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Atlanta, GA, United States

Lindley M.C.,Centers for Disease Control and Prevention | Dube D.,Independent Healthcare Consultant | Kalayil E.J.,Carter Consulting Inc | Kim H.,Family Health and Equity | And 2 more authors.
Vaccine | Year: 2014

Objective: To evaluate Rhode Island's revised vaccination regulations requiring healthcare workers (HCWs) to receive annual influenza vaccination or wear a mask during patient care when influenza is widespread. Design: Semi-structured telephone interviews conducted in a random sample of healthcare facilities. Setting: Rhode Island healthcare facilities covered by the HCW regulations, including hospitals, nursing homes, community health centers, nursing service agencies, and home nursing care providers.Participants Staff responsible for collecting and/or reporting facility-level HCW influenza vaccination data to comply with Rhode Island HCW regulations. Methods: Interviews were transcribed and individually coded by interviewers to identify themes; consensus on coding differences was reached through discussion. Common themes and illustrative quotes are presented. Results: Many facilities perceived the revised regulations as extending their existing influenza vaccination policies and practices. Despite variations in implementation, nearly all facilities implemented policies that complied with the minimum requirements of the regulations. The primary barrier to implementing the HCW regulations was enforcement of masking among unvaccinated HCWs, which required timely tracking of vaccination status and additional time and effort by supervisors. Factors facilitating implementation included early and regular communication from the state health department and facilities' ability to adapt existing influenza vaccination programs to incorporate provisions of the revised regulations. Conclusions: Overall, facilities successfully implemented the revised HCW regulations during the 2012-2013 influenza season. Continued maintenance of the regulations is likely to reduce transmission of influenza and resulting morbidity and mortality in Rhode Island's healthcare facilities. © 2014 Published by Elsevier Ltd.

Anda R.,Carter Consulting Inc | Tietjen G.,University of Toledo | Schulman E.,Lankenau Institute for Medical Research | Felitti V.,Kaiser Permanente | Croft J.,Centers for Disease Control and Prevention
Headache | Year: 2010

Background. - A variety of studies have linked childhood maltreatment to headaches, including migraines, and to headache severity. This study assesses the relationship of adverse childhood experiences (ACEs) to frequent headaches during adulthood. Methods. - We used data from the Adverse Childhood Experiences (ACE) study, which included 17,337 adult members of the Kaiser Health Plan in San Diego, CA who were undergoing a comprehensive preventive medical evaluation. The study assessed 8 ACEs including abuse (emotional, physical, sexual), witnessing domestic violence, growing up with mentally ill, substance abusing, or criminal household members, and parental separation or divorce. Our measure of headaches came from the medical review of systems using the question: "Are you troubled by frequent headaches?" We used the number of ACEs (ACE score) as a measure of cumulative childhood stress and hypothesized a "dose-response" relationship of the ACE score to the prevalence and risk of frequent headaches. Results. - Each of the ACEs was associated with an increased prevalence and risk of frequent headaches. As the ACE score increased the prevalence and risk of frequent headaches increased in a "dose-response" fashion. The risk of frequent headaches increased more than 2-fold (odds ratio 2.1, 95% confidence interval 1.8-2.4) in persons with an ACE score ≥5, compared to persons with and ACE score of 0. The dose-response relationship of the ACE score to frequent headaches was seen for both men and women. Conclusions. - The number of ACEs showed a graded relationship to frequent headaches in adults. Future studies should examine general populations with headache, and carefully classify them. A better understanding of the link between ACEs and migraine may lead to new knowledge regarding pathophysiology and enhanced additional therapies for headache patients. © 2010 American Headache Society.

Kennedy A.,Centers for Disease Control and Prevention | LaVail K.,Carter Consulting Inc | Nowak G.,National Center for Immunization and Respiratory Diseases | Basket M.,National Center for Immunization and Respiratory Diseases
Health Affairs | Year: 2011

The United States has made tremendous progress in using vaccines to prevent serious, often infectious, diseases. But concerns about such issues as vaccines' safety and the increasing complexity of immunization schedules have fostered doubts about the necessity of vaccinations. We investigated parents' confidence in childhood vaccines by reviewing recent survey data. We found that most parents-even those whose children receive all of the recommended vaccines-have questions, concerns, or misperceptions about them. We suggest ways to give parents the information they need and to keep the US national vaccination program a success. © 2011 Project HOPE-The People-to-People Health Foundation, Inc.

Larkin H.,Albany State University | Shields J.J.,Catholic University of America | Anda R.F.,Carter Consulting Inc
Journal of Prevention and Intervention in the Community | Year: 2012

This introduction to the themed issue overviews of the Adverse Childhood Experiences (ACE) Study and discusses prevention and intervention with ACE and their consequences in communities. A commentary by Dr. Robert Anda, an ACE Study Co-Principal Investigator, is incorporated within this introduction. Implications of articles within the issue are addressed, and next steps are explored. © 2012 Taylor & Francis Group, LLC.

Schauer G.L.,Carter Consulting Inc | Schauer G.L.,Emory University | Malarcher A.M.,National Center for Chronic Disease Prevention and Health Promotion | Asman K.J.,Research Triangle International
American Journal of Preventive Medicine | Year: 2015

Introduction Quitting smoking at any age confers health benefits. However, studies have suggested that quitting by age 35 years leads to mortality rates similar to never smokers. This study assessed whether the mean and median ages of past-year quitting and prevalence of past-year quit attempts and successful quitting by age group changed over time. Methods Data came from 113,599 adult cigarette smokers participating in the 1997-2012 National Health Interview Survey, an annual, cross-sectional household survey of U.S. adults aged ≥18 years. Mean and median ages of past-year successful abstinence (quit 6-12 months) were computed. Orthogonal polynomial logistic regression models tested for trends in quit attempts and successful quitting. Data were analyzed in 2014. Results The average age of quitting (40.0 years in 1997-1998, 39.5 years in 2011-2012, p=0.80) and median age of quitting (35.9 years in 1997-1998, 36.9 years in 2011-2012, p=0.62) did not change over time. During 1997-2012, the percentage of smokers making a past-year quit attempt increased among those aged 25-34, 35-44, and 45-64 years; the percentage of smokers who reported quitting successfully increased among those aged 25-34 and 35-44 years (p<0.001). Conclusions Although the average age of quitting did not change over time, increases in past-year quit attempts and successful quitting occurred among adults aged 25-44 years. Proven population-level interventions - including price increases, mass media campaigns, comprehensive smoke-free policies, and health systems interventions - should be continued to further increase cessation, particularly among younger adults. © 2015 American Journal of Preventive Medicine.

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