magee-Womens hospital between 1996 and 2008. Clinical data were available from the University of Pittsburgh Medical Center Network Cancer Registry. Logistic regression analysis was used to calculate the adjusted odds of being diagnosed with Type II EC compared to Type 1 EC. The factors of interest in this analysis were: age, BMI, race, year of diagnosis, parity, menopausal status, and history of additional primaries.
Results: Predictors significantly associated with Type II EC were older age at diagnosis (OR: 1.03, 95% CI 1.02-1.05), non-white race (OR: 2.95, 95% CI 1.66-5.27), obesity (OR: 0.45, 95% CI 0.29-0.70), and history of additional primaries (OR: 1.56, 95% CI 1.05-2.32).
Conclusions: This registry-based study is the most updated evaluation of factors associated with Type I and Type II EC in a large retrospective cohort of patients. The striking difference in risk factors associated with Type I vs. Type II tumors further emphasizes that these subtypes represent different disease entities, potentially requiring different treatment modalities.
Implications for public health: Endometrial cancer is the most common gynecologic malignancy in the U.S. Type II tumors account for a disproportionate amount of EC-related deaths; therefore, an understanding of the etiology of this aggressive disease can lead to prevention opportunities.
Estimating the global burden of aflatoxin-attributed hepatocellular carcinoma -- A risk assessment
Yan Liu, University of Pittsburgh Graduate School of Public Healthh
Objectives: Chronic hepatitis B virus infection (HBV+) and aflatoxin are known causes of hepatocellular carcinoma (HCC) or liver cancer, the 3rd-leading cause of cancer deaths worldwide. Aflatoxin is a fungal toxin found primarily in maize and peanuts. Both HBV infection and aflatoxin-contaminated foods are prevalent in developing countries, and the cancer potency of Aflatoxin is significantly enhanced in individuals with HBV infection. Our objective is to estimate the global burden of HCC attributable to aflatoxin exposure, by itself and in conjunction with chronic HBV infection.
Methods: We collected global data (by seven WHO regions) on foodborne aflatoxin levels, consumption of maize and peanuts, and HBV prevalence, to calculate global liver cancer risk from aflatoxin exposure. Aflatoxin's cancer potencies for HBV+ and HBV- individuals, and uncertainties in all variables were considered in calculations.
Results: Of the annual 550,000-600,000 new HCC cases worldwide, about 25,200-155,000 may be attributable to dietary aflatoxin. 90% of these cases occur in sub-Saharan Africa, Southeast Asia, and Western-Pacific region. If HBV vaccination were made universally available such that HBV prevalence were reduced to ≤2% worldwide, the number of aflatoxin-related HCC cases would drop to 13,400-65,400 annually.
Conclusions: Aflatoxin may play a causative role in 4.6-28.2% of all global liver cancer cases. The most affected areas are sub-Saharan Africa, Southeast Asia, and Western-Pacific region.
Public health implications: Efforts on interventions should be made in less-developed countries where aflatoxin is still a significant public health risk. Specifically, HBV vaccination can significantly reduce aflatoxin-related HCC cases in future generations.
Understanding racial disparities in low birthweight in Pittsburgh, PA: The role of area-level socioeconomic position and individual-level factors
Donna Almario Doebler , University of Pittsburgh Graduate School of Public Health
(presented by Dara Mendez, pictured)
Background: Low birthweight (LBW, <2500g) is a leading cause of infant mortality and differences exist between Blacks and Whites. About 11% of births in Pittsburgh in 2003 were LBW, and the racial differences were wide: 8.4% of LBW infants were born to Whites, whereas 16.0% were born to Blacks. Studies suggest that lower levels of area-level socioeconomic position (SEP) are associated with increased LBW risk.
Objectives: The main research hypothesis tests whether 1) area-level SEP predicts LBW and 2) LBW differences between Blacks and Whites can be explained by area-level SEP. Methods: Using U.S. Census 2000 data, an SEP measure of neighborhood disadvantage (ND) was created for Pittsburgh. LBW, race and other covariates from 10,830 birth records were obtained from the 2003-2006 Allegheny County birth registry. Multilevel logistic regression was utilized to examine how SEP predicts LBW.
Preliminary Results: ND is significantly associated with LBW (OR: 1.31, p<0.001). In addition Blacks are at higher risk for LBW than Whites (OR: 2.12, p<0.001), but the risk decreases for Blacks after adding ND to the model (OR:1.92, p<0.001). 74% of Blacks reside in disadvantaged neighborhoods, compared to 13% of Whites.
Conclusions: An association between ND and LBW exists in Pittsburgh and differences between Blacks and Whites can be partially explained by differences in ND. Public Health Implications: In the absence of individual-level information, knowing one's race and neighborhood may help predict one's risk for LBW. Targeting highly disadvantaged neighborhoods may help reduce LBW in Pittsburgh.
Impact of introducing the rotavirus vaccine into the Expanded Program on Immunization in Niger
Tina-Marie Assi, University of Pittsburgh Graduate School of Public Health
Objective/Research Question: Determine the potential vaccine distribution effects of introducing the rotavirus vaccine to the Niger routine immunization program.
Methods: Using ARENA modeling software, we constructed a stochastic computer simulation of the Niger vaccine supply chain that included all current World Health Organization (WHO) Expanded Program on Immunization (EPI) vaccines. The simulation was based on data collected from Niger on vaccine supply and distribution operations and population characteristics. We then simulated the introduction of rotavirus vaccine to the supply chain and determined the complex dynamic effects.
Results: Compared to the baseline scenario which included only seven current EPI vaccines, the introduction of the rotavirus vaccine increased the number of shipments required per year to meet demand, decreased the available storage capacity for all EPI vaccines, and increased the level of unmet demand at the district and clinic levels which decreased overall immunization coverage.
Conclusions: The simulation results showed that introducing a new vaccine into the routine EPI in Niger had overwhelming impacts on vaccine storage capacity, shipping logistics, and immunization coverage. Responding successfully to such an introduction would require additional cold chain resources.
Implications for Public Health: While rotavirus is a vaccine-preventable disease, it is still a major cause of severe diarrhea and fatal dehydration among children in West Africa. There are two WHO-prequalified rotavirus vaccines available for distribution in developing countries. Understanding the dynamic relationships between vaccine characteristics, population demand and supply chain logistics is an important step in making recommendations on potential advantages and disadvantages of vaccine introduction.
Ethnic differences in HPV knowledge and intentions among Hispanic and Non-Hispanic males
Natalie Hernandez, University of South Florida College of Public Health
Background: Hispanic women have twice the cervical cancer rate than non-Hispanic White women, and rates of penile cancer are higher among Hispanic men than non-Hispanic men. In 2009, the HPV vaccine was approved for males ages 9-26 to prevent genital warts. To effectively disseminate the vaccine among Latino males, factors that may promote or inhibit vaccine acceptability need to be identified. Purpose: To examine differences between Hispanic and Non-Hispanic males in HPV knowledge, vaccine intentions and barriers to vaccination.
Methods: Participants in a natural history study of HPV in men completed a computer-assisted-survey-instrument assessing cognitive and emotional responses to HPV test results. Logistic regression tested for differences in the likelihood of intending to get vaccinated, and in perceiving various barriers to vaccination between Hispanic and non-Hispanic men.
Results: Of 505 participants, 86 (17.0%) identified as Hispanic. Generally, HPV knowledge was high, with no knowledge score differences between Hispanic and non-Hispanic males. Hispanic males were more likely to report stronger HPV vaccine intentions (OR=1.88; 95% CI=1.09-3.27); however, they were less likely to have a place to get the vaccine (OR=0.34; 95% CI=0.12-0.92). Although Hispanics were more likely to perceive getting time off work/school a potential barrier (14%) than non-Hispanics (8%) it was not significant.
Conclusion: Although Hispanic males are knowledgeable about HPV and intend to receive the vaccine, they are more likely to perceive accessibility barriers to vaccination. Identifying positive motives for, and barriers against, vaccination among Hispanic males is an important public health and social justice activity.
Pre-operative breast MRI and treatment outcomes: A cost-effectiveness analysis
Erica Nelson, University of North Carolina at Chapel Hill Gillings School of Global Public Health
Background: Nearly 12% of American women will be treated for invasive breast cancer during their lifetimes. Breast magnetic resonance imaging (BMRI) may improve surgical planning and outcomes. There is concern regarding treatment delay and increased rate of mastectomy in practices utilizing universal BMRI.
Objective: To assess the costs, risks, and benefits associated with universal BMRI in early stage breast cancer compared to no further imaging prior to local therapy, over five years.
Design: Decision tree model
Data Sources: Clinical trials, meta-analyses, government-sponsored research studies
Target Population: Women diagnosed with Stage I or II invasive breast cancer
Intervention: Breast magnetic resonance imagery
Outcome Measures: Life-years saved, costs incurred Base-Case Analysis: BMRI was projected to have almost no effect on 5-year survival compared to no BMRI. The incremental cost-effectiveness ratio was $203 per life-year saved. BMRI was always more expensive and is more effective approximately half of the time.
Sensitivity Analysis: Deterministic sensitivity analyses indicated that results were most sensitive to changes in the probabilities of 5-year survival. Probabilistic sensitivity analyses showed uncertainty did not influence the conclusions of the cost-effectiveness analysis.
Limitations: Costs, risks, and benefits associated with additional BMRI findings and decreased quality of life due to unnecessary mastectomy were beyond the scope of this analysis. Neo-adjuvant therapies were not considered in the model.
Conclusions: Universal BMRI is a costly addition to pre-treatment planning and results in no significant benefits to the patient. Payers should ensure that BMRI is indicated prior to authorizing payment.
Ambient air pollution and respiratory diseases in children in Jefferson County, AlabamaMeghan Tipre, University of Alabama at Birmingham School of Public Health
Environmental air pollution is an important contributor to the global burden of respiratory disease among children and adolescents affecting their developing respiratory systems. Previous studies have evaluated the effect of ambient air pollution on respiratory health in children; however, their results are inconsistent. The aim of this study was to examine the association between fine particulate matter of size 2.5 (PM2.5) and ozone (O3) and respiratory diseases in children in a local setting, in Jefferson County, Alabama, from 1999-2002.
Exposure was estimated using weighted concentrations for PM2.5 and O3. Daily counts of hospital admissions for all upper and lower respiratory diseases in children < 18 years of age were obtained from three hospitals in Jefferson County. A generalized additive model (GAM) was used to analyze the data, adjusting for confounders including seasonal variations, temperature, relative humidity and day of the week.
In two-pollutant model, an increase in PM2.5 equivalent to the observed interquartile range (IQR) resulted in an 8% increase in admissions for respiratory diseases (IQR =11.44 µg/m3, RR=1.08, p= 0.003). O3 was inversely associated with respiratory diseases (p < 0.001). No associations were observed using 1 and 2 days lag periods for PM2.5 and O3.
In conclusion, the results of the study contribute to the evidence of an association between PM2.5 and respiratory diseases in children. Jefferson County currently does not meet the National Ambient Air Quality Standards for PM2.5, and results of this study will be useful to guide the development of more stringent local regulations for PM.