Association of Schools of Public Health

Washington, DC, United States

Association of Schools of Public Health

Washington, DC, United States

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Hong Y.,Texas College | Poon A.N.,Association of Schools of Public Health | Zhang C.,Texas College
AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV | Year: 2011

A rapid increase in heterosexual transmission of HIV and a high prevalence of sexually transmitted infections (STIs) in China signals potential outbreaks of generalized epidemics. A large proportion of heterosexual transmission has been through commercial sex; thus, millions of female sex workers (FSWs) and their clients play a critical role in the country's HIV/STI epidemics. A number of prevention interventions targeting FSWs have been implemented in response to changes in policy toward HIV as well as growing epidemics. This study reviews existing HIV/STI prevention interventions studies targeting FSWs in China. A total of 25 studies (28 articles) were identified from English and Chinese journal databases. Most studies recruited FSWs from entertainment establishments and had small sample sizes of less than 400. A majority employed a simple pre-post design with an open cohort, none applied a randomized controlled trial, and only two studies had a quasi-experimental design. Venue-based knowledge education and condom promotion represented the typical intervention approach. Some adapted internationally validated programs such as Voluntary Counseling and Testing and 100% Condom Use Programs (CUP), but no scale-up data were reported. Significant intervention effects were reported in most studies, especially increases in HIV/STI-related knowledge and condom use rates. Of the nine studies reporting STI rates, the results were mixed; some even reported increased STIs despite higher condom use. We call for more HIV/STI interventions targeting FSWs in China, particularly, interventions with rigorous design and externally validated measures, and more diversity in intervention programs including biomedical and structural interventions as well as innovative intervention delivery. We also advocate that effective intervention programs be translated into sustainable policies and programs that could have an impact on China's HIV and STI epidemics. © 2011 Taylor & Francis.


Nesheim S.,Centers for Disease Control and Prevention | Taylor A.,Centers for Disease Control and Prevention | Lampe M.A.,Centers for Disease Control and Prevention | Kilmarx P.H.,Centers for Disease Control and Prevention | And 7 more authors.
Pediatrics | Year: 2012

The availability of effective interventions to prevent mother-to-child HIV transmission and the significant reduction in the number of HIV-infected infants in the United States have led to the concept that elimination of mother-to-child HIV transmission (EMCT) is possible. Goals for elimination are presented. We also present a framework by which elimination efforts can be coordinated, beginning with comprehensive reproductive health care (including HIV testing) and real-time case-finding of pregnancies in HIV-infected women, and conducted through the following: facilitation of comprehensive clinical care and social services for women and infants; case review and community action; allowing continuous quality research in prevention and long-term follow-up of HIV-exposed infants; and thorough data reporting for HIV surveillance and EMCT evaluation. It is emphasized that EMCT will not be a one-time accomplishment but, rather, will require sustained effort as long as there are new HIV infections in women of childbearing age. Copyright © 2012 by the American Academy of Pediatrics.


Rivera-Nunez. Z.,National Research Council Italy | Wright J.M.,U.S. Environmental Protection Agency | Blount B.C.,Centers for Disease Control and Prevention | Silva L.K.,Centers for Disease Control and Prevention | And 5 more authors.
Environmental Health Perspectives | Year: 2012

Background: Epidemiological studies have used various measures to characterize trihalomethane (THM) exposures, but the relationship of these indicators to exposure biomarkers remains unclear. Objectives: We examined temporal and spatial variability in baseline blood THM concentrations and assessed the relationship between these concentrations and several exposure indicators (tap water concentration, water-use activities, multiroute exposure metrics). Methods: We measured water-use activity and THM concentrations in blood and residential tap water from 150 postpartum women from three U.S. locations. Results: Blood ΣTHM [sum of chloroform (TCM), bromodichloromethane (BDCM), dibromochloromethane (DBCM), and bromoform (TBM)] concentrations varied by site and season. As expected based on variable tap water concentrations and toxicokinetic properties, the proportion of brominated species (BDCM, DBCM, and TBM) in blood varied by site (site 1, 24%; site 2, 29%; site 3, 57%) but varied less markedly than in tap water (site 1, 35%; site 2, 75%; site 3, 68%). The blood-water ΣTHM Spearman rank correlation coefficient was 0.36, with correlations higher for individual brominated species (BDCM, 0.62; DBCM, 0.53; TBM, 0.54) than for TCM (0.37). Noningestion water activities contributed more to the total exposure metric than did ingestion, but tap water THM concentrations were more predictive of blood THM levels than were metrics that incorporated water use. Conclusions: Spatial and temporal variability in THM concentrations was greater in water than in blood. We found consistent blood-water correlations across season and site for BDCM and DBCM, and multivariate regression results suggest that water THM concentrations may be an adequate surrogate for baseline blood levels.


Johnson-Agbakwu C.E.,Health Integrated | Johnson-Agbakwu C.E.,Arizona State University | Helm T.,Association of Schools of Public Health | Killawi A.,University of Michigan | Padela A.I.,University of Chicago
Ethnicity and Health | Year: 2014

Objectives. Somali women are at increased risk of adverse pregnancy outcomes. Anxiety and perceived stigmatization toward female genital cutting (FGC) further fuels an atmosphere of miscommunication and distrust, contributing to poorer health outcomes. While the attitudes and experiences of Somali refugee women toward healthcare are widely known, the views of Somali refugee men are largely unknown. This study examines the perspectives of Somali men toward FGC and women's childbirth experiences in one refugee community in the USA.Design. Community-based participatory research partnerships with key stakeholders within the Somali refugee community incorporated qualitative methods comprising semi-structured focus groups and individual interviews to elicit male participants perspectives on FGC, experiences during childbirth, and the perception of increased cesarean deliveries among Somali women. Qualitative analyses involved a framework and team-based approach using grounded theory and conventional content analysis.Results. Acculturation influenced changes in traditional gender roles fostering new dynamics in shared decision-making within the household and during childbirth. Participants were aware of FGC-related morbidity, ongoing matriarchal support for FGC, and were generally not supportive of FGC. They perceived health-care providers as being unfamiliar with caring for women with FGC fueling profound aversion to cesarean deliveries, miscommunication, and distrust of the health-care system.Conclusion. Our work yields new insights into Somali reproductive healthcare through Somali men, namely: strong matriarchal support of FGC, discomfort in men's presence during delivery, and a strong aversion to cesarean delivery. Our findings support the need for advocacy to engage Somali women, their partners/spouses, and health-care providers in facilitating greater continuity of care, building greater trust as men become engaged throughout the spectrum of care in the decision-making process while respecting traditional norms. Cultural health navigators should bridge communication and support between providers and patients. Our work provides foundational knowledge to inform culturally appropriate health interventions within a Somali refugee community. © 2013 Taylor and Francis.


Weiss H.,University of Pittsburgh | Agimi Y.,Association of Schools of Public Health | Steiner C.,Agency for Healthcare Research and Quality
Pediatrics | Year: 2010

OBJECTIVES: The objectives were to provide national injury and health care cost estimates for youth motorcycle injuries in traffic and nontraffic settings and to focus on the burden of serious motorcycle-related traumatic brain injuries (TBIs) in children and young adults. METHODS: The 2006 Kids' Inpatient Database is a sample of inpatient discharges for US patients <21 years of age from 38 states. This cross-sectional analysis of the 2006 Kids' Inpatient Database included comparisons of TBI versus non-TBI and traffic versus nontraffic motorcycle-related crashes for ages 12 to 20, with national estimates of hospital charges and costs, length of stay, severity, and long-term disability rates. RESULTS: Motorcycle-related crashes accounted for 5662 discharges (95% confidence interval: 5201-6122 discharges), which amounts to 3% of injury hospitalizations among youths and 5% of TBI diagnoses; two-thirds of cases were traffic-related, and one-third of patients sustained a TBI (1793 patients [95% confidence interval: 1631-1955 patients]). Among patients with TBIs, the overall probability of long-term disability was 24%. Patients with TBIs were 3.6 times more likely to be discharged to a rehabilitation facility and >10 times more likely to die in the hospital than were patients without TBIs. CONCLUSIONS: Motorcycle injuries are a substantial cause of youth injury hospitalizations. The large proportion, costs, and morbidity of TBI diagnoses in youth motorcycle crashes emphasize the need for effective crash prevention and head protection. Copyright © 2010 by the American Academy of Pediatrics.


Weiss H.,University of Pittsburgh | Agimi Y.,University of Pittsburgh | Agimi Y.,Association of Schools of Public Health | Steiner C.,Agency for Healthcare Research and Quality
Pediatrics | Year: 2010

BACKGROUND AND OBJECTIVES: Twenty-seven states have youth-specific helmet laws even though such laws have been shown to decrease helmet use and increase youth mortality compared with all-age (universal) laws. Our goal was to quantify the impact of age-specific helmet laws on youth under age 20 hospitalized with traumatic brain injury (TBI). METHODS: Our cross-sectional ecological group analysis compared TBI proportions among US states with different helmet laws. We examined the following null hypothesis: If age-specific helmet laws are as effective as universal laws, there will be no difference in the proportion of hospitalized young motorcycle riders with TBI in the respective states. The data are derived from the 2005 to 2007 State Inpatient Databases of the Healthcare Cost and Utilization Project. We examined data for 17 states with universal laws, 6 states with laws for ages <21, and 12 states with laws for children younger than 18 (9287 motorcycle injury discharges). RESULTS: In states with a <21 law, serious TBI among youth was 38% higher than in universal-law states. Motorcycle riders aged 12 to 17 in 18 helmet-law states had a higher proportion of serious/severe TBI and higher average Abbreviated Injury Scores for head-region injuries than riders from universal-law states. CONCLUSIONS: States with youth-specific laws had an increased risk of TBI that required hospitalization, serious and severe TBI, TBI-related disability, and in-hospital death among the youth they are supposed to protect. The only method known to keep motorcycle-helmet use high among youth is to adopt or maintain universal helmet laws. Copyright © 2010 by the American Academy of Pediatrics.


Van Handel M.,National Center for HIV AIDS | Van Handel M.,Association of Schools of Public Health | Beltrami J.F.,National Center for HIV AIDS | MacGowan R.J.,Prevention Research Branch | And 2 more authors.
American Journal of Public Health | Year: 2012

We used Centers for Disease Control and Prevention HIV Counseling and Testing System data from 2007 to determine the percentage and characteristics of persons newly identified as HIVpositive in US correctional facilities. The newly identified HIV positivity was 0.7%, and 30% of detainees newly identified with HIV were categorized as having low-risk heterosexual contact or no acknowledged risk. Correctional facilities should provide detainees with routine opt-out HIV testing, unless the prevalence of previously undiagnosed HIV infection has been documented to be less than 0.1%.


Garcia M.C.,Flinders University | Garcia M.C.,Us Agency For International Development | Duong Q.L.,Independent Consultant | Mercer L.E.,Association of Schools of Public Health | And 2 more authors.
BMC Public Health | Year: 2013

Background: Men who have sex with men in Viet Nam have been under-studied as a high-risk group for HIV infection, and this population's percentage and determinants of HIV testing have not been comprehensively investigated. Methods. A national Internet-based survey of self-reported sexual and health seeking behaviours was conducted between August and October 2011 with 2077 Vietnamese men who had sex with men in the last twelve months to identify the frequency of 'never testing for HIV' among Internet-using MSM living in Viet Nam, as well as the factors associated with this HIV-related high-rish behavior. Logistic regression analyses were conducted to assess the demographic characteristics and behaviours predicting never testing for HIV. Results: A total of 76.5% of men who have sex with men who were surveyed reported never having been voluntarily tested for HIV. Predictors of never being tested included having a monthly income less than VND 5 Million, being a student, using the Internet less than 15 hour per week, and not participating in a behavioural HIV intervention. Conclusions: Never testing for HIV is common among Internet-using men who have sex with men in Viet Nam. Given the dangerously high prevalence of this high-risk behaviour, our findings underscore the urgent need for segmented and targeted HIV prevention, care and treatment strategies, focusing on drastically reducing the number of men who have sex with men never testing for HIV in Viet Nam. © 2013 García et al.; licensee BioMed Central Ltd.


Calhoun J.G.,University of Michigan | Spencer H.C.,Association of Schools of Public Health | Buekens P.,Tulane University
Infectious Disease Clinics of North America | Year: 2011

Competency specification and competency-based education (CBE) are increasingly being viewed as essential for optimizing educational outcomes for the next generation of global health workers. An overview is provided of this movement in graduate health professions education in the United States, the Association of Schools of Public Health (ASPH) contributions to advancing and researching related CBE processes and best practices, and the evolving ASPH competency model for graduate global health education. © 2011.


Poon A.N.,Association of Schools of Public Health | Li Z.,National Center for Prevention and Control | Wang N.,National Center for Prevention and Control | Hong Y.,National Center for Prevention and Control
AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV | Year: 2011

Female sex workers (FSW) are at greater risk for HIV and STIs. A systematic literature review of HIV and STI prevalence and incidence data for FSW in China was conducted to assess current trends. Studies between 1996 and 2010 detailing seroprevalence or incidence data, other laboratory-based tests, and clinical diagnoses of infections among FSW were reviewed. Select articles from Chinese literature around street-based and drug-abusing FSW were also reviewed. Results revealed high median prevalence for a variety of STIs among FSW: active syphilis range 0.8-12.5% (median = 6.9%), herpes range 29.7-70.8% (median = 56.2%), chlamydia range 3.9-58.6% (median = 25.7%), gonorrhea range 2.0-85.4% (median = 16.4%), and trichomoniasis range 7.1-43.2% (median = 12.5%). HIV prevalence has remained relatively low and stable with a range of 0-10.3% (median = 0.6%), with the exception of higher prevalence in several areas of Yunnan and some areas of Guangxi. The FSW who are injecting drug users may be at even greater risk for HIV infection with 12-49% found to be HIV positive and 7-25% self-reporting positive status. A number of gaps in the literature remain, especially in the number of studies that detail prevalence confirmed by laboratory testing or that collect incidence data. Assessment of incidence and prevalence according to sampling methodology appropriate for the population, behavioral risks such as injecting drug use, and diverse venues especially those at the lower end are needed. Theory-based interventions to reduce the incidence and prevalence of HIV/STIs need to be piloted with successful models scaled-up. © 2011 Taylor & Francis.

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