Utility of Population Attributable Fraction Assessment in Guiding Interventions to Reduce Low Birthweight in the High-Altitude State of Colorado.

Objectives We evaluated the ability of population attributable fraction (PAF) assessments to alter significant modifiable risks for low birthweight (LBW) and the impact of high altitude as a risk for LBW in Colorado. Methods Logistic regression analysis of birth certificate parameters in 1995-1997 identified risk factors for PAF assessment. PAF for birth at high altitude, multiple births, and LBW in singleton births were determined. Subsequent analysis of singleton LBW risks, using number needed to treat (NNT) analysis, estimated how elimination of major modifiable risk factors could reduce LBW in the study population. Public health interventions were initiated and PAF analysis conducted 12 years afterward to determine the effect of interventions. Results PAF in singleton births revealed low maternal weight gain in pregnancy and maternal smoking as the greatest modifiable attributable risk factors for LBW (12.7/12.5 %, respectively, in 1995-1997 and 12.9/7.1 % in 2007-2009). Significant interaction between these variables resulted in PAF of 34.4 % when the two occurred together in 1995-1997, decreasing to 19.4 % in 2007-2009. NNT analysis of singleton births in 1995-1997 revealed that eliminating low maternal weight gain, smoking, late prenatal care in all women and interpregnancy intervals <1 year in multiparous women reduced LBW by 46.5 %. The respective proportional reductions in PAF of 40.3 and 46.3 % for maternal smoking and weight gain/smoking interaction were associated with a 1.4 % LBW reduction in singleton births between the two study periods. Conclusions for Practice PAF and NNT analyses are valuable tools to predict intervention targets to lower LBW.

Tools for identifying and prioritizing evidence-based obesity prevention strategies, Colorado.

Colorado's adult obesity rate has more than doubled since 1995, prompting its Department of Public Health and Environment to list obesity as its top prevention priority. To initiate comprehensive and effective action, the department used a well-known evidence-based public health framework developed by Brownson and others. This article describes the tools and process developed to conduct 2 of the 7 stages in this framework that challenge public health organizations: reviewing the literature and prioritizing effective strategies from that literature. Forty-five department staff participated in an intensive literature review training to identify physical activity and nutrition strategies that effectively address obesity and worked with external stakeholders to prioritize strategies for the state. Divided into 8 multidisciplinary teams organized by the setting where public health could exert leverage, they scanned the scientific literature to identify potential strategies to implement. These teams were trained to use standardized tools to critique findings, systematically abstract key information, and classify the evidence level for each of 58 identified strategies. Next, departmental subject matter experts and representatives from local public health and nonprofit health agencies selected and applied prioritization criteria to rank the 58 strategies. A team charter, group facilitation tools, and 2 web-based surveys were used in the prioritization stage. This process offered the staff a shared experience to gain hands-on practice completing literature reviews and selecting evidence-based strategies, thereby enhancing Colorado's obesity prevention efforts and improving public health capacity. Practitioners can use these tools and methodology to replicate this process for other health priorities.

Behavioral risks for West Nile virus disease, northern Colorado, 2003.

In 2003, residents in 2 adjacent cities in northern Colorado (Loveland and Fort Collins) had severe outbreaks of human West Nile virus (WNV) disease. Unexpectedly, age-adjusted neuroinvasive disease rates were higher in Loveland (38.6 vs. 15.9 per 100,000), which had a more extensive mosquito control program and fewer mosquitoes. A survey was conducted to assess differences in personal protection and risk practices by each city's residents. During May and June 2004, a random-digit dial telephone survey was conducted among adults to assess personal protection behavioral practices used to prevent WNV infection during the 2003 outbreak. After we adjusted for identified risk factors, Loveland residents were 39% more likely to report seldom or never using N,N-diethyl-m-toluamide (DEET), and approximately 30% were more likely to report being outdoors during prime mosquito-biting hours than Fort Collins residents. Personal protective practices may directly influence rates of WNV infection and remain important even when comprehensive community mosquito control measures are implemented.

Sex differences in mortality after traumatic brain injury, Colorado 1994-1998.

PRIMARY OBJECTIVE: The purpose of this study was to assess the relationship between sex and traumatic brain injury (TBI) mortality. METHODS AND PROCEDURES: A total of 20,465 persons with TBI were identified from a Colorado population-based surveillance system for 1994-1998. Case fatality ratios were calculated to identify sex differences for selected risk factors. Unconditional logistic regression was used to determine the relationship between TBI mortality and sex controlling for risk factors. MAIN OUTCOMES AND RESULTS: Adjusting for age, race, metropolitan residence and penetrating injury, the estimated odds of TBI mortality for males compared to females was 1.21 (95% CI 1.10, 1.34) for pre-hospital fatalities and 1.19 (95% CI 1.05, 1.37) for hospital fatalities. CONCLUSION: Results indicate differences in TBI mortality comparing males and females. Future studies are warranted to identify if behaviour and physiological responses are associated with TBI outcomes among males and females.