Pneumococcal and Meningococcal Vaccination among Michigan Children with Sickle Cell Disease.

OBJECTIVES: To determine the proportion of Michigan children with sickle cell disease (SCD) who were vaccinated according to pneumococcal vaccination recommendations and, secondarily, to examine uptake of meningococcal vaccine, and to compare up-to-date (UTD) vaccination status between children with and without SCD. STUDY DESIGN: Children with SCD who were born in Michigan were matched to controls without SCD using age, sex, race, and zip code. Using data from the state immunization registry, we assessed the significance of SCD status on UTD vaccination in logistic regression models. RESULTS: By 36 months, substantially more children with SCD had completed the pneumococcal conjugate vaccine series (68.8%) than children without SCD (45.2%), and 59% of children with SCD had received a meningococcal vaccine. Compared with children without SCD, children with SCD had higher odds of UTD pneumococcal status at 5, 7, and 16 months. However, a large proportion of children with SCD were missing key vaccination targets: of those who received a full 7-valent pneumococcal conjugate vaccine series, 29.1% had not received a 13-valent pneumococcal conjugate vaccine dose, and 21.8% had not had pneumococcal polysaccharide vaccine administered. CONCLUSIONS: The pneumococcal and meningococcal vaccination schedules have become increasingly complex in recent years. Assessment algorithms programmed to forecast doses due based on high-risk conditions, such as SCD, could provide a useful reminder to healthcare providers in the context of increasingly complex and changing recommendations.

An examination of EPPM predictions when threat is perceived externally: an asthma intervention with school workers.

Little research informs the use of the Extended Parallel Process Model (EPPM) of persuasion when threat and efficacy judgments are rendered for someone other than the message recipient. Nevertheless, a wide range of health promotion consists of influencing such judgments. Two studies examine the utility of using the EPPM in a context involving threats to others. Results show that the expected measurement models hold in this new context, and that an additive model is a stronger fit than a multiplicative one when considering how threat and efficacy combine to affect behavioral intentions but not when considering behavior. The study also examines the effects of a print intervention implemented with school employees in Michigan derived from the EPPM. The results are discussed in terms of their theoretical import and their application in this new context.

A review of potential state and local policies to reduce asthma disparities.

Although policies promoting asthma-friendly communities should reduce asthma disparities, not much is known about the status of policy implementation or effectiveness. We review the efforts of state and local agencies to identify and target asthma disparities for reduction, as evidenced by written laws and policy documents and use of funding. Policies targeting health care, homes, schools, and workplaces hold promise for creating asthma-friendly communities; however, the scope and reach of these activities must be increased to have statewide or national impact. In addition, there is a general lack of systematic review of evidence about the institutionalization of successful demonstration programs into policy.

Investigating asthma deaths among children and young adults: Michigan Asthma Mortality Review.

OBJECTIVE: We developed a surveillance system to investigate asthma deaths in children and young adults. METHODS: A rapid asthma death notification and investigation system for Michigan was developed to identify interventions to prevent future deaths among people aged 2-34 years. Multidisciplinary panels to determine causal factors and recommend preventative actions reviewed information from death certificates, autopsies, next-of-kin interviews, and medical records. An annual report was disseminated to public health workers, health-care providers, insurers, and others. RESULTS: Eighty-six asthma deaths in Michigan residents, aged 2-34, occurred from 2002-2004. Sixty-one next of kin were interviewed and medical records were obtained for 84 of the deceased. Summaries were prepared on each of the deceased and were reviewed by expert panels, which reached consensus on causal factors and potential preventive action for each death. Each year an annual report, which summarized the causal factors and potential preventive activity, was prepared. CONCLUSION: This review has informed and catalyzed interventions to improve asthma care and management in Michigan. Factors leading to the review's success and future activities are discussed.

Pediatric asthma surveillance using Medicaid claims.

OBJECTIVE: The purpose of this study was to describe the prevalence of asthma among children using alternative case definitions applied to administrative claims data, and to assess year-to-year classification concordance. METHODS: This study was a retrospective cohort analysis of 357,729 children 0-18 years using 2001-2002 Michigan Medicaid claims. Asthma cases were classified using six alternative definitions based on outpatient, emergency department, inpatient, and pharmacy claims for asthma, including the Health Plan Employer Data Information Set (HEDIS) persistent asthma criteria commonly used for assessments of asthma health care quality: at least one asthma inpatient admission or emergency department visit, four or more asthma medications events, or four asthma outpatient visits and two asthma medication events. RESULTS: Overall, asthma prevalence varied widely between alternative case definitions, ranging from 14.9% based on claims evidence of any type of asthma utilization to 3.7% when restricted to those with four or more asthma medication dispensing events. Among cases meeting HEDIS persistent asthma criteria in 2001, 55.5% met these criteria in 2002. Those with four or more asthma medication dispensing events had the best overall classification concordance between 2001 and 2002. Utilization of asthma services and prevalence estimates were highest among children younger than 5 years old, but year-to-year classification concordance was poorest among these cases (p < 0.0001), irrespective of case definition. CONCLUSIONS: While overall asthma prevalence may remain relatively stable from year to year, individuals may not be classified consistently as cases over time, regardless of case definition. Studies that identify asthma cases in one year and assess asthma outcomes in a subsequent year may introduce substantial bias as a result of case misclassification. Among the case definitions considered in this study, our findings suggest that this bias is minimized among cases classified using the four or more asthma medication dispensing events criterion.

The impact of dog walking on leisure-time physical activity: results from a population-based survey of Michigan adults.

BACKGROUND: The extent to which dog walking promotes leisure-time physical activity (LTPA) remains unresolved. We describe the characteristics of people who walk their dog, and assess the impact on LTPA. METHODS: Information on dog ownership, dog walking patterns, total walking activity and LTPA were assessed in the 2005 Michigan Behavioral Risk Factor Survey. Multiple logistic regression was used to generate adjusted odds ratios (AOR) for the effect of dog walking on total walking and LTPA. RESULTS: Of 5902 respondents 41% owned a dog, and of these, 61% walked their dog for at least 10 minutes at a time. However, only 27% walked their dog at least 150 minutes per week. Dog walking was associated with a significant increase in walking activity and LTPA. Compared with non-dog owners, the odds of obtaining at least 150 minutes per week of total walking were 34% higher for dog walkers (AOR = 1.34, 95% CI = 1.13 to 1.59), and the odds of doing any LTPA were 69% higher (AOR = 1.69, 95% CI = 1.33 to 2.15). CONCLUSIONS: Dog walking was associated with more walking and LTPA, however a substantial proportion of dog owners do not walk their dog. The promotion of dog walking could help increase LTPA.