Toward a Climate-Ready Health Care System: Institutional Motivators and Workforce Engagement.

Policy Points The US health care system faces mounting pressure to reduce greenhouse gas emissions and adapt to the impacts of climate change; motivated institutions and an engaged health care workforce are essential to the development, implementation, and maintenance of a climate-ready US health care system. Health care workers have numerous profession-specific and role-specific opportunities to address the causes and impacts of climate change. Policies must address institutional barriers to change and create incentives aligned with climate readiness goals. Institutions and individuals can support climate readiness by integrating content on the health care implications of climate change into educational curricula.

Advocating for Change to Meet the Developmental Needs of Young Children Experiencing Homelessness.

Young children experiencing homelessness are at considerable risk for developing physical and cognitive impairments, yet federal and state programs often overlook their needs. Although early intervention programs should serve as family-centered, health-promoting resources for families experiencing homelessness, many do not locate and comprehensively screen eligible children ages ≤3 yr in their communities. Occupational therapy practitioners have a role in advocating for improved access to high-quality, federally mandated programming for this population. They should be aware of the barriers faced by homeless families in accessing equitable early developmental services and of strategies to support individual families and communities experiencing homelessness.

A CLIMATE: A Tool for Assessment of Climate-Change-Related Health Consequences in the Emergency Department.

Climate change is an urgent public health problem that has looming implications and associated deleterious health consequences. The intersection of climate change and health has broad implications for health professionals in a variety of settings but especially for ED settings. Climate change is already affecting human health and health systems-which includes impacts on ED care. Disaster response and emergency preparedness are critically important public health interventions in our climate-changing world, and the contributions of emergency nurses are essential. Disaster preparedness, environmental emergency response, and health emergency management are important elements of emergency nursing and are explicated in Sheehy's Emergency Nursing Principles and Practices, 7th Edition. The purpose of this article is to present an overview of a clinical tool and mnemonic, A CLIMATE, developed by the authors with application to a case review. It is imperative that the nursing profession-particularly emergency clinicians-address the intersection of climate and health to engage in the assessment, intervention, management, evaluation, education, and referral of those who present to emergency departments with potential climate-related health impacts.

Social Support as a Predictor of Community Participation After Stroke.

Participation is a primary goal of neurorehabilitation; however, most individuals post stroke experience significant restrictions in participation as they attempt to resume their everyday roles and routines. Despite this emphasis on participation, there is a paucity of evidence-based interventions for optimizing this outcome and a limited understanding of factors that contribute to poor participation outcomes. Caregiver support at discharge from inpatient rehabilitation positively influences physical and psychological outcomes after stroke but more research is needed to understand the association between social support and participation. This study aimed to examine the independent contribution of perceived social support to participation 3 months post discharge from inpatient stroke rehabilitation. This study was a secondary analysis of the Stroke Recovery in Underserved Populations 2005-2006 data. Participants were adults ≥55 years old, living in the community 3 months post discharge from inpatient rehabilitation for ischemic stroke (n = 422). Hierarchical linear regressions were performed. The primary variables of interest were the PAR-PRO Measure of Home and Community Participation and the Duke-University of North Carolina Functional Social Support Questionnaire. Perceived social support at discharge from inpatient rehabilitation for ischemic stroke contributed uniquely to the variance in participation 3 months later (ß = 0.396, P < 0.001) after controlling for race, sex, age, years of education, comorbidities, stroke symptoms, depression, FIM Motor, and FIM Cognitive. Social support accounted for 12.2% of the variance in participation and was the strongest predictor of participation relative to the other independently significant predictors in the model including FIM Motor and depression. There is already a focus on caregiver training during inpatient rehabilitation related to basic self-care, transfers, and medical management. These findings suggest the need for rehabilitation professionals to also address social support during discharge planning in the context of promoting participation. Given the findings, expanding caregiver training is necessary but novel interventions and programs must be carefully developed to avoid increasing caregiver burden.

Adolescent fertility and religion in Rio de Janeiro, Brazil in the year 2000: the role of Protestantism.

Social transformations in Brazil in recent years have included a substantial increase in adolescent fertility, a dramatic rise in membership of Protestant religious denominations, and an accompanying decline in the number of Catholics. We used the 2000 Brazil Census to examine differentials in fertility and family formation among adolescents living in Rio de Janeiro by the following religious denominations: Catholic; Baptist; other mainline Protestant; Assembly of God Church; Universal Church of the Kingdom of God; other Pentecostal Protestant; and no religion. Results from logistic regression models show that the majority of the Protestants are at a lower risk of adolescent fertility than Catholics, and that among adolescents who have had a child, most Protestants are more likely than Catholics to be in a committed union. Our findings offer some support for the hypothesis that Protestant churches are more effective than the Catholic Church in discouraging premarital sexual relations and childbearing among adolescents.

Risk and protective factors among high school students on the US/Mexico border.

OBJECTIVE: To study risk and protective factors for alcohol-related problems among high schools students in El Paso, Tex. METHODS: A total of 1366 high school students from 16 different high schools in El Paso, Tex, participated in an anonymous questionnaire regarding alcohol use and alcohol-related behaviors. The sample was 70% Hispanic. RESULTS: Results showed that academic performance, peer influence, parental attitudes, and age at first consumption of alcohol were important predictors of drinking among border youth. CONCLUSION: Risk factors contribute to alcohol use among high school students.

Global geographic differences in marine metals toxicity.

Biochemical reaction rates, metabolic rates, and other rates of biological activity increase exponentially with temperature. It has thus been hypothesized that toxicity to chemical contaminants may increase from polar to temperate to tropical species; however, until recently, polar data to test this hypothesis were not available. This study examined differences in the acute sensitivities of marine invertebrates to four metals (Cu, Cd, Zn, Pb) for polar, temperate and tropical species; data deficiencies for polar regions prohibited comparisons using chronic end-points or other chemicals. Differences between the three geographic regions were not predictable based on temperature (other factors such as differences in dissolved organic carbon concentrations also affect toxicity). There appears to be no universal, predictable pattern of increased toxicity from polar to tropical regions. Toxicity data from one geographic region will not be universally protective of other regions.

Alcohol use and abuse by adolescents: the impact of living in a border community.

PURPOSE: To determine the rates of alcohol consumption and alcohol-related risk behaviors among a sample of high school students living on the U.S.-Mexico border, as well as to investigate factors associated with alcohol use among this population. METHODS: A self-administered anonymous questionnaire was administered to students in grades 9-12 during Fall and Spring semesters of 2001 (n = 1366; 639 males and 722 females) in 16 high schools in a community along the U.S.-Mexico border. The questionnaire addressed demographic factors, alcohol consumption, and alcohol-related behaviors. Surveys were completed by Chi-square tests for homogeneity of the odds ratio and logistic regression models were used to identify factors significantly associated with the outcome variables. RESULTS: Rates of binge drinking (45%), drinking and driving (19%), and riding with a driver who had been drinking (46%) were higher for our study population when compared with state and national rates. Students who consumed alcohol were more likely to report alcohol-related problems and lower academic grades. Drinking while in Mexico was significantly associated with binge drinking (OR = 6.44), drinking and driving (OR = 5.39), and riding with a driver who has been drinking (OR = 3.12). CONCLUSIONS: The high rates of alcohol risk behaviors among students living on the U.S.-Mexico border underscore the need to develop and implement culturally appropriate prevention programs that address alcohol consumption in Mexico, particularly in terms of students driving back home.

Increased risk of alcohol abuse among college students living on the US-Mexico border: implications for prevention.

Alcohol abuse is a serious problem for students on college campuses. The authors conducted a cross-sectional study to (1) compare measures of alcohol-risk behaviors among college students attending a university on the US-Mexico border with other students and (2) identify factors associated with risk behaviors among border students. They used a self-administered survey to collect data from 286 freshman and sophomore students. Rates of binge drinking were higher among study respondents than among respondents in a national survey of freshman and sophomore college students (46% vs 42% to 45%, respectively). Drinking in high school and drinking in Mexico were significantly associated with all outcomes (binge drinking, drinking and driving, and riding with a drinker). The findings underscore the need for targeted prevention programs among this high-risk population.

Frustrated demand for sterilization among low-income Latinas in El Paso, Texas.

CONTEXT: Sterilization is the most commonly used contraceptive in the United States, yet access to this method is limited for some. METHODS: A 2006-2008 prospective study of low-income pill users in El Paso, Texas, assessed unmet demand for sterilization among 801 women with at least one child. Multivariable logistic regression analysis identified characteristics associated with wanting sterilization. In 2010, at an 18-month follow-up, women who had wanted sterilization were recontacted; 120 semistructured and seven in-depth interviews were conducted to assess motivations for undergoing the procedure and the barriers faced in trying to obtain it. RESULTS: At baseline, 56% of women wanted no more children; at nine months, 65% wanted no more children, and of these, 72% wanted sterilization. Only five of the women interviewed at 18 months had undergone sterilization; two said their partners had obtained a vasectomy. Women who had not undergone sterilization were still strongly motivated to do so, mainly because they wanted no more children and were concerned about long-term pill use. Among women's reasons for not having undergone sterilization after their last pregnancy were not having signed the Medicaid consent form in time and having been told that they were too young or there was no funding for the procedure. CONCLUSIONS: Because access to a full range of contraceptive methods is limited for low-income women, researchers and providers should not assume a woman's current method is her method of choice.

Continuation of prescribed compared with over-the-counter oral contraceptives.

OBJECTIVE: To estimate differences in continuation of oral contraceptive pills (OCPs) between U.S. resident women obtaining pills in U.S. family planning clinics compared with over-the-counter in Mexican pharmacies. METHODS: In El Paso, Texas, we recruited 514 OCP users who obtained pills over the counter from a Mexican pharmacy and 532 who obtained OCPs by prescription from a family planning clinic in El Paso. A baseline interview was followed by three consecutive surveys over 9 months. We asked about date of last supply, number of pill packs obtained, how long they planned to continue use, and experience of side effects. Retention was 90%, with only 105 women lost to follow-up. RESULTS: In a multivariable Cox proportional hazards model, discontinuation was higher for women who obtained pills in El Paso clinics compared with those who obtained their pills without a prescription in Mexico (hazard ratio 1.6, 95% confidence interval [CI] 1.1-2.3). Considering the number of pill packs dispensed to clinic users, discontinuation rates were higher (hazard ratio 1.8, 95% CI 1.2-2.7) for clinic users who received one to five pill packs. However, there was no difference in discontinuation between clinic users receiving six or more pill packs and users obtaining pills without a prescription. CONCLUSION: Results suggest providing OCP users with more pill packs and removing the prescription requirement would lead to increased continuation.

Response accuracy of hazard identification in migrant farm workers.

This study assessed potential biases introduced by using maternal proxies for reporting work hazards, illness symptoms, and acute agricultural injuries in studies of migrant farmworker families. A convenience sample of 79 mother/spouse and mother/oldest child pairs was obtained from a two-year cohort study of migrant farmworker families from Starr County, Texas. Pairs completed an interviewer-administered survey including 27 close-ended items describing work history, illness symptoms, and acute injuries during the 2001 migration season. Data analysis included prevalence, sensitivity, and specificity measures. Maternal proxy reports of subjective symptoms of a spouse or child were approximately 50% lower than spouse or child self-reports. Sensitivity and specificity of mothers' responses regarding hazard items were higher for spouses than for children. For items measuring illness symptoms, sensitivity of mothers' responses for spouses and oldest child pairs was generally less than 30%; however, specificity was generally above 90%. For acute agricultural injury, the mother/spouse sensitivity was 75%, the mother/child 40%, and specificities were 100% and 97%, respectively. Sensitivity and specificity for mother/ spouse pairs was generally higher than mother/child pairs for work hazards, illness symptoms and acute injuries. While mothers may be acceptable proxies for spouses in this population, efforts should be made to collect data directly from adolescent children in studies of agricultural injuries.

Efficacy of a secondary adolescent pregnancy prevention program: an ecological study before, during and after implementation of the Second Chance Club.

Teen mothers are at increased risk of subsequent adolescent births. Interventions to reduce secondary teen pregnancies are expensive and difficult to evaluate. An ecological evaluation compared change in the repeat teen birth rate in an intervention community in Charleston, South Carolina over time to state birth certificate data to determine the efficacy of a school-based pregnancy prevention program. Evaluation included comparison of birth rates for multigravida teens in the program's school catchment area (intervention zip codes) to selected state and community data before, during and after program implementation. The intervention community demonstrated a decrease in repeat teen births during the intervention period of the program with a rebound after it was discontinued. This trend differed from a 50% linear decrease across these time periods in the state. This low cost evaluation method may be useful for evaluation of teen pregnancy prevention programs with limited resources for program evaluation.