PAR07-231 Abstracts

PAR07-231 Abstracts

1 R36 CK000104-01 - Dengue epidemiology in Thailand and implications for vaccine development

ANDERSON, KATHRYN B

Dengue is an important global health problem that is increasing in geographic range and epidemic severity each year. This research project will address critical gaps in our understanding of the epidemiology and pathogenesis of dengue illnesses. Specific aims. The major aims of this research will be: (1) to evaluate the association of prior flavivirus immunity with DHF, as well as the association of infecting dengue serotype and the outcome of primary and secondary infections; (2) to better define the spectrum of clinical presentations in dengue illness and to develop and test more sensitive and specific case definitions; to use hospital-based data to evaluate predictors of progression to DHF and dengue shock syndrome (DSS) to guide early intervention; (3) to evaluate how and why the demographics and distribution of dengue viruses have changed over time in Thailand. Research Desiqn. The research will involve both existing datasets and primary data collection in Bangkok, Thailand, and AFRIMS' dengue field site in Kamphaeng Phet Province (KPP), Thailand. 30 years of passive surveillance data on DHF hospitalizations have been collected in Bangkok, with 12 years of more detailed clinical data from children hospitalized with dengue at Queen Sirikit National Children's Hospital in Bangkok. A prospective study in KPP has collected data on symptomatic dengue illnesses and asymptomatic seroconversion in cohorts of school-aged children since 1998, with a cluster component for viremic cases added for the period 2003-2008. Methods. The effects of prior flavivirus immunity will be evaluated using the KPP cohort data which include information on the presence/absence of antibodies to Japanese Encephalitis at enrollment, the clinical severity of incident dengue illnesses, and whether the infection represented a primary, secondary, or post-secondary infection. Case definitions will be tested and modified by incorporating existing data into predictive models, with evaluation of sensitivity, specificity and Receiver Operating Characteristic curves. Predictors for progression to DHF will be assessed based upon laboratory markers and clinical characteristics on admission to the hospital. "Best fit" models for case definitions and predictors of progression to DHF will then be tested prospectively. Changes in the demographics and transmission patterns of dengue infections will be assessed, including whether and how the mean age of DHF has increased. Siqnificance. Dengue is an important global health problem. This research will address key questions in the epidemiology, virology, and immunology of dengue viruses and dengue illness.

 

1 R36 DP001161-01 - Parental Influences on Young Adult Sexual Risk Behaviors

BOURIS, ALIDA M

The overall aim of the present research is to examine sexual risk behaviors in early adulthood in a nationally representative sample of young adults, and to relate these behaviors to a comprehensive range of parenting practices encountered during adolescence. The study will utilize data from Waves 1 and 3 of the National Longitudinal Study of Adolescent Health (Add Health), the largest longitudinal study of adolescents in the U.S.. Specifically, the proposed project will evaluate two competing theoretical perspectives. The first perspective posits that parenting practices during adolescence influence adolescent sexual behavior, which in turn influences young adult sexual behavior. This perspective suggests that parenting practices during adolescence indirectly influence sexual behavior during young adulthood through their direct influence on adolescent sexual behavior. In other words, adolescents whose decisions about sexual risk behavior are positively influenced by parenting practices make lower risk sexual decisions in young adulthood as a function of having made lower risk sexual decisions during adolescence. The second, theoretical perspective hypothesizes that parenting practices during adolescence influence sexual decision making in early adulthood not only through their indirect influence on adolescent sexual behavior, but also through their direct influence on sexual behavior in early adulthood. This perspective suggests that the total effect of parenting practices during adolescence on young adult sexual risk behavior is a combination of both an indirect effect (e.g., through adolescent sexual behavior) and a direct effect (e.g., independent of adolescent sexual behavior). Whereas the first perspective suggests that parental influences on young adult sexual behavior primarily work through their influence on adolescent sexual risk behavior, the second perspective proposes that parenting practices in adolescence may have unique and important implications for sexual decision making in early adulthood. The application of two competing theoretical perspectives is a novel approach to the study of sexual risk behaviors in young adults and has important public health implications for the development of parent-based prevention programs targeting the prevention of HIV, sexually transmitted infections, and unintended pregnancies in adolescents and young adults.

 

1 R36 PS000845-01 - Effects of a Mass Media Intervention on HIV-Related Stigma and Uptake of Voluntary Counseling and Testing: Radio Diaries Program in Malawi

CREEL, ALISHA HEATHER

This project aims to evaluate the effects of a mass media program on HIV-related stigma and fear and HIV testing behavior. The Malawi Radio Diaries program features men and women who are living with HIV who openly discuss their lives, with the goal of reducing HIV stigma. This project will follow preliminary evidence of effectiveness with a comprehensive analysis using multiple methods. Evaluations in the peer-reviewed literature of stigma reduction interventions have not included mass media programs, and stigma is not often included as an outcome of interest in evaluating HIV prevention programs. Furthermore, evaluations of mass media interventions often fail to examine the role of interpersonal communication in spreading the message of a program beyond the individuals who are directly exposed to the program message. This project will fill these gaps in the literature by using three methods a representative household survey, an experiment-based design, and in-depth interviews to assess whether the Radio Diaries program has an impact on HIV-related stigma and fear and HIV testing. The aims of the project are 1) to understand whether and how exposure to the Radio Diaries program is associated with reductions in HIV-related stigma and fear and increased rates of HIV testing; 2) to understand how interpersonal communication alters the effects of exposure to the Radio Diaries program; and 3) to understand, through qualitative means, how listening contexts modify the effects of exposure to the Radio Diaries. A representative household survey will assess exposure to the program and HIV- related stigma (along with other HIV knowledge, attitudes and behaviors) in 960 participants. An experimental design will compare groups that are exposed to the Radio Diaries program with control groups and will additionally compare an exposure group that has a discussion afterwards with a group that is only exposed, to assess the effects of interpersonal communication. In-depth interviews will probe listeners and non- listeners to understand how listening contexts modify the effects of exposure to the Radio Diaries. Listening contexts include the social context (alone or in a group), the program context (accompanied by a call-in show, expert panel, or other segments) and overall radio listenership patterns. As a whole, this program will contribute to our understanding of how to reduce HIV-related stigma for improvement of HIV prevention and it will contribute to health communication by building the theoretical background of a new paradigm in entertainment-education, use of real personal narratives instead of scripted material.

 

1 R36 PS000843-01 - Helminth infection and the risk of tuberculosis in children

FRANKE, MOLLY FORREST

In the year 2000, an estimated 884,019 children less than 15 years of age became ill with tuberculosis. Despite the existence of curative therapy, the World Health Organization (WHO) has estimated that approximately one third of TB cases among children in this age group result in death. The paucity of data describing TB risk factors in children poses a challenge to the design of interventions that could decrease TB disease progression in this group. The identification of modifiable risk factors might lead to interventions that could substantially decrease TB-related morbidity and mortality in children. Helminth infection, including round worm and hookworm infection, may be one such risk factor. Recent case-control studies in adults and adolescents demonstrate that TB disease is associated with both helminth infection and immunological responses consistent with helminth infection. To date, however, no studies have examined the association between TB endpoints and helminth infection in children, the group most vulnerable to helminth infection and about which the least is known regarding risk factors for progression to active TB disease. The general objective of this study is to examine whether helminth infection increases susceptibility to TB infection and TB disease in children. We will pursue the following specific aims: (1) To determine whether helminth infection among children is associated with an increased risk of TB infection and disease; (2) To examine whether there is a dose-response relationship between the total burden of helminths and/or the number of helminth species with which a child is infected and progression to active TB disease and infection; (3) To compare the immune response to TB disease in children with and without helminths. We will conduct two matched case-control studies in Lima, Peru. To examine whether helminth infection is a risk factor for active TB disease, we will compare the prevalence of helminth infection among children with and without TB disease. To examine whether helminth infection is a risk factor for TB infection, we will compare the prevalence of helminth infection among children with and without TB infection. In both studies we will measure parasite burden and compare serum IgE levels in these two groups. Cases will be matched to controls by age, neighborhood, and TB contact history.

 

1 R36 DP001164-01 - Energy density of food intake in overweight adults

GROSSNIKLAUS, DAURICE A

An estimated 66% of US adults are overweight. Abdominal obesity, the central distribution of adipose tissue, is more closely related to insulin resistance than generalized obesity and is associated with hypertension, dyslipidemia, type 2 diabetes, and premature coronary death. The prevalence of abdominal obesity is rising, and in 2004, more than 50% of the adult population had abdominal obesity. Recent research studies suggest that psychological factors may also contribute to disease risk by their influence on deleterious health behaviors and neuroendocrine pathways. The long range objective of this project is to develop a program of research aimed at reducing obesity through dietary approaches. The purpose of this correlational study is to investigate the associations among psychological factors (perceived stress and depressive symptoms), biobehavioral responses (dietary energy density and salivary cortisol), and risk of disease (abdominal obesity) in overweight adults. Sample: A sample of 91 overweight, sedentary, working adults ages 21-65 years will be recruited. Variables and measures: Individual characteristics to be examined include age, gender, race/ethnicity, and dietary restraint (Three Factor Eating Revised Questionnaire); psychological factors include perceived stress (Perceived Stress Scale) and depressive symptoms (Beck Depression Inventory-II); biobehavioral response includes dietary energy density (3 day weighed food record) and salivary cortisol; and disease risk includes abdominal obesity (waist circumference). Data analysis: Hierarchial linear regression will be used to test dietary energy density and salivary cortisol as potential mediators between psychological factors and abdominal obesity. The findings of this study will lead to the 1) development and testing of clinical assessment tools and tailored interventions aimed at weight loss and weight control for at risk populations; 2) development and testing of dietary energy density interventions to reduce obesity and abdominal obesity; and 3) support policy development to increase availability of low energy dense foods.

 

1 R36 PS000847-01 - Determinants of Repeated HIV Testing in Sub-Saharan Africa

HALL, GRACE JEAN

For more than a decade, global funding and national efforts within sub-Saharan Africa have been utilized to curb the HIV/AIDS pandemic. Monitoring the trends and changes of each country's epidemic is critical to determine the rate and scope of HIV transmission. HIV testing and counseling, introduced in 1985, is the essential link for seropositive people to receive appropriate care and services. HIV testing also provides the best prevention information to both seropositive and seronegative individuals. In recent years, in the US, repeated HIV testing among high-risk people has become a growing target of surveillance because of increasing seropositive rates (such as those seen among African American men who have sex with men (MSM)). However, little is known about repeated testing among general populations in high endemic areas. Using the Kenya 2003 Demographic and Health Survey data (KDHS'03), this study will examine the relationship of surveyed participants' HIV testing patterns (repeated testing, first-time testing, and non-testing) with their - social demographic characteristics; knowledge, attitudes, and behaviors associated with HIV infection; and attitudes about women's sexual empowerment. Repeated HIV testing in this context is defined as having self-reported prior HIV testing and subsequently testing as part of the KDHS'03. Repeated testers will be compared to first-time DHS testers (those who reported no prior HIV testing and who tested with the KDHS'03) and non-testers (those who reported no prior HIV testing and who refused to test with the KDHS'03). The proposed research project has the following specific aims: 1. To describe the socio-demographic characteristics of Kenyans with different patterns of HIV testing (repeat testing, never testing). 2. To describe how knowledge, attitudes, and behaviors related to HIV infection affect the use of HIV testing in Kenya, net of other factors. 3. To describe attitudes about women's sexual empowerment in Kenya, and how such attitudes may differentiate use of HIV testing patterns in Kenya, net of other factors. 4. To examine how each of the above factors impact intention to test among those offered an opportunity to test for the first time during the KDHS'03.

 

1 R36 DP001163-01 - Neighborhood Characteristics and Risk of Gestational Diabetes in New York City

JANEVIC, TERESA

The incidence of gestational diabetes, characterized as glucose intolerance with onset during pregnancy, is increasing. Diet, physical activity, and obesity are modifiable risk factors that have been implicated in gestational diabetes. Concurrently, there has been concern regarding the increase in obesity, motivating interest in identifying environmental determinants of obesity that might impact individual behavior, including features of the neighborhood in which one lives. One neighborhood feature that might impact the risk of obesity and that of gestational diabetes is the availability of healthy foods. Another neighborhood feature is ethnic concentration. South Asian, Latin American, African, and Caribbean women are at an increased risk of gestational diabetes, especially those who are foreign-born. It has been suggested that this increased risk found in immigrant women might in part be due to change in diet and lifestyle upon immigration. Thus, it is likely that for immigrant women, living outside of ethnic enclaves might increase their risk of gestational diabetes by exposing them to greater changes in diet and lifestyle, while experiencing decreased social and instrumental support. Using linked New York City hospital discharge, birth certificate, commercial food, and census data, this study will be the first ever to examine the association between neighborhood characteristics and the risk of gestational diabetes. The following research questions will be addressed using multilevel models controlling for potential individual-level (education, ethnicity, parity, age, Medicaid status) and neighborhood-level (deprivation) confounders: 1) Is a poor neighborhood food environment score, defined as a combination of number of supermarkets, fast food restaurants, fruit and vegetable stands, and natural food stores, associated with higher risk of gestational diabetes?; 2) Does the strength of this association vary according to the mother's education level and employment status?; and 3) What is the association between neighborhood food environment, ethnic concentration and GDM within seven immigrant groups in NYC? Infants of mothers with gestational diabetes are at greater risk of complications at birth including macrosomia and trauma during delivery. They are also at greater risk of obesity, impaired glucose tolerance, and diabetes in childhood and adolescence. Given the increasing incidence of gestational diabetes, along with the ethnic disparity in risk, learning more about contextual risk factors for gestational diabetes is essential for addressing the CDC objectives of promoting healthy pregnancy and birth outcomes and improving risk factors for future disease among infants and toddlers. The proposed study is unique in that it addresses how the neighborhoods in which women live affect their risk of an important complication during pregnancy. Information regarding the associations of neighborhood food environment and ethnic concentration with gestational diabetes can support the design of healthy communities that promote health by encouraging healthy behaviors, quality of life, and social connectedness.

 

1 R36 DP001167-01 - Assessing Smoking and Tobacco in Ohio Prisons

KAUFFMAN, ROSS M

Smoking is the leading cause of preventable death in the United States, and exposure to passive smoke is responsible for disease and death in non-smokers (USDHHS, 2004; USDHHS, 2006). Reducing the disability, illness, and death caused by tobacco use is a key Healthy People 2010 goal (USDHHS, 2000). Prisoners are disproportionately affected by tobacco use. Estimates of the smoking prevalence among prisoners range from 60-80%, compared to only 21% in the non-institutionalized population (Vaughn and del Carmen, 1993; CDC, 2006). Though often invisible to the larger society, prisoners represent a large and growing segment of the U.S. population, where incarceration rates are now the highest in the world (Travis, 2005). At any given time more than 2.1 million people are being held in American jails and prisons, and nearly 8 million individuals exit jail and prison each year and return to their home communities (Harrison and Beck, 2006; Hammett, 2002). As centers for the amplification and spread of disease, poorly managed prisons have the potential to act as epidemiological pumps, undermining the public health, yet prisons also offer unique public health opportunities (Jacobi, 2005). Interventions that improve the health of prisoners have the potential to reduce health disparities that have long been resistant to change. Given the well-documented health effects of tobacco smoke exposure and high rates of prisoner smoking noted above, tobacco control efforts are an ideal first step in improving prisoner health; however a paucity of research examining smoking in prisons has left prison administrators ill-equipped to develop sound tobacco control policies for correctional institutions. Social, economic, and legal factors have led many prisons to adopt total or partial tobacco bans (Vaughn and del Carmen, 1993; Linhorst et al., 2001), however the efficacy of these policies remains unclear. We seek to study tobacco use in two Ohio prisons with indoor tobacco bans using complimentary quantitative and qualitative research methods. One objective of this proposal is to examine the influence of an indoor tobacco ban on smoking behaviors among low-security prisoners. While prior work has examined the prevalence of smoking in facilities with limited or no smoking restrictions and, to a lesser extent, those with complete tobacco bans there has not been an examination of the influence of an indoor smoking ban, like that in Ohio prisons, on prisoner smoking behaviors (Cropsey et al., 2004; Vaughn and del Carmen, 1993; Cropsey and Kristeller, 2005; Lankenau, 2001). A second objective is to provide prison administrators with the information needed to develop successful policies by gathering information on prisoner attitudes toward tobacco control policies and cessation programs in correctional settings. The study is also intended to lay the groundwork for future studies of tobacco use in prison facilities.

 

1 R36 CI000598-01 - Outcomes of and Risk factors for Infections due to USA300 MRSA

KREISEL, KRISTEN M

Staphylococcus aureus is an opportunistic bacterial pathogen causing substantial morbidity and mortality. Antibiotic resistance is common in S. aureus, of which methicillin resistance is the resistance of greatest clinical consequence. Infections due to methicillin-resistant S. aureus (MRSA) cause longer hospital stays, more deaths, and are more expensive to treat than infections due to methicillin-susceptible S. aureus (MSSA) and uninfected controls. MRSA isolates can be molecularly characterized using pulsed-field gel electrophoresis (PFGE). PFGE has found that one strain of MRSA, the USA300 MRSA strain, is the most common cause of community-associated MRSA infections. Reasons for the success of this clone are not known, but given that USA300 MRSA isolates have a number of unique virulence factors, there could be an increase in morbidity and mortality associated with this shift. Few studies have evaluated USA300 MRSA as the cause of bacteremic infections. The overall objective of this evaluation is to identify risk factors and outcomes associated with bacteremic infections caused by USA300 MRSA. Specific Aims: 1) To determine whether the mortality in adults with bacteremic infections due to USA300 MRSA is greater than the mortality of a) adults with bacteremic infections due to non-USA300 MRSA, and b) adults without bacteremic infections due to S. aureus. 2) To determine the risk factors for bacteremic infections due to USA300 MRSA among a) adults with bacteremic infections due to S. aureus, and b) all adults. The risk factors of interest are injection drug use and homelessness. Methods: These studies will use cohort and case-control study designs and PFGE to identify USA300 MRSA. Significance: These aims promote the mission of the CDC to promote health and quality of life by preventing and controlling infectious diseases. Aim #1 will investigate the relationship among pathogen genetic factors and infection outcome in human subjects. Aim #2 focuses on high-risk populations for developing these infections. Both areas have been identified as priority research in Advancing the Nation's Health: A Guide to Public Health Research Needs: 2006-2015 established by the CDC, on p. 29 and 30, respectively.

 

1 R36 DD000348-01 - State-level Family Support: Impacts on Children with Special Health Care Needs

MANDIC, CARMEN GOMEZ

The proposed research will examine the range, adequacy, and impact of state policies affecting family support programs that serve families of children with special health care needs (SHCN). The study uses multilevel methods with the only nationally- and state-representative data on children with special health care needs (the National Survey of Children with Special Health Care Needs) to examine contextual influences of state policies on the functioning of children with SHCN, as measured by school absenteeism, and on the financial and employment- related problems faced by their caregivers. Specifically, the proposed research poses the following questions: 1) Does state-level commitment to family support influence the likelihood of school absenteeism among children and youth with special health care needs?; 2) Are the financial and employment-related impacts of children's special health care needs on families associated with higher school absenteeism?; and 3) Is the relationship between state-level commitment to family support and school absenteeism mediated by the financial and employment-related problems that families experience? The study will potentially provide a foundation for further exploration of the extent to which family support policy at the state level minimizes or exacerbates disparities in functioning and disability among children.

 

1 R36 DD000349-01 - Mealtime Communication and Oral-Motor Feeding Skills in 6 Month Old Infants

MCCOMISH, CARA

The proposed study will analyze mealtime communication and oral-motor feeding skills in 6-month- old African American infants who were born prematurely, and will examine whether these skills predict later speech and language development at 2 years of age. Having an increased understanding of the specific oral- motor feeding skills and mealtime communicative acts of preterm infants at 6 months of age that are predictive of speech and language skills at 24 months of age will enable professionals to partner with families in the future in early interventions for feeding and early language difficulties. This dissertation research study proposal specifically addresses the first Health Protection Goal of the CDC: Healthy People in Every Stage of Life- Start Strong (Infants and Toddlers, ages 0-3 years). This health impact goal states that, All people, and especially those at greater risk of health disparities, will achieve their optimal lifespan with the best possible quality of health in every stage of life (CDC, 2006). The health disparities of rural, African American premature infants are significant, and the sample of children to be studied from this population represents a group of infants and young children that are vulnerable and at risk for poor developmental outcomes. Therefore, the specific aims of this dissertation research study are to: 1. Examine the characteristics of early oral-motor feeding skills in African American premature infants at six months of age. 2. Examine the characteristics of early communicative behavioral acts of these infants during mealtimes at six months of age. 3. Explore the relationship between these early oral-motor feeding skills and communicative behavioral acts during mealtimes at six months of age with later language skills at 2 years of age. 4. Determine which early oral-motor feeding skills and communicative acts at 6 months of age are most predictive of later speech and language skills at 2 years of age in these at risk infants.

 

1 R36 PS000848-01 - Understanding the Care-Seeking Behavior of HIV Positive Persons in North Carolina

MCCOY, SANDRA

Early presentation for medical care among HIV infected persons can improve the length and quality of life and reduce high-risk behavior. Despite these benefits, many adults enter care late in the course of HIV infection, countering the benefits of timely access to HIV services and missing opportunities for risk reduction. Linking HIV positive persons to high-quality care and prevention services has consequently been identified as a priority of the U.S. Centers for Disease Control and Prevention (CDC). The objective of this proposal is to examine the structural and individual factors that influence HIV testing and care-seeking behavior in North Carolina. In our first Aim, we will describe the effect of perceived social support on late presentation to medical care among HIV positive persons receiving care at the University of North Carolina (UNC) Infectious Disease (ID) Clinic. This secondary analysis will utilize data from the Clinical Socio-Demographic Survey and the Clinical and Research Database at the Center for AIDS Research (CFAR) at UNC. Social support will be quantified with a modified MOS Social Support Survey Scale and entered into a Cox proportional hazard model to determine its effect on delays seeking care after testing positive. In our second Aim, we propose a qualitative study to describe the attitudes and beliefs about HIV care among HIV-infected persons attending the UNC ID clinic who presented with clinically advanced illness. We plan to conduct semi-structured, individual qualitative interviews of HIV-infected persons who presented to care in the previous year with immunosuppression at their initial visit, defined as an indication for HAART therapy (CD4+ T-lymphocyte cell count < 350 cells/mm3). The conceptual framework and interview instrument will be developed with constructs from the Health Belief Model. Recent testing recommendations issued by the CDC aim to incorporate HIV testing into routine medical care. A comprehensive understanding of how, when, and why newly diagnosed individuals enter care is therefore necessary to ensure that the new screening guidelines yield their maximum benefit. Towards this end, the findings from this research will elucidate barriers and facilitators to early HIV testing and medical care. Our findings will have direct public health implications for the evaluation of the HIV/AIDS referral system, post- test counseling messages, and bridging case management programs.

 

1 R36 DP001162-01 - Intended by Whom? A Look into Mexican-American Pregnancy Intentions, Maternal Behaviors and the Role of Social Support

MENENDEZ, KAREN

The overall objective of the dissertation study, Intended by Whom? A Look into Mexican American Pregnancy Intentions, Maternal Behaviors and the role of Social Support is to use mixed methods to learn more about unintended pregnancy and the relation between unintended pregnancy, maternal behaviors and perceived social support among immigrant Mexican-American women living in neighborhoods in Los Angeles County, CA. The quantitative component of this study will use data collected as part of the Los Angeles Mommies and Babies Survey (LAMBS) to measure reported unintended pregnancy among Mexican-American women. Among the aims of this quantitative work is to (1) characterize unintended pregnancy among Mexican-American women by women's length of stay in the US and to (2) describe social support as well as partner support by women's length of stay. Lastly, to (3) assess the relation between unintended pregnancy and prenatal care use and smoking among Mexican women and to (4) test the influence of social support on maternal behaviors by pregnancy intentions within this population. The qualitative supplement will serve to investigate and understand underlying determinants of Mexican-American women's pregnancy intentions. This study will help build evidence for understanding the underlying determinants of growing unintended pregnancy among Mexican-American women the longer they live in the US and suggest directions for future interventions in Los Angeles County to help reduce unintended pregnancy and improve maternal behaviors.

 

1 R36 DP001175-01 - The Effects of Parental Work on Child Obesity

MILLER, DANIEL P

This research project proposes to study the effects of parental work on child obesity. The project will use data from two large, national datasets ---the Early Childhood Longitudinal Study-Kindergarten Cohort (ECLS-K) and the National Longitudinal Study of Youth (NLSY) and has four specific aims: 1) To explore the effects of parental employment on child obesity across different stages of childhood; 2) To assess how non- standard parental work affects child obesity; 3) If parental work is found to affect childhood obesity, to explore how features of the home environment and child after school activity mediate this effect across different periods of childhood and; 4) To determine how the features of schools might affect child obesity above and beyond the potential effects of parental work for children in middle-childhood. The increased incidence of obesity is widely recognized as a threat to the health and well-being of young people. To the extent that this project can discern an effect of parental work and the pathways through which this effect might operate, it will be useful in helping to direct public health efforts and policies aimed at stemming the increases in obesity among young people. Similarly, understanding how schools may cause child obesity can provide clear directions for anti-obesity programs and policies. In order to best address the aims identified above, the project will employ various statistical methods to determine if a causal relationship between parental work and obesity exists, and how this effect may differ across periods of childhood. For one, the analysis will capitalize on the rich information offered by both datasets and the availability of a longitudinal sample in each to estimate the causal effect of parental work independent of the influences of both observed and unobserved factors that might bias this effect. Additionally, the causal effect of such work on child obesity will be estimated using a statistical method that mimics a randomized experimental design. Results from each dataset will be compared to assess whether any stage-specific effect of parental work on child obesity exists.

 

1 R36 DP001165-01 - Dietary Factors in Relation to Prenatal and Postpartum Depression

MOHLLAJEE, ANSHU PRABHA

Together prenatal and postpartum depression affect 15% of pregnancies annually, and may compromise the mother's psychological well-being as well as the health and development of her infant and family. Most studies examining predictive factors for prenatal and postpartum depression have focused on demographic and psychosocial characteristics, but few have examined the role of modifiable behavioral factors such as diet. Adequate nutritional status is a necessary precursor for normal brain function and may be associated with depression. Omega-3 polyunsaturated fatty acids (PUFAs), such as docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), are important in neural tissues and affect receptor function, neurotransmitter uptake, and signal transmission. Higher intake of fish (the main dietary source of elongated omega-3 PUFAs) and of omega-3 PUFAs have been associated with lower risk of major depression. Previous studies among populations with higher dietary fish intake than United States women have suggested that there may be an inverse relation between fish and omega-3 PUFA intake and postpartum depression. To our knowledge, no study has examined the relation between omega-3 PUFA intake and prenatal depression. We will use data from a prospective cohort study of 1,662 mothers, Project Viva, to examine the following hypotheses: a) Higher maternal blood levels of omega-3 PUFAs during pregnancy are associated with lower risk of prenatal and postpartum depression. b) Higher dietary fish and omega-3 PUFA intake during pregnancy are associated with lower risk of prenatal depression and postpartum depression. c) Higher dietary fish and omega-3 PUFA intake during the postpartum period are associated with lower risk of postpartum depression. This project will take advantage of the wealth of data already collected by Project Viva, including stored maternal blood samples, validated prenatal dietary assessment, and detailed information about a number of covariates. Dietary intake of specific nutrients is a modifiable behavior that is well suited for interventions. Our study will shed further light in evaluating whether intake of omega-3 PUFA could be a cost-effective method of preventing prenatal and postpartum depression.

 

1 R36 DP001166-01 - Social Determinants of Smoking in Working Class Populations

OKECHUKWU, CASSANDRA A

This dissertation study proposes to address one of CDC's goals regarding "Healthy People in Healthy Places" and reducing health disparities affecting low-income and minority groups. The results of the study will promote CDC starter objectives (#49-50) of reducing the number of workers that are killed, injured or made ill on the job and increasing the number of workplaces that coordinate worker safety and health efforts with efforts to promote health. The study will use data from two studies to investigate the social determinants of cigarette smoking behaviors among working class populations. Part A of the study will use data from the "United for Health Disparities" study to investigate the relationship between smoking behaviors and single and combined exposure to physical and social hazards in the workplace. Part B of the study will evaluate the intervention implemented in the "Smoking Cessation with Building Trade Unions" study. The project aims to fill several gaps that exist in research knowledge regarding smoking by occupational class. Several studies have documented persistent disparities in smoking behaviors by occupational class. But, fewer studies have focused on exposure to hazards in the workplace as a determinant of smoking behavior. In fact, no study has investigated the relationship between smoking behavior and exposure to both physical and social hazards in the workplace as proposed by part A of the study. Part B of the project will evaluate whether getting a union delivered smoking cessation intervention is associated with significant smoking cessation among blue collar workers. Together, the study findings will elucidate the relationship between hazardous workplace exposures and smoking behavior and will be useful in the design of worksite based interventions.

 

1 R36 CK000103-01 - HPV Testing in Cervical Cancer Screening: Time Trends and Evidence-Based Practice

PHELAN, DARCY

The overarching objective of this research is to describe time trends and identify potential barriers to use of human papillomavirus (HPV) DNA testing in routine cervical cancer screening practice. High-risk HPV infection is a necessary, but insufficient cause of cervical cancer. A preponderance of evidence supports the use of HPV DNA testing in cervical cancer screening of women 30 years and older to improve the cost- effectiveness of cervical cancer prevention. However, little is known about actual provider use of the test. Rapid assessment of HPV DNA testing uptake in routine cervical cancer screening is directly responsive to the CDC's Health Protection Goal of `Healthy People at Every Stage in Life,' specifically starter objectives among adults, older adults, and the elderly, as related to chronic disease prevention, infectious diseases prevention, and increasing the number of individuals who receive preventive health services. Cervical cancer rates continue to reflect racial and socio-economic disparities and this research will focus on a CDC priority population, women, including low-income groups, minority groups, and the elderly. To examine provider use of HPV DNA testing in routine cervical cancer screening, provider practice data collected at Johns Hopkins Hospital & Health System in Baltimore, Maryland from 2001-2006 will be utilized. The Division of Cytopathology will provide cross-sectional specimen record data and associated de-identified patient information. Provider information will be purchased, de-identified, and appended to the appropriate specimen record. Specific Aim 1 will assess temporal trends of HPV DNA testing in women 30 years and older and will compare these trends with the uptake of HPV DNA testing for follow-up of abnormal Pap test results of undetermined significance (i.e., ASC-US triage). Specific Aim 2 will identify provider and patient characteristics associated with evidence-based and non-evidence based use of HPV DNA testing in general screening. This research will establish baseline screening practices prior to wide HPV vaccine coverage and release of updated screening guidelines. Identifying current factors related to appropriate practices may allow for preemptive intervention, if needed, for future guideline changes. If HPV DNA testing fails to be properly used in screening for women 30 years and older and annual Pap testing is maintained as the status quo, the US will divert critical health care dollars away from more pressing needs in this large, aging population. Broad uptake of HPV DNA testing in routine screening of women 30 years and older is critical for continuing the decline in cervical cancer incidence without inflating the cost of its prevention. In order to achieve the most cost-effective combination of screening and HPV vaccination, it's crucial to monitor and characterize the uptake of HPV DNA testing in routine screening.

 

1 R36 SH000003-01 - Cross Survey Comparison of Informal Caregiving to the Disabled Elderly in the US

RAND-GIOVANNETTI, ERIN

Informal caregivers are a critical part of the long-term care system in the US. Public health surveillance of informal caregivers in the United States is necessary to promote healthy aging in the community, inform public support systems and research the economic cost of long-term care. However, the surveillance methods for studying caregivers vary widely. Published estimates of the number of informal caregivers in this country range from 3.5 million to 44.4 million. This wide variation in estimates stems largely from a lack of consensus in the field regarding the definition of caregiving. The nature, scope and impact of caregiving may be particularly underestimated in racially and ethnically diverse communities. This proposed dissertation research will review current methods used to study caregivers in national data sets and explore how differences in definition and survey design influence the estimated prevalence and profile of caregivers in the United States. To date no researcher has compared caregiving across data sets. Findings from this study will inform future research on how concept definition and survey design can affect caregiving research, and serve as a guide for the interpretation of research from current caregiver data sets. The first aim (1) is to describe methodological differences in national surveys of caregivers in the United States, including key issues in the definition of caregiving and survey design methodology. The second aim (2) is to examine the implication of survey design methodology on prevalence estimates in three major national surveys used for caregiving estimates, the National Long Term Care Survey, Health and Retirement Survey and Survey of Income and Program Participation, when definition is held constant. Particularly of interest is the impact of survey methodology on the prevalence estimates of particular subgroups within the national caregiving population (e.g. racial and ethnic minorities, young adults, and male caregivers). The third aim (3) is to investigate how different definitions of caregiver affect estimates of caregiver numbers and characteristics.

 

1 R36 SH000004-01 - Emergence of Disparities in US Mortality: A Focus on Prevention and Treatment

RUBIN, MARCIE S

As evidenced by Healthy People 2010's goal of eliminating health disparities, the large and persistent disparities in health in the United States (US) are an area of tremendous concern. Identifying health disparities and understanding their root causes are essential prerequisites for developing appropriate policy recommendations and designing effective interventions to address and prevent disparities. This proposal is designed to test a fundamental cause theory-driven approach to examine in detail the production of disparities in mortality over time in the US from HIV/AIDS and lung cancer. Fundamental cause theory holds that as the capacity to control disease and prevent death increases, this expanded capacity combines with existing social and economic inequalities to create health disparities by race and socioeconomic status (SES). Therefore, when new treatments, as in the case of HIV/AIDS, or new prevention strategies, as in the case of lung cancer, become available, it is predicted that these developments will disproportionately benefit those with better access to resources and therefore result in disparities. In contrast, the theory predicts no significant changes in disparities over time for diseases for which there is no new information or treatment. To test this theory, case studies of the following three categories of disease will be analyzed in detail: 1) HIV/AIDS, an infectious disease for which there have been major advances in treating disease and delay death, 2) lung cancer, a disease for which there have been major improvements in knowledge of how to prevent disease, and 3) pancreatic cancer, a disease for which there have been no major changes in prevention or treatment. Mortality data from the National Center for Health Statistics from 1968 to 2004 and county level census data from the same time period will be used to construct all-cause and cause-specific age-, sex-, and race- specific mortality rates for HIV/AIDS, lung cancer, pancreatic cancer for every county in the United States. County-level SES measures will be constructed for the decennial census from 1960 to 2000. These sources of data will be merged into a single data base and prepared for analysis. This project will generate several products to enhance public health: 1) the results from this study will help to further elucidate the causes of the development of disparities, 2) a series of policy recommendations will be developed based on the findings, and 3) the methods used to create the data base will be made available to other investigators.

1 R36 EH000291-01 - School Environmental Exposures and Measures of the Asthmatic Disease Process

SIDMAN, ELANOR A

This dissertation study will investigate whether school environmental exposures and building characteristics affect biochemical and clinical markers of disease activity in children with physician diagnosed asthma. A cohort of 65,100 elementary school aged children with asthma will be recruited through Group Health Cooperative, a regional non profit health maintenance organization. The children will be asked to provide exhaled breath samples and forced expiratory volume in 1 second (FEV1) measurements during a home visit and then twice during a single school visit. The breath samples will be analyzed for fractional exhaled nitric oxide (FENO), a sensitive and non invasive measure of lower airway inflammation. During the school visit, data on school environmental exposures and classroom and school building characteristics will be collected through a combination of direct sampling, measurements, and observation. Environmental exposures of primary interest include animal and pest allergens in settled dust, particulate matter d2.5< m, carbon dioxide (as a marker of ventilation adequacy), relative humidity, and observed moisture or mold. Associations between these exposures and changes in children's asthma health outcomes (FENO and FEV1) during the course of a school day (morning to afternoon) and between a weekend and a weekday will be examined. Similar analyses will investigate associations between a range of classroom and building features and these within child changes in health outcomes. School features will include type of heating, ventilation, and air conditioning systems, classroom construction materials, furnishings, decorations, instructional and cleaning supplies, and school building structure and location. In a subset of schools, selected environmental samples and measures will be repeated in additional classrooms during a follow up visit in order to collect data on variability of these environmental exposures in school settings.

 

1 R36 OH009402-01 - Effects of Secondary Occupational Pesticide Exposure on Childhood Growth

SUAREZ, JOSE R

Agriculture is the greatest source of pesticide exposure, and children of agricultural workers are at risk of pesticide contamination. Animal and human studies suggest that pesticide intoxication in early childhood delays growth and neurodevelopment; however, no research exists on the effects of secondary occupational pesticide exposure on child development, and remains a Public Health concern because of the high frequency of exposure worldwide. The proposed study will take place in the rural County of Pedro Moncayo, Ecuador, where 18% of adults work for the flower industry. This investigation will be the Doctoral Dissertation for the Epidemiology PhD degree that the Principal Investigator pursues. Its completion will additionally expand his practical skills to carryout interdisciplinary and intercultural research in underserved populations. The objective of the proposed investigation is to evaluate the effects of secondary occupational pesticide exposure on childhood growth and neurobehavioral development among children of flower plantation workers. The following hypotheses will be addressed: Compared to non-exposed children, exposed children will have 1) neurobehavioral delays, 2) slower growth, 3) smaller head circumferences, 4) lower acetylcholinesterase (AChE) levels (a marker of pesticide contamination), 5) higher systolic blood pressure and 6) lower resting heart rate. The feasibility of this study is enhanced by the availability of a cohort of children 5 years of age and younger, established in 2004 through the Survey of Access and Demand of Health Services in the County of Pedro Moncayo, Ecuador. This survey collected demographic, socio-economic and occupational information on approximately 70% of adults and growth data on 1414 children residing in the community. To address these hypotheses, the following specific aims will be accomplished: 1) Among the baseline (2004) study participants (children 5 years of age and younger), data will be analyzed for the relationship between secondary occupational pesticide exposure and child growth. 2) A sample of children from the cohort will be re- contacted and assessed for changes from 2004 in growth, and prevalent neurobehavioral development, head circumference, heart rate, blood pressure and blood acetylcholinesterase levels. 3) Subjects' parents will be interviewed to collect more occupational pesticide exposure information than what was available in 2004. The proposed study will, therefore, have 1) a 2004 cross-sectional component to assess growth, 2) a retrospective cohort component to assess growth by contrasting 2004 to 2007/2008 collected data and 3) a cross-sectional component in 2007/2008 to assess neurobehavioral development, neurobehavioral development, head circumference, heart rate, blood pressure and blood (fingerstick) AChE levels.

 

1 R36 CI000597-01 - Streptococcal pharyngitis in slum versus non-slum communities in Salvador Brazil

TARTOF, SARA

Streptococcal pharyngitis is the acute disease that precedes the chronic disease process of rheumatic heart disease (RHD). Recent studies have revealed that the microbiologic and epidemiologic features of RHD in tropical environments are distinct from those described in the literature, which are based mostly on studies from temperate zone communities. Whether these differences are due to temperate versus tropical environment, or the nature of community structures in the so-called tropical areas slum versus non- slum remains unknown. In Brazil, RHD appears to occur predominantly in populations that reside in urban slums (favelas). RHD epidemiology in slums may be very distinct from what is described in the literature. This may be due to structural, social or other aspects of slums. Effective prevention strategies depend on understanding the disease dynamics in a population. Therefore, this project seeks to study the early events that are known to be associated with the eventual outcome of RHD in these communities. Specifically, this project will compare the epidemiology and microbiology of streptococcal pharyngitis in contrasting populations- -slum versus non-slum--in the same urban center. Specific Aims: One aim of the CDC Health Protection Goal of Healthy People in a Healthy World is to prevent infectious diseases and their consequences. This study will help achieve this objective with the following studies: 1.) An assessment of the diversity and clonal composition of Group A Streptococcus isolates from pharyngitis (symptomatic) cases from favela and non-favela populations in the same urban setting in a developing country (Salvador, Brazil), and a comparison of these isolates with the population structure of GAS from an unrelated geographic setting in a developed country (Oakland, CA, USA); and 2.) An evaluation of the relative prevalence, proportion, and clonal composition of Group G Streptococcus (GGS) and Group C Streptococcus (GCS) from pharyngitis (symptomatic) cases in three populations: favela and non-favela populations in Salvador, Brazil; and a pediatric population in Oakland, CA, USA. Research Design and Methods: Streptococcal isolates will be collected from children aged 5-14 who present with pharyngitis to two clinics in Salvador, Brazil. One clinic serves a population with high socioeconomic status, and the other clinic serves a favela population. Isolates will be genotyped and analyzed for clonal diversity and serogroup with emm-typing, as well as multilocus sequence typing (MLST). Conclusion: By addressing these aims, this study will determine whether streptococcal pharyngitis in a slum population has patterns distinct from that described in the medical literature; and also from communities in the same city but which are not considered slums. Past literature has demonstrated that strain type (based on M surface protein) has important implications for development of RHD. It is important that we assess this known risk factor in a slum community at high risk for RHD.

 

1 R36 PS000844-01 - Rural/Urban Differences in Missed Opportunities to Identify HIV-Infected

WEIS, KRISTINA ERIN

Rural/Urban Differences in Missed Opportunities for Identification of HIV-Infected Individuals in South Carolina Transmission of human immunodeficiency virus (HIV) continues to be a problem in the US, even after years of research and prevention efforts. The Centers for Disease Control and Prevention (CDC) recently published new guidelines recommending routine HIV screening in healthcare settings for all individuals, regardless of risk. These changes are based on evidence that former guidelines for risk-based testing failed to identify a large proportion of HIV-infected individuals. Many are either diagnosed late or remain unaware of their infection because they are not being tested, even though they are accessing healthcare services many times prior to their diagnosis. These healthcare encounters represent missed opportunities for earlier identification of HIV infection. Increasing incidence of HIV in certain areas of the US is also a problem. Evidence shows that the South caries a disproportionate burden of HIV, which is concentrated in women and minorities, and in the rural areas of these states. Rural areas already face many unique health challenges, increasing the burden that HIV places on their healthcare systems. South Carolina (SC) offers a unique opportunity to study both the rural HIV/AIDS epidemic in the South and missed opportunities for identification of HIV-infected individuals. SC has consistently ranked in the top 10 nationwide for annual AIDS incidence since 1998. Furthermore, approximately 40% of the population of SC is rural. SC has a well-established HIV/AIDS Reporting System and a unique statewide healthcare discharge database. These databases will be used to link HIV diagnoses with prior healthcare encounters to investigate the main objectives for this study. The overall objectives are to assess whether degree of urbanization of an individual's place of residence at diagnosis leads to increased risk for being a late tester or an increased risk of missed opportunities for earlier HIV diagnosis. This proposal is in response to at least one of the CDC's Health Protection Goals, Healthy People in Every Stage of Life, as it investigates health disparities among HIV- infected rural residents of SC, of which a large majority are minorities.

 

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