Improving Sexual Assault and Sexual Harassment Prevention from the Bottom-up: a Pilot of Getting To Outcomes in the US Military.

While the Department of Defense (DoD) has given increased attention and priority to preventing sexual assault and sexual harassment (SA/SH), it remains a problem. To build its prevention capacity, DoD piloted Getting To Outcomes® (GTO®) from 2019 to 2022 at 10 military installations. GTO is an evidence-based planning and implementation support that has been used in many civilian contexts but has only recently been adapted for military SA/SH. The purpose of this study was to describe GTO use, identify its benefits and challenges, and discuss lessons the GTO effort yielded for prevention more broadly using a framework of organizational and program-level capacities needed for successful prevention in the military context, called the Prevention Evaluation Framework (PEF). GTO was piloted with 10 military installations ("sites") representing all Military Services, plus the Coast Guard and National Guard. GTO is comprised of a written guide, training, and ongoing coaching. The pilot's goal was for each site to use GTO to implement a SA/SH prevention program twice. Participants from each site were interviewed and data was collected on GTO steps completed, whether GTO spurred new evaluation activities and collaborations, and the degree of leadership support for GTO. Most sites completed all GTO steps at least once. Interviews showed that DoD participants believe GTO improved prevention understanding, planning, and evaluation capacity; strengthened confidence in chosen programs; and helped sites tailor programs to the military context. Barriers were the complexity of GTO, DoD personnel turnover, and the disruption that the COVID pandemic caused in sexual assault prevention program delivery. Many respondents were unsure if they would continue all of GTO after the coaching ended, but many believed they would continue at least some parts. According to the PEF, the GTO pilot revealed several additional prevention system gaps (e.g., need for leadership support) and changes needed to GTO (e.g., stronger leader and champion engagement), to support quality prevention. The military and other large organizations will need to focus on these issues to ensure prevention implementation and evaluation are conducted with quality.

Child Maltreatment: A Comparison of Wisconsin Children Identified in Health Care and Child Protective Services (CPS) Records, 2018-2019.

CONTEXT: Child Protective Services (CPS) reports and health records (hospital inpatient and emergency department visits) are the primary data sources to measure child maltreatment; yet, they are not linked at the state or national level. Linking provides novel insight into the demographic characteristics of the populations served by one or both agencies, thus informing opportunities for prevention and intervention. OBJECTIVE: This study compares children identified as maltreated in health records (based on International Classification of Diseases, Tenth Revision, Clinical Modification [ ICD-10-CM ] codes indicating suspected or confirmed child maltreatment) and/or CPS reports. DESIGN: Three mutually exclusive comparison groups were created: group 1- children with a nonfatal hospitalization and/or emergency department visit with a maltreatment ICD-10-CM code and an investigated CPS report; group 2- children with a maltreatment ICD-10-CM code in a health record without an investigated CPS report; and group 3- children with an investigated CPS report without a health record with a maltreatment ICD-10-CM code. Descriptive statistics and tests for statistically significant differences were conducted. SETTING AND PARTICIPANTS: Wisconsin children with maltreatment ICD-10-CM code in health record and/or CPS-investigated report from 2018 to 2019. MAIN OUTCOME MEASURE: Demographic and maltreatment type differences between groups. RESULTS: Group 1 children were significantly younger than those in other groups ( P <. 001), and group 2 children were significantly more female (69.6%; P < .001). Black children were overrepresented in all groups and most disproportionate among group 1 (39.5%; P < .001). Maltreatment type also differed significantly across groups. CONCLUSIONS: CPS staff and health providers encounter overlapping and nonoverlapping populations of children experiencing different types of maltreatment. Although interventions may be tailored toward the type of maltreatment and other relevant child characteristics, all populations could benefit from referrals and access to supportive social services. Agency contact provides an opportunity to intervene and support at-risk children and families.

Increased Alcohol-Related Mortality in Wisconsin Pre-COVID: A Two-Decade Trend.

INTRODUCTION: Alcohol-related mortality is increasing nationally, but state-specific trends still need to be explored. This paper reviews the patterning of alcohol-related deaths among Wisconsin residents in the 2 decades prior to the COVID-19 pandemic. METHODS: Data are from death certificates for state residents from 2000 through 2019. We used underlying cause of death codes (ICD-10) to classify deaths as 100% attributable to alcohol (ie, acute, chronic liver, and other chronic). Demographic characteristics were available for the most recent decedents (2015-2019). We assess trends in alcohol-related mortality and used chi-square tests to assess demographic differences compared to deaths from all other causes. RESULTS: The number of alcohol-related deaths more than doubled from 2000 through 2019 in Wisconsin, rising from 394 in 2000 to 857 in 2019. In the 5 most recent years (2015-2019), the populations with significantly higher rates of alcohol-related deaths included men, middle-aged adults, Black residents, and those of Hispanic descent. Education level also was significantly related to alcohol-attributable mortality, as those with the highest and lowest education levels were the least likely to die from this cause. DISCUSSION/CONCLUSIONS: Results of these analyses show that the number of deaths due to alcohol-related diseases has risen significantly since 2000, and this trend preceded the COVID-19 pandemic. These rising mortality rates deserve the attention of the medical and public health communities. Our findings show that, in recent years, Hispanic individuals, men, and middle-aged adults are at a higher risk for alcohol-related deaths. Stakeholders may wish to consider interventions targeted to these groups.

Self-harm injury hospitalisations: an analysis of case selection criteria.

BACKGROUND: This study explores the impact of using different criteria to identify nonfatal hospitalisations with self-harm injuries using 2017-2018 Wisconsin discharge data. METHODS: Using International Classification of Diseases, 10th Revision, Clinical Modification codes, we classified records by three mutually exclusive selection criteria: subset A--principal diagnosis of injury, and any code for self-harm, initial encounter only; subset B--non-injury principal diagnosis, and any code for self-harm, initial encounter only; subset C--any principal diagnosis, and any code for self-harm, subsequent and sequelae encounters only. These categories were used to conduct two separate logistic regression models. Model 1 analysed the impact of surveillance limited to a principal diagnosis of injury, initial self-harm encounter (subset B compared with A). Model 2 analysed the impact if limited to initial encounters for self-harm, regardless of principal diagnosis (subset C compared with (A+B)). Both patient-level and visit-level analyses were conducted. RESULTS: For both patient-level models, subsets that included additional records based on an expansion of selection criteria were significantly more likely to include children (model 1: OR 2.8, model 2: OR 2.9; compared with those 25-54 years), those with mental health disorders (model 1: OR 6.5, model 2: OR 4.3) and rural residents (model 1: OR 1.2, model 2: OR 1.4). Drug-related disorder and means of self-harm were significantly different among subsets for both models. Visit-level analyses revealed similar results. DISCUSSION: Expanding case selection criteria would better capture the scale of hospitalisation for nonfatal self-harm. Using restrictive selection criteria may result in biased understanding of the affected populations, potentially impacting the development of policy and prevention programmes.

Assessment of racial and ethnic bias in autism spectrum disorder prevalence estimates from a US surveillance system.

This study assessed potential under-ascertainment of autism spectrum disorder due to missing administrative information for Hispanic and non-Hispanic Black children within the Autism and Developmental Disabilities Monitoring Network. We analyzed data from two Network sites (Colorado and Wisconsin) for surveillance years 2012 and 2014 to determine whether children excluded from autism spectrum disorder prevalence estimates due to missing residency and other information differed from those included by race and ethnicity. We used multiple approaches to impute missing information to evaluate impacts on racial and ethnic disparities in autism spectrum disorder prevalence. Compared with confirmed autism spectrum disorder cases, those excluded due to missing residency were more than twice as likely to be Hispanic (19% vs 44%; p < 0.002), yet the number of cases excluded due to missing residency information was too small to account for prevalence differences. Confirmation of autism spectrum disorder case status was more likely for children with relevant health records than for those with school records only. Moreover, relevant health records were more likely to be missing for Black and Hispanic children than for White children. Observed disparities in autism spectrum disorder prevalence were not accounted for by missing demographic data, but may reflect disparities in healthcare access for developmental evaluations.

Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2014.

PROBLEM/CONDITION: Autism spectrum disorder (ASD). PERIOD COVERED: 2014. DESCRIPTION OF SYSTEM: The Autism and Developmental Disabilities Monitoring (ADDM) Network is an active surveillance system that provides estimates of the prevalence of autism spectrum disorder (ASD) among children aged 8 years whose parents or guardians reside within 11 ADDM sites in the United States (Arizona, Arkansas, Colorado, Georgia, Maryland, Minnesota, Missouri, New Jersey, North Carolina, Tennessee, and Wisconsin). ADDM surveillance is conducted in two phases. The first phase involves review and abstraction of comprehensive evaluations that were completed by professional service providers in the community. Staff completing record review and abstraction receive extensive training and supervision and are evaluated according to strict reliability standards to certify effective initial training, identify ongoing training needs, and ensure adherence to the prescribed methodology. Record review and abstraction occurs in a variety of data sources ranging from general pediatric health clinics to specialized programs serving children with developmental disabilities. In addition, most of the ADDM sites also review records for children who have received special education services in public schools. In the second phase of the study, all abstracted information is reviewed systematically by experienced clinicians to determine ASD case status. A child is considered to meet the surveillance case definition for ASD if he or she displays behaviors, as described on one or more comprehensive evaluations completed by community-based professional providers, consistent with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) diagnostic criteria for autistic disorder; pervasive developmental disorder-not otherwise specified (PDD-NOS, including atypical autism); or Asperger disorder. This report provides updated ASD prevalence estimates for children aged 8 years during the 2014 surveillance year, on the basis of DSM-IV-TR criteria, and describes characteristics of the population of children with ASD. In 2013, the American Psychiatric Association published the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which made considerable changes to ASD diagnostic criteria. The change in ASD diagnostic criteria might influence ADDM ASD prevalence estimates; therefore, most (85%) of the records used to determine prevalence estimates based on DSM-IV-TR criteria underwent additional review under a newly operationalized surveillance case definition for ASD consistent with the DSM-5 diagnostic criteria. Children meeting this new surveillance case definition could qualify on the basis of one or both of the following criteria, as documented in abstracted comprehensive evaluations: 1) behaviors consistent with the DSM-5 diagnostic features; and/or 2) an ASD diagnosis, whether based on DSM-IV-TR or DSM-5 diagnostic criteria. Stratified comparisons of the number of children meeting either of these two case definitions also are reported. RESULTS: For 2014, the overall prevalence of ASD among the 11 ADDM sites was 16.8 per 1,000 (one in 59) children aged 8 years. Overall ASD prevalence estimates varied among sites, from 13.1-29.3 per 1,000 children aged 8 years. ASD prevalence estimates also varied by sex and race/ethnicity. Males were four times more likely than females to be identified with ASD. Prevalence estimates were higher for non-Hispanic white (henceforth, white) children compared with non-Hispanic black (henceforth, black) children, and both groups were more likely to be identified with ASD compared with Hispanic children. Among the nine sites with sufficient data on intellectual ability, 31% of children with ASD were classified in the range of intellectual disability (intelligence quotient [IQ] <70), 25% were in the borderline range (IQ 71-85), and 44% had IQ scores in the average to above average range (i.e., IQ >85). The distribution of intellectual ability varied by sex and race/ethnicity. Although mention of developmental concerns by age 36 months was documented for 85% of children with ASD, only 42% had a comprehensive evaluation on record by age 36 months. The median age of earliest known ASD diagnosis was 52 months and did not differ significantly by sex or race/ethnicity. For the targeted comparison of DSM-IV-TR and DSM-5 results, the number and characteristics of children meeting the newly operationalized DSM-5 case definition for ASD were similar to those meeting the DSM-IV-TR case definition, with DSM-IV-TR case counts exceeding DSM-5 counts by less than 5% and approximately 86% overlap between the two case definitions (kappa = 0.85). INTERPRETATION: Findings from the ADDM Network, on the basis of 2014 data reported from 11 sites, provide updated population-based estimates of the prevalence of ASD among children aged 8 years in multiple communities in the United States. The overall ASD prevalence estimate of 16.8 per 1,000 children aged 8 years in 2014 is higher than previously reported estimates from the ADDM Network. Because the ADDM sites do not provide a representative sample of the entire United States, the combined prevalence estimates presented in this report cannot be generalized to all children aged 8 years in the United States. Consistent with reports from previous ADDM surveillance years, findings from 2014 were marked by variation in ASD prevalence when stratified by geographic area, sex, and level of intellectual ability. Differences in prevalence estimates between black and white children have diminished in most sites, but remained notable for Hispanic children. For 2014, results from application of the DSM-IV-TR and DSM-5 case definitions were similar, overall and when stratified by sex, race/ethnicity, DSM-IV-TR diagnostic subtype, or level of intellectual ability. PUBLIC HEALTH ACTION: Beginning with surveillance year 2016, the DSM-5 case definition will serve as the basis for ADDM estimates of ASD prevalence in future surveillance reports. Although the DSM-IV-TR case definition will eventually be phased out, it will be applied in a limited geographic area to offer additional data for comparison. Future analyses will examine trends in the continued use of DSM-IV-TR diagnoses, such as autistic disorder, PDD-NOS, and Asperger disorder in health and education records, documentation of symptoms consistent with DSM-5 terminology, and how these trends might influence estimates of ASD prevalence over time. The latest findings from the ADDM Network provide evidence that the prevalence of ASD is higher than previously reported estimates and continues to vary among certain racial/ethnic groups and communities. With prevalence of ASD ranging from 13.1 to 29.3 per 1,000 children aged 8 years in different communities throughout the United States, the need for behavioral, educational, residential, and occupational services remains high, as does the need for increased research on both genetic and nongenetic risk factors for ASD.

Autism Spectrum Disorder Among US Children (2002-2010): Socioeconomic, Racial, and Ethnic Disparities.

OBJECTIVES: To describe the association between indicators of socioeconomic status (SES) and the prevalence of autism spectrum disorder (ASD) in the United States during the period 2002 to 2010, when overall ASD prevalence among children more than doubled, and to determine whether SES disparities account for ongoing racial and ethnic disparities in ASD prevalence. METHODS: We computed ASD prevalence and 95% confidence intervals (CIs) from population-based surveillance, census, and survey data. We defined SES categories by using area-level education, income, and poverty indicators. We ascertained ASD in 13 396 of 1 308 641 8-year-old children under surveillance. RESULTS: The prevalence of ASD increased with increasing SES during each surveillance year among White, Black, and Hispanic children. The prevalence difference between high- and low-SES groups was relatively constant over time (3.9/1000 [95% CI = 3.3, 4.5] in 2002 and 4.1/1000 [95% CI = 3.6, 4.6] in the period 2006-2010). Significant racial/ethnic differences in ASD prevalence remained after stratification by SES. CONCLUSIONS: A positive SES gradient in ASD prevalence according to US surveillance data prevailed between 2002 and 2010, and racial and ethnic disparities in prevalence persisted during this time among low-SES children.

Levels of persistent contaminants in relation to fish consumption among older male anglers in Wisconsin.

Fish are an important source of nutrients which may reduce risk of adverse health outcomes such as cardiovascular disease; however, fish may also contain significant amounts of environmental pollutants such as mercury, polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs), and perfluorinated compounds (PFCs, also called perfluoroalkyl compounds), which confer increased risk for adverse health effects. The Wisconsin Departments of Health Services and Natural Resources developed a survey instrument, along with a strategy to collect human biological samples to assess the risks and benefits associated with long-term fish consumption among older male anglers in Wisconsin. The target population was men aged 50 years and older, who fish Wisconsin waters and live in the state of Wisconsin. Participants provided blood and hair samples and completed a detailed (paper) questionnaire, which included questions on basic demographics, health status, location of catch and species of fish caught/eaten, consumption of locally caught and commercially purchased fish, and awareness and source of information for local and statewide consumption guidelines. Biological samples were used to assess levels of PCBs, PBDEs, PFCs (blood), and mercury (hair and blood). Quantile regression analysis was used to investigate the associations between biomarker levels and self-reported consumption of fish from the Great Lakes and other areas of concern, other locally caught fish, and commercially purchased fish (meals per year). Respondents had a median age of 60.5 (interquartile range: 56, 67) years. The median fish consumption was 54.5 meals per year, with most fish meals coming from locally-caught fish. Participants had somewhat higher mercury levels compared with the US general population, while levels of other contaminants were similar or lower. Multivariate regression models showed that consumption of fish from the Great Lakes and areas of concern was associated with higher levels of each of the contaminants with the exception of PBDEs, as was consumption of locally caught fish from other water bodies. All commercial fish consumption was also associated with both hair and blood mercury. When looking at specific PCB, PBDE and PFC analytes, consumption of fish from the Great Lakes and areas of concern was associated with higher levels of each of the individual PCB congeners examined, as well as higher levels of all of the PFCs examined, with the exception of PFHxS. Among the PFCs, locally caught fish from other water bodies was also associated with higher levels of each of the congeners examined except PFHxS. Finally, all commercial fish was associated with higher levels of PFHxS.

Levels of nutrients in relation to fish consumption among older male anglers in Wisconsin.

Fish is an important source of nutrients including omega-3 fatty acids, which may reduce risk of adverse health outcomes such as cardiovascular disease; however, fish may also contain significant amounts of environmental pollutants. The Wisconsin Departments of Health Services and Natural Resources developed a survey instrument, along with a strategy to collect human biological samples to assess the risks and benefits associated with long-term fish consumption among older male anglers in Wisconsin. The target population was men aged 50 years and older, who fish Wisconsin waters and live in the state of Wisconsin. Participants provided blood and hair samples and completed a detailed (paper) questionnaire, which included questions on basic demographics, health status, location of catch and species of fish caught/eaten, consumption of locally caught and commercially purchased fish, and awareness and source of information for local and statewide consumption guidelines. Biological samples were used to assess levels of docosahexaenoic acid (DHA), docosapentaenoic acid (DPA), eicosapentaenoic acid (EPA); vitamin D; and selenium in blood. Quantile regression analysis was used to investigate the associations between biomarker levels and self-reported consumption of fish from the Great Lakes and other areas of concern, other locally caught fish, and commercially purchased fish (meals per year). Respondents were largely non-Hispanic white men in their 60's with at least some college education, and about half were retired. Fish consumption was high (median of 54.5 meals per year), with most fish meals coming from locally-caught fish. Multivariate regression models showed that the effect of supplement use was much greater than that of fish consumption, on nutrient levels, although consumption of fish from the Great Lakes and areas of concern was significantly associated with higher levels of vitamin D even after controlling for supplement usage.

Quantile regression in environmental health: Early life lead exposure and end-of-grade exams.

Conditional means regression, including ordinary least squares (OLS), provides an incomplete picture of exposure-response relationships particularly if the primary interest resides in the tail ends of the distribution of the outcome. Quantile regression (QR) offers an alternative methodological approach in which the influence of independent covariates on the outcome can be specified at any location along the distribution of the outcome. We implemented QR to examine heterogeneity in the influence of early childhood lead exposure on reading and math standardized fourth grade tests. In children from two urban school districts (n=1,076), lead exposure was associated with an 18.00 point decrease (95% CI: -48.72, -3.32) at the 10th quantile of reading scores, and a 7.50 point decrease (95% CI: -15.58, 2.07) at the 90th quantile. Wald tests indicated significant heterogeneity of the coefficients across the distribution of quantiles. Math scores did not show heterogeneity of coefficients, but there was a significant difference in the lead effect at the 10th (ß=-17.00, 95% CI: -32.13, -3.27) versus 90th (ß=-4.50, 95% CI: -10.55, 4.50) quantiles. Our results indicate that lead exposure has a greater effect for children in the lower tail of exam scores, a result that is masked by conditional means approaches.

Evaluating the impact of getting to outcomes-underage drinking on prevention capacity and alcohol merchant attitudes and selling behaviors.

Underage drinking is a significant problem facing US communities. Several environmental alcohol prevention (EAP) strategies (laws, regulations, responsible beverage service training and practices) successfully address underage drinking. Communities, however, face challenges carrying out these EAP strategies effectively. This small-scale, 3-year, randomized controlled trial assessed whether providing prevention coalitions with Getting To Outcomes-Underage Drinking (GTO-UD), a tool kit and implementation support intervention, helped improve implementation of two common EAP strategies, responsible beverage service training (RBS) and compliance checks. Three coalitions in South Carolina and their RBS and compliance check programs received the 16-month GTO-UD intervention, including the GTO-UD manual, training, and onsite technical assistance, while another three in South Carolina maintained routine operations. The measures, collected at baseline and after the intervention, were a structured interview assessing how well coalitions carried out their work and a survey of merchant attitudes and practices in the six counties served by the participating coalitions. Over time, the quality of some RBS and compliance check activities improved more in GTO-UD coalitions than in the control sites. No changes in merchant practices or attitudes significantly differed between the GTO-UD and control groups, although merchants in the GTO-UD counties did significantly improve on refusing sales to minors while control merchants did not.

Moderate lead exposure and elementary school end-of-grade examination performance.

PURPOSE: This study investigated the association between moderate lead poisoning in early childhood with performance on a comprehensive set of end-of-grade examinations at the elementary school level in two urban school districts. METHODS: Children born between 1996 and 2000 who resided in Milwaukee or Racine, WI, with a record of a blood lead test before the age of 3 years were considered for the analysis. Children were defined as exposed (blood lead level ≥10 and <20 µg/dL) or not exposed (BLL < 5 µg/dL). Parents of eligible children were mailed surveys to consent to participation and elicit information on potential confounders. On consent, children were matched to educational records for fourth grade Wisconsin Knowledge and Concepts Examinations. Seemingly unrelated regression was used to evaluate the relation between scaled scores on all sections of the examination (math, reading, language arts, science, and social studies) with exposure status, controlling for demographics, social status indicators, health indicators, and district-based poverty indicators. RESULTS: A total of 1133 families responded to the survey and consented to have educational records released; 43% of children were considered exposed. After controlling for demographic and socioeconomic covariates, lead exposure was associated with significantly lower scores in all sections of the Wisconsin Knowledge and Concepts Examinations (range: science, ß = -5.21, P = .01; reading, ß = -8.91, P = .003). Children who were black, had a parent with less than a high-school education, and were classified by parents as having less than excellent health had significantly lower performance on all examination components. CONCLUSIONS: Children with moderate lead poisoning in early childhood performed significantly lower on all components of elementary school end-of-grade examinations compared with unexposed children. Household level social status and childhood health indicators partially explain decreased examination scores.

Early lead exposure (<3 years old) prospectively predicts fourth grade school suspension in Milwaukee, Wisconsin (USA).

School suspensions are associated with negative student outcomes. Environmental lead exposure increases hyperactivity and sensory defensiveness, two traits likely to increase classroom misbehavior and subsequent discipline. Childhood Blood Lead Level (BLL) test results categorized urban fourth graders as exposed (2687; lifetime max BLL 10-20 µg/dL) or unexposed (1076; no lifetime BLL ≥5 µg/dL). Exposed children were over twice as likely as unexposed children to be suspended (OR=2.66, 95% CI=[2.12, 3.32]), controlling for covariates. African American children were more likely to be suspended than white children, but lead exposure explained 23% of the racial discipline gap. These results suggest that different rates of environmental lead exposure may contribute to the racial discipline gap.

Fish consumption and advisory awareness among older Wisconsin fishermen.

OBJECTIVES: The provision of fish consumption advice issued by the Wisconsin Department of Health Services (DHS) and Department of Natural Resources (DNR) has evolved over the past 40 years. In 2010, DHS received a US Environmental Protection Agency Great Lakes Restoration Initiative (GLRI) grant to evaluate existing advisory approaches, identify gaps, and adapt current communication approaches. METHODS: Previous research conducted by DHS found that older, male anglers eat more sport fish and have higher body burdens of persistent contaminants found in fish than other groups. As part of the GLRI, Wisconsin DHS and DNR aimed to engage this subpopulation and improve communication by using an Internet-based survey to collect information about fishing habits, consumption, and advisory awareness. At the end of the survey, participants were provided with answers to advisory questions and links to relevant online information. From fall 2011 through spring 2012, 827 men aged 50 and older completed this survey. RESULTS: Nearly all fishermen were aware of the existence of consumption advisories. Although awareness was high, penetration of traditional outreach materials was low with fewer than 35% having seen any of the pamphlets featured in the survey. Knowledge of the advisories was significantly higher among residents of counties along Lakes Michigan and Superior and among more frequent sport fish consumers. Men who were aware of these advisories were significantly more likely to have modified their consumption behavior. CONCLUSION: Wisconsin's experience suggests general awareness among older male anglers. Participation in the online survey and responses to sources of advisory information supports the need to expand the current outreach program to reach and inform the fish-consuming public.

The Carrot and the Stick: A Cross-Sectional Study of the Influences on Responsible Merchant Practices to Reduce Underage Drinking.

Alcohol merchants (N=331) completed a cross-sectional survey assessing their attitudes and beliefs about underage drinking, its likely consequences, requirements for responsible beverage service (RBS) training, and performance of RBS practices and checking IDs. Merchants requiring more rigorous RBS training (i.e., state-approved versus in-house or none) have stronger beliefs that outlets who sell to minors will get cited and that their employees know RBS practices. Also, merchants who engage in more RBS practices require more rigorous RBS training, and believe more strongly that outlets who sell to minors are more likely to face, and deserve, stricter sanctions. Merchants who check IDs more strictly conduct more RBS practices and believe more strongly that underage drinking is serious and will result in stronger consequences if caught selling to minors. These findings about the attitudes, practices, and enforcement of alcohol merchants suggests ways communities can better target their limited resources to prevent underage drinking.

Lead exposure and educational proficiency: moderate lead exposure and educational proficiency on end-of-grade examinations.

PURPOSE: To investigate and quantify the impact of moderate lead exposure on students' ability to score at the "proficient" level on end-of-grade standardized tests. METHODS: We compared the scores of 3757 fourth grade students from Milwaukee, Wisconsin, on the Wisconsin Knowledge and Concepts Exam (WKCE). The sample consisted of children with a blood lead test before age 3 years that was either unquantifiable at the time of testing (<5 µg/dL) or in the range of moderate exposure (10-19 µg/dL). RESULTS: After controlling for gender, poverty, English language learner status, race/ethnicity, school disciplinary actions, and attendance percentage, results showed a significant negative effect of moderate lead exposure on academic achievement for all 5 subtests of the WKCE. Test score deficits owing to lead exposure were equal to 22% of the interval between student categorization at the "proficient" or "basic" levels in Reading, and 42% of the interval in Mathematics. CONCLUSIONS: Children exposed to amounts of lead before age 3 years that are insufficient to trigger intervention under current policies in many states are nonetheless at a considerable educational disadvantage compared with their unexposed peers 7 to 8 years later. Exposed students are at greater risk of scoring below the proficient level, an outcome with serious negative consequences for both the student and the school.

Perfluoroalkyl chemicals in vacuum cleaner dust from 39 Wisconsin homes.

Perfluoroalkyl chemicals (PFCs) have been used as surfactants and stain repellants in a variety of consumer products for more than 50years and there is growing concern regarding their persistence and toxicity. Human exposure to these chemicals is essentially universal in North America and researchers have linked them to a variety of health problems ranging from higher rates of cancer, to developmental and reproductive problems, and higher cholesterol levels. Major exposure pathways are food and water ingestion, dust ingestion via hand to mouth transfer. In an effort to assess residential exposure, the Wisconsin Department of Health Services tested vacuum cleaner contents from thirty-nine homes for 16 perflouroalkyl chemicals. PFOS, PFOA, PFHxS, PFHpA and PFNA were found in all of the vacuum dust samples and dust from eight homes contained all 16 PFCs included in our analysis. The most commonly detected compounds were perfluorooctanesulfonate (PFOS), perfluorohexanesulfonate (PFHxS) and perfluorooctanoic acid (PFOA) which together made up 70% of the total PFC residues in dust from these homes. Summed PFC concentrations in these dust samples ranged from 70 to 2513ng/g (median 280ng/g). Our investigation suggests that these chemicals may be ubiquitous contaminants in US homes.

Polychlorinated biphenyls in vacuum dust and blood of residents in 20 Wisconsin households.

Human exposure to PCBs is nearly universal in North America. While most exposure can be linked to consumption of contaminated fish, detection of PCBs in non-fish eating populations suggests that other routes of exposure including inhalation of PCB-laden particles or volatile congeners, ingestion of contaminated soil or dust, or dermal absorption following direct contact are also important. In an effort to assess the role of the residential environment as a source of exposure, vacuum dust was collected from the homes of 26 Wisconsin residents whose serum PCB levels had been measured approximately 2 years earlier. More than 60 congeners were detected in dust with all of the samples containing congeners 101, 110, 138 and 153. Total PCB levels ranged from 8.8 to 1186 ng g(-1) with levels being highest in vacuum dust from homes built between 1959 and 1970. Total PCB levels ranged from 0.05 to 8.34 µg L(-1) in serum collected from the adults living in these households, with congeners 138, 153 and 180 predominating. Hexa- and hepta-chlorinated biphenyls comprised 73% of the total residues detected in serum. However, most of the residues found in dust were lower chlorinated congeners with tetra- and penta-chlorinated biphenyls being dominant. Following log transformation, a positive association was found between serum and house dust PCB levels. This association was stronger among infrequent consumers of Great Lake fish, but of borderline statistical significance. This exploratory study suggests that house dust may be a significant source of exposure to PCBs and supports the need for further investigations.

The premises is the premise: understanding off- and on-premises alcohol sales outlets to improve environmental alcohol prevention strategies.

Environmental strategies to prevent the misuse of alcohol among youth--e.g., use of public policies to restrict minors' access to alcohol--have been shown to reduce underage drinking. However, implementation of policy changes often requires public and private partnerships. One way to support these partnerships is to better understand the target of many of the environmental strategies, which is the alcohol sales outlet. Knowing more about how off-premises outlets (e.g., liquor and convenience stores) and on-premises outlets (e.g., bars and restaurants) are alike and different could help community-based organizations better tailor, plan, and implement their environmental strategies and strengthen partnerships between the public and commercial sectors. We conducted a survey of managerial or supervisory staff and/or owners of 336 off- and on-premises alcohol outlets in six counties in South Carolina, comparing these two outlet types on their preferences regarding certain alcohol sales practices, beliefs toward underage drinking, alcohol sales practices, and outcomes. Multilevel logistic regression showed that while off- and on-premises outlets did have many similarities, off-premises outlets appear to engage in more practices designed to prevent sales of alcohol to minors than on-premises outlets. The relationship between certain Responsible Beverage Service (RBS) practices and outcomes varied by outlet type. This study furthers the understanding of the differences between off- and on-premises alcohol sales outlets and offers options for increasing and tailoring environmental prevention efforts to specific settings.