Carter Consulting Inc

Atlanta, GA, United States

Carter Consulting Inc

Atlanta, GA, United States

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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.


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.


Ford E.S.,Centers for Disease Control and Prevention | Anda R.F.,Carter Consulting Inc. | Edwards V.J.,Centers for Disease Control and Prevention | Perry G.S.,Centers for Disease Control and Prevention | And 3 more authors.
Preventive Medicine | Year: 2011

Objective: Our objective was to examine the associations between adverse childhood experiences (ACEs) and smoking behavior among a random sample of adults living in five U.S. states. Methods: We used data from 25,809 participants of the 2009 Behavioral Risk Factor Surveillance System to assess the relationship of each of the 8 adverse childhood experiences and the adverse childhood experience score to smoking status. Results and conclusions: Some 59.4% of men and women reported at least one adverse childhood experience. Each of the eight adverse childhood experiences measures was significantly associated with smoking status after adjustment for demographic variables. The prevalence ratios for current and ever smoking increased in a positive graded fashion as the adverse childhood experience score increased. Among adults who reported no adverse childhood experiences, 13.0% were currently smoking and 38.3% had ever smoked. Compared to participants with an adverse childhood experience score of 0, those with an adverse childhood experience score of 5 or more were more likely to be a current smoker (adjusted prevalence ratio (aPR): 2.22, 95% confidence interval [CI]: 1.92-2.57) and to have ever smoked (aPR: 1.80, 95% CI: 1.67-1.93). Further research is warranted to determine whether the prevention of and interventions for adverse childhood experiences might reduce the burden of smoking-related illness in the general population. © 2011.


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.


Fox M.H.,Centers for Disease Control and Prevention | Witten M.H.,Centers for Disease Control and Prevention | Lullo C.,Carter Consulting Inc
Journal of Disability Policy Studies | Year: 2014

Achieving healthy weight for people with disabilities in the United States is a challenge. Obesity rates for adults and children with disabilities are significantly higher than for those without disabilities, with differences remaining even when controlling for other factors. Reasons for this disparity include lack of healthy food options for many people with disabilities living in restrictive environments, difficulty with chewing or swallowing food, medication use contributing to changes in appetite, physical limitations that can reduce a person’s ability to exercise, constant pain, energy imbalance, lack of accessible environments in which to exercise or fully participate in other activities, and resource scarcity among many segments of the disability population. In order for there to be a coordinated national effort to address this issue, a framework needs to be developed from which research, policy, and practice can emerge. This paper reviews existing literature and presents a conceptual model that can be used to inform such a framework, provides examples of promising practices, and discusses challenges and opportunities moving forward. © Hammill Institute on Disabilities 2013.


Kalayil E.J.,Carter Consulting Inc | Kalayil E.J.,Centers for Disease Control and Prevention | Dolan S.B.,Centers for Disease Control and Prevention | Lindley M.C.,Centers for Disease Control and Prevention | Ahmed F.,Centers for Disease Control and Prevention
American Journal of Infection Control | Year: 2015

Background The purpose of this project was to evaluate a standardized measure of health care personnel (HCP) influenza vaccination during the first year of implementation. The measure requires acute care hospitals to gather vaccination status data from employees, licensed independent practitioners (LIPs), and adult students/trainees and volunteers. The evaluation included a hospital sampling frame stratified by 4 United States Census Bureau Regions and hospital bed count. The hospitals were selected within strata using simple random sampling and the probability proportional to size method, without replacement. Methods Semi-structured telephone interviews were conducted. Two qualitative data analysts independently coded each interview, and data were synthesized using a thematic analysis. This evaluation took place at hospitals reporting HCP influenza vaccination data as part of the Centers for Medicare & Medicaid Services Hospital Inpatient Quality Reporting (IQR) Program. Participants included the staff at 46 hospitals who were knowledgeable about data collection to fulfill IQR program requirements. Results Facilitators of data collection included having a small number of HCP, having a data collection system already in place, and providing HCP with advance notice of data collection. Major challenges included the absence of an established tracking process and monitoring HCP not regularly working in the facility, particularly LIPs. More than half of the facilities noted the time- and/or resource-intensive nature of data collection. Most facilities used data collected to meet other reporting requirements beyond the IQR Program. Conclusions Hospitals implemented a range of data collection methods to comply with reporting requirements. Lessons learned from the first year of measure implementation can be used to enhance data collection practices across HCP groups for future influenza seasons. © 2015 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.


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.


Schauer G.L.,Carter Consulting Inc. | Schauer G.L.,Emory University | King B.A.,National Center for Chronic Disease Prevention and Health Promotion | Bunnell R.E.,National Center for Chronic Disease Prevention and Health Promotion | And 2 more authors.
American Journal of Preventive Medicine | Year: 2016

Introduction Policies legalizing marijuana for medical and recreational use have been increasing in the U.S. Considering the potential impact of these policies, important knowledge gaps exist, including information about the prevalence of various modes of marijuana use (e.g., smoked in joints, bowls, bongs; consumed in edibles or drinks) and about medical versus recreational use. Accordingly, this study assessed (1) prevalence and correlates of modes of current and ever marijuana use and (2) prevalence of medicinal and recreational marijuana use in U.S. adults. Methods Data came from Summer Styles (n=4,269), a nationally representative consumer panel survey of adults aged ≥18 years, collected in 2014. The survey asked about past 30-day (current) and ever mode of marijuana use and current reason for use (medicinal, recreational, both). Weighted prevalence estimates were computed and correlates were assessed in 2014 using logistic regression. Results Overall, 7.2% of respondents reported current marijuana use; 34.5% reported ever use. Among current users, 10.5% reported medicinal-only use, 53.4% reported recreational-only use, and 36.1% reported both. Use of bowl or pipe (49.5%) and joint (49.2%) predominated among current marijuana users, with lesser use of bong, water pipe, or hookah (21.7%); blunts (20.3%); edibles/drinks (16.1%); and vaporizers (7.6%); 92.1% of the sample reported combusted-only marijuana use. Conclusion Combusted modes of marijuana use are most prevalent among U.S. adults, with a majority using marijuana for recreation. In light of changing policies and patterns of use, improved marijuana surveillance is critical for public health planning. © 2016 American Journal of Preventive Medicine.


Crider K.S.,National Center on Birth Defects and Developmental Disabilities | Cordero A.M.,National Center on Birth Defects and Developmental Disabilities | Qi Y.P.,National Center on Birth Defects and Developmental Disabilities | Mulinare J.,Carter Consulting Inc | And 2 more authors.
American Journal of Clinical Nutrition | Year: 2013

Background: Childhood asthma has become a critical public health problem because of its high morbidity and increasing prevalence. The impact of nutrition and other exposures during pregnancy on long-term health and development of children has been of increasing interest. Objective: We performed a systematic review and meta-analysis of the association of folate and folic acid intake during pregnancy and risk of asthma and other allergic outcomes in children. Design: We performed a systematic search of 8 electronic databases for articles that examined the association between prenatal folate or folic acid exposure and risk of asthma and other allergic outcomes (eg, allergy, eczema, and atopic dermatitis) in childhood. We performed a meta-analysis by using a random-effects model to derive a summary risk estimate of studies with similar exposure timing, exposure assessment, and outcomes. Results: Our meta-analysis provided no evidence of an association between maternal folic acid supplement use (compared with no use) in the prepregnancy period through the first trimester and asthma in childhood (summary risk estimate: 1.01; 95% CI: 0.78, 1.30). Because of substantial heterogeneity in exposures and outcomes, it was not possible to generate summary measures for other folate indicators (eg, blood folate concentrations) and asthma or allergyrelated outcomes; however, the preponderance of primary risk estimates was not elevated. Conclusions: Our findings do not support an association between periconceptional folic acid supplementation and increased risk of asthma in children. However, because of the limited number and types of studies in the literature, additional research is needed. © 2013 American Society for Nutrition.

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