Journal of Primary Prevention最新文献

The 2014 disease outbreak in West Africa of the Ebola virus was the longest, largest, deadliest, and most complex epidemic of its kind in history. It was believed to have originated from bushmeat consumption and exhibited sustained human-to-human transmission. We assessed the effects of the virus outbreak in West Africa on bushmeat enterprise and environmental health risk behaviors among households in Nigeria. We adopted a multistage sampling technique to select 100 respondents. We structured two sets of questionnaires for both bushmeat sellers and consumers. The questionnaire contained information about the respondent's socioeconomic characteristics; perceived causes of the Ebola outbreak; risk behaviors; level of sales; and consumption before, during, and after the Ebola outbreak. We found a significant decrease in the levels of sales and consumption of bushmeat during the outbreak. Consumers perceived touching an infected person, but not eating bushmeat, as a significant mode of Ebola transmission. Although respondents knew about some practices that help to prevent Ebola, they did not practice these to a reasonable extent. We also found that females were 25% more likely than males to consume bushmeat during the outbreak. Given these findings, we recommend that the government should sensitize people and educate them on risk prevention behaviors they should adopt to prevent the transmission of the Ebola disease.

Transgender individuals are at increased risk for suicidal behaviors. We estimated lifetime suicidal ideation, planning, and attempts within a national sample of African American transgender individuals (n = 790). Using data from the 2015 US Transgender Survey, we found that 33.5% of these individuals had thought about attempting suicide at least once, 20.0% had planned to attempt suicide, and 38.0% had attempted suicide. Significant differences were found in regard to demographics and lifetime substance use; individuals who experienced intimate partner violence and used alcohol, marijuana, or other drugs were at the highest risk for attempting suicide. Our findings may assist health professionals in creating interventions designed to prevent suicide in this underserved and vulnerable population.

Although pediatricians routinely counsel parents about preventing childhood injuries, we know little about parents' locus of control (LOC) in regards to preventing their children from being injured. We performed an observational analysis of sociodemographic differences in LOC for injury prevention, as measured by four items adapted from the Parental Health Beliefs Scales, in English- and Spanish-speaking parents of infants participating in the treatment arm of an obesity prevention study. First, we examined associations of parental LOC for injury prevention at the time their children were 2 months old with parents' age, race/ethnicity, income, and education. Next, we analyzed time trends for repeated LOC measures when the children were 2, 6, 9, 12, and 24 months old. Last, we examined the association between injury-related LOC items and children's injury (yes/no) at each time point. Of 452 parents, those with lower incomes had both lower internal and higher external LOC. Lower educational achievement was associated with higher external LOC. Both internal and external LOC scores decreased over time. Injuries were more common in children whose parents endorsed low internal and high external LOC. Future studies should examine whether primary care-based interventions can increase parents' sense of control over their children's safety and whether that, in turn, is associated with lower injury rates.Clinical Trial Registration: NCT01040897.

This paper describes a multi-phase effort to develop a web-based training for adults serving as mentors in school-based programs for youth with a parent in the military. In Phase 1, we conducted focus groups with military parents to: gauge their receptivity to this type of supportive intervention, identify program features that would make the option of mentoring for their children more or less appealing, and identify specific training needs for adult volunteers preparing for the role of mentor to youth in this population. In Phase 2, we used an iterative process to develop the training protocol, including cycling through multiple drafts, creating a web-based platform, reviewing and incorporating feedback from various stakeholders, and then pilot testing the training with two groups of mentor volunteers as part of a school-based mentoring program for military-connected students. We report on what we learned from the military parent focus groups, including parent skepticism about the need for such a program, concerns about potential stigma, and the need for mentors to have some understanding of military culture. We describe how we used that information to develop a practical and accessible training module for volunteer mentors, especially those without a military background, who could be matched with military-connected youth.

Research concerning children who are overweight has historically focused on providing services to the affected individuals, and limited attention has been paid to their families. Further, childhood obesity prevention and clinical programs continue to be impacted by contextual factors that increase the likelihood of attrition when targeting underserved populations. This paper provides data with relevance for interventions aimed at promoting healthy eating and regular physical activity with low-income families. Participants in a childhood obesity exploratory study provided recommendations to improve programs by reflecting on specific family and contextual issues related to children who are overweight and obese. Following a thematic analysis approach, we conducted semi-structured interviews with 16 low-income, single, female parents. All participants had, at the time of the interview, at least one overweight or obese child between the ages of 3 and 8. We report the critical role of context in the etiology and challenges of childhood obesity among disadvantaged populations. Findings also highlight the need for interventions to be culturally relevant and sensitive and to create opportunities to address and discuss participant experiences of discrimination, cultural factors, and family of origin influences. Interventions that do not address these contextual factors run the risk of being unsuccessful. Our findings are important for mental and public health professionals who are interested in the direct provision of services using a combination of social determinants of systemic perspectives.

Positive deviance approaches, which have been used to identify and study high performers (bright spots) and translate their successes to poorer performers, offer great potential for chronic disease management. However, there are few examples of applying positive deviance approaches across different geographic contexts. Building on prior research that developed a new measure for appropriate diabetes preventive care (DMPrevCare) and identified priority counties for this strategy, we introduce a geospatial approach for identifying bright spot counties and case matching them to priority counties that need improvement. We used the Local Moran's I tool to identify DMPrevCare spatial outliers, which are counties with larger percentages of Medicare beneficiaries receiving appropriate diabetes preventive care (DMPrevCare) surrounded by counties with smaller percentages of Medicare beneficiaries receiving DMPrevCare. We define these spatial outliers as bright spots. The Robert Wood Johnson Foundation County Health Rankings Peer Counties tool was used to link bright spot counties to previously identified priority counties. We identified 25 bright spot counties throughout the southern and mountain western United States. Bright spot counties were linked to 45 priority counties, resulting in 23 peer (bright/priority) county groups. A geospatial approach was shown to be effective in identifying peer counties across the United States that had either poor or strong metrics related to DMPrevCare, but were otherwise similar in terms of demographics and socioeconomic characteristics. We describe a framework for the next steps in the positive deviance process, which identifies potential factors in bright spot counties that positively impact diabetes care and how they may be applied to their peer priority counties.

Jacob Cohen developed two statistical measures for judging the magnitude of effects produced by an intervention, known as Cohen's d, appropriate for assessing scaled data, and Cohen's h, appropriate for assessing proportions. These have been widely employed in evaluating the effectiveness of alcohol, cigarette, marijuana, and other drug prevention efforts. I present two tests to consider the adequacy of using these statistics when applied to drug use prevention programs. I used student survey data from grades 6 through 12 (N = 1,963,964) collected by the Georgia Department of Education between 2015 and 2017 and aggregated at the school level (N = 1036). I calculated effect sizes for an imaginary drug prevention program that (1) reduced 30-day alcohol, cigarette, and marijuana prevalence by 50%; and (2) maintained 30-day prevalence at a pretest level for multiple years. While both approaches to estimating intervention effects represent ideal outcomes for prevention that surpass what is normally observed, Cohen's statistics failed to reflect the effectiveness of these approaches. I recommend including an alternative method for calculating effect size for judging program outcomes. This alternative method, Relative Reduction in Prevalence (RRP), calculates ratio differences between treatment and control group drug use prevalence at posttest and follow-up, adjusting for differences observed at pretest. RRP allows researchers to state the degree to which an intervention could be viewed as efficacious or effective that can be readily understood by practitioners.

Obesity is a serious public health problem within the United States. One promising approach to obesity prevention is health behavior change among college students, focusing on diet, sleep, and exercise. However, it remains unclear whether a health behavior change promotion program implemented in the classroom will effectively improve these health behaviors and negative outcomes related to obesity, particularly within classes of different topics. We examined the impact of a 6-week health behavior change program based on the Theory of Planned Behavior. Across several years, with two seemingly distinct samples of students from either a health psychology (n = 433) or a home gardening (n = 155) course, we conducted two studies and employed a single group, pre/post design in which self-reported and objectively measured health outcomes were assessed for change relative to the health promotion program. Participants selected one of three health behaviors and sought to meet current Centers for Disease Control and Prevention recommendations by setting goals, tracking behavior, and meeting with social support groups. Within both studies, dramatic changes emerged in the targeted health behaviors of fruit and vegetable consumption, sleep quantity and quality, and exercise. Moreover, several other health indicators improved among our subjective and objective health variables, and a few outcomes (i.e., subjective health, sleep quality, flexibility, loneliness) improved across all health behavior groups. Collectively, these results suggest this health behavior change program may be an effective way to elicit behavior change and highlight avenues for future remediation and prevention of obesity and related disease.

As states move beyond simply managing their homelessness crises to looking for ways to reduce and ultimately end homelessness, broad-scale efforts to prevent homelessness are lacking. Experiences of homelessness are often harmful, traumatic, and costly, making a compelling case for why homelessness prevention should be prioritized. In recent years, countries such as Australia, Finland, and Wales have shifted their focus to prevention, but there remains a conceptual and systematic gap in our collective knowledge about what precisely homelessness prevention is, what policies, programs, and interventions are captured in a homelessness prevention strategy, and how to build a framework for orienting our response to homelessness towards prevention. This article begins to fill that gap by providing a definition and typology of homelessness prevention (THP). Our definition offers a schema to clarify the nature of homelessness prevention and to develop a collective response between various policies and practices that can and should be framed as homelessness prevention. Building off of the public health model of prevention and pre-existing homelessness prevention classification systems, our THP complements the definition by specifying the pragmatic nature of prevention initiatives and the range of sectors, stakeholders, and levels of government required to respond to the causes of homelessness. Our typology is made up of five interrelated elements: structural, systems, early intervention, evictions prevention, and housing stabilization. Each of these elements contains actionable strategies that cut across primary, secondary, and tertiary prevention to ensure that people at various levels of risk have access to the tools and resources necessary to find and maintain safe, appropriate, and suitable housing. Together the definition and THP are useful tools to envision a new way forward in how we respond to homelessness.

Neck circumference is quick and simple to measure and thus an attractive proxy of neck strength, a putative mechanism underlying risk of sport-related concussion (SRC). Research, however, is limited on the relationship of neck circumference to SRC. Our study examined differences in neck circumference based on sex, concussion history, concussions experienced subsequent to college entry, and participation in sports with high versus low risk for contact. Neck circumference was measured in incoming NCAA Division I athletes (N = 324) from a large northeastern university during athlete pre-participation physicals. Sex, sport team, and self-reported concussion history were obtained from retrospective pre-participation questionnaires and medical chart review. Concussion diagnoses during college were collected subsequent to neck measurements from medical chart review. Proportional neck circumference (normalized by body mass index) was computed. Each sport was categorized as involving high or low risk of contact (as a proxy of risk for injury). Sex differences in neck circumference and proportional neck circumference were assessed. Differences in neck circumference and proportional neck circumference were also characterized by contact risk and SRC history (with biological sex included as a covariate). Differences in neck circumference and proportional neck circumference were explored among those who did versus did not experience subsequent SRC diagnosis. Males had significantly larger neck circumference and proportional neck circumference than females. Neck circumference and proportional neck circumference were not related to SRC history or subsequent SRC. Neck circumference is a quick and simple measure; however, even when considered in proportion to body mass, it was unrelated to SRC. Future studies are needed to assess whether this is due to a lack of relationship between the neck and injury or limitations in circumference as a proxy measure of cervical spine characteristics and biomechanics.